Publications by authors named "Yves Rolland"

227 Publications

Factors Associated With Potentially Inappropriate Transfer to the Emergency Department Among Nursing Home Residents.

J Am Med Dir Assoc 2021 May 5. Epub 2021 May 5.

Gérontopôle, Toulouse University Hospital, Toulouse, France; INSERM, UMR 1027, Toulouse, France.

Objectives: To determine the factors associated with the potentially inappropriate transfer of nursing home (NH) residents to emergency departments (EDs) and to compare hospitalization costs before and after transfer of individuals addressed inappropriately vs those addressed appropriately.

Design: Multicenter, observational, case-control study.

Setting And Participants: 17 hospitals in France, 1037 NH residents.

Measures: All NH residents transferred to the 17 public hospitals' EDs in southern France were systematically included for 1 week per season. An expert panel composed of family physicians, emergency physicians, geriatricians, and pharmacists defined whether the transfer was potentially inappropriate or appropriate. Residents' and NHs' characteristics and contextual factors were entered into a mixed logistic regression to determine factors associated independently with potentially inappropriate transfers. Hospital costs were collected in the national health insurance claims database for the 6 months before and after the transfer.

Results: A total of 1037 NH residents (mean age 87.2 ± 7.1, 68% female) were transferred to the ED; 220 (21%) transfers were considered potentially inappropriate. After adjustment, anorexia [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.57-3.71], high level of disability (OR 0.90, 95% CI 0.81-0.99), and inability to receive prompt medical advice (OR 1.67, 95% CI 1.20-2.32) were significantly associated with increased likelihood of potentially inappropriate transfers. The existence of an Alzheimer's disease special care unit in the NH (OR 0.66, 95% CI 0.48-0.92), NH staff trained on advance directives (OR 0.61, 95% CI 0.41-0.89), and calling the SAMU (mobile emergency medical unit) (OR 0.47, 95% CI 0.34-0.66) were significantly associated with a lower probability of potentially inappropriate transfer. Although the 6-month hospitalization costs prior to transfer were higher among potentially inappropriate transfers compared with appropriate transfers (€6694 and €4894, respectively), transfer appropriateness was not significantly associated with hospital costs.

Conclusions And Implications: Transfers from NHs to hospital EDs were frequently appropriate. Transfer appropriateness was conditioned by NH staff training, access to specialists' medical advice, and calling the SAMU before making transfer decisions.

Trial Registration: clinicaltrials.gov, NCT02677272.
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http://dx.doi.org/10.1016/j.jamda.2021.04.002DOI Listing
May 2021

Associations between physical activity, blood-based biomarkers of neurodegeneration, and cognition in healthy older adults: The MAPT study.

J Gerontol A Biol Sci Med Sci 2021 Apr 17. Epub 2021 Apr 17.

Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.

Physical activity (PA) demonstrated benefits on brain health but its relationship with blood biomarkers of neurodegeneration remains poorly investigated. We explored the cross-sectional associations of physical activity with blood concentrations of neurofilament light chain (NFL) and beta amyloid (Aβ)42/40. We further examined whether the interaction between PA and these biomarkers was longitudinally related with cognition. Four-hundred and sixty-five non-demented older adults engaged in an interventional study and who had concomitant assessment of PA levels and blood measurements of NFL (pg/ml) and Aβ42/40 were analysed. A composite Z score combining 4 cognitive tests was used for cognitive assessment up to a 4-year follow-up. Multiple linear regressions demonstrated that people achieving 500-999 and 2000 + MET-min/week of PA had lower (ln)NFL concentrations than their inactive peers. Logistic regressions revealed that achieving at least 90 MET-min/week of PA was associated with lower probability of having high NFL concentrations (i.e ≥ 91.961 pg/ml (3 rd quartile)). PA was not associated with (Aβ)42/40. Mixed-model linear regressions demonstrated that the reverse relationship between PA and cognitive decline tended to be more pronounced as Aβ42/40 increased, while it was dampened with increasing levels of (ln)NFL concentrations. This study demonstrates that PA is associated with blood NFL but not with Aβ42/40. Further, it suggests that PA may attenuate the negative association between amyloid load and cognition, while having high NFL levels mitigates the favourable relationship between PA and cognition. More investigations on older adults not involved any interventional study are required for further validation of the present findings.
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http://dx.doi.org/10.1093/gerona/glab094DOI Listing
April 2021

Visit-to-visit blood pressure variability and incident frailty in older adults.

J Gerontol A Biol Sci Med Sci 2021 Apr 12. Epub 2021 Apr 12.

Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France.

To determine whether visit-to-visit blood pressure (BP) variability (BPV) is associated with incident frailty. We included 1,394 non-frail community-dwelling participants aged ≥ 70 years from the Multidomain Alzheimer Preventive Trial (MAPT) who underwent repeated clinical examinations, including BP and frailty, over a 5-year follow-up period. Systolic BPV (SBPV), diastolic BPV (DBPV), mean arterial pressure variability (MAPV) and pulse pressure variability (PPV) were evaluated using standard deviation, coefficient of variation (CV), average real variability, successive variation, variation independent of mean and residual standard deviation. Incident frailty was assessed using the Fried phenotype. Cox proportional hazards models were used for the analyses. Higher SBPV was significantly associated with greater risk of frailty (1-sd increase of CV: HR = 1.18, 95% CI [1.02-1.36]) after adjustment for demographics, systolic BP, antihypertensive drugs, body mass index, diabetes, ischemic heart disease, congestive heart failure, stroke, atrial fibrillation, MAPT randomization group and frailty status. Similar results were observed with all indicators of variability. Higher PPV was associated with a greater risk of developing frailty over time (1-sd increase of CV: HR = 1.17, 95% CI [1.01-1.35]). DBPV and MAPV were not significantly associated with incident frailty. Higher SBPV and PPV were associated with greater risk of incident frailty. Our findings support the concept of BP physiological dysregulation underlying the frail state and suggest that BP instability could be an early marker of frailty.
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http://dx.doi.org/10.1093/gerona/glab112DOI Listing
April 2021

Management of anaphylaxis due to COVID-19 vaccines in the elderly.

