Tools for assessing social isolation and feelings of loneliness in older adults: a systematic review.

Older adults who are socially isolated or who feel lonely have a higher risk of morbidity and mortality. It is important to be able to assess them with efficient tools. The objective was to describe tools for assessing feelings of loneliness (FoL) and social isolation (SI) in older adults, and to estimate their prevalence. A systematic review was conducted including 18 studies. For FoL, the most frequently used tool was the UCLA Loneliness Scale. For SI, the most frequently used tool was the Lubben Social Network Scale. The median prevalences of FoL and SI were 24.1% and 42.5%, respectively. Both of these constructs will become more prominent in the coming decades; therefore, there is a need to identify the best tools.

Correlates of Health-Related Quality of Life in Community-Dwelling Older Adults in Guadeloupe (French West Indies): Results from the KASADS Study.

OBJECTIVES: The aim of this study was to determine the correlates of health-related quality of life (HRQoL) in community-dwelling older adults in Guadeloupe. METHODS: We used the Karukera Study of Aging-Drugs Storage (KASADS), an observational, cross-sectional study on community-dwelling older people living in Guadeloupe. A visual analogue scale ranging from 0 to 100 was used to assess HRQoL. RESULTS: The study sample consisted of 115 patients aged 65 years or older; 67.8% were women. Participants were 76 (±7.8) years old with a mean HRQoL of 66.2 (±20.3). The correlates of HRQoL were complaints of pain (p < 0.001) and IADL dependency (p = 0.030) after adjustment. We found no significant interactions between HRQoL and other variables such as marital status, socio-educational level and cognitive decline. CONCLUSIONS: Pain and IADL dependency were independently associated with lower HRQoL in community-dwelling older people in Guadeloupe.

Correlates of diabetic polyneuropathy of the elderly in Sub-Saharan Africa.

BACKGROUND: Diabetic polyneuropathy is associated with significant physical disability among older adults. However, their frequency and correlates are not well known in the older adults in Sub-Saharan-Africa. The objectives were to evaluate the hospital-based prevalence of diabetic polyneuropathy and identify its correlates in older adults. METHODS: Over a period of 5 months, a cross-sectional survey was carried out at Douala Laquintinie Hospital (DLH), a main reference hospital in Douala, the economic capital of Cameroon. Participants in our study group comprised all patients with type 2 diabetes, whatever the reason for their reporting to the hospital. Diabetic Polyneuropathy was defined according to a Diabetic Neuropathy Examination score > 3/16. RESULTS: A total of 159 older adults with diabetes were examined during this recruitment period, among whom 106 (66.7%) were women. The mean age was 68.3 ± 6.5 years. Diabetes median duration was 108 months. For all patients assessed using the Diabetic Neuropathy Examination score, polyneuropathy was reported in 31.4%; among them, polyneuropathy proved symptomatic in 78% of them. Correlates of polyneuropathy were glycated hemoglobin (p = 0.049), HIV infection (p = 0.031) and albuminuria (p< 0.001), even after adjustment for age, gender and duration of diabetes. CONCLUSION: A third of older adults with diabetes who visited our hospital were diagnosed with prevalent diabetes-related polyneuropathy. It shows that early detection is required through routine screening and regular follow-up examinations in order to reduce the risk of disability and improve the quality of life in elderly diabetics.

Gait speed and body mass index: Results from the AMI study.

BACKGROUND: While physical frailty and malnutrition/obesity (parameters easily measured by a nurse) are not the same, older persons who are malnourished/obese are more likely to be frail and there is a potential overlap between these conditions. The objective was to examine the relationship between gait speed (GS) and body mass index (BMI) in men and women aged 75 years and older. DESIGN: Cross-sectional analysis. SETTING, PARTICIPANTS: Data from the Aging Multidisciplinary Investigation (AMI), a French prospective cohort study with participants randomly selected from the farmer Health Insurance rolls. MEASUREMENTS: Usual GS was measured over a 4 meters-track. BMI was categorized using clinical cut-points for European populations: (e.g, <20.0 kg/m2; 20.0-24.9 kg/m2; 25.0-29.9 kg/m2; 30.0-34.9 kg/m2; ≥35.0 kg/m2). RESULTS: The current analyses were performed in 449 participants. Mean age was 81 years. Being malnourished/obese was significantly associated with slow GS. Unadjusted and age-adjusted models showed that underweight, overweight and obesity statuses were significantly associated with slow GS for both women (0.83m/s [0.61; 1.04], 0.87m/s [0.72; 1.02], 0.70 m/s [0.41; 0.98], respectively) and men (0.83m/s [0.61; 1.04], 1.11m/s [1.03; 1.20], 0.97m/s [0.75; 1.19], respectively). CONCLUSION: Malnourished/obese are associated with slow GS in older persons. These variables could be contributed at comprehensively and complementarily assessing the older person.

