Diabetes mellitus in older persons with neurocognitive disorder: overtreatment prevalence and associated structural brain MRI findings.

BACKGROUND: Tight diabetes control is often applied in older persons with neurocognitive disorder resulting in increased hypoglycemic episodes but little is known about the pattern of brain injury in these overtreated patients. This study aims to: (a) quantify the prevalence of diabetes overtreatment in cognitively impaired older adults in a clinical population followed in an academic memory clinic (b) identify risk factors contributing to overtreatment; and (c) explore the association between diabetes overtreatment and specific brain region volume changes. METHODS: Retrospective study of older patients with type 2 diabetes and cognitive impairment who were diagnosed in a memory clinic from 2013 to 2020. Patients were classified into vulnerable and dependent according to their health profile. Overtreatment was defined when glycated hemoglobin was under 7% for vulnerable and 7.6% for dependent patients. Characteristics associated to overtreatment were examined in multivariable analysis. Grey matter volume in defined brain regions was measured from MRI using voxel-based morphometry and compared in patients over- vs. adequately treated. RESULTS: Among 161 patients included (median age 76.8 years, range 60.8-93.3 years, 32.9% women), 29.8% were considered as adequately treated, 54.0% as overtreated, and 16.2% as undertreated. In multivariable analyses, no association was observed between diabetes overtreatment and age or the severity of cognitive impairment. Among patients with neuroimaging data (N = 71), associations between overtreatment and grey matter loss were observed in several brain regions. Specifically, significant reductions in grey matter were found in the caudate (adj ß coeff: -0.217, 95%CI: [-0.416 to -0.018], p = .033), the precentral gyri (adj ßcoeff:-0.277, 95%CI: [-0.482 to -0.073], p = .009), the superior frontal gyri (adj ßcoeff: -0.244, 95%CI: [-0.458 to -0.030], p = .026), the calcarine cortex (adj ßcoeff:-0.193, 95%CI: [-0.386 to -0.001], p = .049), the superior occipital gyri (adj ßcoeff: -0.291, 95%CI: [-0.521 to -0.061], p = .014) and the inferior occipital gyri (adj ßcoeff: -0.236, 95%CI: [-0.456 to - 0.015], p = .036). CONCLUSION: A significant proportion of older patients with diabetes and neurocognitive disorder were subjected to excessively intensive treatment. The association identified with volume loss in several specific brain regions highlights the need to further investigate the potential cerebral damages associated with overtreatment and related hypoglycemia in larger sample.

Unplanned transfer to acute care during inpatient geriatric rehabilitation: incidence, risk factors, and associated short-term outcomes.

BACKGROUND: Information is scarce on unplanned transfers from geriatric rehabilitation back to acute care despite their potential impact on patients' functional recovery. This study aimed 1) to determine the incidence rate and causes of unplanned transfers; 2) to compare the characteristics and outcomes of patients with and without unplanned transfer. METHODS: Consecutive stays (n = 2375) in a tertiary geriatric rehabilitation unit were included. Unplanned transfers to acute care and their causes were analyzed from discharge summaries. Data on patients' socio-demographics, health, functional, and mental status; length of stay; discharge destination; and death, were extracted from the hospital database. Bi- and multi-variable analyses investigated the association between patients' characteristics and unplanned transfers. RESULTS: One in six (16.7%) rehabilitation stays was interrupted by a transfer, most often secondary to infections (19.3%), cardiac (16.8%), abdominal (12.7%), trauma (12.2%), and neurological problems (9.4%). Older patients (AdjORage≥85: 0.70; 95%CI: 0. 53-0.94, P = .016), and those admitted for gait disorders (AdjOR: 0.73; 95%CI: 0.53-0.99, P = .046) had lower odds of transfer to acute care. In contrast, men (AdjOR: 1.71; 95%CI: 1.29-2.26, P < .001), patients with more severe disease (AdjORCIRS: 1.05; 95%CI: 1.02-1.07, P < .001), functional impairment before (AdjOR: 1.69; 95%CI: 1.05-2.70, P = .029) and at rehabilitation admission (AdjOR: 2.07; 95%CI: 1.56- 2.76, P < .001) had higher odds of transfer. Transferred patients were significantly more likely to die than those without transfer (AdjOR 13.78; 95%CI: 6.46-29.42, P < .001) during their stay, but those surviving had similar functional performance and rate of home discharge at the end of the stay. CONCLUSION: A significant minority of patients experienced an unplanned transfer that potentially interfered with their rehabilitation and was associated with poorer outcomes. Men, patients with more severe disease and functional impairment appear at increased risk. Further studies should investigate whether interventions targeting these patients may prevent unplanned transfers and modify associated adverse outcomes.

