Pre-Therapeutic Assessment of Older People in Sub-Saharan Africa: Introduction to the Comprehensive Geriatric Assessment.

Objectives: With the ongoing epidemiological transition in sub-Saharan Africa (SSA), conditions that require invasive treatment (surgery, cancer, and anaesthesia, etc.) will become increasingly common. Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic process aimed at identifying older people at risk of negative outcomes. It is important to know whether this approach integrates care management strategies for older people in a context where health services for older people are scarce, and staff members have little training in geriatrics. The current work is a situational analysis on the use of CGA on invasive care (cancer, surgery, etc.) among older people in SSA. Methods: We searched PubMed-MEDLINE and other sources for studies reporting on CGA and conditions requiring invasive treatment in older patients in SSA. Results/Conclusions: We found no study that had comprehensively examined CGA and invasive care in SSA. There is, however, evidence that the offer of invasive care to older people has improved in SSA. Further research is needed to explore the applicability of CGA in SSA. Similarly, more investigations are needed on the role of CGA in the care trajectories of older people in SSA, in terms of outcomes and affordability.

Short Physical Performance Battery and Study of Osteoporotic Fractures Index in the Exploration of Frailty Among Older People in Cameroon.

Objectives: To investigate the relationship between the Short Physical Performance Battery (SPPB) and the Study of Osteoporotic Fractures (SOF) index. Methods: We present data from a cross-sectional survey conducted in Cameroon. Frailty was defined as an SOF index > 0. The sensitivity and specificity of the SPPB were investigated. Principal component analysis (PCA) was performed to assess the contribution of each subtest of the SPPB to the relationship with the SOF. Results: Among 403 people included (49.6% women), average age of 67.1 (±6.2) years, 35.7% were frail according to the SOF. After determining the best SPPB threshold for diagnosing frailty (threshold = 9, Se = 88.9%, Sp = 74.9%), 47.9% were frail according to the SPPB. The first dimension of PCA explained 55.8% of the variability in the data. Among the subtests of the SPPB, the chair stand test item was the component most associated with the SOF index. Conclusion: Despite the overlap between the SOF and the SPPB, our results suggest that a negative result on the five chair-stands test alone would be sufficient to suspect physical frailty.

Correlates of Undernutrition in Older People in Guadeloupe (French West Indies): Results from the KASADS Study.

Objectives: This study aimed to determine the risk factors for undernutrition in community-dwelling older adults in Guadeloupe (Caribbean islands). Methods: We used data from the KArukera Study of Aging-Drugs Storage (KASADS), an observational cross-sectional study of community-dwelling older people living in Guadeloupe. The Mini Nutritional Assessment (MNA) was used to assess the risk of undernutrition. An MNA-short form (SF) score ≤11 defined the risk of undernutrition. Depression was assessed using the Center for Epidemiologic Studies Depression (CES-D) scale, cognitive function was assessed using the Mini Mental State Examination (MMSE), frailty was assessed using the Study of Osteoporotic Fractures index (SOF), and dependency was assessed using Lawton's instrumental activities of daily living (IADL) scale. Bivariate and multivariate analyses were used to determine the correlates of undernutrition. Results: The study sample comprised 115 patients aged 65 years or older; 67.8% were women, and the mean age was 76 ± 7.8 years. The prevalence of undernutrition was 21.7% (95% CI = 15.2-30.1%). In our bivariate analysis, the risk of undernutrition was associated with MMSE score, IADL score, frailty, and CES-D score. We found no significant relation between nutrition risk and other variables, such as marital status, pain, or polypharmacy. In the multivariate analysis, the factors associated with the risk of undernutrition were MMSE score (Odd-Ratio (OR): 0.74 (0.58-0.97)) and CES-D score (OR: 1.13 (1.02-1.27)). Conclusions: Cognitive decline and the risk of depression were independently associated with the risk of undernutrition in community-dwelling older people in Guadeloupe. Although we cannot imply causality in this relation, the detection of these three key geriatric syndromes in community-dwelling elders is essential to prevent adverse health outcomes. Further studies are warranted to confirm these findings.

Drug storage, polypharmacy and frailty syndrome in older people: an observational study.

