Effectiveness of an Ambient Assisted Living (HomeAssist) Platform for Supporting Aging in Place of Older Adults With Frailty: Protocol for a Quasi-Experimental Study

International audienceBackground: Ambient assisted living (AAL) technologies are viewed as a promising way to prolong aging in place, particularly when they are designed as closely as possible to the needs of the end users. However, very few evidence-based results have been provided to support its real value, notably for frail older adults who have a high risk of autonomy loss as well as entering a nursing home. Objective: We hypothesized that the benefit from an AAL with a user-centered design is effective for aging in place for frail older adults in terms of everyday functioning (instrumental activities of daily-life scale). In addition, our secondary hypotheses are that such an AAL decreases or neutralizes the frailty process and reduces the rates of institutionalization and hospitalization and that it improves the psychosocial health of participants and their caregivers when compared with the control condition. We also assume that a large proportion of equipped participants will have a satisfactory experience and will accept a subscription to an internet connection to prolong their participation. Methods: HomeAssist (HA) is an AAL platform offering a large set of apps for 3 main age-related need domains (activities of daily-living, safety, and social participation), relying on a basic set of entities (sensors, actuators, tablets, etc). The HA intervention involves monitoring based on assistive services to support activities related to independent living at home. The study design is quasi-experimental with a duration of 12 months, optionally extensible to 24 months. Follow-up assessments occurred at 0, 12, and 24 months. The primary outcome measures are related to everyday functioning. Secondary outcome measures include indices of frailty, cognitive functioning, and psychosocial health of the participants and their caregivers. Every 6 months, user experience and attitudes toward HA are also collected from equipped participants. Concomitantly, data on HA use will be collected. All measures of the study will be tested based on an intention-to-treat approach using a 2-tailed level of significance set at α=.05, concerning our primary and secondary efficacy outcomes. Results: Descriptive analyses were conducted to characterize the recruited equipped participants compared with the others (excluded and refusals) on the data available at the eligibility visit, to describe the characteristics of the recruited sample at baseline, as well as those of the dropouts. Finally, recruitment at 12 months included equipped participants (n=73), matched with control participants (n=474, from pre-existing cohorts). The results of this study will be disseminated through scientific publications and conferences. This will provide a solid basis for the creation of a start-up to market the technology. Conclusions: This trial will inform the real-life efficacy of HA in prolonging aging in place for frail older adults and yield an informed analysis of AAL use and adoption in frail older individuals

An Ambient Assisted Living platform for supporting aging in place of prefrail and frail older adults: Rationale, HomeAssist plaform, quasiexperimental design, and baseline characteristics

Background: Ambient Assisted Living (AAL) technology is expected as a promising way for prolonging the aging in place. Very few evidence-based results are provided support to its real value, notably for frail older adults who have high risk of autonomy loss and of entering in nursing home. Objective: HomeAssist (HA) is a human-centered AAL platform offering a large set of applications for three main age-related need domains (Activities of Daily Living, Safety and Social participation), relying on a basic set of entities (sensors, actuators...). The HA intervention involves monitoring as well as assistive services to support independent living at home. The primary outcomes measures are related to aging in place in terms of effectiveness (institutionalization and hospitalization rates) and efficiency (everyday functioning indices). Secondary outcomes measures include indices of frailty, cognitive functioning, and psychosocial health of participants and their caregivers. Every 6 months, user experience and attitudes towards HA are also collected in equipped participants. Concomitantly, HA usages are collected. Methods: A study assessing the HA efficacy has been designed and is now conducted with 131 older adults aged 81.9 (±6.0) years (from autonomous to frail) who lived alone. The study design is quasi-experimental with a duration of 12 months optionally extensible to 24 months. It includes equipped participants, matched with non-equipped participants (n= 474). Followup assessments occurred at 0, 12 and 24 months. Results: The expected results are to inform the AAL value for independent living, but also to yield informed analysis on AAL usages and adoption in frail older individuals

Non-REM Sleep Characteristics Predict Early Cognitive Impairment in an Aging Population

Objective: Recent research suggests that sleep disorders or changes in sleep stages or EEG waveform precede over time the onset of the clinical signs of pathological cognitive impairment (e.g., Alzheimer's disease). The aim of this study was to identify biomarkers based on EEG power values and spindle characteristics during sleep that occur in the early stages of mild cognitive impairment (MCI) in older adults.Methods: This study was a case-control cross-sectional study with 1-year follow-up of cases. Patients with isolated subjective cognitive complaints (SCC) or MCI were recruited in the Bordeaux Memory Clinic (MEMENTO cohort). Cognitively normal controls were recruited. All participants were recorded with two successive polysomnography 1 year apart. Delta, theta, and sigma absolute spectral power and spindle characteristics (frequency, density, and amplitude) were analyzed from purified EEG during NREM and REM sleep periods during the entire second night.Results: Twenty-nine patients (8 males, age = 71 ± 7 years) and 29 controls were recruited at T0. Logistic regression analyses demonstrated that age-related cognitive impairment were associated with a reduced delta power (odds ratio (OR) 0.072, P < 0.05), theta power (OR 0.018, P < 0.01), sigma power (OR 0.033, P < 0.05), and spindle maximal amplitude (OR 0.002, P < 0.05) during NREM sleep. Variables were adjusted on age, gender, body mass index, educational level, and medication use. Seventeen patients were evaluated at 1-year follow-up. Correlations showed that changes in self-reported sleep complaints, sleep consolidation, and spindle characteristics (spectral power, maximal amplitude, duration, and frequency) were associated with cognitive impairment (P < 0.05).Conclusion: A reduction in slow-wave, theta and sigma activities, and a modification in spindle characteristics during NREM sleep are associated very early with a greater risk of the occurrence of cognitive impairment. Poor sleep consolidation, lower amplitude, and faster frequency of spindles may be early sleep biomarkers of worsening cognitive decline in older adults

