Routinization: risk factor or marker of adjustment to negative health issues?

OBJECTIVES: Routinization reflects how older people cope with the health problems. It remains to be seen whether it should be considered as a risk factor of negative health outcomes, or rather, a mechanism of adjustment to health issues: mortality, institutionalization, dementia, disability, cognitive decline, depression and subjective health. METHODS: From longitudinal data of two large-scale French epidemiological studies, the study sample consists of 961 participants aged 77 years on average, living at home and with no neurocognitive disorder. The relationship between the level of routines measured by the Preferences for Routines Scale-Short form and the adverse health outcomes are studied considering the level of routines at baseline and in time-dependent using Cox proportional hazards models and Latent process mixed models. RESULTS: After adjustment for sociodemographic variables, the routinization score at baseline is not associated with any health outcomes while the routinization score as a time-dependent variable is significantly associated with an increased risk of dementia (hazard ratios (HR) = 1.08, 95% confidence intervals (CI) = 1.02-1.15, p = 0.016) and institutionalization (HR = 1.18, 95% CI = 1.03-1.36, p = 0.019), greater global cognitive decline (ß = -0.02, p = 0.001) and depressive symptoms (ß = 0.02, p = 0.023) and a decrease in subjective health (ß = 0.02, p = 0.008). CONCLUSIONS: The level of routines measured at a given time is not associated with long-term prediction of negative health outcomes, while in time-dependent, it reveals to be a significant predictor. It should be seen as a marker of adjustment process.

[Memory(ies) at risk ]. / Mémoire(s) en péril.

When an elderly person suffers from severe memory problems, it is useful to look at the behaviour of those around him or her. Serious "absences" can be observed, revealing an intergenerational memory at risk.

Validation of Short Form of Preferences for Routines Scale: Norms in Older Adults.

High level of preferences for routines is an indicator of psychological vulnerability in older adults. However, the psychometric properties of the Preferences for Routines Scale (PRS) initially validated in a small selected sample of older adults revealed a low Cronbach's α (.50) in the general elderly population. The present study aims to improve the PRS using the data from the "AMI" and "PAQUID" population-based studies. Among 718 older persons, the most discriminative items are identified using item response theory methodology. A short form of the PRS (PRS-S) included five of the ten items of the original scale and showed improved internal consistency and test-retest reliability. The factors associated with the PRS-S are similar to those found in previous studies. Norms are provided according to gender and educational level. The reduction of the number of items tends to facilitate its administration and promote its use in both clinical and epidemiologic research contexts.

[Access to care and precariousness of the elderly, complex and simple responses]. / Des réponses complexes et simples.

The theme of access to care for the elderly brings us into the susceptibility to precariousness-made precarious-precarious debate. The answers are necessarily complex; but the simplest ones are not to be overlooked. It is possible to propose some ideas based on the experience of the DomCare team.

[Caregivers in geriatrics: burnout and loss of meaning]. / Soignants en gériatrie : usure de sens et sens de l'usure.

The burnout of caregivers in geriatrics reveals a serious loss of meaning: that of 'ageing', of the status and the function of old age in the process and orientation of life. Faced with this challenge, the key is to find meaning in one's work. In geriatrics in particular, caregivers play a valuable role of 'conveyor'.

[The PASA, a unique place of interconnection]. / Le PASA, un espace privilégié de reliance.

The PASA, a centre for adapted activities and care, enables nursing homes to become places of progress and innovation in the management of residents suffering from Alzheimer's disease and related conditions. The multidisciplinary approach and the convergence of new perspectives enables some to revive essential threads of their identity, and others to evolve and build themselves through more rewarding experiences.

Short STAI-Y anxiety scales: validation and normative data for elderly subjects.

