The prevention school diary: Evaluability assessment of a widely adopted intervention in Ile-de-France.

OBJECTIVES: The prevention school diary is distributed each year to children aged between 10 and 11 years old by La Ligue contre le cancer, a French association promoting prevention and research against cancer. While they write their homework in the diary, children can learn about a range of health determinants. This diary promotes health in a fun and educational way, as it integrates drawings made by children about the different themes covered by the diary. This paper aims to present the evaluability assessment of this intervention in Ile-de-France (Paris area), where it is already widely deployed. MATERIAL AND METHODS: We have traced the history of the prevention school diary and assessed how it is currently used in Ile-de-France by leading interviews with county committees of La Ligue contre le cancer. Successive versions of the diary and results of teacher satisfaction surveys were examined. All information collected was integrated into a logic model, which characterizes the main components, actors, and effects of the intervention. RESULTS: The prevention school diary was created in the West of France in the late 90s. It was then implemented in Paris and extended to other counties of Ile-de-France. Currently, six counties collaborate on the production of a common diary. Whereas it only dealt with tobacco consumption at the beginning, the prevention school diary now covers nutrition, physical activity, sun exposure, sleep and screen use, addiction, as well as safety in some counties. Three levels of intervention have been identified, depending on whether or not the distribution of the diary is followed by the production of drawings for the next edition or health education sessions. The expected effects of the prevention school diary have been integrated into a logic model emphasizing children, school, and family level. Outcomes include Capabilities (knowledge and skills), Opportunities, and Motivation to adopt healthy Behaviours, according to the theoretical model of behaviour change COM-B. CONCLUSION: The evaluability assessment phase enabled us to gain a better understanding of the conditions under which the intervention is deployed, and thus to identify the factors to be considered for a broad assessment of its effectiveness. It is especially important since the intervention is already well established in Ile-de-France.

Potentially inappropriate medications in nursing homes and the community older adults using the French health insurance databases.

PURPOSE: Potentially inappropriate medications (PIMs) have become a major issue in improving prescribing practices and reducing the risk of adverse drug events in older people. However, very few studies have compared exposition to PIMs controlling for differences in demographic and health between nursing home residents (NHRs) and community-dwelling older adults (CDOAs). This study aimed to assess the prescribing pattern of PIMs between NHRs and CDOAs. METHODS: We conducted a cross-sectional study over three months in 2019 using the French Health Insurance databases. The study population included 274 971 NHRs and 4 893 721 CDOAs aged 75 years or over. The prevalence ratio (PR) between NHRs and CDOAs of 17 PIM indicators, based on the Beers and STOPP criteria lists, was assessed using multivariable robust Poisson regression adjusted for age, sex, diseases, and polypharmacy. RESULTS: During the study period, 54% of NHRs and 29% of CDOAs received at least one PIM. After adjustment, the prevalence of PIMs was 33% higher among NHRs compared to CDOAs (aPR = 1.33; 95% CI [1.33-1.34]). NHRs received PIMs related to benzodiazepines (aPR = 1.43; 95% CI [1.42-1.43]), anticholinergic drugs (aPR = 1.29; 95% CI [1.27-1.31]), and at least three central nervous system-active drugs (aPR = 1.94; 95% CI [1.92-1.96]) more frequently. Prevalence of PIMs related to non-steroidal anti-inflammatory drugs (aPR = 0.50; 95% CI [0.48-0.52]) and long-acting benzodiazepines (aPR = 0.84; 95% CI [0.82-0.85]) was lower among NHRs. CONCLUSION: The NHRs were at greater risk for PIM than CDOAs, although differences exist according to the category of PIMs. As the population is aging, it is essential to promote and evaluate interventions in NHs and the community to enhance medication optimization.

Potentially inappropriate prescriptions: Associations with the health insurance contract and the quality of the patient-physician relationship?

CONTEXT: Potentially Inappropriate Prescriptions (PIP) are often used as an indicator of potential drug overuse or misuse to limit adverse drug events in older people. OBJECTIVE: To determine whether PIP exposure differs as a function of the patient's health insurance scheme and the patient-physician relationship. METHODS: Our dataset was collected from two surveys delivered to two cohorts of the Swiss Lc65+ study, together with a stratified random sample of older people in the Swiss canton of Vaud. The study sample consisted of 1,595 people aged 68 years and older living in the community and reporting at least one prescription drug. Logit regression models of PIP risk were run for various categories of variables: health related, socioeconomic, health insurance scheme and patient-physician relationship. RESULTS: 17% of our respondents had at least one PIP. Our results suggested that being enrolled in a health plan with restriction in the patient's choice of providers and having higher deductibles were associated with lower PIP risk. PIP risk did not differ as a function of the quality of the patient-physician relationship. CONCLUSION: Our study helps to raise awareness about the organizational risk factors of PIP and, more specifically, how health insurance contracts could play a role in improving the management of drug consumption among community-dwelling older people.

