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Abstract Background The health of the agricultural population has been previously explored, particularly in relation to the farming exposures and among professionally active individuals. However, few studies specifically focused on health and aging among elders retired from agriculture. Yet, this population faces the long-term effects of occupational exposures and multiple difficulties related to living and aging in rural area (limited access to shops, services, and practitioners). However, these difficulties may be counter-balanced by advantages related to healthier lifestyle, richer social support and better living environment. The general aim of the AMI cohort was to study health and aging in elderly farmers living in rural area through a multidisciplinary approach, with a main focus on dementia. Methods/design The study initially included 1 002 participants, randomly selected from the Farmer Health Insurance rolls. Selection criteria were: being 65 years and older; living in rural area in Gironde (South-Western France); being retired from agriculture after at least 20 years of activity and being affiliated to the Health Insurance under own name. The study started in 2007, with two follow-up visits over 5 years. Baseline visits were conducted at home by a neuropsychologist then by a geriatrician for all cases suspected of dementia, Parkinson’s disease and depression (to confirm the diagnosis), and by a nurse for others. A large panel of data were collected through standardised questionnaires: complete neuropsychological assessment, material and social living environment, psychological transition to retirement, lifestyle (smoking, alcohol and diet), medications, disability in daily living, sensory impairments and some clinical measures (blood pressure, depression symptomatology, anxiety, visual test, anthropometry…). A blood sampling was performed with biological measurements and constitution of a biological bank, including DNA. Brain MRI were also performed on 316 of the participants. Finally, the three-year data on health-related reimbursements were extracted from the Health System database (medications, medical and paramedical consultations, biological examinations and medical devices), and the registered Long-Term Diseases (30 chronic diseases 100% covered by the Insurance System). Discussion AMI is the first French longitudinal study on health and aging set up in a population of elderly farmers living in rural area through a multidisciplinary approach.

Context: More than half of new cancer cases occurred in older adults. Older patients with cancer are particularly at risk of physical, psycho-existential or socio-familial suffering as defined by the concept of Serious Health-related Suffering (SHS)., Objectives: To assess the direct and indirect effects of physical, psycho-existential and socio-familial dimensions of suffering on cancer treatability, supportive care needs and 12-month mortality in older patients with cancer., Methods: We included patients with cancer aged 70 years and over from the Elderly Cancer Patients cohort (ELCAPA, Ile-de-France), referred for geriatric assessment between 2007 and 2019 before cancer treatment. Structural equation modelling examined the direct and indirect relationships between SHS dimensions (latent variables), patients' characteristics (age, sex, tumor location and metastatic status, comorbidity, period of care), and outcomes., Results: The analysis included 4,824 patients (mean age: 82.2 ± 4 years; women: 56%; main cancer sites: breast [22.3%], colorectal [15.2%], prostate [8.5%], and lung [6.8%]; metastatic cancer: 46%). Physical suffering had direct pejorative effects on cancer treatability, and mortality (standardized coefficient [SC] = 0.12 [P < 0.001], SC = 0.27 [P < 0.001], respectively). Psycho-existential and socio-familial sufferings had indirect pejorative effects on survival through decreased cancer treatability (SC = 0.08 [P < 0.001], SC = 0.03 [P < 0.001], respectively). Psycho-existential dimension had the main direct effect size on supportive care needs (SC = 0.35 [P < 0.001]) and was interrelated with physical suffering., Conclusion: Physical suffering has direct pejorative effect on survival. All dimensions indirectly decrease survival due to poorer cancer treatability. Our findings support concomitant management of physical and psycho-existential suffering., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Social isolation is a risk factor for older adults' physical and psychological health. The beneficial effect of social connections in times of major health events is undeniable. Nevertheless, it remains unclear whether the positive effect of social support depends on the relationship type., Objectives: This study aimed to investigate the influence of older adults' living conditions on the risk of experiencing negative affect during the first lockdown and post-lockdown., Design: An epidemiological study conducted during the COVID-19 crisis, at the time of the first lockdown, and 2 to 3 months following the lockdown., Setting: A subset sample of the PACOVID survey, a population-based survey of older adults., Participants: Altogether, 277 participants were included into three groups depending on their living conditions: Group 1 "living alone" (n = 141); Group 2 "living with their spouse" (n = 106); Group 3 "living in cohabitation with relatives" (n = 30)., Measurements: Mixed logistic regression analyses were used to study the change in the risk of experiencing negative affects over time according to the living conditions. The presence of negative affects during lockdown was assessed using three items from the 20-item Center for Epidemiologic Studies Depression Scale : «Do you feel sad?»; «Do you feel depressed?; «Do you feel lonely?, Results: Participants living with their relatives or partner were significantly less likely to experience negative affect than those living alone during lockdown. Moreover, over time, only those living with their spouse had this lesser risk compared to those living alone., Conclusions: These findings highlight the protective effect of social support over time and more specifically of that provided by the spouse. Couple functioning ought to be given consideration when studying the impact of health crisis situation on the mental health of older adults., Competing Interests: The authors report there are no competing interests to declare.

