Study protocol for a pragmatic cluster randomized controlled trial to improve dietary diversity and physical fitness among older people who live at home (the “ALAPAGE study”)

Background : Diet and physical activity are key components of healthy aging. Current interventions that promote healthy eating and physical activity among the elderly have limitations and evidence of French interventions’ effectiveness is lacking. We aim to assess (i) the effectiveness of a combined diet/physical activity intervention (the “ALAPAGE” program) on older peoples’ eating behaviors, physical activity and fitness levels, quality of life, and feelings of loneliness; (ii) the intervention’s process and (iii) its cost effectiveness. Methods : We performed a pragmatic cluster randomized controlled trial with two parallel arms (2:1 ratio) among people ≥60 years old who live at home in southeastern France. A cluster consists of 10 people participating in a “workshop” (i.e., a collective intervention conducted at a local organization). We aim to include 45 workshops randomized into two groups: the intervention group (including 30 workshops) in the ALAPAGE program; and the waiting-list control group (including 15 workshops). Participants (expected total sample size: 450) will be recruited through both local organizations’ usual practices and an innovative active recruitment strategy that targets hard-to-reach people. We developed the ALAPAGE program based on existing workshops, combining a participatory and a theory-based approach. It includes a 7-week period with weekly collective sessions supported by a dietician and/or an adapted physical activity professional, followed by a 12-week period of post-session activities without professional supervision. Primary outcomes are dietary diversity (calculated using two 24-hour diet recalls and one Food Frequency Questionnaire) and lower-limb muscle strength (assessed by the 30-second chair stand test from the Senior Fitness Test battery). Secondary outcomes include consumption frequencies of main food groups and water/hot drinks, other physical fitness measures, overall level of physical activity, quality of life, and feelings of loneliness. Outcomes are assessed before the intervention, at 6 weeks and 3 months later. The process evaluation assesses the fidelity, dose, and reach of the intervention as its causal mechanisms (quantitative and qualitative data). Discussion : This study aims to improve healthy aging while limiting social inequalities. We developed and evaluated the ALAPAGE program in partnership with major healthy aging organizations, providing a unique opportunity to expand its reach

Economics of the Iceberg: Informal Care Provided to French Elderly with Dementia

ACL-2International audienceOBJECTIVES: Dementia has a substantial effect on patients and their relatives, who have to cope with medical, social, and economic changes. In France, most elderly people with dementia live in the community and receive informal care, which has not been well characterized. METHODS: Using a sample of 4680 people aged 75 years and older collected in 2008 through a national comprehensive survey on health and disability, we compared the economic value of the care received by 513 elderly people with dementia to that received by a propensity score- matched set of older people without dementia. RESULTS: More than 85% of elderly people with dementia receive informal care; the estimation of its economic value ranges from €4.9 billion (proxy good method) to €6.7 billion (opportunity cost method) per year. CONCLUSIONS: The informal care provided to people with dementia has substantial annual costs; further work should be done to examine the social and economic roles foregone as a result of this care. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved

Le corps opulent: quelle corpulence pour le senior en bonne santé ?

International audienc

Qu’est-ce qui pèse de tout son poids sur la corpulence du sujet âgé ?

International audienc

Quels sont les facteurs associés à l’indice de masse corporelle chez les personnes âgées vivant à domicile en France ?

International audienceObesity is a complex and multifactorial chronic disease. Body weight can be affected by environmental and socio-economic conditions, genetic factors, lifestyle, etc. The aim of this study was to investigate the links between body mass index (BMI) categories and socio-demographic, health and life style variables among people aged 60 years or over who live at home. Data were collected from the 2008 cross-sectional national survey on health and disability (Handicap Santé Ménages) and are representative of the elderly population in France living at home (N = 9,867). We have performed multinomial logistic regressions with weight status as the outcome variable. Compared to individuals aged 75 to 79, people aged 80 and over were more likely to be overweight than obese, and of normal weight rather than overweight. Having at least one chronic disease increased the probability of being obese as opposed to overweight. Women with severe physical limitations were also more likely to be obese than overweight. Doing physical exercise decreased the probability of being obese as opposed to overweight and overweight vs. normal weight. Time spent watching TV increased the probability of being overweight vs. normal weight. There is an urgent need for public health measures to prevent obesity among the elderly, such as those that promote good nutrition, exercise and social relationships, in order to help old people to maintain their capacities and autonomy.L’obésité est une maladie chronique complexe et multifactorielle. Le poids peut être affecté par des facteurs environnementaux, socio-économiques, génétiques et de mode de vie. Notre objectif est d’étudier, chez les personnes de 60 ans et plus, les liens entre les catégories d’indice de masse corporelle (IMC) et des variables sociodémographiques, de santé et de mode de vie. Les données sont issues de l’enquête Handicap Santé Ménages 2008, représentative de la population résidant en France et vivant à domicile (n = 9 867). Les données ont été analysées au moyen de régressions logistiques multinomiales, la variable dépendante étant l’IMC en trois catégories. Comparées aux personnes de 75 à 79 ans, les personnes de 80 ans et plus ont une probabilité majorée d’être en surpoids plutôt qu’obèses, et en poids normal qu’en surpoids. Avoir une maladie chronique accroît le risque d’être obèse plutôt qu’en surpoids. Les femmes âgées souffrant de limitations physiques importantes ont une plus grande probabilité d’être obèses qu’en surpoids. Faire de l’exercice diminue la probabilité d’être obèse plutôt qu’en surpoids, et en surpoids plutôt qu’en poids normal. Le temps passé à regarder la télévision augmente la probabilité d’être en surpoids plutôt qu’en poids normal. Il est nécessaire de poursuivre la mise en oeuvre desmesures de santé publique visant à prévenir l’obésité chez les personnes âgées, comme celles favorisant l’alimentation saine, l’exercice, les relations sociales, pour maintenir l’autonomie et les capacités des aînés

