Health conditions of older citizens in Sweden,
perspectives over the last 50 years
Ingmar Skoog, M.D., Ph.D.
Director of the Forte Centre for Ageing and Health (AGECAP)
Institute of Neuroscience and Physiology
Unit of Neuropsychiatric Epidemiology
Sahlgrenska Academy at Göteborg University
Göteborg, Sweden
www.gu.se
CENTRE FOR AGEING AND HEALTH- AGECAP
Centre for Ageing and Health
- AgeCap
AgeCap – centre for ageing and health is a research
centre at the University of Gothenburg that is supported by
FORTE* and started in 2014.
MAIN GOAL:
Increase older individuals’ capability
– the ability to perform actions in order to reach goals he or she
has reason to value
*FORTE: Swedish Research Council for Health, Working Life and Welfare.
To understand capability in older individuals, a
multidisciplinary approach on multiple levels is needed:
MACRO LEVEL
Ageism , laws and regulations regarding
home care, housing, assistance, health
care, taxes, pensions, and support systems.
MESO LEVEL
Community, work place, home
environment, assistive devices,
social network, family, and friends.
MICRO LEVEL
Mental and physical health, cognition,
functional ability, neurobiology, genes,
and socioeconomic factors.
CAPABILITY
AgeCap is a collaboration containing five research groups from
different disciplines at the Univeristy of Gothenburg:
Sahlgrenska Academy
Neurochemical Pathophysiology and
Diagnostics
NEUROCHEM
Research Leader: Kaj Blennow
School of Business, Economics and Law / Faculty of Social Sciences
Labour Market Exit and Living Conditions in Old
Age
LEXLIV
Research Leader: Björn Halleröd
Sahlgrenska Academy / Faculty of Social Sciences
Frail Elderly Support Research Group
FRESH
Research Leader: Synneve Dahlin-Ivanoff
Faculty of Social Sciences
Adult Development and Aging
ADA-Gero
Research Leader: Boo Johansson
Sahlgrenska Academy
Neuropsychiatric Epidemiology
EPINEP
Research Leader: Ingmar Skoog
NEUROPSYCHIATRIC
EPIDEMIOLOGY
THE GOTHENBURG STUDIES
Demented
(N) %
Men (N=75)
37
Women (N=263)
56 *
•H70-study
•H85-study
•The 95+ Study
•The Prospective Population Study of
Women (PPSW)
H70
Ålder
70 75 79 81 83 85 88 90 92 95 97 99 100 101
1901-02
+ + + + + + + + + + + +
1906-07
+
+ +
1911-12
+
+
1922
+
1930
+ + +
1944
2014
+
+
+
2015
+
+
H85 GÖTEBORG
Ålder
85 88 90 92 95 97 99
1901-02
+
+ +
1923-24
+
+ +
1930
2015
+
+
+ +
95+ STUDY
GOTHENBURG, SWEDEN
70 75 79 81 83 85 88 90 92 95 97 99 100 101-109
1901-02
+ + +
+
+
1903
+ + +
+
+
1904
+
+
+
+ +
+
+
+ +
+
+
+
+
1905-06
1907-09
1910-12
+ + + + + + + + +
+
+
+
Prospective Population Study of Women
in Gothenburg
Year of examination and ages studied
Cohort
1968
1974
1981
1992
2000 2005 2010
1908
60
66
73
84
92
97
101
1914
54
60
67
78
86
91
95
1918
50
56
63
74
82
87
91
1922
46
52
59
70
78
83
87
1930
N
38
1462
44
51
62
70
661
75
580
79
450
General examinations
•Neuropsychiatric examination
•Key informant interview
•Medical examination (somatic disorders, alcohol, smoking)
•Functional ability (ADL, iADL, transportation)
•Anthropometry (length, weight etc)
•Social interview, social network, physical, social and cultural
activities, life events, working life etc)
•Psychometric testings
•Personality (Eysenck, Five Factor, KASAM)
•Gender
•Blood, serum, plasma
•Genetic analyses
•ECG, blood pressure
•Lung function
•Physical function (walking speed, hand grip, balance, chair stand etc)
•Audiology
•Ophtalmology
•Dietary examination, DEXA (bone, muscle, fat)
•CT and MRI of brain
•Lumbar puncture/ Neurochemistry
What does an increased longevity mean?
• May reflect a healthier population
• More people with diseases and risk
factors will survive to old age
• Are we getting healthier or sicker?
www.gu.se
100
THE JOURNEY THROUGH LIFE
Age
70
50
0
1901
1930
1950
Year
1971
2000

