Athanassia Karmaniola

What is the Relationship Between Fear of Falling and Gait in Well-Functioning Older Persons Aged 65 to 70 Years?

OBJECTIVE To investigate the association between fear of falling and gait performance in well-functioning older persons. DESIGN Survey. SETTING Community. PARTICIPANTS Subjects (N=860, aged 65-70y) were a subsample of participants enrolled in a cohort study who underwent gait measurements. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Fear of falling and its severity were assessed by 2 questions about fear and related activity restriction. Gait performance, including gait variability, was measured using body-fixed sensors. RESULTS Overall, 29.6% (210/860) of the participants reported fear of falling, with 5.2% (45/860) reporting activity restriction. Fear of falling was associated with reduced gait performance, including increased gait variability. A gradient in gait performance was observed from participants without fear to those reporting fear without activity restriction and those reporting both fear and activity restriction. For instance, stride velocity decreased from 1.15+/-.15 to 1.11+/-.17 to 1.00+/-.19 m/s (P<.001) in participants without fear, with fear but no activity restriction and with fear and activity restriction, respectively. In multivariate analysis, fear of falling with activity restriction remained associated with reduced gait performance, independent of sex, comorbidity, functional status, falls history, and depressive symptoms. CONCLUSIONS In these well-functioning older people, those reporting fear of falling with activity restriction had reduced gait performance and increased gait variability, independent of health and functional status. These relationships suggest that early interventions targeting fear of falling might potentially help to prevent its adverse consequences on mobility and function in similar populations.

Child care in the preschool years: Attachment, behaviour problems and cognitive development

The possible implications of the experience of non parental care on cognitive development and on behaviour problems are considered in interaction with individual and contextual variables. A sample of 47 Swiss children who experienced varying kinds of care arrangements were studied longitudinally between 1 and 5 years of age. The effects of the experience of care were related to mothers’ reports of behavioral problems (CBCL, with subscales of internalizing and of externalizing problems) at age 5, and to cognitive developmental quotients (at 1, 2 and 5 years). Several variables were considered for their potential interaction with the experience of care, such as the pattern of attachment to the mother (observed at 21 months of age in the “Strange Situation”), characteristics of the experience of care (duration and type of care), its quality (relationship with non parental caregivers), the socio-economic status of the family, etc. The effect of non parental care on behaviour problems (5 years) happened to be mediated by the the pattern of attachment to the mother: insecurely attached children had some risk to be reported as having externalizing problems, but this didn’t occur when they had an extended experience of non parental care, and when non parental care was mainly family-based. The effect of non parental care on cognitive development was mediated by the quality of care: children with a positive contact with the caregivers had greater cognitive gains between 2 and 5 years; the relationship with the care-givers itself was influenced by the quality of the relationship with the mother. The limited size and origin of the sample restricts generalization, however these data might contribute to the notion that non parental care can have varying effects depending of the type of care, the quality of the relation with the caregivers, the age and personal traits of the child.RésuméUn échantillon de 47 enfants suisses ayant connu différents types de garde non-parentale a fait l’objet d’une étude longitudinale entre les âges de un et cinq ans. Les effets des modes de garde ont été appréhendés à cinq ans à partir des problèmes de comportement rapportér par les mères (échelle CBCL) et des quotients de développement cognitifs établis à un, deux et cinq ans. Plusieurs variables ont été prises en compte du fait de leur liaison éventuelle avec l’expérience de garde: pattern d’attachement à la mère (observé à 21 mois), durée, type et qualité (relations avec les gardiennes) de la prise en charge, statut socio-économique de la famille, etc. L’effet de la garde sur le problèmes comportementaux varient en fonction du pattern d’attachement à la mère. L’ effet sur le développement cognitif dépend la qualité de la relation avec les gardiennes, cette dernière dépendant elle-même de la qualtté de la relation à la mère.

Quality of child care in the preschool years: A comparison of the influence of home care and day care characteristics on child outcome

One hundred and six families of 2-year-old children, having experienced either family day care or centre-based day care, took part in this study. Parents’ and day care providers’ representations and values concerning their ideal definition of child care were assessed, and direct observations of child care settings conducted, using a time-sampling procedure. The instruments concerning both representations and observations have a seven dimension structure: caregiver availability, stimulation, firmness, warmth, autonomy, achievement, and organisation. When children were 3 years of age, the families were contacted again (16% drop out) for an evaluation of various outcomes: parental reports of child behaviour problems (CBCL) and egoresiliency (CCQ), assessments of child developmental quotient (McCarthy), and of attachment representations (ASCT). The day care variables (care providers’ representations and observed variables of the setting), unexpectedly explained the variance of the dependent variables (especially behaviour problems) more than the corresponding parental variables. These results contrast with other studies in the field. Apparently, they can be attributed to the relatively wide span of dimensions, as well as to the variety of child care settings considered. Non-parental and parental care had some selective effects on the different dependent variables. The effects of representations were globally stronger than those of observed characteristics. These data point to the importance of child care quality, emphasise the idea that quality is multidimensional, and stress the significance of caregivers’ representations and values.

