Micheline Dubé

Sleep quality and 1-year incident cognitive impairment in community-dwelling older adults.

STUDY OBJECTIVES To examine in cognitively intact older men and women the associations between subjective sleep quality and 1-yr incident cognitive impairment. DESIGN Prospective cohort study. SETTING General community. PARTICIPANTS 1,664 cognitively intact individuals age 65 to 96 years. MEASUREMENTS AND RESULTS Sleep quality at baseline was measured using the Pittsburgh Sleep Quality Index (PSQI). Cognitive functioning was assessed at baseline and 12 months later using the Mini-Mental State Examination (MMSE). Incident general cognitive impairment was defined according to a follow-up MMSE score below the 15(th) percentile according to normative data and of at least 2 points below baseline. General cognitive impairments were also separated into amnestic and nonamnestic subtypes according to MMSE delayed recall performance. Associations between sleep quality indicators at baseline and incident cognitive impairment were assessed by odds ratio (OR) adjusted for age, education, baseline MMSE score, psychotropic drug use, anxiety, depressive episodes, cardiovascular conditions, and chronic diseases. Results revealed that global PSQI score was significantly linked with incident cognitive impairment (OR 1.17, 95% confidence interval (CI) 1.05-1.30) in men, but not in women. In women, sleep disturbance score (OR 2.62, 95% CI 1.41-4.86) and long sleep duration (≥ 9 hr; OR 3.70, 95% CI 1.49-9.17) were associated with nonamnestic and amnestic incident cognitive impairment, respectively. In men, short sleep duration (≤ 5 hr; OR 4.95, 95% CI 1.72-14.27) and habitual sleep efficiency score (OR 1.94, 95% CI 1.42-2.66) were associated with amnestic and general incident cognitive impairment, respectively. CONCLUSIONS Sleep quality in older adults should receive particular attention by clinicians because poor sleep quality can be an early sign of cognitive decline.

The Epidemiology of Psychiatric Disorders in Quebec's Older Adult Population

Objective: To document the prevalence of psychiatric disorders in Quebecs older adult population. Method: Data came from the Enquête sur la santé des aînés study conducted in 2005–2006 using a representative sample (n = 2798) of community-dwelling older adults. Results: Our results indicate that 12.7% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression, mania, anxiety disorders, or benzodiazepine dependency. The 12-month prevalence rate of major depression was 1.1% and the prevalence of minor depression 5.7%. A total of 5.6% of the respondents reported an anxiety disorder. The most prevalent anxiety disorders were specific phobia (2.0%), obsessive–compulsive disorder (OCD) (1.5%), and generalized anxiety disorder (GAD) (1.2%). Agoraphobia without panic disorder and panic disorder were reported by 0.3% and 0.6% of the respondents, respectively. The prevalence rate of benzodiazepine dependency was 2.3%. The 12-month comorbidity prevalence rate between any psychiatric disorders was 2.2%. Among those with depressive disorder, the most frequent comorbidity was observed between minor depression and specific phobia (4.3%), GAD (4.3%), OCD (3.7%), and mania (1.3%). Further, only 39% of those having at least one active DSM-IV diagnosis reported having used health services for their psychological distress symptoms during the previous 12 months. Among those who consulted health services, 85% visited a general practitioner. Conclusions: Our results indicate that a large proportion of the elderly population in Quebec presents mental health needs. Longitudinal research focusing on the individual and social consequences of mental health problems reported by older adults is needed to avoid misinterpretation of this finding.

Social relationships and depression among people 65 years and over living in rural and urban areas of Quebec

To compare the prevalence of depression within the elderly Quebec population residing in rural areas, urban areas and metropolitan Montreal, and to assess differences in the associations between social relationships and depression across these urban and rural settings.

Daily hassles, physical illness, and sleep problems in older adults with wishes to die.

BACKGROUND Factors associated with the wish to die should be investigated in order to gain more opportunities for preventive interventions targeting older adults at risk for suicide. The goal of the research was to study the prevalence and associated factors of wishes to die in older adults living in the community using the data from a survey on the prevalence of mental disorders in this population. METHODS With a representative sample of community living older adults aged 65 years and over (N = 2777), we compared individuals with the wish to die (n = 163) to those without the wish to die on the basis of the presence and severity of daily hassles, physical illness, and sleep quality. RESULTS Logistic regression revealed that when depression and sociodemographic variables were held constant, self-rated physical health, number of chronic illnesses, number and intensity of daily hassles, as well as sleep problems were significantly associated with the wish to die in older adults. Painful illnesses and daytime dysfunction due to sleep problems were also associated factors with the wish to die. CONCLUSION Since desire for death is the first step into the suicidal process, health professionals should seriously consider the important and unique contribution of these variables in order to have more opportunities for detection and intervention.

Development and validation of an instrument measuring individual empowerment in relation to personal health care: the Health Care Empowerment Questionnaire (HCEQ).

Purpose. The purpose of this study was to develop and validate a questionnaire that measures the degree of individual empowerment in relation to personal health care and services. Design. The questionnaire was developed by identifying individual empowerment indicators from the literature, generating corresponding items, and pretesting the tool with older persons. Setting. The Health Care Empowerment Questionnaire (HCEQ) was developed and validated with subjects participating in the Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) in the Sherbrooke and Quebec City area. Subjects. Eight hundred seventy-three subjects agreed to participate, for a response rate of 56.28%. The mean ages of men and women were 81.1 and 82.4 years, respectively. Analysis. Factor analysis (exploratory and confirmatory) determined the validity of the questionnaire, and the reliability was assessed using measures of internal consistency and temporal stability (test-retest). Results. The multidimensional nature of the concept of individual empowerment was confirmed by three factors that explain more than 68% of the total variance. The Cronhbachs alpha coefficient of internal consistency was .83 and the intraclass correlation coefficients (test-retest) was .70 (95% CI: .48–.83). Conclusion. In light of these findings, the characteristics and multidimensional perspective of the HCEQ appear to be useful in advancing knowledge about individual empowerment in relation to personal health care and services.

