Individual and collective factors predicting change in diet quality over 3 years in a subset of older men and women from the NuAge cohort.

PURPOSE: This study examined individual and collective factors as predictors of change in global diet quality (DQ). METHODS: Subjects were 373 older adults (57 % female) aged 68-82 years at recruitment (T1) into the NuAge Cohort Study, and followed for three years. Data were collected by questionnaires, physical performance tests and anthropometric measurements. Diet was assessed at T1 and T4 using three non-consecutive 24-h diet recalls (24HR) and DQ (Canadian Healthy Eating Index), and was computed on the means of the 24HR. DQ change over three years was determined as "DQT4-DQT1". Baseline (T1) measures significantly correlated with DQ at T1 were entered into backward stepwise linear regression analyses along with selected theoretical constructs and controlled for baseline DQ to determine predictors of change in DQ over 3 years. RESULTS: Among men, education (p = .009) and sensations of hunger (p = .01) were positive predictors of DQ change over time, while DQ at T1 (p < .0001), cognition (p = .003) and social network (p = .019) were negative predictors (adjusted R (2) = 30.4 %). Finally, among women, diet knowledge (p = .044) was a positive predictor of DQ change, while DQ at T1 (p < .0001) and social network (p = .033) were negative predictors of DQ change over 3 years (adjusted R (2) = 24.1 %). CONCLUSIONS: These results can inform dietary intervention programmes targeting gender-specific determinants of diet quality in older adults.

Perception et réceptivité des proches-aidants à l'égard de la vidéosurveillance intelligente pour la détection des chutes des aînés à domicile.

To address the issue of falls, which are increasing as the population ages, an intelligent video-monitoring system is being developed. The aim of the study is to explore caregivers' perceptions of and receptiveness to a prototype of this fall detection system. A cross-sectional mixed-method study was carried out with individual interviews of 18 caregivers. Statistical frequencies and content analysis were conducted (SPSS and N'Vivo). The results show that most participants (n = 15/18) liked the intelligent video-monitoring system and were willing to use it. They would worry less if they could be alerted if a care recipient fell, but they were concerned about privacy and cost. Participants had a positive perception of the system and expressed their wishes regarding the kind of alert and the person to contact in case of a fall.

Cooking task assessment in frail older adults: who performed better at home and in the clinic?

AIM: The purpose of this study was to determine: (i) the proportion of frail older adults who demonstrate (a) statistically significant and (b) clinically meaningful differences between home and clinic cooking task performance; and (ii) factors associated with a better performance in each environment. METHODS: Thirty-seven participants were evaluated with the Assessment of Motor and Process Skills (AMPS) in home and clinic environments using a counterbalanced design. Demographic, physical, cognitive, psychological, and environmental characteristics were also collected. RESULTS: Thirty-three participants were retained for analysis. A statistically significant difference (> ±2 standard errors of measurement) between environments was found in 33% of the participants on the motor scale and the same proportion on the process scale. A clinically meaningful difference (based on cut-off scores predicting need for assistance) was noted in 30% of the participants. Better performance at home on the process scale was associated with a decrease in some executive functions, while better performance in the clinic on the motor scale was mostly related to a decline in grip strength. CONCLUSIONS: Our findings may help occupational therapists identify frail patients for whom home assessments would be advisable prior to discharge so that assistance provided meets their needs at home.

Neurofunctional (re)organization underlying narrative discourse processing in aging: evidence from fNIRS.

Relatively few studies have analyzed the mechanisms underlying the cognitive changes that affect language in the elderly, and fewer have done so for narrative discourse. The goal of this study was to explore the neurofunctional changes associated with aging for different components of narrative discourse. Functional near-infrared spectroscopy (fNIRS) and behavioral data on 10 younger adults and 10 healthy elderly participants were collected. Ten younger adults in a non-proficient second language condition were included to explore the possibility that the age-related neurofunctional reorganization partly expresses demanding resource allocation. Results show within- and across-hemispheric differences in the neurofunctional pattern of activation in the older participants with reference to the younger ones, partially shared with the low-proficiency young adults, providing support for the recognized mechanisms underlying neural reserve and compensation. fNIRS was shown to be appropriate for studying the age-related neurofunctional reorganization of complex cognitive abilities.