Assessing Attachment Cognitions and Their Associations with Depression in Youth with Eating or Drug Misuse Disorders

The study investigates associations between attachment cognitions and depression symptoms in 71 15–25-year-olds, 26 of whom have eating disorders, and 20 of whom are drug misusers. Attachment cognitions were measured with the CaMir Q-sort, which provides indexes for secure, avoidant, and preoccupied attachment, as well as scores on 13 dimensions. The BDI-13 was used to measure depressive symptomatology. Consistent with the literature, BDI scores were associated with cognitions of preoccupied attachment. They were also related to cognitions of avoidant attachment, confirming Bowlbys theory on defensive exclusion. For participants with eating disorders, depressive symptomatology was related to preoccupation and parental interference, whereas for drug misusers, it was negatively related to security, preoccupation, parental support, and lack of parental concern. These findings help understand how attachment cognitions may participate in depressive symptomatology, namely in youth whose behavior problems may be associated with specific attachment experiences.

Vulnerability in high-functioning persons aged 65 to 70 years: the importance of the fear factor

Background and aims: Falls efficacy has been shown to predict functional decline, but whether it is independently associated with frailty is still unclear. This study investigated the cross-sectional association between falls efficacy and the frailty pheno-type in high-functioning older persons. Methods: Subjects (n=861) were a sub-sample of community-dwelling persons aged 65 to 70 years enrolled in the “Lc65+” cohort, who had gait assessment. Data included demographics, functional, cognitive, affective and health status, as well as measures of physical performance. Falls efficacy was measured with the Falls Efficacy Scale-International (FES-I) and frailty with Fried’s criteria. Participants were categorized into robust (no frailty criterion) and vulnerable (1 or more criteria). Low falls efficacy was defined as a FES-I score in the lowest quartile. Results: Overall, 23.9% of participants were vulnerable. Compared with robust participants, they were more likely to report low falls efficacy (43.3% vs 19.1%, p<0.001) and had poorer health and functional and mental status. They had slower gait speed (1.07±0.18 vs 1.15±0.15 m/s, p<0.001) and increased gait speed variability (coefficient of variation 4.10±4.03 vs 3.33±1.45%, p<0.001), although only 6 participants (0.7%) fulfilled Fried’s slow walking criterion. In multivariate analysis, low falls efficacy remained associated with being vulnerable (adjusted OR 1.80, 95%, CI 1.19–2.74, p=0.006), independent of comorbidity, functional status, falls history and gait performance. Conclusion: In high-functioning older persons, low falls efficacy was associated with vulnerability, even after controlling for gait performance and falls history. Whether low falls efficacy is a potential target on the pathway leading to frailty should be further examined prospectively.

Disturbing life events and wellbeing after 80 years of age: a longitudinal comparison of survivors and the deceased over five years

This paper assesses the impact of disturbing life events over five years on the wellbeing of 340 people aged 80–84 years at baseline, by analysing data from a longitudinal survey in Switzerland. The guiding proposition was that the negative effect of life events is moderated by the event domain, i.e. health, deaths and changes in family setting and relationships, and by cognitive adaptation to ones own health state (adopting a more or less optimistic view). Multi-level regression that controlled for the effect of socio-demographic and health factors was used. Corroborating the first hypothesis, a model that differentiated the event categories, instead of their additive inclusion, gave the best fit. In support of the second hypothesis, it was shown that the positive impact of self-rated health reduced the negative effect of life events on wellbeing for survivors, but not for those who died within five years. This suggests that the former made more optimistic appraisals of their mental and physical health, while the latter adjusted their subjective health rating to their functional abilities. Survivors had better psychological resources for coping with disturbing life events, while the deceased lacked these resources, which buffered the impact of negative events. The psychological meaning of stressful events at the end of life is discussed. By encouraging optimistic self-evaluations of health, and raising awareness of the range of normal functioning of older people, health- and social-care practitioners can promote the maintenance of meaningful lives in old age.

The Effects of Non-Parental Care and the Quality of the Child Care Setting on the Young Child's Development: A Swiss Study.

ABSTRACT The effects of the non-parental care and the quality of the child care setting on the young child development: a Swiss study. This paper presents, on one hand the results of a longitudinal study concerning the effects of non parental care on the development of the young child and on the other hand a new research project on the quality of the childs rearing environment. 47 children from the French-speaking Switzerland have been followed between 0 and 5 years old; their level of development has been evaluated at 2 and 5 years old. The results obtained show that the children who had a non parental care experience during their earliest childhood (from 0 to 2 years old) had a developmental quotient inferior to those who did not have such experience. These results contrast with the data of studies made in other countries. We have put forward the hypothesis that the determining factor would be the quality of the child care setting. With the aim of exploring this hypothesis, a new research project has b...