Maria Soto
University of Toulouse
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Clinics in Geriatric Medicine | 2010
Gabor Abellan van Kan; Yves Rolland; Mathieu Houles; Sophie Gillette-Guyonnet; Maria Soto; Bruno Vellas
No clear consensual definition regarding frailty seems to emerge from the literature after 30 years of research in the topic, and a large array of models and criteria has been proposed to define the syndrome. Controversy continues to exist on the choice of the components to be included in the frailty definition. Two main definitions based on clusters of components are found in literature: a physical phenotype of frailty, operationalized in 2001 by providing a list of 5 measurable items of functional impairments, which coexists with a multidomain phenotype, based on a frailty index constructed on the accumulation of identified deficits based on comprehensive geriatric assessment. The physical phenotype considers disability and comorbidities such as dementia as distinct entities and therefore outcomes of the frailty syndrome, whereas comorbidity and disability can be components of the multidomain phenotype. Expanded models of physical frailty (models that included clusters other than the original 5 items such as dementia) increased considerably the predicting capacity of poor clinical outcomes when compared with the predictive capacity of the physical phenotype. The unresolved controversy of the components shapes the clusters of original frailty syndrome, and the components depend very much on how frailty is defined. This update also highlights the growing evidence on gait speed to be considered as a single-item frailty screening tool. The evaluation of gait speed over a short distance emerges from the literature as a tool with the capacity to identify frail older adults, and slow gait speed has been proven to be a strong predictor for frailty-adverse outcomes.
Journal of Nutrition Health & Aging | 2013
Eirini Kelaiditi; Matteo Cesari; Marco Canevelli; G. Abellan van Kan; Pierre-Jean Ousset; Sophie Gillette-Guyonnet; Patrick Ritz; F. Duveau; Maria Soto; Véronique Provencher; Fati Nourhashemi; Antoni Salvà; Philippe Robert; Sandrine Andrieu; Yves Rolland; J. Touchon; J. L. Fitten; Bruno Vellas
The frailty syndrome has recently attracted attention of the scientific community and public health organizations as precursor and contributor of age-related conditions (particularly disability) in older persons. In parallel, dementia and cognitive disorders also represent major healthcare and social priorities. Although physical frailty and cognitive impairment have shown to be related in epidemiological studies, their pathophysiological mechanisms have been usually studied separately. An International Consensus Group on “Cognitive Frailty” was organized by the International Academy on Nutrition and Aging (I.A.N.A) and the International Association of Gerontology and Geriatrics (I.A.G.G) on April 16th, 2013 in Toulouse (France). The present report describes the results of the Consensus Group and provides the first definition of a “Cognitive Frailty” condition in older adults. Specific aim of this approach was to facilitate the design of future personalized preventive interventions in older persons. Finally, the Group discussed the use of multidomain interventions focused on the physical, nutritional, cognitive and psychological domains for improving the well-being and quality of life in the elderly. The consensus panel proposed the identification of the so-called “cognitive frailty” as an heterogeneous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment. In particular, the key factors defining such a condition include: 1) presence of physical frailty and cognitive impairment (CDR=0.5); and 2) exclusion of concurrent AD dementia or other dementias. Under different circumstances, cognitive frailty may represent a precursor of neurodegenerative processes. A potential for reversibility may also characterize this entity. A psychological component of the condition is evident and concurs at increasing the vulnerability of the individual to stressors.