Introduction: the increasing prevalence of polypharmacy in the older population could lead to inappropriate storage of medicines at home. Since polypharmacy is associated with frailty, the main objective of the Karukera Study of Aging - Drug Storage (KASADS) study was to investigate the association between drug storage and frailty. If such an association exists, drug storage could be a simple tool for the identification of medication vulnerability by non-medical staff in the elderly. Methods: observational, cross-sectional study in community-dwelling older adults (>65 years old). Drug storage was defined as any drug in excess compared to a medical prescription, any unused and/or expired drug, or any drug without a medical prescription. Frailty was measured with the Study of Osteoporotic Fractures (SOF) scale, and polypharmacy was defined as a prescription of at least 5 drugs. Bivariate and multivariate analyses were performed to study the associations between drugs storage, frailty, and polypharmacy. Results: during the study period (01/10/2019 to 15/03/2020), 115 elderly people were interviewed in their own homes. The average age was 76.0 ± 7.8 years old. Seventy-two percent of the participants met the criteria for polypharmacy and 30.4% were prefrail/frail. They stored an average of 14.7 ± 18.2 boxes. Drug storage was associated with polypharmacy (17.5 boxes versus 10.0; p=0.031) but not with frailty (15.6 versus 14.3; p=0.724). In multivariate analysis, drug storage was associated with not having a school degree (OR: 1.78; 95%CI: 1.13-2.79), suffering from dyslipidemia (OR: 2.00; 95% CI: 1.28-3.17) and suffering from cognitive disorders evaluated by the Mini Mental State Examination (MMSE) score (OR: 1.10; 95%CI: 1.02-1.17). Conclusion: drug storage was not significantly associated with frailty. Nevertheless, it was associated with polypharmacy and other medical outcomes, and could therefore represent a new area for research in geriatrics and pharmacy.

Profiles of Elderly Patients with Obesity Hypoventilation Syndrome in Martinique: A Single-Center Study.

Obesity hypoventilation syndrome (OHS) is a form of chronic respiratory insufficiency related to obesity that affects young and old people. Age appears to be associated with poorer response to treatment by nighttime ventilation. This study aimed to describe the characteristics of elderly subjects (>65 years) with OHS compared to younger patients, with a view to adapting therapy in older individuals. We conducted a retrospective study comparing socio-demographic, clinical, functional characteristics as well as treatment and outcomes between young (<65 years) and older (65 years and older) individuals with OHS at the University Hospital of Martinique. We included 143 patients (114 women), of whom 82 were 65 years or older (57%). Charlson index was higher in the older group. Patients in ≥65 years group were less frequently obese, but more frequently had diabetes mellitus, cardiac arrythmia and arterial hypertension compared to younger patients. There was no difference in the circumstances of diagnosis or arterial blood gas at diagnosis. At follow up, partial pressure of carbon dioxide (pCO2) was higher in ≥65 years group. Despite comparable NIV settings, apart from lower expiratory positive airway pressure (EPAP) with higher apnea-hypopnea index (AHI), patients in the ≥65-year-old group remained more frequently hypercapnic. In conclusion, over half (57%) of patients with OHS in our cohort were aged over 65 years. Older patients developed OHS at lower BMI levels than their younger counterparts, and more frequently, had comorbidities such as diabetes, hypertension and cardiac arrhythmia. Increased Charlson index, lower BMI and female sex were independent factors associated with OHS in the elderly.

The Health Care Trajectories of Older People in Foster Families: Protocol for an Observational Study.

BACKGROUND: With aging of the population, the search for alternative models of care adapted to older people with dependency is necessary. In this setting, foster families (1-3 older people per family) could be an alternative to nursing homes, residential care facilities, or community- and home-based care. OBJECTIVE: The KArukera Study of Ageing in Foster Families is a prospective cohort study designed to investigate the care pathways of older people with dependency in foster care over a year. The 1-year hospitalization rate (main objective), cost of hospitalization, incidence of mortality, prevalence of geriatric syndromes, and quality of life of residents will be assessed. Quality of life and burnout of their respective foster caregivers will also be studied. METHODS: This study cohort will include 250 older people living in foster families in Guadeloupe (French West Indies), as well as their respective foster caregivers. Both older people and caregivers will be interviewed concurrently on site at three time points: (1) at baseline, (2) at 6 months, and (3) at 12 months. For older people, we will collect anthropometric measures, cognitive impairment, depressive and anxiety symptoms, functional abilities, physical frailty, information on general health status, quality of life, and care pathways (hospitalization, mortality, and medical and paramedical consultations). We will also assess the quality of life and burnout symptoms of family caregivers at each follow-up. A phone update of vital status (alive or death) and care pathways of residents will be carried out at 3 and 9 months after the baseline examination. RESULTS: Recruitment opened in September 2020 and ended in May 2021, with 109 older people recruited and 56 respective foster caregivers. The 1-year follow-up was ended in June 2022. Data analyses are ongoing and the first results are expected to be published in May 2023. CONCLUSIONS: Foster families are a potentially innovative way to accommodate dependent older people. This study could help define the clinical profile of older people adapted to foster families in the transition from frailty to dependency. The effectiveness of foster families, in terms of hospitalizations and mortality, will be compared with other models of care, particularly nursing homes. In this setting, a twin study carried out in nursing homes in Guadeloupe with similar aims and outcomes will be conducted. Beyond mortality and morbidity, the numerous outcomes will allow us to assess the evolution of geriatric syndromes over time. TRIAL REGISTRATION: ClinicalTrials.gov NCT04545775; https://clinicaltrials.gov/ct2/show/NCT04545775. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40604.

