Objectives
To investigate the association between hearing loss, hearing aid use, and cognitive decline.
Design
Prospective population‐based study.
Setting
Data gathered from the Personnes Agées QUID ...study, a cohort study begun in 1989–90.
Participants
Individuals aged 65 and older (N = 3,670).
Measurements
At baseline, hearing loss was determined using a questionnaire assessing self‐perceived hearing loss; 137 subjects reported major hearing loss, 1,139 reported moderate problems (difficulty following the conversation when several persons talk at the same time or in a noisy background), and 2,394 reported no hearing trouble. Cognitive decline was measured using the Mini‐Mental State Examination (MMSE), administered at follow‐up visits over 25 years.
Results
Self‐reported hearing loss was significantly associated with lower baseline MMSE score (β = −0.69, P < .001) and greater decline during the 25‐year follow‐up period (β = −0.04, P = .01) independent of age, sex, and education. A difference in the rate of change in MMSE score over the 25‐year follow‐up was observed between participants with hearing loss not using hearing aids and controls (β = −0.06, P < .001). In contrast, subjects with hearing loss using a hearing aid had no difference in cognitive decline (β = 0.07, P = .08) from controls.
Conclusion
Self‐reported hearing loss is associated with accelerated cognitive decline in older adults; hearing aid use attenuates such decline.
Hearing loss in older adults is suspected to play a role in social isolation, depression, disability, lower quality of life, and risk of dementia. Such suspected associations still need to be ...consolidated with additional research. With a particularly long follow-up, this study assessed the relationship between hearing status and four major adverse health events: death, dementia, depression, and disability.
Prospective community-based study of 3,777 participants aged ≥65 followed up for 25 years. At baseline, 1,289 reported hearing problems and 2,290 reported no trouble. The risk of occurrence of the negative outcomes, including death, dementia, depressive symptoms, disability in activities of daily living (ADL), and instrumental ADL (IADL), was assessed with Cox proportional hazards models.
Adjusting for numerous confounders, an increased risk of disability and dementia was found for participants reporting hearing problems. An increased risk of depression was found in men reporting hearing problems. In additional exploratory analyses, such associations were not found in those participants using hearing aids. Mortality was not associated with self-reported hearing loss.
Our study confirms the strong link between hearing status and the risk of disability, dementia, and depression. These results highlight the importance of assessing the consequences of treating hearing loss in elders in further studies.
The aim of this work was to determine the predictive value of 2 indicators of psychosocial isolation (living alone and feelings of loneliness) in elderly people.
Twenty-two-year follow-up cohort ...study of 3,620 community-dwelling elderly people enrolled in the PAQUID study, a French prospective population-based study. Participants completed a battery of tests including the Centre for Epidemiological Studies Depression scale and a question regarding living conditions (living alone or living with another person). Feelings of loneliness were measured using the Item 14 ("I felt lonely") of the French version of the Centre for Epidemiological Studies Depression scale. Mortality rate was measured over a 22-year follow-up period after the baseline assessment visit. The risk of death was estimated using Cox proportional hazards models, adjusted for age, sex, and educational level.
At baseline, 1,535 participants (42.4%) were living alone, and a total of 498 persons (13.8%) reported frequent feelings of loneliness (FoL). The participants reporting FoL were more frequently women (82.7%), and the mean (SD) age was 76.5 (7.1) years. At the end of the follow-up, 3,116 deaths (86.6%) occurred. Living alone and FoL were both independent predictors of death after 22 years of follow-up (hazard ratio, 1.14; 95% confidence of interval, 1.05-1.23; p = .001) and (hazard ratio, 1.20; 95% confidence of interval, 1.08-1.33; p = .001), respectively. No significant interaction was found between feelings of loneliness and living alone, suggesting that a joint exposure has only an additive effect (β = 0.08; relative risk = (0.85; 1.40); p = .48). The associations of both measures persisted after adjusting for health status. Adjusting for depression attenuated the predictive value of FoL.
Living alone and FoL were independently associated with higher risk of mortality. These factors may be useful as readily available psychosocial measures to identify vulnerability in community-dwelling older adults.