Allergy 2021 Apr 2. Epub 2021 Apr 2.

Regional Ministry of Health of Andalusia, Seville, Spain.

Older adults, especially men and/or those with diabetes, hypertension and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritised to receive COVID-19 vaccines due to high risk of death. In very rare instances,the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society)Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients.
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http://dx.doi.org/10.1111/all.14838DOI Listing
April 2021

Malnutrition and physical performance in nursing home residents: results from the INCUR study.

Aging Clin Exp Res 2021 Mar 26. Epub 2021 Mar 26.

Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.

We investigated the association between the risk of malnutrition, assessed through the Mini Nutritional Assessment-Short Form (MNA-SF), and physical performance, measured with the Short Physical Performance Battery (SPPB), in nursing home residents. Moreover, we evaluated which MNA-SF items were most related to the SPPB and the association of the MNA-SF with each SPPB subtest. A total of 499 older people enrolled in the Incidence of pNeumonia and related ConseqUences in nursing home Residents cohort study were examined. Higher scores of MNA-SF were associated with better physical performance (in particular with gait speed). Food intake deficiency, mobility impairment, and recent psychological stress or acute disease were the items of the MNA-SF most associated with the SPPB. In nursing home residents, the MNA-SF and three of its sub-items were significantly correlated with physical performance, independently of potential confounders. In particular, the association was evident for the gait speed subtask of the SPPB.
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http://dx.doi.org/10.1007/s40520-021-01798-yDOI Listing
March 2021

Bidirectional relationship between depressive symptoms and physical performance in community-dwelling older people with subjective memory complaints.

Eur Geriatr Med 2021 Mar 5. Epub 2021 Mar 5.

Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Toulouse, France.

Purpose: This study examined the bidirectional relationship between depressive symptoms and physical performance in community-dwelling older people with subjective memory complaints.

Methods: Secondary analyses using data from the Multidomain Alzheimer Preventive Trial (MAPT) study were performed. The participants were 1679 subjects (female, 64.8%; mean age, 75.3 ± 4.4 years). The outcome measures were depressive symptoms assessed by the 15-item Geriatric Depression Scale (GDS) and physical performance assessed by the Short Physical Performance Battery (SPPB) and handgrip strength (HGS). All measurements were performed at baseline and at 6, 12, 24, and 36 months. The bidirectional relationships of GDS with SPPB and HGS were examined using mixed-effect regression analysis.

Results: Baseline physical performance was significantly associated with a decreased GDS score (SPPB score: β = - 0.210, 95% confidence interval [CI], - 0.283 to - 0.137; HGS: β = - 0.038, 95% CI - 0.056 to - 0.019). The baseline GDS score was significantly associated with decreased physical performance (SPPB score: β = - 0.082, 95% CI - 0.107 to - 0.056; HGS: β = - 0.261, 95% CI - 0.370 to - 0.152).

Conclusion: Since depressive symptoms and physical performance had a bidirectional relationship, prevention or improvement of decreased physical performance could play a role in reducing depressive symptoms, and addressing depressive symptoms may play a role in improving physical performance.

Trial Registration Number: NCT01513252.
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http://dx.doi.org/10.1007/s41999-021-00473-9DOI Listing
March 2021

Atypical symptoms, SARS-CoV-2 test results and immunisation rates in 456 residents from eight nursing homes facing a COVID-19 outbreak.

Age Ageing 2021 05;50(3):641-648

Charité, Univeersitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany.

Background: Frail older persons may have an atypical presentation of coronavirus disease 2019 (COVID-19). The value of real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) testing for identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nursing homes (NHs) residents is not known.

Objective: To determine whether (i) atypical symptoms may predict rRT-PCR results and (ii) rRT-PCR results may predict immunisation against SARS-CoV-2 in NH residents.

Design: A retrospective longitudinal study.

Setting: Eight NHs with at least 10 rRT-PCR-positive residents.

Subjects: A total of 456 residents.

Methods: Typical and atypical symptoms recorded in residents' files during the 14 days before and after rRT-PCR testing were analysed. Residents underwent blood testing for IgG-SARS-CoV-2 nucleocapsid protein 6 to 8 weeks after testing. Univariate and multivariate analyses compared symptoms and immunisation rates in rRT-PCR-positive and negative residents.

Results: A total of 161 residents had a positive rRT-PCR (35.3%), 17.4% of whom were asymptomatic before testing. Temperature >37.8°C, oxygen saturation <90%, unexplained anorexia, behavioural change, exhaustion, malaise and falls before testing were independent predictors of a further positive rRT-PCR. Among the rRT-PCR-positive residents, 95.2% developed SARS-CoV-2 antibodies vs 7.6% in the rRT-PCR-negative residents. Among the residents with a negative rRT-PCR, those who developed SARS-CoV-2 antibodies more often had typical or atypical symptoms (P = 0.02 and <0.01, respectively).

Conclusion: This study supports a strategy based on (i) testing residents with typical or unexplained atypical symptoms for an early identification of the first SARS-CoV-2 cases, (ii) rT-PCR testing for identifying COVID-19 residents, (iii) repeated wide-facility testing (including asymptomatic cases) as soon as a resident is tested positive for SARS-CoV-2 and (iv) implementing SARS-CoV-2 infection control measures in rRT-PCR-negative residents when they have unexplained typical or atypical symptoms.
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http://dx.doi.org/10.1093/ageing/afab050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929417PMC
May 2021

What day is today? Cognitive capacity and the risk of incident dementia in the context of integrated care for older people (ICOPE Step 1).

