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Provencher V.,Université de Sherbrooke | Desrosiers J.,Université de Sherbrooke | Demers L.,University of Montréal | Carmichael P.-H.,Center Dexcellence Sur Le Vieillissement Of Quebec
Disability and Rehabilitation | Year: 2016

Purpose: This study aimed to (1) determine the categories of behavioral coping strategies most strongly correlated with optimal seniors social participation in different activity and role domains and (2) identify the demographic, health and environmental factors associated with the use of these coping strategies optimizing social participation. Method: The sample consisted of 350 randomly recruited community-dwelling older adults (≥65 years). Coping strategies and social participation were measured, respectively, using the Inventory of Coping Strategies Used by the Elderly and Assessment of Life Habits questionnaires. Information about demographic, health and environmental factors was also collected during the interview. Results: Regression analyses showed a strong relationship between the use of cooking- and transportation-related coping strategies and optimal participation in the domains of nutrition and community life, respectively. Older age and living alone were associated with increased use of cooking-related strategies, while good self-rated health and not living in a seniors residence were correlated with greater use of transportation-related strategies. Conclusions: Our study helped to identify useful behavioral coping strategies that should be incorporated in disability prevention programs designed to promote community-dwelling seniors social participation. However, the appropriateness of these strategies depends on whether they are used in relevant contexts and tailored to specific needs.Implications for RehabilitationOur results support the relevance of including behavioral coping strategies related to cooking and transportation in disability prevention programs designed to promote community-dwelling seniors social participation in the domains of nutrition and community life, respectively.Older age and living alone were associated with increased use of cooking-related strategies, while good self-rated health and not living in a seniors residence were correlated with greater use of transportation-related strategies. These factors should be considered in order to optimize implementation of these useful strategies in disability prevention programs.The appropriateness of these selected strategies depends on whether they are used in relevant contexts and tailored to specific needs. © 2015 Taylor & Francis.


Anderson N.D.,Rotman Research Institute | Anderson N.D.,University of Toronto | Damianakis T.,University of Windsor | Kroger E.,Center Dexcellence Sur Le Vieillissement Of Quebec | And 9 more authors.
Psychological Bulletin | Year: 2014

There is an urgent need to identify lifestyle activities that reduce functional decline and dementia associated with population aging. The goals of this article are to review critically the evidence on the benefits associated with formal volunteering among older adults, propose a theoretical model of how volunteering may reduce functional limitations and dementia risk, and offer recommendations for future research. Database searches identified 113 papers on volunteering benefits in older adults, of which 73 were included. Data from descriptive, cross-sectional, and prospective cohort studies, along with 1 randomized controlled trial, most consistently reveal that volunteering is associated with reduced symptoms of depression, better self-reported health, fewer functional limitations, and lower mortality. The extant evidence provides the basis for a model proposing that volunteering increases social, physical, and cognitive activity (to varying degrees depending on characteristics of the volunteer placement) which, through biological and psychological mechanisms, leads to improved functioning; we further propose that these volunteering-related functional improvements should be associated with reduced dementia risk. Recommendations for future research are that studies (a) include more objective measures of psychosocial, physical, and cognitive functioning; (b) integrate qualitative and quantitative methods in prospective study designs; (c) explore further individual differences in the benefits associated with volunteering, (d) include occupational analyses of volunteers' specific jobs in order to identify their social, physical, and cognitive complexity; (e) investigate the independent versus interactive health benefits associated with volunteering relative to engagement in other forms of activity; and (f) examine the relationship between volunteering and dementia risk. © 2014 American Psychological Association.


PubMed | University of Windsor, Baycrest Health science, University of York, Geriatrics and Extended Care Data and Analysis Center and 3 more.
Type: Journal Article | Journal: Psychological bulletin | Year: 2014

