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

Population-based cohorts of the 50s and over: a summary of worldwide previous and ongoing studies for research on health in ageing

As most countries face the ageing of their population, understanding successful and pathologic ageing is a research priority. Longitudinal studies examining the ageing process from middle-age are required to establish causal and valid relationships. This systematic review of the literature aimed at identifying large community-based longitudinal studies either including exclusively elderly people or following people from middle-age (50+ years at enrolment) to death, and resulted in a selection of 72 cohort studies. Design features of selected studies show that most were conducted in North America or Northern Europe, most included both genders, and follow-up period was often less than 10years. Many cohorts focused on cardiovascular health, cognitive decline or osteoporosis. Usually collected variables comprise of self-reported data on socio-demographics, chronic diseases and functional status, as well as measures of cognition, anthropometrics and physical performances. Biological samples were taken in about 60% of the studies, and a third also undertook genetic analyses. This review summarises information on design and content of large population-based cohorts of older persons, and represents a valuable background from which additional data may be retrieve

Sources and level of information about health issues and preventive services among young-old persons in Switzerland

Summary: Objectives:: to describe the sources of health information in young-old persons, and how they feel informed about preventive services. Methods:: 1,567 randomly selected persons aged 65-69 years were asked where they did get information about health, and whether they felt sufficiently informed about recommended preventive services. Results:: Most participants (over 90 %) cited their physician as a source of health information, while only 4 % cited the Internet. Level of information was low for several preventive services, including colon cancer screening (55 % felt sufficiently informed) and immunization against pneumonia (27 % sufficiently informed). Conclusions:: Promotion of preventive services in older populations should take into account the preponderant role of physicians as a source of information and advic

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

Adverse life events among community-dwelling persons aged 65-70years: gender differences in occurrence and perceived psychological consequences

Objectives: To describe the occurrence of selected adverse life events in young-old men and women, as well as their perceived psychological consequences. Methods: In 2005, 1,422 participants in the Lausanne Cohort 65+ study, born in 1934-1938, self-reported whether they experienced any of 26 life events during the preceding year. Most participants (N=1,309, 92%) completed the geriatric adverse life events scale during a face-to-face interview, by rating the level of stress associated with each event, as well as its impact on their psychological well-being. Results: Overall, 72% of the participants experienced at least one of the 26 events in the preceding year (range 1-9). Disease affecting the respondent (N=525) or a close relative (N=276) was most frequent, as well as the death of a friend or non-close relative (N=274). Women indicated a higher frequency of events (mean 2.1 vs. 1.7 events, P<0.001), as well as a higher level of stress and a stronger negative impact on well-being than men. In multivariate analyses adjusting for self-rated health, depressive symptoms and comorbidity, female gender remained significantly associated with the level of stress and negative impact on psychological well-being. Conclusion: This exploratory study shows that several types of adverse life events frequently occur at age 65-70, with gender differences both in the frequency of reporting and consequences of these events. However, information on this topic is limited and studies based on different populations and designs are needed to better understand the impact of such event

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)