Journal of the American Medical Directors Association | 2014
Basema Afram; Astrid Stephan; Hilde Verbeek; Michel H.C. Bleijlevens; Riitta Suhonen; Caroline Sutcliffe; Katrin Raamat; Esther Cabrera; Maria Soto; Ingalill Rahm Hallberg; Gabriele Meyer; Jan P.H. Hamers
OBJECTIVES To explore reasons for institutionalization of people with dementia according to informal caregivers as well as variation in reasons between countries. DESIGN An explorative cross-sectional study was conducted in 8 European countries. SETTING Per country, a minimum of 3 long term care facilities, offering care and accommodation as a package, participated in this study. Participating countries were selected to represent different geographic areas in Europe. PARTICIPANTS Of the 791 informal caregivers involved in the RightTimePlaceCare project of people with dementia who were recently admitted to a long term care facility, 786 were included for this study. MEASUREMENTS As part of a semistructured interview, informal caregivers were asked the main reason for institutionalization in an open-ended question. Answers were categorized according to a conventional coding approach. All reasons were then quantified and tested. RESULTS Mainly patient-related reasons were stated, such as neuropsychiatric symptoms (25%), care dependency (24%), and cognition (19%). Neuropsychiatric symptoms were among the most often mentioned reasons in most countries. Besides patient-related reasons, caregiver burden and the inability of the informal caregiver to care for the patient were stated as reasons (both 15%). Further analyses showed countries differ significantly in reasons according to informal caregivers. Additionally, reasons were analyzed for spouses and child-caregivers, showing that spouses more often stated reasons related to themselves compared with child-caregivers. CONCLUSION Multiple reasons contribute to the institutionalization for people with dementia, with several factors that may influence why there were country differences. Variation in the organization of dementia care and cultural aspects, or the relationship between the informal caregiver and person with dementia may be factors influencing the reasons. Because of a wide variation in reasons between countries, no one-size-fits-all approach can be offered to guide informal caregivers when facing the possibility of institutionalization of the person with dementia.
Journal of Nutrition Health & Aging | 2014
Neda Tavassoli; S. Guyonnet; G. Abellan van Kan; S. Sourdet; T. Krams; Maria Soto; J. Subra; Bruno Chicoulaa; A. Ghisolfi; L. Balardy; Philippe Cestac; Yves Rolland; Sandrine Andrieu; Fati Nourhashemi; S. Oustric; Matteo Cesari; Bruno Vellas
IntroductionFrailty is considered as an early stage of disability which, differently from disability, is still amenable for preventive interventions and is reversible. In 2011, the “Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability” was created in Toulouse, France, in association with the University Department of General Medicine and the Midi-Pyrenees Regional Health Authority. This structure aims to support the comprehensive and multidisciplinary assessment of frail older persons, to identify the specific causes of frailty and to design a personalized preventive plan of intervention against disability. In the present paper, we describe the G.F.C structure, organization, details of the global evaluation and preventive interventions against disability, and provide the main characteristics of the first 1,108 patients evaluated during the first two years of operation.MethodsPersons aged 65 years and older, considered as frail by their physician (general practitioner, geriatrician or specialist) in the Toulouse area, are invited to undergo a multidisciplinary evaluation at the G.F.C. Here, the individual is assessed in order to detect the potential causes for frailty and/or disability. At the end of the comprehensive evaluation, the team members propose to the patient (in agreement with the general practitioner) a Personalized Prevention Plan (PPP) specifically tailored to his/her needs and resources. The G.F.C also provides the patient’s follow-up in close connection with family physicians.ResultsMean age of our population was 82.9 6.1 years. Most patients were women (n=686, 61.9%). According to the Fried criteria, 423 patients (39.1%) were pre-frail, and 590 (54.5%) frail. Mean ADL (Activities of Daily Living) score was 5.5±1.0. Consistently, IADL (Instrumental ADL) showed a mean score of 5.6 2.4. The mean gait speed was 0.78±0.27 and 25.6% (272) of patients had a SPPB (Short Physical Performance Battery) score equal to or higher than 10. Dementia was observed in 14.9% (111) of the G.F.C population according to the CDR scale (CDR ≥2). Eight percent (84) presented an objective state of protein-energy malnutrition with MNA (Mini Nutritional Assessment) score < 17 and 39.5% (414) were at risk of malnutrition (MNA=17–23.5). Concerning PPP, for 54.6% (603) of patients, we found at least one medical condition which needed a new intervention and for 32.8% (362) substantial therapeutic changes were recommended. A nutritional intervention was proposed for 61.8% (683) of patients, a physical activity intervention for 56.7% (624) and a social intervention for 25.7% (284). At the time of analysis, a one-year reassessment had been carried out for 139 (26.7%) of patients.ConclusionsThe G.F.C was developed to move geriatric medicine to frailty, an earlier stage of disability still reversible. Its particularity is that it is intended for a single target population that really needs preventive measures: the frail elderly screened by physicians. The screening undergone by physicians was really effective because 93.6% of the subjects who referred to this structure were frail or pre-frail according to Fried’s classification and needed different medical interventions. The creation of units like the G.F.C, specialized in evaluation, management and prevention of disability in frail population, could be an interesting option to support general practitioners, promote the quality of life of older people and increase life expectancy without disability.
