Régis Gonthier

Dual-task-related gait changes in transitionally frail older adults: the type of the walking-associated cognitive task matters.

Background: Changes in gait patterns due to a simultaneously performed cognitive task have been reported previously and associated with an increased falling risk among older adults. Little is known whether the type of cognitive task performed while walking is important concerning possible gait interference in older fall-prone individuals. Objective: To quantify and compare the effects of two different cognitive tasks on gait in transitionally frail older adults. Measurements: Gait was tested in 30 transitionally frail older adults (mean age 82.6 ± 7.1 years, 90% female) while either walking alone, performing a simple arithmetic task, or performing a task of verbal fluency. Walking time in seconds, number of steps, frequency of lateral line stepping-over, and stops were recorded. Health status was assessed using standard instruments of geriatric assessment. The classification of Speechley and Tinetti was used to define the participants’ degree of frailty. Results: Walking time and number of steps increased significantly under both dual-task conditions compared to walking alone (p < 0.001) without reaching a significant difference between the two dual-task conditions (respectively, p = 0.131 and p = 0.407), whereas lateral gait instability (frequency of lateral line stepping-over) increased significantly in association with counting backward (p = 0.006) but not with the verbal fluency task (p = 1). Conclusion: Among the studied sample of transitional older adults, a walking- associated arithmetic task significantly interfered with lateral gait stability, whereas no lateral gait deviations were seen in association with a verbal fluency task. We, therefore, suggest that the choice of the attention-splitting task in dual-task gait assessment among older adults must be made carefully.

Relationship between dual-task related gait changes and intrinsic risk factors for falls among transitional frail older adults

Background and aims: Gait changes in dual-task conditions have been associated with an increased risk of falling in older adults, and become more important in increasingly frail older adults. We studied the relationship between commonly known intrinsic risk factors for falls and dual-task related gait changes among transitional frail older adults. Methods: Walking time and number of steps were measured while walking alone and while walking with counting backward on a 10-m walkway in 66 transitional frail older adults (mean age 83.6±6.1, 84.9% women). Uni- and multiple linear regression analyses were performed to explore the relationship between dual-task related gait changes (walking time and number of steps) and age over 85 years, polymedication, psychoactive drugs, poor distance vision, abnormal mobility and cognitive impairment. Results: Compared with walking alone, both walking time and number of steps increased significantly while counting backward (p<0.001). Polymedication and abnormal mobility were associated with a significant increase of walking time and number of steps (p<0.01 for unadjusted change, p<0.05 for adjusted change). Conclusions: Dual-task related gait changes were closely correlated with polymedication and impaired mobility in our sample of transitional frail older adults. These findings give some insight into the complexity of performing attention-demanding tasks while walking and accentuate the need for multi-factorial, personalized intervention strategies, to prevent decline in dual-task performance in this fall-prone population.

Can maintaining cognitive function at 65 years old predict successful ageing 6 years later? The PROOF study

BACKGROUND preservation of cognitive abilities is required to have a good quality of life. The predictive value of cognitive functioning at 65 years old on successful ageing 6 years later is not established. METHODS nine hundred and seventy-six questionnaires were sent by mail to a sample of healthy and voluntary French pensioners. Successful ageing was defined through health status and well-being. Cognitive abilities had been assessed 6 years earlier according to an objective method (Free and Cued Selective Recall Reminding Test (FCSRT), the Benton visual retention test and the similarities subtest of the Wechsler Adult Intelligence Scale-Revised) and a subjective one (Goldbergs anxiety scale, Mac Nairs scale and a Visual Analogue Scale to evaluate memory abilities change in the last 5 years). RESULTS six hundred and eighty-six questionnaires could be analysed. The mean age was 72.9 ± 1.2 years old with 59% of women and 99% lived at home. Well-being was negatively correlated with the FCSRT (r = -0.08, P = 0.0318) but positively related with the Benton (r = 0.09, P = 0.0125) and the similarities tests (r = 0.09, P = 0.0118). There is a negative correlation between anxious and cognitive complaints measured at baseline, and successful ageing indicators 6 years later. CONCLUSION preservation of cognitive abilities at the age of retirement can predict a successful ageing 6 years later. ClinicalTrials.gov Identifier: NCT00759304.

Behavioral and psychological symptoms of dementia and bipolar spectrum disorders: review of the evidence of a relationship and treatment implications.