Syntactic processing in bilinguals: an fNIRS study.

The study of the neural basis of syntactic processing has greatly benefited from neuroimaging techniques. Research on syntactic processing in bilinguals has used a variety of techniques, including mainly functional magnetic resonance imaging (fMRI) and event-related potentials (ERP). This paper reports on a functional near-infrared spectroscopy (fNIRS) study on syntactic processing in highly proficient young adult speakers of Portuguese (mother tongue) (L1) and French (second language) (L2). They made a syntactic judgment of visually presented sentences, which either did or did not contain noun-verb agreement violations. The results showed that syntactic processing in both languages resulted in significant activation in anterior frontal regions of the left hemisphere and in the temporal superior posterior areas of the right hemisphere, with a more prominent activation for L2 in some areas. These findings corroborate previously reported neuroimaging evidence, showing the suitability of fNIRS for the study of syntactic processing in the bilingual brain.

Transitions in the functional status of disabled community-living older adults over a 3-year follow-up period.

The purpose of this study was to investigate transitions over time in the functional status of disabled community-living elderly. The study explored clinical and socio-demographic predictors of functional status decline. Data from the SIPA 3-year longitudinal study were analyzed (n=1164). Three categories of functional status were defined: no important disability, significant IADL disability and significant ADL disability. At baseline, results show that the prevalence rates were 26.9%, 58.6% and 14.5% for the three categories of functional status. After 12 months, about 50-60% of participants had remained in the same status, while some 10-15% of those with baseline significant disability had improved. The patterns of transitions between 12 and 36 months of follow-up were slightly different. The results indicated more deterioration (13-38%) and less improvement (6-9%). After controlling for baseline functional status, the best predictors for functional decline at 36 months were prior disability, functional limitations, cognitive impairment and comorbidity burden. We found that older adults' functional status may decline or improve even if the participants are disabled. Disabled conditions play a crucial role in the development of future disability and preventive actions need to be implemented.

An intelligent videomonitoring system for fall detection at home: perceptions of elderly people.

We explored the perception and receptivity of elderly people regarding the introduction of an intelligent videomonitoring system (IVS) at home. Using a mixed methods design, 25 elderly people with a history of falls completed a structured interview (two questionnaires). In the year preceding the interview, 72% of the participants fell as many as seven times. Open-ended questions (qualitative data) were used to supplement the quantitative data. A content analysis (qualitative data) and a descriptive analysis (quantitative data) were carried out. The participants were 84% favourable or partially favourable to technologies which ensured home security and 96% favourable or partially favourable to the IVS. About half (48%) said that they would use it. The other participants did not wish to use it unless they had been left to live alone or if their health condition worsened. Thus the living conditions of the elderly appear to influence their perception and receptivity regarding the acceptance and use of an IVS.

Brazilian version of the Protocole Montréal d'Evaluation de la Communication (Protocole MEC): normative and reliability data.

The lack of standardized instruments to evaluate communication disorders related to the right hemisphere was verified. A new evaluation tool was developed: Protocole Montréal d'Evaluation de la Communication--Protocole MEC, adapted to Brazilian Portuguese--Bateria Montreal de Avaliação da Comunicação--Bateria MAC (Montreal Evaluation of Communication Battery). The purpose was to present stratified normative data by age and educational level, and to verify the reliability parameters of the MEC Battery. 300 individuals, between the ages of 19 and 75 years, and levels of formal education between 2 and 35 years, participated in this study. They were divided equally into six normative groups, according to three age categories (young adults, intermediary age, and seniors) and two educational levels (low and high). Two procedures were used to check reliability: Cronbach alpha and reliability between evaluators, Results were established at the 10th percentile, and an alert point per task for each normative group. Cronbach's alpha was, in general, between .70 and .90 and the average rate of agreement between evaluators varied from .62 to .94. Standards of age and education were established. The reliability of this instrument was verified. The psychometric legitimization of the MEC Battery will contribute to the diagnostic process for communicative disorders.

