[Clustering of cognitive domains among older adults with HIV]. / Agrupación de dominios cognitivos en personas mayores con VIH.

Background: Age and HIV are synergistic risk factors for conditions such as HIV-associated neurocognitive disorders (HAND). Yet, it is unclear whether OAWH display different cognitive profiles for HAND. Objective: To describe the cognitive patterns of OAWH treated with combined antiretroviral therapy (cART). Methods: Cross-sectional study that included 330 participants with HIV, aged 50 years or older, cared for at a tertiary care hospital in Mexico City. A short neuropsychological test battery was used to assess a wide spectrum of cognitive functions. The optimal number of cognitive clusters was determined by the silhouette method and a minimization of the Bayesian information criterion. Results: Participants' mean age was 58.8 years (SD = 6.6), and 12.1% were women. A 3-cluster solution yielded stable Jaccard coefficients (p > 0.70). Cluster 1 showed more significant impairment in visual and verbal memory domains, whereas participants in cluster 3 showed significant impairment in language, and abstraction. Cluster 2 showed no predominance of any domain for alterations. Conclusions: There are different cognitive profiles among OAWH with HAND. These differences may be due to individual patterns of HIV-related and non-HIV-related factors.

Antecedentes: La edad y el VIH constituyen factores de riesgo sinérgicos de afecciones como los trastornos neurocognitivos asociados al VIH (TNAV). No se ha esclarecido si las personas mayores con VIH presentan perfiles cognitivos diferentes en caso de padecer TNAV. Objetivo: Describir los patrones cognitivos de adultos mayores con VIH tratados con terapia antirretroviral combinada (TARc). Métodos: Estudio transversal que incluyó a 330 participantes con VIH, de 50 años o más, atendidos en un centro hospitalario de tercer nivel en la Ciudad de México. Se utilizó una batería neuropsicológica corta estandarizada a fin de evaluar un amplio espectro de funciones cognitivas. Se determinó el número óptimo de grupos de dominios cognitivos a partir del método de la silueta y minimización del criterio de información bayesiano. Resultados: La edad promedio de los participantes fue de 58.8 años; las mujeres constituyeron 12.1 %. Una solución de tres grupos produjo coeficientes de Jaccard estables (p > 0.70). El grupo 1 mostró deterioro más significativo en la memoria visual y verbal, en tanto que el grupo 3 mostró deterioro significativo en el lenguaje y la abstracción. En el grupo 2 no se registró predominio de ningún dominio en cuanto a alteraciones. Conclusiones: Existen perfiles cognitivos diferentes entre las personas mayores con VIH y TNAV. Estas diferencias pueden deberse a patrones individuales de factores relacionados o no con el VIH.

Mapping Cognitive Trajectories and Detecting Early Dementia Using the Mini-Mental State Examination Cognitive Charts: Application to the French Three-City Cohort.

The Cognitive Quotient (QuoCo) classification algorithm monitoring decline on age- and education-adjusted Mini-Mental State Examination (MMSE)-derived cognitive charts has proved superior to the conventionally-used cut-off for identifying incident dementia; however, it remains to be tested in different settings. Data were drawn from the Three-City Cohort to 1) assess the screening accuracy of the QuoCo, and 2) compare its performance to that of serial MMSE tests applying different cut-offs. For the QuoCo, sensitivity was 74.2 (95% CI: 71.4-76.8) and specificity 84.1 (83.6-84.7) and for the MMSE < 24, 64.1 (61.1-67.0) and 94.8 (94.4-95.1), respectively; whereas overall accuracy and sensitivity was highest for MMSE cut-offs <25 and <26. User-friendly charts for mapping cognitive trajectories over visits with an alert for potentially 'abnormal' decline can be of practical use and encourage regular monitoring in primary care where the <24 cut-off is still widely used despite its poor sensitivity.

Association between Helicobacter pylori infection and incident risk of dementia: The AMI cohort.

