1
|
Dumontet M, Henchoz Y, Santos-Eggimann B. Do financial hardships affect health? A study among older adults in Switzerland. Eur J Public Health 2024; 34:7-13. [PMID: 37995328 PMCID: PMC10843939 DOI: 10.1093/eurpub/ckad202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND A growing number of studies have underlined the relationship between socioeconomic status and health. Following that literature, we explore the causal effect of financial hardships on changes in health at older ages. Rather than traditional measures of socioeconomic variables, we study the role of financial hardships. The declarative measurement of financial hardships is particularly relevant for assessing the impact of short-term financial difficulties on health among older adults. METHODS In this study, we use data from the Lausanne cohort 65+. Participants are community-dwelling older adults representative of the population aged 65-70 years in 2004 and living in Lausanne (Switzerland) (n = 1352). We use longitudinal annual data with 11 years of follow-up (2006-16) to estimate dynamic panel models on several indicators measuring older adults' health (self-rated health, number of medical conditions, depressive symptoms, difficulties with daily living activities). RESULTS We find evidence of causal effects of financial hardships on self-rated health (coef. = 0.059, P < 0.10) and on depressive symptoms (coef.=0.060, P < 0.05). On the other hand, we find no evidence of causality running from financial hardships to the number of medical conditions and the difficulties in daily living activities. CONCLUSION These results make a contribution to the literature where nearly all previous research on associations between financial hardship and health does not establish causal relationships. Our results support the need to integrate health policies that mitigate the potential adverse health effects of financial hardship for older adults.
Collapse
Affiliation(s)
- Magali Dumontet
- EconomiX, UPL, University Paris Nanterre, CNRS, Nanterre, France
- Department of epidemiology and health systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yves Henchoz
- Department of epidemiology and health systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Department of epidemiology and health systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
2
|
Märki-Germann D, Seematter-Bagnoud L, Fustinoni S, Spaltenstein J, Bula C, Henchoz Y. Older people's experience of the partial lockdown during the COVID-19 pandemic in Switzerland: a cross-sectional study. BMJ Open 2023; 13:e067167. [PMID: 36963798 PMCID: PMC10039977 DOI: 10.1136/bmjopen-2022-067167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate older people's experience of a COVID-19 partial lockdown (16 March-11 May 2020) in Lausanne, Switzerland. SETTING AND PARTICIPANTS Community-dwelling participants of the Lausanne cohort (Lc65+) in 2020, aged 71-86 years (n=2642). DESIGN AND OUTCOME This cross-sectional study was nested within the Lc65+ longitudinal study. A specific COVID-19 questionnaire was sent on 17 April 2020 to evaluate participants' experience of the lockdown (outcome). Multinomial logistic regression models were used to determine the sociodemographic, living environment, health and social factors associated. RESULTS Out of 2642 participants, 67.8% described the lockdown as 'somewhat' difficult (reference group), 21.5% as 'not at all' difficult (positive) and 10.7% as 'very or extremely' difficult (negative). The relative risk of a positive experience was higher in participants living alone (relative risk ratio, RRR=1.93, 95% CI 1.52 to 2.46) or in a house (RRR=1.49, 1.03 to 2.16); lower in those who reported fear of falling (RRR=0.68, 0.54 to 0.86), functional difficulties (RRR=0.78, 0.61 to 0.99), feeling of loneliness (RRR=0.67, 0.49 to 0.91), unfamiliarity with communication technologies (RRR=0.69, 0.52 to 0.91), usual social support (RRR=0.71, 0.50 to 0.93), previous participation in group activities (RRR=0.74, 0.59 to 0.92) and among women (RRR=0.75, 0.59 to 0.95). The relative risk of a negative experience was higher in participants with fear of falling (RRR=1.52, 1.07 to 2.15), and lower in those who had a terrace/garden (RRR=0.66, 0.44 to 0.99) and owned a dog (RRR=0.32, 0.11 to 0.90). CONCLUSIONS Only one in 10 participants experienced the lockdown as very or extremely difficult. Specific interventions targeting vulnerability factors, such as fear of falling, could lessen the impact of any future similar situation.
Collapse
Affiliation(s)
- Daphné Märki-Germann
- Department of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Department of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sarah Fustinoni
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Julia Spaltenstein
- Department of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Christophe Bula
- Department of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Yves Henchoz
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
3
|
Smith C, Seematter-Bagnoud L, Santos-Eggimann B, Krief H, Bula CJ. Executive function and prospective falls: a 6-year longitudinal study in community-dwelling older adults. BMC Geriatr 2023; 23:140. [PMID: 36899323 PMCID: PMC10007810 DOI: 10.1186/s12877-023-03790-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/01/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Older people with impaired executive function (EF) might have an increased fall risk, but prospective studies with prolonged follow-up are scarce. This study aimed to investigate the association between a) EF at baseline; b) 6-year decline in EF performance; and fall status 6 years later. METHODS Participants were 906 community-dwelling adults aged 65-69 years, enrolled in the Lausanne 65 + cohort. EF was measured at baseline and at 6 years using clock drawing test (CDT), verbal fluency (VF), Trail Making Test (TMT) A and B, and TMT ratio (TMT-B - TMT-A/TMT-A). EF decline was defined as clinically meaningful poorer performance at 6 years. Falls data were collected at 6 years using monthly calendars over 12 months. RESULTS Over 12-month follow-up, 13.0% of participants reported a single benign fall, and 20.2% serious (i.e., multiple and/or injurious) falls. In multivariable analysis, participants with worse TMT-B performance (adjusted Relative Risk Ratio, adjRRRTMT-B worst quintile = 0.38, 95%CI:0.19-0.75, p = .006) and worse TMT ratio (adjRRRTMT ratio worst quintile = 0.31, 95%CI:0.15-0.64, p = .001) were less likely to report a benign fall, whereas no significant association was observed with serious falls. In a subgroup analysis among fallers, participants with worse TMT-B (OR:1.86, 95%CI = 0.98-3.53, p = .059) and worse TMT ratio (OR:1.84,95%CI = 0.98-3.43,p = .057) tended to have higher odds of serious falls. EF decline was not associated to higher odds of falls. CONCLUSIONS Participants with worse EF were less likely to report a single benign fall at follow-up, while fallers with worse EF tended to report multiple and/or injurious falls more frequently. Future studies should investigate the role of slight EF impairment in provoking serious falls in active young-old adults.
Collapse
Affiliation(s)
- Cindi Smith
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Mont Paisible 16, 1011, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Mont Paisible 16, 1011, Lausanne, Switzerland. .,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de La Corniche 10, 1010, Lausanne, Switzerland.
| | - Brigitte Santos-Eggimann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de La Corniche 10, 1010, Lausanne, Switzerland
| | - Helene Krief
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Mont Paisible 16, 1011, Lausanne, Switzerland
| | - Christophe J Bula
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Mont Paisible 16, 1011, Lausanne, Switzerland
| |
Collapse
|
4
|
Roth L, Seematter-Bagnoud L, Le Pogam MA, Dupraz J, Blanco JM, Henchoz Y, Peytremann-Bridevaux I. Identifying common patterns of health services use: a longitudinal study of older Swiss adults' care trajectories. BMC Health Serv Res 2022; 22:1586. [PMID: 36572888 PMCID: PMC9793504 DOI: 10.1186/s12913-022-08987-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Population ageing puts pressure on health systems initially designed to handle acute and episodic illnesses. Segmenting an ageing population based on its healthcare utilization may enable policymakers to undertake evidence-based resource planning. We aimed to derive a typology of healthcare utilization trajectories in Swiss older adults. METHODS Our work used data from the Lc65 + study, a population-based cohort of individuals aged 65 to 70 years at enrolment. The dimensions of healthcare utilization considered were ambulatory care, emergency care, hospitalizations, professional home care and nursing home stay. We applied the Sequence Analysis framework, within which we quantified the variation between each multidimensional pair of sequences, implemented a clustering procedure that grouped together older persons with similar profiles of health services use, and characterized clusters of individuals using selected baseline covariates. RESULTS Healthcare utilization trajectories were analysed for 2271 community-dwelling older adults over a period of 11 years. Six homogeneous subgroups were identified: constant low utilization (83.3% of participants), increased utilization (4.9%), late health deterioration (4.4%), ambulatory care to nursing home (1.5%), early fatal event (3.8%) and high ambulatory care (2.1%). Associations were found between cluster membership and age, sex, household composition, self-perceived health, grip strength measurement, comorbidities, and functional dependency. CONCLUSIONS The heterogeneous healthcare utilization profiles can be clustered into six common patterns. Different manifestations of functional decline were apparent in two distinct trajectory groups featuring regular home care use. Furthermore, a small proportion of individuals with a unique set of characteristics was related to the highest levels of ambulatory and emergency care use. New research avenues are outlined to investigate time-varying effects of health factors inside the clusters containing most unfavourable outcomes.
Collapse
Affiliation(s)
- Leonard Roth
- grid.9851.50000 0001 2165 4204Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de La Corniche, 1010 Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- grid.9851.50000 0001 2165 4204Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de La Corniche, 1010 Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- grid.9851.50000 0001 2165 4204Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de La Corniche, 1010 Lausanne, Switzerland
| | - Julien Dupraz
- grid.9851.50000 0001 2165 4204Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de La Corniche, 1010 Lausanne, Switzerland
| | - Juan-Manuel Blanco
- grid.9851.50000 0001 2165 4204Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de La Corniche, 1010 Lausanne, Switzerland
| | - Yves Henchoz
- grid.9851.50000 0001 2165 4204Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de La Corniche, 1010 Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- grid.9851.50000 0001 2165 4204Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de La Corniche, 1010 Lausanne, Switzerland
| |
Collapse
|
5
|
Kozicka I, Guligowska A, Chrobak-Bień J, Czyżewska K, Doroba N, Ignaczak A, Machała A, Spałka E, Kostka T, Borowiak E. Factors Determining the Occurrence of Frailty Syndrome in Hospitalized Older Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12769. [PMID: 36232069 PMCID: PMC9564663 DOI: 10.3390/ijerph191912769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Frailty syndrome (FS) is a condition characterized by a decline in reserves, observed with aging. The most important consequences of the frailty syndrome include disability, hospitalization, fractures, institutionalization, and early mortality. The aim of this study was to identify the most important risk factors for FS in a group of older hospitalized patients in Poland. A total of one hundred and forty-one (78 women, 63 men) elderly patients from the Departments of Internal Medicine of the Medical University of Lodz (Poland) were recruited for this study. Frailty Instrument of the Survey of Health, Aging and Retirement in Europe (SHARE-FI), handgrip strength (HGS), depressive symptoms using the Geriatric Depression Scale (GDS), and functional ability (FA) using the Instrumental Activities of Daily Living (IADL) were assessed. According to SHARE-FI score, participants were divided into control group, frail, and pre-frail patients. Out of all 141 tested patients, FS was confirmed in 55 patients, and pre-frailty was observed in 52 patients. The occurrence of FS in the group of studied patients was related to age (p < 0.001), widowhood (p < 0.001), comorbidities (p < 0.001), heart diseases (p = 0.04), more medications taken (p < 0.001), lower FA (p < 0.001), weaker HGS, and depression (p < 0.001). The strongest positive correlations were between Share-FI score and the number of diseases (rS = 0.31), GDS (rS = 0.32), while negative correlations with IADL (rS = -0.47) and HGS (rS = -0.35). The study shows that FS is associated with age, comorbidities, number of medications taken, and widowhood. The present study has also demonstrated that FA, depression, and especially HGS are essential determinants of FS of elderly hospitalized people.
