Etudier la fragilité : une priorité de santé publique

L'étude de cohorte Lc65+ suit depuis 2004 plusieurs milliers de personnes pour mieux comprendre la fragilisation liée au vieillissement. Que sait-on aujourd'hui de la fragilité ? Peut-on la mesurer ? Pourquoi le faire

Understanding recent trends in Swiss ambulatory care utilization when out-of-pocket payment is minimal

Summary.: Objective:: To examine trends in ambulatory care utilization when individuals face almost no financial barriers to health care. Methods:: Observational study of insurance data. Adults with minimal deductible were included. Ambulatory care visits and costs were measured from 1997 to 2002. Results:: Mean ambulatory care costs/insuree increased from 1 292.- to 1 790.- CHF, corresponding to higher increases in drug costs (+61.7%) than services costs (+24.3%). The proportion of visits to generalists decreased while those to hospital outpatient services increased. Conclusions:: In a demographically stable population of insurees, increases in ambulatory care costs were due neither to growth in physicians' ?visits nor to increasing physicians' fees per act, but to what was included in or prescribed during the visit

Soll man in der klinischen Praxis Frailty abschätzen?

Frailty, ein geriatrisches Syndrom mit altersbedingter Gebrechlichkeit assoziiert, heisst Verlust physiologischer Reserven verschiedener Organe. Die Folge ist eine erhöhte Verletzlichkeit durch Stress. Eine allseits anerkannte Definition fehlt, und die Abschätzung erfolgt hauptsächlich aufgrund zweier Modelle: des Phänotyps nach Fried und des Index nach Rockwood. Frailty bringt ein deutlich erhöhtes Risiko für funktionelle Hilfebedürftigkeit, Hospitalisation oder Einweisung in eine Institution für Langzeitpflege sowie Tod mit sich. Der Spontanverlauf ist progressiv, kann aber auch reversibel sein, und daher könnte Prävention grundsätzlich in Frage kommen. Unsere Kenntnisse sind derzeit aber immer noch zu lückenhaft, als dass wir gezielt gegen Frailty angehen könnten. Klinische Forschung über Frailty wird erst seit kurzem betrieben. Die Empfehlung, den Frailtygrad durch Leistungsmessung (wie Ganggeschwindigkeit, Griffkraft etc.) zu evaluieren, stützt sich auf die Beobachtung eines Zusammenhangs mit einer späteren ungünstigen Entwicklung, und nicht darauf, dass wir wirksam eingreifen könnten. Klinische und epidemiologische Studien über Frailty sind wichtig. Da die Babyboomer nun älter werden, ist die Gefahr einer Epidemie funktioneller Hilfebedürftigkeit Mitte des Jahrhunderts absehbar, und somit stellt das Problem der Frailty eine grosse Herausforderung dar

Older Citizens' Opinions on Long-Term Care Options: A Vignette Survey.

Older citizens are directly concerned, as potential beneficiaries and informal caregivers, by access to long-term care (LTC) services matching their expectations. The aim of this research was to collect their opinions regarding LTC arrangements for a diversity of disability profiles. Mailed vignette survey in a representative population-based sample of 3133 community-dwelling persons 68 years or older residing in a Swiss region. All persons received a set of 10 vignettes. For each vignette, they considered 2 social situations successively: a person (1) living with an able-bodied spouse, and (2) living alone or with a spouse unable to help (resulting in 20 vignettes). Subjects selected a care setting (home, sheltered housing, or nursing home) and specified the preferred type of caregivers (spouse, professionals, or both) after community-based care options. Population estimates were based on weighted data accounting for the stratification of the survey sample. A total of 2985 participants (95.3%) expressed opinions on 55,178 vignettes (mean 18.5 vignettes, SD 4.1) Institutionalization was selected by 0.8% (95% confidence interval 0.3-1.4) of the population for the vignette of lowest disability with able-bodied spouse and 78.8% (76.1-81.6) for the vignette of highest disability and no possible help from a spouse. Continence, cognitive, and behavioral difficulties further influenced the preferences expressed for LTC options. Community-based LTC choices involved professionals mostly as a complement to informal help by the spouse, except for vignettes describing isolated moderate cognitive impairment or difficulties in instrumental activities of daily living. In these cases, most favored help provided by spouses only. This survey had high acceptance. Responses to variations in the disability and social profile displayed in the vignettes suggested the validity of measurements

Physical activity in daily life is associated with lower adiposity values than doing weekly sports in Lc65+ cohort at baseline.