BACKGROUND: Chronic infectious diseases are increasingly being considered as potential contributors to dementia risk. Among those infections, Helicobacter pylori, the main cause of chronic gastritis worldwide, has been suggested. As the prevalence of H. pylori infection has decreased, the main objective of this work was to reconsider the association between H. pylori infection and the risk of incident dementia, including Alzheimer's disease. METHODS: Prospective cohort of 689 older (≥65 years) agricultural workers from Southwest France. Descriptive and comparative analyses were performed according to H. pylori status determined by serology at baseline. The risk of incident dementia according to H. pylori status over a 7-year follow-up was explored by survival analyses: Kaplan-Meier curve and Cox proportional hazards models. RESULTS: Two-hundred (29.0%) participants were H. pylori-positive at baseline. Compared to H. pylori-negative participants, they showed worse cognitive performances at baseline. Eighty-five incident dementia cases were diagnosed during the follow-up period. After adjustment for age, sex, education, apolipoprotein ε4, and several cardiovascular risk factors, H. pylori remained associated with an increased risk of dementia (HR 1.70, 95% CI, 1.05-2.74). The risk was stronger for Alzheimer's disease (HR 2.85, 95% CI, 1.58-5.12). CONCLUSIONS: Despite an observed decrease in H. pylori infection prevalence, this study provides evidence for the association between H. pylori infection and dementia. These results should encourage further research on the mechanisms underlying the contribution of infectious diseases to pathological brain aging, especially the influence of gut inflammation on the brain.

Validity and diagnostic performance of a virtual reality-based supermarket application "MEMOSHOP" for assessing episodic memory in normal and pathological aging.

Objective: MEMOSHOP is a virtual reality (VR)-based supermarket application for assessing episodic memory in aging. The aim of this study was to examine its construct validity against the gold standard paper-and-pencil neuropsychological test for clinical memory assessment in mild cognitive impairment (MCI) in older adults. Methods: Patients with isolated subjective cognitive complaints (SCCs) or MCI were recruited in the Bordeaux Memory Clinic (MEMENTO cohort). Cognitively normal elderly controls were also recruited. MEMOSHOP allows a near-ecological evaluation of episodic memory during a usual daily life activity, i.e. shopping at the supermarket. MEMOSHOP and the gold standard Free and Cued Selective Reminding Test (FCSRT: French adaptation) were administered to all participants to assess episodic memory. Non-parametric tests and receiver operating characteristic curves were computed to compare their performances. Results: Twenty-nine patients (21 females, age = 71 years ±7) and 29 matched controls were evaluated. The performance trends observed with MEMOSHOP and FCSRT on free and cued recall were associated (p < .01) and comparable (p < .0001), without any participants' groups interaction. Although easier than FCSRT in free recall for participants, MEMOSHOP demonstrated better diagnostic performance based on cued recall in isolated SCCs/MCI patients (p < .05). Conclusion: MEMOSHOP demonstrated its reliability and validity for VR-based episodic memory assessment in the early stage of MCI and is potentially of interest for use in memory clinic settings.

Depression in Older Adults: Do Current DSM Diagnostic Criteria Really Fit?

OBJECTIVES: The great heterogeneity in symptoms and clinical signs of depression in older adults makes the current diagnostic criteria difficult to apply. This scoping review aims to provide an update on the relevance of each of the diagnostic criteria as defined in the DSM-5. METHODS: In order to limit the risk of bias inherent in the study selection process, a priori inclusion and exclusion criteria were defined. Articles meeting these criteria were identified using a combination of search terms entered into PubMed, PsycINFO, PsycARTICLES and SocINDEX. RESULTS: Of the 894 articles identified, 33 articles were selected. This review highlights a different presentation of depression in older adults. Beyond the first two DSM core criteria, some symptoms are more common in older adults: appetite change, sleep disturbance, psychomotor slowing, difficulty concentrating, indecisiveness, and fatigue. CONCLUSIONS: This review provides an updated description of the clinical expression of depressive symptoms in the older population while highlighting current pending issues. CLINICAL IMPLICATIONS: Somatic symptoms should be systematically considered in order to improve the diagnosis of depression in older adults, even if, in some cases, they may reflect symptoms of age-related illnesses.

