[Did entry into nursing home during the health crisis favor the emergence of traumatic symptoms in the elderly?: Entry into nursing home and Covid]. / L'entrée en Ehpad, durant la crise sanitaire, a-t-elle favorisé l'émergence de symptômes traumatiques chez le sujet âgé ?

Our aim is to explore the possible emergence of traumatic symptoms and the identity-related repercussions of the restrictions on elderly, who entered into nursing homes during the Covid-19 health crisis in France. Twenty-five subjects institutionalised before the health crisis and twenty-six subjects institutionalised during the periods of lockdown into nursing homes completed scales assessing anxiety-depressive symptomatology, traumatic symptoms and identity. Anxiety and depression symptoms were similar between the groups. The institutionalised group showed a significantly higher prevalence of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria D and E on the Post traumatic Stress Disorder Checklist version DSM-5 (PCL-5) during lockdown. Entry into an institution during the health crisis would have favored the emergence of traumatic symptoms in the participants. Consideration of the ethical issues raised by this study could make it possible to offer more individualised support to elderly during their transition to a new home.

[Conscience des déficits dans le cadre de la maladie d'Alzheimer : représentations et vécu des professionnels soignants].

La qualité des soins apportés aux personnes vivant avec la maladie d'Alzheimer (MA) dépend en partie de la capacité des professionnels à déterminer le degré de conscience de la maladie chez les patients. La présente recherche s'est intéressée aux représentations des soignants concernant la conscience des troubles chez les résidents d'établissements de soins de longue durée présentant un diagnostic de MA. Le pouvoir prédicteur de l'anosognosie sur le fardeau soignant a également été examiné. L'anosognosie des troubles de la construction (r = 0,40, p = 0,0164) et de l'initiation (r = 0,32, p = 0,052) était corrélée au fardeau soignant. Les professionnels se représentaient les résidents comme ayant une conscience altérée de leurs capacités, même en l'absence d'anosognosie. Les scores réels d'anosognosie ne prédisaient pas les estimations soignantes, hormis le score global sous forme de tendance (χ2 = 3,38, p = 0,066). Les soignants surestimaient pourtant les performances cognitives des résidents, telles que mesurées au moyen du protocole Misawareness (prédictions aidants/performances réelles : DC = 12,32, p < 0,0001).

Exploring Characteristics of Self-Defining Memories in Older Adults.

The aim of this descriptive study was to investigate the Self-Defining Memories (SDMs) in a large sample of 181 older adults (65-90 years; mean age = 73.0 years) and to target the relationships between their different dimensions. The sampling method was nonprobabilistic, based on voluntary participation. Participants were asked to recall three SDMs. They also completed the Mini-Mental State Examination, the Hospital Anxiety and Depression Scale, and a Self-esteem Scale. Almost half of the SDMs were specific and more than a quarter were integrated. Specificity, tension, redemption, contamination sequences, and affective response varied regarding thematic content. Specificity was positively correlated to tension whereas autobiographical reasoning was positively correlated to redemption and negatively linked to emotional response and depression. This research highlighted that identity is constituted by the main types of events that make up a life: interpersonal relationships, life-threatening events, achievement, and leisure.

A cross-sectional study using self-defining memories to explore personal identity throughout adulthood.

Little research has examined changes in personal identity over different periods of adult development. The aim of the present cross-sectional study was to target these changes through the characterization of the main dimensions in self-defining memories (SDMs; thematic content, specificity, integrative meaning, tension, contamination/redemption, and emotion) and their interactions. Our final sample was composed of 652 healthy French adults aged from 18 to 97 years, divided into four age groups: young adults (n = 163, M = 23.7 years), middle-aged adults (n = 135, M = 44.0 years), young-old adults (n = 178, M = 64.5 years), and old-old adults (n = 176, M = 79.6 years). Participants were asked to recollect three SDMs. A similar pattern of thematic content was observed throughout adulthood, except for relationship narratives were more frequent in the two younger groups. The findings highlighted that specific and integrated SDMs decreased with age and that tension and contaminative sequences were the most frequent in young adults. Redemptive memories did not significantly differ whatever the age of participants. No clear positivity effect was observed with aging. Finally, an analysis of the correlations among the main SDMs' dimensions showed that specificity correlated positively with tension in young adults and integrative meaning with redemption in young and middle-aged participants. We found no significant correlation between specificity and integration in any age group. For the first time, this study sheds new light on lifelong identity adjustments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

[Restraint in geriatrics: France's backwardness]. / Contention en gériatrie : le retard de la France.