Dementia is a neuropsychiatric disorder characterized by cognitive impairment and behavioral disturbances. The behavioral and psychological symptoms of dementia (BPSD) are common, contributing to caregiver burden and premature institutionalization. Management of BPSD is complex and often needs recourse to psychotropic drugs. Though widely prescribed, there is a lack of consensus concerning their use, and serious side effects are frequent. This is particularly the case with antidepressant treatment based on the assumption that BPSD is depressive in nature. A better understanding of BPSD etiology could lead to better management strategies. We submit that some BPSD could be the consequence of both dementia and an undiagnosed comorbid bipolar spectrum disorder, or a pre-existing bipolar diathesis pathoplastically altering the clinical expression of dementia. The existence of such a relationship is based on clinical observation, as far as the high frequency of bipolar spectrum disorders in the general population, with a prevalence estimated to be between 5.4% and 8.3%, and the psychopathological similarities between BPSD and mood disorder episodes in bipolar illness. We will review the concept of the bipolar spectrum and explain BPSD before proposing clinical pointers of a possible bipolar spectrum contaminating the phenomenology of dementia, which could lead to the targeted prescription of mood-stabilizing agents in lieu of antidepressant monotherapy. These considerations are of heuristic interest in reconceptualizing the origin of the behavioral manifestations of dementia, with important implications for geriatric practice.

SEVEN-YEAR PREDICTORS OF SELF-RATED HEALTH AND LIFE SATISFACTION IN THE ELDERLY: THE PROOF STUDY

OBJECTIVES To investigate the relationship between cognitive performance, affective state, metabolic syndrome and 7-year follow-up self-rated health (SRH) and perceived life satisfaction (PLS). DESIGN Analysis of a prospective cohort study. SETTING The PROOF study, including 1011 elderly community residents. PARTICIPANTS Six hundred and fifty seven subjects completed metabolic syndrome (Met S) variables, neuropsychological and affective measurements at baseline, and then returned a 7-year follow-up questionnaire which included SRH and PLS. MEASUREMENTS The prospective association between cognitive function, Met S and each of its components, and affective disorders and subsequent subjective health and quality of life was examined. Covariates included educational level and use of tobacco. The analyses were made in men and women separately. RESULTS In multivariate models, the presence of Met S was significantly associated to weaker SRH (OR = 2.78, p = 0.009 in men and OR = 2.0, p = 0.02 in women). Higher triglycerides rate were associated with weaker SRH in men (OR = 2.23, p = 0.002) and higher fasting glucose in women (OR = 2.54, p = 0.006). Global Met S and abdominal obesity was significantly associated to weaker PLS in women only (respectively OR = 2.70, p = 0.0002 and OR = 1.9, p = 0.02). Depressive symptoms were significantly associated to both weaker SRH and PLS in men (OR = 1.30, p = 0.002; OR = 1.44, p < 0.0001 for SRH and PLS respectively) and in woman (OR = 1.09, p = 0.04; OR = 1.26, p < 0.0001 for SRH and PLS respectively). Anxiety was linked to both weaker SRH and PLS in women (OR = 1.17, p = 0.002 and 0R = 1.11, p = 0.03 for SRH and PLS respectively). Finally, lower executive function was associated with weaker PLS in men (OR = 0.43, p = 0.0005). CONCLUSION metabolic syndrome and certain of its components, anxiety and depressive symptoms, are independent predictors of poorer subjective health and quality of life as assessed over a period of 7 years in a population of a non-demented aging community. Moreover, executive performance was linked to subsequent quality of life in men. Many of these factors being treatable, our findings point to the necessity of providing preventive care strategies by the management of cardiovascular risk factors and anxio-depressive symptoms.

Level of physical activity at the age of 65 predicts successful aging seven years later: the PROOF study.

BACKGROUND Physical activity has a pleiotropic effect and is a significant factor in successful aging. This study aims to quantify the relationship between the physical activity of a 65-year-old cohort and the level of life satisfaction and self-rated health 7 years later. METHODS A total of 988 questionnaires were sent by mail to a representative sample of healthy pensioners. Life satisfaction and health status were estimated on two visual analogical scales in answer to the following questions: (1) How would you estimate your state of health? and (2) Are you generally satisfied with your life? The level of physical activity was estimated using a questionnaire which enabled us to calculate: (1) Daily energy expenditure (DEE), (2) physical activity energy expenditure (PAEE), (3) daily energy expenditure higher than 5 metabolic equivalents (METs) (DEQisa), (4) Activity index (PAEE/DEE), (5) VO(2) peak. RESULTS In all, 686 responses were validated. The average age was 72.9 ± 1.2 years old with 59.5% of women (n = 408). Amongst the sample, 98.8% (n = 676) lived in their own homes and 25.2% (n = 172) lived alone. Mean DEE was 10.365 ± 1.964  kJ/24  h, mean PAEE was 4.479 ± 1.170  kJ/24  h, mean activity index was 0.42 ± 0.05, and mean estimated oxygen uptake (VO(2)) peak was 22.5 ± 1.6  mL/min per kg. Activity index and VO(2) peak were the variables most significantly correlated with self-rated health (p = 0.0032 and p = 0.0011, respectively) and life satisfaction (p = 0.0117 and p = 0.0053). CONCLUSIONS Energy spent in activity and VO(2) peak estimated from DEE, measured at the age of 65, appear to be strong predictors of well-being 7 years later.