Night-to-night variability in sleep and amyloid beta burden in normal aging.

INTRODUCTION: Alzheimer's disease is associated with sleep disturbances and accumulation of cerebral amyloid beta. The objective was to examine whether actigraphy-detected sleep parameters might be biomarkers for early amyloid burden. METHODS: Participants underwent a week of actigraphy and an amyloid positron emission tomography (PET) scan. Sleep duration and continuity disruption (sleep fragmentation and nocturnal awakenings) were extracted and compared between amyloid-positive and amyloid-negative participants. Then multiple linear regressions were used between mean or night-to-night intra-individual variability (standard deviation) of sleep parameters and brain amyloid burden in a voxel-wise analysis. RESULTS: Eighty-six subjects were included (80.3 ± 5.4 years; 48.8% of women). Amyloid-positive participants had a higher variability of sleep fragmentation compared to amyloid-negative participants. This parameter was associated with a higher amyloid burden in the frontal and parietal regions, and in the precuneus, in the whole sample. DISCUSSION: This study highlights the relevance of using variability in sleep continuity as a potential biomarker of early amyloid pathogenesis.

Assessing subjective cognitive decline in older adults attending primary health care centers: what question should be asked?

INTRODUCTION: Subjective Cognitive Decline (SCD) refers to a self-perceived experience of decreased cognitive function without objective signs of cognitive impairment in neuropsychological tests or daily living activities. Despite the abundance of instruments addressing SCD, there is no consensus on the methods to be used. Our study is founded on 11 questions selected due to their recurrence in most instruments. The objective was to determine which one of these questions could be used as a simple screening tool. METHODS: 189 participants aged 65 and over selected from Primary Care centers in Santiago de Chile responded to these 11 questions and were evaluated with the MiniMental State Examination (MMSE), the Free and Cued Selective Reminding Test (FCSRT), the Pfeffer functional scale, and the Geriatric Depression Scale (GDS). An Item ResponseTheory (IRT) method was performed to assess the contribution of each of the 11 questions to the SCD latent trait and its discrimination ability. RESULTS: Based on the results of the exploratory factor analysis showing very high/low saturation of several questions on the factors, and the high residual correlation between some questions, the IRT methods led to select one question ("Do you feel like your memory has become worse?") which revealed to be the most contributive and discriminant. Participants who answered yes had a higher GDS score. There was no association with MMSE, FCSRT, and Pfeffer scores. CONCLUSION: The question "Do you feel like your memory has become worse?" may be a good proxy of SCD and could be included in routine medical checkups.

Social connections and depressive symptoms among older adults during the initial lockdown period for COVID-19 / Conexiones sociales y síntomas depresivos entre adultos mayores durante el primer período de confinamiento por COVID-19

Abstract Introduction Little information from developing countries during the first lockdown for COVID-19 is available. We hypothesized that the use of communication tools, and not living alone would provide a protective effect against DS. Objective To determine the association between social connections and depressive symptoms (DS) during the first lockdown period among Mexican community-dwelling older adults. Method Cross-sectional phone survey including 269 participants aged 65 years or older. Participants were asked about their social connections and the presence of DS during the first lockdown for COVID-19. Results Mean age was 83.2 (SD = 6.7). Compared with those without DS, those with DS reported a greater number of phone calls or videocalls although this was not statistically significant. However, when stratifying by housing situation, only the participants who lived alone and that received less calls from friends had more DS (p = .04). Discussion and conclusion Living alone allowed the participants not to have much contact with family and this caused friends to represent the most important social relationship outside the home. We hypothesize that the means to stay socially active for older adults in Latin America are different and have a different impact. Because, DS only were present among the participants who reported living alone and having fewer calls from friends during the confinement period.