Physical status and frailty index in nursing home residents: Results from the INCUR study.

AIM: The Short Physical Performance Battery (SPPB) is a widely used instrument for measuring physical performance, consisting of 3 sub-tests: a hierarchical test of balance, a gait speed test, and a chair stand test. Although equally considered in the computation of the SPPB score, each of the components may present a specific and different weight in clinical practice. The aim of this study was to estimate the relationship between SPPB and its component of an age-related deficit accumulation index (the so-called Frailty Index [FI] proposed by Rockwood). METHOD: Data are from a longitudinal cohort study (ie, the Incidence of pNeumonia and related ConseqUences in nursing home Residents [INCUR]) of 730 older persons (74.29% women) living in 13 French nursing homes. The FI was computed as the ratio between 30 actual and potential deficits the participant might have presented at the baseline visit (range between 0 [no deficit] and 1 [30 deficits]). Physical status was assessed using the SPPB score at baseline. Descriptive statistics and linear regression analyses were used to determine the relationship between the SPPB and FI and estimate which components of the SPPB were most strongly associated with the FI. RESULTS: Mean age of participants was 86.5 (SD 7.5) years, with a mean FI of 0.37 (SD 0.11) and SPPB of 2.5 (range between 0 and 12). The SPPB and its components were all significantly associated with the FI, but the magnitude of the associations varied. Linear regression analyses adjusted for age, sex, showed that the balance test [beta=-0.045 (95%CI -0.042; -0.028), p<0.0001] and chair stand test [beta=-0.040 (95%CI -0.054; -0.027), p<0.0001] was more strongly associated with the FI than the gait speed [beta=-0.015 (95%CI -0.021; -0.008), p<0.0001]. CONCLUSION: Of the 3 components of the SPPB, both balance and chair tests seem particularly relevant indicator of frailty among very old and complex elders living in nursing homes.

Association of Gait Speed, Psychomotor Speed, and Dementia.

BACKGROUND: Gait speed (GS) and psychomotor speed (PS) could be considered as two different dimensions of age-related slowness and both measures are associated with higher risk of adverse health-related outcomes among elderly people. OBJECTIVE: To determine the association between GS, PS, and incident dementia among community-dwelling older adults. METHODS: Twelve-year longitudinal study of 1,265 participants in the Bordeaux Three-City Study, a French prospective cohort designed to determine the risk of dementia and cognitive impairment attributable to cardiovascular risk factors. Participants completed a battery of cognitive tests, including time to complete the Trail Making Test A, and a walking speed test. The incidence of dementia was determined over the 12-year follow-up period. Cox proportional hazards models with delayed entry were used to estimate the cumulative risk of dementia and were adjusted for sex, education, and ApoE4 genotype. RESULTS: Mean age of participants was 74.0 years (SD 4.8). Over the 12-year follow-up, 203 participants developed dementia. GS and PS were both independent predictors of incident all-cause dementia after 12 years of follow-up. For a one SD increase of either GS or PS, the hazard ratio (HR) for Alzheimer's disease was 1.2 (95% CI = 1.02-1.32) and 1.4 (95% CI = 1.2-1.61), respectively; whereas for incident vascular dementia, the HR was 1.3 (95% CI = 1.05-1.71) and 1.5 (95% CI = 1.16-2.08), respectively. No significant interaction between GS and PS was observed. CONCLUSIONS: In older French people aged 65+, our findings showed that both low GS and PS were independently associated with risk of incident Alzheimer's disease and vascular dementia.

Frailty in elderly: a brief review.

The identification of frail older persons is a public health priority. Frailty is defined as an extreme vulnerability of the organism to endogenous and exogenous stressors, a syndrome that exposes the individual at higher risk of negative health-related outcomes as well as a transition phase between successful aging and disability. The theoretical concept of frailty is largely agreed, its practical translation still presents some limitations due to the existence of multiple tools and operational definition. In this brief review, we would like to clarify the frailty concept regarding scientific literature.