Objectives:
The objective of this longitudinal study was to compare the trajectory of subjective quality of life in 2 groups of older adults: those who entered a nursing home and those who remained ...living in the community with similar clinical conditions.
Method:
PAQUID is a prospective population-based study. It included, at baseline, 3777 community-dwelling participants aged 65 years and over. Participants were followed-up for up to 27 years. Among people living at home at baseline, 2 groups were compared: participants who entered a nursing home over a 20-year follow-up (n = 528) and those who remained community dwellers (n = 2273). We used latent process mixed models to estimate the relationship between mean trajectory of subjective quality of life and admission into a nursing home. We computed univariate and multivariate models taking into account potential confounders (age, gender, education, income, comorbidities, dementia, disability and depression).
Results:
Nursing home placement was significantly associated with a drop in quality of life between the last visit before and after institutionalization. Nevertheless, we found no difference in quality of life trajectory after this initial drop.
Conclusion:
Older adults exhibit an acute drop in quality of life after nursing home admission, probably reflecting the associated psychological distress. Even though their quality of life does not go back to pre-admission levels, the residents do not show a steeper decline when compared to the “natural” evolution of quality of life in older adults living in the community, which suggests a relative adaptation to their new living conditions.
Dementia, stroke, depression, and disability are frequent in late life and are major causes of quality of life disruption and family burden. Even though each of these disorders relies on specific ...pathogenic processes, a common clinical manifestation is psychomotor slowing.
We assessed the relevance of a simple marker of low psychomotor speed in predicting several brain outcomes: dementia, Alzheimer's disease (AD), Parkinson's disease (PD), stroke, depressive symptoms, and disability in activities of daily living (ADL) and instrumental ADL (IADL).
PAQUID is a population-based study involving 3,777 individuals aged 65 or older prospectively followed-up with repeated clinical evaluations. After 10 years, 437 participants developed dementia, 333 developed AD, 71 developed PD, 207 reported incident stroke, 404 developed disability in ADL, 994 in IADL, and 494 developed depressive symptomology. Psychomotor speed was measured with the digit symbol substitution test (DSST). Cox proportional hazards models controlled for several confounders assessed the risk of incident outcomes.
Participants with low DSST performance had increased risk of incident all-type dementia (hazard ratio HR 3.41, p < 0.0001) and AD-type dementia (HR 3.18, p < 0.0001). Higher risk for PD (HR 2.98, p = 0.04), IADL (HR 1.82, p < 0.0001), ADL disability (HR 1.95, p = 0.001), depressive symptoms (HR 1.53, p = 0.03), and a statistical trend for stroke (HR 1.88, p = 0.09) was also found.
Low psychomotor speed is associated with an increased risk of developing various brain outcomes: dementia, AD, PD, disability, depressive symptoms, and marginally stroke. Low psychomotor speed may be the consequence of a number of discrete cerebral abnormalities and could be considered as a marker of brain vulnerability. In clinical practice, a low score in DSST should be seen as a warning sign of possible negative evolution.
Based on literature and available questionnaires, the present study aimed at creating and validating the Perceived Social Support Questionnaire (PSSQ): a 4-item scale assessing the perceived social ...support in older adults. Normative scores were also computed.
Three hundred and two participants (mean age 87.68) selected from ongoing population-based studies completed a phone interview. Among these, 247 completed a second interview 4 months later allowing assessing the questionnaire fidelity over time.
The factor analysis evidenced two dimensions: availability of social support and satisfaction with it. Both dimensions had a satisfactory internal consistency but weak intraclass correlation coefficient. Univariate analyses revealed that age, number of calls per week and living environment marginally associated with the availability score. The satisfaction score was associated with perceived health status, sadness, depressive mood, feeling of loneliness, anxiety, and the perception of social support during the pandemic context. The norms computed were stratified on age.
The PSSQ is a short and easy-to-administer tool allowing assessing perceived social support in older population. Despite a weak fidelity that could actually be explained by changes in perceived social support over time, the questionnaire revealed good psychometric qualities and validity.