Resumen Introducción Hay poca información disponible sobre los países en desarrollo durante el primer período de confinamiento por COVID-19. Planteamos la hipótesis de que el uso de herramientas de telecomunicación y vivir acompañado proporciona un efecto protector frente a la presencia de síntomas depresivos (SD). Objetivo Determinar la asociación entre las conexiones sociales y los SD durante el primer período de confinamiento en adultos mayores mexicanos que viven en la comunidad. Método A través de un estudio transversal, 269 participantes de 65 años o más completaron una encuesta telefónica sobre sus conexiones sociales y la presencia de SD durante el primer período de confinamiento por COVID-19. Resultados La edad media fue de 83.2 (DE = 6.7). En comparación con los que no tenían SD, los que tenían SD reportaron un mayor número de llamadas telefónicas o videollamadas, pero esto no fue estadísticamente significativo. Sin embargo, al estratificar por situación de vivienda, los participantes que vivían solos y que recibían menos llamadas de amigos tenían más SD (p = .04). Discusión y conclusión Vivir solo permitió a los participantes no tener mucho contacto con la familia y esto provocó que los amigos representaran la relación social más importante fuera del hogar. Creemos que los medios para mantenerse socialmente activos de los adultos mayores en América Latina son diferentes y tienen un impacto diferente. Debido a que los SD solo estuvieron presentes entre los participantes que reportaron vivir solos y tener menos llamadas de amigos durante período de confinamiento.

Characterization of data-driven geriatric syndrome clusters in older people with HIV: a Mexican multicenter cross-sectional study.

Background: As living with HIV has been proposed as a condition that may accelerate aging, the main objective of this work was to estimate the prevalence of geriatric syndromes (GS) among older Mexicans with HIV dwelling in the community. Secondly, to evaluate whether the accumulation of GS could be associated with an adverse HIV-related clinical profile, independent of chronological age. Methods: Multicenter, cross-sectional study including 501 community-dwelling people aged ≥50 years with HIV. The overall prevalence of nine selected GS and their cumulative number were estimated. An Age-Independent Cumulative Geriatric Syndromes scale (AICGSs) was constructed, and correlations between the AICGSs and HIV-related parameters assessed. Finally, k-mean clustering analyses were performed to test the secondary objective. Findings: Median age 56 (IQR: 53-61) years, 81.6% of men. Polypharmacy (74.8%), sensorial deficit (71.2%), cognitive impairment (53.6%), physical disability (41.9%), pre-frailty (27.9%), and falls (29.7%), were the more prevalent GS. A significant negative correlation was found between the AICGSs and normalized values of CD4+ nadir cell counts (r = -0.126; 95%: CI: -0.223 to -0.026, p < 0.05). Similarly, a significant inverse adjusted association between the CD4+ nadir cells and the AICGSs was observed on linear regression analysis (ß -0.058; 95%: CI: -0.109 to -0.007, p = 0.03). Cluster analysis identified three differentiated groups varying by age, metabolic comorbidities, AICGSs, and HIV-related parameters. Interpretation: An elevated prevalence of GS was observed in the studied population. Moreover, the accumulation of GS was associated with adverse HIV-related profiles, independent of age. Thus, early detection and management of GS are crucial to promote healthier aging trajectories in people with HIV. Funding: This work was funded in part by the National Center for the Prevention and Control of HIV/AIDS in Mexico (CENSIDA)-National Ministry of Health.

Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review.