OBJECTIVES: The aim of this study was to develop short forms of the STAI-Y trait and state scales and associated norms suitable for the screening of anxiety in elderly populations. METHOD: This study was based on population-based cohorts of older persons from two epidemiological French studies that each included one subscale of the STAI-Y, i.e. state and trait anxiety scales. For both scales, the most discriminative items were retained and their factorial structure was examined using principal components analysis. Internal consistency (Cronbach's alpha) was estimated and cut-offs and norms were computed. RESULTS: A 10-item STAI-Y version produced scores similar to those obtained with the full form of the STAI-Y. The factorial structure of the shortened form is comparable to that of the full scales. Results showed good internal consistency (alpha coefficients were 0.92 and 0.85 for short STAI-Y state and trait scales, respectively). Moreover, both short STAI-Y state and trait scales correctly classified 88% of the participants using a cut-off point of 23. Norms for both short trait and state anxiety scales are provided according to age, gender, educational level and depressive symptoms. CONCLUSION: Both shortened scales have similar factorial structure and internal consistency to the longer scales and classify anxious/non-anxious elderly with acceptable accuracy. The shorter form is likely to be more acceptable to elderly persons through reduction of fatigue effects.

[Construct and validation of a quality of life's scale for older French people]. / Élaboration et validation d'une échelle de qualité de vie adaptée aux personnes âgées (EQVPA).

Given changing and subjective aspects of quality of life, the current assessment scales are often encompassing and not very adapted for older people. Thus, the present validation study has several objectives: 1) To elaborate a specific measure of the quality of life of older people, given the characteristics and problems of this population; 2) To propose a simple scale to use for any health care professional and fast passation to encourage the inclusion of such measures in the framework of a comprehensive care of the elderly; 3) To validate this scale in a large cohort of retired older farmers. This scale resulted in 14 items illustrating the various dimensions of quality of life of older people. It was then proposed for validation in a large cohort of retired elderly farmers of 65 years and over, and living at home. After exploratory factor analysis of subjects' responses to the EQVPA, five items were extracted explaining 48.8% of the total variance. Its internal consistency was satisfactory (Cronbach's alpha=0.72). The five items permitted to assess daily and social activities in environment, social and familial relationships, physical and functional health and mental health. The results showed that quality of life is significantly correlated with greater life satisfaction, more social support and social network, higher level of subjective health, lower level of functional impairments, lower level of anxious and depressive symptoms, and lower level of routinization. Validation of the tools such as EQVPA seems important for the prevention and preservation of the quality of life of older people.

Psychosocial correlates of nutritional status of family caregivers of persons with dementia.

BACKGROUND: This exploratory study investigated the associations of individual characteristics of both persons with dementia and family caregivers with the nutritional status of caregivers. METHODS: This cross-sectional study was conducted at home by psychogerontologist within the frame of a community gerontological center in rural areas of south west France. The study participants comprised 56 community-dwelling persons with dementia (mean 80.7 years, SD 6.5) and 56 family caregivers (mean 70.9 years, SD 11.0). Persons with dementia were assessed with Mini-Mental State Examination (MMSE), Basic Activities Of Daily Living (ADL), Instrumental ADL (IADL), and NeuroPsychiatric Inventory (NPI), and family caregivers with the Burden Interview (Zarit scale), the State-Trait Anxiety Inventory (STAI Y-B), the Center for Epidemiologic Studies Depression Scale (CES-D), the emotional impact measure of NPI and the Autonomy, Gerontology and Group Resources scale (AGGIR scale). For both, nutritional status was evaluated using the Mini Nutritional Assessment (MNA®). RESULTS: Among family caregivers, 32.1% were at risk of malnutrition and 5.4% were malnourished, and among people with dementia, 58.9% and 23.2%, respectively. NPI severity score of apathy of persons with dementia (Beta = -0.342, p = 0.001), dependency on AGGIR scale (Beta = -0.336, p = 0.002), and CES-D score of caregivers (Beta = -0.365, p = 0.001) were associated with caregivers' MNA score (Adjusted R 2 = 0.480, p < 0.001). CONCLUSION: These preliminary findings emphasize the need for routine assessment of depressive symptoms, functional and nutritional status in dementia family caregivers, and confirm the value of investigating caregivers' nutritional risk through an integrative view including psychosocial approach.