Recommendations for the use of Serious Games in people with Alzheimer's Disease, related disorders and frailty.

International audienceAlzheimer's disease and other related disorders (ADRD) represent a major challenge for health care systems within the aging population. It is therefore important to develop better instruments to assess the disease severity and progression, as well as to improve its treatment, stimulation, and rehabilitation. This is the underlying idea for the development of Serious Games (SG). These are digital applications specially adapted for purposes other than entertaining; such as rehabilitation, training and education. Recently, there has been an increase of interest in the use of SG targeting patients with ADRD. However, this field is completely uncharted, and the clinical, ethical, economic and research impact of the employment of SG in these target populations has never been systematically addressed. The aim of this paper is to systematically analyze the Strengths, Weaknesses, Opportunities, and Threats (SWOT) of employing SG with patients with ADRD in order to provide practical recommendations for the development and use of SG in these populations. These analyses and recommendations were gathered, commented on and validated during a 2-round workshop in the context of the 2013 Clinical Trial of Alzheimer's Disease (CTAD) conference, and endorsed by stakeholders in the field. The results revealed that SG may offer very useful tools for professionals involved in the care of patients suffering from ADRD. However, more interdisciplinary work should be done in order to create SG specifically targeting these populations. Furthermore, in order to acquire more academic and professional credibility and acceptance, it will be necessary to invest more in research targeting efficacy and feasibility. Finally, the emerging ethical challenges should be considered a priority

Rev neuropsychol

« Bien vieillir » est au cœur des politiques publiques de santé comme en témoignent les divers plans/programmes nationaux et internationaux qui se succèdent. Pour autant, quelles que soient les politiques mises en œuvre, le vieillissement reste un processus fondamentalement hétérogène. À mesure que nous avançons dans la vie, nous accumulons un grand nombre de différences dans les facteurs de risque et de protection auxquels nous avons été exposés tout au long de la vie expliquant que face à l’avancée en âge, et au risque de déclin des fonctions cognitives, tous les individus ne sont pas égaux. La recherche épidémiologique de ces 30 dernières années a permis de pointer divers facteurs associés à un risque augmenté ou diminué de déclin cognitif, parmi lesquels neuf sont des facteurs modifiables : l’activité physique, l’alimentation, l’obésité, le diabète, l’hypertension artérielle, les déficits sensoriels, les loisirs, l’environnement social et l’éducation. Forte de ces constats, la recherche sur la prévention est passée, ces dernières années, des études descriptives aux études d’intervention. Du fait de l’origine multifactorielle du déclin des fonctions cognitives, des programmes d’intervention multidomaines ont ainsi été mis en place en vue d’être testés. L’estimation par l’Alzheimer's Association International Conference en 2017, selon laquelle 35 % des cas de démence seraient « théoriquement » évitables, ajoutée à aux premiers résultats prometteurs de ces études d’intervention – qui restent toutefois à consolider –, constitue de réels espoirs et encourage à poursuivre dans la voie de la prévention

Does Treating Hearing Loss in Older Adults Improve Cognitive Outcomes? A Review

Hearing loss is the third most prevalent health condition in older age. In recent years, research has consistently reported an association between hearing loss and mental health outcomes, including poorer cognitive performances. Whether treating hearing loss in elders improves cognition has been directly or indirectly addressed by several studies. This review aims at providing a synthesis of those results. Regarding the literature on hearing aids’ use and cognition, although the lack of interventional studies has to be underlined, observational data suggest that hearing aids positively impact long-term cognition, even though more research is necessary to ascertain this statement and provide information on the length or frequency of use required in order to observe benefits. Regarding cochlear implants in elders experiencing more severe auditory deprivation, the literature is scarcer. The available studies have many limitations and do not allow the drawing of clear conclusions. Taken together, the results are encouraging. Nevertheless, because hearing loss is suspected to account for 9% of dementia cases, and also because hearing loss is one of the few potentially modifiable factors from a dementia prevention perspective, the need to stimulate research to have clearer knowledge of the benefits of treating hearing loss on cognitive outcomes is urgent