Objectives: The great heterogeneity in symptoms and clinical signs of depression in older adults makes the current diagnostic criteria difficult to apply. This scoping review aims to provide an update on the relevance of each of the diagnostic criteria as defined in the DSM-5., Methods: In order to limit the risk of bias inherent in the study selection process, a priori inclusion and exclusion criteria were defined. Articles meeting these criteria were identified using a combination of search terms entered into PubMed, PsycINFO, PsycARTICLES and SocINDEX., Results: Of the 894 articles identified, 33 articles were selected. This review highlights a different presentation of depression in older adults. Beyond the first two DSM core criteria, some symptoms are more common in older adults: appetite change, sleep disturbance, psychomotor slowing, difficulty concentrating, indecisiveness, and fatigue., Conclusions: This review provides an updated description of the clinical expression of depressive symptoms in the older population while highlighting current pending issues., Clinical Implications: Somatic symptoms should be systematically considered in order to improve the diagnosis of depression in older adults, even if, in some cases, they may reflect symptoms of age-related illnesses.

Objective: 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., Methods: 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., Results: 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., Conclusions: 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.

Objectives: Routinization reflects how older people cope with the health problems. It remains to be seen whether it should be considered as a risk factor of negative health outcomes, or rather, a mechanism of adjustment to health issues: mortality, institutionalization, dementia, disability, cognitive decline, depression and subjective health., Methods: From longitudinal data of two large-scale French epidemiological studies, the study sample consists of 961 participants aged 77 years on average, living at home and with no neurocognitive disorder. The relationship between the level of routines measured by the Preferences for Routines Scale-Short form and the adverse health outcomes are studied considering the level of routines at baseline and in time-dependent using Cox proportional hazards models and Latent process mixed models., Results: After adjustment for sociodemographic variables, the routinization score at baseline is not associated with any health outcomes while the routinization score as a time-dependent variable is significantly associated with an increased risk of dementia (hazard ratios (HR) = 1.08, 95% confidence intervals (CI) = 1.02-1.15, p = 0.016) and institutionalization (HR = 1.18, 95% CI = 1.03-1.36, p = 0.019), greater global cognitive decline (β = -0.02, p = 0.001) and depressive symptoms (β = 0.02, p = 0.023) and a decrease in subjective health (β = 0.02, p = 0.008)., Conclusions: The level of routines measured at a given time is not associated with long-term prediction of negative health outcomes, while in time-dependent, it reveals to be a significant predictor. It should be seen as a marker of adjustment process., (© 2022 John Wiley & Sons Ltd.)

Objectives: Some factors influence the experience of the COVID-19 pandemic (health, loneliness, digital access...), but what about the living area? The objective was to compare between rural and urban areas, the psychological and social experiences of the older individuals with regard to the COVID-19 crisis during the first French lockdown., Methods: The sample included participants of three existing population-based cohorts on aging. Telephone interviews conducted by psychologists focused on the lockdown period. Data collected included living environment, professional assistance, social support, contacts with relatives, difficulties encountered, health, and knowledge and representations of the epidemic. The negative experience was defined by the presence of at least two of the following items: high anxiety symptomatology, depressive symptoms, worries or difficulties during the lockdown and insufficient social support., Results: The sample included 467 participants, aged on average 87.5 years (5.2), 58.9% were female and 47.1% lived in rural areas. Persons living in rural area had better social support, greater family presence, a less frequent feeling of imprisonment (OR = 0.60, 95 CI% = 0.36-0.99), 95% had a garden (vs. 56%), fewer depressive symptoms and lower anxiety scores, but also tended to lower comply with the health measures. Finally, they had an almost twofold lower risk of having a negative experience of the lockdown compared to their urban counterparts (OR = 0.55, 95% CI = 0.33-0.92, p = 0.0223)., Conclusions: The oldest old living in rural area experienced the first lockdown better than the urbans. Living conditions, with access to nature, a greater social support and family presence, could have contributed to these findings., (© 2021 John Wiley & Sons Ltd.)

High level of preferences for routines is an indicator of psychological vulnerability in older adults. However, the psychometric properties of the Preferences for Routines Scale (PRS) initially validated in a small selected sample of older adults revealed a low Cronbach's α (.50) in the general elderly population. The present study aims to improve the PRS using the data from the "AMI" and "PAQUID" population-based studies. Among 718 older persons, the most discriminative items are identified using item response theory methodology. A short form of the PRS (PRS-S) included five of the ten items of the original scale and showed improved internal consistency and test-retest reliability. The factors associated with the PRS-S are similar to those found in previous studies. Norms are provided according to gender and educational level. The reduction of the number of items tends to facilitate its administration and promote its use in both clinical and epidemiologic research contexts.