Addressing suicidal ideations through the realization of meaningful personal goals.

A personal goal intervention program was offered to early retirees aged 50 to 65 years with the objective of increasing their subjective well-being. The program was aimed at helping the participants set, plan, pursue, and realize their personal goals. A subsample of 21 participants with suicidal ideas was identified from a larger sample (N = 354) of retirees living in the community who took part in the study to evaluate the program. The experimental (n = 10) and control (n = 11) groups were compared on their answers to 16 goal and psychological well-being questionnaires. By the end of the program, the experimental group had improved significantly more than the control group on hope, goal realization process, serenity, flexibility, and positive attitude toward retirement. The levels of depression and psychological distress significantly decreased. These gains were maintained 6 months later. The positive results obtained from this study could lead to an innovative way to help people with suicidal ideations.

Development and validation of the Health Care Satisfaction Questionnaire (HCSQ) in elders.

The Health Care Satisfaction Questionnaire (HCSQ) was designed for the evaluation of health care and services in a manner that controls acquiescence bias yet is characterized by a simple structure. The HCSQ was developed and validated within the context of the Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) in the Sherbrooke and Quebec City areas of Quebec, Canada. Exploratory and confirmatory factor analyses were done with 873 subjects and confirmed the multidimensional nature of the concept of satisfaction. Three factors explained more than 52% of the total variance. The analysis of internal consistency produced Cronbach alpha coefficients of .93, .74, and .78 for Factors 1, 2, and 3, respectively. The alpha of the overall scale was .92. The intraclass correlation coefficient (test-retest) for the entire scale was .72 (95% CI: .52–.84). In light of these findings, the characteristics and multidimensional perspective of the HCSQ appear to be useful for measuring and advancing knowledge about health care and services satisfaction.

Reliability of a New Measure of Self-Actualization

The purpose of this study was to investigate both the internal consistency and temporal reliability of the Measure of Self-actualization of Potential. Results from the initial pilot study (n = 414) used to develop the inventory are compared with those of a new sample (n = 156) designed to evaluate its stability. Responses from the new sample support our initial findings of moderate to relatively high alpha coefficients for the two main scales and five subscales. Test-retest reliability for the new set of responses indicates high stability, with intraclass correlation coefficients ranging from .74 to .88. For the over-all scale, Cronbach alpha reaches .90 and the intraclass coefficient .87. In addition to better psychometric properties, the new inventory has two other advantages over the Personal Orientation Inventory, fewer items and a self-report format.

Valued Activities of Everyday Life Among the Very Old

Abstract Based on panel data from the Quebec Longitudinal Study on Aging, this article investigates the preferred types of activity of 80-85 year-olds, contrasting for gender and functional health condition. Both MANCOVA (p <.05) and ANCOVA (p <.01), with repeated measures, were used to assess the significance of a change in activity commitment. Results showed that respondents were more involved in emotional, spiritual, and social types of activity. Engagement in activities among older adults did not change significantly over a 1-year period. A reduced capacity in performing instrumental activities of daily living was found to have the most detrimental effect on valued activity. These results indicate that incapacity may have an adverse impact not only on physical activity, but on all other types of activity as well. The analyses suggest that the elderly manage to compensate for the loss in one type of activity by increasing their commitment in other types.

Normalisation du Mini-Mental State Examination (MMSE) chez les Québécois francophones âgés de 65 ans et plus et résidant dans la communauté *

Cette étude vise à produire un standard normatif pour le Mini-Mental State Examination (MMSE). Les normes ont été constituées à partir d’un échantillon (n = 2409) de Québécois francophones de 65 ans et plus résidant dans la communauté. Les analyses ont indiqué que les variables sociodémographiques, tel que la scolarité, l’âge et le genre, influencent significativement les cotes des personnes âgées au MMSE. Les cotes au MMSE augmentent avec le niveau de scolarité et diminuent avec l’âge. De plus, les femmes obtiennent des cotes significativement supérieures à celles des hommes. Ainsi, des tableaux de normes séparés ont été développés pour les femmes et les hommes. Dans chaque tableau, les cotes au MMSE correspondant aux percentiles 5, 10, 15 et 50 ont été identifiées selon quatre tranches d’âge et trois niveaux de scolarité. L’utilisation des données normatives de cette étude optimisera la détection des troubles cognitifs dans la population âgée du Québec.ABSTRACTThis study was aimed at providing normative data for the Mini-Mental State Examination (MMSE). The norms were built from a sample (n = 2409) of community-dwelling French speaking residents from Québec aged 65 and older. The analyses indicated that socio-demographic variables such as education level, age, and gender of individuals influenced significantly the scores of older adults on the MMSE. More precisely, MMSE scores increased with education level and decreased with age. Moreover, women had significantly higher scores than men. On this basis, distinct tables of normative data were produced for women and men. In each table, the MMSE scores corresponding to percentiles 5, 10, 15 and 50 were identified according to four age categories and three education levels. Overall, the use of the present normative data by clinicians will improve their accuracy in detecting cognitive impairment in older adults from Québec.