BACKGROUND: Overweight and obesity prevalence is the highest at age 65-75 years in Lausanne (compared with younger classes). We aimed to describe 1) eating habits, daily physical activity (PA), and sports frequency in community-dwelling adults aged 65-70, 2) the links of these behaviors with socio-economic factors, and 3) with adiposity. METHODS: Cross-sectional analysis of Lc65+ cohort at baseline, including 1260 adults from the general population of Lausanne aged 65-70 years. Eating habits (8 items from MNA) and PA (sports frequency and daily PA: walking and using stairs) were assessed by questionnaires. Body mass index (BMI), supra-iliac (SISF), triceps skin-folds (TSF), waist circumference (WC), and WHR were measured. RESULTS: Prevalence of overweight (BMI 25.0-29.9 kg/m2), obesity (BMI ≥ 30.0 kg/m2), and abdominal obesity was 53%, 24%, and 45% in men; 35%, 23%, and 45% in women.Intake of fruits or vegetables (FV) ≥ twice/day was negatively associated with male sex (prevalence 81% versus 90%, chi-square P < 0.001). The proportion avoiding stairs in daily life was higher among women (25%) than among men (20%, chi-square P=0.003).In multivariate analyses among both sexes, eating FV, using stairs in daily life ("stairs"), and doing sports ≥ once/week were significantly negatively associated with financial difficulties (stairs: OR=0.54, 95% CI=0.40-0.72) and positively with educational level (stairs: OR=1.68, 95% CI=1.17-2.43 for high school).For all five log-transformed adiposity indicators in women, and for all indicators except SISF and TSF in men, a gradual decrease in adiposity was observed from category "no stairs, sports < once/week" (reference), to "no stairs, sports ≥ once/week", to "stairs, sports < once/week", and "stairs, sports ≥ once/week" (for example: WC in men, respectively: ß= -0.03, 95% CI= -0.07-0.02; ß= -0.06, 95% CI= -0.09- -0.03; ß= -0.10, 95% CI= -0.12- -0.07). CONCLUSIONS: In this population with high overweight and obesity prevalence, eating FV and PA were strongly negatively associated with financial difficulties and positively with education. Using stairs in daily life was more strongly negatively associated with adiposity than doing sports ≥ once/week

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

Healthcare utilization of overweight and obese Europeans aged 50-79years

To examine the association between overweight/obesity and healthcare utilization in middle-aged and aged Europeans. This is a baseline cross-sectional analysis of self-reported data from ten countries participating in the Survey of Health, Ageing and Retirement in Europe (SHARE), which reached an overall response rate of 62%. Included in the study were 16,695 non-institutionalized individuals aged 50-79years with body mass indexes (BMI) ≥18.5kg/m2. We used height and weight to compute BMI and categorized it into normal weight (BMI 18.5-24.9kg/m2), overweight (BMI 25.0-29.9kg/m2) and obesity (BMI ≥ 30kg/m2). Dichotomous measures of healthcare utilization during the previous 12months included any use of ambulatory care, high use of a general practitioner, visits to specialists, high use of medication, hospitalization, high number of times hospitalized and nights spent in the hospital, surgery, home healthcare and domestic help. Logistic regressions adjusted for age, socio-economic status, smoking, physical activity, alcohol consumption, country of residence, and chronic conditions. All analyses were stratified by gender. Among men and women, being overweight or obese was associated with a significantly increased risk of using ambulatory care and visiting general practitioners, as well as taking ≥2 medication categories. Those relationships were only partially explained by chronic conditions. Obese women were at increased risk and overweight men at decreased risk of hospitalization. For men, exploring other hospitalization dimensions did not reveal significant associations, however. Men and women, whether overweight or obese, did not report higher use of specialists, surgery, home healthcare or domestic help. For all outcomes, similar trends were found at the country level. Population-attributable fractions were highest for medication use, both for men (23%) and women (19%). Despite the rising prevalence of obesity and aging of the population, findings from SHARE show that overweight and obesity place a moderate burden on European healthcare systems, mostly by increasing ambulatory care and medication us

La santé des aînés : portrait de la santé et de ses déterminants sociaux en ville de Lausanne

L'influence du vieillissement démographique se ressent dans divers secteurs de la société. Le financement des assurances sociales, l'organisation des soins et l'accueil destiné aux aînés doivent être repensés. Une récente analyse de l'Office fédéral de la statistique suggère que l'on vieillit en meilleure santé, avec une meilleure qualité de vie que par le passé. La mise en place de programmes pour un vieillissement en bonne santé s'impose en même temps qu'évolue notre système de santé. Les données actuelles décrivant la population des Lausannois de 65 ans et plus (la cohorte Lc65+) nous invitent à réfléchir à la question. Le présent document est le premier de trois rapports qui présenteront les données de la cohorte Lc65+. Il se fonde principalement sur les informations recueillies durant les années 2010 et 2011, et présentera avant tout les problèmes de santé d'une population âgée entre 68 et 77 ans. Les aspects de la santé seront mis en perspective avec des facteurs sociaux structurels, les déterminants sociaux de la santé. Le rapport se divise en deux parties. La première donne un aperçu de l'état de santé dans la population des seniors domiciliés à Lausanne; les fréquences relatives à chaque indicateur ont été calculées et les résultats présentés sous forme de graphiques ou tableaux. La seconde partie s'attache à évaluer le lien entre les variables de santé et les facteurs socio-économiques. La significativité statistique de l'association (brute, puis ajustée sur le sexe et le groupe d'âge) entre les facteurs socio-économiques et les variables de santé a été testée par des tests du" chi" d'indépendance

Medical Appropriateness of Hospital Utilization: an Overview of the Swiss Experience

We present here the principal results of four concurrent hospital utilization reviews conducted in Switzerland in 1990 and 1991, based on an adapted Appropriateness Evaluation Protocol. The studies were performed on all the hospital days from a sample of patients admitted over a 6 month period. The level of inappropriate use ranged between 8 and 15% in terms of days and was consistently higher in medicine than in surgery. In comparison with other published studies, the low proportion of observed inappropriate days is probably due, at least partly, to differences in study desig