[Equality across ages : addressing gender discrimination among older patients]. / Égalité à tous les âges : aborder la discrimination de genre chez les patient-e-s âgé-e-s.

The aim of this article is to draw attention to sex- and gender-related differences in the management of elderly patients. This issue is illustrated with two diseases linked to gender and sex: osteoporosis and high blood pressure. On one hand, patients of the sex less affected by the disease may feel less concerned; on the other hand, these patients are at greater risk of being under-diagnosed by medical and nursing staff. In addition, studies tend to overlook patients of the less-affected sex, resulting in guidelines that do not take account of sex or gender specific characteristics. There is even less literature on gender-related disparities in care in the elderly population than in the young, but it can be assumed that this risk of disparities exists even more in relation to specificities in diagnosis and care of elderly patients.

Cet article vise à attirer l'attention sur le risque de différences de prise en charge des patient-e-s âgé-e-s liées au sexe et au genre, illustré par deux pathologies considérées l'une comme féminine, l'autre comme masculine : l'ostéoporose et l'hypertension artérielle. Dans ce type de pathologies, les patient-e-s du sexe le moins touché par la maladie peuvent se sentir moins concerné-e-s et ont un risque accru de sous-diagnostic de la part du corps médicosoignant. De plus, les études tendent à négliger les patient-e-s du sexe moins touché, aboutissant à des guidelines ne tenant pas compte de spécificités liées au sexe ou au genre. La littérature sur les disparités de prise en charge liées au genre dans la population âgée est encore très limitée. Néanmoins, il est important de prendre en compte les spécificités liées au genre au même titre que celles liées à l'âge avancé.

Executive function and prospective falls: a 6-year longitudinal study in community-dwelling older adults.

BACKGROUND: Older people with impaired executive function (EF) might have an increased fall risk, but prospective studies with prolonged follow-up are scarce. This study aimed to investigate the association between a) EF at baseline; b) 6-year decline in EF performance; and fall status 6 years later. METHODS: Participants were 906 community-dwelling adults aged 65-69 years, enrolled in the Lausanne 65 + cohort. EF was measured at baseline and at 6 years using clock drawing test (CDT), verbal fluency (VF), Trail Making Test (TMT) A and B, and TMT ratio (TMT-B - TMT-A/TMT-A). EF decline was defined as clinically meaningful poorer performance at 6 years. Falls data were collected at 6 years using monthly calendars over 12 months. RESULTS: Over 12-month follow-up, 13.0% of participants reported a single benign fall, and 20.2% serious (i.e., multiple and/or injurious) falls. In multivariable analysis, participants with worse TMT-B performance (adjusted Relative Risk Ratio, adjRRRTMT-B worst quintile = 0.38, 95%CI:0.19-0.75, p = .006) and worse TMT ratio (adjRRRTMT ratio worst quintile = 0.31, 95%CI:0.15-0.64, p = .001) were less likely to report a benign fall, whereas no significant association was observed with serious falls. In a subgroup analysis among fallers, participants with worse TMT-B (OR:1.86, 95%CI = 0.98-3.53, p = .059) and worse TMT ratio (OR:1.84,95%CI = 0.98-3.43,p = .057) tended to have higher odds of serious falls. EF decline was not associated to higher odds of falls. CONCLUSIONS: Participants with worse EF were less likely to report a single benign fall at follow-up, while fallers with worse EF tended to report multiple and/or injurious falls more frequently. Future studies should investigate the role of slight EF impairment in provoking serious falls in active young-old adults.

Older patients referred for geriatric consultation in the emergency department: characteristics and healthcare utilization.