Aging Clin Exp Res 2021 Feb 13. Epub 2021 Feb 13.

Gerontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France.

Based on clinical observations, our objective was to test if the older adults who failed to recall the name of the weekday, or had a higher number of mistakes in the word recall were at higher risk of mild cognitive impairment (MCI) or dementia. Longitudinal data of the Multidomain Alzheimer Preventive Trial (MAPT) was used to retrospectively measure the cognitive capacity according to the ICOPE Step 1 tool. Incident dementia was assessed by two multidisciplinary committees independent from each other. MCI was defined as Clinical Dementia Rating scale CDR = 0.5. Failure to recall the name of the weekday had a three-fold risk of incident dementia in the next 5 years (HRa = 3.11, 95%CI: 1.18-8.17). Having two or three mistakes in the word recall carried a higher risk of incident dementia, (HRa for two mistakes = 3.50, 95% CI: 1.49-8.26; HRa for three mistakes = 4.28, 95% CI: 1.60-11.46), but not MCI. People with impaired cognitive capacity according to the ICOPE Step 1 tool deserve further assessment and a closer follow-up.
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http://dx.doi.org/10.1007/s40520-021-01803-4DOI Listing
February 2021

Potential Interplay between Nrf2, TRPA1, and TRPV1 in Nutrients for the Control of COVID-19.

Int Arch Allergy Immunol 2021 10;182(4):324-338. Epub 2021 Feb 10.

Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, United Kingdom.

In this article, we propose that differences in COVID-19 morbidity may be associated with transient receptor potential ankyrin 1 (TRPA1) and/or transient receptor potential vanilloid 1 (TRPV1) activation as well as desensitization. TRPA1 and TRPV1 induce inflammation and play a key role in the physiology of almost all organs. They may augment sensory or vagal nerve discharges to evoke pain and several symptoms of COVID-19, including cough, nasal obstruction, vomiting, diarrhea, and, at least partly, sudden and severe loss of smell and taste. TRPA1 can be activated by reactive oxygen species and may therefore be up-regulated in COVID-19. TRPA1 and TRPV1 channels can be activated by pungent compounds including many nuclear factor (erythroid-derived 2) (Nrf2)-interacting foods leading to channel desensitization. Interactions between Nrf2-associated nutrients and TRPA1/TRPV1 may be partly responsible for the severity of some of the COVID-19 symptoms. The regulation by Nrf2 of TRPA1/TRPV1 is still unclear, but suggested from very limited clinical evidence. In COVID-19, it is proposed that rapid desensitization of TRAP1/TRPV1 by some ingredients in foods could reduce symptom severity and provide new therapeutic strategies.
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http://dx.doi.org/10.1159/000514204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018185PMC
April 2021

Cross-sectional associations between cortical thickness and physical activity in older adults with spontaneous memory complaints: The MAPT Study.

J Sport Health Sci 2021 Feb 2. Epub 2021 Feb 2.

Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse 31000, France; Université Paul-Sabatier/Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1027, Faculté de médecine, University of Toulouse III, Toulouse 31000, France.

Background: Age-related changes in brain structure may constitute the starting point for cerebral function alteration. Physical activity (PA) demonstrated favorable associations with total brain volume, but its relationship with cortical thickness (CT) remains unclear. We investigated the cross-sectional associations between PA level and CT in community-dwelling people aged 70 years and older.

Methods: A total of 403 older adults aged 74.8 ± 4.0 years (mean ± SD) who underwent a baseline magnetic resonance imaging examination and who had data on PA and confounders were included. PA was assessed with a questionnaire. Participants were categorized according to PA levels. Multiple linear regressions were used to compare the brain CT (mm) of the inactive group (no PA at all) with 6 active groups (growing PA levels) in 34 regions of interest.

Results: Compared with inactive persons, people who achieved PA at a level of 1500-1999 metabolic equivalent task-min/week (i.e., about 6-7 h of brisk walking for exercise and those who achieved it at 2000-2999 metabolic equivalent task-min/week (i.e., 8-11 h of brisk walking for exercise) had higher CT in the fusiform gyrus and the temporal pole. Additionally, dose-response associations between PA and CT were found in the fusiform gyrus (B = 0.011, SE = 0.004, adj. p = 0.035), the temporal pole (B = 0.026, SE = 0.009, adj. p = 0.048), and the caudal middle frontal gyrus, the entorhinal, medial orbitofrontal, lateral occipital, and insular cortices.

Conclusion: This study demonstrates a positive association between PA level and CT in temporal areas such as the fusiform gyrus, a brain region often associated to Alzheimer's disease in people aged 70 years or older. Future investigations focusing on PA type may help to fulfil remaining knowledge gaps in this field.
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http://dx.doi.org/10.1016/j.jshs.2021.01.011DOI Listing
February 2021

Physical activity and exercise in the context of SARS-Cov-2: A perspective from geroscience field.

Ageing Res Rev 2021 03 12;66:101258. Epub 2021 Jan 12.

Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France; UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France.

The recent pandemics of the SARS-Cov-2 has pushed physical activity (PA) and exercise at the forefront of the discussion, since PA is associated with a reduced risk of developing all the chronic diseases strongly associated with severe cases of SARS-Cov-2 and exercise is considered a complimentary therapeutics for the treatment of these age-related conditions. The mechanisms through which PA and exercise could contribute to reduce the severity of the SARS-Cov-2 infection would be multiple, including their capacity to boost the immune system, but also their global effect on slowing down the progression of the aging process. The present perspective presents a discussion on how PA and exercise might hypothetically be linked with SARS-Cov-2 infection, current scientific gaps and shortcomings as well as recommendations for advancing research in this area, placing the debate in the context of aging and gerosciences.
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http://dx.doi.org/10.1016/j.arr.2021.101258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042847PMC
March 2021

Five-Year Lower Extremity Function is Associated with White Matter Abnormality in Older Adults.