Introduction: The literature draws a mitigated picture of the psychosocial effects of the lockdown in older adults. However, the studies conducted so far are mainly based on web surveys which may involve selection bias. The PACOVID survey relies on a population-based design and addresses the attitudes, psychological and social experiences of the oldest old regarding the pandemic and lockdown and their impact. Material and Methods: Cross-sectional phone survey involving 677 persons. Baseline report on attitudes, psychological, and social experiences of the oldest old, regarding the pandemic and lockdown measures. Results: The mean age was 87.53 (SD 5.19). About 46% were living alone during the lockdown. Concerning difficulties, " none " was the most frequent answer (35.6%). For questions addressing how often they had felt sad, depressed, or lonely (CESD-scale), the most frequent answers were " never/very rarely " (58.7, 76.6, 60.8%) and 27.1% had anxious symptomatology (STAI scale). Most (92.9%) felt socially supported. Engaging in leisure activities was the most frequent coping strategy, and for numerous participants the lockdown did not represent much of a change in terms of daily routine. A very good knowledge and awareness of COVID-19 and the safety measures was observed. Comparisons with measures collected before the pandemic showed low changes in subjective health and the CES-D questions. Discussion: With a methodological design limiting selection bias, our results claim for a weakened psychosocial impact even though the participants are concerned and aware of the pandemic issues. These results highlight the resources and resilience abilities of older persons including in advancing age., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hernández-Ruiz, Meillon, Avila-Funes, Bergua, Dartigues, Koleck, Letenneur, Ouvrard, Pérès, Rascle, Tabue-Teguo and Amieva.)

Introduction: The present study aims to examine the process of mutual influence in older couples with cancer diagnosis by studying their risk of depression., Materials and Methods: 282 couples with one spouse diagnosed with cancer were selected from the Three-City cohort study. Dyadic analyses were used to determine whether trait anxiety affects the risk of depression and whether a mutual influence process occurs prior and post cancer diagnosis. Cross-sectional analyses were performed at two time-points: before and after receiving the diagnosis., Results: A higher level of anxiety among cancer patients resulted in a decreased risk of depression among spousal caregivers. Moreover, a higher anxiety among spousal caregivers increased their own risk of depression, but it didn't influence depression risk among cancer patients. While there is an intra-individual relationship between a higher level of trait anxiety and a greater risk of depression prior to cancer diagnosis, there is no cross-influence between spouses., Discussion: The study findings indicate that a dyadic psychological adjustment process might help older adults to cope with cancer by limiting the risk of depression among spousal caregivers., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2020 Elsevier Inc. All rights reserved.)

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.

Background: In 2015 in France, 585,560 people were nursing home residents. A large body of studies has identified predictors of poor quality of life and poor adaptation in institution, mostly for residents without dementia. With 42 to 72% of these residents diagnosed with dementia, it is crucial to identify what factors prior to admission might have an impact on quality of life once the admission is finalized, in order to target specific domains of intervention, while the person still lives at home and after his/her admission., Methods: QOL-EHPAD is a prospective, multi-centred, observational cohort study. At baseline, we will collect retrospective data on the life of 150 persons with dementia and their caregivers. These data will refer to the conditions of admission to a nursing home (emergency admission, involvement in the decision, admission from home or from the hospital) and to the 6 months prior to the admission of the person with dementia: sociodemographic and medical data, psychological tests, information on quality of life, satisfaction, behaviour, and nutrition. Similar data about life in the nursing home will be collected after 6 months, along with information on adaptation of the person with dementia to his/her new living environment. We will use univariate regression analyses followed by stepwise linear regression models to identify which factors pertaining to life at home are associated with quality of life and adaptation after 6 months., Discussion: This study will provide data on the impact of institutionalization on quality of life and the determinants of a successful institutionalization in people with dementia. This could be helpful in setting up targeted interventions to prepare admission into a nursing home before the actual admission and to accompany both the caregiver and the person with dementia throughout this process.

Background: Given the rate of the undiagnosed cases of dementia and the consequences of inappropriate care, understanding the factors that explain the use of medical and health care in dementia is a critical concern. Our objective was to identify the psychosocial and medical determinants of use of care in dementia., Methods: The study sample consisted of 308 participants: the persons with dementia (n = 99) selected from three French population-based cohorts (i.e. PAQUID, 3C, AMI), their family caregivers (primary, n = 96, and secondary, n = 51), and their general practitioners (n = 62). Use of care in dementia was considered according to two indicators: (1) recourse to secondary care, (2) number of community and health services used., Results: Multiple logistic models including sociodemographics and psychosocial variables revealed that the determinants of nonuse of care are similar both for the recourse to secondary care and for the number of community and health services used: lack of education and the contribution of the people with dementia to the decisions regarding their own care and dementia care services in the community area. In addition, satisfaction of the primary caregiver with the services used by his/her relative is associated with non-recourse to secondary care., Conclusions: Taken together, these results highlight the predominant role of psychosocial factors in the use of care in dementia and the importance of addressing this issue through an integrative approach including psychological, social, medical, and family dimensions.