"If You Were Me": Proxy Respondents' Biases in Population Health Surveys

Proxy respondents are widely used in population health surveys to maximize response rates. When surveys target frail elderly, the measurement error is expected to be smaller than selection or participation biases. However, in the literature on elderly needs for care, proxy use is most often considered with a dummy variable in which endogeneity with subjects' health status is rarely scrutinised in a robust way. Pitfalls of this choice extend beyond methodological issues. Indeed, the mismeasurement of needs for care with daily activities might lead to irrelevant social policies or to private initiatives that try to address those needs. This paper proposes a comprehensive and tractable strategy supported by various robustness checks to cope with the suspected endogeneity of proxy use to the unobserved health status of subjects in reports of needs for care with activities of daily living. Proxy respondents' subjectivity is found to inflate the needs of the elderly who are replaced or assisted in answering the questionnaire and to deflate the probability of unmet or undermet needs

Socioeconomic determinants of the need for personal assistance reported by community-dwelling elderly: Empirical evidence from a French national health survey

A bivariate probit model with sample selection is used to estimate the conditional probability of reporting a need for personal assistance (NPA) with at least one activity of daily living among French community-dwelling elderly. 71.8% of men and 77.3% of women reported impairments and among those who reported impairments, 7.5% of men and 10.8% of women reported NPA. NPA is associated not only with age (i.e., the oldest individuals, for women only) and health status (such as a specific type of impairment), but also with socioeconomic (living with intermediate income; living with someone, partner or other) and environmental factors (having and using assistive technologies).Elderly Impairments Need for personal assistance Andersen and Newman' s behavioral model Bivariate probit model with sample selection

The non-take up of long-term care benefit in France: A pecuniary motive?

ACL-2International audienceWith aging populations, European countries face difficult challenges. In 2002, France implemented a public allowance program (APA) offering financial support to the disabled elderly for their long-term care (LTC) needs. Although currently granted to 1.2 million people, it is suspected that some of those eligible do not claim it—presenting a non-take-up behavior. The granting of APA is a decentralized process, with 94 County Councils (CC) managing it, with wide room for local interpretation. This spatial heterogeneity in the implementation of the program creates the conditions for a “quasi-natural experiment”, and provides the opportunity to study the demand for APA in relation to variations in CCs’ “generosity” in terms of both eligibility and subsidy rate for LTC. We use a national health survey and administrative data in a multilevel model controlling for geographical, cultural and political differences between counties. The results show that claiming for APA is associated with the “generosity” of CCs: the population tends to apply less for the allowance if the subsidy rate is in average lower. This pecuniary trade-off, revealed by our study, can have strong implications for the well-being of the elderly and their relatives

Endogénéité du statut du répondant dans les enquêtes sur la santé. Quelles implications pour la mesure des besoins d'aide ?

Most of population health surveys appeal to proxy respondents, when surveyed persons with poor health are not able or do not want to answer the questionnaire by themselves. Yet, it may give rise to a strong endogeneity problem since the use of a proxy respondent is likely to be linked to subjects? health status. That paper aims at giving a convenient and tractable way to cope with the twofold potential endogeneity of the respondent status in the estimation of two probit equations concerning the need for care with daily activities and unmet or undermet need reported by people aged 60 years and over living in the community. Unlike previous papers dealing with that topic, evidence is found that proxy respondents do not entail any subjectivity when they assess old people?s need for care but they seem to overestimate undermet and unmet need. Classification JEL : C35 ; I12 ; J14.