BACKGROUND: Comprehensive geriatric assessment (CGA) is difficult to perform in the emergency department (ED) environment and performance of screening tools in identifying vulnerable older ED patients who are best candidates for a geriatric consultation remain questionable. AIM: To determine the characteristics of older patients referred for a geriatric consultation by ED staff and to investigate these patients' subsequent healthcare utilization. METHODS: Secondary analysis of data previously collected for a prospective observational study of patients aged 75 + years visiting the ED of an academic hospital in Switzerland over four months (Michalski-Monnerat et al., J Am Geriatr Soc 68(12):2914-20, 2020). Socio-demographic, health, functional (basic activities of daily living; BADL), cognitive, and affective status data were collected at admission by a research nurse using a standardized brief geriatric assessment. Information on geriatric consultations, hospitalization, discharge destination, and 30-day readmission were retrieved from hospital database. Bivariable and multivariable analyses were performed using this data set collected previously. RESULTS: Thirty-two (15.8%) of the 202 enrolled patients were referred for a geriatric consultation. Compared to the others, they were older (84.9 ± 5.4 vs 82.9 ± 5.4 years, p = .03), more impaired in BADL (4.8 ± 1.6 vs 5.5 ± 1.0, p = .01), with more comorbid conditions (5.3 ± 1.5 vs 4.5 ± 1.9, p = .03), more frequently admitted after a fall (43.7% vs 19.4%, p = .01), and hospitalized over the previous 6-month period (53.1% vs 30.6%, p = .02). Multivariable analyses that adjusted for variables significantly associated with outcomes in bivariable analysis found that being admitted after a fall (AdjOR 4.0, 95%CI 1.7-9.4, p < .01) and previously hospitalized (AdjOR 2.7, 95% CI 1.2-6.2, p = .02) remained associated with increased odds of consultation, whereas the inverse association with BADL performance remained (AdjOR 0.7, 95%CI 0.5-0.9, p = .01). Patients referred for geriatric consultation had higher odds of hospitalization (84.4% vs 49.4%; AdjOR 5.9, 95%CI 2.1-16.8, p < .01), but similar odds of home discharge when admitted, and of 30-day readmission. CONCLUSION: About one in six older ED patients were referred for a geriatric consultation who appeared to be those most vulnerable, as suggested by their increased hospitalization rate. Alternative strategies are needed to enhance access to geriatric consultation in the ED.

Identifying common patterns of health services use: a longitudinal study of older Swiss adults' care trajectories.

BACKGROUND: Population ageing puts pressure on health systems initially designed to handle acute and episodic illnesses. Segmenting an ageing population based on its healthcare utilization may enable policymakers to undertake evidence-based resource planning. We aimed to derive a typology of healthcare utilization trajectories in Swiss older adults. METHODS: Our work used data from the Lc65 + study, a population-based cohort of individuals aged 65 to 70 years at enrolment. The dimensions of healthcare utilization considered were ambulatory care, emergency care, hospitalizations, professional home care and nursing home stay. We applied the Sequence Analysis framework, within which we quantified the variation between each multidimensional pair of sequences, implemented a clustering procedure that grouped together older persons with similar profiles of health services use, and characterized clusters of individuals using selected baseline covariates. RESULTS: Healthcare utilization trajectories were analysed for 2271 community-dwelling older adults over a period of 11 years. Six homogeneous subgroups were identified: constant low utilization (83.3% of participants), increased utilization (4.9%), late health deterioration (4.4%), ambulatory care to nursing home (1.5%), early fatal event (3.8%) and high ambulatory care (2.1%). Associations were found between cluster membership and age, sex, household composition, self-perceived health, grip strength measurement, comorbidities, and functional dependency. CONCLUSIONS: The heterogeneous healthcare utilization profiles can be clustered into six common patterns. Different manifestations of functional decline were apparent in two distinct trajectory groups featuring regular home care use. Furthermore, a small proportion of individuals with a unique set of characteristics was related to the highest levels of ambulatory and emergency care use. New research avenues are outlined to investigate time-varying effects of health factors inside the clusters containing most unfavourable outcomes.

Falls Efficacy Is Associated With Better Gait and Functional Outcomes After Rehabilitation in Older Patients.