Residential care facility may provide a transition between living at home and a nursing home for dependent older people or an alternative to nursing homes. The objective of this review was to compare mortality and hospitalizations of older adults living in residential care facilities with those living in nursing homes or in the community. We searched Medline, Scopus and Web of Science from inception to December 2022. Fifteen cohort studies with 6 months to 10 years of follow-up were included. The unadjusted relative risk (RR) of mortality was superior in nursing homes than in residential care facilities in 6 of 7 studies (from 1.3 to 1.68). Conversely, the unadjusted relative risk of hospitalizations was higher in residential care facilities in 6 studies (from 1.3 to 3.37). Studies conducted on persons with dementia found mixed results, the only study adjusted for co-morbidities observing no difference on these two endpoints. Compared with home, unadjusted relative risks were higher in residential care facilities for mortality in 4 studies (from 1.34 à 10.1) and hospitalizations in 3 studies (from 1.12 to 1.62). Conversely, the only study that followed older adults initially living at home over a 10-year period found a reduced risk of heavy hospital use (RR = 0.68) for those who temporarily resided in a residential care facilities. There is insufficient evidence to determine whether residential care facilities might be an alternative to nursing homes for older people with similar clinical characteristics (co-morbidities and dementia). Nevertheless, given the high rate of hospitalizations observed in residential care facilities, the medical needs of residents should be better explored.

Evaluation of Dementia-Friendly Initiatives, Small-Scale Homelike Residential Care, and Dementia Village Models: A Scoping Review.

OBJECTIVES: Numerous initiatives are emerging to improve the care management of persons suffering from Alzheimer's disease or related disorders (ADRD). The aim of this review is to identify research evaluations of initiatives in long-term care facilities and those making society more inclusive. DESIGN: Scoping review with systematic search of PubMed. SETTING AND PARTICIPANTS: Reviewed articles focused on the impact of (1) dementia-friendly initiatives (DFIs), (2) small-scale homelike (SSHL) facilities, and (3) dementia/Alzheimer villages. The intervention targets people (or their carers) with dementia or cognitive impairment. METHODS: A scoping review was performed on PubMed, including papers published up to November 2022. Further hand-searching from reference lists and the gray literature was carried out. RESULTS: A total of 477 articles were identified initially, and finally 12 more specifically related to the impact of DFI (n = 4) and SSHL facilities (n = 8) were selected. They included preliminary effectiveness analyses on DFI-related training and awareness intervention and comparative studies on an SSHL model. Scarce but promising results were found on the physical functioning, social participation, and quality of life for older adults living in SSHL facilities compared to those living in conventional nursing homes. No quantitative evaluation on dementia villages was published. CONCLUSIONS AND IMPLICATIONS: The article highlights the lack of studies providing data on the efficacy of such innovative facilities on clinical, economic, and social outcomes. Such data are essential to better characterize these models and assess their potential efficiency and reproducibility.

Health trajectories of elderly living in French senior housing: a longitudinal perspective.

Senior housing for older adults could be an alternative or a transitional care model between home care and nursing home care. Using two longitudinal cohorts of community dwellers aged 65 years or older, we compared risks of mortality and of nursing homes admission between older adults who did or did not move to senior housing over time. In the 3C study (n = 2104, 17 years of follow-up), 143 (6.8%) participants moved into a senior housing during the follow-up. This move was associated with a lower risk of mortality (hazard ratio (HR): 0.64; 95% confidence interval (CI) 0.46-0.77) and a higher risk of nursing home admissions (HR: 1.54 (1.10-2.15)). The risks of hospitalizations (HR: 0.54 (0.40-0.73)) and falls (HR: 0.63 (0.50-0.79)) were lower. In the PAQUID study (n = 3777, 27 years of follow-up), 161 (4.3%) participants moved into a senior housing. This move was also associated with a lower mortality risk (HR: 0.72 (0.58-0.88)) and a higher risk of nursing home admissions (HR: 1.39 (1.05-1.86)). Our results showing lower risks of mortality suggest that senior housing may be a relevant model for vulnerable older adults.

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.

Psychometric properties of the Perceived Social Support Questionnaire (PSSQ), a new measure of perceived social support among older adults.