In the absence of legal provisions, passive physical restraint methods in geriatrics were defined at the start of this century, accompanied by recommendations relating to their use. Despite the frequency of these measures of restraint, there are few French publications on this subject. It seems that this practice varies according to the geriatric establishments and prevails in hospital more than in nursing home. The most widespread method is the dual barrier on the bed, as well as in hospital than in nursing home. To this should be added restraint provided by the premises themselves, intended to secure access to a facility, found in 90% of residences for the dependent elderly, and also medication. Passive physical restraint, mainly implemented to prevent falls, has however clearly shown its deleterious effects, particularly in the USA where it is thought to be responsible for 1/1000 deaths in nursing homes, although when it is absent there appears to be no increased risk of falls. Medication-based restraint is more readily used to sedate in case of disruptive behaviors (agitation, aggressiveness) although no clear data is available to date. Restraint provided by the premises themselves, used preventively in case of wandering and straying, is nevertheless a deprivation of freedom, and seems to concern the majority of geriatric facilities today. In the absence of legislation to regulate these practices, the present authors discuss the need for ethical reflection before the implementation of measures of restraint, whatever their nature, and they propose certain ideas on possible methods for passive physical restraint: raising awareness among caregivers and family members who often call for these measures, the existence of alternative measures, and the delaying of implementation as long as possible and/or sequentially.

Evaluation of apathy among institutionalized older persons: Its mediating role between cognitive functioning and lack of awareness.

OBJECTIVES: The main objective of this study was to determine the directions of the relationships between apathy, cognitive deficits and lack of awareness. METHODS: One hundred and twenty-one older persons living in nursing homes, aged between 65 and 99 years old, participated in the study. Cognitive functioning, autonomy, depressive and anxious symptoms, general self-efficacy, self-esteem and apathy were evaluated through tests and questionnaires. Lack of awareness was calculated using the patient-caregiver discrepancy method. The sample was divided into two groups (n1 = 60, n2 = 61) depending on cognitive functioning level (Dementia Rating Scale < median score: 120). We first explored the characteristics of each group. Then, we compared the mode of evaluation of apathy. Finally, we investigated the direction of relationships by applying mediation analyses. RESULTS: Older persons in the low cognitive functioning group were less autonomous, had a lower cognitive functioning level, higher caregiver-rated apathy and higher lack of awareness than the high cognitive functioning group (ps < 0.05). Evaluation differences were found only in the low cognition group. Caregiver-rated apathy totally mediated the relationship between cognitive functioning (predictor) and lack of awareness (dependent variable) for the whole sample (90%) and for the low cognitive functioning group (100%). CONCLUSIONS: Cognitive deficits should be taken into account when evaluating apathy. Interventions should combine cognition training and emotion intervention to reduce lack of awareness. Future research should develop a therapy dedicated to apathy among older persons without pathologies.

[Updates on anosognosia in Alzheimer's disease]. / Actualités sur l'anosognosie dans la maladie d'Alzheimer.

Impaired awareness increases dependency of patients suffering from Alzheimer's Disease (AD) and caregivers' burden but remains insufficiently evaluated in clinical practice. The numerous conceptualisations of this symptomatology (anosognosia, denial, insight…) have only a slight impact on the three main assessment methodologies which are: the patient-caregiver discrepancy; the clinician rating of patients' awareness of illness; and the prediction of performance discrepancy methods. Nevertheless, most of evaluating tools are not validated yet, in particular regarding the clinician rating, leading to contrasted results. Most of recent studies reported positive correlations with apathy and AD severity, and negative relationships with depressive symptoms. Therefore, impaired awareness seems to be mainly influenced by patient's depression and apathy. We discuss these correlates and shared aspects of apathy and impaired awareness from neuroanatomical, clinical and conceptual viewpoints. We also highlight the relevance and limits of quantitative and qualitative assessment methods, in particular phenomenological.