J Am Geriatr Soc 2021 Apr 8;69(4):995-1002. Epub 2021 Jan 8.

Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.

Objective: To explore associations between changes of lower extremity function (LEF) parameters over a 5-year period and diffusion tensor imaging (DTI) parameters of white matter tracts among community-dwelling older adults.

Design: A secondary analysis on image and physical function data collected from the Multidomain Alzheimer's Preventive Trial (MAPT).

Participants: 208 older adults (aged 75 ± 4 years, with spontaneous memory complaint or limited instrumental daily living activity or slow gait speed, 60% female) of the MAPT-magnetic resonance imaging (MRI) ancillary study. The time interval between a participant's enrolment and MRI scan was on average 110 ± 97 days.

Measurements: Forty-eight white matter tracts (WMTs) were measured. LEF parameters (measured after the MRI scan) were assessed as the short physical performance battery (SPPB) score, gait speed, and chair stands time over a 5-year period. Mixed-effects models were performed to explore the associations between baseline DTI values and the progression of LEF parameters. Bonferroni correction was applied for multiple comparison correction.

Results: The progression of LEF was associated with 35 baseline DTI parameters from 24 WMTs. Higher baseline DTI parameter values were related to more decreases in SPPB score and gait speed, and greater increases in chair stands time. Bilateral uncinate fasciculus was associated with all LEF parameters. Other WMTs in cingulum, cerebral and cerebellar peduncle, internal capsule, and corpus callosum also showed close connections with LEF changes.

Conclusions: Our findings show that DTI parameters of some WMTs are associated with the 5-year decline in LEF, suggesting that alterations in WMT integrity (evaluated by DTI parameters) might be used to explore potential causes of impaired mobility in older adults when no clear explanations can be found.
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http://dx.doi.org/10.1111/jgs.16989DOI Listing
April 2021

Spices to Control COVID-19 Symptoms: Yes, but Not Only….

Int Arch Allergy Immunol 2020 Dec 22:1-7. Epub 2020 Dec 22.

Maladies Infectieuses et Tropicales, CHU, Montpellier, France.

There are large country variations in COVID-19 death rates that may be partly explained by diet. Many countries with low COVID-19 death rates have a common feature of eating large quantities of fermented vegetables such as cabbage and, in some continents, various spices. Fermented vegetables and spices are agonists of the antioxidant transcription factor nuclear factor (erythroid-derived 2)-like 2 (Nrf2), and spices are transient receptor potential ankyrin 1 and vanillin 1 (TRPA1/V1) agonists. These mechanisms may explain many COVID-19 symptoms and severity. It appears that there is a synergy between Nrf2 and TRPA1/V1 foods that may explain the role of diet in COVID-19. One of the mechanisms of COVID-19 appears to be an oxygen species (ROS)-mediated process in synergy with TRP channels, modulated by Nrf2 pathways. Spicy foods are likely to desensitize TRP channels and act in synergy with exogenous antioxidants that activate the Nrf2 pathway.
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http://dx.doi.org/10.1159/000513538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900475PMC
December 2020

Exercise effects on falls, fractures, hospitalizations and mortality in older adults with dementia: an individual-level patient data meta-analysis.

J Gerontol A Biol Sci Med Sci 2020 Dec 7. Epub 2020 Dec 7.

Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France.

Background: To study the effects of exercise on falls, fractures, hospitalizations and death in people with dementia.

Methods: We conducted an individual-level patient data meta-analysis of seven randomized controlled trials (RCT). We looked for studies from the reference list of previous systematic reviews and undertook an electronic search for articles published between 2013 and 2019 in Ageline, CENTRAL, PsycINFO, PubMed, and SportsDiscus. Main (binary) outcome measures were the risk of mortality; hospitalization; faller; multiple faller; injurious faller; and fractures. Secondary (count) outcomes were the incident rates of hospitalizations, falls, and injurious falls.

Results: From the 1,314 participants, 771 were allocated to the exercise group and 543 to the control group. The number of cases regarding the main outcome measures in exercisers and controls were, respectively: 45 (5.8%) and 31 (5.7%) deaths; 102 (14.4%) and 65 (13.4%) participants hospitalized; 221 (34.4%) and 175 (41.3%) had at least one fall; 128 (20.2%) and 92 (21.7%) had multiple falls; 78 (24.8%) and 92 (29.3%) had injurious falls; and 19 (2.9%) and 15 (3.5%) had suffered a fracture. Two-step meta-analysis found no effects of exercise on any outcome. One-step meta-analysis found exercise reduced the risk of falls (OR 0.75; 95%CI 0.57-0.99). Exploratory analysis showed exercise decreased the rate of incident falls in participants with the lowest functional ability (IRR 0.48; 95%CI 0.30-0.79).

Conclusions: Although the two-step meta-analysis suggests exercise does not have an effect on the outcomes, one-step meta-analysis suggested that exercise may reduce fall risk. Data from further high-quality RCTs is still needed.
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http://dx.doi.org/10.1093/gerona/glaa307DOI Listing
December 2020

Biological and Neuroimaging Markers as Predictors of 5-year Incident Frailty in Older Adults: a Secondary Analysis of the MAPT study.

J Gerontol A Biol Sci Med Sci 2020 Nov 27. Epub 2020 Nov 27.

Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France.

Background: This study aims to investigate the predictive value of biological and neuroimaging markers to determine incident frailty among older people over 5 years.

