Spousal Caregiving Is Associated with an Increased Risk of Frailty: A Case-Control Study.

BACKGROUND: Evidence suggests that providing care for a disabled elderly person may have implications for the caregiver's own health (decreased immunity, hypertension, and depression). OBJECTIVE: Explore if older spousal caregivers are at greater risks of frailty compared to older people without a load of care. DESIGN: Case-control study. SETTING: Participants were assessed at home in Wallonia, Belgium. PARTICIPANTS: Cases: community-dwelling spousal caregivers of older patients, recruited mainly by the geriatric outpatient clinic. CONTROLS: people living at home with an independent spouse at the functional and cognitive level matched for age, gender and comorbidities. MEASUREMENTS: Mini nutritional assessment-short form (MNA-SF), short physical performance battery (SPPB), frailty phenotype (Fried), geriatric depression scale (GDS-15), clock drawing test, sleep quality, and medications. The multivariable analysis used a conditional logistic regression. RESULTS: Among 79 caregivers, 42 were women; mean age and Charlson comorbidity index were 79.4±5.3 and 4.0±1.2, respectively. Among care-receivers (mean age 81.4±5.2), 82% had cognitive impairment. Caregiving was associated with a risk of frailty (Odd Ratio (OR) 6.66; 95% confidence interval (CI) 2.20-20.16), the consumption of antidepressants (OR 4.74; 95% CI 1.32 -17.01), shorter nights of sleep (OR 3.53; 95% CI 1.37-9.13) and more difficulties maintaining a social network (OR 5.25; 95% CI 1.68-16.40). CONCLUSIONS: Spousal caregivers were at an increased risk of being frail, having shorter nights of sleep, taking antidepressants and having difficulties maintaining their social network, compared to non-caregiver controls. Older spousal caregivers deserve the full attention of professionals to prevent functional decline and anticipate a care breakdown.

[Ultrastructural and microanalytic study of gold depots in the synovial membrane of man and animals during treatment with sodium aurothiopropanol sulfonate]. / Etude ultrastructurale et microanalyse des dépôts d'or dans la membrane synoviale chez l'homme et chez l'animal au cours des traitements par l'aurothiopropanol-sulfonate de sodium.

In inflammatory rheumatism treated by gold therapy synoviocytes A are stuffed with gold salt deposits leading to a therapeutic thesaurismosis. These deposits are localized in lysosomes, then called aurosomes. However they may be rarely near collagen fibers or free, particularly in ankylosing spondylitis synovitis. Their structural morphological aspect is the same in several human rheumatic diseases and in rabbit experimental arthritis whatever the gold salt used. In such deposits, microprobe analysis shows gold and sulphur. This latter is probably given by the cell. Therapeutic effect of gold salts may imply the effect of the thiol moiety and the gold metal one.

[Rheumatism caused by lipid thesaurismosis. Articular involvement in hyperlipoproteinemia type II : presence of microcrystals in the mitochondria of synoviocytes]. / Le rhumatisme des thésaurismoses à lipides. Atteinte articulaire au cours de l'hyperdyslipidémie de type II : présence de microcristaux dans les mitochondries des synoviocytes.

For 13 years polyarthritis with specific synovial involvement was observed in a case of type II hyperlipoproteinemia. Microcrystals similar to those described in Gaucher's and Fabry's disease were seen in synovial cytoplasm and mitochondria. These data suggest a microcrystalline pathogenesis for type II hyperlipoproteinemia arthritis as in gout and chondrocalcinosis.

[Lipid thesaurismosis rheumatism. Joint manifestation during glucocerebrosidase deficiency (Gaucher's disease). Ultrastructural study of the synovial membrane]. / Le rhumatisme des thésaurismoses à lipides. Atteinte articulaire au cours de la carence en glucocérébrosidase (maladie de Gaucher. Etude ultrastructurale de la synoviale.

Articular inflammatory involvement may be the first sign of gluocecerebrosidase deficiency (Gaucher's disease). Electron microscope study shows specific synovial storage lesions which explain arthritic manifestations. Furthermore presence of mitochondrial microcrystals, (apatite?), suggest microcrystal pathogenesis of Gaucher's arthritis.

[Lipid thesaurismosis rheumatism. Arthropathies in alpha galactosidase A deficiency (Fabry's disease). Ultrastructural study of the synovial membrane demonstrating microcrystals in the mitochondria of synoviocytes]. / Le rhumatisme des thésaurismoses à lipides. Arthropathies au cours de la carence en alpha galactosidase A (maladie de Fabry). Etude ultrastructurale de la membrane synoviale avec mise en évidence de microcristaux dans les mitochondries des synoviocytes.

Articular manifestations may be the onset of genetic alpha galactosidase deficiency (Fabry's disease). Ultrastructural study shows typical osmiophilic lamellar inclusions of trihexosylceramides in synoviocytes, capillaries and adipocytes. Furthermore microcrystals identical to those seen in Gaucher's disease and type II hyperlipoproteinemia were observed in mitochondria and free in cytoplasm. These data suggest a microcrystalline pathogenesis of these arthropathies, as in gout and chondrocalcinosis, and what we have generally called crystallopathic arthropathies.

[Hydroxyapatite rheumatism (multiple tendon calcification disease). II. - Microscopic study - HL-A antigen - Experimental arthritis - Pathogeny]. / Le rhumatisme à hydroxyapatite (la maladie des calcifications tendineuses multiples). II - Etude microscopique - Antigène HLA - Arthrite expérimentale - Pathogénie.

Optical and electron microscopic studies of the articular fluid in multiple calcification disease reveals the existence of rounded intra- and extracellular crystalline formations. These crystalline formations of calcium and phosphorus are made up of accumulations of tiny crystals shaped like fine needles 200 nm X 15-20 nm and are highly suggestive of hydroxyapatite. Crystals injected into the plantar pads of rats or the knees of rabbits induce an acute inflammatory reaction maximal at 5 hours and recovering in 24 72 hours. Hydroxyapatite crystals are swiftly dissolved in serum and more rapidly still when cells are present. Their dissolution releases calcium into the surrounding area. HLA typing of patients with multiple tendinous calcification (28 cases) or single tendinous calcification (10 cases) shows an increased frequency of HLA A2 and BW 35 in comparison with controls.

[Diagnostic value of ultrastructural study of the synovial membrane in rheumatic diseases]. / Intérêt diagnostique de l'étude ultrastructurale de la synoviale dans les maladies rhumatismales.

This paper deals with diagnosis value of synovium electron microscopic study in inflammatory and metabolic rheumatism. Detection in synovium of hydroxyapatite, Ca pyrophosphate and other biological crystals often need the use of EM. It is also a good diagnosis tool in inherited lipid and glucid metabolism disorders and to establish an anatomic correlation between the osteo-articular localization and the systemic disease. Furthermore EM is able to detect stigmata of previous treatment such as chrysotherapy, immune complexes deposits in tissues, amyloidosis fibrils and even viral or bacterial material.