Collapse
Affiliation(s)
- Izabela Kozicka
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Agnieszka Guligowska
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Joanna Chrobak-Bień
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Katarzyna Czyżewska
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Natalia Doroba
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Anna Ignaczak
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Anna Machała
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Ewelina Spałka
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Ewa Borowiak
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| |
Collapse
|
6
|
Season, Vegetation Proximity and Building Age Shape the Indoor Fungal Communities’ Composition at City-Scale. J Fungi (Basel) 2022; 8:jof8101045. [PMID: 36294610 PMCID: PMC9605656 DOI: 10.3390/jof8101045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 12/04/2022] Open
Abstract
Exposure to particular microbiome compositions in the built environment can affect human health and well-being. Identifying the drivers of these indoor microbial assemblages is key to controlling the microbiota of the built environment. In the present study, we used culture and metabarcoding of the fungal Internal Transcribed Spacer ribosomal RNA region to assess whether small-scale variation in the built environment influences the diversity, composition and structure of indoor air fungal communities between a heating and an unheated season. Passive dust collectors were used to collect airborne fungi from 259 dwellings representative of three major building periods and five building environments in one city—Lausanne (Vaud, Switzerland)—over a heating and an unheated period. A homogenous population (one or two people with an average age of 75 years) inhabited the households. Geographic information systems were used to assess detailed site characteristics (altitude, proximity to forest, fields and parks, proximity to the lake, and density of buildings and roads) for each building. Our analysis indicated that season was the factor that explained most of the variation in colonies forming unit (CFU) concentration and indoor mycobiome composition, followed by the period of building construction. Fungal assemblages were more diverse during the heating season than during the unheated season. Buildings with effective insulation had distinct mycobiome compositions from those built before 1975 — regardless of whether they were constructed with pre-1945 technology and materials or 1945 — 1974 ones. The urban landscape—as a whole—was a significant predictor of cultivable Penicillium load—the closer the building was to the lake, the higher the Penicillium load—but not of fungal community composition. Nevertheless, the relative abundance of eleven fungal taxa detected by metabarcoding decreased significantly with the urbanization gradient. When urban landscape descriptors were analyzed separately, the explanatory power of proximity to vegetation in shaping fungal assemblages become significant, indicating that land cover type had an influence on fungal community structure that was obscured by the effects of building age and sampling season. In conclusion, indoor mycobiomes are strongly modulated by season, and their assemblages are shaped by the effectiveness of building insulation, but are weakly influenced by the urban landscape.
Collapse
|
7
|
Abolhassani N, Fustinoni S, Henchoz Y. Slowness as a Predictor of Functional Decline in Older Adults: Comparison of Moberg Picking-Up Test and Walking Speed. J Am Med Dir Assoc 2022; 23:1705-1711.e5. [PMID: 35995094 DOI: 10.1016/j.jamda.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES Slowness, generally assessed by walking speed (WS), is an estimator of frailty and its outcomes. Because of potential difficulties in assessing WS, the Moberg picking-up test (MPUT) might be an alternative. This study investigated the capacity of slowness measurements (WS and MPUT) to predict nonfatal adverse consequences of frailty: primarily, decline in basic activities of daily living (BADL); and secondarily, decline in instrumental activities of daily living (IADL), fall, hospitalization, and incident disease. DESIGN Observational (prospective longitudinal study). SETTING AND PARTICIPANTS This study used data from the population-based Lausanne cohort 65+. At baseline, 1887 individuals (aged 72-77 years) completed both WS (time to walk 20 m at usual pace) and MPUT (time to pick up 12 objects) assessments. METHODS All outcomes, assessed at 1- and 4-year follow-ups, were entered in separate logistic regression models with adjustment for age, sex, and respective values at baseline. The prediction of all outcomes by either WS or MPUT was assessed using area under the receiver operating characteristic curve and compared by χ2 tests. RESULTS There were positive associations between slowness either assessed by WS [relative risk (RR) = 2.48; P < .001] or MPUT (RR = 1.91; P < .001) and decline in BADL at 1-year follow-up. These associations remained significant at 4-year follow-up for both WS (RR = 2.28; P < .001) and MPUT (RR = 1.95; P < .001). There was no significant difference between predictive values of slow WS and MPUT for decline in BADL at 1-year (P = .328) and 4-year follow-ups (P = .413). The prediction was not significantly different for secondary outcomes, except for decline in IADL for which the prediction was slightly better for WS. CONCLUSIONS AND IMPLICATIONS MPUT may be an alternative measurement of slowness with predictive value of functional decline. No significant difference in predictive capabilities of MPUT and WS for specific adverse consequences of frailty is promising in favor of using MPUT for measuring slowness.
Collapse
Affiliation(s)
- Nazanin Abolhassani
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | - Sarah Fustinoni
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Yves Henchoz
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| |
Collapse
|
8
|
Belloni G, Büla C, Santos-Eggimann B, Henchoz Y, Fustinoni S, Seematter-Bagnoud L. Fear of falling and all-cause mortality among young-old community-dwelling adults: a 6-year prospective study. Eur J Ageing 2022; 19:293-300. [PMID: 35663911 PMCID: PMC9156588 DOI: 10.1007/s10433-021-00635-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
This study investigated whether fear of falling (FOF) measured by two different instruments, the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR), is associated with mortality at 6-year follow-up. Participants (n = 1359, 58.6% women) were community-dwelling persons enrolled in the Lausanne cohort 65 + , aged 66 to 71 years at baseline. Covariables assessed at baseline included demographic, cognitive, affective, functional and health status, while date of death was obtained from the office in charge for population registration. Unadjusted Kaplan Meyer curves were performed to show the survival probability for all-cause mortality according to the degree of FOF reported with FES-I and SQ-FAR, respectively. Bivariable and multivariable Cox regression analyses were performed to assess hazard ratios, using time-in-study as the time scale variable and adjusting for variables significantly associated in bivariable analyses. During the 6-year follow-up, 102 (7.5%) participants died. Reporting the highest level of fear at FES-I (crude HR 3.86, 95% CI 2.37-6.29, P < .001) or "FOF with activity restriction" with SQ-FAR (crude HR 2.42, 95% CI 1.44-4.09, P = .001) were both associated with increased hazard of death but these associations did not remain significant once adjusting for gender, cognitive, affective and functional status. As a conclusion, although high FOF and related activity restriction, assessed with FES-I and SQ-FAR, identifies young-old community-dwelling people at increased risk of 6-year mortality, this association disappears when adjusting for potential confounders. As a marker of negative health outcomes, FOF should be screened for in order to provide personalized care and reduce subsequent risks.
Collapse
Affiliation(s)
- Giulia Belloni
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Mont-Paisible 16, CH-1011 Lausanne, Switzerland
- Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Mont-Paisible 16, CH-1011 Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yves Henchoz
- Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sarah Fustinoni
- Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Mont-Paisible 16, CH-1011 Lausanne, Switzerland
- Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
9
|
Le Pogam MA, Seematter-Bagnoud L, Niemi T, Assouline D, Gross N, Trächsel B, Rousson V, Peytremann-Bridevaux I, Burnand B, Santos-Eggimann B. Development and validation of a knowledge-based score to predict Fried's frailty phenotype across multiple settings using one-year hospital discharge data: The electronic frailty score. EClinicalMedicine 2022; 44:101260. [PMID: 35059615 PMCID: PMC8760435 DOI: 10.1016/j.eclinm.2021.101260] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Most claims-based frailty instruments have been designed for group stratification of older populations according to the risk of adverse health outcomes and not frailty itself. We aimed to develop and validate a tool based on one-year hospital discharge data for stratification on Fried's frailty phenotype (FP). METHODS We used a three-stage development/validation approach. First, we created a clinical knowledge-driven electronic frailty score (eFS) calculated as the number of deficient organs/systems among 18 critical ones identified from the International Statistical Classification of Diseases and Related Problems, 10th Revision (ICD-10) diagnoses coded in the year before FP assessment. Second, for eFS development and internal validation, we linked individual records from the Lc65+ cohort database to inpatient discharge data from Lausanne University Hospital (CHUV) for the period 2004-2015. The development/internal validation sample included community-dwelling, non-institutionalised residents of Lausanne (Switzerland) recruited in the Lc65+ cohort in three waves (2004, 2009, and 2014), aged 65-70 years at enrolment, and hospitalised at the CHUV at least once in the year preceding the FP assessment. Using this sample, we selected the best performing model for predicting the dichotomised FP, with the eFS or ICD-10-based variables as predictors. Third, we conducted an external validation using 2016 Swiss nationwide hospital discharge data and compared the performance of the eFS model in predicting 13 adverse outcomes to three models relying on well-designed and validated claims-based scores (Claims-based Frailty Index, Hospital Frailty Risk Score, Dr Foster Global Frailty Score). FINDINGS In the development/internal validation sample (n = 469), 14·3% of participants (n = 67) were frail. Among 34 models tested, the best-subsets logistic regression model with four predictors (age and sex at FP assessment, time since last hospital discharge, eFS) performed best in predicting the dichotomised FP (area under the curve=0·71; F1 score=0·39) and one-year adverse health outcomes. On the external validation sample (n = 54,815; 153 acute care hospitals), the eFS model demonstrated a similar performance to the three other claims-based scoring models. According to the eFS model, the external validation sample showed an estimated prevalence of 56·8% (n = 31,135) of frail older inpatients at admission. INTERPRETATION The eFS model is an inexpensive, transportable and valid tool allowing reliable group stratification and individual prioritisation for comprehensive frailty assessment and may be applied to both hospitalised and community-dwelling older adults. FUNDING The study received no external funding.
Collapse
Affiliation(s)
- Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
- Corresponding author.
| | - Laurence Seematter-Bagnoud
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Tapio Niemi
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Dan Assouline
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Nathan Gross
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Bastien Trächsel
- Department of Training, Research and Innovation, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 113 Route de Berne, Lausanne 1010, Switzerland
| | - Valentin Rousson
- Department of Training, Research and Innovation, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 113 Route de Berne, Lausanne 1010, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Bernard Burnand
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Brigitte Santos-Eggimann
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| |
Collapse
|
10
|
Henchoz Y, Blanco JM, Fustinoni S, Nanchen D, Büla C, Seematter-Bagnoud L, von Gunten A, Santos-Eggimann B. Cohort Profile: The Lausanne cohort 65+ (Lc65+). Int J Epidemiol 2021; 51:e156-e166. [PMID: 34849932 PMCID: PMC9365621 DOI: 10.1093/ije/dyab245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yves Henchoz
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland
| | - Juan Manuel Blanco
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland
| | - Sarah Fustinoni
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland
| | - David Nanchen
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland.,Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old-age Psychiatry, Department of Psychiatry, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
11
|
Anker D, Carmeli C, Zwahlen M, Rodondi N, Santschi V, Henchoz Y, Wolfson C, Chiolero A. How blood pressure predicts frailty transitions in older adults in a population-based cohort study: a multi-state transition model. Int J Epidemiol 2021; 51:1167-1177. [PMID: 34652417 PMCID: PMC9365628 DOI: 10.1093/ije/dyab210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Indexed: 11/14/2022] Open
Abstract
Background Low blood pressure (BP) is associated with frailty in older adults. Our aim was to explore how BP predicts transitions between frailty states. Methods We used data from the Lausanne cohort Lc65+, a population-based cohort of older adults randomly drawn from a population registry in Switzerland, in 2004, 2009 and 2014. BP was measured using a clinically validated oscillometric automated device and frailty was defined using Fried’s phenotype, every 3 years. We used an illness-death discrete multi-state Markov model to estimate hazard ratios of forward and backward transitions between frailty states (outcome) in relation to BP categories (predictor of interest) with adjustment for sex, age and antihypertensive medication (other predictors). Results Among 4200 participants aged 65–70 years (58% female) at baseline, 70% were non-frail, 27% pre-frail and 2.0% frail. Over an average follow-up of 5.8 years, 2422 transitions were observed, with 1575 (65%) forward and 847 (35%) backward. Compared with systolic BP (SBP) <130 mmHg, the hazard ratio (95% confidence interval) of the transition from non-frail to pre-frail was 0.86 (0.74 to 1.00) for SBP 130–150 mmHg, and 0.89 (0.74 to 1.06) for SBP ≥150 mmHg. Compared with SBP <130 mmHg, the hazard ratio of the transition from pre-frail to frail was 0.71 (0.50 to 1.01) for SBP 130–150 mmHg, and 0.90 (0.62 to 1.32) for SBP ≥150 mmHg. Diastolic BP was a weaker predictor of forward transitions. Conclusions BP categories had no strong relationship with either forward transitions or backward transitions in frailty states. If our findings are confirmed with greater precision and assuming a causal relationship, they would suggest that there is no well-defined optimal BP level to prevent frailty among older adults.