Methods: We included 1,394 adults ≥70 years from the Multidomain Alzheimer Preventive Trial (MAPT), who were not frail at baseline (according to Fried's criteria) and who had at least one post-baseline measurement of frailty. Participants who progressed to frailty during the 5-year follow-up were categorized as "incident frailty" and those who remained non-frail were categorized as "without frailty". The differences of baseline biochemical factors (25-hydroxyvitamin D, homocysteine, omega-3 index, C-reactive protein - CRP), other biological markers (Apolipoprotein E genotypes, amyloid-β deposits) and neuroimaging data (grey matter volume, hippocampal volume, white matter hyperintensities) were compared between groups. Cox proportional hazard model was used to evaluate the associations between biomarkers and incident frailty.

Results: A total of 195 participants (14.0%) became frail over 5 years. Although 25-hydroxyvitamin D deficiency, homocysteine levels, low-grade inflammation (persistently increased CRP 3-10 mg/L), grey matter and hippocampal volume were significantly associated with incident frailty in unadjusted models, these associations disappeared after adjustment for age, sex, and other confounders. Omega-3 index was the sole marker that presented a trend of association with incident frailty (HR: 0.92; 95% CI: 0.83-1.01; p=0.082).

Conclusion: This study failed to identify biomarkers able to predict frailty incidence in community-dwelling older adults over 5 years. Further longitudinal research with multiple measurements of biomarkers and frailty is needed to evaluate the long-term relationships between changes in biomarkers levels and frailty evolution.
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http://dx.doi.org/10.1093/gerona/glaa296DOI Listing
November 2020

Kidney Function and Cognitive Decline in Older Adults: Examining the Role of Neurodegeneration.

J Am Geriatr Soc 2021 Mar 20;69(3):651-659. Epub 2020 Nov 20.

Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France.

Background/objectives: Cognitive decline associated with impaired kidney function might involve neurodegeneration. Our objectives were to evaluate the longitudinal association between kidney function and cognitive decline in older adults and to assess the involvement of cortical beta-amyloid and hippocampal atrophy (features of Alzheimer's disease (AD)) in this association.

Design: Secondary analysis of the randomized controlled Multidomain Alzheimer Preventive Trial (MAPT).

Settings: Thirteen memory centers (France and Monaco, 2008-2016).

Participants: A total of 1,334 community-dwellers >70 years old without dementia at baseline.

Measurements: We estimated glomerular filtration rate (eGFR) from serum creatinine using CKD-Epi equation. Cognition was assessed at baseline, 6, 12, 24, 36, 48, and 60 months using a composite Z-score designed for MAPT. The Clinical Dementia Rating (CDR) score was used to assess cognition and functional independence. We examined the association between eGFR and (1) evolution of the composite cognitive Z-score using mixed-effect models and (2) progression on CDR using Cox models and mixed-effect models. Adjustments were made for age, sex, education, ApoE genotype, cardiovascular risk factors and disease, hippocampal volume (measured with magnetic resonance), and cortical beta-amyloid (measured with positron emission tomography).

Results: Median (IQR) eGFR was 73(60-84) mL/min/1.73 m . Two hundred sixty-nine participants experienced progression on CDR score during follow-up. eGFR<60 was significantly associated with progression on CDR score (adjusted hazard ratio (aHR) = 1.35, 95% CI 1.01-1.80) and with both the cognitive and functional independence components of CDR, but not with the evolution of the composite cognitive Z-score (adjusted β-coefficient -0.004, 95% CI -0.014; 0.006). Associations were not modified after further adjustment for beta-amyloid (subsample: n = 252) and hippocampal volume (subsample: n = 270).

Conclusions: We did not find a mild to moderate renal insufficiency to be associated with brain imaging features of AD, and our results do not support the involvement of AD mechanisms in the incidence of cognitive impairment and functional decline associated with chronic kidney disease.
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http://dx.doi.org/10.1111/jgs.16954DOI Listing
March 2021

August 2020 Interim EuGMS guidance to prepare European Long-Term Care Facilities for COVID-19.

Eur Geriatr Med 2020 12 3;11(6):899-913. Epub 2020 Nov 3.

Department of Geriatrics, CHRU de Nancy and Inserm DCAC, Université de Lorraine, Nancy, France.

Purpose: The European Geriatric Medicine Society (EuGMS) is launching a second interim guidance whose aim is to prevent the entrance and spread of COVID-19 into long-term care facilities (LTCFs).

Methods: The EuGMS gathered experts to propose a guide of measures to prevent COVID-19 outbreaks in LTCFs. It is based on the specific features of SARS-CoV-2 transmission in LTCFs, residents' needs, and on experiences conducted in the field.

Results: Asymptomatic COVID-19 residents and staff members contribute substantially to the dissemination of COVID-19 infection in LTCFs. An infection prevention and control focal point should be set up in every LTCF for (1) supervising infection prevention and control measures aimed at keeping COVID-19 out of LTCFs, (2) RT-PCR testing of residents, staff members, and visitors with COVID-19 symptoms, even atypical, and (3) isolating subjects either infected or in contact with infected subjects. When a first LCTF resident or staff member is infected, a facility-wide RT-PCR test-retest strategy should be implemented for detecting all SARS-CoV-2 carriers. Testing should continue until no new COVID-19 cases are identified. The isolation of residents should be limited as much as possible and associated with measures aiming at limiting its negative effects on their mental and somatic health status.

Conclusions: An early recognition of symptoms compatible with COVID-19 may help to diagnose COVID-19 residents and staff more promptly. Subsequently, an earlier testing for SARS-CoV-2 symptomatic and asymptomatic LTCF staff and residents will enable the implementation of appropriate infection prevention and control. The negative effects of social isolation in residents should be limited as much as possible.
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http://dx.doi.org/10.1007/s41999-020-00405-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608456PMC
December 2020

Atypical clinical presentation of COVID-19 infection in residents of a long-term care facility.

