Impact of Cohabitation during Confinement on Older Adults' Negative Affect: What Specificity of Life as a Couple?

BACKGROUND: Social isolation is a risk factor for older adults' physical and psychological health. The beneficial effect of social connections in times of major health events is undeniable. Nevertheless, it remains unclear whether the positive effect of social support depends on the relationship type. OBJECTIVES: This study aimed to investigate the influence of older adults' living conditions on the risk of experiencing negative affect during the first lockdown and post-lockdown. DESIGN: An epidemiological study conducted during the COVID-19 crisis, at the time of the first lockdown, and 2 to 3 months following the lockdown. SETTING: A subset sample of the PACOVID survey, a population-based survey of older adults. PARTICIPANTS: Altogether, 277 participants were included into three groups depending on their living conditions: Group 1 "living alone" (n = 141); Group 2 "living with their spouse" (n = 106); Group 3 "living in cohabitation with relatives" (n = 30). MEASUREMENTS: Mixed logistic regression analyses were used to study the change in the risk of experiencing negative affects over time according to the living conditions. The presence of negative affects during lockdown was assessed using three items from the 20-item Center for Epidemiologic Studies Depression Scale : «Do you feel sad?¼; «Do you feel depressed?; «Do you feel lonely? RESULTS: Participants living with their relatives or partner were significantly less likely to experience negative affect than those living alone during lockdown. Moreover, over time, only those living with their spouse had this lesser risk compared to those living alone. CONCLUSIONS: These findings highlight the protective effect of social support over time and more specifically of that provided by the spouse. Couple functioning ought to be given consideration when studying the impact of health crisis situation on the mental health of older adults.

Ten Years after the National Alzheimer's Plan: Dementia Remains a Hidden Syndrome in France.

Ten years after the implementation of the French Plan on Alzheimer's Disease (2008-2012), the present study aimed at describing the situation of the persons living with dementia in terms of diagnosis and high-risk situations (living alone, continuing driving, inability to handle budget and to manage medication). Among the 115 dementia cases followed-up in the AMI population-based cohort on aging in 2018 (i.e. ten years after the launch of the Plan), the prevalence of under-diagnosis was similar to the one estimated ten years earlier (53.0% vs. 55.6%). Almost all cases (95.3%) were concerned by high-risk situations (61.2% were unable to handle finances, 48.2% were living alone, 27.1% continued driving). Being diagnosed as demented was not associated with a lower frequency of high-risk situations, excepting for driving (16.7% vs. 37.2%). Ten years after the beginning of the French Alzheimer's Plan, dementia remains a hidden syndrome, with a frequent inadequate management of high-risk situations.

Efficacy and follow-up of anti-VEGF injections in diabetic macular edema in real-life practice at the Dijon university medical centre through the Save Sight Registries.

PURPOSE: To evaluate the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections (IVT) in diabetic macular edema (DME) in real-life practice using the Save Sight Registries (SSR). MATERIAL AND METHODS: We conducted an observational, single-centre, retrospective study in the department of ophthalmology of the Dijon University Hospital. We included treatment-naive patients who presented with DME between January 2016 and December 2017. Demographic and clinical data, follow-up visits, and treatments administered were entered into the SSR, an international online ophthalmic registry. Primary endpoints were the change in best-corrected visual acuity (BCVA) and central subfield thickness (CST) from baseline to 12 and 24 months. RESULTS: Fifty-eight eyes of 43 patients with a mean [standard deviation (SD)] age of 67.1 [9.5] years were included. Forty-one eyes completed 12 months of follow-up, and 17 eyes completed 24 months of follow up. Median [SD] baseline BCVA was 56.1 [22.9] ETDRS letters and the median [95% confidence interval (95% CI)] baseline CST was 447.9 [161.0] micrometers (µm). Median [95% CI] improvement in BCVA from baseline to months 12 and 24 were respectively, +5.6 [+0.5; +10.7] ETDRS letters and +7.7 [-2.8; +18.2] ETDRS letters. The median [95% CI] decrease in CST from baseline to months 12 and 24 were respectively, -110.9 [-154.5; -67.3] µm and -125.5 [-198.0; -53.0] µm. CONCLUSION: Our clinical practice can be evaluated easily with the SSR system. In real life, anti-VEGF IVT are an effective treatment for DME, which result in improved BCVA and decreased CST.

Psychosocioeconomic Precariousness and Frailty: The Respective Contribution in Predicting Mortality.