Collapse
Affiliation(s)
- Daniela Anker
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Cristian Carmeli
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland
| | - Yves Henchoz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology and Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| |
Collapse
|
12
|
Cattagni Kleiner A, Henchoz Y, Fustinoni S, Seematter-Bagnoud L. Volunteering transitions and change in quality of life among older adults: A mixed methods research. Arch Gerontol Geriatr 2021; 98:104556. [PMID: 34678646 DOI: 10.1016/j.archger.2021.104556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The activity theory posits that productive activities are beneficial to older people's well-being. This study examined how quality of life (QoL), globally and in its different dimensions, may be affected by stopping or initiating volunteering, and which psychosocial mechanisms might be at work in such associations. METHOD This study used an explicative sequential mixed method design: analyses of 2011 and 2016 data from participants to the Lausanne cohort 65+ (n = 1,976, age 68-77 years in 2011) were followed by qualitative analyses of focus groups made of volunteers participating in the same cohort. Quantitative and qualitative results were then integrated to search for explanations of the former by the latter. RESULTS Stopping (versus maintaining) volunteering was independently associated with higher odds of a decrease in global QoL and in the "self-esteem and recognition" and "autonomy" dimensions. Observed associations were mediated by the satisfaction of transmitting skills and knowledge, of witnessing the progress of the people being helped, and of feeling useful. Volunteering gave participants a sense of structure and taught them new skills. Initiating volunteering (versus not participating) was independently associated with lower odds of a decrease in the "material resources" dimension and experiencing financial problems was believed to hinder volunteering. CONCLUSION Our findings show a positive impact of volunteering on the self-esteem and autonomy of older adults, suggesting that they should be supported in maintaining their volunteer activities. Further exploration of the relationship between material resources and opportunities to volunteer is needed.
Collapse
Affiliation(s)
- Anne Cattagni Kleiner
- Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Switzerland
| | - Yves Henchoz
- Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Switzerland
| | - Sarah Fustinoni
- Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Switzerland; Service of Geriatric medicine and geriatric rehabilitation, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
13
|
Fustinoni S, Santos-Eggimann B, Henchoz Y. Trajectories of phenotypical frailty over a decade in young-old community-dwelling adults: results from the Lc65+ study. J Epidemiol Community Health 2021; 76:216-222. [PMID: 34433618 DOI: 10.1136/jech-2021-216633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/08/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Few studies have examined the frailty trajectories of young-old adults using Fried frailty phenotype. Dropouts due to death were rarely taken into account. This longitudinal study aimed to identify trajectories with and without adjustment for non-random attrition and to analyse related factors. METHODS We used the first two samples of community-dwelling people in the Lausanne cohort 65+. Frailty phenotype was assessed at age 66-71 years and every third year over 10 years. A group-based trajectory modelling-first without and then with adjustment for non-random attrition-identified trajectories among all individuals with at least two observations (n=2286), excluding dropouts for reasons other than death. Multinomial logistic regressions estimated independent effects of participants' baseline characteristics. RESULTS We identified three frailty trajectories (low, medium and high). Participants in the highest trajectory had a higher mortality over 10 years. (Pre)frailty at baseline was the main factor associated with adverse trajectories. Smoking, obesity, comorbidity and negative self-perceived health were associated with unfavourable trajectories independently of baseline frailty, while social engagement was related to the lowest frailty trajectory. Ignoring transitions to death attenuated the estimated effects of age on trajectories. CONCLUSIONS Fried frailty phenotype should be assessed in individuals aged late 60s as it is strongly associated with frailty trajectories in the following decade of their life. Lifetime prevention of behavioural risk factors such as smoking and obesity is the strategy most likely to influence the development of frailty in older populations. Furthermore, our results underline social engagement as an important area of interest for future research.
Collapse
Affiliation(s)
- Sarah Fustinoni
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Yves Henchoz
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| |
Collapse
|
14
|
Seematter-Bagnoud L, Santos-Eggimann B, Nanchen D, Blanco JM, Büla C, von Gunten A, Démonet JF, Henchoz Y. Older People's Health-Related Behaviors: Evidence from Three Cohorts of the Lc65+ Study. Behav Med 2021; 47:246-250. [PMID: 32078491 DOI: 10.1080/08964289.2019.1684234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Baby-boomers might be more health-conscious than earlier birth cohorts, but limited evidence has been produced so far. To investigate such changes, this study compared health-related behaviors at age 65 to 70 among three successive five-year birth cohorts (pre-war: born 1934-1938; war: born 1939-1943 and baby-boom: born 1944-1948) representative of the community-dwelling population. Information about alcohol use, smoking, physical activity, and nutrition was compared across the three cohorts (n = 4,270 participants) using Chi-squared test. Alcohol and the mean nutritional intake score did not vary across cohorts, whereas the consumption of nonalcoholic drinks increased significantly from pre-war to war and to baby-boom cohort (p<.001). Other differences across cohorts were observed only in women: the proportion of women who never or rarely engaged in sports decreased from 52.9% in the pre-war cohort to around 43% in subsequent cohorts (p<.001), while the proportion of women who had never smoked was higher in the pre-war cohort (56.1%) than in the war and the baby-boom cohorts (49.8% and 46.8%, respectively, p<.001). Overall, these results show some positive changes in older persons' health behaviors over time. Nevertheless, considerable room remains for improving lifestyles through public health interventions.
Collapse
Affiliation(s)
- Laurence Seematter-Bagnoud
- Center for Primary Care and Public Health (Unisanté), University of Lausanne.,Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre
| | | | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Juan-Manuel Blanco
- Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre
| | - Armin von Gunten
- Service of Old-Age Psychiatry, University of Lausanne Hospital Centre
| | | | - Yves Henchoz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne
| |
Collapse
|
15
|
Chauvin P, Fustinoni S, Seematter-Bagnoud L, Herr M, Santos Eggimann B. Potentially inappropriate prescriptions: Associations with the health insurance contract and the quality of the patient-physician relationship? Health Policy 2021; 125:1146-1157. [PMID: 34266705 DOI: 10.1016/j.healthpol.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/19/2021] [Accepted: 06/22/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Potentially Inappropriate Prescriptions (PIP) are often used as an indicator of potential drug overuse or misuse to limit adverse drug events in older people. OBJECTIVE To determine whether PIP exposure differs as a function of the patient's health insurance scheme and the patient-physician relationship. METHODS Our dataset was collected from two surveys delivered to two cohorts of the Swiss Lc65+ study, together with a stratified random sample of older people in the Swiss canton of Vaud. The study sample consisted of 1,595 people aged 68 years and older living in the community and reporting at least one prescription drug. Logit regression models of PIP risk were run for various categories of variables: health related, socioeconomic, health insurance scheme and patient-physician relationship. RESULTS 17% of our respondents had at least one PIP. Our results suggested that being enrolled in a health plan with restriction in the patient's choice of providers and having higher deductibles were associated with lower PIP risk. PIP risk did not differ as a function of the quality of the patient-physician relationship. CONCLUSION Our study helps to raise awareness about the organizational risk factors of PIP and, more specifically, how health insurance contracts could play a role in improving the management of drug consumption among community-dwelling older people.
Collapse
Affiliation(s)
- Pauline Chauvin
- LIRAES - EA4470, Université de Paris, Centre des Saints-Pères, 45 rue des Saints-Pères, 75006 Paris, France.
| | - Sarah Fustinoni
- Center for primary care and public health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Center for primary care and public health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Marie Herr
- Université Paris-Saclay, UVSQ, Inserm,CESP, Echappement aux anti-infectieux et pharmaco-épidémiologie, 94807, Montigny-le-Bretonneux, France; Département Hospitalier d'Epidémiologie et de Santé Publique, AP-HP. Université Paris-Saclay, 2 avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, Paris, France
| | - Brigitte Santos Eggimann
- Center for primary care and public health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, 1010 Lausanne, Switzerland
| |
Collapse
|
16
|
Duay M, Morgiève M, Niculita-Hirzel H. Sudden Changes and Their Associations with Quality of Life during COVID-19 Lockdown: A Cross-Sectional Study in the French-Speaking Part of Switzerland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4888. [PMID: 34064382 PMCID: PMC8124785 DOI: 10.3390/ijerph18094888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022]
Abstract
The lockdown due to the COVID-19 pandemic has led to various sudden changes in a large number of individuals. In response, the question of how individuals from different social and economic strata cope with those changes has arisen, as well as how much they have affected their mental well-being. Choosing strategies that cope with both the pandemic and the well-being of the population has also been a challenge for different governments. While a large number of studies have investigated the mental health of people from different populations during the COVID-19 pandemic, few have explored the number and type of changes experienced during lockdown by the general population, alongside their relationships with health-related quality of life (HRQoL). To fill this research gap, an observational cross-sectional study on those associations was conducted in the French-speaking part of the Swiss general population. Data were collected from 431 participants during the first four weeks of lockdown due to COVID-19. Multivariate regressions were used to identify the sociodemographic profile of the population that experienced different types and numbers of changes during this period, the association of those changes with the HRQoL-mental and physical-and infection beliefs, and the perception of the governmental measures. We show that the more changes people experienced, the lower their mental HRQoL; however, adherence to governmental measures has helped people to cope with the imposed changes, even though the number of unexpected and unwished changes have strained their mental HRQoL. The low-income population experienced financial difficulties and changes in their food intake more frequently, while dual-citizenship or non-Swiss individuals declared conflictual situations more frequently. Sport practice had a positive association with mental HRQoL; nevertheless, a decrease in sport practice was frequently reported, which correlated with a lower mental HRQoL. Risk perception of COVID-19 increased with lower physical HRQoL score, which supports the efficiency of governmental communication regarding the pandemic. Our results support that government measures should be accompanied by effective and targeted communication about the risk of infection, in order to encourage all strata of the general population to follow such measures and adapt to the changes without unduly affecting their mental health. The usage of such tools might help to reduce the impact of policy-imposed changes on the mental HRQoL of the general population, by inducing voluntary changes in informed and engaged populations.
Collapse
Affiliation(s)
- Manon Duay
- Department of Occupational Health and Environment, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, CH-1066 Epalinges, Switzerland;
| | - Margot Morgiève
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, 34 000 Montpellier, France;
- Brain and Spine Institute (ICM), Hôpital de la Pitié-Salpetrière, 75 013 Paris, France
- Centre for Research on Medicine, Science, Health, Mental Health, and Society (Cermes3), 75 006 Paris, France
| | - Hélène Niculita-Hirzel
- Department of Occupational Health and Environment, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, CH-1066 Epalinges, Switzerland;
| |
Collapse
|
17
|
Meyer ML, Fustinoni S, Henchoz Y, Hottinger AF, Santos-Eggimann B. Slowness Predicts Mortality: A Comparative Analysis of Walking Speed and Moberg Picking-Up Tests. J Am Med Dir Assoc 2021; 22:1652-1657.e2. [PMID: 33785308 DOI: 10.1016/j.jamda.2021.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Slow walking speed (WS) is predictive of mortality but may be difficult to measure, which compromises the assessment of frailty, based on Fried et al's phenotype. The timed Moberg picking-up test (MPUT), developed to evaluate hand's function, was found moderately but significantly correlated with WS. We compared the relationship between slowness, assessed by MPUT and WS tests, and mortality. DESIGN Observational (prospective cohort study). SETTING AND PARTICIPANTS 4731 community-dwelling adults included in 2004, 2009, or 2014 in the ongoing Lausanne cohort 65+ (Lc65+) were assessed at the age of 66-71 years. METHOD Mortality was compared for individuals above and below percentile 80 of MPUT, and respectively WS performance time, according to the Fried criterion. Multivariable analysis using Cox's regression models were adjusted for age, sex, height and grip strength. The predictive capability of MPUT and WS was assessed in adjusted models using Harrell C. RESULTS Slowness in MPUT and in WS test was associated with mortality at 4, 9, and 14 years (P < .001). Survival curves showed lower survival rates in the highest percentile for both tests (P < .001), regardless of the follow-up period. Cox models indicated a higher risk of death at 4 years [adjusted hazard ratio (95% confidence interval): MPUT, 2.1 (1.5-3.0); WS, 2.2 (1.5-3.1)], 9 years [MPUT 1.7 (1.3-2.3); WS 2.0 (1.5-2.6)] and 14 years [MPUT 1.8 (1.4-2.3); WS 1.8 (1.4-2.4)] for participants above the 80th percentile (all P < .001). The 2 tests had similar predictive capability (Harrell C: MPUT, between 61% and 68%; WS, between 62% and 69%). CONCLUSIONS AND IMPLICATIONS Poor performance in MPUT is associated with increased mortality at the short and long term among community-dwelling older adults. This alternative to WS in the assessment of slowness has similar predictive capability for mortality and avoids biased estimates because of nonrandom exclusion of individuals unable to complete WS.