OBJECTIVE: To examine the relationship between falls efficacy and the change in gait speed and functional status in older patients undergoing postacute rehabilitation. DESIGN: Prospective cohort study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=180) aged 65 years and older (mean age ± SD, 81.3±7.1y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Data on demographics; functional, cognitive, and affective status; and falls efficacy using a 10-item version of the Falls Efficacy Scale (FES; range, 0-100) were collected upon admission. Data about gait speed and functional status (Barthel Index and Basic Activities of Daily Living [BADL]) were measured at admission and discharge. In addition, BADL performance was self-reported 1 month after discharge. RESULTS: Compared with admission, all rehabilitation outcomes improved at discharge: gait speed (0.41±0.15 m/s vs 0.50±0.16 m/s; P<.001), Barthel Index score (68.4±16.3 vs 82.5±13.6; P<.001), and BADL (3.5±1.6 vs 4.7±1.3; P<.001). Adjusting for baseline status and other potential confounders, baseline FES independently predicted gait speed (adjusted coefficient: 0.002; 95% confidence interval [CI], 0.000-0.004; P=.025) and Barthel index (adjusted coefficient: 0.225; 95% CI, 0.014-0.435; P=.037) at discharge, with higher confidence at baseline predicting greater improvement. Baseline FES was also independently associated with self-reported BADL performance at the 1-month follow-up (adjusted coefficient: 0.020; 95% CI, 0.010-0.031; P<.001). CONCLUSIONS: In older patients, higher falls efficacy predicted better gait and functional rehabilitation outcomes, independently of baseline performance. These results suggest that interventions aiming at falls efficacy improvement during rehabilitation might also contribute to enhancing gait speed and functional status in patients admitted to this setting.

Older People's Health-Related Behaviors: Evidence from Three Cohorts of the Lc65+ Study.

Baby-boomers might be more health-conscious than earlier birth cohorts, but limited evidence has been produced so far. To investigate such changes, this study compared health-related behaviors at age 65 to 70 among three successive five-year birth cohorts (pre-war: born 1934-1938; war: born 1939-1943 and baby-boom: born 1944-1948) representative of the community-dwelling population. Information about alcohol use, smoking, physical activity, and nutrition was compared across the three cohorts (n = 4,270 participants) using Chi-squared test. Alcohol and the mean nutritional intake score did not vary across cohorts, whereas the consumption of nonalcoholic drinks increased significantly from pre-war to war and to baby-boom cohort (p<.001). Other differences across cohorts were observed only in women: the proportion of women who never or rarely engaged in sports decreased from 52.9% in the pre-war cohort to around 43% in subsequent cohorts (p<.001), while the proportion of women who had never smoked was higher in the pre-war cohort (56.1%) than in the war and the baby-boom cohorts (49.8% and 46.8%, respectively, p<.001). Overall, these results show some positive changes in older persons' health behaviors over time. Nevertheless, considerable room remains for improving lifestyles through public health interventions.

Advance care planning dispositions: the relationship between knowledge and perception.

BACKGROUND: Legal dispositions for advance care planning (ACP) are available but used by a minority of older adults in Switzerland. Some studies found that knowledge of and perception of those dispositions are positively associated with their higher usage. The objective of the present study is to test the hypothesis of an association between increased knowledge of ACP dispositions and a more positive perception of them. METHODS: Data collected in 2014 among 2125 Swiss community-dwellers aged 71 to 80 of the Lausanne cohort 65+ (Lc65+), a population-based longitudinal study on aging and frailty. Data collection was conducted through a questionnaire on knowledge, use and perception of lasting power of attorney, advance directives and designation of a health care proxy. Covariables were extracted from the Lc65+ database. Bivariable and multivariable regression analyses assessed the association between level of knowledge and perception. RESULTS: Half the participants did not know about legal dispositions for ACP; filing rates were 14% for advance directives, 11% for health care proxy and 6% for lasting power of attorney. Level of knowledge about the dispositions was associated with a more positive perception of them, even when adjusting for confounding factors. CONCLUSION: Although the direction of the association's causality needs more investigation, results indicate that better knowledge on ACP dispositions could improve the perception older people have of them. Communication on dispositions should take into account individual knowledge levels and address commonly enunciated barriers that seem to diminish with increased knowledge.

How much do combined affective and cognitive impairments worsen rehabilitation outcomes after hip fracture ?