Highlights • The predictive value of 3 different frailty instruments (Fried's phenotype criteria, Rockwood's Frailty Index and Tilburg Frailty Indicator), for selected outcomes are compared in a ...population based study sample. • Rockwood's FI seems to be the most efficient scale for predicting negative mortality, incident disability and falls in our cohort. • For proposing prevention strategies or therapeutic plans directed to a targeted population is key to adequately select the suitable frailty instrument.
Abstract
Objectives
To determine the impact of both individual psychosocioeconomic precariousness and geographical deprivation on risk of dementia in older adults followed-up for 25 years.
Method
The ...sample consisted of 3,431 participants aged 65 years or over from the PAQUID cohort study. Individual psychosocioeconomic precariousness was measured computing eight economic and psychosocial indicators. Geographical deprivation was assessed by the FDep99 index, consisting of four community socioeconomic variables. For both measures, the fourth quartile of the distribution was considered as the more precarious or deprived category, while the first quartile was considered as the less precarious or deprived one. Clinical dementia diagnosis was assessed all along study follow-up. The association between individual psychosocioeconomic precariousness, geographical deprivation and risk of dementia was assessed using illness-death regression models adjusted for age, sex, depression, psychotropic drug consumption, comorbidities, disability, and body mass index, while accounting for death as a competing event.
Results
The risk of dementia was higher for the more psychosocioeconomic precarious participants (HR = 1.51; 95% CI: 1.24–1.84). No increased risk of dementia was found for those living in communities with high index of deprivation.
Discussion
Psychosocioeconomic precariousness, but not geographical deprivation, is associated with a higher risk of dementia.
Although non-drug interventions are widely used in patients with Alzheimer's disease, few large scale randomized trials involving a long-term intervention and several cognitive-oriented approaches ...have been carried out. ETNA3 trial compares the effect of cognitive training, reminiscence therapy, and an individualized cognitive rehabilitation program in Alzheimer's disease to usual care.
This is a multicenter (40 French clinical sites) randomized, parallel-group trial, with a two-year follow-up comparing groups receiving standardized programs of cognitive training (group sessions), reminiscence therapy (group sessions), individualized cognitive rehabilitation program (individual sessions), and usual care (reference group). Six hundred fifty-three outpatients with Alzheimer's disease were recruited. The primary efficacy outcome was the rate of survival without moderately severe to severe dementia at two years. Secondary outcomes were cognitive impairment, functional disability, behavioral disturbance, apathy, quality of life, depression, caregiver's burden, and resource utilization.
No impact on the primary efficacy measure was evidenced. For the two group interventions (i.e. cognitive training and reminiscence), none of the secondary outcomes differed from usual care. The larger effect was seen with individualized cognitive rehabilitation in which significantly lower functional disability and a six-month delay in institutionalization at two years were evidenced.
These findings challenge current management practices of Alzheimer's patients. While cognitive-oriented group therapies have gained popularity, this trial does not show improvement for the patients. The individualized cognitive rehabilitation intervention provided clinically significant results. Individual interventions should be considered to delay institutionalization in Alzheimer's disease.
Objective: Similarities between spouses in cognitive functions have been mainly explained by the assortative mating phenomenon and the convergence for age and education. The mutual influence between ...spouses is another explanation particularly relevant in the elderly population. Today, it remains difficult to determine whether cognitive similarities exclusively result from the convergence effect or from the mutual influence. Using a novel methodology, the present study aimed to assess the impact of the marital relationship on cognitive similarities among elderly couples.
Methods: 1723 couples from the Three-City Cohort Study were classified in two groups of couples with homogeneous and heterogeneous age and education. We also constituted two groups of pseudo-couples by a random association of individuals, with homogeneous and heterogeneous age and education. Dyadic analyses were conducted in the four groups, regarding the similarities in lexicosemantic abilities, executive functions, memory and global cognitive functioning.
Results: Similarities were found on lexicosemantic abilities both in mate-assorted couples and in couples heterogeneous in age and education but no similarity was found in pseudo-couples.
Discussion: Beyond the convergence effect, the fact that the spouses co-construct their lifestyles may contribute to cognitive similarities in the lexicosemantic domain.
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