Collapse
Affiliation(s)
- May-Lucie Meyer
- Department of Oncology, University of Lausanne Hospital Center (CHUV) & University of Lausanne, Lausanne, Switzerland.
| | - Sarah Fustinoni
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yves Henchoz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Andreas F Hottinger
- Department of Oncology, University of Lausanne Hospital Center (CHUV) & University of Lausanne, Lausanne, Switzerland; Department of Clinical Neurosciences, University of Lausanne Hospital Center (CHUV) & University of Lausanne, Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
18
|
Zhang Y, Lu S, Yang Y, Wang Z, Wang B, Zhang B, Yu J, Lu W, Pan M, Zhao J, Guo S, Cheng J, Chen X, Hong K, Li G, Yu Z. The diversity of gut microbiota in type 2 diabetes with or without cognitive impairment. Aging Clin Exp Res 2021; 33:589-601. [PMID: 32301029 DOI: 10.1007/s40520-020-01553-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diabetes is associated with a high risk of developing cognitive impairment, but the underlying mechanism remains unclear. Recent studies have found that gut microbiota may be involved in the progression of diabetes-associated cognitive impairment. AIMS To analyze the diversity of gut microbiota in type 2 diabetes with or without cognitive impairment METHODS: 16S rRNA sequencing was used to detect the gut microbiota composition in 154 type 2 diabetes (T2DM) subjects RESULTS: Among 154 elderly T2DM participants included in our study, 73 with normal and 81 with impaired cognition. Lower levels of hemoglobin and HDL were observed in subjects with cognitive impairment. Patients with cognitive impairment had a lower abundance of Tenericutes. Comparison at the genus level revealed that T2DM patients with cognitive impairment had a decreased abundance of Bifidobacterium and unranked-RF39 and an increased abundance of Peptococcus and unranked-Leuconostocaceae. Additionally, the relative abundance of Veillonella and Pediococcus were decreased in subjects with cognitive impairment. Furthermore, the relative abundance of 7 sub-functions was significantly changed in the group with cognitive impairment. Calcium signaling pathways and the Renin-angiotensin system were upregulated in the cognitive impairment group while GnRH signaling, Fc gamma R-mediated phagocytosis, endocytosis, isoflavonoid biosynthesis, and cytochrome P450 were deregulated. CONCLUSION Bifidobacterium may be associated with cognition in T2DM. Calcium signaling and renin-angiotensin system were shown to be associated with diabetes-associated cognitive impairment through gut microbiota.
Collapse
Affiliation(s)
- Yunyun Zhang
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Shourong Lu
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Ying Yang
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Zhuo Wang
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Bin Wang
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Bingshan Zhang
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Jie Yu
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China
| | - Wenwei Lu
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, 214122, China
| | - Mingluo Pan
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, 214122, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, 214122, China
| | - Shenghua Guo
- Department of Medicine, Wuxi Xin'an Community Health Service Center, Wuxi, 214135, China
| | - Jin Cheng
- Department of Medicine, Wuxi Xin'an Community Health Service Center, Wuxi, 214135, China
| | - Xiaorong Chen
- Department of Medicine, Wuxi Xin'an Community Health Service Center, Wuxi, 214135, China
| | - Kan Hong
- Geriatric Department, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China.
| | - Gang Li
- Department of Neurology, Nanjing Medical University Affiliated Shanghai East Hospital, Shanghai, 200123, China.
| | - Zhiming Yu
- Department of Cardiovascular, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, 214000, China.
| |
Collapse
|
19
|
Henchoz Y, Büla C, von Gunten A, Blanco JM, Seematter-Bagnoud L, Démonet JF, Waeber G, Nanchen D, Santos-Eggimann B. Trends in Physical and Cognitive Performance Among Community-Dwelling Older Adults in Switzerland. J Gerontol A Biol Sci Med Sci 2021; 75:2347-2353. [PMID: 31942995 DOI: 10.1093/gerona/glaa008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With population aging, a key question is whether new cohorts of older people are in better health than previous ones. This study aimed to compare the physical and cognitive performance of community-dwelling older adults assessed at similar age in 2005, 2010, and 2015. METHODS This repeated cross-sectional analysis used data from the Lausanne cohort 65+, a three random sample population-based study. Performance of participants aged 66-71 years in 2005 (N = 1,309), 2010 (N = 1,253), and 2015 (N = 1,328) was compared using a battery of six physical and four cognitive tests. Analyses included tests for trend across samples and multivariable linear regression models. RESULTS Adjusted performance in all four timed physical tests (gait speed, Timed Up-and-Go, five times chair stand, and Moberg Picking-Up) improved across samples from 2005 to 2015, by +12.7% (95% confidence interval {CI} +10.5%; +14.9%) to +20.4% (95% CI +17.7%; +23.0%) in females, and by +10.6% (95% CI +8.7%; +12.4%) to +16.7% (95% CI +13.4%; +20.0%) in males. In contrast, grip strength and balance did not improve across samples. Adjusted cognitive performance showed no change in the Trail Making Test, but worsened significantly across samples for the Mini-Mental State Examination, verbal fluency, and the clock drawing test in both females (-1.9% [95% CI -2.7%; -1.1%] to -6.7% [95% CI -8.9%; -4.6%]) and males (-2.5% [95% CI -3.4%; -1.6%] to -8.0% [95% CI -11.1%; -4.9%]). CONCLUSIONS Over the last decade, performance of adults aged 66-71 years improved significantly in timed physical tests but worsened in most cognitive measures among later-born samples.
Collapse
Affiliation(s)
- Yves Henchoz
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Switzerland
| | - Armin von Gunten
- Service of Geriatric Psychiatry, Department of Psychiatry, University of Lausanne Hospital Centre, Switzerland
| | - Juan Manuel Blanco
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Switzerland
| | | | - Gérard Waeber
- Department of Internal Medicine, University of Lausanne Hospital Centre, Switzerland
| | - David Nanchen
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | | |
Collapse
|
20
|
Santos-Eggimann B, Ballan K, Fustinoni S, Büla C. Measuring Slowness in Old Age: Times to Perform Moberg Picking-Up and Walking Speed Tests. J Am Med Dir Assoc 2020; 21:1729-1734.e2. [DOI: 10.1016/j.jamda.2020.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/14/2023]
|
21
|
Henchoz Y, Büla C, Guessous I, Goy R, Dupuis M, Santos-Eggimann B. Validity of the older people quality of life-7 domains (OQoL-7) scale. Health Qual Life Outcomes 2020; 18:340. [PMID: 33054841 PMCID: PMC7557060 DOI: 10.1186/s12955-020-01589-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background The Older people Quality of Life-7 domains (OQoL-7) is a 28-item multidimensional questionnaire developed to measure community-dwelling older people’s QoL. The OQoL-7 assesses both importance of and satisfaction in seven QoL domains (Material resources; Close entourage; Social and cultural life; Esteem and recognition; Health and mobility; Feeling of safety; and Autonomy). This study aimed to investigate concurrent and construct validity of the OQoL-7. A secondary aim was to compare different methods of weighting participants’ ratings of satisfaction according to their individual ratings of importance, as compared to the OQoL-7 total score (unweighted). Methods Data came from the first and second samples of the Lausanne cohort 65+ study, assessed at the same age of 72–77 years in 2011 (N = 1117) and 2016 (N = 1091), respectively. To assess concurrent validity, the OQoL-7 was compared to other measures of the same concept (single QoL item) or related concepts (self-rated health, SF-12). Construct validity was tested by comparing subscores in the seven QoL domains in the presence and absence of two stressful events during the preceding year (financial difficulties and relationship difficulties). The effect of importance weighting was assessed using moderated regression analysis. Results The OQoL-7 total score was significantly associated with the single QoL item (Spearman’s rho 0.46), self-rated health (Spearman’s rho 0.34), SF-12 physical (Spearman’s rho 0.22) and mental (Spearman’s rho 0.28) component scores. Large differences (Cohen’s d > 0.8) were observed in the presence or absence of stressful events in the expected QoL domains: “Material resources” in the presence or absence of “Financial difficulties” (Cohen’s d 1.34), and “Close entourage” in the presence or absence of “Relationship difficulties” (Cohen’s d 0.84). Importance weighting resulted in a very small improvement in the prediction of the single QoL item (ΔR2 0.018). All results were highly consistent across 2011 and 2016 samples. Conclusions The OQoL-7 showed adequate concurrent and construct validity in two samples of older people. In future studies, the decision to use weighted or unweighted scores will depend on the priority given to either optimizing the prediction of QoL or limiting the burden on respondents and the amount of missing data.
Collapse
Affiliation(s)
- Yves Henchoz
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland.
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Idris Guessous
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - René Goy
- Pro Senectute Vaud, Lausanne, Switzerland
| | - Marc Dupuis
- Department of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Brigitte Santos-Eggimann
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| |
Collapse
|
22
|
Belloni G, Büla C, Santos-Eggimann B, Henchoz Y, Seematter-Bagnoud L. A Single Question as a Screening Tool to Assess Fear of Falling in Young-Old Community-Dwelling Persons. J Am Med Dir Assoc 2020; 21:1295-1301.e2. [DOI: 10.1016/j.jamda.2020.01.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 11/25/2022]
|
23
|
Spaltenstein J, Bula C, Santos-Eggimann B, Krief H, Seematter-Bagnoud L. Factors associated with going outdoors frequently: a cross-sectional study among Swiss community-dwelling older adults. BMJ Open 2020; 10:e034248. [PMID: 32843514 PMCID: PMC7449269 DOI: 10.1136/bmjopen-2019-034248] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/17/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study examines potential risk and protective factors associated with going outdoors frequently among older persons, and whether these factors vary according to physical limitations. DESIGN Cross-sectional analysis. SETTING AND PARTICIPANTS Community-dwelling participants of the Lausanne cohort Lc65+ in 2016, aged 68-82 years (n=3419). METHODS Associations between going outdoors frequently and physical limitations, sociodemographic, health, psychological and social variables were examined using logistic regression models. Subgroup analyses were performed according to the severity of physical limitations. MAIN OUTCOME MEASURES 'Going outdoors frequently' was defined as going out ≥5 days/week and not spending most of the time sitting or lying down. RESULTS Three in four (73.9%) participants reported going outdoors frequently. Limitations in climbing stairs (adjusted OR (AdjOR) 0.61, 95% CI 0.47 to 0.80) and walking (AdjOR 0.24, 95% CI 0.18 to 0.31), as well as depressive symptoms (AdjOR 0.58, 95% CI 0.47 to 0.70), dyspnoea (AdjOR 0.60, 95% CI 0.48 to 0.75), age (AdjORolder age group 0.73, 95% CI 0.59 to 0.92) and fear of falling (AdjOR 0.75, 95% CI 0.62 to 0.91) reduced the odds of going outdoors frequently. In contrast, living alone (AdjOR 1.30, 95% CI 1.08 to 1.56), reporting a dense (AdjOR 1.57, 95% CI 1.26 to 1.96) and a high-quality (AdjOR 1.28, 95% CI 1.06 to 1.53) social network increased the odds of going outdoors frequently. Among participants with severe limitations, 44.6% still went outdoors frequently. Among this subgroup, a new emotional relationship (AdjOR 2.52, 95% CI 1.18 to 5.38) was associated with going outdoors, whereas cognitive complaints (AdjOR 0.66, 95% CI 0.47 to 0.93), urinary incontinence (AdjOR 0.67, 95% CI 0.46 to 0.97), dyspnea (AdjOR:0.67, 95%CI:0.48-0.93), and depressive symptoms (AdjOR 0.67, 95% CI 0.48 to 0.93) lowered the odds of going outdoors. CONCLUSION Physical limitations are associated with decreased odds of going outdoors frequently. However, social characteristics appear to mitigate this association, even among older persons with severe limitations. Further studies are needed to determine causality and help guide interventions to promote going outdoors as an important component of active ageing.
Collapse
Affiliation(s)
- Julia Spaltenstein
- Service of Geriatric Medicine and Geriatric Rehabilitation, University Hospital of Lausanne, Lausanne, Switzerland
| | - Christophe Bula
- Service of Geriatric Medicine and Geriatric Rehabilitation, University Hospital of Lausanne, Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Helene Krief
- Service of Geriatric Medicine and Geriatric Rehabilitation, University Hospital of Lausanne, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, University Hospital of Lausanne, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
24
|
Belloni G, Büla C, Santos-Eggimann B, Henchoz Y, Fustinoni S, Seematter-Bagnoud L. Is Fear of Falling Associated With Incident Disability? A Prospective Analysis in Young-Old Community-Dwelling Adults. J Am Med Dir Assoc 2020; 22:464-467.e4. [PMID: 32693997 DOI: 10.1016/j.jamda.2020.05.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Fear of falling (FOF) is common in older people and is related to negative outcomes. This study aimed to investigate whether 2 different instruments, the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR), were associated with incident disability at 3 years. DESIGN Prospective observational study. SETTING AND PARTICIPANTS Participants (n = 1219, 57.4% women) were disability-free community-dwelling persons enrolled in the Lausanne cohort 65+, aged 66 to 71 years, in 2005. MEASURES Baseline covariates included demographic, cognitive, affective, and health status. Basic activities of daily living (BADL) assessment was recorded annually from a self-administered questionnaire. Disability outcome was defined as reporting difficulty or help needed in ≥1 of 5 BADL in ≥2 consecutive years, or being institutionalized during follow-up. RESULTS At 3 years, disability was reported by 77 participants (6.3%). Reporting the highest level of fear at FES-I [adjusted odds ratio (aOR) 5.14, 95% confidence interval (CI) 1.82-14.55, P = .002] or "FOF with activity restriction" with SQ-FAR (aOR 3.23, 95% CI 1.29-8.08, P = .012) were both associated with increased odds of disability even after adjusting for covariates. The FES-I model explained incident disability slightly better than the SQ-FAR one [Bayesian information criterion (BIC) values of 466.70 and 469.43, respectively]. CONCLUSIONS AND IMPLICATIONS High FOF and related activity restriction, assessed with FES-I and SQ-FAR, are associated with incident disability in young-old community-dwelling people. The SQ-FAR is suitable as a screening tool to proactively detect a potentially reversible risk factor for disability. Using the FES-I may serve additional clinical purposes, such as FOF characterization and management.