[Refusal of application to care in Alzheimer's disease and related diseases: establishment of a mobile unit hospital extra].

UNLABELLED Refusal of care and support in these patients with Alzheimers disease and related illnesses at home is a cause of accelerated loss of autonomy and increases the risk of a crisis with early institutionalization. Factors contributing to the denial of care are poorly understood and very few epidemiological data exist. MATERIALS AND METHODS we compared age, diagnosis, level of severity of the disease, the type of behavioral, family status of 101 patients living in denial of care and support as seen by a mobile home (group UPEPc) to 136 control patients seen at the memory clinic (group CM). Patients living in denial of care appear to significantly low age [82/80.5, p<0.0001], with more advanced disease [average MMSE 18/22, p<0.0001], the presence family conflicts and behavioral disorders [delirious--hallucination, agitation--aggression, depression, apathy, p<0.05]. CONCLUSION the profile of patients refusing home care is specific and it is important to educate GPs conditions that favor an obstacle to medicalization. The advantage of a mobile extramural to analyze risk factors for refusal of care and propose alternatives should be further investigated.

Botulinum toxin in the elderly to the care of limbs spastic hypertonia and toes or fingers dystonias

OBJECTIVE To show the botulinum toxin interest and limits in the elderly presenting a limbs spastic hypertonia and/or a dystonia, through a clinical study and a literature review. METHOD We report a 6 years and 8 months retrospective single center study, concerning 49 patients, all of them was more than 70 years old and had received one or several botulinum toxin injections for a limbs spastic hypertonia and/or a dystonia. RESULTS The population average was 76,9 years old (70 to 92 years old). It was possible to realize several sessions for the same patient if respecting a three months interval between two sessions. No major side effects was noticed. More than half of the patients felt a significant improvement of their life quality, their functional status and/or on pain. A multidisciplinary care was systematically associated with the botulinum toxin. CONCLUSION The botulinum toxin is an additional asset for the spasticity care of the geriatric patient in rehabilitation, if indications and contraindications are advisedly targeted. The age cannot be considered as a limitating factor.

Decision-making for gastrostomy after 70 years old: a prospective study about 26 patients

Management of undernutrition is based on young adults analysis. However, enteral nutrition is mainly discussed in the elderly. The aim of this study was to analyse factors related to laying gastrostomy, in geriatrics. A prospective, descriptive study, was conducted in the Loire department, from 2014 to 2016, in geriatric and palliative units. All patients over 70 years who had a theorical indication of gastrostomy were included. Decision-making process was analyzed from data affecting the reflection. Patients were followed for three months. Twenty-six patients were included with an average of 81 years old. They were frailty with a low mean serum albumin (29.2 g/L), an undernutrition (85%), an extended bedridden (73%), a medical history of aspiration pneumonia (46%) and with pressure ulcers (27%). The main diagnoses were strokes (38%) and dementia (23%). After a singular decision-making, only 15% received a gastrostomy. At three months, 69.2% of patients had died. Patients over 70 years old, with a vital prognosis at short term, are not good candidates for gastrostomy. In geriatrics, decision-making for gastrostomy laying is complex because managed by contradictory recommendations. It requires a global assessment to identify risk situations. The early detection of undernutrition is the key to successful management, for patients requiring gastrostomy.

Intérêt d’une unité médico-chirurgicale gériatrique dans un hôpital de proximité : étude rétrospective

BACKGROUND Orthogeriatric units have shown through several studies their effectiveness on reducing the morbidity and mortality after hip fracture. What about other emergency surgeries at the elderly? We evaluated the results of a small medical surgical geriatric unit (UMCG) for all the not sheduled surgeries. METHODS A retrospective sudy has been done, analyzing management of patients over 75 years after an emergency surgery, between 1st January 2013 and 15 February 2014 for the surgical unit, and between 15 February 2014 and 15 April 2014 for the UMCG. 3-month mortality, 6-month mortality and the main early complications were compared between the two groups, by a multivariated analysis fitting on the data on patient characteristics. RESULTS 3-month mortality was significantly lower in the UMCG group (odds ratio 0.07 [95%IC: 0.004-0.48]; p=0.02), while the patients in this unit were more likely with dementia, with fall antecedent and with more comorbidity. 6-month mortality as well was lower in the UMCG group (0.10 [0.02-0.36]; p=0.001). CONCLUSION Management of not sheduled surgeries at the elderly in specific surgical geriatric unit is associated in a statistically significant reduction of 3-month mortality and 6-month mortality.