Publications by authors named "Emilie Crawford-Achour"

13 Publications

  • Page 1 of 1

Predictive performance of four frailty screening tools in community-dwelling elderly.

BMC Geriatr 2017 11 10;17(1):262. Epub 2017 Nov 10.

Département de Gérontologie Clinique, CHU de Saint Etienne, Hôpital de la Charité, 44 rue Pointe Cadet, 42000, Saint-Etienne, France.

Background: This study compares the performance of four frailty screening tools in predicting relevant adverse outcome (disability, institutionalization and mortality) in community-dwelling elderly.

Methods: Our study involved a secondary analysis of data from the FréLE cohort study. We focused on the following four frailty screening tools: the abbreviated Comprehensive Geriatric Assessment (aCGA), the Groningen Frailty Indicator (GFI), the Vulnerable Elders Survey-13 (VES-13) and the Fried scale. We used the Barberger-Gateau scale to assess disability. For comparison, we determined the capacity of these tools to predict the occurrence of disability, institutionalization or death using the receiver operating characteristic (ROC) curve. We also determined the threshold at which an optimal balance between sensitivity and specificity was reached. Odds ratios (ORs) were calculated to compare the risk of adverse outcome in the frail versus non-frail groups.

Results: In total, 1643 participants were included in the mortality analyses; 1224 participants were included in the analyses of the other outcomes (74.5% of the original sample). The mean age was 77.7 years, and 48.1% of the participants were women. The prevalence of frailty in this sample ranged from 15.0% (Fried) to 52.2% (VES-13). According to the Barberger-Gateau scale, 643 (52.5%) participants were fully independent; 392 (32.0%) were mildly disabled; 118 (9.6%) were moderately disabled; and 71 (5.8%) were severely disabled. The tool with the greatest sensitivity for predicting the occurrence of disability, mortality and institutionalization was VES-13, which showed sensitivities of 91.0%, 89.7% and 92.3%, respectively. The values for the area under the curve (AUC) of the four screening tools at the proposed cut-off points ranged from 0.63 to 0.75. The odds (univariate and multivariate analysis) of developing a disability were significantly greater among the elderly identified as being frail by all four tools.

Conclusion: The multivariate analyses showed that the VES-13 may predict the occurrence of disability, mortality and institutionalization. However, the AUC analysis showed that even this tool did not have good discriminatory ability. These findings suggest that despite the high number of frailty screening tools described in the literature, there is still a need for a screening tool with high predictive performance.
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http://dx.doi.org/10.1186/s12877-017-0633-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681791PMC
November 2017

[Study of patients benefiting from a geriatric oncology assessment].

Soins Gerontol 2017 Jul - Aug;22(126):33-39

Pôle gériatrie et médecine interne, CHU de Saint-Étienne, hôpital de La Charité, 44 rue Pointe Cadet, 42055 Saint-Étienne, France.

A retrospective study carried out in 2014 focused on the 124 geriatric oncology consultations carried out at Saint-Étienne university hospital. The opinion of the geriatric oncologist was evidently incorporated into the treatment plan, with requests for early assessments. The geriatric oncologist often recommended a specific curative treatment and the majority of assessments were followed up by the oncologist. The benefit of the liaison between the oncologist and gerontologist with regard to the patient's care was clearly demonstrated.
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http://dx.doi.org/10.1016/j.sger.2017.05.007DOI Listing
September 2017

[Identifying frailty and the importance of personalised support].

Soins Gerontol 2017 Mar - Apr;22(124):23-29

Service de gérontologie clinique, CHU de Saint-Étienne, hôpital la Charité, 44 rue Pointe Cadet, 42055 Saint-Étienne, France. Electronic address:

Over recent years, many hospitals have been looking to promote optimum ageing by developing a strategy for identifying frailty in elderly people. This raises the question of prevention in the field of ageing and the capacities to change behaviour which is harmful to health at any age. Early and long-term support is essential.
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http://dx.doi.org/10.1016/j.sger.2017.02.005DOI Listing
August 2017

[Pulmonary hypertension in the elderly].