Collapse
Affiliation(s)
- Giulia Belloni
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Lausanne, Switzerland; Health services unit, Center for primary care and public health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Health services unit, Center for primary care and public health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yves Henchoz
- Health services unit, Center for primary care and public health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sarah Fustinoni
- Health services unit, Center for primary care and public health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Lausanne, Switzerland; Health services unit, Center for primary care and public health (Unisanté), University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
25
|
Blood pressure control and complex health conditions in older adults: impact of recent hypertension management guidelines. J Hum Hypertens 2020; 35:280-289. [PMID: 32346124 DOI: 10.1038/s41371-020-0334-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/08/2022]
Abstract
The American College of Cardiology and the American Heart Association (ACC/AHA) 2017 guidelines for hypertension management lowered blood pressure (BP) thresholds to 130/80 mmHg to define hypertension while the European Society of Cardiology and the European Society of Hypertension (ESC/ESH) 2018 guidelines retained 140/90 mmHg. Both guidelines recommend adapting management for older patients with complex health conditions, without however clear indications on how to adapt. Our aims were to assess the impact of lowering BP thresholds on the prevalence of elevated BP and BP control, as well as the proportion of participants with a complex health condition across these BP categories. We used data from 3210 participants in the Lausanne cohort Lc65+ aged between 67 and 80 years. Hypertension diagnosis and antihypertensive medication use were self-reported. BP was measured three times at one visit. Some 51% of participants reported having hypertension and 44% reported taking antihypertensive medication. Compared with ESC/ESH thresholds, the prevalence of measured elevated BP was 24% percentage points higher and BP control was 24% percentage points lower using ACC/AHA thresholds. About one out of two participants with elevated BP and four out of five participants with uncontrolled BP had a complex health condition, i.e., frailty, multimorbidity, or polypharmacy. To comply with ACC/AHA guidelines, considerable effort would be required to reach BP control. This is a serious challenge because a large share of hypertensive older adults has complex health conditions, a type of patients for whom there is no strong evidence on how to manage hypertension.
Collapse
|
26
|
Carvalho N, Fustinoni S, Abolhassani N, Blanco JM, Meylan L, Santos-Eggimann B. Impact of urine and mixed incontinence on long-term care preference: a vignette-survey study of community-dwelling older adults. BMC Geriatr 2020; 20:69. [PMID: 32070294 PMCID: PMC7029586 DOI: 10.1186/s12877-020-1439-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In view of population aging, a better knowledge of factors influencing the type of long-term care (LTC) among older adults is necessary. Previous studies reported a close relationship between incontinence and institutionalization, but little is known on opinions of older citizens regarding the most appropriate place of care. This study aimed at evaluating the impact of urine and/or fecal incontinence on preferences of community-dwelling older citizens. METHODS We derived data from the Lausanne cohort 65+, a population-based study of individuals aged from 68 to 82 years. A total of 2974 community-dwelling persons were interviewed in 2017 on the most appropriate place of LTC delivery for three vignettes displaying a fixed level of disability with varying degrees of incontinence (none, urinary, urinary and fecal). Multinomial logistic regression analyses explored the effect of respondents' characteristics on their opinion according to Andersen's model. RESULTS The level of incontinence described in vignettes strongly determined the likelihood of considering institutional care as most appropriate. Respondents' characteristics such as age, gender, educational level, being a caregiver, knowledge of shelter housing or feeling supported by family influenced LTC choices. Self-reported incontinence and other indicators of respondents' need, however, had no significant independent effect. CONCLUSION Among older community-dwelling citizens, urinary and fecal incontinence play a decisive role in the perception of a need for institutionalization. Prevention and early initiation of support for sufferers may be a key to prevent this need and ensure familiar surrounding as long as possible.
Collapse
Affiliation(s)
- Nicolas Carvalho
- University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, CH-1010, Lausanne, Switzerland.
| | - Sarah Fustinoni
- University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Nazanin Abolhassani
- University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Juan Manuel Blanco
- University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Lionel Meylan
- University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| |
Collapse
|
27
|
Formal home care use by older adults: trajectories and determinants in the Lc65+ cohort. BMC Health Serv Res 2020; 20:22. [PMID: 31914993 PMCID: PMC6950923 DOI: 10.1186/s12913-019-4867-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/23/2019] [Indexed: 12/04/2022] Open
Abstract
Background Given the increasing importance of formal home care services in policies dedicated to elder care, there is major interest in studying individuals’ characteristics determining their utilization. The main objective of this research was to quantify, during a 6-year timeframe, home care use trajectories followed by community-dwelling participants in a cohort study of older adults. The secondary objective was to identify factors associated with home care utilization using Andersen’s Behavioural Model of Health Services Use. Methods We proceeded to an analysis of data prospectively collected in the setting of the Lc65+ population-based study conducted in Lausanne (Switzerland). Self-reported utilization of professional home care in 2012 and 2018 was used to define trajectories during this timeframe (i.e. non-users, new users, former users and continuing users). Bivariable analyses were performed to compare new users to non-users regarding the three dimensions of Andersen’s model (predisposing, enabling and need factors) measured at baseline. Then, binomial logistic regression was used in a series of two hierarchical models to adjust for need factors first, before adding predisposing and enabling factors in a second model. Results Of 2155 participants aged between 69 and 78 in 2012, 82.8% remained non-users in 2018, whereas 11.2% started to use professional home care. There were 3.3% of continuing users and 2.7% of former users. New users exhibited a higher burden of physical and psychological complaints, chronic health conditions and functional limitations at baseline. After adjusting for these need factors, odds of home care utilization were higher only in participants reporting a difficult financial situation (OR 1.65, 95% CI 1.12–2.45). Conclusions In the setting of a Swiss city, incident utilization of formal home care by older adults appeared to be largely determined by need factors. Modifiable factors like personal beliefs and knowledge about home care services did not play a role. After adjusting for need, odds of becoming home care user remained higher in participants reporting a difficult financial situation, suggesting such vulnerability does not hamper access to professional home care in this specific context.
Collapse
|
28
|
Simoes Maria M, Büla C, Santos-Eggimann B, Krief H, Heinzer R, Seematter-Bagnoud L. Sleep characteristics and self-rated health in older persons. Eur Geriatr Med 2019; 11:131-138. [PMID: 32297231 DOI: 10.1007/s41999-019-00262-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE It remains unclear, how much older persons' sleep problems are due to age-related changes in sleep architecture and pattern, or whether they are a consequence of health problems. This work aimed to examine the association between sleep characteristics and self-rated health, taking into account potential confounders. METHODS Data about sleep, including sleep efficiency (ratio of sleep duration to the amount of time spent in bed, considered as good if > 85%), as well as health-rated characteristics were self-reported by community-dwelling persons enrolled in the Lausanne cohort 65+ study (n = 2712, age 66-75 years). Participants' subjective health was categorized as good versus poor. The cross-sectional association between good self-rated health and sleep characteristics was examined in bivariate and multivariate analysis. RESULTS The majority of participants (68.4%) rated their health as good. Compared to the participants with poor-rated health, they more often reported a good sleep efficiency (59.5% vs 45.0%, p < 0.001) and less often reported napping (41.6% vs 54.0%, p < 0.001) as well as using sleep medication (12.7% vs 31.8%, p < 0.001). After adjustment for comorbidity, depressive symptoms and cognitive difficulties, a positive association persisted between good sleep efficiency and good self-rated health (adjOR: 1.35, 95% CI 1.10-1.66). Regular napping remained negatively associated to feel healthy (adjOR: 0.65, 95% CI 0.53-0.79). CONCLUSION Sleep efficiency is positively associated with subjective health, whereas napping and use of sleep medication are negatively associated to rating own health as good. These associations need to be further investigated in longitudinal analyses to better understand causality.
Collapse
Affiliation(s)
- Mariana Simoes Maria
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Mont-Paisible 16, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Mont-Paisible 16, 1011, Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Hélène Krief
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Mont-Paisible 16, 1011, Lausanne, Switzerland
| | - Raphaël Heinzer
- Center for Investigation and Research in Sleep (CIRS), University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Mont-Paisible 16, 1011, Lausanne, Switzerland. .,Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| |
Collapse
|
29
|
Anker D, Santos-Eggimann B, Zwahlen M, Santschi V, Rodondi N, Wolfson C, Chiolero A. Blood pressure in relation to frailty in older adults: A population-based study. J Clin Hypertens (Greenwich) 2019; 21:1895-1904. [PMID: 31661601 DOI: 10.1111/jch.13722] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 01/23/2023]
Abstract
In frail older adults, low blood pressure (BP) might be associated with worse health outcomes and hypertension management in this population is highly debated. Using data from a population-based study of older adults, we assessed the association between frailty and BP. We used data collected between 2014 and 2016 from 3157 participants aged between 67 and 80 years in the Lausanne cohort Lc65+. BP was measured three times at one visit, and frailty status was assessed based on Fried's phenotype model. We analyzed the cross-sectional association between BP and frailty by computing mean systolic and diastolic BP stratified by sex, age, and frailty and by fitting regression models. The average age of the participants was 73.3 (standard deviation [SD]: 4.1) years, and 59.1% were women. 34.1% were pre-frail, and 3.3% were frail. Mean BP was 135.1/76.3 mm Hg (SD 18.5/11.0). Age- and sex-adjusted systolic BP was on average lower by 2.8 mm Hg (95% confidence interval [CI]: 1.4-4.2) and 6.7 mm Hg (95% CI: 3.2-10.3) among pre-frail and frail compared to non-frail participants. Similar differences in mean diastolic BP across frailty status were found. Upon adjustment for antihypertensive treatment, the associations between frailty status and BP did not change substantially. Frail individuals had a substantially lower BP compared with non-frail older adults. Because low BP could be detrimental among frail older patients, our findings raise questions about hypertension management in this population and stress the need for additional evidence.
Collapse
Affiliation(s)
- Daniela Anker
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Brigitte Santos-Eggimann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Valérie Santschi
- La Source, School of nursing sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada.,Population Health Laboratory, Department of Community Health, University of Fribourg, Fribourg, Switzerland
| |
Collapse
|
30
|
Readiness to accept health information and communication technologies: A population-based survey of community-dwelling older adults. Int J Med Inform 2019; 130:103950. [PMID: 31446357 DOI: 10.1016/j.ijmedinf.2019.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/24/2019] [Accepted: 08/10/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The development of health information and communication technologies (HICTs) could modify the quality and cost of healthcare services delivered to an aging population. However, the acceptance of HICTs - a prerequisite for users to benefit from them - remains a challenge. This population-based study aimed to 1) explore the acceptance of HICTs by community-dwelling older adults as well as the factors associated to the overall acceptance/refusal of HICTs; 2) identify the factors associated with confidentiality (i.e., access to data allowed to physicians only versus to all caregivers) in the subgroup of older adults willing to accept HICTs. METHODS A total of 3195 community-dwelling 69-83 year-old members of the Lausanne cohort 65+ were included. In 2017, participants filled out a 9-item questionnaire to assess their acceptance of HICTs ("yes without reluctance"; "yes but with reluctance"; "no"). A bivariate analysis was conducted to examine gender and age differences in the acceptance of HICTs. A multivariable logistic regression was performed to model 1) accepting all or rejecting all HICTs items; 2) willing to share HICTs items with physicians only versus all caregivers. RESULTS The answer "acceptance without reluctance" ranged from 26.4% to 70.4% across HICTs and was the most frequent answer to six out of nine HICT items. For every HICT item, the acceptance rate decreased across age categories in women. Overall, 20.2% accepted all the HICTs without reluctance and 9.9% rejected them all. Older age and a lower level of education were significantly associated with both accepting all HICTs without reluctance (OR = 0.78 and OR = 0.65, respectively) and rejecting all HICTs (OR = 1.54 and OR = 2.89, respectively). Women and participants with health vulnerability (depressive symptoms, difficulty in activities of daily living (ADLs)) were less likely to accept data accessibility to non-physicians. CONCLUSION Acceptance of HICTs was relatively high. To deploy HICTs in the older population, demographic, socioeconomic and health profiles, alongside confidentiality concerns, should be considered.
