PubMed Health⌕ Search

Biomedical subjects

P Barberger-Gateau

Publications and source records attributed to P Barberger-Gateau.

At least 19 recordsLinked to original sources

Characteristics of undiagnosed diabetes in community-dwelling French elderly: the 3C study.

We aimed to assess clinical and socio-demographic characteristics of undiagnosed diabetes, including glucose control, in French community-living elderly people. Diagnosed and undiagnosed diabetes, impaired fasting glucose (IFG) and characteristics of subjects were assessed by interview, clinical examination and fasting blood glucose measures at the baseline visit of the Three-City (3C) study including 9294 people over 65 in three urban areas in France. In the Bordeaux sample, HbA1c was measured in diabetic and IFG subjects and in a sub-sample of non-diabetic subjects. The proportion of diagnosed diabetes, undiagnosed diabetes and IFG was, respectively, 8.2%, 1.4% and 3.6%. Diabetic and IFG subjects were more likely to be men, to suffer from hypertension and to be overweight. They were less likely to have a high income and more likely to have a lower educational level. These factors were unrelated to knowledge of diabetic status. In the Bordeaux sub-sample, 19.6% of the diagnosed diabetic subjects and 16.1% of those undiagnosed had an HbA1c greater than 8%. Prevalence of ischemic heart disease was more common in diagnosed than in undiagnosed diabetic subjects (P=.021). A significant number of undiagnosed elderly had poor glucose control suggesting a potential benefit for diabetes screening in the elderly.

Aged↗

Restriction in complex activities of daily living in MCI: impact on outcome.

OBJECTIVE: To describe the restriction in instrumental activities of daily living (IADL) in mild cognitive impairment (MCI) and to assess the impact of IADL restriction on the progression to dementia and on MCI reversibility. METHODS: The study sample included 1,517 participants of the PAQUID cohort, visited at 8- and 10-year follow-ups. Subjects classified as having MCI had no dementia but a cognitive deficit according to five neuropsychological tests. Four IADL (telephone, transports, medication, finances) were assessed and considered restricted if at least two of them were not performed at the highest level of performance. Cross-sectional and longitudinal analyses were conducted. RESULTS: A total of 285 subjects were classified as having MCI at baseline, and 15.2% developed dementia within 2 years. MCI subjects were more frequently IADL restricted (34.3%) than controls (5.4%) but less than those with dementia (91.1%). The IADL-restricted MCI subjects were more likely to develop dementia over 2 years (30.7%) than the nonrestricted ones (7.8%). In multivariate analyses, the odds ratio for dementia was 7.4 (CI: 3.3 to 16.5) in the IADL-restricted MCI and 2.8 (CI: 1.3 to 6.0) in the non-IADL-restricted MCI compared with the non-IADL-restricted controls. IADL restriction also lowered the chance of reversibility to normal, observed in 10.7% of the restricted MCI and 34.7% of the nonrestricted MCI. CONCLUSIONS: Inclusion of instrumental activities of daily living restriction in the criteria of mild cognitive impairment improves the prediction of dementia and the stability of this status over time. Conversely, its exclusion results in inappropriate selection of subjects with a low probability of short-term progression to dementia.

Activities of Daily Living↗

[Quasi-experimental evaluation of a nutritional educational intervention among home support assistants for the elderly].