BACKGROUND: To investigate the association between isolated and combined affective and cognitive impairments with functional outcomes and discharge destination in older patients admitted to rehabilitation after a hip fracture. METHODS: Prospective study in 612 community-dwelling patients aged 65 years and over, admitted to rehabilitation after surgery for hip fracture. Information on socio-demographics, medical, functional, affective, and cognitive status was systematically collected at admission. Functional status, length of stay and destination were assessed at discharge. Functional improvement was defined as any gain on the Barthel Index score between admission and discharge from rehabilitation. RESULTS: At admission, 8.2% of the patients had isolated affective impairment, 27.5% had cognitive impairment only, and 7.5% had combined impairments. Rate of functional improvement steadily decreased from 91.2% in patients with no cognitive nor affective impairment to 73.8% in those with combined impairments. Compared to patients without any impairment, those with combined impairments had lower odds of functional improvement, even after adjustment for age, gender, health and functional status at admission (adjOR: 0.40; 95%CI: 0.16-1.0; p = .049). The proportion of patients discharged back home gradually decreased from 82.8% among patients without any impairment to only 45.6% in patients with combined impairments. In multivariate analysis, the odds of returning home remained significantly reduced in these latter patients (adjOR: 0.31; 95%CI:0.15-0.66; p = .002). CONCLUSIONS: Affective and cognitive impairments had both independent, and synergistic negative association with functional outcome and discharge destination in patients admitted to rehabilitation after a hip fracture. Nevertheless, patients with combined affective and cognitive impairments still achieved significant functional improvement, even though its magnitude was reduced. Further studies should investigate whether these patients would benefit from better targeted, longer, or more intensive rehabilitation interventions to optimize their functional recovery.

Relationship between oral health and Fried's frailty criteria in community-dwelling older persons.

BACKGROUND: Oral health and frailty might be linked through several pathways, but previous studies are scarce. This study examined the association between oral health and components of Fried's frailty phenotype. METHODS: This cross-sectional analysis was based on a sample of 992 community-dwelling persons aged 73 to 77 years observed in the 2011 follow-up of the Lausanne 65+ cohort (Lc65+) study. Data were collected through annual mailed questionnaires, interview and physical examination. Oral health was assessed according to self-reported oral pain and masticatory ability. Frailty was defined as meeting at least one criterion of the Fried's phenotype. RESULTS: Oral pain was reported by 14.8% and chewing problems by 9.7%. Impaired masticatory ability (IMA) was more frequent in subjects with missing teeth or removable dentures (13.5%) than among those with full dentition or fixed dental prostheses (3.2%). In logistic regression analyses adjusting for demographics, alcohol consumption, smoking, comorbidity and financial difficulties, persons with oral pain and those with chewing problems had significantly higher odds of being frail (adjusted ORpain = 1.72; 95% CI 1.17-2.53 and adjORIMA1.70; 1.07-2.72, respectively). Lack of endurance was associated with both oral pain (adjOR = 3.61; 1.92-6.76) and impaired masticatory ability (adjOR = 2.20; 1.03-4.72). The latter was additionally linked to low physical activity (adjOR = 2.35; 1.29-4.28) and low gait speed (adjOR = 3.12; 1.41-6.90), whereas oral pain was associated with weight loss (adjOR = 1.80; 1.09-2.96) and low handgrip strength (adjOR = 1.80; 1.17-2.77). CONCLUSION: Self-reported oral pain and chewing impairment had a significant relation with frailty and its components, not only through a nutritional pathway of involuntary weight loss. Longitudinal analyses are needed to examine whether a poor oral condition might be a risk factor for the onset of frailty.

Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation.

OBJECTIVE: To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN: Observational study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS: Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS: Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.

Health System Performance and Resilience in Times of Crisis: An Adapted Conceptual Framework.

With the COVID-19 pandemic, the notion of health system (HS) performance has been discussed, and the notion of resilience has become increasingly important. Lacking a recognised framework that measures the performance of HSs throughout a crisis, i.e., one that explicitly includes time as a key aspect, we examined the literature about conceptual frameworks for measuring the performance and the resilience of HSs. This review highlighted a significant diversity among 18 distinct HS performance frameworks and 13 distinct HS resilience frameworks. On this basis, we developed a model that integrates the WHO's widely recognised six building block framework in a novel approach derived from the European Observatory on HSs and Policies. The resulting framework adapts the building blocks to the different stages of a crisis, thereby allowing for a comprehensive assessment of an entire health system's performance throughout the crisis's duration, while also considering the key aspect of resilience. For a more pragmatic use of this framework in the future, indicators will be developed as a next step.