Geriatr Psychol Neuropsychiatr Vieil 2015 Mar;13(1):8-14

Gérontologie clinique, La Charité, CHU Saint-Étienne, Saint-Étienne, France, SNA-EPIS (EA 4607), Université Saint-Étienne, Jean Monet, Saint-Étienne, France.

In the past decade, a significant improvement has been done in the management of pulmonary arterial hypertension, a devastating disease. Beside the aging population, one of the next challenges is to develop a specific management of a pulmonary hypertension's suspicion, in the aged patients. In fact, recent data have shown that if pulmonary hypertension were mostly related to chronic heart or lung failure, or pulmonary embolism, some elderly may in fact develop a real pulmonary arterial hypertension. Because of the potential therapies which may be proposed, the evaluation of a pulmonary hypertension's suspicion in the elderly needs a stringent evaluation by trained physicians, in collaboration with geriatricians.
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http://dx.doi.org/10.1684/pnv.2015.0526DOI Listing
March 2015

Protective Effect of Long-Term CPAP Therapy on Cognitive Performance in Elderly Patients with Severe OSA: The PROOF Study.

J Clin Sleep Med 2015 Apr 15;11(5):519-24. Epub 2015 Apr 15.

Laboratoire de Physiologie de l'exercice, Equipe SNA Epis EA 4607, Université Jean Monnet, Faculté de médecine J. Lisfranc, Hôpital universitaire, Saint-Etienne, France.

Objective: Obstructive sleep apnea syndrome (OSA) leads to a deterioration in cognitive functions, with regard to memory and executive functions. However, few studies have investigated the impact of treatment on these cognitive functions in elderly subjects.

Methods: The study was conducted in a large cohort of subjects aged 65 years or older (the PROOF cohort). Subjects were not diagnosed or treated for OSA. Subjects underwent a polygraphic recording. Cognitive performance was assessed in all OSA subjects at baseline and 10 years later, whether or not they were receiving continuous positive airway pressure (CPAP) therapy.

Results: A group of 126 patients were analyzed. Only 26% of them were treated, with therapy initiated at the discretion of the primary care physician. Among treated subjects, self-reported compliance with therapy was good (> 6 h/night on average), and 66% of them reported an improvement in their quality of life. Patients receiving CPAP treatment had a higher apneahypopnea index (p = 0.006), a higher oxygen desaturation index (p < 0.001), and experienced more pronounced daytime repercussions (p = 0.004). These patients showed a statistically significant improvement in mental agility (similarities test; p < 0.0001) and memory performance (Grober and Buschke delayed free recall; p = 0.02).

Conclusion: CPAP treatment is associated with the maintenance of memory performance over time.
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http://dx.doi.org/10.5664/jcsm.4694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410925PMC
April 2015

Sleep-related autonomic overactivity in a general elderly population and its relationship to cardiovascular regulation.

Heart Vessels 2016 Jan 24;31(1):46-51. Epub 2014 Aug 24.

Faculté de Médecine Jacques Lisfranc, Service de Physiologie et de l'Exercice, EA 4607 SNA EPIS, CHU Nord, Université Jean Monnet, Saint-Etienne PRES de Lyon, France.

Alteration in cardiac autonomic activity during sleep is a common feature of sleep disorders. Diurnal sympathetic overactivity is a possible consequence and could contribute to future cardiovascular complications. The aim of this study is to assess the relationship between cardiac autonomic activity during sleep and diurnal autonomic cardiovascular control. In a large cohort (n = 1011) of subjects aged 65 years old (± 0.4) free of cardiac and cerebrovascular events and of sleep-related breathing disorders, we evaluated (cross-sectional study) the prevalence of unexpected alteration in sleep-related autonomic overactivity according to the presence of a cyclical nocturnal heart rate variability [quantified using the relative power spectral density of the very low-frequency band of the heart rate increment (VLFi%) from ECG Holter monitoring]. We tested its relationship with diurnal ambulatory blood pressure and spontaneous baroreflex sensitivity (sBRS). An abnormal cardiac autonomic activity during sleep was retained in 34.4% of this population according to a VLFi% >4. Using multiple logistic regression analysis, the severity of the autonomic alteration was mainly correlated after adjustment with lower sBRS (p = 0.01; OR: 0.94; 95% CI: 0.90-0.98). Diurnal baroreflex control alteration is associated with sleep-related autonomic overactivity elderly. Such alteration may contribute to the increased incidence of cardiovascular complications in sleep disorders.
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http://dx.doi.org/10.1007/s00380-014-0573-9DOI Listing
January 2016

Stress hormones in obstructive sleep apnea complications: the role of cortisol.