BACKGROUND: The French National Program on Nutrition and Health has defined two specific objectives targeting older persons: (i) to improve their status in calcium and vitamin D and (ii) to prevent undernutrition. Home help provides support in activities of daily living, including meals, to dependent persons. The objective of our study was to evaluate the impact of a nutritional education intervention on knowledge and practices among home support assistants for the elderly. METHODS: Three facilities providing home support in Gironde (France) selected 132 home support assistants to follow an education program and 134 controls. Nutrition training was conducted in the intervention group by a dietician during two half-day sessions in May-June 2004. A non randomized controlled trial design was used for evaluation. Nutritional knowledge (20 questions) and practice (5 questions) of home support assistants were assessed by questionnaire before (April 2004) and after (September 2004) the training period in each group. Satisfaction of the intervention group was also assessed. RESULTS: The intervention group included 101 participants and the control group 106 persons who answered both questionnaires before and after the education program. The intervention group was significantly younger (p < 0.05), less educated (p = 0.01) and had less often participated to previous nutrition training (p < 0.001) than the control group. There was no significant difference between the two groups before intervention for their mean scores of knowledge or practices. The intervention group significantly improved its knowledge score (mean gain 2.5 points, p < 0.001) after the training period, whereas the score remained unchanged in the control group (mean gain 0.5 points, p = 0.06). The impact of the nutritional education was very significant (p < 0.0001) after adjustment for the characteristics which differed between the two groups. The practice scores did not differ significantly after intervention in multivariate analyses. Satisfaction of trained home support assistants was very high. CONCLUSION: An education program of home support assistants for elderly persons can improve their nutritional knowledge, but this study cannot conclude that the intervention was efficient to improve the nutritional status of older persons.

Adult↗

Validation of the St. George's Respiratory Questionnaire in patients with COPD or asthma in Morocco.

SETTING: Chronic obstructive pulmonary disease (COPD) and asthma are a public health problem in Morocco. Their evaluation should be supplemented by quality of life measurement, but there is no specific instrument available in local Moroccan Arabic. OBJECTIVE: To validate a Moroccan Arabic version of the St George's Respiratory Questionnaire (SGRQ) in patients with COPD or asthma in Morocco. DESIGN: After a rigorous translation process of the SGRQ into local Moroccan Arabic (SGRQm), the SGRQm, spirometry, Fletcher scale and a visual analogical scale (VAS) were administered to each patient at recruitment. Data were used to examine the construct validity and reliability of the SGRQm. To examine the test-retest reliability, patients completed the SGRQm a second time 10 days later. RESULTS: A total of 131 patients with a mean age of 52 years were recruited into the study. Patients had a mean forced expiratory volume in one second (FEV1) of 1.70 1 and a mean VAS of 51.5 mm. Internal consistency of symptoms, activity and impact components was assessed using Cronbach's alpha (a) reliability coefficient; they were 0.94, 0.91 and 0.90, respectively. The test-retest reliability of components scores ranged from 0.70 to 0.87. The Fletcher scale correlated with all SGRQm scores, while the VAS had a similar correlation except with symptoms (P > 0.05). FEV1 values were negatively correlated with all SGRQm scores. CONCLUSION: The SGRQm yielded satisfactory psychometric properties.

Adolescent↗

Accelerated degradation model and its applications to statistical analysis of the role played by dementia and sex in the loss of functional autonomy in elderly patients.

The paper considers the statistical analysis of aging and degradation processes in the elderly. The role played by dementia and sex in the loss of functional autonomy in elderly patients, in terms of progression and recovery, through several stages of increasing disability is analysed. The conjoint accelerated degradation model for statistical analysis of survival and degradation data is discussed.

Activities of Daily Living↗

Correlates of regular fish consumption in French elderly community dwellers: data from the Three-City study.

OBJECTIVE: Several studies have found an inverse association between fish consumption and risk of dementia. The objective of this study was to describe the characteristics of older fish consumers, in order to identify potential confounders in this relationship. DESIGN: Cross-sectional analysis of the baseline data of a prospective cohort study. SETTING: Bordeaux, Dijon, and Montpellier (France) in 1999-2000. SUBJECTS: A total of 9280 community dwellers aged 65 y and above participating in the baseline examination of the Three-City Study. INTERVENTIONS: All participants answered a face-to-face interview and underwent a physical examination. Cross-sectional analyses were performed by logistic regressions. RESULTS: Regular fish consumers (at least weekly) had a higher education (OR from 1.19 to 1.65, P = 0.0003) and income (OR from 1.37 to 1.89, P < 0.0001). Controlling for age, sex, education, and city, they had a higher consumption of pulses, fruit, and vegetables (P < 0.001). They were more often alcohol drinkers (P < 0.0001). They felt in better health (P < 0.05), exhibited less depressive symptoms (P < 0.001), and scored higher on the Mini Mental Status Examination (P < 0.05). However, their objective physical health status was not better, except that they were leaner. They suffered more often from hypertension and past stroke. CONCLUSIONS: Socioeconomic status, dietary habits, depression, and vascular risk factors could act as confounders in the relationship between fish consumption and risk of dementia.

