Katharina Schmidt-Mende

Research problem and specific questions: Fall injuries among older adults are one of few public health problems that have not decreased with better health care and lifestyles, the number of falls will instead increase with an ageing population. A fall injury often leads to loss of independence and reduced quality of life. In addition, one fall often leads to more falls, leaving a vulnerable group of patients with increasing difficulty maintaining their independence.  Prognosis after a fall injury likely depends on an accumulation of sociodemographic- medical- and social factors. A combination of factors that either makes an individual vulnerable or resilient after a fall injury. Despite this, we know very little about the types of fall injuries that lead to more, worse injuries. In addition, the research focus is on individual risk factors for poor prognosis, lacking a focus on healthy factors and a real-world perspective that acknowledges health complexity and synergy of multiple factors.The aim of this project is to 1) identify the types of fall injuries that affect different groups of older people and which injuries lead to more fall injuries, identifying patterns of factors that make an individual 2) extra vulnerable after a fall, and 3) more resilient, who despite a fall injury regain independence.Data and method: Using a combination of national registries and survey data, we can follow individuals over many years to study patterns of fall injuries but also resilience after a fall injury in terms of medical care, medications, and home care. Using data on medical- and socio-economic factors - as well as personality and health behaviors in a sample of the older population - we can also get a picture of what characterizes vulnerability and resilience.Relevance: Fall injuries are the main cause of years with disability among people over 70 years in Sweden. The economic costs are high, with a fall leading to a serious injury costing the society around 273 600 SEK/person. Thus, falls among older adults are a major public health problem that will increase in magnitude and cost in the future. Our project will provide evidence to improve the prognosis after a fall injury, which can benefit both the individual and society.Plan for project realization: The project will be carried out at the Unit of Epidemiology, IMM, KI. We will use advanced machine learning methods to answer the research questions in linked national registers. The main cost is personnel costs.

Dementia is a major public health problem not only for affected individuals but also their families. In Sweden, care for people with dementia is regulated by national guidelines. However, previous research as well as an evaluation by the National Board of Health and Welfare have pointed to limited adherence to these guidelines with regards to both diagnostic processes and provided care. The National Board of Health and Welfare identifies several areas for improvement, two of which are addressed in this application: better conditions for people with dementia in primary care and a need for more qualitative data describing the content and quality of provided care.Primary care is often the first point of contact with health care and plays a key role both in the diagnostic process and in the provision and coordination of care for older people with dementia. Yet, there is little research on primary care for older people with dementia in Sweden. One reason is the lack of a primary care register at the national level.With the use of both quantitative and qualitative methods, this project aims to explore barriers to dementia diagnosis in primary care as well as the extent to which dementia is underdiagnosed in primary but also specialist care in different population subgroups. Furthermore, we aim to explore co-morbidity at the time of dementia diagnosis across the population and whether older individuals’ health is related to specified dementia diagnoses.Our project aims to examine to which extent people with dementia and their relatives have similar views on dementia care as care providers, specifically general practitioners, nurses, and home care staff. We will describe care trajectories for people with a diagnosis of dementia and how they vary across population groups. We know that family members play an important role in the care of older people. Therefore, we aim to highlight older people without close relatives and examine to which extent formal care for older people succeeds in compensating for the potential lack of informal support.The project is based on a large register database with national coverage for specialist care, and regional coverage for primary care. This is complemented by focus group discussions with healthcare providers, and individual interviews with people with dementia and their relatives. The research team includes a general practitioner, nurses, ageing epidemiologists, behavioral scientists and qualitative researchers.