Eur Geriatr Med 2020 12 6;11(6):1085-1088. Epub 2020 Oct 6.

Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.

Purpose: To assess the magnitude of the infection in residents from-and staff working in-a long-term-care facility (LTCF) 7 days after the identification of one resident with confirmed COVID-19 infection and to assess the clinical presentation of the infected residents.

Methods: All residents and staff members of a LTCF were tested for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction on nasopharyngeal swab. Residents were studied clinically 4 weeks after the first COVID diagnosis.

Results: Thirty-eight of the 79 residents (48.1%) tested positive for SARS-CoV-2. Respiratory symptoms were preceded by diarrhea (26.3%), a fall (18.4%), fluctuating temperature with hypothermia (34.2%) and delirium in one resident. Respiratory symptoms, including cough and oxygen desaturation, appeared after those initial symptoms or as the first sign in 36.8% and 52.2%, respectively. At any time of the disease, fever was observed in 65.8%. Twelve deaths occurred among the COVID-19 residents. Among the 41 residents negative for SARS-CoV-2, symptoms included cough (21.9%), diarrhea (7.3%), fever (21.9%), hypothermia (9.7%), and transient hypoxemia (9.8%). No deaths were observed in this group. 27.5% of the workers were also COVID-19 positive.

Conclusion: The rapid dissemination of the COVID-19 infection may be explained by the delay in the diagnosis of the first cases due to atypical presentation. Early recognition of symptoms compatible with COVID-19 may help to diagnose COVID-19 residents earlier and test for SARS-CoV-2 symptomatic and asymptomatic staff and residents earlier to implement appropriate infection control practices.
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http://dx.doi.org/10.1007/s41999-020-00352-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538265PMC
December 2020

[Scales assessing geriatric dependence].

Rev Prat 2020 03;70(3):e106-e107

Gérontopôle de Toulouse, Institut du vieillissement, centre hospitalo-universitaire de Toulouse, 37, allée Jules-Guesde, 31000 Toulouse, France.

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March 2020

[Autonomy and dependence in the elderly].

Rev Prat 2020 03;70(3):e97-e105

Gérontopôle de Toulouse, Institut du vieillissement, centre hospitalo-universitaire de Toulouse, 37, allée Jules-Guesde, 31000 Toulouse, France.

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March 2020

Expert Opinion on Benefits of Long-Chain Omega-3 Fatty Acids (DHA and EPA) in Aging and Clinical Nutrition.

Nutrients 2020 Aug 24;12(9). Epub 2020 Aug 24.

Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, UK.

Life expectancy is increasing and so is the prevalence of age-related non-communicable diseases (NCDs). Consequently, older people and patients present with multi-morbidities and more complex needs, putting significant pressure on healthcare systems. Effective nutrition interventions could be an important tool to address patient needs, improve clinical outcomes and reduce healthcare costs. Inflammation plays a central role in NCDs, so targeting it is relevant to disease prevention and treatment. The long-chain omega-3 polyunsaturated fatty acids (omega-3 LCPUFAs) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are known to reduce inflammation and promote its resolution, suggesting a beneficial role in various therapeutic areas. An expert group reviewed the data on omega-3 LCPUFAs in specific patient populations and medical conditions. Evidence for benefits in cognitive health, age- and disease-related decline in muscle mass, cancer treatment, surgical patients and critical illness was identified. Use of DHA and EPA in some conditions is already included in some relevant guidelines. However, it is important to note that data on the effects of omega-3 LCPUFAs are still inconsistent in many areas (e.g., cognitive decline) due to a range of factors that vary amongst the trials performed to date; these factors include dose, timing and duration; baseline omega-3 LCPUFA status; and intake of other nutrients. Well-designed intervention studies are required to optimize the effects of DHA and EPA in specific patient populations and to develop more personalized strategies for their use.
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http://dx.doi.org/10.3390/nu12092555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551800PMC
August 2020

Neuroimaging markers of chronic fatigue in older people: a narrative review.

Aging Clin Exp Res 2020 Jul 30. Epub 2020 Jul 30.

Gérontopôle of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France.

Background: Chronic fatigue is a common symptom in older adults. Although some studies have attempted to identify the neuronal correlates of fatigue associated with chronic diseases, the scientific evidence is scarce regarding fatigue in older people not suffering from a specific disease.

Aims: To gather available evidence of neuroimaging studies investigating the associations between fatigue and brain health in older adults out of the context of a specific disease, and to identify potential brain structures associated with this symptom.

Methods: Studies considering exclusively patients with a specific disease and/or studies focusing on physiological mechanisms of acute fatigue induced by the realization of cognitive and physical tasks were excluded.

Results: Very few studies on the associations of fatigue with neuroimaging markers are currently available. Fatigue was associated with reduced hippocampus volumes and with hippocampal amyloid deposition. Regarding the association between fatigue and the circuit of basal ganglia, putamen and thalamus were associated with physical fatigability, whereas amygdala and thalamus with mental fatigability. Very limited evidence about white matter integrity found that healthy individuals with high levels of fatigue had a greater total volume of leukoaraiosis.

Conclusion: This review suggests that hippocampus damage and potentially loss of function in basal ganglia networks could play a role on chronic fatigue during aging. Further studies are needed to assess the associations of fatigue with white matter alterations.
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http://dx.doi.org/10.1007/s40520-020-01666-1DOI Listing
July 2020

Efficacy of a Test-Retest Strategy in Residents and Health Care Personnel of a Nursing Home Facing a COVID-19 Outbreak.