Brazilian Version of the Protocole Montréal d’Évaluation de la Communication (Protocole MEC): Normative and Reliability Data

The lack of standardized instruments to evaluate communication disorders related to the right hemisphere was verified.A new evaluation tool was developed: Protocole Montréal d’Évaluation de la Communication - Protocole MEC, adapted to Brazilian Portuguese - Bateria Montreal de Avaliação da Comunicação - Bateria MAC (Montreal Evaluation of Communication Battery). The purpose was to present stratified normative data by age and educational level, and to verify the reliability parameters of the MEC Battery. 300 individuals, between the ages of 19 and 75 years, and levels of formal education between 2 and 35 years, participated in this study. They were divided equally into six normative groups, according to three age categories (young adults, intermediary age, and seniors) and two educational levels (low and high). Two procedures were used to check reliability: Cronbach alpha and reliability between evaluators. Results were established at the 10th percentile, and an alert point per task for each normative group. Cronbach's alpha was, in general, between .70 and .90 and the average rate of agreement between evaluators varied from .62 to.94. Standards of age and education were established. The reliability of this instrument was verified. The psychometric legitimization of the MEC Battery will contribute to the diagnostic process for communicative disorders (AU)

Se verificó la falta de instrumentos estandarizados para evaluar los trastornos de comunicación relacionados con el hemisferio derecho. Se desarrolló una herramienta de evaluación nueva: el Protocole Montréal d'Évaluation de la Communication - Protocolo MEC, adaptado al portugués brasileño - Bateria Montreal de Avaliação da Comunicação - Batería MAC (Batería de Evaluación de la Comunicación de Montreal). El objetivo fue presentar datos normativos estratificados por edad y nivel académico, y verificar los parámetros de fiabilidad de la batería MEC. 300 individuos, de edades entre los 19 y los 75 años y con 2 a 35 años de educación formal, participaron en este estudio. Se dividieron en seis grupos normativos, en función de tres categorías de edad (adultos jóvenes, edad mediana y mayores) y dos niveles educacionales (bajo y alto). Se emplearon dos procedimientos para confirmar la fiabilidad: alfa de Cronbach y fiabilidad inter-jueces. Se establecieron los resultados en el percentil 10 con un punto de alerta por tarea para cada grupo normativo. Los valores de alfa de Cronbach eran, en general, entre 0.70 y 0.90 y el grado de acuerdo entre los evaluadores variaba entre 0.62 y 0.94. Se establecieron normas de edad y educación. Se verificó la fiabilidad de este instrumento. La legitimación psicométrica de la Batería MEC contribuirá al proceso diagnóstico de los trastornos de comunicación (AU)

Predicting longitudinal patterns of psychological distress in older husband caregivers: further analysis of existing data.

Further analysis of existing data from a previous longitudinal study of older husband caregivers sought to determine whether primary objective and subjective stressors drawn from Pearlin's model of caregiving could predict three patterns of psychological distress observed in the sample over 1 year: (a) stable high (n=115), (b) stable low (n=44), and (c) rising (n=46). Results of discriminant function analyses show that subjective stressors (level of role overload, role captivity and relational deprivation) at baseline, distinguish the stable low group of husbands from the stable-high. The results suggest that there is considerable stability over time. Many husband caregivers report high-psychological distress and need help, whereas there is a need of preventive interventions to keep psychological distress low. Implications for singular interventions that target specific factors according to group membership are discussed.

Changes in health outcomes among older husband caregivers: a one-year longitudinal study.

This one-year longitudinal study carried out on a sample of 232 older husband caregivers sought to describe changes in psychological distress and self-perceived health, and to examine relationships between factors drawn primarily from Pearlin's model of caregiving and changes in these two health outcomes. Prediction analyses shows that nearly two thirds of the husbands have unsuccessful outcomes with respect to these two dimensions, that is, most husbands obtain either steadily poor scores at both times of the study or worse scores on one or both outcomes. Higher levels of education and informal instrumental support at time 1, as well as an increase in role overload, are predictive of unsuccessful outcome for psychological distress, whereas an increase in self-efficacy predicts successful outcome for self-perceived health. Overall, husband caregivers vary in their response to caregiving over time. The findings support previous study results showing subjective stressors, rather than objective stressors, and caregiver resources to be significant predictors of caregiving outcomes.

[Text comprehension, cognitive resources and aging]. / Compréhension de textes, ressources cognitives et vieillissement.