OBJECTIVE: Based on literature and available questionnaires, the present study aimed at creating and validating the Perceived Social Support Questionnaire (PSSQ): a 4-item scale assessing the perceived social support in older adults. Normative scores were also computed. METHODS: Three hundred and two participants (mean age 87.68) selected from ongoing population-based studies completed a phone interview. Among these, 247 completed a second interview 4 months later allowing assessing the questionnaire fidelity over time. RESULTS: The factor analysis evidenced two dimensions: availability of social support and satisfaction with it. Both dimensions had a satisfactory internal consistency but weak intraclass correlation coefficient. Univariate analyses revealed that age, number of calls per week and living environment marginally associated with the availability score. The satisfaction score was associated with perceived health status, sadness, depressive mood, feeling of loneliness, anxiety, and the perception of social support during the pandemic context. The norms computed were stratified on age. CONCLUSIONS: The PSSQ is a short and easy-to-administer tool allowing assessing perceived social support in older population. Despite a weak fidelity that could actually be explained by changes in perceived social support over time, the questionnaire revealed good psychometric qualities and validity.

Lessons Learned From the SoBeezy Program for Older Adults During the COVID-19 Pandemic: Experimentation and Evaluation.

BACKGROUND: The SoBeezy program is an innovative intervention aimed at promoting and fostering healthy aging and aging in place by proposing to older adults concrete solutions to face daily life, tackle loneliness, promote social participation, and reduce the digital divide, thanks to a specific, easy-to-use voice assistant (the BeeVA smart display). OBJECTIVE: This study aims to assess the acceptability of the SoBeezy program and its voice assistant and to identify potential areas of improvement. METHODS: A 12-month experimentation of the program was deployed in real-life conditions among older adults living in the community in 4 pilot cities of France. Launched during the first lockdown of the COVID-19 crisis, this multisite study aimed to assess acceptability using questionnaires and interviews conducted at baseline and at the end of the experimentation. In addition, a series of meetings were conducted with SoBeezy staff members to obtain direct feedback from the ground. RESULTS: In total, 109 older individuals were equipped with BeeVA to use the SoBeezy program; of these, 32 (29.4%) left the experimentation before its end and 69 (63.3%) completed the final questionnaires. In total, 335 interventions were conducted and 27 (39%) of the participants requested services, mainly for supportive calls and visits and assistance with shopping, transportation, and crafting-gardening. Of the whole sample, 52 (75%) considered BeeVA as a reassuring presence, and few persons (15/69, 22%) reported a negative opinion about the program. Among the participants, the voice assistant appeared easy to use (n=57, 82%) and useful (n=53, 77%). They also were positive about the BeeVA smart display and the SoBeezy intervention. CONCLUSIONS: This multisite study conducted in real-life conditions among more than 100 older adults living in the community provides enlightening results of the reality from the ground of digital tools designed for the aging population. The COVID-19 context appeared both as an opportunity, given the massive needs of the older adults during this crisis, and as limiting due to sanitary constraints. Nevertheless, the experimentation showed overall good acceptability of the voice assistant and a high level of satisfaction of the participants among those who really used the system and could be a way of improving the autonomy and well-being of older adults and their families. However, the findings also highlighted resistance to change and difficulties for the users to ask for help. The experimentation also emphasized levers for next deployments and future research. The next step will be the experimentation of the activity-sharing component that could not be tested due to the COVID-19 context.

Effectiveness of an Ambient Assisted Living (HomeAssist) Platform for Supporting Aging in Place of Older Adults With Frailty: Protocol for a Quasi-Experimental Study.