Birth conditions

Marital and child care

Working and housing conditions

Vacation durations

Infections, antibiotics, other medical
developments

Nutrition

Formal and informal education

Etc etc
CONCLUSIONS 1
• Large changes in a number of factors among Swedish elderly
today compared to three decades ago
• Large changes in pattern of vascular risk factors in later born
birth cohorts, especially blood pressure. Changes more
pronounced in women
• Swedish elderly today more active and less dependent
• Better cognitive function and less dementia in later-born birth
cohorts
• Swedish elderly today are less vulnerable to risk factors. May
reflect better cognitive, physical and social reserve
• More disorders, but Swedish elderly today are more healthy
with their disorders (We are healthier with our disorders)
• Shows that lifestyle factors have a large influence on the
frequency of dementia and other disorders
www.gu.se
CONCLUSIONS 2
• Time-trends shows the influence of environmental factors
compared to genetic
• New epidemiological studies are always needed to update
knowledge about prevalence and risk factors
• Phenotypes of disorders might also change
• Birth year important to report in all studies
• Cohort differences in relation to social gradient and gender
www.gu.se
Sahlgrenska akademin
Neuropsychiatric Epidemiology
EPINEP
www.gu.se
Neuropsychiatric
Epidemiology (Epinep)
Institute of Neuroscience and
Physiology Department of
Psychiatry and Neurochemistry
Sahlgrenska Academy at University
of Gothenburg, Sweden
www.epinep.gu.se
Senior researchers
Ingmar Skoog
Margda Waern
Tore Hällström
Svante Östling
Pia Gudmundsson
Hanna Falk
Kerstin Frändin
Xinxin Guo
Anne Börjesson-Hanson
Silke Kern
Helena Hörder
Simona Sacuíu
Lena Johansson
Anna Zetterberg
Jürgen Kern
Madeleine Mellqvist Fässberg
Eva Billstedt
Deborah Gustafson
Björn Karlsson
Stefan Wiktorsson
Nils Beckman
PhD students
Thorsteinn Gislasson
Johan Nilsson
Robert Sigström
Daniel Jaraj
Mats Ribbe
Scientific Coordinator
Pia Gudmundsson
Administrative Coordinator
Tina Jacobsson
Administrativ Assistant
Cecilia Mellqvist
Felicia Nord
Statisticians
Kristoffer Bäckman
Erik Joas
Thomas Marlow
Valter Sundh
Research nurses
Carina Alklid
Fredrika Jönsson
Rebecca Ibstedt
Margareta Lewander
Helen Lidén
Birgitta Tengelin Widepalm
Malin Thorell
Bosse Svenningsson
PhD students
Isak Fredén Klenfeldt
Therese Rydberg
Johan Skoog
Jenna Al-Najjar
www.gu.se
Other
collaborators
Psychology
Boo Johansson
Valgeir Thorvaldsson
Peter Karlsson
Neurochemistry
Kaj Blennow
Henrik Zetterberg
Sociology
Björn Halleröd
Rehabilitation
Synneve Dahlin-Ivanoff
Susanne Gustafsson
Opthalmology
Madeleine Zetterberg
Nutrition
Elisabeth Rothenberg
Brain imaging
Lars-Olof Wahlund
Eric Westman
Karolinska Institute
Genetics
John Hardy, London
Department of Public Health
and Community Medicine
Cecilia Björkelund
Lauren Lissner
Kjell Thorén
Geriatric Medicine
Bertil Steen
Sten Landahl
Bodil Lernfelt
Audiology
Ulf Rosenhall
Maria Hoff
Neurology
Carsten Wikkelsö
www.gu.se