Prediction of Autonomy Loss in Alzheimer’s Disease

The evolution of functional autonomy loss leads to institutionalization of people affected by Alzheimer’s disease (AD), to an alteration of their quality of life and that of their caregivers. To predict loss of functional autonomy could optimize prevention strategies, aids and cost of care. The aim of this study was to develop and to cross-validate a model to predict loss of functional autonomy as assessed by Instrumental Activities of Daily Living (IADL) score. Outpatients with probable AD and with 2 or more visits to the Clinical and Research Memory Centre of the University Hospital were included. Four Tree-Augmented Naïve bayesian networks (6, 12, 18 and 24 months of follow-up) were built. Variables included in the model were demographic data, IADL score, MMSE score, comorbidities, drug prescription (psychotropics and AD-specific drugs). A 10-fold cross-validation was conducted to evaluate robustness of models. The study initially included 485 patients in the prospective cohort. The best performance after 10-fold cross-validation was obtained with the model able to predict loss of functional autonomy at 18 months (area under the curve of the receiving operator characteristic curve = 0.741, 27% of patients misclassified, positive predictive value = 77% and negative predictive value = 73%). The 13 variables used explain 41.6% of the evolution of functional autonomy at 18 months. A high-performing predictive model of AD evolution of functional autonomy was obtained. An external validation is needed to use the model in clinical routine so as to optimize the patient care.

Autonomy Loss, Privacy Invasion and Data Misuse as Psychological Barriers to Peer-to-Peer Collaborative Car Use

The present study aimed to identify psychological barriers, which potentially prevent people from implementing collaborative car use in their every-day mobility behaviour. We suggested a model consisting of four psychological barriers: Autonomy Loss, Privacy Invasion, Interpersonal Distrust, and Data Misuse. Perceived Financial Benefit was included as a main incentive of collaborative car use. Using two samples, a community (N = 176) and a student sample (N = 265), three forms of peer-to-peer collaborative car use were examined: lending your own car to another private person (Lending To), renting a car from another private person (Renting From) and sharing rides with others (Ridesharing). For all three forms, a standardised questionnaire was developed which included the psychological barriers, self-reported collaborative car use intention and behaviour, and scenario evaluations. The results showed that specific barriers predicted specific forms of collaborative car use: Autonomy Loss was connected negatively with Ridesharing and Privacy Invasion predicted Lending To negatively. Data misuse was connected negatively with Renting From, when the renting was arranged via internet. Interpersonal Distrust showed no predictive value of collaborative car use. Perceived Financial Benefit was a consistent incentive for all forms of collaborative car use. Overall, the results confirm the relevance of psychological barriers to collaborative car use. Practical implications to overcome the psychological barriers are discussed.

Personnes âgées à domicile avec limitations fonctionnelles : étude préliminaire d’une intervention centrée sur le bien-être et l’autonomie

In the context of demographic aging, preventing autonomy loss is a major issue. Adapting care systems to help keep seniors at home is a daily challenge. “La Mutualité Française”, a national mutual insurance company, has implemented in one of its healthcare services an innovative program to strengthen well-being: “The Well-Being Autonomy Pole.” This program comprises five Prevention and Support Care components and hypothesizes that strengthening the well-being of elderly people already suffering from physical limitations would prevent their autonomy decline. The originality of this program is its focus on elderly people who have rarely been studied in terms of preventing autonomy loss, given their existing functional limitations. A first evaluation was carried out over three months to verify the methodological feasibility of an impact assessment and to provide preliminary results on the effectiveness of the program. Key findings suggest improved levels of self-esteem, physical well-being, psychological autonomy and decreased anxiety. Methodological limitations of this first feasibility assessment and perspectives for future research are discussed.