J Am Med Dir Assoc 2020 Jul 11;21(7):933-936. Epub 2020 Jun 11.

Charité, Universitätsmedizin Berlin, Humboldt-Universität Berlin, Berlin, Germany; Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany; MACVIA-France, Montpellier, France.

Objective: To assess the American Testing Guidance for Nursing Homes (NHs)-updated May 19, 2020-with a new COVID-19 case.

Design: Case investigation.

Setting And Subjects: All 79 residents and 34 health care personnel (HCP) of an NH.

Methods: Seven days after identification of a COVID-19 resident, all residents and HCP underwent real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) testing for SARS-CoV-2 with nasopharyngeal swabs. This was repeated weekly in all previously negative subjects until the testing identified no new cases, and in all positive subjects until the testing was negative. COVID-19 infection prevention and control (IPC) measures were implemented in all residents and HCP with positive testing or with COVID-19 symptoms. Standard IPC was also implemented in all HCP. Six weeks after initial testing, all residents underwent testing for enzyme-linked immunosorbent assay-based IgG antibodies directed against the SARS-CoV-2. Symptoms were serially recorded in residents and HCP.

Results: A total of 36 residents had a positive rRT-PCR at baseline and 2 at day 7. Six HCP had a positive rRT-PCR at baseline and 2 at day 7. No new COVID-19 cases were diagnosed later. Among the SARS-CoV-2-positive cases, 6 residents (16%) and 3 HCP (37%) were asymptomatic during the 14 days before testing. Twenty-five residents (92.3%) and all 8 HCP (100%) with a positive rRT-PCR developed IgG antibodies against SARS-CoV-2. Among the residents and HCP always having tested negative, 2 (5%) and 5 (11.5%), respectively, developed IgG antibodies against SARS-CoV-2. These 2 residents had typical COVID-19 symptoms before and after testing and 2/5 HCP were asymptomatic before and after testing.

Conclusions And Implications: This study shows the validity of the updated American Testing Guidance for Nursing Homes (NHs). It suggests implementing COVID-19 IPC in both residents and HCP with positive testing or COVID-19 symptoms and warns that asymptomatic HCP with repeated negative rRT-PCR testing can develop antibodies against SARS-CoV-2.
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http://dx.doi.org/10.1016/j.jamda.2020.06.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287418PMC
July 2020

Cross-sectional and prospective associations between cerebral cortical thickness and frailty in older adults.

Exp Gerontol 2020 10 11;139:111018. Epub 2020 Jul 11.

Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France; UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France.

Background: Several neurodegenerative markers measured by magnetic resonance imaging (MRI) have shown to be related with frailty. While most studies have focused on surrogates of cerebral vascular damage such as increased white matter lesions, the associations between cortical atrophy and frailty were less often investigated.

Objectives: To investigate the cross-sectional and prospective associations between cortical thickness and frailty evolution in older adults.

Methods: We enrolled 484 community-dwelling adults aged ≥70 years, participants from the Multidomain Alzheimer Preventive Trial (MAPT), with data on cerebral cortical thickness and frailty. Cortical thickness was acquired by MRI for whole-brain and regional cortices. Two function-specific regions of interest, i.e., mobility-related regions and Alzheimer's disease (AD) signature, were selected on the basis of previous studies. Frailty status was assessed by the Fried frailty phenotype (i.e., weakness, slowness, involuntary weight loss, fatigue and low physical activity level) at baseline, after 6 months and every year until the end of the 5-year follow-up.

Results: Older adults with higher global cortical thickness were less likely to be pre-frail and frail at baseline (adjusted OR: 0.13, 95% CI: 0.03-0.65, p = 0.013). In addition, higher cortical thickness in mobility-related and AD-signature regions were associated with lower likelihood of being pre-frail and frail. Similar associations were observed for having weakness and slowness. However, neither global nor region-specific cortical thickness showed prospective associations with future frailty onset.

Conclusions: The global and regional cortical thickness cross-sectionally associated with frailty in older adults, but no prospective associations with incident frailty were found. The longitudinal relationship between cortical thickness and frailty evolution requires further investigation.
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http://dx.doi.org/10.1016/j.exger.2020.111018DOI Listing
October 2020

Nursing Home Residents' Functional Trajectories and Mortality After a Transfer to the Emergency Department.

J Am Med Dir Assoc 2021 Feb 11;22(2):393-398.e3. Epub 2020 Jul 11.

UPS/INSERM UMR 1027, Toulouse, France; Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France.

Objective: To describe nursing home residents' (NHRs) functional trajectories and mortality after a transfer to the emergency department (ED).

Design: Case-control observational multicenter study.

Setting And Participants: In total, 1037 NHRs presenting to 17 EDs in France over 4 nonconsecutive weeks in 2016.

Methods: Finite mixture models were fitted to longitudinal data on activities of daily living (ADL) scores before transfer (time 1), during hospitalization (time 2), and within 1 week after discharge (time 3) to identify groups of NHRs following similar functional evolution. Factors associated with mortality were investigated by Cox regressions.

Results: Trajectory modeling identified 4 distinct trajectories of ADL. The first showed a high and stable (across time 1, time 2, and time 3) functional capacity around 5.2/6 ADL points, with breathlessness as the main condition leading to transfer. The second displayed an initial 37.8% decrease in baseline ADL performance (between time 1 and time 2), followed by a 12.5% recovery of baseline ADL performance (time 2‒time 3), with fractures as the main condition. The third displayed a similar initial decrease, followed by a 6.7% recovery. The fourth displayed an initial 70.1% decrease, followed by an 8.5% recover, with more complex geriatric polypathology situations. Functional decline was more likely after being transferred for a cerebrovascular condition or for a fracture, after being discharged from ED to a surgery department, and with a heavier burden of distressing symptoms during transfer. Mortality after ED transfer was more likely in older NHRs, those in a more severe condition, those who were hospitalized more frequently in the past month, and those transferred for cerebrovascular conditions or breathlessness.