Trends in the disability-free life expectancy in Switzerland over a 10-year period: an analysis of survey-based data.

INTRODUCTION: Increasing life expectancy raises concerns whether the years gained will be spent free of disability. Lately, trends across countries have been heterogeneous. This work examined recent trends in disability-free life expectancy and life expectancy with mild  or severe disability in Switzerland. METHODS: Life expectancy was estimated using national life tables, by sex and 5-year age groups. Based on Sullivan's method, disability-free life expectancy and life expectancy with disability were computed using information from the Swiss Health Survey on age- and sex-specific prevalence of mild and severe disability. Life expectancy, disability-free life expectancy and life expectancy with disability were estimated in 2007, 2012, and 2017, at 65 and 80 years of age, for both sexes. RESULTS: Between 2007 and 2017, disability-free life expectancy at 65 and 80 years of age increased by 2.1 and 1.4 years, respectively, in men and by 1.5 and 1.1 years, respectively, in women. Meanwhile, life expectancy with mild disability decreased by 6 months in both sexes at age 65 and in men at age 80, but only 1 month in women at age 80. Life expectancy with severe disability also decreased at both ages, by approximately 6 months in women but only 2 to 3 months in men. The proportion of disability-free life expectancy increased significantly in both sexes and ages. For example, disability-free life expectancy / life expectancy at age 65 increased from 67% (95% confidence interval [CI] 66‒69) to 73% (95% CI 71‒74) in women and from 77% (95% CI 75‒79) to 82% (95% CI 81‒84) in men. CONCLUSION: From 2007 to 2017, disability-free life expectancy at age 65 and 80 increased in Swiss women and men. These gains outweighed those in life expectancy, reflecting some compression of morbidity.

Older people's experience of the partial lockdown during the COVID-19 pandemic in Switzerland: a cross-sectional study.

OBJECTIVES: This study aimed to evaluate older people's experience of a COVID-19 partial lockdown (16 March-11 May 2020) in Lausanne, Switzerland. SETTING AND PARTICIPANTS: Community-dwelling participants of the Lausanne cohort (Lc65+) in 2020, aged 71-86 years (n=2642). DESIGN AND OUTCOME: This cross-sectional study was nested within the Lc65+ longitudinal study. A specific COVID-19 questionnaire was sent on 17 April 2020 to evaluate participants' experience of the lockdown (outcome). Multinomial logistic regression models were used to determine the sociodemographic, living environment, health and social factors associated. RESULTS: Out of 2642 participants, 67.8% described the lockdown as 'somewhat' difficult (reference group), 21.5% as 'not at all' difficult (positive) and 10.7% as 'very or extremely' difficult (negative). The relative risk of a positive experience was higher in participants living alone (relative risk ratio, RRR=1.93, 95% CI 1.52 to 2.46) or in a house (RRR=1.49, 1.03 to 2.16); lower in those who reported fear of falling (RRR=0.68, 0.54 to 0.86), functional difficulties (RRR=0.78, 0.61 to 0.99), feeling of loneliness (RRR=0.67, 0.49 to 0.91), unfamiliarity with communication technologies (RRR=0.69, 0.52 to 0.91), usual social support (RRR=0.71, 0.50 to 0.93), previous participation in group activities (RRR=0.74, 0.59 to 0.92) and among women (RRR=0.75, 0.59 to 0.95). The relative risk of a negative experience was higher in participants with fear of falling (RRR=1.52, 1.07 to 2.15), and lower in those who had a terrace/garden (RRR=0.66, 0.44 to 0.99) and owned a dog (RRR=0.32, 0.11 to 0.90). CONCLUSIONS: Only one in 10 participants experienced the lockdown as very or extremely difficult. Specific interventions targeting vulnerability factors, such as fear of falling, could lessen the impact of any future similar situation.

Government recommendations during the COVID-19 epidemic in Switzerland: clarity, compliance and impact on the daily life of seniors in a population-based cohort.