Aged↗

Expiratory flow limitation and obstruction in the elderly.

Elderly people commonly suffer from dyspnoea, which may stem from expiratory flow limitation (EFL). The relationship between EFL, as assessed by the negative expiratory pressure method and spirometric indices, was investigated in an elderly French population. Subjects, aged 66-88 yrs, filled in socio-demographic and standardised questionnaires, which dealt with: medical history, smoking status and respiratory symptoms. EFL measurements and forced expiratory manoeuvres were performed. Validated measurements were obtained in 750 out of 1,318 subjects: 47% were EFL+ (EFL >0), with a higher prevalence in females than in males. EFL and forced expiratory volume in one second (FEV1) were correlated with age. A total of 116, from the 750 subjects, with no medical history and no symptoms, served as a healthy group. The prevalence of EFL+ subjects increased with the grade of dyspnoea and was highest in respiratory and cardiac patients when compared with the healthy subjects. EFL did not correlate with FEV1/forced vital capacity (FVC), the usual index of obstruction. Some elderly subjects (15%) with dyspnoea but with no medical history, mainly females with small FVC and normal FEV1/FVC, had a greater EFL than the healthy subjects. In elderly people, expiratory flow limitation measurements, along with the usual forced expiratory volume in one second/ forced vital capacity ratio, may be of value for the interpretation of dyspnoea.

Age Factors↗

Relationship between body mass index and different domains of disability in older persons: the 3C study.

OBJECTIVE: To study the relationships between body mass index (BMI) and different domains of disability in elderly subjects from the French 3C study. SETTING: Three cities in France: Bordeaux (South-West), Dijon (North-East) and Montpellier (South-East). DESIGN: Cross-sectional study. SUBJECTS: A sample of 8966 elderly community dwellers (age: 65-101 y). MEASUREMENTS MAIN OUTCOME MEASURES: BMI, continence, basic and Instrumental Activities of Daily Living (ADL and IADL) and mobility. Adjustment variables: age, educational level, lifestyle, cognitive functioning, smoking and drinking history, depression, dyspnea, diabetes and indicator of cardiovascular disease. RESULTS: Obesity (BMI> or =30 kg/m2) was significantly associated with disability in each domain for women. The relationship tended to be linear for ADL and for continence; whereas for IADL, underweight women (BMI <21 kg/m2) were also at higher risk of disability. In men, relationships were weaker since BMI was only associated with mobility restriction, with a higher risk for both underweight and obese subjects. CONCLUSION: These results are in favor of a strong association between obesity and the three domains of disability and incontinence. Weaker relationships between underweight and disability were observed. Results suggest that maintaining a BMI in the healthy range could contribute to independence in activities of daily living.

Activities of Daily Living↗

IgE level and Phadiatop in an elderly population from the PAQUID cohort: relationship to respiratory symptoms and smoking.

BACKGROUND: In the last decades in industrialized countries, the increase of life expectancy has resulted in an increase in the population of the elderly. However, little is known about the prevalence of allergies in the elderly population. The aim of the study was to investigate the specific relationship of serum IgE and Phadiatop, with asthma, rhinitis, and smoking in a sample of an elderly population. METHODS: Subjects from the Paquid cohort living in Gironde Department (age 65 years and over) in France were followed up since 1988 (PAQUID cohort). RESULTS: Among the randomized sample of 352 subjects, there were 158 men (45%) and 194 women (55%). The lowest levels of IgE were in subjects with chronic sputum; and in normal subjects (47.1 +/- 56.4 vs 56.2 +/- 73.9, NS). Multiple linear regression was performed with log(10) IgE values as a dependent variable and age, Phadiatop test, smoking, and respiratory symptoms independently in men and in women. In men, a significant relationship was observed between IgE values and Phadiatop test (P < 0.001), asthma history (P = 0.002), and smoking (P = 0.019). CONCLUSIONS: Respiratory allergy is present in persons >65 years of age. There is an association between smoking and IgE level independent of allergic reactivity to common allergens in the elderly.