There is an urgent need to identify lifestyle activities that reduce functional decline and dementia associated with population aging. The goals of this article are to review critically the evidence on the benefits associated with formal volunteering among older adults, propose a theoretical model of how volunteering may reduce functional limitations and dementia risk, and offer recommendations for future research. Database searches identified 113 papers on volunteering benefits in older adults, of which 73 were included. Data from descriptive, cross-sectional, and prospective cohort studies, along with 1 randomized controlled trial, most consistently reveal that volunteering is associated with reduced symptoms of depression, better self-reported health, fewer functional limitations, and lower mortality. The extant evidence provides the basis for a model proposing that volunteering increases social, physical, and cognitive activity (to varying degrees depending on characteristics of the volunteer placement) which, through biological and psychological mechanisms, leads to improved functioning; we further propose that these volunteering-related functional improvements should be associated with reduced dementia risk. Recommendations for future research are that studies (a) include more objective measures of psychosocial, physical, and cognitive functioning; (b) integrate qualitative and quantitative methods in prospective study designs; (c) explore further individual differences in the benefits associated with volunteering; (d) include occupational analyses of volunteers specific jobs in order to identify their social, physical, and cognitive complexity; (e) investigate the independent versus interactive health benefits associated with volunteering relative to engagement in other forms of activity; and (f) examine the relationship between volunteering and dementia risk.


PubMed | McMaster University, Ottawa Hospital Research Institute, Sunnybrooke Health science Center, Center Dexcellence Sur Le Vieillissement Of Quebec and University of Montréal
Type: Journal Article | Journal: The journals of gerontology. Series A, Biological sciences and medical sciences | Year: 2015

This study aims to (i) describe frailty in the subgroup of independent community-dwelling seniors consulting emergency departments (EDs) for minor injuries, (ii) examine the association between frailty and functional decline 3 months postinjury, (iii) ascertain the predictive accuracy of frailty measures and emergency physicians for functional decline.Prospective cohort in 2011-2013 among 1,072 seniors aged 65 years or older, independent in basic daily activities, evaluated in Canadian EDs for minor injuries.Frailty was assessed at EDs using the Canadian Study of Health and Aging-Clinical Frailty scale (CSHA-CFS) and the Study of Osteoporotic Fracture frailty index (SOF). Functional decline was defined as a loss 2/28 on the Older American Resources Services scale 3 months postinjury. Generalized mixed models were used to explore differences in functional decline across frailty levels. Areas under the receiver operating characteristic curve were used to ascertain the predictive accuracy of frailty measures and emergency physicians clinical judgment.The SOF and CSHA-CFS were available in 342 and 1,058 participants, respectively. The SOF identified 55.6%, 32.7%, 11.7% patients as robust, prefrail, and frail. These CSHA-CFS (n = 1,058) proportions were 51.9%, 38.3%, and 9.9%. The 3-month incidence of functional decline was 12.1% (10.0%-14.6%). The Areas under the receiver operating characteristic curves of the CSHA-CFS and the emergency physicians were similar (0.548-0.777), while the SOF was somewhat higher (0.704-0.859).Measuring frailty in community-dwelling seniors with minor injuries in EDs may enhance current risk screening for functional decline. However, before implementation in usual care, feasibility issues such as inter-rater reliability and acceptability of frailty tools in the EDs have to be addressed.


PubMed | McGill University, Jewish General Hospital and Donald Berman Maimonides Geriatric Center, Center Dexcellence Sur Le Vieillissement Of Quebec, Université de Sherbrooke and 2 more.
Type: | Journal: BMC nursing | Year: 2015

Although detection of delirium using the current tools is excellent in research settings, in routine clinical practice, this is not the case. Together with nursing staff, we developed a screening tool (RADAR) to address certain limitations of existing tools, notably administration time, ease-of-use and generalizability. The purpose of this study was not only to evaluate the validity and reliability of RADAR but also to gauge its acceptability among the nursing staff in two different clinical settings.This was a validation study conducted on three units of an acute care hospital (medical, cardiology and coronary care) and five units of a long-term care facility. A total of 142 patients and 51 residents aged 65 and over, with or without dementia, participated in the study and 139 nurses were recruited and trained to use the RADAR tool. Data on each patient/resident was collected over a 12-hour period. The nursing staff and researchers administered RADAR during the scheduled distribution of medication. Researchers used the Confusion Assessment Method to determine the presence of delirium symptoms. Delirium itself was defined as meeting the criteria for DMS-IV-TR delirium. Inter-rater reliability, convergent, and concurrent validity of RADAR were assessed. At study end, 103 (74%) members of the nursing staff completed the RADAR feasibility and acceptability questionnaire.Percentages of agreement between RADAR items that bedside nurses administered and those research assistants administered varied from 82% to 98%. When compared with DSM-IV-TR criterion-defined delirium, RADAR had a sensitivity of 73% and a specificity of 67%. Participating nursing staff took about seven seconds on average, to complete the tool and it was very well received (98%) overall.The RADAR tool proved to be efficient, reliable, sensitive and very well accepted by nursing staff. Consequently, it becomes an appropriate new option for delirium screening among older adults, with or without cognitive impairment, in both hospitals and nursing homes. Further projects are currently underway to validate the RADAR among middle-aged adults, as well as in newer clinical settings; home care, emergency department, medical intensive care unit, and palliative care.


