Kristina Johnell and Martin Lövdén, researchers at the Aging Research Center, has been granted funding of SEK 5 030 000 and SEK 3 430 000 respectively within Forte’s annual open call for proposals in the fields of health, working life and welfare.
Kristina Johnell, Too much, too late? Use of overly aggressive treatments during the last months of life of older adults with poor prognosis
In Sweden, almost 65 000 people aged ≥75 years die every year. Most of these deaths occur after a long period of physical, psychological and cognitive decline. The main challenges in care provision for older persons at the end of life are to improve quality of life, relieve distress, and enable people to die where they prefer.
A growing body of evidence suggests that overly aggressive treatments are commonly used during the final months and weeks of life. Yet, as illness progresses and life expectancy diminishes, these treatments become less likely to be beneficial and more likely to cause side effects. In other words, treatments that would otherwise have been indicated can become inadequate at the end of life because they are more likely to cause harm than good. This phenomenon, known as ‘overtreatment’, has come under great scrutiny over the past few years. It is formally defined as “when the provision of medical services may present a trivial or no benefit during a patient’s lifetime but can potentially result in serious harms”.
The aim of this interdisciplinary project is to investigate the frequency, the determinants, and the harms of overly aggressive treatments at the end of life of older adults. We will use a broad range of quantitative and qualitative research methods, including analysis of large Swedish national registers and exploration of healthcare professionals’ experiences and attitudes towards end-of-life therapy in focus groups.
This project will provide unique knowledge to inform patients, their caregivers, healthcare professionals, and policymakers about the determinants and the consequences of overtreatment at the end of life of older adults. This will allow for designing appropriate interventions to reduce the provision of unnecessary and potentially harmful treatments at the end of life.
Martin Lövdén, The causal effect of education on health in late life
Many diseases that affect older individuals are partly attributable to modifiable risk factors. Primary prevention is therefore important. Low educational attainment stands out as one of the most important risk factors.
Directing resources to prevention is however only effective if the association is driven by a substantial causal influence of education on health. Studying such effects of education on health is challenging because experiments are not feasible and key disease outcomes are only observable several decades after education. The magnitude of a causal effect of education on specific health outcomes in older age therefore remains debated and the pathways mediating effects of education on health in older age are unknown.
The objectives of this research program are to fill in these lacunae in knowledge by using historical reforms extending compulsory Swedish primary school for studying the causal influence of education on specific health outcomes and potential mediating factors.