Short Physical Performance Battery and Study of Osteoporotic Fractures Index in the Exploration of Frailty Among Older People in Cameroon

Objectives: To investigate the relationship between the Short Physical Performance Battery (SPPB) and the Study of Osteoporotic Fractures (SOF) index.Methods: We present data from a cross-sectional survey conducted in Cameroon. Frailty was defined as an SOF index > 0. The sensitivity and specificity of the SPPB were investigated. Principal component analysis (PCA) was performed to assess the contribution of each subtest of the SPPB to the relationship with the SOF.Results: Among 403 people included (49.6% women), average age of 67.1 (±6.2) years, 35.7% were frail according to the SOF. After determining the best SPPB threshold for diagnosing frailty (threshold = 9, Se = 88.9%, Sp = 74.9%), 47.9% were frail according to the SPPB. The first dimension of PCA explained 55.8% of the variability in the data. Among the subtests of the SPPB, the chair stand test item was the component most associated with the SOF index.Conclusion: Despite the overlap between the SOF and the SPPB, our results suggest that a negative result on the five chair-stands test alone would be sufficient to suspect physical frailty

BMC Geriatr

Background In 2015 in France, 585,560 people were nursing home residents. A large body of studies has identified predictors of poor quality of life and poor adaptation in institution, mostly for residents without dementia. With 42 to 72% of these residents diagnosed with dementia, it is crucial to identify what factors prior to admission might have an impact on quality of life once the admission is finalized, in order to target specific domains of intervention, while the person still lives at home and after his/her admission. Methods QOL-EHPAD is a prospective, multi-centred, observational cohort study. At baseline, we will collect retrospective data on the life of 150 persons with dementia and their caregivers. These data will refer to the conditions of admission to a nursing home (emergency admission, involvement in the decision, admission from home or from the hospital) and to the 6 months prior to the admission of the person with dementia: sociodemographic and medical data, psychological tests, information on quality of life, satisfaction, behaviour, and nutrition. Similar data about life in the nursing home will be collected after 6 months, along with information on adaptation of the person with dementia to his/her new living environment. We will use univariate regression analyses followed by stepwise linear regression models to identify which factors pertaining to life at home are associated with quality of life and adaptation after 6 months. Discussion This study will provide data on the impact of institutionalization on quality of life and the determinants of a successful institutionalization in people with dementia. This could be helpful in setting up targeted interventions to prepare admission into a nursing home before the actual admission and to accompany both the caregiver and the person with dementia throughout this process

JMIR Res Protoc

BACKGROUND: With aging of the population, the search for alternative models of care adapted to older people with dependency is necessary. In this setting, foster families (1-3 older people per family) could be an alternative to nursing homes, residential care facilities, or community- and home-based care. OBJECTIVE: The KArukera Study of Ageing in Foster Families is a prospective cohort study designed to investigate the care pathways of older people with dependency in foster care over a year. The 1-year hospitalization rate (main objective), cost of hospitalization, incidence of mortality, prevalence of geriatric syndromes, and quality of life of residents will be assessed. Quality of life and burnout of their respective foster caregivers will also be studied. METHODS: This study cohort will include 250 older people living in foster families in Guadeloupe (French West Indies), as well as their respective foster caregivers. Both older people and caregivers will be interviewed concurrently on site at three time points: (1) at baseline, (2) at 6 months, and (3) at 12 months. For older people, we will collect anthropometric measures, cognitive impairment, depressive and anxiety symptoms, functional abilities, physical frailty, information on general health status, quality of life, and care pathways (hospitalization, mortality, and medical and paramedical consultations). We will also assess the quality of life and burnout symptoms of family caregivers at each follow-up. A phone update of vital status (alive or death) and care pathways of residents will be carried out at 3 and 9 months after the baseline examination. RESULTS: Recruitment opened in September 2020 and ended in May 2021, with 109 older people recruited and 56 respective foster caregivers. The 1-year follow-up was ended in June 2022. Data analyses are ongoing and the first results are expected to be published in May 2023. CONCLUSIONS: Foster families are a potentially innovative way to accommodate dependent older people. This study could help define the clinical profile of older people adapted to foster families in the transition from frailty to dependency. The effectiveness of foster families, in terms of hospitalizations and mortality, will be compared with other models of care, particularly nursing homes. In this setting, a twin study carried out in nursing homes in Guadeloupe with similar aims and outcomes will be conducted. Beyond mortality and morbidity, the numerous outcomes will allow us to assess the evolution of geriatric syndromes over time. TRIAL REGISTRATION: ClinicalTrials.gov NCT04545775; https://clinicaltrials.gov/ct2/show/NCT04545775. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40604