Collapse
|
31
|
|
32
|
Cattagni Kleiner A, Santos-Eggimann B, Fustinoni S, Dürst AV, Haunreiter K, Rubli-Truchard E, Seematter-Bagnoud L. Advance care planning dispositions: the relationship between knowledge and perception. BMC Geriatr 2019; 19:118. [PMID: 31014271 PMCID: PMC6480869 DOI: 10.1186/s12877-019-1113-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Legal dispositions for advance care planning (ACP) are available but used by a minority of older adults in Switzerland. Some studies found that knowledge of and perception of those dispositions are positively associated with their higher usage. The objective of the present study is to test the hypothesis of an association between increased knowledge of ACP dispositions and a more positive perception of them. METHODS Data collected in 2014 among 2125 Swiss community-dwellers aged 71 to 80 of the Lausanne cohort 65+ (Lc65+), a population-based longitudinal study on aging and frailty. Data collection was conducted through a questionnaire on knowledge, use and perception of lasting power of attorney, advance directives and designation of a health care proxy. Covariables were extracted from the Lc65+ database. Bivariable and multivariable regression analyses assessed the association between level of knowledge and perception. RESULTS Half the participants did not know about legal dispositions for ACP; filing rates were 14% for advance directives, 11% for health care proxy and 6% for lasting power of attorney. Level of knowledge about the dispositions was associated with a more positive perception of them, even when adjusting for confounding factors. CONCLUSION Although the direction of the association's causality needs more investigation, results indicate that better knowledge on ACP dispositions could improve the perception older people have of them. Communication on dispositions should take into account individual knowledge levels and address commonly enunciated barriers that seem to diminish with increased knowledge.
Collapse
Affiliation(s)
- Anne Cattagni Kleiner
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland.
| | - Brigitte Santos-Eggimann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Sarah Fustinoni
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Anne-Véronique Dürst
- Service of geriatric medicine and geriatric rehabilitation, Lausanne university hospital, Chemin de Mont Paisible 16, 1011, Lausanne, Switzerland
| | - Katja Haunreiter
- School of social and education studies (EESP), Higher school of social work and health, Chemin des Abeilles 14, 1010, Lausanne, Switzerland
| | - Eve Rubli-Truchard
- Service of geriatric medicine and geriatric rehabilitation, Lausanne university hospital, Chemin de Mont Paisible 16, 1011, Lausanne, Switzerland.,Chair of palliative geriatric care, Department of medicine, Lausanne university hospital, Av. Pierre Decker 5, 1011, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| |
Collapse
|
33
|
Gender differences regarding opinions on long-term care arrangements: A study of community-dwelling older adults. Arch Gerontol Geriatr 2019; 83:195-203. [PMID: 31082564 DOI: 10.1016/j.archger.2019.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/19/2019] [Accepted: 03/23/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous studies have attempted to identify predictors of institutionalization in the general population. Gender studies have led to inconsistent results. Some authors argued that older women were more likely than older men to use long-term care services, while others failed to highlight a specific gender effect on the use of long-term care services. The aim of this study was to assess the effects of gender on the preferences of older citizens for long-term care using a panel of disability situations. METHODS We used a set of ten vignettes displaying disability situations with or without an able-bodied spouse present and used a population-based survey to inquire about appropriate long-term care. Participants were 3102 community-dwelling persons aged 68-83 years included in the representative Lausanne cohort 65+ study in January 2017. Multinomial logistic regression analyses were used to explore the effect of gender on long-term care choices by older men and women, controlling for the respondent's age and living arrangement. RESULTS The respondents' choices shifted toward institutionalization when the disorder severity increased in vignettes and when there was no spouse able to help. Men were more likely to choose a home setting with caregiving only by spouse even when the level of disability increased. Women chose help from professionals, sheltered homes, or institutionalization more quickly than men. CONCLUSIONS Exploring gender preferences for long-term care arrangements is critical for improving and planning long-term care services.
Collapse
|
34
|
Abolhassani N, Santos-Eggimann B, Büla C, Goy R, Guessous I, Henchoz Y. Quality of life profile in three cohorts of community-dwelling Swiss older people. BMC Geriatr 2019; 19:96. [PMID: 30940085 PMCID: PMC6444620 DOI: 10.1186/s12877-019-1112-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/21/2019] [Indexed: 12/01/2022] Open
Abstract
Background Quality of life (QoL) is a subjective and dynamic concept resulting from an interplay between importance of and satisfaction with different aspects of life. However, it is unclear whether social contexts experienced by individuals born at specific times in history (cohort effects) may influence QoL in old age. This study aimed to compare among older persons born before, during, and at the end of World War II: a) satisfaction with QoL, overall and per domains; b) importance of QoL domains. Methods This repeated cross-sectional study included representative samples of community-dwelling adults born in 1934–1938 (pre-war), 1939–1943 (war), and 1944–1948 (baby-boom) from the Lausanne cohort 65+. QoL was assessed overall, and in seven domains in 2011 and 2016. Two-by-two cohort comparisons were performed at ages 68–72 (war versus baby-boom) and 73–77 years (pre-war versus war). Results Overall satisfaction with QoL did not differ between cohorts despite increased education level across cohorts and a shift between pre-war and war cohorts towards lower morbidity and higher proportion living alone. However, “Feeling of safety” consistently showed significant improvements from earlier to later-born cohorts. Furthermore, the war cohort reported higher satisfaction than pre-war cohort in “Autonomy”. Conversely, no significant difference was observed between cohorts in importance of QoL domains, except increased importance given to “Health and mobility” in the war compared to pre-war cohort. Conclusions Societal changes reflected in the profile of successive elders’ cohorts did not appear to modify the overall satisfaction with QoL. Electronic supplementary material The online version of this article (10.1186/s12877-019-1112-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nazanin Abolhassani
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2, SV-A, Bio2-00-161, Route de la Corniche 10, 1010, Lausanne, Switzerland.
| | - Brigitte Santos-Eggimann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2, SV-A, Bio2-00-161, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne university hospital, Lausanne, Switzerland
| | - René Goy
- Pro Senectute Vaud, Lausanne, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Department of Community Medicine and Primary Care and Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Yves Henchoz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2, SV-A, Bio2-00-161, Route de la Corniche 10, 1010, Lausanne, Switzerland
| |
Collapse
|
35
|
Henchoz Y, von Gunten A, Büla C, Seematter-Bagnoud L, Nanchen D, Démonet JF, Blanco JM, Santos-Eggimann B. Do baby boomers feel healthier than earlier cohorts after retirement age? The Lausanne cohort Lc65+ study. BMJ Open 2019; 9:e025175. [PMID: 30782927 PMCID: PMC6368217 DOI: 10.1136/bmjopen-2018-025175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Despite the popular belief that baby boomers are ageing in better health than previous generations, limited scientific evidence is available since baby boomers have turned retirement age only recently. This study aimed to compare self-reported health status at ages 65-70 years among three cohorts of older people born before, during and at the end (baby boomers) of the Second World War. DESIGN Repeated cross-sectional population-based study. SETTING Community in a region of French-speaking Switzerland. PARTICIPANTS Community-dwelling older adults who enrolled in the Lausanne cohort 65+ study at ages 65-70 years in 2004 (n=1561), 2009 (n=1489) or 2014 (n=1678). OUTCOMES Number of self-reported chronic conditions (from a list of 11) and chronic symptoms (from a list of 11); depressive symptoms; self-rated health (very good, good, average, poor or very poor); fear of disease (not afraid at all, barely afraid, a bit afraid, quite afraid or very afraid); self-perception of ageing; disability in basic and instrumental activities of daily living. RESULTS There was no significant difference between cohorts in the number of self-reported chronic conditions and chronic symptoms as well as the presence of difficulty in basic activities of daily living, depressive symptoms, fear of disease and negative self-perception of ageing. In women only, significant differences between cohorts were observed in self-rated health (p=0.005) and disability in instrumental activities of daily living (p=0.003), but these associations did not remain significant in logistic regression models adjusted for sociodemographic characteristics and unhealthy behaviours. CONCLUSIONS Despite important sociodemographic differences between older baby boomers and earlier cohorts, most health indicators did not suggest any trend towards a compression of morbidity. Future studies comparing these three cohorts at more advanced age are required to further investigate whether differences emerge later in life.
Collapse
Affiliation(s)
- Yves Henchoz
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Geriatric Psychiatry, Department of Psychiatry, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Center, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jean-Francois Démonet
- Leenaards Memory Centre, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Juan-Manuel Blanco
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| |
Collapse
|
36
|
Temporal changes in importance of quality of life domains: a longitudinal study in community-dwelling Swiss older people. Qual Life Res 2019; 28:421-428. [DOI: 10.1007/s11136-018-1983-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
|
37
|
Change in quality of life among community-dwelling older adults: population-based longitudinal study. Qual Life Res 2019; 28:1305-1314. [DOI: 10.1007/s11136-019-02108-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
|
38
|
Haider S, Grabovac I, Dorner TE. Fulfillment of physical activity guidelines in the general population and frailty status in the elderly population : A correlation study of data from 11 European countries. Wien Klin Wochenschr 2018; 131:288-293. [PMID: 30421283 PMCID: PMC6570679 DOI: 10.1007/s00508-018-1408-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/24/2018] [Indexed: 02/07/2023]
Abstract
Background We report on the correlation between the proportion of people who fulfil the recommended amount of aerobic physical activity in the general population and the prevalence of frailty or prefrailty in the population ≥65 years in 11 European countries (Austria, Czech Republic, Denmark, Estonia, France, Germany, Italy, Luxembourg, Slovenia, Spain and Sweden). In a subgroup analysis, it was assessed if people who do aerobic physical activity also do strength training. Methods Aggregated physical activity data were taken from the European Health Interview Survey with the minimum effective sample size of 90,036 participants. Data on frailty status were taken from the Survey of Health Ageing and Retirement in Europe (SHARE) study (N = 24,590). For the subgroup analysis, data of the Austrian Health Interview Survey (ATHIS) (N = 15,770) were included. Results The results indicate a significant negative correlation between the proportion of people fulfilling the minimal aerobic physical activity recommendations (≥150 min/week) and the proportion of prefrail or frail people (R = −0.745; p = 0.008). The correlation between the optimal aerobic physical activity recommendations (≥300 min/week) and the proportion of prefrail or frail individuals was R = −0.691 (p = 0.019). In both data sets a north-south gradient was seen. Austrian data showed that 52.0% of the participants fulfilled the minimal aerobic physical activity recommendations and conducted strength training, whereas 18.4% did not fulfil the aerobic recommendations but performed strength training (p < 0.001). Conclusions By taking into account that the number of people ≥65 years will increase in the future these results may be relevant in planning public health interventions for the whole population with the goal of reducing frailty in the elderly.
Collapse
Affiliation(s)
- Sandra Haider
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
| | - Thomas E Dorner
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| |
Collapse
|
39
|
Hoisnard L, Santos-Eggimann B, Chauvin P, Hiance-Delahaye A, Herr M. Do older adults know the purpose of their medications? A survey among community-dwelling people. Eur J Clin Pharmacol 2018; 75:255-263. [PMID: 30334201 DOI: 10.1007/s00228-018-2575-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/02/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE This study assessed the level of knowledge among community-dwelling older individuals about the purpose of medications and the characteristics that influenced that knowledge. We focused on drugs frequently used and/or often involved in iatrogenic events. METHODS This cross-sectional survey included 2690 community-dwelling older adults, aged 68 years and above, who reported using at least one drug of interest, in the canton of Vaud, Switzerland. Participants reported drugs that they currently used and described their purpose. A good knowledge level was defined as knowledge of the exact purpose or identification of the anatomical system or organ targeted by the drug. We performed a multivariate logistic regression analysis to identify factors associated with a good knowledge level for all drugs of interest. Sampling weights were employed to provide representative estimates. RESULTS On average, patients had good knowledge of 80.6% of the drugs reported. The highest knowledge levels were demonstrated for non-steroidal antiinflammatory drugs, antidiabetics, analgesics, and endocrinological drugs and the lowest for platelet aggregation inhibitors, minerals, anticoagulants, and other narrow therapeutic index drugs. Overall, 66% of participants had good knowledge of the purpose of all the drugs of interest. Polypharmacy and receiving help with drug management were negatively associated with good knowledge (adjusted OR4-5 drugs 0.45; 95% CI 0.29-0.71, adjusted OR≥ 6 drugs 0.20; 95% CI 0.13-0.31, and adjusted ORhelp 0.42; 95% CI 0.18-0.99). CONCLUSION This study showed that education about drugs was lacking among patients that received multiple drugs, particularly patients that used anticoagulants and antiplatelet inhibitors.