Objectives: Quality of life is regarded as a major outcome in epidemiologic research, especially in the older population. Nevertheless, some cohort studies lack a specific instrument to evaluate it. The aim of this study was to propose a subjective quality of life proxy using easily accessible items, available in most epidemiologic studies., Method: We used data from the PAQUID (Personnes Agées Quid) cohort study (1991-1992, France). A subjective quality of life proxy was created based on items on positive affects, subjective health, and life satisfaction. Logistic and linear regression models as well as Cox survival models were used to assess the association between the proxy score and depression, dependence, cognitive complaints, adverse life events, comorbidities, and death. Analyses were replicated in an independent cohort study, AMI (Approche Multidisciplinaire intégrée; 2007-2008, France). All models were adjusted for age, sex, Mini-Mental State Examination score, and place of residence., Results: In the PAQUID sample (n = 2135), we found significant associations between the proxy score and the selected health outcomes. We found the same associations in the AMI cohort., Conclusion: This proxy might be useful when no gold standard for quality of life assessment is available or when in need of a short but reliable instrument that will not require extended administration time.

Objective: General practitioners (GPs) play a major role in the assessment of dementia but it is still unrecognized in primary care and its management is heterogeneous. Our objective is to describe the usual practices, and their determinants, of French GPs in this field., Methods: GPs' characteristics and practices when facing cognitive decline were collected through a telephone interview and a postal questionnaire. A descriptive analysis of all study variables was conducted. The study of quantitative explanatory variables was done by testing the equality of means and the choice of qualitative variables was based on the chi-square independence test or Fischer test., Results: Hundred two GPs completed the study. GPs were in majority men, working in urban areas. Mean age was 54.4 years old. GPs' feeling of confidence and self-perception of follow-up of national recommendations is linked with their practices. Performing a clinical interview to assess cognitive impairment is linked with good communication skills. GPs feel less confident to give information about resources for dementia. The main reason alleged for underdiagnosis is the limited effectiveness of drug therapy., Conclusions: This study underlines the importance of GPs' feeling of confidence when managing cognitively impaired patients with dementia, and the need of increasing training in the field of dementia, which could improve the awareness of GPs about diagnosis and available resources.

Background: Anxiety is common in patients with cognitive impairment and dementia. However, whether anxiety is a risk factor for dementia is still not known. We aimed to examine the association between trait anxiety at baseline and the 10-year risk of incident dementia to determine to which extent depressive symptoms influence this relationship in the general population. Methods: Data came from 5,234 community-dwelling participants from the Three-City prospective cohort study, aged 65 years at baseline and followed over 10 years. At baseline, anxiety trait was assessed using the Spielberger State-Trait Anxiety Inventory (STAI), and depressive symptoms using Center for Epidemiologic Studies-Depression Scale (CESD). Use of anxiolytic drugs was also considered. Diagnoses of dementia were made at baseline and every 2 years. To examine the relationship between anxiety exposures and risk of incident dementia, Cox proportional hazard regression models were performed. Results: Taking anxiolytic drugs or having high trait anxiety (STAI score ≥ 44) increased the risk of dementia assessed over 10 years of follow-up [Hazard Ratio (HR) = 1.39, 95%CI: 1.08-1.80, p = 0.01 and HR = 1.26, 95%CI: 1.01-1.57, p = 0.04, respectively], independently of a large panel of socio-demographic variables, health behaviors, cardio-metabolic disorders, and additional age-related disorders such as cardiovascular diseases, activity limitations, and cognitive deficit. However, the associations were substantially attenuated after further adjustment for depressive symptoms. Conclusion: Our findings suggest that depressive symptoms shape the association between anxiety trait and dementia. Further research is needed to replicate our findings and extrapolate our results to anxiety disorders.