Nutrients

: This study aimed to determine the risk factors for undernutrition in community-dwelling older adults in Guadeloupe (Caribbean islands). : We used data from the KArukera Study of Aging-Drugs Storage (KASADS), an observational cross-sectional study of community-dwelling older people living in Guadeloupe. The Mini Nutritional Assessment (MNA) was used to assess the risk of undernutrition. An MNA-short form (SF) score ≤11 defined the risk of undernutrition. Depression was assessed using the Center for Epidemiologic Studies Depression (CES-D) scale, cognitive function was assessed using the Mini Mental State Examination (MMSE), frailty was assessed using the Study of Osteoporotic Fractures index (SOF), and dependency was assessed using Lawton's instrumental activities of daily living (IADL) scale. Bivariate and multivariate analyses were used to determine the correlates of undernutrition. : The study sample comprised 115 patients aged 65 years or older; 67.8% were women, and the mean age was 76 ± 7.8 years. The prevalence of undernutrition was 21.7% (95% CI = 15.2-30.1%). In our bivariate analysis, the risk of undernutrition was associated with MMSE score, IADL score, frailty, and CES-D score. We found no significant relation between nutrition risk and other variables, such as marital status, pain, or polypharmacy. In the multivariate analysis, the factors associated with the risk of undernutrition were MMSE score (Odd-Ratio (OR): 0.74 (0.58-0.97)) and CES-D score (OR: 1.13 (1.02-1.27)). : Cognitive decline and the risk of depression were independently associated with the risk of undernutrition in community-dwelling older people in Guadeloupe. Although we cannot imply causality in this relation, the detection of these three key geriatric syndromes in community-dwelling elders is essential to prevent adverse health outcomes. Further studies are warranted to confirm these findings

PLoS One

Background While physical frailty and malnutrition/obesity (parameters easily measured by a nurse) are not the same, older persons who are malnourished/obese are more likely to be frail and there is a potential overlap between these conditions. The objective was to examine the relationship between gait speed (GS) and body mass index (BMI) in men and women aged 75 years and older. Design Cross-sectional analysis. Setting, participants Data from the Aging Multidisciplinary Investigation (AMI), a French prospective cohort study with participants randomly selected from the farmer Health Insurance rolls. Measurements Usual GS was measured over a 4 meters-track. BMI was categorized using clinical cut-points for European populations: (e.g, <20.0 kg/m2; 20.0–24.9 kg/m2; 25.0–29.9 kg/m2; 30.0–34.9 kg/m2; ≥35.0 kg/m2). Results The current analyses were performed in 449 participants. Mean age was 81 years. Being malnourished/obese was significantly associated with slow GS. Unadjusted and age-adjusted models showed that underweight, overweight and obesity statuses were significantly associated with slow GS for both women (0.83m/s [0.61; 1.04], 0.87m/s [0.72; 1.02], 0.70 m/s [0.41; 0.98], respectively) and men (0.83m/s [0.61; 1.04], 1.11m/s [1.03; 1.20], 0.97m/s [0.75; 1.19], respectively). Conclusion Malnourished/obese are associated with slow GS in older persons. These variables could be contributed at comprehensively and complementarily assessing the older person