Sevigny A.,Laval University | Sevigny A.,McGill University | Sevigny A.,Center Dexcellence Sur Le Vieillissement Of Quebec | Cohen S.R.,McGill University | And 2 more authors.
Palliative and Supportive Care | Year: 2010

Objective: To encourage communication and contribute to the palliative care movement's need for interdisciplinary care, this article offers to explore the stance of volunteers on two fundamental concepts, "health" and "illness", as well as their related understanding of "palliative care". Volunteers' understandings are then compared with the concepts put forth by the Canadian Hospice Palliative Care Association (CHPCA) in its "Model to Guide Hospice Palliative Care". Method: Focus groups with volunteers, and individual interviews with coordinators from five selected palliative care community action organizations from across Canada, are used. A total of 65 participants from three Canadian provinces were interviewed.Results: Participants view illness as a subjective, multidimensional, and transformative experience that requires multiple adjustments. It is an impediment to personal equilibrium and a challenge for the terminally ill and their close ones. Health, on the other hand, is a complex phenomenon that consists of physical, psychological, social, and spiritual well-being. For participants, health is most often embodied by a person's capacity to adjust to their challenging circumstances. Both volunteers and coordinators see palliative care as an alternative approach to care that centers on helping patients and their families through their ordeal by offering comfort and respite, and helping patients enjoy their life for as long as possible.Significance of Results: Participants describe illness as a destabilizing loss and palliative care as a means to compensate for the numerous consequences this loss brings; their actions reflect these principles and are compatible with the CHPCA model. Copyright © Cambridge University Press 2010.


Nadeau A.,Laval University | Nadeau A.,Center Dexcellence Sur Le Vieillissement Of Quebec | Pourcher E.,Quebec Memory and Motor Skills Disorders Research Center | Pourcher E.,Laval University | And 2 more authors.
Medicine and Science in Sports and Exercise | Year: 2014

Purpose: Recent studies suggest that walking on a treadmill improves gait, mobility, and quality of life of patients with Parkinson's disease (PD). Still, there is a need for larger-scale randomized controlled studies that demonstrate the advantages of treadmill training (TT) with control groups that receive similar amounts of attention. Moreover, to date, no study has combined speed and incline as parameters of progression. The aim of the study was to evaluate the effects of 24 wk of TT, with and without the use of incline, on gait, mobility and quality of life in patients with PD. Methods: The sample comprised 34 patients with PD, at the Hoehn and Yahr stage 1.5 or 2. Participants were randomized to speed TT, mixed TT, and control groups. The intervention consisted of 72 one-hour exercise sessions for 24 wk. The main outcome measures are the Movement Disorder Society-Unified Parkinson's Disease Rating Scale, the 39-item Parkinson's Disease Questionnaire, spatiotemporal parameters of gait and 6-min walking distance. The measures were taken at baseline, mid-term and after 6 months. RESULTS: Both TT groups improved in terms of speed, cadence, and stride length during self-selected walking conditions at the study end point. Both groups also showed improvements in distance traveled. Only the Mixed TT group improved their quality of life. The Control group showed no progress. Conclusions: Participants in this study showed significant improvements in walking speed and walking endurance after 6 months of TT. Improvements were observed after 3 months of intensive TT and persisted at 6 months. It appears that individuals with poorer baseline performance may benefit most from TT. © 2014 by the American College of Sports Medicine.