Aging brings cognitive changes. Language is not immune to these changes. The use of compensation strategies may permit older adults to achieve a performance level identical to the one obtained by younger adults. This research aims to study text comprehension in aging and the reading strategies used for by older and younger adults. Kintsch's cognitive model (1988) allows the identification of different levels of representation within text treatment (linguistic form, macrostructure, microstructure and situation model) and predicts the underlying cognitive components. Eye-tracking analyses during reading permit inference about the moments of reading treatment and detection of reading strategies. Sixty highly educated participants were assessed. They were divided in two age groups (20-40 and 60-80 years old). Participants were asked to read and understand three texts constructed to highlight the features of text comprehension within each one of the different levels of text representation. The amount of detail and the necessity of updating the situation model varied for each text. Eye movements were registered by an eye-tracker (Cambridge research) during the reading process. Specific complementary tasks were administered to evaluate working memory, long-term memory, and executive functions. Variances analyses showed significantly lower performance by older adults regarding: 1) recall of the microstructure of the two texts with a high degree of detail, 2) macrostructure of the text with fewer details, and 3) performance on all tasks that evaluated cognitive components. Aging influenced treatment of levels of text representation depending on text characteristics. However, cluster analysis of the text comprehension and eye-tracker data revealed a group of older adults whose performance in reading comprehension was identical to the performance of younger adults, with the same reading profile. This result seems to show that use of compensation strategies by older adults at the onset of signs of cognitive deterioration is not necessary in reading.

Applicability of a toolkit for geriatric rehabilitation outcomes.

PURPOSE: To field test the applicability of a multidimensional toolkit for geriatric rehabilitation outcomes which includes nine standardized tools. Applicability is defined as context- and population-specific pragmatic qualities of an assessment tool such as respondent and examiner burden, score distribution and format compatibility. METHOD: A sample of 48 older adults representing four diagnostic groups, as well as 26 caregivers, were assessed at home in the first month after discharge from intensive rehabilitation (T1) and 2 months later (T2). Pre-determined qualitative and quantitative applicability criteria were coded and compared at T1 and T2, as well as responsiveness. RESULTS: A higher respondent burden was found for three self-report tools, as well as a ceiling effect on social functioning tools. Respondent burden, examiner burden and score distribution remained stable or diminished at T2. Format compatibility deteriorated only for the mobility test due to a higher proportion of non ambulatory participants (17%). Low to moderate associations between the tools corroborated that they were not redundant (rPearson

The health of family caregivers of older impaired persons in Lebanon: an interview survey.

BACKGROUND: The majority of older persons in Lebanon live with their family, which provides the help and care required when their relative is functionally impaired. Knowing that taking care of an older impaired relative is considered a source of enrichment for the caregiver and an act of gratitude towards the older person in Lebanon. However, there are few formal resources to support these families. This study is informed by a theoretical framework of stress. OBJECTIVE: Identify the dimensions of the caring context related to the health of Lebanese family caregivers living with an older impaired relative. DESIGN: Exploratory correlational study. PARTICIPANTS: Convenience sample (N=319) drawn from all the regions of Lebanon according to predetermined quotas on the basis of relative demographic weight and socio-economic class. The inclusion criteria are: aged 18 years or over; primary caregiver; provided help with at least one ADL or IADL once a week; lived with the older impaired person. 13.5% refused to participate in the study. The caregivers recruited were female (84%), adult children (48%) or spouses (22.6%) with a mean age of 46 years. Almost half of them reported a post-compulsory level of education and a low monthly household income and no medical coverage for 68% of them. METHODS: The data were collected during a face-to-face interviews with the caregivers in their homes. RESULTS: The results from regression analyses indicate that the degree of functional impairment, the frequency of depressive and disruptive behaviours of cared-for relative are linked to at least one of three caregiver health indicators (p<.01). Also, caregiver cognitive appraisal of these stressors is associated with either role strain or feeling of helplessness (p<.05). The informal emotional support received by caregivers is positively related to well-being (p<.001), whereas interpersonal conflicts with family and friends diminish caregiver well-being and increase role strain (p<.001). Sufficiency of emotional support received is negatively associated with role strain (p<.001). CONCLUSION: Many stressors proved associated with one or other of the health indicators under study and the resources emerged as significant factors related to caregiver's health.

Follow-up of an intervention program for caregivers of a relative with dementia living in a long-term care setting: Are there any persistent and delayed effects?