Approche épidémiologique de la fragilité

Now-a-days, geriatric syndromes have become a major public health problem owing to the population aging. In this context, frailty syndrome represents particularly a public health priority in France through PAERPA program. Frailty is defined as an extreme vulnerability of the organism to endogenous and exogenous stressors. This syndrome exposes the individual at higher risk of negative health-related outcomes as well as a transition phase between successful aging and disability. The theoretical concept of frailty is largely agreed, its practical translation still presents some limitations due to the existence of multiple tools and operational definitions. The definition most widely used is the one proposed by Fried and collaborators which essentially includes physical elements. Nonetheless, the inclusion of other non-physical components, in particular cognitive function, social vulnerability state, morbidities is currently debated. Considerable progress has been made in this field over the past ten years. The prevalence and incidence of frailty are reported in several epidemiological studies and are well known, but are quite variable. Many risk factors of frailty have been highlighted, leaving a door open towards prevention. A better knowledge of frailty epidemiology is therefore essential if we are to assess its extent and the means of controlling it. To better define frailty from an epidemiological point of view, it is essential to describe and better understand the different components of epidemiological prognostic studies: describing, prediction of health events, explaining the causal relation and proposing the action. The aim of this thesis was to the study, from an epidemiological point of view, the definition of frailty using the data of three French cohorts: PAQUID, 3C and INCUR. The results are consistent with an association between frailty and negative health-related outcomes. This association depends on the target sample, tools used and investigators.En raison du vieillissement de la population, les syndromes gériatriques sont devenus un enjeu majeur de santé publique, et le syndrome de fragilité une priorité notamment en France avec le programme PAERPA. La fragilité permet d’identifier des personnes âgées présentant des capacités de résistance diminuées face aux agents agresseurs. Elle a pour conséquence d’accroître chez l’individu le risque de survenu d’évènements de santé défavorables (de dépendance, de chutes, d’hospitalisations, d’entrée en institution et de mortalité). Plusieurs outils de mesure sont développés mais aucune mesure de référence ne fait consensus actuellement même si des progrès considérables ont été réalisés dans ce domaine depuis une dizaine d’années. Les données épidémiologiques sur la prévalence, l’incidence et les conséquences de la fragilité ont été abondamment publiées mais se caractérisent par une grande variabilité. Ces indicateurs sont variables en fonction de l’outil de mesure utilisé, de la population étudiée, de l’examinateur et également de l’évènement de santé que l’on veut prédire. De nombreux facteurs de risque de fragilité ont été également mis en évidence et certains ouvrent des voies crédibles de recherche aidant à la prévention. Une meilleure connaissance de l’épidémiologie du syndrome de fragilité est donc une nécessité incontournable pour apprécier l’importance du phénomène et mettre en place les moyens de le contrôler. Afin de mieux définir la fragilité sur le plan épidémiologique, il est indispensable de bien comprendre la notion d’études pronostiques en épidémiologie et les principaux domaines qui la constituent c’est-à-dire : décrire la population, prédire des évènements de santé, comprendre les liens de causalité et proposer des actions. Il est donc indispensable dans les études épidémiologiques, de définir et d’utiliser avec précision les principaux domaines des études pronostiques décrit ci-dessus. Le risque ici est un passage sans précaution de la prédiction à la compréhension du concept de fragilité qui sont deux domaines différents bien que complémentaires. La définition la plus utilisée de la fragilité reste encore celle proposée par Fried et collaborateurs. Elle est basée sur la prise en compte d’éléments essentiellement physiques. Cette définition a de nombreuses limites lorsque la population cible vit en EHPAD par exemple. D’autres composantes non physiques parmi lesquelles la cognition, les vulnérabilités sociales, les comorbidités sont actuellement débattue pour mieux définir le concept de fragilité et identifier ses biomarqueurs. Cette thèse aborde d’un point de vue épidémiologique la définition du syndrome de fragilité grâce aux données des cohortes PAQUID et 3C (deux études Françaises en population) et la cohorte INCUR (une étude Française en EHPAD). Les résultats présentés dans cette thèse nous permettent d’affirmer que la relation entre la fragilité et la prédiction d’évènements défavorables de santé prend en compte la population cible, l’outil de mesure de la fragilité et l’examinateur. Ce résultats ouvrent donc des perspectives intéressantes pour la recherche sur le syndrome fragilité quelques soit les caractéristiques des populations étudiées