BACKGROUND: Ambient assisted living (AAL) technologies are viewed as a promising way to prolong aging in place, particularly when they are designed as closely as possible to the needs of the end users. However, very few evidence-based results have been provided to support its real value, notably for frail older adults who have a high risk of autonomy loss as well as entering a nursing home. OBJECTIVE: We hypothesized that the benefit from an AAL with a user-centered design is effective for aging in place for frail older adults in terms of everyday functioning (instrumental activities of daily-life scale). In addition, our secondary hypotheses are that such an AAL decreases or neutralizes the frailty process and reduces the rates of institutionalization and hospitalization and that it improves the psychosocial health of participants and their caregivers when compared with the control condition. We also assume that a large proportion of equipped participants will have a satisfactory experience and will accept a subscription to an internet connection to prolong their participation. METHODS: HomeAssist (HA) is an AAL platform offering a large set of apps for 3 main age-related need domains (activities of daily-living, safety, and social participation), relying on a basic set of entities (sensors, actuators, tablets, etc). The HA intervention involves monitoring based on assistive services to support activities related to independent living at home. The study design is quasi-experimental with a duration of 12 months, optionally extensible to 24 months. Follow-up assessments occurred at 0, 12, and 24 months. The primary outcome measures are related to everyday functioning. Secondary outcome measures include indices of frailty, cognitive functioning, and psychosocial health of the participants and their caregivers. Every 6 months, user experience and attitudes toward HA are also collected from equipped participants. Concomitantly, data on HA use will be collected. All measures of the study will be tested based on an intention-to-treat approach using a 2-tailed level of significance set at α=.05, concerning our primary and secondary efficacy outcomes. RESULTS: Descriptive analyses were conducted to characterize the recruited equipped participants compared with the others (excluded and refusals) on the data available at the eligibility visit, to describe the characteristics of the recruited sample at baseline, as well as those of the dropouts. Finally, recruitment at 12 months included equipped participants (n=73), matched with control participants (n=474, from pre-existing cohorts). The results of this study will be disseminated through scientific publications and conferences. This will provide a solid basis for the creation of a start-up to market the technology. CONCLUSIONS: This trial will inform the real-life efficacy of HA in prolonging aging in place for frail older adults and yield an informed analysis of AAL use and adoption in frail older individuals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33351.

A Lower CD4+/CD8+ Ratio Predicts Activities of Daily Living Decline Among Older Adults with HIV.

Aging of people with human immunodeficiency virus (HIV) is a worldwide reality, and age-related conditions, including disability, have also increased. Efforts are being made to search for more specific markers of immune system malfunction, which serve as good predictors of adverse health-related outcomes. Therefore, this study aimed to determine the relationship between the CD4+/CD8+ ratio and functional decline in activities of daily living (ADL). Participants in this longitudinal study underwent a standardized comprehensive geriatric assessment by trained staff, using validated tools. Functional decline in ADL was established by the delta resulting from the subtraction of the score on the Barthel index at T1 minus the score at T0 (baseline). Multivariate linear regression analyses were used to determine the independent relationship between the CD4+/CD8+ ratio and ADL decline. Mean age was 57.9 (standard deviation 6.6; range 50-84 years), and 82.7% were men. Eleven of the 209 participants had disability for ADL at baseline. Multivariate linear regression analysis showed an inverse relationship between the log of CD4+/CD8+ ratio at baseline and the delta of Barthel index even after adjustment for multiple confounders (ß = -1.68, 95% confidence interval -3.02 to -0.33; p = .01). A CD4+/CD8+ ratio of <1 predicts the development of functional decline in ADL. This ratio can be a useful marker to identify people at risk of disability and should be considered for the tailored management of older adults with HIV.

The "Alzheimer Village": Assessment of Alzheimer's disease representations in the general population: A cross sectional phone survey.