Collapse
Affiliation(s)
- Léa Hoisnard
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France.,Université de Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
| | - Brigitte Santos-Eggimann
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | | | - Anne Hiance-Delahaye
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France.,Université de Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France.,Service des consultations externes, Hôpitaux Universitaires Paris Ile-de-France Ouest, site Sainte Périne, AP-HP, Paris, France
| | - Marie Herr
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France. .,Université de Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France. .,Département Hospitalier d'Epidémiologie et de Santé Publique, Hôpitaux Universitaires Paris Ile-de-France Ouest, site Sainte Périne, AP-HP, Paris, France.
| |
Collapse
|
40
|
Henchoz Y, Seematter-Bagnoud L, Nanchen D, Büla C, von Gunten A, Démonet JF, Santos-Eggimann B. Childhood adversity: A gateway to multimorbidity in older age? Arch Gerontol Geriatr 2018; 80:31-37. [PMID: 30336372 DOI: 10.1016/j.archger.2018.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/27/2018] [Accepted: 10/05/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Multimorbidity, or co-occurrence of several chronic diseases, has major consequences in terms of function, quality of life and mortality. Recent advances suggest that the aetiology of multimorbidity includes a life-long process. The purpose of this study was to determine the association between childhood adversity and multimorbidity in community-dwelling older adults, and to investigate variation in participants born immediately before, during and at the end of the Second World War. METHODS Participants were 4731 community-dwelling older adults who enrolled in the Lausanne cohort 65+ study (Switzerland) at age 65-70 years in 2004/2009/2014. A baseline questionnaire provided several indicators of childhood adversity including premature birth, food restrictions, child labour, family economic environment, serious illness/accident, and stressful life events. Multimorbidity at age 67-72 years was defined as ≥2 active chronic diseases at the 2-year follow-up questionnaire. RESULTS All childhood adversity indicators except premature birth were significantly associated with multimorbidity. Odds ratio (OR) ranged from 1.23 (P = 0.034) for poor family economic environment to 1.74 (P < 0.001) for stressful life events. In a multivariable model adjusted for socioeconomic status, health behaviours and stressful life events in adulthood (>16 years), a history of serious illness/accident (OR = 1.45; P < 0.001) and stressful life events (OR = 1.42; P = 0.001) in childhood remained significantly associated with multimorbidity. Comparisons between cohorts indicated substantial variations in the prevalence of childhood adversity indicators but similar associations with multimorbidity. CONCLUSION There was an independent association between childhood adversity and multimorbidity after age 65. This study encourages a comprehensive life-course perspective to better understand and potentially prevent multimorbidity.
Collapse
Affiliation(s)
- Yves Henchoz
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland.
| | - Laurence Seematter-Bagnoud
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland.
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland.
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Lausanne, Switzerland.
| | - Armin von Gunten
- Service of Geriatric Psychiatry, Department of Psychiatry, University of Lausanne Hospital Centre, Lausanne, Switzerland.
| | - Jean-Francois Démonet
- Leenaards Memory Centre, University of Lausanne Hospital Centre, Lausanne, Switzerland.
| | - Brigitte Santos-Eggimann
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland.
| |
Collapse
|
41
|
Anker D, Santos-Eggimann B, Santschi V, Del Giovane C, Wolfson C, Streit S, Rodondi N, Chiolero A. Screening and treatment of hypertension in older adults: less is more? Public Health Rev 2018; 39:26. [PMID: 30186660 PMCID: PMC6120092 DOI: 10.1186/s40985-018-0101-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 06/06/2018] [Indexed: 02/16/2023] Open
Abstract
Screening and treatment of hypertension is a cornerstone of cardiovascular disease (CVD) prevention. Hypertension causes a large proportion of cases of stroke, coronary heart disease, heart failure, and associated disability and is highly prevalent especially among older adults. On the one hand, there is robust evidence that screening and treatment of hypertension prevents CVD and decreases mortality in the middle-aged population. On the other hand, among older adults, observational studies have shown either positive, negative, or no correlation between blood pressure (BP) and cardiovascular outcomes. Furthermore, there is a lack of high quality evidence for a favorable harm-benefit balance of antihypertensive treatment among older adults, especially among the oldest-old (i.e., above the age of 80 years), because very few trials have been conducted in this population. The optimal target BP may be higher among older treated hypertensive patients than among middle-aged. In addition, among frail or multimorbid older individuals, a relatively low BP may be associated with worse outcomes, and antihypertensive treatment may cause more harm than benefit. To guide hypertension screening and treatment recommendations among older patients, additional studies are needed to determine the most efficient screening strategies, to evaluate the effect of lowering BP on CVD risk and on mortality, to determine the optimal target BP, and to better understand the relationship between BP, frailty, multimorbidity, and health outcomes.
Collapse
Affiliation(s)
- Daniela Anker
- 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Brigitte Santos-Eggimann
- 2Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Valérie Santschi
- La Source, School of Nursing Sciences, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Cinzia Del Giovane
- 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Christina Wolfson
- 4Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Sven Streit
- 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,5Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arnaud Chiolero
- 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,2Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.,4Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| |
Collapse
|
42
|
Mabire C, Dwyer A, Garnier A, Pellet J. Effectiveness of nursing discharge planning interventions on health-related outcomes in discharged elderly inpatients: a systematic review. ACTA ACUST UNITED AC 2018; 14:217-260. [PMID: 27755325 DOI: 10.11124/jbisrir-2016-003085] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Inadequate discharge planning for the growing elderly population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing's role or the specific components of these interventions. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be proven in practice. OBJECTIVES To determine the best available evidence on the effectiveness of discharge planning interventions involving at least one nurse on health-related outcomes for elderly inpatients discharged home and to assess the relative impact of individual components of discharge planning interventions. INCLUSION CRITERIA TYPES OF PARTICIPANTS Elderly inpatients aged 65 years or older, discharged from acute care and post-acute care rehabilitation hospitals to home. TYPES OF INTERVENTIONS The review focused on the six keys components of Naylor's Transitional Care Model: early geriatric assessment, discharge preparation, patient or caregiver's participation, continuity of care, day of discharge assessment and post-discharge follow-up. TYPES OF STUDIES This review considered randomized and non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. OUTCOMES The outcomes for this review were functional ability, symptoms management, adverse outcomes, unmet needs after discharge, coping with disease, health-related quality of life (QoL), satisfaction with care, readmission rate and healthcare utilization. SEARCH STRATEGY A systematic search was undertaken across 13 databases to retrieve published and unpublished studies in English between 2000 and 2015. METHODOLOGICAL QUALITY Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION Quantitative data were extracted from included studies independently by the two reviewers using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS Due to the wide range of outcome measures, a comprehensive meta-analysis for all studies was not possible. However, meta-analysis was conducted for specific outcome measures, such as readmission, length of stay and QoL. RESULTS Thirteen studies met the inclusion criteria and were included in the review. Two out of the 13 studies were pilot studies and one had a pre-post design. Included studies involved a total of 3964 participants with a median age of 77 years. Nurse discharge planning did not significantly reduce hospital readmission rate (odds ratio [OR] = 0.73, 95% confidence intervals [CIs] = 0.53-1.01, P = 0.06). The overall effect score for length of stay was significant (weighted mean difference = 0.29, P < 0.01), suggesting that discharge planning increased the length of hospitalization. The effectiveness of discharge planning did not significantly impact QoL (mental OR = 0.37, P = 0.19 and physical OR = 0.47, P = 0.15). CONCLUSION Findings of this review suggest that nursing discharge planning for elderly inpatients discharged home increases length of stay, yet neither reduces readmission rates nor improves QoL.
Collapse
Affiliation(s)
- Cedric Mabire
- 1University of Applied Sciences and Arts Western Switzerland (HES-SO), School of Health Sciences (HESAV), Lausanne, Vaud, Switzerland 2Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence 3Institute of Higher Education and Research in Healthcare (IUFRS), Lausanne University and CHUV, Vaud, Switzerland 4Lausanne University Hospital - CHUV, Lausanne, Vaud, Switzerland
| | | | | | | |
Collapse
|
43
|
Mabire C, Dwyer A, Garnier A, Pellet J. Meta-analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home. J Adv Nurs 2017; 74:788-799. [DOI: 10.1111/jan.13475] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Cédric Mabire
- Institute of Higher Education and Research in Healthcare (IUFRS); Lausanne University and Lausanne University Hospital; Lausanne Switzerland
- Bureau d'Echange des Savoirs pour des praTique exemplaires de soins: an Affiliate Center of the Joanna Briggs Institute; Lausanne Switzerland
- Lausanne University Hospital (CHUV); Lausanne Switzerland
| | - Andrew Dwyer
- Institute of Higher Education and Research in Healthcare (IUFRS); Lausanne University and Lausanne University Hospital; Lausanne Switzerland
- Lausanne University Hospital (CHUV); Lausanne Switzerland
- Boston College William F. Connell School of Nursing; Chestnut Hill MA USA
| | | | - Joanie Pellet
- Institute of Higher Education and Research in Healthcare (IUFRS); Lausanne University and Lausanne University Hospital; Lausanne Switzerland
- Bureau d'Echange des Savoirs pour des praTique exemplaires de soins: an Affiliate Center of the Joanna Briggs Institute; Lausanne Switzerland
| |
Collapse
|
44
|
Kamdem B, Seematter-Bagnoud L, Botrugno F, Santos-Eggimann B. Relationship between oral health and Fried's frailty criteria in community-dwelling older persons. BMC Geriatr 2017; 17:174. [PMID: 28764647 PMCID: PMC5539633 DOI: 10.1186/s12877-017-0568-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 07/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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 ORpain = 1.72; 95% CI 1.17-2.53 and adjORIMA1.70; 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). CONCLUSION 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.
Collapse
Affiliation(s)
- Benedikta Kamdem
- Health Services Unit, Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010, Lausanne, CH, Switzerland
| | - Laurence Seematter-Bagnoud
- Health Services Unit, Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010, Lausanne, CH, Switzerland.
| | - Fabiana Botrugno
- Health Services Unit, Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010, Lausanne, CH, Switzerland
| | - Brigitte Santos-Eggimann
- Health Services Unit, Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010, Lausanne, CH, Switzerland
| |
Collapse
|
45
|
Szturm TJ, Sakhalkar VS, Kanitkar A, Nankar M. Computerized Dual-Task Testing of Gait and Visuospatial Cognitive Functions; Test-Retest Reliability and Validity. Front Hum Neurosci 2017; 11:105. [PMID: 28367119 PMCID: PMC5355418 DOI: 10.3389/fnhum.2017.00105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
The common occurrence of age decline in mobility and cognition does cause a decrease in the level of physical activity and an increased falls risk. Consequently, dual -task (DT) assessment that simultaneously addresses both mobility skills and cognitive functions are important because, continued difficulties and fall injuries will have a sizable impact in this population. The first objective of the present study was to assess test-retest reliability of a computerized DT treadmill walking protocol and concurrent outcome measures of gait and visuospatial executive function in a group of healthy older adults. Secondly, discriminative validity was evaluated by examining the effect of DT conditions (single task vs. dual-task) on; (a) spatiotemporal gait measures (average and coefficient of variation) and (b) visuomotor and visuospatial executive performance measures. Twenty-five community-dwelling individuals median age 65 (range 61-67) were recruited from a Fitness Facility. Participants performed a computerized visuomotor tracking task and a visuospatial executive game task in standing and while treadmill walking. Testing was conducted on two occasions, 1 week apart. Moderate to high test-retest reliability (ICC values of 0.65-0.88) were observed for spatiotemporal gait variables. No significant differences between the group means were observed between test periods in any gait variable. Moderate test-retest reliability (ICC values of 0.6-0.65) was observed for measures of visuomotor and visuospatial executive performance during treadmill walking. Significant DT effects were observed for both spatiotemporal gait variables and visuospatial executive performance measures. This study demonstrates the reliability and reproducibility of the computer-based assessment tool for dual task treadmill walking. The high to moderate ICC values and the lack of systematic errors in the measures indicate that this tool has the ability to repeatedly record reliable data from community-dwelling older adults. The present computerized dual-task protocols broaden the types of standardized visuomotor and visuospatial executive activities for use with DT treadmill walking that has previously been reported.