Daily life functioning of community-dwelling elderly couples: an investigation of the feasibility and validity of Ecological Momentary Assessment.

Although ambulatory data collection techniques have been used in elderly populations, their feasibility and validity amongst elderly individuals with cognitive impairment and amongst couples remains unexplored. The main objective of this study is to examine the validity of Ecological Momentary Assessment (EMA) in elderly persons with or without cognitive impairment and their spouses. The sample included 58 retired farmers (mean 77.3 years, standard deviation [SD] 5.5) with or without cognitive impairment, recruited within a French cohort and 60 spouses (mean 73.4 years, SD 6.9). The presence of cognitive impairment determining by a panel of specialized neurologists permitted to define two groups: "The Cognitive Impairment Group" and "The Control Group". EMA procedures consisted of repeated telephone interviews five times per day during four days for each spouse. Our results demonstrate the validity of EMA procedures through a 92.1% level of compliance, the absence of fatigue effects, and the lack of evidence for major reactivity to the methods. However, the specificity of our sample may explain the acceptance (42%) and response (75%) rates and may reduce the generalizability of the results to the general population of elderly individuals. Finally, the validation of such techniques may contribute to future research examining community-dwelling elderly individuals and their spouses.

State anxiety and cognitive functioning in older adults.

OBJECTIVE: To assess the relationship between state anxiety and performance on neuropsychological tests in older adults. METHODS: Nine hundred fifty-five community-dwelling individuals without dementia age 66 and over were evaluated at home by a psychologist. State anxiety was measured by the State-Trait Anxiety Inventory Y. Cognitive assessment included general cognitive functioning (Mini-Mental State Examination), verbal fluency (Isaacs Set Test), short-term visual memory (Benton's Visual Retention Test), speed of information processing/visuomotor coordination (Digit Symbol Coding), conceptual knowledge (Similarities), episodic memory (Verbal Paired Associates), and working memory (Digit Span forward/backward). Covariates included age, education, sex, depressive symptoms (Center for Epidemiologic Studies-Depression Scale), subjective health, subjective cognitive complaint, chronic diseases, functional abilities in basic and instrumental activities of daily living, and use of medication. RESULTS: Adjustments for confounders substantially modified the relationship between state anxiety and cognitive performance. Multivariate analyses revealed positive effects of mild and moderate state anxiety for verbal fluency and general cognitive functioning, respectively. High and moderate anxiety also had beneficial influence on short-term visual memory performance in participants with low education level and on the speed of information/visuomotor coordination processing in participants using medications. CONCLUSIONS: These results suggest that when confounders are taken into account, state anxiety in older adults is not necessarily deleterious for cognitive performance and has no appreciable negative effect on many cognitive domains or can even be beneficial. Relationships between state anxiety and cognitive performances are complex because they are influenced by many factors and differ according to anxiety severity and cognitive domains.

Nutritional status of community-dwelling older people with dementia: associations with individual and family caregivers' characteristics.

OBJECTIVE: The objective of this study was to explore the associations of individual characteristics of both older people with dementia and family caregivers with the nutritional status of older people with dementia. METHODS: This cross-sectional study comprising 56 community-dwelling older persons with dementia and 56 family caregivers was conducted at home by a psychogerontologist working for a community gerontological center. Older people with dementia were assessed with Mini mental state examination, Instrumental Activities of Daily Living, Activities of Daily Living (ADL), and NeuroPsychiatric Inventory (NPI) and family caregivers with the Burden Interview (Zarit scale), the State-Trait Anxiety Inventory, the Center for Epidemiologic Studies Depression Scale, and the emotional impact measure of NPI. For both, nutritional status was evaluated using the Mini Nutritional Assessment (MNA). RESULTS: Among older people with dementia, 58.9% were at risk of malnutrition and 23.2% presented a poor nutritional status, and among the family caregivers, 32.1% and 5.4%, respectively. The MNA score of older people with dementia was strongly and inversely associated with the ADL score and was strongly and positively associated with the MNA score of family caregiver. These two factors significantly explained 32% of variation of MNA score of older people with dementia. CONCLUSIONS: These findings confirm the value of investigating nutritional deficiencies in dementia within the caregiving dyad and suggest that the functional status of older people with dementia and the nutritional status of family caregivers should be carefully assessed.