Background: Despite several attempts to reach a single definition of frailty, no consensus has been reached. The definitions previously published have tried to prove its utility in predicting negative health outcomes. The objective of the present study is to compare the predictive value of 3 different frailty instruments, for selected outcomes., Methods: The study sample includes 1278 participants of the Three-City study, a French prospective population-based study, assessed for frailty using Fried's phenotype criteria, Rockwood's Frailty Index and Tilburg Frailty Indicator. To assess the risk of mortality, incident disability, falls, institutionalization and hospitalization for a follow up period of 12 years, Cox proportional hazard models with delayed entry have been used. The area under the time-dependent ROC curve has been used to estimate and compare the ability of the three instruments of frailty to predict the previous adverse outcomes at 12 years., Results: Five hundred ninety four participants were identified as non-robust with Fried's criteria; 169 with Rockwood's FI and 303 with TFI. The three scales consistently identified 91 participants as non-robust and 574 as robust. Rockwood's FI was a statistically significant predictor of mortality, incident disability and falls, and a strong predictor of hospitalization., Conclusion: In the absence of a "gold standard" definition of frailty, a debate on what measures and how to include them is open. A clue may be that one should select the appropriate definition according to the to-be predicted outcome, the setting and the underlying etiology of frailty., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: The aim of this study was to develop short forms of the STAI-Y trait and state scales and associated norms suitable for the screening of anxiety in elderly populations., Method: This study was based on population-based cohorts of older persons from two epidemiological French studies that each included one subscale of the STAI-Y, i.e. state and trait anxiety scales. For both scales, the most discriminative items were retained and their factorial structure was examined using principal components analysis. Internal consistency (Cronbach's alpha) was estimated and cut-offs and norms were computed., Results: A 10-item STAI-Y version produced scores similar to those obtained with the full form of the STAI-Y. The factorial structure of the shortened form is comparable to that of the full scales. Results showed good internal consistency (alpha coefficients were 0.92 and 0.85 for short STAI-Y state and trait scales, respectively). Moreover, both short STAI-Y state and trait scales correctly classified 88% of the participants using a cut-off point of 23. Norms for both short trait and state anxiety scales are provided according to age, gender, educational level and depressive symptoms., Conclusion: Both shortened scales have similar factorial structure and internal consistency to the longer scales and classify anxious/non-anxious elderly with acceptable accuracy. The shorter form is likely to be more acceptable to elderly persons through reduction of fatigue effects.

Background: Structural gray matter characteristics of anxiety remain unclear. The aim of this study was to assess the influence of current depressive symptoms and history of depression on the gray matter characteristics of trait anxiety., Methods: Structural magnetic resonance imaging (MRI) data from 393 individuals aged 65 years or older were used. Regions of interest (ROIs) included the amygdala, anterior cingulate cortex (ACC), insula, orbitofrontal cortex (OFC), and temporal cortex. Trait anxiety was measured by the State-Trait Anxiety Inventory (STAI). Depression and depressive symptoms were measured using DSM-IV criteria and the Center for Epidemiological Studies Depression Scale (CESD)., Results: After adjustments for sociodemographics and health-related variables, anxiety had a significant influence on the gray matter characteristics in all cortical ROIs. First, in participants without depression antecedents, higher trait anxiety was associated with a larger cortical thickness in all cortical ROIs. Second, in participants with a previous history of depression, higher trait anxiety was associated with a smaller cortical thickness in all cortical ROIs., Conclusions: These results suggest that anxiety is related to cortical thickness differently in healthy older adults and in older adults with psychiatric antecedents. Anxiety associated with thinner cortical areas could reflect symptoms of a specific type of depression or a vulnerability to develop depression.

Introduction: This study explored whether integrity of executive functioning is required for good neurocognitive insight (NI) in subjects with schizophrenia., Methods: NI was measured by subtracting executive difficulties (errors in the Modified Card Sorting Task) from executive cognitive complaints (Subjective Scale to Investigate Cognition in Schizophrenia) in 40 outpatients with schizophrenia and 42 normal controls. The schizophrenia sample was a priori divided into two subgroups on the basis of executive level. Multivariate analyses were conducted to compare groups and to control for potential confounding factors., Results: Only the schizophrenia dysexecutive subgroup had a poorer NI compared to normal controls. Group differences remained significant after adjustment for potential confounding factors (education, depression, anxiety and self-esteem)., Conclusion: These results provide support for the hypothesis that executive dysfunctioning is a limiting factor for NI, independently from depressive and anxiety symptoms.

Given changing and subjective aspects of quality of life, the current assessment scales are often encompassing and not very adapted for older people. Thus, the present validation study has several objectives: 1) To elaborate a specific measure of the quality of life of older people, given the characteristics and problems of this population; 2) To propose a simple scale to use for any health care professional and fast passation to encourage the inclusion of such measures in the framework of a comprehensive care of the elderly; 3) To validate this scale in a large cohort of retired older farmers. This scale resulted in 14 items illustrating the various dimensions of quality of life of older people. It was then proposed for validation in a large cohort of retired elderly farmers of 65 years and over, and living at home. After exploratory factor analysis of subjects' responses to the EQVPA, five items were extracted explaining 48.8% of the total variance. Its internal consistency was satisfactory (Cronbach's alpha=0.72). The five items permitted to assess daily and social activities in environment, social and familial relationships, physical and functional health and mental health. The results showed that quality of life is significantly correlated with greater life satisfaction, more social support and social network, higher level of subjective health, lower level of functional impairments, lower level of anxious and depressive symptoms, and lower level of routinization. Validation of the tools such as EQVPA seems important for the prevention and preservation of the quality of life of older people.

