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Animals↗
Biomedical subjects
R Hébert
Publications and source records attributed to R Hébert.
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Adolescent↗
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Administration, Cutaneous↗
Vascular dementia : incidence and risk factors in the Canadian study of health and aging.
BACKGROUND AND PURPOSE: Very few population-based studies have systematically examined incident vascular dementia (VaD). From the Canadian Study of Health and Aging cohort, incidence rates of VaD were determined and risk factors analyzed. METHODS: This was a cohort incidence study that followed 8623 subjects presumed to be free of dementia over a 5-year period. The risk factors were examined with a nested prospective case-control study. Exposure was determined by means of a risk factor questionnaire administered to the subject or a proxy at the beginning of the study. RESULTS: On the basis of 38 476 person-years at risk, the annual incidence rate was estimated to be 2.52 per thousand undemented Canadians (95% CI 2. 02 to 3.02). Including an estimation of the probability of VaD among the decedents, this figure rose to 3.79. For the risk factors study, 105 incident cases of VaD according to the NINCDS-AIREN criteria were compared with 802 control subjects. Significant risk factors were: age (OR=1.05), residing in a rural area (2.03), living in an institution (2.33), diabetes (2.15), depression (2.41), apolipoprotein E epsilon4 (2.34), hypertension for women (2.05), heart problems for men (2.52), taking aspirin (2.33), and occupational exposure to pesticides or fertilizers (2.05). Protective factors were eating shellfish (0.46) and regular exercise for women (0.46). There was no relation with sex, education, or alcohol. CONCLUSIONS: The study confirmed some previously reported risk factors but also suggested new ones. It raised concerns about the prescription of aspirin and perhaps other factors related to rural life.
Age Distribution↗
Evaluation of postural stability in elderly with diabetic neuropathy.
OBJECTIVE: The objective of this study was to compare clinical and biomechanical characteristics of balance in diabetic polyneuropathic elderly patients and normal age-matched subjects. RESEARCH DESIGN AND METHODS: Fifteen elderly with distal neuropathy (DNP) and 15 healthy age-matched subjects were evaluated with the biomechanical variable COP-COM, which represents the distance between the center of pressure (COP) and the center of mass (COM). Measurements were taken in the quiet position with a double-leg stance, in eyes-open (EO) and eyes-closed (EC) conditions. Subjects were also assessed with clinical balance evaluations. RESULTS: The COP-COM variable was statistically significantly larger in the DNP group than in the healthy group in anterior-posterior (A/P) and medial-lateral (M/L) directions. Furthermore, the DNP group showed statistically significantly larger amplitudes of the COP-COM variable without vision. The severity of the neuropathy, as quantified using the Valk scoring system, was correlated with COP-COM amplitude in both directions. CONCLUSIONS: Evaluation of the postural stability of an elderly diabetic population using the COP-COM variable can detect a very small change in postural stability and could be helpful in identifying elderly with DNP at risk of falling.
Aged↗
[Incidence of the onset of disability and recovery of functional autonomy among the very old after one year].
BACKGROUND: This article measures the survival rate and explores the changes in functional autonomy among both men and women over a one-year period in a sample of 272 subjects aged 80-85. METHODS: Data were taken from the Quebec Longitudinal Study on Aging, a multi-cohort prospective study focusing on health and quality of life. The sample comprises two sub-groups, namely disabled and autonomous subjects. Eligible participants were selected from the Quebec Health Insurance Plan (QHIP) file. However, to obtain the required number of participants, the sample was completed from eligible subjects who volunteered in response to TV, billboard and newspaper advertising about the project. The Functional Autonomy Measurement System (SMAF) was used to assess disability. The SMAF assesses functional disability in 5 domains: activities of daily living (ADL), mobility, instrumental activities (IADL), communication, and mental functioning. RESULTS: After one year, nearly 5% of the subjects had died and 72.5% were still autonomous, i.e., they had a score under 4.5 on the SMAF. The annual incidence of the onset of disability (including death, lengthy hospitalization, functional incapacities and cognitive deficits) was 20%. However, no difference was found between the sexes in regard to the risk of losing autonomy. The main areas where disability occurred among the previously autonomous subjects were, in order of importance, domestic tasks, mobility and communication. The study confirmed that it is possible to recover autonomy, even at this advanced age, particularly for women (11.2%), but less so for men (3.6%). CONCLUSION: This phenomenon of recovering functional autonomy suggests that octogenarians have a residual potential and confirms the effectiveness of preventive and curative measures and the benefits of interventions by community and family networks.
