Defining Your “Life Territory”: The Meaning of Place and Home for Community Dwellers and Nursing Home Residents—A Qualitative Study in Four European Countries

The meaning of place and home for community dwellers and nursing home residents remains unclear. We explored the relationship between older people and their “life territory”, to propose a working definition of this concept, which could be used to orient policy decisions. Individual, semi-structured interviews were performed with older people, nursing home staff, and representatives of local institutions/elected officials in four European countries (France, Belgium, Germany, Italy). Interviews were transcribed and analysed using thematic analysis. In total, 54 interviews were performed. Five main themes emerged: (i) working definition of “your life territory” (a multidimensional concept covering individual and collective aspects); (ii) importance of the built environment (e.g., public transport, sidewalks, benches, access ramps); (iii) interactions between nursing homes and the outside community (specifically the need to maintain interactions with the local community); (iv) a sense of integration (dependent on social contacts, seniority in the area, perceived self-utility); and (v) the use of new technologies (to promote integration, social contacts and access to culture). This study found that the “life territory” of older people is a multidimensional concept, centred around five main domains, which together contribute to integrating older people into the fibre of their community.

Sex differences in Speech and High-frequency Hearing Loss Association With Cognitive Impairment Among Older Adults

Objectives The purpose of this study was to investigate the relationship between speech-frequency hearing loss (SFHL), high-frequency hearing loss (HFHL), and cognitive impairment (CI). Then to determine whether there are any differences in gender among older community dwellers in China. Methods This study involved 1,012 adults aged ≥60 years (428 male; average age, 72.61±5.51 years). The participants had their hearing and cognition measured using pure tone audiometry and Mini Mental State Examination (MMSE), respectively. We used the audiometric definition of hearing loss (HL) adopted by the World Health Organization (WHO). Speech-frequencies were measured as 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz; high-frequencies were measured as 4 kHz and 8 kHz. Pure tone average (PTA) was measured as hearing sensitivity. Results Our studies demonstrated a 37.6% prevalence of HL in males and a 36.0% prevalence of HL in females. Adjusted for confounding variables, the results from a multivariate analysis showed that SFHL was associated with CI in females (OR=2.400, 95% Confidence Interval=1.313–4.385) and males (OR=2.189, 95% Confidence Interval=0.599–2.944). However, HFHL was associated with CI only in females (OR=2.943, 95% Confidence Interval=1.505–5.754). HL was associated with poorer cognitive scores (P<0.05). “Registration” (P<0.05) in MMSE was associated with speech and high-frequency hearing sensitivity. Conclusion The associations between HL and CI varied according to gender in older community-dwellers, suggesting that different mechanisms are involved in the etiology of HL. Moreover, hearing sensitivity was negatively associated with cognition scores; therefore, early screening for HL and CI among older community-dwelling adults is advised.

Gender-specific associations of speech-frequency hearing loss, high-frequency hearing loss, and cognitive impairment among older community dwellers in China

Background and Aims This study aimed atinvestigating the relationship between speech-frequency hearing loss (SFHL), high-frequency hearing loss (HFHL), and cognitive impairment (CI) and then to determine whether there are any differences in gender among older community dwellers in China. Methods 1012 adults aged ≥ 60 years (428 males; average age, 72.61 ± 5.51 years) and living in Chongming District, Shanghai were enrolled in the study. We used the audiometric definition of hearing loss (HL) adopted by the World Health Organization (WHO). Speech-frequencies were measured at 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz; high-frequencies were measured at 4 kHz and 8 kHz. Pure tone average (PTA) was measured as hearing sensitivity. Cognitive performance was measured using the mini mental state examination (MMSE). Results Our studies demonstrated a 37.6% prevalence of HL in males and a 36.0% prevalence of HL in females. Adjusted for confounding variables, the results from a multivariate analysis showed that SFHL was associated with CI in females (OR = 2.922, 95% Confidence Interval = 1.666–5.124) and males (OR = 2.559, 95% Confidence Interval = 1.252–5.232). However, HFHL was associated with CI only in females (OR = 3.490, 95% Confidence Interval = 1.834–6.643). HL was associated with poorer cognitive scores (P < 0.05). “Registration” (P < 0.05) in MMSE was associated with speech- and high-frequency hearing sensitivity. Conclusions The associations between HL and CI varied according to gender in older community-dwellers, suggesting that different mechanisms are involved in the etiology of HL. Moreover, hearing sensitivity was negatively associated with cognition scores; therefore, early screening for HL and CI among older community-dwelling adults is advised.

Self-Rated Health and Frailty in Older Adults from the Population-Based Three-City Bordeaux Cohort

<b><i>Introduction:</i></b> This study aimed to investigate whether self-rated health (SRH) predict frailty and its components among community dwellers aged 75 years and older. <b><i>Methods:</i></b> We ran a cross-sectional and prospective analysis from 643 and 379 participants of the Bordeaux Center (France) of the Three-City Study, respectively. We assessed SRH using a single question with 5 response options. We defined frailty as having at least 3 out of the following 5 criteria: weight loss, exhaustion, slowness, weakness, and low energy expenditure. We used multivariate logistic regression and Cox proportional hazard models. <b><i>Results:</i></b> At baseline, poor SRH was significantly associated with frailty (odds ratio = 5.2; 95% confidence interval [CI]: 2.9–9.5) and its components except for weakness. In the prospective analysis on nonfrail participants, poor SRH was associated with the 4-year risk of slowness (hazard ratio [HR] = 1.7; 95% CI: 1.1–2.6) but not with that of frailty (HR = 1.6; 95% CI: 0.9–2.9) or the other components. <b><i>Conclusions:</i></b> In a French cohort of community dwellers aged 75 years or older, poorer SRH was associated with concomitant frailty and 70% higher risk of slowness over 4 years.