Conclusions And Implications: Identified trajectories and factors associated with functional decline and mortality should help clinicians decide whether to transfer NHRs to ED. NHRs with high functional ability seem to benefit from ED transfers whereas on-site alternatives should be sought for those with poor functional ability.
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http://dx.doi.org/10.1016/j.jamda.2020.05.033DOI Listing
February 2021

Frailty Parameters, Morbidity and Mortality in Older Adults with Cancer: A Structural Equation Modelling Approach Based on the Fried Phenotype.

J Clin Med 2020 Jun 11;9(6). Epub 2020 Jun 11.

Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France.

Background: to distinguish direct and indirect pathways to frailty phenotype, and quantify associations between two frailty components (i.e., sarcopenia and cachexia) regarding mortality and morbidity in older adults with cancer.

Methods: all consecutive older outpatients with cancer were included in a prospective two-centre cohort study between 2013 and 2017 and had geriatric assessment. We used the frailty phenotype. Sarcopenia and cachexia were built as latent variables by including observed variables related to physical performances and related to nutrition and inflammation respectively. Structural equation modelling was used to distinguish between direct and indirect effects of the frailty parameters on the risk of death (Model 1) and the risk of morbidity (defined by unplanned hospitalization and/or disability and/or a fall; Model 2). The root mean square error of approximation (RMSEA) and the comparative fit index (CFI) were used to assess the model fit.

Results: 603 older outpatients were included (mean age: 81.2 ± 6.1; women: 54%; frailty phenotype: 58%). The 6-month mortality and morbidity rates were 18% and 64%, respectively. The fit was good for both models (RMSEA and CFI = 0.029 [0.017-0.039] and 0.99 for Model 1, and 0.028 [0.017-0.039] and 0.99 for Model 2, respectively). Sarcopenia and cachexia were both directly and significantly associated with 6-month mortality (β = 0.18, = 0.01; β = 0.52, < 0.0001) and morbidity (β = 0.37, < 0.0001; β = 0.19, < 0.02).

Conclusions: sarcopenia and cachexia had a direct pathway with 6-month mortality and morbidity in older cancer patients.
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http://dx.doi.org/10.3390/jcm9061826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356550PMC
June 2020

The Importance of Physical Activity to Care for Frail Older Adults During the COVID-19 Pandemic.

J Am Med Dir Assoc 2020 Jul 30;21(7):973-976. Epub 2020 Apr 30.

Gerontopole of Toulouse, University Hospital of Toulouse (CHU-Toulouse), Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France.

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http://dx.doi.org/10.1016/j.jamda.2020.04.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190526PMC
July 2020

Prospective associations between physical activity levels and white matter integrity in older adults: results from the MAPT study.

Maturitas 2020 Jul 23;137:24-29. Epub 2020 Apr 23.

Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, 37 allée Jules Guesde, 31000 Toulouse, France; UPS/INSERM UMR 1027, University of Toulouse III, Toulouse, France Faculté de médecine 37 allées Jules Guesde 31000 Toulouse, France.

Background: Higher levels of physical activity (PA) are known to be associated with better white matter integrity measured by diffusion tensor imaging (DTI) in older adults in cross-sectional studies. However, no studies have investigated the association between PA levels and the evolution of DTI parameters (fractional anisotropy and mean diffusivity).

Objectives: To examine the cross-sectional associations between PA levels and DTI parameters, then to investigate the association between baseline PA levels and the evolution of DTI parameters in older adults.

Methods: Data on magnetic resonance imaging with DTI method from the Multidomain Alzheimer's Preventive Trial (MAPT) study were used; 228 participants had data on DTI measured at three time-points over five years. Fractional anisotropy and mean diffusivity were acquired for six different brain regions.

Results: No significant associations were found in the cross-sectional analyses. Only one association was found: compared with active individuals, a faster worsening in the mean diffusivity of the uncinate fasciculus region was found in inactive individuals (-5.0 × 10 (-9.5 × 10, 4.9 × 10)).

Conclusions: In this study, we found that the condition of the uncinate fasciculus region may be susceptible to changes in PA levels in older adults. Longitudinal studies that assess fitness and PA using objective measurements (e.g. cardiorespiratory fitness and accelerometry) could shed some new light on this topic.
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http://dx.doi.org/10.1016/j.maturitas.2020.04.012DOI Listing
July 2020

Effect of a geriatric intervention aiming to improve polypharmacy in nursing homes.

Eur Geriatr Med 2020 10 27;11(5):863-868. Epub 2020 May 27.

Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, 31059, Toulouse, France.

Purpose: To examine the effect of an intervention comprising professional support by a geriatrician engaged in a quality care indicators' audit for nursing home (NH) staff on reducing polypharmacy.

Methods: Of a total of 3709 NH residents, 90 NHs (2026 residents) were allocated to a light intervention and 85 NHs (1683 residents) to a strong intervention group.

Results: Mixed-effect linear model found no significant variation in the total number of medications over time (β-coefficient for interaction 0.007, 95% CI - 0.15, 0.16). Within-group-adjusted mean differences showed a statistical decline in the psychotropic medication class (- 0.04 SE 0.02 p 0.03 for the strong intervention group and - 0.06 SE 0.02 p 0.001 for the light intervention group) and a statistically significant increase in the analgesics use.

Conclusion: The possibility that a simple audit intervention might reduce psychotropic prescriptions deserves further investigation.
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http://dx.doi.org/10.1007/s41999-019-00279-wDOI Listing
October 2020