Activities of Daily Living↗
Unique PABP2 mutations in "Cajuns" suggest multiple founders of oculopharyngeal muscular dystrophy in populations with French ancestry.
Oculopharyngeal muscular dystrophy (OPMD) is an adult-onset autosomal dominant myopathy found world-wide, but with the highest incidence in French-Canadians. Short GCG expansions in the poly(A) binding protein 2 (PABP2) gene were identified recently as the molecular basis for OPMD in French-Canadians. All French-Canadian cases of OPMD have been traced to a single founder couple [Bouchard, 1997: Neuromuscul Disord 7(Suppl):S5-S11]. Cultural links between French-Canadians and Cajuns suggest that this same founder couple may have transmitted the OPMD mutation to Cajuns as well. To determine if OPMD patients from Louisiana share a founder effect with French-Canadian families, we collected blood samples and muscle biopsies from several Cajuns with OPMD for mutation and linkage studies. We found a unique 'GCA GCG GCG' insertion mutation in Cajuns. Consistent with these sequence data, we identified a disease haplotype in our Cajun families that is different from the ancestral haplotype defined in French-Canadians. These data prove that different founders introduced the PABP2 mutation to Cajuns and French-Canadians and lend support to emerging genealogical data suggesting that French-Canadians and Cajuns represent distinct immigrant groups from France.
Base Sequence↗
Factors associated with functional decline and improvement in a very elderly community-dwelling population.
The objective of this study was to analyze the factors associated with functional decline and improvement in a community-dwelling population of people aged 75 years and older. A representative sample of elderly people living at home in the city of Sherbrooke (Quebec, Canada) was assessed yearly on three occasions (1991-1993) by a nurse. A health questionnaire, together with standardized instruments measuring disabilities, cognitive status, and depressive mood, was administered on the three assessments. From the 655 subjects who agreed to participate, a total of 504 subjects completed the study. The most important factors associated with functional decline were the number of days off regular activities (odds ratio (OR) = 1.31), the number of hot meals per day (OR = 1.59), and cognitive status (OR = 0.96), whereas weight loss (OR = 0.37) and living alone (OR = 0.54) were significant protective factors. Previous declines in functional autonomy, cognitive state, or mood were not independent risk factors. The most important factors associated with functional improvement were the disability score (OR = 1.08), previous functional decline (OR = 6.06), and decline in the disability score (OR = 1.09). Perceiving health to be worse than it was the previous year was a significant factor against improvement (OR = 0.24). This study identifies risk factors that can be helpful for targeting high-risk subgroups within the very elderly population who may benefit from a preventive program.
Activities of Daily Living↗
A brief clinical instrument to classify frailty in elderly people.
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Activities of Daily Living↗
Age-related changes in upper extremity performance of elderly people: a longitudinal study.
The objective of this research was to study age-related changes in the upper extremity performance of healthy community-dwelling elderly people, by using a longitudinal design. In 1995-1996. gross and fine manual dexterity, global performance, motor coordination, grip strength, tactile recognition, two-point discrimination, touch/pressure threshold, and tactile localization of 264 of the 360 subjects initially evaluated in 1992-1993 were reevaluated by using the same upper extremity measuring instruments. Those who did not participate (n = 96) were found to be significantly different from those who participated in the longitudinal study. Although the survivors were younger, more active, and perceived themselves in better health than the nonparticipants, their upper extremity performance significantly decreased in the 3-year period, with a few exceptions. In general, the decline was related to the initial score but not to age.
Aged↗
[Questionnaire on the satisfaction of persons with lower-limb amputations towards their prosthesis: development and validation].