Objective: The objective of this study is to compare cognitive decline of elderly people after entering an institution with that of elders living in the community with similar clinical conditions., Design: The Personnes Agées QUID (PAQUID) cohort is a prospective population-based study which included, at baseline, 3777 community-dwelling people aged 65 years and older. Participants were followed-up for 22 years. Among those who were nondemented and living at home at baseline, 2 groups were compared: participants who entered a nursing home during study follow-up (n = 558) and those who remained living at home (n = 3117). Cognitive decline was assessed with Mini-Mental State Examination (MMSE), Benton visual retention test, and verbal fluency Isaacs Set Test., Results: After controlling for numerous potential confounders, including baseline MMSE and instrumental activities of daily living scores, incident dementia, depressive symptoms, and chronic diseases, nursing home placement was significantly associated with a lower score on MMSE between the last visit before and after institutionalization (difference of 2.8 points, P < .0001) and greater further cognitive decline after institutionalization (difference of 0.7 point per year, P < .0001). Similar results were found for the Benton memory test. In a second series of analysis in which the persons who became demented over the study follow-up were excluded, the results remained unchanged., Conclusions: The present study suggests that institutionalized elderly people present a greater cognitive decline than persons remaining in the community. The reasons of that decline remain unclear and may be related to physical and psychological effects of institutionalization in elderly people., (Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Although ambulatory data collection techniques have been used in elderly populations, their feasibility and validity amongst elderly individuals with cognitive impairment and amongst couples remains unexplored. The main objective of this study is to examine the validity of Ecological Momentary Assessment (EMA) in elderly persons with or without cognitive impairment and their spouses. The sample included 58 retired farmers (mean 77.3 years, standard deviation [SD] 5.5) with or without cognitive impairment, recruited within a French cohort and 60 spouses (mean 73.4 years, SD 6.9). The presence of cognitive impairment determining by a panel of specialized neurologists permitted to define two groups: "The Cognitive Impairment Group" and "The Control Group". EMA procedures consisted of repeated telephone interviews five times per day during four days for each spouse. Our results demonstrate the validity of EMA procedures through a 92.1% level of compliance, the absence of fatigue effects, and the lack of evidence for major reactivity to the methods. However, the specificity of our sample may explain the acceptance (42%) and response (75%) rates and may reduce the generalizability of the results to the general population of elderly individuals. Finally, the validation of such techniques may contribute to future research examining community-dwelling elderly individuals and their spouses., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: This exploratory study investigated the associations of individual characteristics of both persons with dementia and family caregivers with the nutritional status of caregivers., Methods: This cross-sectional study was conducted at home by psychogerontologist within the frame of a community gerontological center in rural areas of south west France. The study participants comprised 56 community-dwelling persons with dementia (mean 80.7 years, SD 6.5) and 56 family caregivers (mean 70.9 years, SD 11.0). Persons with dementia were assessed with Mini-Mental State Examination (MMSE), Basic Activities Of Daily Living (ADL), Instrumental ADL (IADL), and NeuroPsychiatric Inventory (NPI), and family caregivers with the Burden Interview (Zarit scale), the State-Trait Anxiety Inventory (STAI Y-B), the Center for Epidemiologic Studies Depression Scale (CES-D), the emotional impact measure of NPI and the Autonomy, Gerontology and Group Resources scale (AGGIR scale). For both, nutritional status was evaluated using the Mini Nutritional Assessment (MNA®)., Results: Among family caregivers, 32.1% were at risk of malnutrition and 5.4% were malnourished, and among people with dementia, 58.9% and 23.2%, respectively. NPI severity score of apathy of persons with dementia (Beta = -0.342, p = 0.001), dependency on AGGIR scale (Beta = -0.336, p = 0.002), and CES-D score of caregivers (Beta = -0.365, p = 0.001) were associated with caregivers' MNA score (Adjusted R 2 = 0.480, p < 0.001)., Conclusion: These preliminary findings emphasize the need for routine assessment of depressive symptoms, functional and nutritional status in dementia family caregivers, and confirm the value of investigating caregivers' nutritional risk through an integrative view including psychosocial approach.