[Vitamin D and neuropsychological assessment of cognitive functions: a study of their relationships in a sample of 244 patients attending a memory clinic]. / Vitamine D et évaluation neuropsychologique des fonctions cognitives : étude chez 244 sujets âgés pris en charge en hôpital de jour mémoire.

There is evidence of a role of vitamin D in cognitive functioning, but little is known about the type of functions involved. To describe vitamin D status in a population of old patients with memory complaints and its relationships with cognitive performance and white matter lesions. A retrospective single-centre observational study from the medical records of 244 patients who had a measurement of serum 25OHD together with a battery of neuropsychological tests during a complete geriatric and memory assessment in a day care hospital. The results of the 10 neuropsychological tests considered in this study were analysed as binary variables, opposing patients with results within the highest two tertiles to patients with the worse results or unable to perform the test. Mean age of people included was 80.2 ± 8.1 years and 64% of patients were women. Severe deficiency in vitamin D (25OHD <10 ng/mL) was found in 34 patients (13.9%) and moderate deficiency (10 ≤ 25OHD < 30 ng/mL) in 148 (60.7%). Compared to subjects with sufficient concentrations in vitamin D, patients with severe deficiency performed significantly worse on a global test, the Mini mental state examination, and two tests of verbal memory, the 5 words and the 16-item free and cued recall, independently from age, gender, education, body mass index and autonomy (OR = 2.85 [1.04-7.85], 4.31 [1.42-13.07], and 3.04 [1.01-9.19] respectively). Levels of vitamin D did not differ according to the extent of white matter lesions, visualized semi-quantitatively on magnetic resonance imaging of 115 subjects. This study confirms the high prevalence of vitamin D deficiency in elderly population and suggests a link between vitamin D deficiency and memory.

Contribution of socioeconomic position over life to frailty differences in old age: comparison of life-course models in a French sample of 2350 old people.

PURPOSE: To assess the impact of socioeconomic position (SEP) over life on a measure of frailty in old age. METHODS: This is a cross-sectional population study of people aged 70 years and more in which 2350 respondents were interviewed in 2008 to 2010. The relationships between different indicators of SEP (childhood standard of living, level of education, occupational class, and current affluence) and quartiles of a frailty index including 43 variables were assessed in ordinal regression models adjusted for potential confounders. RESULTS: Mean age of the population was 83.3 ± 7.5 years, with 59.4% of women. The mean value of the frailty index was 0.19 ± 0.13, with values ranging between 0 and 0.65. All periods of social disadvantage were associated with increasing frailty in bivariate analysis. In multivariate analysis, a poor level financial security in the old age was the SEP indicator the most strongly associated with frailty (odds ratio [OR]: 2.81, 95% confidence interval [CI]: 2.20-3.59), followed by a low level of education (OR: 1.45, 95% CI: 1.17-1.80) and occupation during active life (OR: 1.38, 95% CI: 1.06-1.79). CONCLUSIONS: Socioeconomic inequalities over life affect health capital in old age. The most important risk factor identified in this study, contemporary financial difficulties, was also the most accessible to prevention.

Unmet health care needs of older people: prevalence and predictors in a French cross-sectional survey.

BACKGROUND: Unmet health care needs are associated with negative health outcomes, yet there is a paucity of data on this problem among older people. OBJECTIVE: To identify unmet health care needs and associated factors among older people in France. METHODS: This is a cross-sectional population study of people aged 70 years or older in which 2350 respondents were interviewed in 2008-10. During a standardized interview, a nurse examined health problems, functional abilities and use of health care resources. Unmet health care needs were defined as situations in which a participant needed health care and did not receive it. RESULTS: The mean age was 83.2 ± 7.4 years. Almost all participants reporting a chronic disease (98.6%) had consulted a physician in the previous 6 months. Unmet health care needs were found in 23.0% of the sample and mainly consisted of lack of dental care (prevalence of 17.7%), followed by lack of management of visual or hearing impairments (prevalence of 4.4% and 3.1%, respectively). Age was the main factor associated with unmet health care needs [compared with people aged 70-79: odds ratio80-89 years = 2.26 (1.70-3.03), odds ratio90 years and over = 3.85 (2.71-5.45)]. Other associated factors were regular smoking, homebound status, poor socioeconomic conditions, depression, limitations in instrumental activities of daily living and low medical density. CONCLUSION: Unmet health care needs affect almost one-quarter of older people in France. Efforts should be made to improve oral health and develop home care, especially for the oldest-olds.