The satisfaction of persons with lower-limb amputations towards their prosthesis constitutes a critical factor in the use of the prosthesis. In order to evaluate a person's satisfaction, the SAT-PRO, a self-administrated questionnaire was developed. The questionnaire includes 15 items developed on the basis of the most significant criteria used by the person when selecting a technical aid. These criteria were measured using an ordinal categorical four-level scale. The validation of the SAT-PRO was established from a sample consisting of 61 people with below-knee or above-knee amputations, aging from 60 years and older. The internal consistency of the instrument is high (Cronback's alpha coefficient is 0.90) and the test-retest reliability coefficient (0.97) indicates a very good consistency of the questionnaire over time. Simple and multiple correlations were used to evaluate construct validity. The degree of use of the prosthesis and the feelings of depression, amongst the measured variables, are the best indicators of the satisfaction of the amputees toward their prosthesis.
Aged↗
Criterion validity of a new measure of self-actualization.
Many authors have questioned the validity of the major existing measures of self-actualization (the Personal Orientation Inventory, the Personal Orientation Dimensions, and the Short Index of Self-actualization), given their serious theoretical and methodological limitations. A new inventory was developed, the Measure of Actualization of Potential, and various studies were conducted to assess its theoretical and empirical content as well as its construct validity, internal consistency, and temporal reliability. The present aim was to estimate the criterion validity of the new measure using humanistic clinical psychologists' assessments as the criterion. The results show that eight clinical psychologists' rankings of 73 individuals are positively and highly correlated with the scores obtained by the same individuals on the Measure of Actualization of Potential.
Adolescent↗
Comparison of cross-sectional and longitudinal designs in the study of aging of upper extremity performance.
The purpose of the study was to compare two research designs, namely the cross-sectional design and the longitudinal design, in the context of upper extremity performance and age-related changes. Upper extremity performance of 360 randomly recruited healthy, community-dwelling elderly persons was evaluated with reliable and valid sensori-motor tests. Three years later, survivors (n = 264) were reevaluated with the same tests. In many tests, cross-sectional and longitudinal designs were comparable for estimating the changes in upper extremity performance with age. However, in some tests, the decline with age using a cross-sectional design was underestimated. The upper extremity performance decline observed with the longitudinal design was larger than the decline predicted with the cross-sectional design. The withdrawal and survivor biases related to the longitudinal design and the cohort bias associated with the cross-sectional design may, in part, explain these results.
Aged↗
Functional decline in old age.
Functional decline is a common condition, occurring each year in nearly 12% of Canadians 75 years of age and older. The model of functional health proposed by the World Health Organization (WHO) represents a useful theoretical framework and is the basis for the SMAF (Système de measure de l'autonomie fonctionelle or Functional Autonomy Measurement System), an instrument that measures functional autonomy. The functional decline syndrome, in which functional autonomy is diminished or lost, may present as an acute condition, i.e., a medical emergency for which the patient must be admitted to a geriatric assessment unit. The subacute form is a more insidious condition in which the patient requires comprehensive assessment and a rehabilitation program. A preventive approach based on screening of those at risk and early intervention should prevent or delay the appearance of functional decline or diminish its consequences. Effective strategies for the prevention of or rehabilitation from functional decline will help reduce the incidence of disabilities and the period of dependence near the end of life. These strategies are absolute prerequisites for controlling sociohealth expenses and, most importantly, for allowing people to live independently in old age.
Activities of Daily Living↗
Incidence of functional decline and improvement in a community-dwelling, very elderly population.
With the aging of the population, functional decline is one of the major challenges to health care systems. The objective of this study was to estimate the incidence of functional decline and improvement in a community-dwelling population of people aged 75 years and above. A representative sample of elderly people living at home in the city of Sherbrooke (Québec, Canada) was assessed yearly on three occasions (1991-1993) by a nurse. Disabilities were measured by the Functional Autonomy Measurement System, a 29-item rating scale developed according to the World Health Organization classification of disabilities. From the 655 subjects who agreed to participate, a total of 572 subjects completed the study, including 68 who subsequently died. The probability of declining was 20.1% for the first year and 12.4% for the second year. The incidence of functional decline among previously stable subjects was 11.9% (95% confidence interval (CI) 8.9-15.9). Age was strongly related to decline (relative risk (RR) = 1.15/year, 95% CI 1.09-1.21), but there was no significant sex effect (RRmale = 0.88, 95% CI 0.55-1.39). The incidence of improvement among previously disabled subjects was estimated at 7.5% (95% CI 5.1-10.9) for the first year and 17.9% (95% CI 14.0-23.0) for the second year. Neither age (RR = 1.07, 95% CI 0.99-1.15) nor sex (RRmale = 1.70, 95% CI 0.90-3.18) was significantly associated with the probability of improving. This study stresses the importance of precise measurement of disabilities and the complex and dynamic process of functional transitions.