Objective: To assess the relationship between state anxiety and performance on neuropsychological tests in older adults., Methods: Nine hundred fifty-five community-dwelling individuals without dementia age 66 and over were evaluated at home by a psychologist. State anxiety was measured by the State-Trait Anxiety Inventory Y. Cognitive assessment included general cognitive functioning (Mini-Mental State Examination), verbal fluency (Isaacs Set Test), short-term visual memory (Benton's Visual Retention Test), speed of information processing/visuomotor coordination (Digit Symbol Coding), conceptual knowledge (Similarities), episodic memory (Verbal Paired Associates), and working memory (Digit Span forward/backward). Covariates included age, education, sex, depressive symptoms (Center for Epidemiologic Studies-Depression Scale), subjective health, subjective cognitive complaint, chronic diseases, functional abilities in basic and instrumental activities of daily living, and use of medication., Results: Adjustments for confounders substantially modified the relationship between state anxiety and cognitive performance. Multivariate analyses revealed positive effects of mild and moderate state anxiety for verbal fluency and general cognitive functioning, respectively. High and moderate anxiety also had beneficial influence on short-term visual memory performance in participants with low education level and on the speed of information/visuomotor coordination processing in participants using medications., Conclusions: These results suggest that when confounders are taken into account, state anxiety in older adults is not necessarily deleterious for cognitive performance and has no appreciable negative effect on many cognitive domains or can even be beneficial. Relationships between state anxiety and cognitive performances are complex because they are influenced by many factors and differ according to anxiety severity and cognitive domains., (Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to explore the associations of individual characteristics of both older people with dementia and family caregivers with the nutritional status of older people with dementia., Methods: This cross-sectional study comprising 56 community-dwelling older persons with dementia and 56 family caregivers was conducted at home by a psychogerontologist working for a community gerontological center. Older people with dementia were assessed with Mini mental state examination, Instrumental Activities of Daily Living, Activities of Daily Living (ADL), and NeuroPsychiatric Inventory (NPI) and family caregivers with the Burden Interview (Zarit scale), the State-Trait Anxiety Inventory, the Center for Epidemiologic Studies Depression Scale, and the emotional impact measure of NPI. For both, nutritional status was evaluated using the Mini Nutritional Assessment (MNA)., Results: Among older people with dementia, 58.9% were at risk of malnutrition and 23.2% presented a poor nutritional status, and among the family caregivers, 32.1% and 5.4%, respectively. The MNA score of older people with dementia was strongly and inversely associated with the ADL score and was strongly and positively associated with the MNA score of family caregiver. These two factors significantly explained 32% of variation of MNA score of older people with dementia., Conclusions: These findings confirm the value of investigating nutritional deficiencies in dementia within the caregiving dyad and suggest that the functional status of older people with dementia and the nutritional status of family caregivers should be carefully assessed., (Copyright © 2012 John Wiley & Sons, Ltd.)

Background: Anxiety has been shown to often precede depression in children and young adults. Only a small number of investigations have examined this form of comorbidity in older adults and the temporal relationship of these syndromes remains unclear. The objective was to verify whether trait anxiety predicts incident/recurrent depressive symptomatology in older adults independently of variables susceptible to explain this relationship in this population, such as cognitive complaints, subjective health, and baseline depressive symptoms., Methods: A random sample of 4,649 individuals aged 65 years or older from the Three-City Study, a prospective longitudinal study with a 10-year follow-up, was used. Incident and recurrent depressive symptomatology were determined by Center for Epidemiological Studies Depression Scale cutoff scores. Anxiety was measured using the trait scale of the State-Trait Anxiety Inventory. Cox proportional hazards models were used to determine the independent risk of depressive symptomatology for baseline anxiety, cognitive complaints, subjective health, and depressive symptoms, adjusting for sociodemographic, mental health, and physical health covariates., Results: Incident depressive symptomatology was independently predicted by baseline anxiety, depressive symptoms, cognitive complaints, and subjective health. Recurrent depressive symptomatology was independently predicted by baseline anxiety and depressive symptoms, but not by cognitive complaints and subjective health. Anxiety was associated with a higher risk of incident depressive symptomatology only in participants without a history of a major depressive episode, and with a higher risk of recurrent depressive symptomatology in men than in women., Conclusions: Trait anxiety constitutes an important independent risk factor for subsequent depressive symptomatology in older adults., (© 2013 Wiley Periodicals, Inc.)

Disabilities in the Instrumental Activities of Daily Living (IADL) are frequently observed in older adults. A restriction in the daily life activities in the elderly may be related to a process of routinization induced by homogenization of activities, in addition to its association with emotional states. The relationship between level of functional disability for IADLs and preferences for routines was explored in 207 non-demented French participants (Mage = 84.2 years, age range: 78-96 years) from the PAQUID cohort study. Multinomial regressions analyses showed that preferences for routines were significantly associated with a higher risk of restriction for at least two functional activities, after adjusting for sociodemographic and psychological variables. However, this association was non significant after controlling for cognitive variables. These findings add new elements for understanding the effect of routinization in the disability process in older persons in that preferences for routines could constitute a risk factor of IADL restriction, similar to cognitive decline.

Background: Whereas the State-Trait Anxiety Inventory (STAI-Y) is probably the most widely used self-reported measure of anxiety, the lack of current norms among elderly people appears to be problematic in both a clinical and research context. The objective of the present study was to provide normative data for the STAI-Y trait scale from a large elderly cohort and to identify the main sociodemographic and health-related determinants of trait anxiety., Methods: The STAI-Y trait scale was completed by 7,538 community-dwelling participants aged 65 years and over from the "Three City" epidemiological study. Trained nurses and psychologists collected information during a face-to-face interview including sociodemographic characteristics and clinical variables., Results: The scale was found to have good internal consistency (Cronbach's α = 0.89). Norms were stratified for gender and educational level differentiating persons with and without depressive symptoms. Multivariate linear regression found the STAI-Y trait score to be significantly associated with female gender, psychotropic medication use, higher depressive symptoms, higher cognitive complaints, and with an interaction between subjective health and marital status. Age was not associated with the total score., Conclusion: This study provides norms for the STAI-Y trait scale in the general elderly population which are of potential use in both a clinical and research context. The present results confirm the importance of several factors previously associated with higher trait anxiety in the elderly. However, more research is needed to better understand the clinical specificities of anxiety in the elderly and the improvement of assessment.