Aged↗

Nutritional factors and risk of incident dementia in the PAQUID longitudinal cohort.

PURPOSE: The aim of this study was to present a summary of the results obtained in the PAQUID study regarding wine consumption, fish and seafood consumption and vitamin A and E plasma concentrations. METHODS: This study was carried out from the PAQUID (Personnes Agees QUID) cohort, an epidemiological study on cognitive and functional aging after 65 years in Southwestern France. The relationship between nutritional factors and risk of incident dementia was measured using logistic regression or Cox proportional hazards models on different subsamples of the cohort. RESULTS: Among 2950 initially non-demented subjects, moderate drinkers had a decreased relative risk of developing a dementia in the subsequent 8 years (RR=0.56) compared to non-drinkers. In a sub-sample of 1416 subjects, those who ate fish or seafood at least once a week had a significant reduced risk of incident dementia adjusted for age and sex (RR=0.66). Lastly, a nested casecontrol study was performed among 182 subjects. Adjusted for confounders, the risk of dementia was significantly increased for the lowest vitamin E concentration compared to the highest one (OR=2.54). DISCUSSION: These results are in agreement with a possible protective role of a diet rich in poly-unsaturated fats and antioxidant components. However, confounding factors such as education and lifestyle may be involved and should be further explored.

Aged↗

Sociodemographic differences in dietary habits in a population-based sample of elderly subjects: the 3C study.

PURPOSE: Diet plays an important role in maintaining quality of life in ageing and can be influenced by sociodemographic factors. We aimed to describe dietary habits in a large population-based sample of elderly people and to explore how they may vary according to sex, age, educational level and lifestyle. METHODS: 9250 community dwellers aged 65 years and over recruited in three French cities were interviewed about their food habits with a brief frequency questionnaire. For each food considered, the subjects were classified as occasional or regular consumers. Quantities of alcoholic beverages consumed daily were also assessed. Dietary habits were compared for men and women separately according each sociodemographic factor. RESULTS: Women were characterized by a more regular consumption of fruit and vegetables and drunk fewer alcoholic beverages. Older subjects ate meat, fish, cereals, raw vegetables and pulses less regularly. The proportion of regular consumers of fish, raw fruit, raw vegetables and cooked fruit or vegetables and the quantity of alcohol consumed increased with educational level. Subjects living alone were less regular consumers of almost all foods. DISCUSSION: The results show that even in a sub-population of elderly people, dietary patterns can vary greatly according to several factors. Identifying such factors is of value for future analytic studies on nutrition and health in the elderly. In view of dietary recommendations advising a high consumption of fruit and vegetables, subjects living alone and people with a low educational level are particularly at risk and should be encouraged to eat more balanced meals.

Aged↗

Body mass index and incidence of dementia: the PAQUID study.

To study the relationship between body mass index (BMI) and risk of dementia, a cohort of 3,646 individuals aged > or =65 years living at home and without cognitive disorders at baseline were followed up for 8 years (the PAQUID [Personnes Agées Quid] Study). Subjects with a BMI < 21 had an increased risk of developing dementia as compared with subjects whose BMI was between 23 and 26 (odds ratio = 1.48, 95% CI = 1.08 to 2.04). However, when individuals who developed dementia early during the follow-up were excluded from the analysis, this relationship was no longer significant. A low BMI does not in itself seem to be a risk factor for dementia.

Aged↗

Association between antioxidant nutritional indicators and the incidence of dementia: results from the PAQUID prospective cohort study.