How do "Young-old" Adults Project their Self? A Study of Self-defining Future Projections in Normal Ageing.

BACKGROUND: Self-defining future projections (SDFP) are mental representations of plausible and highly significant future events that provide core information of one's understanding of self. OBJECTIVE: We explored SDFPs in a large sample of older adults and aimed to target the interrelations between the main dimensions of SDFPs. Moreover, correlations between these dimensions and clinical and cognitive variables were examined. METHODS: We recruited 87 young-old adults (60-75 years) with normal cognitive functioning who were asked to generate three SDFPs. RESULTS: We found integrative meaning as a salient dimension and older individuals preferentially generated projections containing leisure or relationship events. Anxiety and self-esteem were correlated with integrative meaning and high executive functioning was found to be protective towards the simulation of future events containing dependence and death or end-of-life events. CONCLUSION: This study will contribute to the understanding of personal goals and identity in normal ageing.

Self-Concept and Temporality in Institutionalized Elders.

The current investigation examined the self-concept and temporality in institutionalized and non-institutionalized elderly. Sixty-two participants divided into two groups according to their place of residence participated in the study. The analysis focused on psychopathological scales, on self-concept assessment, its positive or negative valence, its development and the time perspective. The results showed that the institutionalized group was defined more with descriptive evaluations, emotional states, and peripheral information. The non-institutionalized group described themselves more with traits and specific attributes. For some identity statements, the emotional valence between the two groups was significantly different. The institutionalized group is not turned towards a particular temporal perspective, unlike the non-institutionalized who is more forward-looking. Findings suggest that there are differences in self-expression and temporality in our sample. This exploratory study emphasizes the importance of taking into account the self of institutionalized elderly and the temporality in which they are projected upon entering an institution.

The immediate impact of Covid-19 infection and the resulting lockdown on nursing home residents / Impact immédiat d'une infection liée à la Covid-19 et du confinement consécutif sur les résidents d'un Ehpad

Introduction: Following the Covid-19 epidemic affecting 76 of the 97 residents (78.3 %) in a French nursing home, we assessed the impact of this cluster period on the physical and psycho-cognitive health of the residents, expecting in particular to observe effects that were dependent on their state of cognitive-behavioural dependence. Methods: We retained twenty-two variables, 5 relating to demographic data, 6 to the specific care linked to Covid-19 infection, 6 to somatic pathologies and psycho-behavioural disturbances before the epidemic and 5 to the period following it. Results: Eleven residents among those diagnosed positive died. Nine were transferred to a Covid unit, and 35 were asymptomatic. The main consequences of the period of infections were in particular behavioural, nutritional, and motor. A history of disruptive behaviours before the appearance of the cluster increased the risk of an aggravation of these behaviours by four (RR = 3.9, IC95 % = 1.38­11.02, p = 0.0042). Twenty per cent of the residents presented under-nutrition at the end of lockdown, but no specific risk factors could be identified. However, states of under-nutrition for the whole of 2020 were significantly more frequent than in 2019, in particular severe cases (χ² = 5.43, p = 0.02). A history of under-nutrition in the previous year increased twofold the likelihood of under-nutrition in the following year (RR = 2.07, IC95 % = 1.14­3.74, p = 0.02). The Covid cluster period also had an effect on the functional autonomy of certain patients. Conclusion: Our main hypothesis relating to cognitive-behavioural dependence was not completely validated. The impact of the occurrence of the cluster remained moderate, in particular because of the care resources afforded by the nursing home. The advantages of a "medicalised" facility, and the problems associated with the restrictions of lockdown, are viewed in the light of ethical considerations.