Restriction in instrumental activities of daily living in older persons: association with preferences for routines and psychological vulnerability.

Disabilities in the Instrumental Activities of Daily Living (IADL) are frequently observed in older adults. A restriction in the daily life activities in the elderly may be related to a process of routinization induced by homogenization of activities, in addition to its association with emotional states. The relationship between level of functional disability for IADLs and preferences for routines was explored in 207 non-demented French participants (Mage = 84.2 years, age range: 78-96 years) from the PAQUID cohort study. Multinomial regressions analyses showed that preferences for routines were significantly associated with a higher risk of restriction for at least two functional activities, after adjusting for sociodemographic and psychological variables. However, this association was non significant after controlling for cognitive variables. These findings add new elements for understanding the effect of routinization in the disability process in older persons in that preferences for routines could constitute a risk factor of IADL restriction, similar to cognitive decline.

The STAI-Y trait scale: psychometric properties and normative data from a large population-based study of elderly people.

BACKGROUND: Whereas the State-Trait Anxiety Inventory (STAI-Y) is probably the most widely used self-reported measure of anxiety, the lack of current norms among elderly people appears to be problematic in both a clinical and research context. The objective of the present study was to provide normative data for the STAI-Y trait scale from a large elderly cohort and to identify the main sociodemographic and health-related determinants of trait anxiety. METHODS: The STAI-Y trait scale was completed by 7,538 community-dwelling participants aged 65 years and over from the "Three City" epidemiological study. Trained nurses and psychologists collected information during a face-to-face interview including sociodemographic characteristics and clinical variables. RESULTS: The scale was found to have good internal consistency (Cronbach's α = 0.89). Norms were stratified for gender and educational level differentiating persons with and without depressive symptoms. Multivariate linear regression found the STAI-Y trait score to be significantly associated with female gender, psychotropic medication use, higher depressive symptoms, higher cognitive complaints, and with an interaction between subjective health and marital status. Age was not associated with the total score. CONCLUSION: This study provides norms for the STAI-Y trait scale in the general elderly population which are of potential use in both a clinical and research context. The present results confirm the importance of several factors previously associated with higher trait anxiety in the elderly. However, more research is needed to better understand the clinical specificities of anxiety in the elderly and the improvement of assessment.

Norms and associated factors of the STAI-Y State anxiety inventory in older adults: results from the PAQUID study.

BACKGROUND: The latest version of the State-Trait Anxiety Inventory (STAI-Y) is commonly used in older adults, even though this anxiety scale was developed in and for young adults. Norms and associated factors of the STAI-Y are lacking for older adults in the general population. The objectives of the present study were to produce norms on the STAI-Y State scale for older adults using a large sample of older adults selected from a general population and to examine the sociodemographic and health-related factors associated with the STAI-Y State score. METHODS: 993 community-dwelling individuals aged 66 years and over from the PAQUID study were evaluated at home by a psychologist for the following variables: age, education, marital status, proximity of relatives, self-assessment of income sufficiency, occupation during active life, depressive symptomatology, objective and subjective health, objective and subjective cognitive functioning, adverse life events, activities of daily living, drug use, and cigarette consumption. RESULTS: Norms were stratified for age, sex, and education and were produced separately for older adults with and without depressive symptomatology. Multivariate analyses revealed that younger age (66-79 years), female sex, lower education, perception of income insufficiency, depressive symptomatology, poor subjective health, subjective cognitive complaints, psychotropic drugs use, and recent adverse life events were independently associated with higher STAI-Y State score. CONCLUSIONS: This study provides norms for the STAI-Y State anxiety inventory in a general population of older adults and indicates the specific factors linked with state anxiety. Such factors should be taken into account by clinicians in order to better understand state anxiety in older adults.