Automated non-invasive pressure-volume loop analysis of cardiac aging in a large cohort of healthy community dwellers

Background/Introduction Pressure-volume loops (PVloops) provide a wealth of information on cardiac function that is not readily available from cardiac imaging alone. Methods To estimate left ventricular (LV) PVloops non-invasively have been available, but have so far not been used to interrogate ventricular function in large patient cohorts, due to the complexity of estimating PVloops. A new method was recently validated that construct PVloops non-invasively from cine cardiac magnetic resonance (CMR), based on the time-varying elastance model [1]. At the same time, we have validated a framework for automated, quality controlled analysis of cine CMR in large cohorts of patients/subjects [2]. Combining these two methods could automated PVloop estimation, enabling analysis of ventricular pressure-volume relationships in large study populations. Purpose Evaluate if CMR-based non-invasive PVloops can be used to interrogate the impact of cardiac ageing on LV function occurring in a large population of healthy community dwellers. Methods Non-invasive PVloops were calculated from a full cardiac cycle LV volume curve and brachial blood pressure data using a recently validated method based on the time-varying elastance model [1], in 7,650 healthy community dwellers from the UKBiobank population study. The LV volume curve was automatically obtained using our state-of-the-art, quality controlled deep learning (DL) based cine CMR analysis framework [2]. External Work, pressure-volume-area (PVA), end-systolic pressure (Pes), ventricular elastance (Ees, an estimate of contractility) and arterial elastance (Ea) and energy per ejected volume (EEV: PVA/ stroke volume) were calculated from the PVloops. We performed univariate regression between PVloop parameters and age. We also calculated the additional impact of cardiovascular risk-factors in a multivariate analysis. Results See results in table 1. With age, LV volumes fall (p&lt;0.001) in healthy subjects, while systolic blood pressure and Pes increases (both p&lt;0.001). As a result of the higher afterload, PVA (p=0.894) and EW (p=0.499) do not significantly change with age despite a lower SV. Arterial elastance (Ea) increased, and so did contractility, as measured by Ees (p&lt;0.001). Due to all these changes, EEV increased with age (p&lt;0.001). In multivariate analysis, cardiovascular risk factors hypercholesterolemia and hypertension negatively impacted Pes, PVA, Ees and EEV. Diabetes and smoking habits did not. Conclusion Non-invasive CMR-based PVloop analyses capture the impact of known changes occurring during cardiac ageing on cardiac work, contractility and energetic expenditure. Obtaining PVloops automatically using our AI analysis system in this large cohort of healthy subjects allows to formulate reference for assessment of cardiac disease. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The authors acknowledge financial support (support) the National Institute for Health Research (NIHR) Cardiovascular MedTech Co-operative (previously existing as the Cardiovascular Healthcare Technology Co-operative 2012 - 2017) award to the Guy's and St Thomas' NHS Foundation Trust, in partnership with King's College London and the NIHR comprehensive Biomedical Research Centre of the Guy's & St Thomas' NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health Univariate regression analysis Example of estimated PV loop

Late-Life Depressive Symptomatology, Motoric Cognitive Risk Syndrome, and Incident Dementia: The “NuAge” Study Results

Background: Late-life depressive symptomatology and motoric cognitive risk syndrome (MCR) have independently been associated with an increased risk for incident dementia. This study aimed to examine the association of late-life depressive symptomatology, MCR, and their combination on incident dementia in community-dwelling older adults living in Quebec (Canada).Methods: The study was carried out in a subset of 1,098 community dwellers aged ≥65 years recruited in the “Nutrition as a determinant of successful aging: The Quebec longitudinal study” (NuAge), an observational prospective cohort study with 3 years follow-up. At baseline, MCR was defined by the association of subjective cognitive complaint with slow walking speed, and late-life depressive symptomatology with a 30-item Geriatric Depression Scale (GDS) score &gt;5/30. Incident dementia, defined as a Modified Mini-Mental State score ≤79/100 test and Instrumental Activity Daily Living score &lt;4/4, was assessed at each annual visit.Results: The prevalence of late-life depressive symptomatology only was 31.1%, of MCR only 1.8%, and the combination of late-life depressive symptomatology and MCR 2.4%. The combination of late-life depressive symptomatology and MCR at baseline was associated with significant overall incident dementia (odds ratio (OR) = 2.31 with P ≤ 0.001) but not for MCR only (OR = 3.75 with P = 0.186) or late-life depressive symptomatology only (OR = 1.29 with P = 0.276).Conclusions: The combination of late-life depressive symptomatology and MCR is associated with incident dementia in older community dwellers. The results suggested an interplay between late-life depressive symptomatology and MCR exposing them to an increased risk for dementia.