Introduction: Suite à une épidémie de Covid-19 ayant affecté 76 des 97 résidents d'un Ehpad, nous avons évalué l'impact de cette période de cluster sur la santé physique et psycho-cognitive des résidents pronostiquant notamment une altération en fonction de leur dépendance cognitivo-comportementale. Méthodes: Nous avons retenus vingt-deux variables relatives : aux données démographiques (5) ; aux prises en charge spécifiques liées à l'infection (6) ; aux pathologies somatiques et troubles psycho-comportementaux avant l'épidémie (6) et après la période de cluster (5). Résultats: Onze résidents diagnostiqués positifs sont décédés. Neuf ont été transférés en unité Covid et 35 étaient asymptomatiques. Les troubles consécutifs à la période de cluster concernaient la majoration des comportements perturbateurs et la dénutrition lorsque des antécédents existaient déjà (respectivement : RR = 3,9, IC95 % = 1,38­11,02, p = 0,0042 ; RR = 2,07, IC95 % = 1,14­3,74, p = 0,02), ainsi que la réduction des capacités motrices. Nous n'avons pu objectiver d'autres facteurs explicatifs spécifiques à ces altérations. Conclusion: Notre hypothèse principale en lien avec la dépendance cognitivo-comportementale n'apparaît pas totalement validée. L'impact de la période de cluster est resté modéré notamment grâce aux moyens médico-soignants dont l'Ehpad disposait. L'avantage d'un dispositif médicalisé et l'inconvénient des restrictions liées au confinement est discuté au regard de questions éthiques.

Apathy Is the Best Dimension to Consider for Awareness Assessment in Alzheimer's Disease.

Previous studies have reported the major role of apathy in awareness assessment among Alzheimer's patients using the patient-caregiver discrepancy method, whatever the awareness dimension assessed. Using the Apathy Evaluation Scales among other awareness scales, we report that apathy is the sole awareness dimension distinguishing healthy controls (25), mild (57) and moderate-to-moderately-severe (11) Alzheimer's patients. A linear regression showed that the Mini-Mental State Examination score used as a risk factor for non-awareness was the only factor associated with awareness of apathy and was the best predictor. This suggests that apathy is the most discriminant dimension for awareness assessment in Alzheimer's disease.

Adaptation of a short-form nostalgia scale: convergent and divergent validity in a sample of French elders.

Nostalgia is an efficient coping strategy that helps elders overcome major life transitions. To better explore the protective functions of nostalgia, we set out to adapt a short-form nostalgia scale to French elders and examine its convergent and divergent validity in terms of self-esteem, depression, and wellbeing. Participants were 175 institutionalized French elders. After providing their written informed consent, they were asked to complete a demographic information form and respond to four questionnaires probing self-esteem, nostalgia, depression, and wellbeing. Principal component analyses and fit indices were used to explore convergent validity. An 8-item version showed acceptable psychometric properties and measured two dimensions of nostalgia. Spearman correlations were conducted to explore divergent validity. In our sample, the first dimension was negatively associated with global cognitive functioning, while the second dimension was positively associated with self-esteem and wellbeing, and negatively associated with depression. The negative relationship between depression and nostalgia supports the idea that nostalgia is a positive concept. Future research should explore factors liable to impact nostalgia, such as cultural differences and reminiscence therapy.

[Unawareness of deficits in dementia and its impact on the caregiver-patient relationship: a literature review]. / L'impact de l'anosognosie sur la qualité de la relation aidant-aidé dans les maladies neuro-évolutives : revue de la littérature.

To date, few studies have focused on the impact of anosognosia on patients' and caregivers' daily lives. However, in more general studies, anosognosia has been linked to increased burden of family caregivers, refusals to receive care, and increased caregivers' psycho-behavioral disorders. However, these studies did not specify the nature of the impact of anosognosia on these manifestations, often attributed to cognitive impairment which is more representative of the disease. The aim of this review is to provide an overview of the current knowledge of the impact of anosognosia on the patient-caregiver relationship and to identify possible future directions to lessening its consequences.

How to project oneself without positive and integrated memories? Exploration of self-defining memories and future projections in bipolar disorder.