The epidemiological approach of frailty

En raison du vieillissement de la population, les syndromes gériatriques sont devenus un enjeu majeur de santé publique, et le syndrome de fragilité une priorité notamment en France avec le programme PAERPA. La fragilité permet d’identifier des personnes âgées présentant des capacités de résistance diminuées face aux agents agresseurs. Elle a pour conséquence d’accroître chez l’individu le risque de survenu d’évènements de santé défavorables (de dépendance, de chutes, d’hospitalisations, d’entrée en institution et de mortalité). Plusieurs outils de mesure sont développés mais aucune mesure de référence ne fait consensus actuellement même si des progrès considérables ont été réalisés dans ce domaine depuis une dizaine d’années. Les données épidémiologiques sur la prévalence, l’incidence et les conséquences de la fragilité ont été abondamment publiées mais se caractérisent par une grande variabilité. Ces indicateurs sont variables en fonction de l’outil de mesure utilisé, de la population étudiée, de l’examinateur et également de l’évènement de santé que l’on veut prédire. De nombreux facteurs de risque de fragilité ont été également mis en évidence et certains ouvrent des voies crédibles de recherche aidant à la prévention. Une meilleure connaissance de l’épidémiologie du syndrome de fragilité est donc une nécessité incontournable pour apprécier l’importance du phénomène et mettre en place les moyens de le contrôler. Afin de mieux définir la fragilité sur le plan épidémiologique, il est indispensable de bien comprendre la notion d’études pronostiques en épidémiologie et les principaux domaines qui la constituent c’est-à-dire : décrire la population, prédire des évènements de santé, comprendre les liens de causalité et proposer des actions. Il est donc indispensable dans les études épidémiologiques, de définir et d’utiliser avec précision les principaux domaines des études pronostiques décrit ci-dessus. Le risque ici est un passage sans précaution de la prédiction à la compréhension du concept de fragilité qui sont deux domaines différents bien que complémentaires. La définition la plus utilisée de la fragilité reste encore celle proposée par Fried et collaborateurs. Elle est basée sur la prise en compte d’éléments essentiellement physiques. Cette définition a de nombreuses limites lorsque la population cible vit en EHPAD par exemple. D’autres composantes non physiques parmi lesquelles la cognition, les vulnérabilités sociales, les comorbidités sont actuellement débattue pour mieux définir le concept de fragilité et identifier ses biomarqueurs. Cette thèse aborde d’un point de vue épidémiologique la définition du syndrome de fragilité grâce aux données des cohortes PAQUID et 3C (deux études Françaises en population) et la cohorte INCUR (une étude Française en EHPAD). Les résultats présentés dans cette thèse nous permettent d’affirmer que la relation entre la fragilité et la prédiction d’évènements défavorables de santé prend en compte la population cible, l’outil de mesure de la fragilité et l’examinateur. Ce résultats ouvrent donc des perspectives intéressantes pour la recherche sur le syndrome fragilité quelques soit les caractéristiques des populations étudiées.Now-a-days, geriatric syndromes have become a major public health problem owing to the population aging. In this context, frailty syndrome represents particularly a public health priority in France through PAERPA program. Frailty is defined as an extreme vulnerability of the organism to endogenous and exogenous stressors. This syndrome exposes the individual at higher risk of negative health-related outcomes as well as a transition phase between successful aging and disability. The theoretical concept of frailty is largely agreed, its practical translation still presents some limitations due to the existence of multiple tools and operational definitions. The definition most widely used is the one proposed by Fried and collaborators which essentially includes physical elements. Nonetheless, the inclusion of other non-physical components, in particular cognitive function, social vulnerability state, morbidities is currently debated. Considerable progress has been made in this field over the past ten years. The prevalence and incidence of frailty are reported in several epidemiological studies and are well known, but are quite variable. Many risk factors of frailty have been highlighted, leaving a door open towards prevention. A better knowledge of frailty epidemiology is therefore essential if we are to assess its extent and the means of controlling it. To better define frailty from an epidemiological point of view, it is essential to describe and better understand the different components of epidemiological prognostic studies: describing, prediction of health events, explaining the causal relation and proposing the action. The aim of this thesis was to the study, from an epidemiological point of view, the definition of frailty using the data of three French cohorts: PAQUID, 3C and INCUR. The results are consistent with an association between frailty and negative health-related outcomes. This association depends on the target sample, tools used and investigators

Neurocognitive Disorders: Importance of Early/Timely Detection in Daily Clinical Practice

International audienc

Promote a new paradigm to prevent neurodegenerative disease in sub-Saharan Africa

Prevention is the corner stone when dealing with disability as it must be considered as a nearly irreversible condition in elderly people. There is a growing demand for the identification of effective solutions against the detrimental consequences that age-related conditions (in particular, disabilities) exert on our healthcare systems. Therefore, preventive interventions able to modify the natural history of age-related conditions are urgently needed. Nutritional interventions appear to be a potentially effective way to prevent dementia in high income countries. The promotion of a healthy lifestyle and the adoption of preventive countermeasures for a specific condition are quite challenging. The approach based on the use of local natural resources such as diversified and rich food must be explored in SSA

Promote a new paradigm to prevent neurodegenerative disease in sub-Saharan Africa

Prevention is the corner stone when dealing with disability as it must be considered as a nearly irreversible condition in elderly people. There is a growing demand for the identification of effective solutions against the detrimental consequences that age-related conditions (in particular, disabilities) exert on our healthcare systems. Therefore, preventive interventions able to modify the natural history of age-related conditions are urgently needed. Nutritional interventions appear to be a potentially effective way to prevent dementia in high income countries. The promotion of a healthy lifestyle and the adoption of preventive countermeasures for a specific condition are quite challenging. The approach based on the use of local natural resources such as diversified and rich food must be explored in SSA