Older People Facing the Crisis of COVID-19: Between Fragility and Resilience.

The health crisis we are facing is challenging seniors' resources and capacities for adaptation and resilience. The PACOVID survey, set up a few days after containment, investigates their psychological and social experiences with regard to the COVID-19 crisis and to what extent these characteristics, representations and attitudes have an impact on health and mortality. A telephone survey is being carried out on 935 people already followed up in the framework of ongoing epidemiological studies. As we are writing this article, the interviews conducted during the containment have just ended. Even though we will have to wait for the analysis of the results to draw conclusions, words collected by the psychologists during the interviews already illustrate a great heterogeneity in the way older adults lived this experience: social isolation, anxiety, the importance of family and the difficulty of being deprived of it, but also remarkable coping skills and resilience capacities.

Support practices by an interdisciplinary team in a palliative-care unit for relatives of patients in agonal phase.

BACKGROUND: In the absence of extant recommendations, the aim of this study was to formalise support practices used by an interdisciplinary team in a palliative-care unit (PCU) for the relatives of patients in the agonal phase preceding death. The secondary objective was to understand the expectations of relatives during this phase in terms of the support provided by professionals and volunteers. METHODS: Thirty-two people took part in this study; all were interviewed through focus groups (FGs). Each FG comprised one category of individuals working in the PCU: nurses, care- assistants, doctors, psychologists, other professionals, palliative-care volunteers, and relatives. Groups were surveyed using an interview guide, and the interviews were recorded and transcribed to enable identification and characterization of all practices. Care practices were classified into four categories: current consensual practices (i.e. performed by all team members), occasional consensual practices, non-consensual practices (performed by one or a few participants), and practices to be developed. RESULTS: In total, 215 practices were mentioned by professionals and palliative-care volunteers: 150 current consensual practices, 48 occasional consensual practices, 1 non-consensual practice, 16 practices yet to be developed, and 29 practices for relatives. Many practices were mentioned by different categories of participants; thus, after cross-checking, the number of practices decreased from 215 to 52. A list of practices deemed desirable by all was drawn up and then validated by the entire interprofessional team. These practices were organised around four themes: providing care and ensuring comfort; communicating, informing, and explaining; interacting; and mobilising interdisciplinary skills. CONCLUSIONS: These results underline the importance of the quality of care provided to patients, the attention given to the relatives themselves, and they highlight the importance of the helping relationship. Following this study, which established a list of varied practices aimed at supporting the relatives of patients in agonal phase, it will be important to set up a broader study seeking to establish a consensus on these practices with an interprofessional group of experts from other PCUs using broad surveys and an adapted methodology. Such studies will make it possible to develop training modules for teams working with relatives.

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.

A program for linear regression with a common point of intersection: the isokinetic relationship.

A program is described for statistically correct calculations of the enthalpy-entropy relationship, applicable also generally for linear regression when several regression lines are constrained by a common point of intersection. Examples from the chemical literature show the difference between a correct and incorrect statistical treatment.

[Cardiac arrhythmia observed in 400 workers without obvious heart disease by Holter monitoring]. / Troubles du rythme cardiaque observés chez 400 salariés sans cardiopathie évidente par l'enregistrement Holter.

To obtain information on the cardiac rhythm characteristics of subjects without heart disease during their daily work, we examined the continuous 24-hour electrocardiographic recordings of 400 workers from 4 factories in Eastern France presenting with criteria of cardiac normality. Sex, age and socio-professional category were taken into account. Supraventricular extrasystoles were extremely common, being observed in 52 p. 100 of men and 39 p. 100 of women. In men, the frequency of these extrasystoles increased with age (p less than 0.001), and their number was less than 20 per 24 hours in 90 p. 100 of the cases. Ventricular extrasystoles were detected in 40 p. 100 of men and 32 p. 100 of women. They too were age-related, though not significantly. Their number was less than 10 per 24 hours in 68 p. 100 of the cases and 10 to 50 per 24 hours in 28 p. 100. These ventricular extrasystoles usually were monomorphous, regularly coupled (92 p. 100) and isolated. However, 2 attacks of tachycardia were discovered. Episodes of bradyarrhythmia (RR superior or equal to 1500 ms) were present in 25 p. 100 of men and 19 p. 100 of women. They occurred more frequently before the age of 35 than later (p less than 0.001) and the recordings confirmed that they were predominantly nocturnal. Recordings without "disorders of rhythm" were relatively rare (20 p. 100 of men, 28.5 p. 100 of women). Finally, there was no clear-cut correlation between the prevalence or characteristics of these various "rhythmic abnormalities" and the type of professional activity.

[Continuous electrocardiographic registration in occupational medicine]. / Enregistrement électrocardiographique continu en médecine du travail.

Continuous 24 hour electrocardiography (Holter method) was carried out during work time in 64 workers. They were divided into two groups: the first group comprised 34 subjects with either organic heart disease (coronary artery disease, valvular heart disease, operated coarctation, hypertrophic cardiomyopathy) or a documented arrhythmia without proven underlying cardiac disease; the second group comprised 30 subjects without known cardiac disease but complaining of symptoms suspected to be of cardiac origin or with isolated electrocardiographic abnormalities. At the end of the study we concluded that Holter monitoring is possible in subjects performing physical occupations even in difficult conditions. The trends of heart rate, especially mean heart rate calculated over 10 minute periods, confirmed the relationship between heart rate and the intensity of the physical activity. Atrial extrasystoles and episodes of supraventricular tachycardia were as common in the first as in the second group (20% and 18% respectively). This did not apply to ventricular extrasystoles: they were observed in both groups but were significantly more common in the first group (55% compared to 33%); ventricular extrasystoles, usually of a single configuration and isolated, were more common in the first group, especially amongst the coronary patients. Sinus node dysfunction was only observed in the second group (12.5%), in young subjects, and this occurred with only one exception at night. These findings support previous reports in the literature. However, the interpretation of these results is difficult because of the absence of well established normal values.