Brief assessments and screening for geriatric conditions in older primary care patients: a pragmatic approach.

This paper discusses the rationale behind performing a brief geriatric assessment as a first step in the management of older patients in primary care practice. While geriatric conditions are considered by older patients and health professionals as particularly relevant for health and well-being, they remain too often overlooked due to many patient- and physician-related factors. These include time constraints and lack of specific training to undertake comprehensive geriatric assessment. This article discusses the epidemiologic rationale for screening functional, cognitive, affective, hearing and visual impairments, and nutritional status as well as fall risk and social status. It proposes using brief screening tests in primary care practice to identify patients who may need further comprehensive geriatric assessment or specific interventions

Impact épidémiologique du vieillissement démographique : quels enjeux pour les médecins de premier recours?

Le vieillissement démographique s'accentue avec l'arrivée au troisième âge des baby-boomers. Si la santé de la population âgée s'est plutôt améliorée au fil des générations, le nombre élevé de personnes atteintes d'une ou plusieurs maladies chroniques s'accompagnera d'une demande croissante de soins, tandis que la profession médicale connaîtra vraisemblablement une situation de pénurie

Government recommendations during the COVID-19 epidemic in Switzerland: clarity, compliance and impact on the daily life of seniors in a population-based cohort.

In March 2020, the Swiss Federal Council issued recommendations for a partial lockdown, with an emphasis on people aged 65 years and over because of their vulnerability to COVID-19. This study investigated whether seniors clearly understood the meaning of four recommendations (do not go grocery shopping; do not use public transport; avoid personal contact; stay at home), whether they complied with them, and what was the impact of the partial lockdown on their daily life, including difficulties and opportunities. In April 2020, a questionnaire about how seniors experienced the partial lockdown was sent to the participants in the Lausanne Cohort Lc65+, a population-based study. The response rate reached 89%, with 2746 participants aged 72-86 years included in the analysis. Bivariable analyses and multivariable logistic models were used to identify sociodemographic and health-related characteristics associated with each outcome (clarity; compliance; impact). Most seniors rated the recommendations as clear (84-91%, depending on the recommendation) and complied with them (70-94%). In multivariable analyses, men were more likely to rate the recommendations as unclear. Perceiving the recommendation as unclear and having a low level of fear of the virus were associated with noncompliance. People who complied with the recommendations were more likely to experience difficulties, but also to seize opportunities during the partial lockdown. Most seniors followed the recommendations and found them clearly worded. However, some subgroups, such as men and seniors who do not fear the virus, were less likely to clearly understand the recommendations. As a correct understanding is a key factor for compliance, the findings emphasise the importance of tailoring public health communications to the characteristics of the target group, and of testing whether they are correctly understood

How much do combined affective and cognitive impairments worsen rehabilitation outcomes after hip fracture ?

To investigate the association between isolated and combined affective and cognitive impairments with functional outcomes and discharge destination in older patients admitted to rehabilitation after a hip fracture. Prospective study in 612 community-dwelling patients aged 65 years and over, admitted to rehabilitation after surgery for hip fracture. Information on socio-demographics, medical, functional, affective, and cognitive status was systematically collected at admission. Functional status, length of stay and destination were assessed at discharge. Functional improvement was defined as any gain on the Barthel Index score between admission and discharge from rehabilitation. At admission, 8.2% of the patients had isolated affective impairment, 27.5% had cognitive impairment only, and 7.5% had combined impairments. Rate of functional improvement steadily decreased from 91.2% in patients with no cognitive nor affective impairment to 73.8% in those with combined impairments. Compared to patients without any impairment, those with combined impairments had lower odds of functional improvement, even after adjustment for age, gender, health and functional status at admission (adjOR: 0.40; 95%CI: 0.16-1.0; p = .049). The proportion of patients discharged back home gradually decreased from 82.8% among patients without any impairment to only 45.6% in patients with combined impairments. In multivariate analysis, the odds of returning home remained significantly reduced in these latter patients (adjOR: 0.31; 95%CI:0.15-0.66; p = .002). Affective and cognitive impairments had both independent, and synergistic negative association with functional outcome and discharge destination in patients admitted to rehabilitation after a hip fracture. Nevertheless, patients with combined affective and cognitive impairments still achieved significant functional improvement, even though its magnitude was reduced. Further studies should investigate whether these patients would benefit from better targeted, longer, or more intensive rehabilitation interventions to optimize their functional recovery

The Association between Different Levels of Alcohol Use and Gait under Single and Dual Task in Community-Dwelling Older Persons Aged 65 to 70 Years.

Objectives. This study aimed to describe the cross-sectional and longitudinal association between alcohol intake and gait parameters in older persons. Methods. Community-dwelling persons aged 65-70 years (N = 807). Information on health, functional status, and alcohol use was self-reported at baseline and at 3-year follow-up, whereas gait speed and stride-to-stride variability were measured while walking only (single task) and under dual tasking (counting backwards). Results. Compared to light-to-moderate drinking, heavy drinking was associated with slower gait speed in single task (adj. coeff.: -.040, 95% CI: -.0.78 to -.002, p = .035). No significant association was observed between heavy drinking and gait speed variability. Nondrinkers walked significantly slower than light-to-moderate drinkers in dual task and had significantly higher gait speed variability in both single and dual task, but these associations disappeared after adjustment for comorbidity. At follow-up, 35.2% and 34.1% of the participants walked significantly slower in single and dual task, respectively. This proportion varied a little across drinking categories. Conclusion. At baseline, heavy alcohol consumption was significantly associated with slower gait speed in single task. Selective survival of the fittest heavy drinkers probably explains why this association faded in longitudinal analyses. The trend of poorer gait performance in nondrinkers disappeared after adjustment for comorbidity, suggesting confounding by a worse health status