OBJECTIVE: To analyse the relation between antioxidant vitamins A, E, and malondialdehyde (MDA) lipoperoxidation product plasma concentrations with incident dementia. DESIGN: : A nested case-control within the PAQUID (Personnes Agées QUID) cohort. SETTING: The PAQUID population-based prospective cohort in southwestern France. SUBJECTS: Among 626 subjects with blood collection at baseline, 46 developed a dementia during the follow-up and were considered to be cases. Each case was matched (on age and sex) to three controls. RESULTS: Plasma vitamin E concentrations were lower among cases (mean value at 22.62 micromol/l (s.d.: 7.38) vs 24.99 (s.d.: 6.73 among controls). The same trend was observed for vitamin A concentrations, but the difference was not significant. On the contrary, MDA concentrations tended to be higher (mean value 1.35 micromol/l (s.d.: 0.53) vs 1.23 (s.d.: 0.44)) among cases. In logistic regression models, plasma values were split into tertiles. Adjusted for confounders, the risk of dementia was significantly increased in the lowest vitamin E tertile (< or =21.0 micromol/l) (OR=3.12, P=0.033) compared to the highest one (> or =25.5 micromol/l). The risk of Alzheimer's disease was also increased, with borderline significance (OR=3.06, P=0.053). Risks associated with vitamin A were nonsignificant. Similarly, there was a trend to an increased risk of dementia in the highest tertile of MDA (OR=1.67, P=0.31). CONCLUSIONS: These results suggest that subjects with low plasma vitamin E concentrations are at a higher risk of developing a dementia in subsequent years.

Aged↗

[Prevalence of dementia and Alzheimer's disease among subjects aged 75 years or over: updated results of the PAQUID cohort].

The progression of the prevalence of dementia in developed countries will increase the difficulties of medical and psycho-social management of demented patients and their family. The aim of this study was to estimate the prevalence of dementia among subjects aged 75 years and over. These subjects have been followed-up ten years after the baseline examination of the PAQUID study, a prospective population-based cohort study on normal and pathological aging after 65 years. A total of 1,461 subjects, aged 75 years and over, have been visited. The prevalence of dementia was estimated to be at 17.8 p.cent. About 38.5 p.cent of these demented subjects ware living in an institution, which leads to the fact that more than the two thirds of the subjects living in an institution were demented persons. Alzheimer's disease was the main etiology of dementia (79.6 p.cent). Based on the French population census, currently there would be about 769,000 demented people aged 75 years or over in France. Dementia accounts for 72 p.cent of the potential need for the French subvention for dependent persons, called Allocation Personnalisee d'Autonomie P. These results point out the importance of regarding dementia as a Public Health priority and of developing necessary measures for caring for these subjects, whether residing in their home or an institution.

Activities of Daily Living↗

Risk adjustment of quality indicators in French long term care facilities for elderly people. A preliminary study.

BACKGROUND: In France, the funding reform for long term care facilities mandates quality improvement efforts and the measurement of quality of care indicators. In the United States, the Center for Health Systems Research and Analysis (CHSRA) has proposed 24 indicators, which measure practices and outcomes ("events") in long term care facilities. The objective of this preliminary study was to propose risk adjustments on the CHSRA indicators for future use in France. METHODS: The unit of analysis was residents assessments (558) in eight French facilities wich voluntarily participated to the experimentation of the Resident Assessment Instrument (RAI) from January 1996 to June 1999. This preliminary study focused on nine of the CHSRA's indicators: "prevalence of falls", "use of nine or more different medications", "prevalence of bladder or bowel incontinence", "prevalence of occasional or frequent bladder or bowel incontinence without a toileting plan", "prevalence of urinary tract infections", "prevalence of dehydration", "prevalence of bedfast residents", "prevalence of little or no activity" and "prevalence of stage 1-4 pressure ulcers". A working group selected residents'characteristics for risk adjustment based on the literature, risk adjustments selected by CHSRA, and their own propositions. For each event, candidate independent characteristics were screened using univariate analyses and, when significant, were entered into a stepwise selection analysis to obtain the final model. The proposed indicator was the ratio between observed and expected numbers of events. RESULTS: Six indicators were left unadjusted. For the event "prevalence of occasional or frequent bladder or bowel incontinence without a toileting plan", we proposed a stratification on "dementia - neurological diseases" (p<0.001). We proposed two models of prediction: for the event "prevalence of bladder or bowel incontinence" we adjusted on "severe cognitive impairment" (OR=4.00), "dementia- neurological diseases" (OR=1.75) and "total dependence in mobility" (OR=9.30); for the event "prevalence of stage 1-4 pressure ulcers" we adjusted on "dependence for bed mobility" (OR=4.97), "leaves 25% or more food uneaten at most meals" (OR=1.82) and "diabetes mellitus" (OR=3.45). CONCLUSION: This preliminary study underlines the importance of considering risk-adjustment for quality indicators in elderly care facilities.