Encoding processes influence word-stem completion priming in Alzheimer's disease: a meta-analysis.

Despite the numerous studies focused on priming performances in Alzheimer's disease (AD), the question of whether word-stem completion priming persists in AD is still prone to controversy. Methodological variations, such as encoding instructions, have been proposed to explain the discrepancy of word-stem completion priming results in AD. We conducted a meta-analysis on 678 AD patients and 640 controls to assess whether word-stem completion priming in AD differs according to instructions provided at encoding. When the data across the different encoding instructions were combined, the results showed that AD patients manifest significant completion priming, even though the magnitude of priming is reduced. Taking into account the different encoding conditions, the results suggested that whereas completion priming is impaired in AD when encoding conditions consist in reading or rating words, priming is equivalent to that of controls when encoding conditions require semantic judgments or generating words. In this latter condition in particular, self-generating a word at encoding may provide an aid to partially overcome conceptual deficits of the patients and increase the degree of adequacy between cognitive operations employed at encoding phase and those triggering implicit retrieval.

Gender-related differences in visuospatial memory persist in Alzheimer's disease.

Gender differences in visuospatial cognition favoring men are larger in tasks requiring active information manipulation than in tasks requiring passive storage. This study was designed to determine whether male advantage in active manipulation of visuospatial information can still be evidenced in Alzheimer's disease (AD). Twenty male and 20 female AD patients with equivalent age, education, dementia severity (Mini-Mental State Examination and Mattis Dementia Rating Scale), and visual discrimination abilities were recruited. We administered the forward span of Corsi block-tapping task and Vecchi's matrix memory task involving passive temporary retention of stimuli location. Active manipulation of visuospatial information was assessed with the backward span of Corsi block-tapping task and Vecchi's pathway task in which patients were required to mentally generate a pathway within a matrix. The results showed that scores on the tasks involving passive storage of visuospatial information were equivalent between the two groups of patients, whereas men performed significantly better than women in tasks requiring active manipulation of visuospatial information. This result was limited to visuospatial processing since no difference between male and female patients was evidenced in the verbal short-term memory tasks, neither when the task involved passive storage nor when the task required active processing. Therefore, this study suggests that, besides other variables such as education or lifestyle factors, gender might also modulate the cognitive manifestation of AD.

[Aging and routinization: a review]. / Vieillesse et routinisation: une revue de la question.

The concept of routinization in the elderly is defined as the performance of environmental, behavioral, and social activities, in the same manner over time. First, routines are described from a developmental point of view and a multidisciplinary approach. Second, the development of this concept in recent studies is analyzed. Different functions of routinization are discussed as a general model of disability. Based on the results of the PAQUID epidemiological investigation, routinization of behaviors and activities in older persons appears as a complex phenomenon that cannot only be understood in terms of adaptive functioning. Various relationships were found between preference for routines and vulnerability factors in psychological, functional or cognitive domains. Finally, the theoretical issues and clinical implications are discussed with regard to distinct dimensions of the routinization concept, including its relevance for identifying the vulnerability markers in the elderly, and improving early detection, prevention and management of adaptation difficulties in this population.

[Using the SHiPA with the elderly: a person-centered approach]. / Utilisation des << Sept histoires pour personnes âgées >> (SHiPA) : une analyse centrée sur la personne.

Qualitative differences in control, distance and relationship with other people were examined using multidimensional and configurational analyses with data from the SHiPA. The SHiPA, developed by Bouisson (2005), contributes to inform on psychological functioning the elderly, using open responses, no limited into choices, and assesses some aspects of distress and adaptative resources in common daily life events that are frequently causes of difficulties. Based on scores in differential weighting of SHiPA dimensions, multivariate analyses revealed five psychological functioning profiles, characterized by anxiety, depression, cognition, internality, satisfaction with life, and routinization levels. Analyse of the differences between SHiPA profiles suggested a first discrimination depending on the individuals, psychological resources level, and the situation of subjects in third and fourth age.