The purpose of this randomized study was to test the persistent and delayed effects of an intervention program entitled "Taking Care of Myself " on selected mental health outcomes of daughter caregivers of a relative with dementia living in a long-term care setting. One group of caregivers took part in the experimental program (EG, n = 45), one in a comparison program offered by an Alzheimer Society (AG, n = 51), and another constituted a control group (CG, n = 41). Effects were verified at the end of the program and 3 months later. Results from prediction analyses reveal that competence dealing with healthcare staff and use of the coping strategy of reframing were persistent effects unique to the EG condition, whereas perceived availability of informal and formal support was a persistent effect in the EG and in the AG. A delayed effect was observed in the AG regarding competence dealing with healthcare staff. These results underline the importance of follow-up assessments of intervention programs and suggest avenues to support caregivers of institutionalized seniors.

The heterogeneity of picture-supported narratives in Alzheimer's disease.

This study describes discourse patterns produced by 46 Alzheimer disease (AD) patients and 53 normal elderly subjects in two picture-supported narratives. Nine measures derived from a cognitive model of discourse processing were obtained and submitted to cluster analysis. Results indicate that discourse patterns elicited from both stimuli were heterogeneous. Further, they fail to clearly differentiate between normal aging and AD in half of the AD patients. Discourse patterns are examined in light of various sources of heterogeneity including severity of cognitive impairment, subject characteristics, and task demands. The usefulness of discourse as a diagnostic and therapeutic tool is discussed.

[Intervention to promote recognition of the rights of families of an elderly relative with dementia living in a long-term care facility]. / Intervention pour promouvoir la reconnaissance des droits des familles d'un parent âgé atteint de démence en milieu d'hébergement.

The rights of families of an institutionalized elderly relative with dementia have yet to be recognized. The results of our pilot study based on a participatory approach show, among other things, that family caregivers, women for the most part, have little input in the decisions regarding their relative's care and are uneasy to express their opinions to health care staff. As part of the pilot study, caregivers developed a group intervention program entitled "Taking Care of Myself" geared, among other things, towards increasing their competence in expressing their viewpoint to health care staff and in taking part in care-related decisions. According to an efficacy study conducted after the pilot study, the program produced successful outcomes in terms of caregiver competence in dealing with the health care staff and of perceived challenge of the caregiver situation. Recommendations are made aimed at giving caregivers recognition, that is their due.

Processing of metaphoric and non-metaphoric alternative meanings of words after right- and left-hemispheric lesion.

This study examines the specificity of the contribution of the right hemisphere to the processing of metaphoric meaning of words. Ten right- and 10 left-hemisphere-damaged subjects, and 20 normal control subjects were submitted to: (1) a word-triad task where they had to associate alternative metaphoric and non-metaphoric words to a target word, and to (2) a word-dyad task where they had to decide whether or not there was a semantic relationship between two words. The two tasks aimed at differentiating between the subjects' preference for a given semantic meaning versus a genuine semantic deficit for a particular meaning. Results revealed that both right- and left-hemisphere-damaged groups presented a genuine semantic deficit for the processing of metaphoric meaning. The absence of a double dissociation between the two brain-damaged groups does not support the hypothesis of a specific contribution of the right-hemisphere to the processing of metaphoric meaning of words.

Heterogeneidade cognitiva na doença de Alzheimer / Cognitive heterogeneity in Alzheimer's disease

Os autores relatam e discutem aspectos neuro-psicológicos relacionados à organizaçäo funcional do cérebro ligados à cogniçäo em 81 pacientes com doença de Alzheimer. Confrontam aspectos clínicos da homogeneidade com os da heterogeneidade, dentro da organizaçäo funcional do cérebro. Foram utilizados para diagnóstico os critérios do NINCDS-ADRDA. Todos os pacientes estavam no início da evoluçäo, nos estágios 3 ou 4 de Reisberg (Functional Assessement Staging-FAST). A conclusäo mostra que existem dois perfis cognitivos: o perfil näo recorrente formado da maioria dos pacientes, o qual testemunha a heterogeneidade dependente dos fatores genéticos e ambientais da cada indivíduo; e o outro, perfil recorrente formado por grupo menor de pacientes, retrata alteraçöes na heterogeneidade de formas clínicas, nosológicas, patológicas e senescentes