BACKGROUND: Low socioeconomic status and frailty are factors of vulnerability in old age. They are both well-known risk factors of death. On the other hand, low socioeconomic status has been reported as a predictor of frailty, which questions the relationship between socioeconomic status, frailty and death. OBJECTIVES: The aim of this work was to explore the respective contribution of psychosocioeconomic precariousness - which covers socioeconomic status and also psychosocial vulnerability - and frailty in predicting mortality. DESIGN: Prospective population-based study. SETTING: Three-City (3C) Bordeaux study, France. PARTICIPANTS: The sample consisted of 1586 subjects aged 65 or older. MEASUREMENTS: Psychosocioeconomic precariousness was assessed utilizing a structured instrument which assessed poor socioeconomic status, and psychosocial vulnerability. Frailty status was defined by Fried's phenotype. RESULTS: After 14 years of follow-up, 665 deaths (42%) occurred. Psychosocioeconomic precariousness and frailty had both an independent contribution to mortality prediction (hazard ratio (HR) 1.51 (95% confidence interval (CI) 1.11-2.07)) and (HR 1.68 (95% CI 1.19-2.38)), respectively. Such relationships were adjusted for age, sex, disability, and comorbidities. No interaction term was found between precariousness and frailty. CONCLUSIONS: If psychosocioeconomic precariousness and frailty are both aspects of vulnerability in old age, they have a non-overlapping contribution in the prediction of mortality. These findings emphasize the importance of considering both psychosocioeconomic precariousness and frailty when identifying elderly people at risk of death.

Norms for standard neuropsychological tests from the French CONSTANCES cohort.

BACKGROUND AND PURPOSE: Neuropsychological testing plays a key role in various clinical contexts. Even though a substantial number of adults suffer neurological disorders such as early-onset dementia, stroke, traumatic brain injury or multiple sclerosis, most normative data do not include persons below 65. The aim of this study was to produce updated norms for the Mini-Mental State Examination, the Free and Cued Selective Reminding Test, the Trail Making Test, verbal fluency tasks and the Digit Symbol Substitution Test for middle-aged and older adults. METHODS: The sample consisted of 51 879 participants aged 45-70 years from the CONSTANCES study. Norms are presented in percentiles stratified on age, education and gender. RESULTS: The results illustrated the effect of age in all tests considered. For tests involving speed processing, the impact of age was observed including in tight age range categories (5 years). The results also showed the well-known effect of education and an effect of gender in tests involving verbal memory and speed processing. CONCLUSIONS: The norms provided allow the variability of the cognitive performances of middle-aged to older populations to be understood, with a high precision in age categories. The tests considered are broadly used in neuropsychological practice and should be helpful in a variety of clinical contexts.

Why Is Later Age at Retirement Beneficial for Cognition? Results from a French Population-based Study.

OBJECTIVE: To determine whether and how age at retirement influences the risk of dementia. The association between the age at retirement, the number of working years and the risk of dementia was evaluated over 12 years of follow-up. DESIGN: A prospective population-based study. SETTING: Three-City cohort, a French population-based study of community-dwelling individuals aged 65 to 95. PARTICIPANTS: The sample consisted of 1,658 non-demented participants at baseline. MEASUREMENTS: All participants were evaluated at home at the initial visit and at two years interval for a period of 12 years. An active research of dementia was conducted at each follow-up; all suspected cases were analysed by an independent committee of neurologists. Information regarding retirement age and number of working years was collected at baseline using a structured questionnaire. RESULTS: The multivariate Cox model, including both the age at retirement and the number of working years and adjusted for potential confounders, revealed that the risk of dementia was independently associated with the age at retirement (p=0.022) but not with the number of working years (p=0.296). CONCLUSION: Although our results are in accordance with previous studies (i.e., older age at retirement is associated with decreased risk of dementia), it provides additional information regarding the possible explanation for such results. Given that a longer working life did not reduce the risk of dementia, the age at retirement cannot be considered as a new factor of cognitive reserve but rather seems to be a psycho-social vulnerability factor. Further evidence is necessary to identify work and retirement related factors that influence the association between the age at retirement and the risk of dementia.

[Incidence of endophthalmitis after intravitreal injection: is antibioprophylaxis mandatory?]. / Incidence de l'endophtalmie après injection intravitréenne : peut-on se passer de l'antibioprophylaxie ?

INTRODUCTION: Endophthalmitis is the most dreaded complication after intravitreal injection. With the rise of antiangiogenics their rate is getting higher each year. The use of antibioprophylaxis is controversial. We tried to evaluate the impact of antibioprophylaxis on intravitreal injection endophthalmitis incidence. METHODS: All patients who received intravitreal injections between January 2007 and October 2012 were included in this retrospective study. Until June 2012 all patients had antibiotics the days following the injection. From July 2012 the antibiotic was replaced by an antiseptic immediately after the injection. RESULTS: An overall number of 11,450 injections were performed. The overall rate of endophthalmitis was 6/11,450 (0.052%). The incidence of endophthalmitis in the group with antibiotics was 3/10,144 injections (0.03%), 2 were culture proven (0.02%). The incidence in the group without antibiotics was 3/1306 (0.23%). The difference was significant (P=0.024). CONCLUSION: The incidence of endophthalmitis post-intravitreal injections seems to be lower when using antibiotics. However, a prospective study is mandatory to draw more robust conclusions.