Introduction: In most countries, the societal view of Alzheimer's disease (AD) is very negative. The initiatives that are part of the so-called "dementia-friendly approach" aim not only at promoting well-being and dignity of persons suffering from AD but also improving the way they are regarded and their inclusion in society. Unfortunately, scarce research has been conducted to assess whether such goals can be achieved. In France, the experimental Alzheimer Village in Dax is designed as a dementia-friendly community. Due to the recent opening (2020) and the strong local media coverage of this project, a survey has been designed to determine whether the representations of AD have been impacted by such a project. Methods: The survey was conducted before and after the opening of the Alzheimer Village in the city of Dax (hosting the village) and surrounding areas, and in a control city with similar socio-demographics. The analyses intend to compare different dimensions of the representations and attitudes toward AD in the general population. Results: A total of 423 persons living in the Alzheimer Village city (37.4% were men) and 415 persons living in the control city (40.2% were men) were interviewed, resulting in 838 complete questionnaires. The main results report significantly lower rating in the perception of loss of identity (ß = -0.57, P = .014) and in the feeling of disgust for persons with AD (ß = -0.61, P = .008) in the city hosting the village after the opening of the Alzheimer Village. No significant changes were seen in the control city sample. Discussion: While societal representations of AD are very robust and difficult to change, this study suggests a modest but significant evolution of representations of AD in the surrounding areas of the Alzheimer Village. Highlights: The French Alzheimer Village is one of the very few ones in the world.This is the first study assessing the impact of an Alzheimer Village on disease representations.After the opening of the village, attitudes toward Alzheimer's disease have changed.

Veterans Aging Cohort Study Index and Frailty: One Part of the Whole.

In HIV medicine, the Veterans Aging Cohort Study (VACS) index is associated to some geriatric syndromes and has also been recently used as a proxy of frailty. However, using it as a proxy for the frailty phenotype may inadvertently interchange two different concepts. The purpose of this study was to evaluate to what extent the frailty phenotype may be explained by the index. Cross-sectional analysis included 393 participants with HIV aged 50 or older. Somers' delta (d) was calculated, and a multinomial logistic regression model was run to determine to what extent the VACS index scores explained the probability of being prefrail or frail. Mean age was 57.6 (standard deviation 6.5) years and 87.3% men. A weak, but positive association between the VACS 2.0 index score and the frailty phenotype was established (Somers' d = 0.120, p < .001). The multinomial logistic regression showed that prefrail and frail participants had higher probabilities for greater VACS index scores [OR = 1.05, 95% confidence intervals (CI) 1.01-1.09; p = .006 and OR = 1.17, 95% CI 1.09-1.26; p < .001, respectively]; however, VACS index only explained <12% of the variability observed in the frailty phenotype. High VACS index scores were associated with a greater probability of being frail; however, with a weak association. Thus, we should be cautious when using the VACS index as a general proxy of frailty, particularly for the frailty phenotype. However, the VACS index may be used as a means to identify persons who might benefit from further comprehensive geriatric assessment.

Infectious diseases and cognition: do we have to worry?

OBJECTIVES: Age-related physiological changes, particularly immune system decline, may contribute to greater vulnerability to infectious diseases in older individuals. A growing body of evidence shows that both, acute, and chronic infections may be accompanied by cognitive disturbances as part of their manifestations. Given the importance of cognition in aging trajectories, the objective of this article was to review current knowledge on cognitive outcomes of infectious diseases in older adults, and to emphasize the importance of considering cognition as a domain of interest in its own rights in these diseases. METHODS: A MEDLINE/PubMed database search was conducted to identify articles reporting cognitive impairment associated with various severe acute infections and specific chronic infectious conditions such as human immune deficiency virus, the herpes virus family, hepatitis C virus, Lyme borreliosis, Helicobacter pylori, periodontitis, and emerging pathogens like SARS-CoV-2, as well as potentially preventive strategies like vaccination. RESULTS/ CONCLUSIONS: Taken together, the studies examined in the present review emphasize that numerous acute and chronic infectious diseases share mechanisms that, when added to specific risk factors frequently found in older persons, contribute to considerably increase the risk of cognitive outcomes such as cognitive decline and dementia. This review may help to appreciate the role that infectious diseases play in cognitive trajectories and thus promote further investigation on the topic.