Age Factors↗

Incidence and outcome of mild cognitive impairment in a population-based prospective cohort.

OBJECTIVE: To estimate the age-specific incidence rate of mild cognitive impairment (MCI) according to sex and educational level and to explore the course of MCI, particularly its progression to AD, in a population-based cohort. METHODS: A community-based cohort of nondemented elderly people (Personnes Agées QUID [PAQUID]) was followed longitudinally for 5 years. MCI was defined as memory complaints with objective memory impairment, without dementia, impairment of general cognitive functioning, or disability in activities of daily living. Incidence rates were calculated using the person-years method. A descriptive analysis at the different follow-up times was performed to study the course of MCI. RESULTS: At baseline, there were 58 prevalent cases of MCI (2.8% of the sample). During a 5-year follow-up, 40 incident cases of MCI occurred in 1,265 subjects at risk. The global incidence rate of MCI was 9.9/1,000 person-years. MCI was a good predictor of AD with an annual conversion rate of 8.3% and a good specificity, but it was very unstable over time: Within 2 to 3 years, only 6% of the subjects continued to have MCI, whereas >40% reverted to normal. CONCLUSIONS: Conventionally defined MCI has reasonable predictive value and specificity for AD. However, MCI was very unstable across time in this study. Furthermore, the definition of MCI seems to be too restrictive and should probably be extended to other categories of individuals also at high risk of developing AD.

Activities of Daily Living↗

Nutritional status of healthy elderly persons living in Dordogne, France, and relation with mortality and cognitive or functional decline.

OBJECTIVE: Description of the nutritional status of healthy elderly people and investigation of its longitudinal relationship with mortality and cognitive or functional decline. DESIGN: Longitudinal study. SETTING: In Dordogne, France. SUBJECTS: A total of 169 French elderly community dwellers aged 68 y and older from in the PAQUID (Personnes Agées QUID) study were included. Dietary intake was assessed by a 3 day food record and a dietary history. Self-reported weight and height were used to calculate the body mass index (BMI, kg/m(2)). Mortality, activities of daily living (ADL), instrumental activities of daily living (IADL) and the Mini Mental State Examination (MMSE) were measured at 5 y follow-up. RESULTS: Nutritional intake and BMI vary according to age and sex. Men generally have a higher nutritional intake than women. Intake decreases with age especially in men. Among the 169 subjects, 22 died. When analyzed by logistic regression, there was no relation between markers of risk of poor nutrition and mortality but a BMI greater or equal 27 at baseline was associated with a increased risk of 5 y mortality (OR=6.27, 95% CI 1.29-30.37) adjusted for sex and age. With regard to cognitive decline, subjects with a BMI greater or equal than 23 kg/m(2) had 3.6 times lower chance of presenting a decline in the subsequent 5 y adjusted by age and sex (OR=0.28, 95%, CI 0.09-0.90). BMI ranging between 23 and 27 was associated with a significantly decreased risk of IADL disability (OR=0.31, 95% CI 0.10-0.93) in multivariate analyses. CONCLUSION: In apparently healthy elderly people a BMI ranging between 23 and 27 is associated with lower risks of functional and cognitive declines in the subsequent 5 y.

Activities of Daily Living↗

The disablement process: a conceptual framework for dementia-associated disability.

Most of the social and economic burden of dementia is attributable to its consequences in terms of disability. In this review, we describe the concepts defined in the disablement process model of Verbrugge and Jette [Soc Sci Med 1994;38:1-14] and show how they apply to dementia. The main pathway leads from pathology to impairments, functional limitations and disability. Pathologies (any cause of dementia) are expressed by impairments in specific cognitive processes. Functional limitations are limitations in generic cognitive tasks such as remembering a list of words or orientating oneself in time and space. They are responsible for disability in activities of daily living. Predisposing risk factors as well as introduced intraindividual and extraindividual factors speed up or slow down the main pathway. We show how the model can help in understanding the functional consequences of dementia, for better assessment and management of demented subjects.

Activities of Daily Living↗