Dementia and Geriatric Cognitive Disorders | 2008
Maria Soto; Sandrine Andrieu; Christelle Cantet; Emma Reynish; Pierre-Jean Ousset; Christophe Arbus; Sophie Gillette-Guyonnet; Fati Nourhashemi; Bruno Vellas
Background: Given the poorer prognosis of Alzheimer’s disease (AD) patients with rapid cognitive decline (RCD), there is a need for a clinical assessment tool to detect these patients. Objective: To investigate if there is a Mini Mental State Examination (MMSE) threshold of decline during 6 months of follow-up which predicts a worse disease progression at the 2-year follow-up. Then, to propose a feasible definition of RCD for routine clinical practice. Methods: Data from 565 community-dwelling AD patients recruited in a multi-centre prospective observational study were assessed. All patients had MMSE scores between 10 and 26 at inclusion and were followed up 6-monthly using a standardised clinical assessment. Patients were classified as rapid and non-rapid decliners according to 2 MMSE decline thresholds tested: ≧3 points and ≧4 points for decline over the first 6 months of the study. Worse disease outcome was defined as attainment of 1 of 4 clinical end points 18 months later: institutionalisation, death, increased physical dependence or worsening of behavioural and psychological symptoms. Results: 135 patients (23.9%) lost ≧3 points during the first 6 months of follow-up in the MMSE score and 77 patients (13.6%) lost ≧4 points. Patients with moderate disease and a loss of ≧4 points showed a significantly increased risk of mortality (HR = 5.6, 95% CI 2.0–15.9) and institutionalisation (HR = 3.8, 95% CI 1.8–8.1) at the 2-year follow-up. The same MMSE threshold was associated with a higher risk of physical decline (HR = 1.6, 95% CI 1.2–2.3). Conclusion: The loss of ≧4 points in MMSE during the first 6 months of follow-up seems to be a predictor of worse clinical course, and thus it could be used to define the category of AD patients presenting a RCD.
Journal of Nutrition Health & Aging | 2008
Maria Soto; Sandrine Andrieu; Christophe Arbus; Mathieu Ceccaldi; P. Couratier; T. Dantoine; Jean-François Dartigues; S. Gillette-guyonette; F. Nourhashemi; Pierre-Jean Ousset; M. Poncet; F. Portet; Jacques Touchon; Bruno Vellas
The rate of cognitive decline in Alzheimer’s disease (AD) varies considerably between individuals, with some subjects showing substantial deterioration and others showing little or no change over the course of the disease. These wide variations support the relatively new concept of Rapid Cognitive Decline (RCD). Patients with an accelerated rate of cognitive decline have showed to present a worse evolution in terms of mortality, loss of autonomy and institutionalisation. The conclusions from RCD studies conducted in the past years remain very heterogeneous and sometimes contradictory. This is possibly due to methodological differences, mainly the different “a priori” definitions of RCD used to identify rapid decliners. Consequently of this, there is considerable variation in reported frequency of patients with RCD which may vary from 9.5% to 54%. The lack of both consensus definition and consensual clinical assessment tools is one of the major barriers for establishing an appropriated management of rapid decliners in clinical practice. Presently, management of rapid decliners in AD remains to be a challenge waiting to better know predictive factors of a RCD. To date no specific guidelines exist to follow-up or to treat patients with this condition. This consensus paper proposes the loss of 3 points or greater in Mini-Mental State Examination (MMSE) during six months as an empirical definition of rapid cognitive decline to be used in routine medical practice and to be relevant for clinical-decision making in patients with mild to moderately-severe AD.