Sleep Med 2014 Jan 6;15(1):3-4. Epub 2013 Nov 6.

Laboratoire de Physiologie de l'exercice, Equipe SNA Epis EA 4607, Université Jean Monnet, Faculté de médecine J. Lisfranc, Hôpital universitaire, 42055 Saint-Etienne, France; Centre VISAS, Université Jean Monnet, Faculté de médecine J. Lisfranc, Hôpital universitaire, 42055 Saint-Etienne, France.

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http://dx.doi.org/10.1016/j.sleep.2013.10.004DOI Listing
January 2014

[Successful aging: how to improve its occurrence in the elderly?].

Geriatr Psychol Neuropsychiatr Vieil 2012 Jun;10(2):207-14

Département de gérontologie clinique.

Objectives: To assess the seniors' expectations for acceding to successful aging and the impact of preventive actions.

Method: Descriptive study of a representative sample of healthy pensioners using a 20-item questionnaire exploring the difficulties in daily life, the options chosen to achieve successful aging and the impact of preventive actions. Self-rated health feelings and well-being were assessed by visual analogical scales.

Results: The questionnaire was sent to 998 subjects and 651 responses were completed. Mean age of the subjects was 72.9±1.2 years, and 60% were women. Main reported complaints concerned memory loss (20.4%) and mood swings (18.9%). Sleep (82.3%) and physical activity (81.4) were considered as priorities to accede to successful aging. Social activities were significantly more important for subjects with higher educational level than for subjects with lower educational level (p<0.0001). Women and people living alone were more interested in preventive action concerning physical and psychological well-being than men and people living in family (p<0.05).

Conclusion: A better analysis of the complaints and needs of aging subjects should be useful to ensure successful ageing.
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http://dx.doi.org/10.1684/pnv.2012.0318DOI Listing
June 2012

A 3-year longitudinal study of sleep disordered breathing in the elderly.

Eur Respir J 2012 Sep 9;40(3):665-72. Epub 2012 Mar 9.

Service de Physiologie Clinique, EFCR, CHU Nord - Niveau 6, F-42055 Saint-Etienne Cedex 2, France.

Limited and controversial data exist on the natural evolution of sleep disordered breathing (SDB) in untreated individuals. This study examines the evolution of SDB over a 3-yr period in a community-based sample of elderly subjects. From the initial cohort of 854 healthy subjects aged mean ± SD 68.4 ± 0.8 yrs, 519 untreated subjects accepted clinical and instrumental follow-up 3.6 ± 1.6 yrs later. SDB was defined as a respiratory disturbance index (RDI) >15 events · h(-1). At baseline, 202 (39%) subjects had an RDI ≤ 15 events · h(-1) and 317 (61%) had an RDI >15 events · h(-1). 3 yrs later, 280 (54%) subjects were non-SDB and 239 (46%) had SDB. Between evaluations, the RDI decreased from 22.3 ± 16.2 to 16.4 ± 13.0 events · h(-1), with a greater decrease in the number of cases with an RDI >30 events · h(-1) that in those with RDI ≥ 30 events · h(-1). In the non-SDB group, 81% had a stable RDI and 19% increased their RDI by a mean of 13.7 events · h(-1). In the SDB group, the RDI decreased to values ≤ 15 events · h(-1) in 36.6% of cases, 63.4% still having SDB. The RDI changes did not depend on weight changes. In healthy elderly subjects, the prevalence and severity of SDB did not show a tendency toward natural worsening, some cases having improvement or a remission independent of weight changes. These findings also suggest that in the elderly, natural SDB progression is still hypothetical.
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http://dx.doi.org/10.1183/09031936.00133011DOI Listing
September 2012

Level of physical activity at the age of 65 predicts successful aging seven years later: the PROOF study.