Murr J.,Center Dexcellence Sur Le Vieillissement Of Quebec | Murr J.,Laval University | Carmichael P.-H.,Center Dexcellence Sur Le Vieillissement Of Quebec | Julien P.,Laval University | And 3 more authors.
Neurobiology of Aging | Year: 2014

This study examines the association of plasma oxidized low-density lipoprotein (OxLDL) levels with all-cause dementia, including Alzheimer's disease (AD) and vascular dementia. Data are taken from the Canadian Study of Health and Aging, a population-based study of a representative sample of persons aged more than 65 years conducted from 1991 to 2002. The present study sample included 670 subjects of which, 155 developed all-cause dementia with 109 cases of AD and 32 of vascular dementia. In Cox regression models, no association between OxLDL and risks of dementia or subtypes was found. A triple interaction between OxLDL, sex, and history of cardiovascular disease on the risk of AD (p= 0.0077) was found. Increased levels of OxLDL were significantly associated with an increased risk of AD in men with a history of cardiovascular disease (hazard ratio= 1.11; 95% confidence interval 1.04-1.19); no association in women was found. These findings suggest that increased levels of OxLDL are not associated with the risk of dementia, AD, and vascular dementia. The association of OxLDL with AD in men with a history of cardiovascular disease merits further investigation. © 2014 Elsevier Inc.


Kroger E.,Center Dexcellence Sur Le Vieillissement Of Quebec | Kroger E.,University Utrecht | Van Marum R.,University Utrecht | Souverein P.,University Utrecht | And 2 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2015

Treatment of Alzheimer disease (AD) with cholinesterase inhibitors (ChEIs) may increase the risk of urinary incontinence (UI). Objective: To assess whether ChEI use was associated with the risk of UI among older patients with AD. Methods: A crossover cohort study using the PHARMO Record Linkage System included 10years of data on drug dispensing histories for over two million Dutch residents. Included patients were aged 50 +, free of UI for the last 6months, received a first ChEI prescription during the study period, had at least 12months prior drug exposure history and one subsequent prescription of any drug. UI was defined as a first dispensing of a urinary spasmolytic or of incontinence products for at least 30days. Cox regression with time-varying covariates and multivariate adjustment allowed assessing whether UI incidence was associated with ChEI exposure. Results: Among 3154 patients there were 657 UI cases during a mean follow-up of 5.1years before a first ChEI dispensing, and 499 cases after ChEI initiation, during a mean follow-up of 2.0years. Among the 2700 participants free of UI one year before ChEI initiation, the adjusted hazard ratio (HR) for UI was 1.13 (95% CI: 0.97-1.32) when periods with ChEI use were compared to periods without ChEI use. Sensitivity analyses may suggest an increased risk in the 1st month after ChEI initiation (HR: 1.72, p=0.09) Conclusion: Worsening AD may increase incidence of UI, but no firm association between ChEI treatment and risk of UI could be shown from these data. © 2015 John Wiley & Sons, Ltd.


Kroger E.,Center Dexcellence Sur Le Vieillissement Of Quebec | Berkers M.,University Utrecht | Carmichael P.-H.,Center Dexcellence Sur Le Vieillissement Of Quebec | Souverein P.,University Utrecht | And 2 more authors.
American Journal of Geriatric Pharmacotherapy | Year: 2012

Background: Two cholinesterase inhibitors (ChEIs), rivastigmine and galantamine, are used to treat Alzheimer disease in the Netherlands. Several adverse cardiac events have been reported for these medications. Objective: We aimed to assess if the use of ChEIs increased the risk of cardiac events in the Netherlands. Methods: A cohort crossover study of the PHARMO Record Linking System database included patients who initiated ChEIs at age 50 years or older, had at least 1 dispensing of a ChEI drug between 1998 and 2008, a 1-year history in PHARMO, and 1 subsequent dispensing of any medication. Two outcomes were assessed: a first hospitalization for syncope or atrioventricular block. Poisson and Cox regression were used to calculate incidence densities and hazard ratios for cardiac events during periods with ChEI use, compared with periods without ChEI use. Results: During the complete observation period of 8.9 years (interquartile range 6.7 to 10.2) there were 132 first hospitalizations for atrioventricular block and 17 first hospitalizations for syncope among 3358 patients. The adjusted incidence densities were significantly increased during ChEI exposure for syncope and atrioventricular block, when compared with the background incidence densities in the roughly 5 years before the last year before ChEI initiation. However, when exposed periods were compared with the unexposed periods 1 year before ChEI initiation and times after exposure, the adjusted hazard ratios remained increased for syncope and atrioventricular block, but increases were not significant anymore. Conclusions: Exposure to ChEIs might increase the risk of adverse cardiac events, but small numbers of cases limit conclusions about the risk in this population and research on larger study samples is needed. © 2012 Elsevier HS Journals, Inc.

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