Background: The latest version of the State-Trait Anxiety Inventory (STAI-Y) is commonly used in older adults, even though this anxiety scale was developed in and for young adults. Norms and associated factors of the STAI-Y are lacking for older adults in the general population. The objectives of the present study were to produce norms on the STAI-Y State scale for older adults using a large sample of older adults selected from a general population and to examine the sociodemographic and health-related factors associated with the STAI-Y State score., Methods: 993 community-dwelling individuals aged 66 years and over from the PAQUID study were evaluated at home by a psychologist for the following variables: age, education, marital status, proximity of relatives, self-assessment of income sufficiency, occupation during active life, depressive symptomatology, objective and subjective health, objective and subjective cognitive functioning, adverse life events, activities of daily living, drug use, and cigarette consumption., Results: Norms were stratified for age, sex, and education and were produced separately for older adults with and without depressive symptomatology. Multivariate analyses revealed that younger age (66-79 years), female sex, lower education, perception of income insufficiency, depressive symptomatology, poor subjective health, subjective cognitive complaints, psychotropic drugs use, and recent adverse life events were independently associated with higher STAI-Y State score., Conclusions: This study provides norms for the STAI-Y State anxiety inventory in a general population of older adults and indicates the specific factors linked with state anxiety. Such factors should be taken into account by clinicians in order to better understand state anxiety in older adults.

The concept of routinization in the elderly is defined as the performance of environmental, behavioral, and social activities, in the same manner over time. First, routines are described from a developmental point of view and a multidisciplinary approach. Second, the development of this concept in recent studies is analyzed. Different functions of routinization are discussed as a general model of disability. Based on the results of the PAQUID epidemiological investigation, routinization of behaviors and activities in older persons appears as a complex phenomenon that cannot only be understood in terms of adaptive functioning. Various relationships were found between preference for routines and vulnerability factors in psychological, functional or cognitive domains. Finally, the theoretical issues and clinical implications are discussed with regard to distinct dimensions of the routinization concept, including its relevance for identifying the vulnerability markers in the elderly, and improving early detection, prevention and management of adaptation difficulties in this population.

Qualitative differences in control, distance and relationship with other people were examined using multidimensional and configurational analyses with data from the SHiPA. The SHiPA, developed by Bouisson (2005), contributes to inform on psychological functioning the elderly, using open responses, no limited into choices, and assesses some aspects of distress and adaptative resources in common daily life events that are frequently causes of difficulties. Based on scores in differential weighting of SHiPA dimensions, multivariate analyses revealed five psychological functioning profiles, characterized by anxiety, depression, cognition, internality, satisfaction with life, and routinization levels. Analyse of the differences between SHiPA profiles suggested a first discrimination depending on the individuals, psychological resources level, and the situation of subjects in third and fourth age.

Objectives: Although routine activities are important to normal functioning across all phases of life, their expression in older people may be associated with cognitive and psychological vulnerability., Methods: The relationship between these variables was explored in 235 elderly French participants from the PAQUID cohort study., Results: Cross-sectional positive associations were found between preferences for routines, anxiety and depression levels, and cognitive complaints. General cognitive decline over a three-year time span was also associated with a greater desire for routines at the end of this period., Conclusions: The progressive routinization of behaviors and activities in older people is discussed as a marker of affective and cognitive vulnerability, and its understanding has potential for improving the early detection of adaptation difficulties and overall care in this population., (Copyright (c) 2006 John Wiley & Sons, Ltd.)

The cognitive reserve hypothesis proposes that a high educational level could delay the clinical expression of Alzheimer's disease (AD) although neuropathologic changes develop in the brain. Therefore, some studies have reported that when the clinical signs of the disease emerge, high-educated patients may decline more rapidly than low-educated patients because the neuropathology is more advanced. However, these studies have only investigated the decline of global cognition or an isolated cognitive process. To study the differential deterioration pattern of several cognitive processes according to education, the performance of 20 AD patients with a high educational level and a low educational level were compared with the performance of 20 control subjects on a neuropsychological battery. The results showed that cognitive deterioration of AD patients is different according to education, although the global performance was similar in AD patients. The high-educated patients exhibited greater impairment of abstract thinking whereas the low-educated patients showed greater impairment of memory and attentional function. This confirms that some cognitive processes, such as abstract thinking, decline more rapidly in high-educated patients whereas others seem to evolve more slowly if compared to low-educated patients. In this latter case, high-educated patients may still benefit from cognitive reserve after the diagnosis of the dementia.