Rejuvenation Res 2011 Apr 31;14(2):215-21. Epub 2011 Mar 31.

Equipe d'Accueil Système Nerveux Autonome, Epidémiologie, Physiologie, Exercice, Santé (SNA-EPIS), PRES Lyon, Université Jean Monnet, Hôpital Universitaire, Saint-Étienne, France.

Background: Physical activity has a pleiotropic effect and is a significant factor in successful aging. This study aims to quantify the relationship between the physical activity of a 65-year-old cohort and the level of life satisfaction and self-rated health 7 years later.

Methods: A total of 988 questionnaires were sent by mail to a representative sample of healthy pensioners. Life satisfaction and health status were estimated on two visual analogical scales in answer to the following questions: (1) How would you estimate your state of health? and (2) Are you generally satisfied with your life? The level of physical activity was estimated using a questionnaire which enabled us to calculate: (1) Daily energy expenditure (DEE), (2) physical activity energy expenditure (PAEE), (3) daily energy expenditure higher than 5 metabolic equivalents (METs) (DEQisa), (4) Activity index (PAEE/DEE), (5) VO(2) peak.

Results: In all, 686 responses were validated. The average age was 72.9 ± 1.2 years old with 59.5% of women (n = 408). Amongst the sample, 98.8% (n = 676) lived in their own homes and 25.2% (n = 172) lived alone. Mean DEE was 10.365 ± 1.964  kJ/24  h, mean PAEE was 4.479 ± 1.170  kJ/24  h, mean activity index was 0.42 ± 0.05, and mean estimated oxygen uptake (VO(2)) peak was 22.5 ± 1.6  mL/min per kg. Activity index and VO(2) peak were the variables most significantly correlated with self-rated health (p = 0.0032 and p = 0.0011, respectively) and life satisfaction (p = 0.0117 and p = 0.0053).

Conclusions: Energy spent in activity and VO(2) peak estimated from DEE, measured at the age of 65, appear to be strong predictors of well-being 7 years later.
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http://dx.doi.org/10.1089/rej.2010.1101DOI Listing
April 2011

Can maintaining cognitive function at 65 years old predict successful ageing 6 years later? The PROOF study.

Age Ageing 2011 Mar 20;40(2):259-65. Epub 2011 Jan 20.

Department of Geriatrics, University Hospital of Saint-Etienne, 42055 Saint Etienne Cedex 2, France.

Background: preservation of cognitive abilities is required to have a good quality of life. The predictive value of cognitive functioning at 65 years old on successful ageing 6 years later is not established.

Methods: nine hundred and seventy-six questionnaires were sent by mail to a sample of healthy and voluntary French pensioners. Successful ageing was defined through health status and well-being. Cognitive abilities had been assessed 6 years earlier according to an objective method (Free and Cued Selective Recall Reminding Test (FCSRT), the Benton visual retention test and the similarities subtest of the Wechsler Adult Intelligence Scale-Revised) and a subjective one (Goldberg's anxiety scale, Mac Nair's scale and a Visual Analogue Scale to evaluate memory abilities change in the last 5 years).

Results: six hundred and eighty-six questionnaires could be analysed. The mean age was 72.9 ± 1.2 years old with 59% of women and 99% lived at home. Well-being was negatively correlated with the FCSRT (r = -0.08, P = 0.0318) but positively related with the Benton (r = 0.09, P = 0.0125) and the similarities tests (r = 0.09, P = 0.0118). There is a negative correlation between anxious and cognitive complaints measured at baseline, and successful ageing indicators 6 years later.

Conclusion: preservation of cognitive abilities at the age of retirement can predict a successful ageing 6 years later. ClinicalTrials.gov Identifier: NCT00759304.
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http://dx.doi.org/10.1093/ageing/afq174DOI Listing
March 2011