International Psychogeriatrics | 2014
Clarissa M. Giebel; Caroline Sutcliffe; Minna Stolt; Staffan Karlsson; Anna Renom-Guiteras; Maria Soto; Hilde Verbeek; Adelaida Zabalegui; David Challis
BACKGROUND Performing basic activities of daily living (ADLs) is one of the major difficulties encountered in dementia, which can have considerable negative impacts on the quality of life (QoL) of people with dementia (PwD). However, the extent to which basic ADL performance deteriorates across mild, moderate, and severe dementia is little examined and its impact, together with depression and neuropsychiatric behavior, upon QoL, is of considerable relevance across European countries. METHODS Data were drawn from people living in the community who were participants in a large-scale European study on transition from community living to care homes of PwD. PwD completed measures on cognitive functioning and QoL, and informal carers reported upon QoL, depressive symptomatology, psychopathology, and functional ability of the PwD. RESULTS ADL performance deteriorated differently for each activity. In particular, toileting, transfer, and feeding remained relatively intact throughout, whereas performance on bathing and dressing deteriorated to a greater extent from mild to severe dementia. It appears that continence was not affected by the stage of dementia with similar levels of impairment. Basic ADL performance impacted to different degrees on QoL across dementia stages and countries. CONCLUSIONS Interventions aimed at maintaining independence or QoL need to target different ADLs across different dementia stages and perhaps also tailor interventions to the context of different countries. Findings contribute to the development of non-pharmaceutical interventions and governmental pledges to promote independence in dementia.
Journal of the American Geriatrics Society | 2013
Maria Soto; Gabor Abellan van Kan; Fati Nourhashemi; Sophie Gillette-Guyonnet; Matteo Cesari; Christelle Cantet; Yves Rolland; Bruno Vellas
To assess whether angiotensin‐converting enzyme inhibitor (ACE‐I) treatment is associated with less cognitive decline in older adults with Alzheimers disease (AD) than in those using other hypertensive or no drugs.
International Journal of Geriatric Psychiatry | 2013
Marco Canevelli; Nawal Adali; Thierry Voisin; Maria Soto; Giuseppe Bruno; Matteo Cesari; Bruno Vellas
Behavioral and psychological symptoms of dementia represent common clinical features of dementias, contributing to the heterogeneous phenotypic expression of Alzheimers disease (AD). During the last two decades, several studies explored the possible presence of neuropsychiatric subsyndromes in dementia by examining the internal structure of the Neuropsychiatric Inventory (NPI). The aim of the present review is to present available evidence coming from studies adopting factor analysis to explore the NPI and describe neuropsychiatric clusters of symptoms in AD.
Patient Education and Counseling | 2014
Adelaida Zabalegui; Jan P.H. Hamers; Staffan Karlsson; Helena Leino-Kilpi; Anna Renom-Guiteras; Kai Saks; Maria Soto; Caroline Sutcliffe; Esther Cabrera
OBJECTIVE To identify effective interventions which improve quality of care for people with dementia (PwD) living at home. METHODS MEDLINE-(via PubMed), CINAHL, PsycINFO and ISI Web of Science databases were searched. INCLUSION CRITERIA (1) randomized controlled trials; (2) published in English-language, peer-reviewed journals between 1990 and 2012; (3) evaluated strategies to improve quality of care for PwD cared at home; and (4) participants older than 65. RESULTS 23 studies met inclusion criteria. All the studies aimed to improve PwD quality of care and most of them focused on PwD caregivers. Psychoeducational programs are the most frequently assessed interventions and multicomponent interventions produced the most promising results. CONCLUSION Due to the great variety of interventions describing specific samples and contexts, comparison of practice effectiveness is difficult. However, cognitive rehabilitation in PwD is effective when applied at an early stage of the disease. Case managers have demonstrated to reduce PwD institutionalization and the use of other community services. The studies were limited by sample heterogeneity, short follow-up or insufficiently detailed description. PRACTICE IMPLICATIONS To improve PwD homecare, health professionals should educate and support caregivers. Before specific interventional recommendations can be made, further research addressing the limitations of current studies is needed.