Directives anticipées, représentant thérapeutique et mandat pour cause d'inaptitude : connaissance, utilisation et perception chez les personnes âgées

Le droit de protection de l’adulte, entré en vigueur au 1er janvier 2013, permet à toute personne de faire part à l’avance de ses volontés en cas d’incapacité de discernement. Cette loi met à disposition trois instruments qui sont les directives anticipées (décisions relatives aux traitements médicaux), la désignation d’un représentant thérapeutique (représentation dans le domaine médical) et le mandat pour cause d’inaptitude (assistance personnelle, gestion du patrimoine, représentation juridique). En l’absence de documents, le Code civil suisse (CCS) précise aussi qui sera habilité à représenter la personne incapable de discernement. En 2014, une enquête a été menée auprès de 1’701 Lausannois âgés de 71 à 80 ans afin d'évaluer le niveau de connaissance des différentes dispositions dans cette population, ainsi que leur taux d’utilisation et la façon dont elles étaient perçues. Malgré une utilisation encore très faible, cette étude révèle un intérêt marqué de la population âgée vivant à domicile pour les dispositions du droit de protection de l’adulte. Elle indique également le besoin d’une communication par étapes auprès du public afin de susciter un processus de maturation qui semble nécessaire avant d’avoir recours à des dispositions formelles. Cette étude montre aussi que les médecins de famille devraient être sensibilisés à ces questions et soutenus dans leur rôle d’interlocuteurs privilégiés. Sur la base de ces résultats, des recommandations sont émises en fin de rapport (cf. 5 Discussion et conclusion)

Relationship between oral health and Fried's frailty criteria in community-dwelling older persons.

Oral health and frailty might be linked through several pathways, but previous studies are scarce. This study examined the association between oral health and components of Fried's frailty phenotype. This cross-sectional analysis was based on a sample of 992 community-dwelling persons aged 73 to 77 years observed in the 2011 follow-up of the Lausanne 65+ cohort (Lc65+) study. Data were collected through annual mailed questionnaires, interview and physical examination. Oral health was assessed according to self-reported oral pain and masticatory ability. Frailty was defined as meeting at least one criterion of the Fried's phenotype. Oral pain was reported by 14.8% and chewing problems by 9.7%. Impaired masticatory ability (IMA) was more frequent in subjects with missing teeth or removable dentures (13.5%) than among those with full dentition or fixed dental prostheses (3.2%). In logistic regression analyses adjusting for demographics, alcohol consumption, smoking, comorbidity and financial difficulties, persons with oral pain and those with chewing problems had significantly higher odds of being frail (adjusted OR javax.xml.bind.JAXBElement@4700992c  = 1.72; 95% CI 1.17-2.53 and adjOR javax.xml.bind.JAXBElement@a67b3e3 1.70; 1.07-2.72, respectively). Lack of endurance was associated with both oral pain (adjOR = 3.61; 1.92-6.76) and impaired masticatory ability (adjOR = 2.20; 1.03-4.72). The latter was additionally linked to low physical activity (adjOR = 2.35; 1.29-4.28) and low gait speed (adjOR = 3.12; 1.41-6.90), whereas oral pain was associated with weight loss (adjOR = 1.80; 1.09-2.96) and low handgrip strength (adjOR = 1.80; 1.17-2.77). Self-reported oral pain and chewing impairment had a significant relation with frailty and its components, not only through a nutritional pathway of involuntary weight loss. Longitudinal analyses are needed to examine whether a poor oral condition might be a risk factor for the onset of frailty

Les courts-séjours médico-sociaux dans le canton de Vaud : expériences des usagers de 65 ans et plus

La prestation court-séjour est proposée dans le canton de Vaud depuis 1984. Elle s'inscrit dans la volonté des services publics de permettre aux personnes, âgées notamment, de vivre à domicile le plus longtemps possible. Il s'agit d'accueillir temporairement en établissement médico-social (EMS) ou en division C d'un hôpital, les personnes momentanément affaiblies à la suite d'une hospitalisation ou d'un problème de santé, mais aussi des personnes durablement atteintes dans leur santé, en particulier pour donner quelques jours ou semaines de répit à leur entourage. En 2013, afin de faire un bilan de cette prestation et démarrer une phase de réflexion quant aux améliorations qui pourraient lui être apportées, le Service des assurances sociales et de l'hébergement (SASH) a mandaté l'Institut universitaire de médecine sociale et préventive (IUMSP) pour la réalisation d'une enquête sur l'expérience des usagers des courts-séjours dans le canton de Vaud

Projet pilote "Pas de retraite pour ma santé" : évaluation de l'effet sur les participants

"Pas de retraite pour ma santé" est un projet de promotion du mouvement et de l'alimentation favorables à la santé dédié spécifiquement aux seniors. Ce projet mené par les Ligues de la Santé du Canton de Vaud est le fruit d'une collaboration entre le programme cantonal « Ça marche ! », Pro Senectute Vaud, le Service de gériatrie du CHUV et le Service de l'éducation physique et du sport. Le projet s'inscrit dans la politique « Vieillissement et Santé » du canton de Vaud. Il bénéficie également d'un soutien financier de Promotion Santé Suisse. Le projet « Pas de retraite pour ma santé » a été développé avec les objectifs suivants : - susciter une prise de conscience quant à l'importance de bouger plus et manger mieux - (re)donner goût au mouvement aux seniors par les rencontres actives - améliorer leurs capacités physiques globales - favoriser l'intégration sociale et sportive des participants au sein d'un groupe et de la commun