Bipolar disorder (BD) is a disabling disorder with functional impact on everyday life. Recent studies suggest that autobiographical memory impairment may contribute to the maintenance of psychopathology, leading to enduring altered self-construct. Moreover, past personal experiences also support the ability to project oneself into the future to pre-experience an event, this capacity can be modified by psychiatric disorders. Self-defining memories and future projections by accessing highly significant events that are vivid and focused on central goals or enduring concerns can both provide a better understanding of the impact of disorders on self-perception and on the ability to project oneself into the future. Therefore we proposed to explore self-defining memories and future projections in BD patients (n = 25) compared to control participants (n = 25). BD patients' self-defining events were associated with more tension, life-threatening events, and negative emotion. BD patients also reported less integrated past but not less integrated future self-defining events. And their future projections were more closely related to leisure, and associated with positive emotions, compared to controls. For both groups, the future projections were less specific, integrated, and tense than the memories. These results question the self-coherence of patients' identity and should be confirmed to propose appropriate interventions to project oneself adaptively into the future and contribute to a better outcome.

Characteristics of Self-Defining Memories in Middle-Aged and Older Adults.

BACKGROUND: Self-Defining Memories (SDMs) are a specific type of autobiographical memory, which play a key role in the construction of personal identity. ; Objective: We investigated the characteristics of SDMs in elderly subjects. The originality of the present study is to compare our elderly group to middle-aged subjects instead of young adults, as previously reported in the literature, to understand the age-related modifications in SDMs. ; Methods: We recruited 41 elderly subjects with normal cognitive functioning and 37 middle-aged adults. They were matched for education level and verbal knowledge. ; Results: Older participants recalled the same number of specific memories than middle-aged participants. SDMs were predominantly constituted of episodic characteristics, with specific details, in both the groups. However, middle-aged subjects gave more integrative meaning of SDMs and more redemptive events than older participants. The two samples differed in three content dimensions (exploration/recreation, relationship contents, and not classifiable). As predicted, older participants reported memories that were more positive, on average, than the middle-aged participants' memories. ; Conclusion: Our study added some contributions to the understanding of the consequences of aging on the sense of self. Future research should explore the continuity of SDMs characteristics across the lifespan.

Modelling Awareness in Alzheimer's Disease.

This study aimed to provide a model of awareness in Alzheimer's disease using the stage of the disease as a risk factor. Awareness was assessed using three methods (patient-caregiver discrepancy, prediction-performance discrepancy, clinical rating). Twenty-five healthy control subjects and sixty-one patients participated, with measures of cognition, apathy, depression, and awareness. These measures were introduced into a manual backward regression. Confounding factors impacting at least 15% of the exposure factor estimate were maintained in the model. Except for the prediction performance discrepancy, also presenting cognitive associations, the other awareness assessments suggested a major role of depression and apathy as impacting factors.

Effects of depression and cognitive impairment on quality of life in older adults with schizophrenia spectrum disorder: Results from a multicenter study.

BACKGROUND: Little is known about the respective effects of depression and cognitive impairment on quality of life among older adults with schizophrenia spectrum disorder. METHODS: We used data from the Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia or schizoaffective disorder (N = 353). Quality of life (QoL), depression and cognitive impairment were assessed using the Quality of Life Scale (QLS), the Center of Epidemiologic Studies Depression scale and the Mini-Mental State Examination, respectively. We used structural equation modeling to examine the shared and specific effects of depression and cognitive impairment on QoL, while adjusting for sociodemographic characteristics, general medical conditions, psychotropic medications and the duration of the disorder. RESULTS: Depression and cognitive impairment were positively associated (r = 0.24, p < 0.01) and both independently and negatively impacted on QoL (standardized ß = -0.41 and ß = -0.32, both p < 0.01) and on each QLS quality-of-life domains, except for depression on instrumental role and cognitive impairment on interpersonal relations in the sensitivity analyses excluding respondents with any missing data. Effects of depression and cognitive impairment on QoL were not due to specific depressive symptoms or specific cognitive domains, but rather mediated through two broad dimensions representing the shared effects across all depressive symptoms and all cognitive deficits, respectively. LIMITATIONS: Because of the cross-sectional design of this study, measures of association do not imply causal associations. CONCLUSIONS: Mechanisms underlying these two broad dimensions should be considered as important potential targets to improve quality of life of this vulnerable population.

Metabolic syndrome among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study.