Collapse
Affiliation(s)
- Tony J Szturm
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; Department of Physical Therapy, University of ManitobaWinnipeg, MB, Canada
| | - Vedant S Sakhalkar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; School of Medical Rehabilitation, University of ManitobaWinnipeg, MB, Canada
| | - Anuprita Kanitkar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; Applied Health Sciences, University of ManitobaWinnipeg, MB, Canada
| | - Mayur Nankar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of Manitoba Winnipeg, MB, Canada
| |
Collapse
|
46
|
Henchoz Y, Büla C, Guessous I, Rodondi N, Goy R, Demont M, Santos-Eggimann B. Chronic symptoms in a representative sample of community-dwelling older people: a cross-sectional study in Switzerland. BMJ Open 2017; 7:e014485. [PMID: 28096256 PMCID: PMC5253546 DOI: 10.1136/bmjopen-2016-014485] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The burden of multiple diagnoses is well documented in older people, but less is known about chronic symptoms, many of which are even not brought to medical attention. This study aimed to determine the prevalence of chronic symptoms, their relationships with disability in basic activities of daily living (BADL) and quality of life (QoL), and their public health impact. DESIGN A large cross-sectional population-based study. SETTING Community in 2 regions of French-speaking Switzerland. PARTICIPANTS Community-dwelling older adults aged 68 years and older in 2011 (N=5300). OUTCOMES Disability in BADL defined as difficulty or help needed with any of dressing, bathing, eating, getting in/out of bed or an arm chair, and using the toilet. Overall QoL dichotomised as favourable (ie, excellent or very good) or unfavourable (ie, good, fair or poor). Disturbance by any of the following 14 chronic symptoms for at least 6 months: joint pain, back pain, chest pain, dyspnoea, persistent cough, swollen legs, memory gaps, difficulty concentrating, difficulty making decisions, dizziness/vertigo, skin problems, stomach/intestine problems, urinary incontinence and impaired sexual life. RESULTS Only 17.1% of participants did not report being disturbed by any of these chronic symptoms. Weighted prevalence ranged from 3.1% (chest pain) to 47.7% (joint pain). Most chronic symptoms were significantly associated with disability in BADL or unfavourable QoL, with substantial gender differences. The number of chronic symptoms was significantly associated with disability in BADL and unfavourable QoL, with gradients suggesting dose-response relationships. Joint pain and back pain had the highest population attributable fractions. CONCLUSIONS Chronic symptoms are highly prevalent in older people, and are associated with disability in BADL and unfavourable QoL, particularly when multiple chronic symptoms co-occur. Owing to their high public health impact, musculoskeletal chronic symptoms represent good targets for preventive interventions.
Collapse
Affiliation(s)
- Yves Henchoz
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Geneva University Hospitals, Geneva, Switzerland
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, University Hospital of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - René Goy
- Pro Senectute Vaud, Lausanne, Switzerland
| | | | - Brigitte Santos-Eggimann
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| |
Collapse
|
47
|
Henchoz Y, Büla C, Guessous I, Santos-Eggimann B. Association between Physical Frailty and Quality of Life in a Representative Sample of Community-Dwelling Swiss Older People. J Nutr Health Aging 2017; 21:585-592. [PMID: 28448091 DOI: 10.1007/s12603-016-0772-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Though the association between physical frailty and health is well established, little is known about its association with other domains of quality of life (QoL). This study investigated the association between physical frailty and multiple domains of QoL in community-dwelling older people. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Data of the 2011 annual assessment of 927 older people (age 73-77 years) from the Lc65+ cohort study were used. MEASUREMENTS Physical frailty was assessed by Fried's five criteria: 'shrinking'; 'weakness'; 'poor endurance, exhaustion'; 'slowness'; and 'low activity'. QoL was assessed using 28 items yielding a QoL score and seven domain-specific QoL subscores (Feeling of safety; Health and mobility; Autonomy; Close entourage; Material resources; Esteem and recognition; and Social and cultural life). Low QoL (QoL score or QoL subscores in the lowest quintile) was used as dependent variable in logistic regression analyses adjusted for age and sex (model 1), and additionally for socioeconomic (model 2) and health (model 3) covariates. RESULTS Physical frailty was associated with a low QoL score, as well as decreased QoL subscores in all seven specific domains, even after adjusting for socio-economic covariates. However, when performing additional adjustment for health covariates, only the domain Health and mobility remained significantly associated with physical frailty. Among each specific Fried's criteria, 'slowness' had the strongest association with a low QoL score. CONCLUSION Physical frailty is associated with all QoL domains, but these associations are largely explained by poor health characteristics. Longitudinal studies are needed to better understand temporal relationships between physical frailty, health and QoL.
Collapse
Affiliation(s)
- Y Henchoz
- Yves Henchoz; Institute of Social and Preventive Medicine (IUMSP), University of Lausanne Hospital Centre, Route de la Corniche 10, CH-1010 Lausanne, Switzerland; ; Tel.:+41 21 314 84 23; Fax: +41 21 314 97 67
| | | | | | | |
Collapse
|
48
|
Santos-Eggimann B, Meylan L. Older Citizens' Opinions on Long-Term Care Options: A Vignette Survey. J Am Med Dir Assoc 2016; 18:326-334. [PMID: 27956072 DOI: 10.1016/j.jamda.2016.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/14/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND 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. DESIGN/SETTING/PARTICIPANTS Mailed vignette survey in a representative population-based sample of 3133 community-dwelling persons 68 years or older residing in a Swiss region. MEASUREMENTS 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. RESULTS 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. CONCLUSIONS This survey had high acceptance. Responses to variations in the disability and social profile displayed in the vignettes suggested the validity of measurements.
Collapse
Affiliation(s)
- Brigitte Santos-Eggimann
- Lausanne University Hospital, Institute of Social and Preventive Medicine, Lausanne, Switzerland.
| | - Lionel Meylan
- Lausanne University Hospital, Institute of Social and Preventive Medicine, Lausanne, Switzerland
| |
Collapse
|
49
|
Determinants of quality of life in community-dwelling older adults: comparing three cut-offs on the excellent-to-poor spectrum. Qual Life Res 2016; 26:283-289. [PMID: 27558783 DOI: 10.1007/s11136-016-1394-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to identify modifications in health, economic and social determinants of quality of life (QoL) in community-dwelling older adults when using different cut-offs to defining favorable QoL. METHODS Data of year 2011 annual assessment in 1003 older men and women from the Lc65+ cohort study were used. Overall QoL was self-rated as 'excellent,' 'very good,' 'good,' 'fair,' or 'poor.' To identify significant health (self-rated health, SF-12v2 physical and mental health), economic (financial situation), and social (living with others, being socially supported, emotional support, group activities participation) determinants of QoL, a cut-off was set at three different positions to define favorable QoL on the 'excellent' to 'poor' spectrum: at least 'good' (model 1); at least 'very good' (model 2); and 'excellent' only (model 3). RESULTS In all three models, bivariable analyses indicated significant associations between QoL and at least one variable from each health, economic, and social dimension. In multivariable analyses, only health-related variables remained significantly associated with QoL in model 1. Model 3 additionally retained financial situation. In model 2, QoL was positively associated with physical health [odds ratio (OR) 1.10, p < 0.001], mental health (OR 1.12, p < 0.001), self-rated health (OR 2.43, p < 0.001), group activities participation (OR 1.43, p = 0.037), being socially supported (OR 1.58, p = 0.024), and not reporting financial difficulties (OR 1.76; p = 0.036). CONCLUSIONS Using different cut-offs to defining favorable QoL results in important changes in the number and type of significant health, economic and social determinants. A cut-off between 'good' and 'very good' appears to best reflect the multidimensional nature of QoL.
Collapse
|
50
|
Vergara I, Rivas-Ruiz F, Vrotsou K, Contreras-Fernández E, Téllez-Santana T, Machón M, Díez Ruiz AI, de Mesa Berenguer Y, Bueno A, Núñez J, Saucedo Figueredo MC, Montiel-Luque A, Nava Del Val MA, Quirós-López R, Carrasco E, Abellan G. Validation and comparison of instruments to identify frail patientes in primary care settings: Study protocol. BMC Health Serv Res 2016; 16:354. [PMID: 27492438 PMCID: PMC4974766 DOI: 10.1186/s12913-016-1540-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 07/07/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In the last few years several indices and tools, aimed at identifying frail subjects in various care settings have been developed. However, to date none of them has been incorporated into usual practice in the primary care setting. The purposes of this study are: 1) to evaluate the predictive capacity of the Tilburg Frailty Indicator (TFI), the Gérontopôle Frailty Screening Tool (GFST) and the KoS model together with two biomarker levels (SOX2 and p16INK4a) for adverse events related to frailty; 2) to determine differences in the use of healthcare services according to frailty. METHODS/DESIGN Prospective multicentre cohort study with a 2-year follow-up. The study will be performed in primary care centres of Gipuzkoa and Costa del Sol, both located in Spain. Autonomous, non-institutionalized individuals aged 70 and over that agree to participate in this study will constitute the study population. A total of 900 individuals will be randomly selected from the healthcare administrative data bases of the participating health services. Data will be collected at baseline and at 1 and 2 years. The main independent variables assessed at baseline will be TFI outcomes, GFST and the KoS model, together with the expression of SOX2 and p16INK4a levels. During follow-up, loss of autonomy, the occurrence of death and consumption of healthcare resources will be assessed. DISCUSSION The main focus of this work is the identification and evaluation of several instruments constructed under different rationales to identify frail subjects in primary care settings. The resulting outcomes have potential for direct application to the primary care practice. Early identification of the onset of functional impairment of elderly is an essential, still unresolved aspect in the prevention of dependence in the scope of primary care.
Collapse
Affiliation(s)
- Itziar Vergara
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Donostia-San Sebastian, Spain. .,Instituto Biodonostia, Donostia-San Sebastian, ᅟSpain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC, Paseo Dr. Begiristain s/n; 2014, San Sebastián-Donostia, Spain.
| | - Francisco Rivas-Ruiz
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC, Paseo Dr. Begiristain s/n; 2014, San Sebastián-Donostia, Spain.,Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain
| | - Kalliopi Vrotsou
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Donostia-San Sebastian, Spain.,Instituto Biodonostia, Donostia-San Sebastian, ᅟSpain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC, Paseo Dr. Begiristain s/n; 2014, San Sebastián-Donostia, Spain
| | | | - Teresa Téllez-Santana
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC, Paseo Dr. Begiristain s/n; 2014, San Sebastián-Donostia, Spain.,Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain
| | - Mónica Machón
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Donostia-San Sebastian, Spain.,Instituto Biodonostia, Donostia-San Sebastian, ᅟSpain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC, Paseo Dr. Begiristain s/n; 2014, San Sebastián-Donostia, Spain
| | - Ana Isabel Díez Ruiz
- Instituto Biodonostia, Donostia-San Sebastian, ᅟSpain.,Centro de Salud Beraun, OSI Donostialdea, Osakidetza, Renteria, Spainᅟ
| | - Yolanda de Mesa Berenguer
- Unidad de Gestión Clínica de La Lobilla, Estepona, Málaga, Spain.,Unidad Gestión Clínica Los Boliches, Fuengirola, Málaga, Spain
| | - Andoni Bueno
- Centro de Salud Beraun, OSI Donostialdea, Osakidetza, Renteria, Spainᅟ
| | - Jazmina Núñez
- Centro de Salud Beraun, OSI Donostialdea, Osakidetza, Renteria, Spainᅟ
| | - M Carmen Saucedo Figueredo
- Unidad Gestión Clínica Los Boliches, Fuengirola, Málaga, Spain.,Unidad de Gestión Clínica San Miguel, Torremolinos, Málaga, Spain
| | | | | | - Raúl Quirós-López
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC, Paseo Dr. Begiristain s/n; 2014, San Sebastián-Donostia, Spain.,Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain
| | - Estefanía Carrasco
- Neuro-Oncology Group, Biodonostia Institute, Paseo Dr. Beguiristain s/n, San Sebastian, Spain
| | - Gabor Abellan
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,INSERM UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| |
Collapse
|