Self-reported visual impairment and sarcopenia among older people in Cameroon.

Aging has been clearly associated with decline in visual and physical performance. Alteration of visual function is associated with negative health outcomes including physical frailty. We assessed the relationship between Visual Impairment (VI) and sarcopenia in older persons in Cameroon. In a cross-sectional survey conducted in Douala in 2019, sarcopenia was assessed using the SPPB (Short Physical Performance Battery) test scored from 0 to 12. The diagnosis of sarcopenia was based on SPPB test score < 9 while VI was self-reported. Of the 403 participants (50.4% male) with a mean age of 67.1 (± 6.2) years, 356 (88.3%) reported a VI while the prevalence of sarcopenia was 47.9% [95% CI 43.0-52.7]. After adjusting for several factors, VI was significantly associated with sarcopenia (OR 2.66 [95% CI 1.29-5.48]). Of the SPPB subtests, only chair stand test was negatively associated with VI (ß = - 0.45 [95% CI - 0.82 to 0.07]). Our study supports an association between VI and sarcopenia. If confirmed by further cohort studies, this result would suggest that VI could be considered as an early indicator of sarcopenia among older people in sub-Saharan Africa.

Frailty index, mortality, and length of stay in a geriatric short-stay unit in Guadeloupe.

Context: The COVID-19 pandemic has placed a tremendous stress on healthcare systems and caused reorganization. As the pandemic intensifies, identifying the profile of patients with COVID-19 was primordial in order to predict negative outcomes and organize healthcare resources. Age is associated with COVID-19's mortality, but for obvious ethical reasons, chronological age cannot be the sole criterion for predicting negative outcomes. Objective: The objective of this study was to determine the relationship between frailty index (FI) and length of hospital stay, and death in a non-COVID population of patients aged 75 years old and above. Methods and design: A retrospective, analytical, single-centered observational study was performed in the geriatric short-stay accommodation unit at Guadeloupe University Hospital. For this study, 158 patients who were at least 75 years old were recruited from November 2020 to May 2021. FI was calculated as the number of deficits in a participant divided by the total number of deficits considered (the cut-off of FI is.25 in outpatient). Multivariate logistics regression analyses were conducted to assess the association between frailty and death, and length of stay. Results: The average age of the participants was 85.7 ± 6.74 with a range of 75-104. Twenty-four of the patients died during hospitalization. FI was only significantly associated with mortality even after adjustment for age and gender (HR 26.3, 95% CI 1.7-413.4, P = 0.021). The association was stronger in the highest tertile of the FI (age- and gender-adjusted HR 4.6, 95% CI 1.39-15.11, P = 0.01). There was no significant interaction between FI and length of stay. Conclusion: Our study shows an association between FI (in terms of age-related deficit accumulation) and mortality in a non-COVID geriatric short-stay unit in Guadeloupe. The FI seems to have a lower capacity to catch events such as length of stay in this very complex population. Further research studies have to be conducted for better understanding and investigation of our findings.

Feelings of Loneliness and Living Alone as Predictors of Mortality in the Elderly: The PAQUID Study.

OBJECTIVE: The aim of this work was to determine the predictive value of 2 indicators of psychosocial isolation (living alone and feelings of loneliness) in elderly people. METHODS: Twenty-two-year follow-up cohort study of 3,620 community-dwelling elderly people enrolled in the PAQUID study, a French prospective population-based study. Participants completed a battery of tests including the Centre for Epidemiological Studies Depression scale and a question regarding living conditions (living alone or living with another person). Feelings of loneliness were measured using the Item 14 ("I felt lonely") of the French version of the Centre for Epidemiological Studies Depression scale. Mortality rate was measured over a 22-year follow-up period after the baseline assessment visit. The risk of death was estimated using Cox proportional hazards models, adjusted for age, sex, and educational level. RESULTS: At baseline, 1,535 participants (42.4%) were living alone, and a total of 498 persons (13.8%) reported frequent feelings of loneliness (FoL). The participants reporting FoL were more frequently women (82.7%), and the mean (SD) age was 76.5 (7.1) years. At the end of the follow-up, 3,116 deaths (86.6%) occurred. Living alone and FoL were both independent predictors of death after 22 years of follow-up (hazard ratio, 1.14; 95% confidence of interval, 1.05-1.23; p = .001) and (hazard ratio, 1.20; 95% confidence of interval, 1.08-1.33; p = .001), respectively. No significant interaction was found between feelings of loneliness and living alone, suggesting that a joint exposure has only an additive effect (ß = 0.08; relative risk = (0.85; 1.40); p = .48). The associations of both measures persisted after adjusting for health status. Adjusting for depression attenuated the predictive value of FoL. CONCLUSIONS: Living alone and FoL were independently associated with higher risk of mortality. These factors may be useful as readily available psychosocial measures to identify vulnerability in community-dwelling older adults.