Metabolic syndrome and its associated morbidity and mortality have been well documented in adults with schizophrenia. However, data is lacking for their geriatric counterparts. We sought to investigate the frequency of screening and the prevalence of metabolic syndrome in older adults with schizophrenia, as well as its possible correlates, using the Cohort of individuals with schizophrenia Aged 55 years or more study (n = 353). We found that 42.2% (n = 149) of our sample was screened for metabolic syndrome. Almost half of those (n = 77; 51.7%) screened positive according to ATPIII criteria. Hypertension and abdominal obesity were the two most prevalent metabolic abnormalities. Screening was positively associated with male gender and urbanicity, and metabolic syndrome diagnosis was positively associated with cardiovascular disorders and consultation with a general practitioner (all p < 0.05). However, there were no significant associations of metabolic syndrome with socio-demographic or clinical characteristics, psychotropic medications, other medical conditions and other indicators of mental health care utilization. Our findings support that the prevalence of metabolic syndrome among older adults with schizophrenia spectrum disorder is high and screening is crucial mainly in those patients with hypertension and/or abdominal obesity. Factors at play might be different than those in the younger population.

Subsyndromal and syndromal depressive symptoms among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study.

BACKGROUND: Few studies have examined the prevalence and correlates of subsyndromal and syndromal depressive symptoms (SSSD) among older adults with schizophrenia spectrum disorder. In this report, we examined the prevalence of SSSD and their associations with sociodemographic characteristics, clinical characteristics of schizophrenia, comorbidity, psychotropic medications, quality of life, functioning and mental health care utilization in a large, multicenter sample of older adults with schizophrenia spectrum disorder. METHODS: Data from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) were used to examine the prevalence of SSSD, defined using the Center of Epidemiologic Studies Depression (CESD) scale. Clinical characteristics associated with SSSD were explored. RESULTS: Among 343 older adults with schizophrenia spectrum disorder, 78.1% had either subsyndromal (30.6%) or syndromal (47.5%) depressive symptoms. SSSD were independently associated with positive and negative symptoms, lower quality of life, non-late-onset psychosis, benzodiazepine use and urbanicity. There were no significant associations of SSSD with other sociodemographic characteristics and psychotropic medications, or with general medical conditions. We found no significant differences in the proportion of participants who were treated with antidepressants between those with syndromal depressive symptoms and those without depression (22.1% vs. 20.0%, p = 0.89). SSSD were not associated with higher mental health care utilization. LIMITATIONS: Data were cross-sectional and depression was not evaluated with a semi-structured interview. CONCLUSION: SSSD may be highly prevalent and under-assessed and/or undertreated among older adults with schizophrenia spectrum disorder. Our findings should alert clinicians about the need to assess systematically and regularly depression in this vulnerable population.

Fibromyalgia patients make scarce reference to pain in self-defining memories.

OBJECTIVE: Self-defining memories (SDMs) are vivid, emotionally intense and well-rehearsed autobiographical memories that provide fundamental information about one's cognitive affective motivational representation of self. Exploring SDMs in fibromyalgia (FM) is of interest for understanding the psychopathology of this disorder and improving clinical interventions. Our aim was to compare patients and healthy controls (HC) on SDM characteristics. METHOD: We included 25 patients with FM and 24 HC matched for age, sex and education level. Each participant described five SDMs, which were coded for content, specificity, integration, tension, redemption, contamination, affective response, date, and reference to pain. We statistically controlled our results for the most plausible confounding factors related to FM that could affect SDM recall, namely depression, anxiety, cognitive inhibition, pain severity and medication. RESULTS: Compared with HC, patients retrieved less specific SDMs with a more negative emotional valence but less tension. They reported more relationship-related memories, and fewer redemptive ones, with less meaning-making. The number of memories referring to physical or psychological pain did not differ between groups. None of the confounding factors we analysed could explain (either alone or in combination) the statistical differences between groups for SDMs characteristics. CONCLUSION: We discuss functional avoidance and alexithymia as two main factors for poor reference to pain in patients' SDMs that further reveal affective dysregulation in FM. In clinical practice, remediating the way in which pain is integrated into SDMs in FM may help to mitigate its negative impact on everyday life.