CONTEXT: In March 2020, the Swiss Federal Council issued recommendations for a partial lockdown, with an emphasis on people aged 65 years and over because of their vulnerability to COVID-19. This study investigated whether seniors clearly understood the meaning of four recommendations (do not go grocery shopping; do not use public transport; avoid personal contact; stay at home), whether they complied with them, and what was the impact of the partial lockdown on their daily life, including difficulties and opportunities. METHODS: In April 2020, a questionnaire about how seniors experienced the partial lockdown was sent to the participants in the Lausanne Cohort Lc65+, a population-based study. The response rate reached 89%, with 2746 participants aged 72-86 years included in the analysis. Bivariable analyses and multivariable logistic models were used to identify sociodemographic and health-related characteristics associated with each outcome (clarity; compliance; impact). RESULTS: Most seniors rated the recommendations as clear (84-91%, depending on the recommendation) and complied with them (70-94%). In multivariable analyses, men were more likely to rate the recommendations as unclear. Perceiving the recommendation as unclear and having a low level of fear of the virus were associated with noncompliance. People who complied with the recommendations were more likely to experience difficulties, but also to seize opportunities during the partial lockdown. CONCLUSION: Most seniors followed the recommendations and found them clearly worded. However, some subgroups, such as men and seniors who do not fear the virus, were less likely to clearly understand the recommendations. As a correct understanding is a key factor for compliance, the findings emphasise the importance of tailoring public health communications to the characteristics of the target group, and of testing whether they are correctly understood.

Volunteering transitions and change in quality of life among older adults: A mixed methods research.

BACKGROUND: The activity theory posits that productive activities are beneficial to older people's well-being. This study examined how quality of life (QoL), globally and in its different dimensions, may be affected by stopping or initiating volunteering, and which psychosocial mechanisms might be at work in such associations. METHOD: This study used an explicative sequential mixed method design: analyses of 2011 and 2016 data from participants to the Lausanne cohort 65+ (n = 1,976, age 68-77 years in 2011) were followed by qualitative analyses of focus groups made of volunteers participating in the same cohort. Quantitative and qualitative results were then integrated to search for explanations of the former by the latter. RESULTS: Stopping (versus maintaining) volunteering was independently associated with higher odds of a decrease in global QoL and in the "self-esteem and recognition" and "autonomy" dimensions. Observed associations were mediated by the satisfaction of transmitting skills and knowledge, of witnessing the progress of the people being helped, and of feeling useful. Volunteering gave participants a sense of structure and taught them new skills. Initiating volunteering (versus not participating) was independently associated with lower odds of a decrease in the "material resources" dimension and experiencing financial problems was believed to hinder volunteering. CONCLUSION: Our findings show a positive impact of volunteering on the self-esteem and autonomy of older adults, suggesting that they should be supported in maintaining their volunteer activities. Further exploration of the relationship between material resources and opportunities to volunteer is needed.

Fear of falling and all-cause mortality among young-old community-dwelling adults: a 6-year prospective study.

This study investigated whether fear of falling (FOF) measured by two different instruments, the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR), is associated with mortality at 6-year follow-up. Participants (n = 1359, 58.6% women) were community-dwelling persons enrolled in the Lausanne cohort 65 + , aged 66 to 71 years at baseline. Covariables assessed at baseline included demographic, cognitive, affective, functional and health status, while date of death was obtained from the office in charge for population registration. Unadjusted Kaplan Meyer curves were performed to show the survival probability for all-cause mortality according to the degree of FOF reported with FES-I and SQ-FAR, respectively. Bivariable and multivariable Cox regression analyses were performed to assess hazard ratios, using time-in-study as the time scale variable and adjusting for variables significantly associated in bivariable analyses. During the 6-year follow-up, 102 (7.5%) participants died. Reporting the highest level of fear at FES-I (crude HR 3.86, 95% CI 2.37-6.29, P < .001) or "FOF with activity restriction" with SQ-FAR (crude HR 2.42, 95% CI 1.44-4.09, P = .001) were both associated with increased hazard of death but these associations did not remain significant once adjusting for gender, cognitive, affective and functional status. As a conclusion, although high FOF and related activity restriction, assessed with FES-I and SQ-FAR, identifies young-old community-dwelling people at increased risk of 6-year mortality, this association disappears when adjusting for potential confounders. As a marker of negative health outcomes, FOF should be screened for in order to provide personalized care and reduce subsequent risks.