Activities of Daily Living↗
Age- and education-specific reference values for the Mini-Mental and modified Mini-Mental State Examinations derived from a non-demented elderly population.
MAIN OBJECTIVE: To report age- and education-specific reference values for the Mini-Mental State Examination (MMSE) and Modified Mini-Mental State (3MS) Examination. DESIGN: Cross-sectional study. SETTING: Community and institutional settings in five regions across Canada. PARTICIPANTS: 7754 subjects aged 65 and over randomly chosen to take part in the Canadian Study of Health and Aging. Subjects classified as cognitively impaired or demented following a clinical and neuropsychological examination were excluded. MEASUREMENTS: Total scores on the MMSE and 3MS, and the degree to which they are influenced by the age, sex, education, mother tongue and living environment of the subject. RESULTS: Reference values on the two tests are reported through various descriptive statistics for five age groups and four education levels. These values decrease with age and increase with years of schooling. Test scores are also influenced by the subject's sex and mother tongue, albeit to a lesser extent. These observations led to the development of predictive equations of the performance to be expected from a 'normal' elderly subject, given his/her socio-demographic characteristics. CONCLUSION: The use of the reference values and related predictive equations will allow the clinician to interpret a patient's performance on two widely used cognitive tests, in light of the value expected from a group of 'normal' subjects with the same sociodemographic profile.
Age Factors↗
Setting the minimal metrically detectable change on disability rating scales.
OBJECTIVE: To determine the minimal metrically detectable change (MMDC) on rating scales by comparing two methods: (1) using the reliability coefficient derived from an external study in the calculation of the standard error of measurement (psychometric method); and (2) examining the variability of scores in a stable subsample from a longitudinal study (empirical method). DESIGN: Longitudinal survey. SETTING: General community. PARTICIPANTS: Population-based representative sample of community-dwelling people older than 75 (n = 572). MAIN OUTCOME MEASURE: Disability as measured by the Functional Autonomy Measuring System (SMAF). RESULTS: Using the psychometric method, a change in score of 3.7 on the SMAF was obtained using a reliability coefficient derived from an external test-retest study, and 5.2 using the reliability coefficient measured in a stable subsample of the longitudinal study. With the empirical method, a change of 5 points was established as the MMDC. CONCLUSION: The setting of the MMDC on a disability scale could be useful for calculating sample size or interpreting results from clinical trials because it helps to establish the minimal clinically important difference, which should be equal to or larger than the MMDC.
Aged↗
Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared.
The objectives of this study were to assess whether Teng's modification of the Mini-Mental State Examination (MMSE) improves its performance as a screening test for cognitive impairment and dementia, and to replicate this comparison in French and English language groups, and for differing assumptions concerning the relative importance of false negative and false positive errors. Screening interviews were conducted with representative samples of people aged 65 or over, set in 36 communities in 10 Canadian provinces. There were 8900 community participants in the Canadian Study of Health and Aging, of whom 1600 also underwent an extensive clinical and neuropsychological examination. Sensitivity, specificity and areas under the receiver operating characteristic (ROC) curve for the original MMSE and modified version (the 3MS) were the main outcome measures. Results are reported for French and English versions of the tests. The results indicate the alpha internal consistency for the 3MS was 0.87, compared to 0.78 for the MMSE. The area under the ROC curve in identifying dementia was 0.93 for the 3MS and 0.89 for the MMSE (p < 0.001). There was less difference between the two tests in identifying all levels of cognitive impairment (AUC 0.80 versus 0.77, p < 0.01). The superiority of the 3MS appears more due to its extended scoring system than to its additional questions. The validity of the MMSE was comparable in English and French samples; results for the 3MS were inconsistent between the two samples, suggesting possible translation problems. In conclusion, the 3MS was superior to the MMSE, justifying the slightly greater burden for its administration and scoring. Neither test worked well in identifying lower levels of cognitive impairment.
Aged↗