Development and validation of a knowledge-based score to predict Fried's frailty phenotype across multiple settings using one-year hospital discharge data: The electronic frailty score.

Background: Most claims-based frailty instruments have been designed for group stratification of older populations according to the risk of adverse health outcomes and not frailty itself. We aimed to develop and validate a tool based on one-year hospital discharge data for stratification on Fried's frailty phenotype (FP). Methods: We used a three-stage development/validation approach. First, we created a clinical knowledge-driven electronic frailty score (eFS) calculated as the number of deficient organs/systems among 18 critical ones identified from the International Statistical Classification of Diseases and Related Problems, 10th Revision (ICD-10) diagnoses coded in the year before FP assessment. Second, for eFS development and internal validation, we linked individual records from the Lc65+ cohort database to inpatient discharge data from Lausanne University Hospital (CHUV) for the period 2004-2015. The development/internal validation sample included community-dwelling, non-institutionalised residents of Lausanne (Switzerland) recruited in the Lc65+ cohort in three waves (2004, 2009, and 2014), aged 65-70 years at enrolment, and hospitalised at the CHUV at least once in the year preceding the FP assessment. Using this sample, we selected the best performing model for predicting the dichotomised FP, with the eFS or ICD-10-based variables as predictors. Third, we conducted an external validation using 2016 Swiss nationwide hospital discharge data and compared the performance of the eFS model in predicting 13 adverse outcomes to three models relying on well-designed and validated claims-based scores (Claims-based Frailty Index, Hospital Frailty Risk Score, Dr Foster Global Frailty Score). Findings: In the development/internal validation sample (n = 469), 14·3% of participants (n = 67) were frail. Among 34 models tested, the best-subsets logistic regression model with four predictors (age and sex at FP assessment, time since last hospital discharge, eFS) performed best in predicting the dichotomised FP (area under the curve=0·71; F1 score=0·39) and one-year adverse health outcomes. On the external validation sample (n = 54,815; 153 acute care hospitals), the eFS model demonstrated a similar performance to the three other claims-based scoring models. According to the eFS model, the external validation sample showed an estimated prevalence of 56·8% (n = 31,135) of frail older inpatients at admission. Interpretation: The eFS model is an inexpensive, transportable and valid tool allowing reliable group stratification and individual prioritisation for comprehensive frailty assessment and may be applied to both hospitalised and community-dwelling older adults. Funding: The study received no external funding.

Is Fear of Falling Associated With Incident Disability? A Prospective Analysis in Young-Old Community-Dwelling Adults.

OBJECTIVES: Fear of falling (FOF) is common in older people and is related to negative outcomes. This study aimed to investigate whether 2 different instruments, the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR), were associated with incident disability at 3 years. DESIGN: Prospective observational study. SETTING AND PARTICIPANTS: Participants (n = 1219, 57.4% women) were disability-free community-dwelling persons enrolled in the Lausanne cohort 65+, aged 66 to 71 years, in 2005. MEASURES: Baseline covariates included demographic, cognitive, affective, and health status. Basic activities of daily living (BADL) assessment was recorded annually from a self-administered questionnaire. Disability outcome was defined as reporting difficulty or help needed in ≥1 of 5 BADL in ≥2 consecutive years, or being institutionalized during follow-up. RESULTS: At 3 years, disability was reported by 77 participants (6.3%). Reporting the highest level of fear at FES-I [adjusted odds ratio (aOR) 5.14, 95% confidence interval (CI) 1.82-14.55, P = .002] or "FOF with activity restriction" with SQ-FAR (aOR 3.23, 95% CI 1.29-8.08, P = .012) were both associated with increased odds of disability even after adjusting for covariates. The FES-I model explained incident disability slightly better than the SQ-FAR one [Bayesian information criterion (BIC) values of 466.70 and 469.43, respectively]. CONCLUSIONS AND IMPLICATIONS: High FOF and related activity restriction, assessed with FES-I and SQ-FAR, are associated with incident disability in young-old community-dwelling people. The SQ-FAR is suitable as a screening tool to proactively detect a potentially reversible risk factor for disability. Using the FES-I may serve additional clinical purposes, such as FOF characterization and management.