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This study is concerned with social factors related to neighborhood interaction and disengagement among elderly persons controlling for race. Utilizing a scale of neighborhood cohesion as an index of disengagement, it was hypothesized that racial groups would not differ significantly as to their respective levels of neighborhood cohesiveness and local interest. It was also hypothesized that age groups would not differ significantly as to their respective levels of neighborhood cohesiveness and local interest.

The purpose of this research was to determine if differences exist between the young/old (55-74) and the old/old (75+) regarding external search behavior and the importance of information sources.

This paper is drawn from oral history interviews from elderly residents who survived the Hurricane Katrina disaster in 2005. The aged faced similar challenges as their younger counterparts in the evacuation, aftermath, and rebuilding phases of the storm; however, their responses are limited by a number of factors that make the impact on their lives more intense. The majority of storm casualties in New Orleans were elderly. Those elderly who did survive the flooding experienced life-threatening physical and emotional stress. Life-altering changes, such as relocation from familiar neighborhoods to nursing homes in unfamiliar cities or a dependent life with family members, have often meant a loss of independence, a loss of community, and a loss of their sense of history. As natural storytellers, many elderly New Orleanians have important accounts to relate and oral history offers a method to preserve their narratives.

A relação entre a sarcopenia e o comprometimento cognitivo ainda não foi completamente avaliada, especialmente entre os idosos mais longevos. Sendo assim, foram desenvolvidos um estudo de revisão sistemática com meta-análise e um estudo empírico que compuseram a presente Dissertação. Os objetivos dos estudos foram: 1) identificar estudos prévios que investigaram a associação entre cognição e sarcopenia em idosos; 2) identificar a relação entre cognição e sarcopenia em idosos longevos da comunidade participantes de estudo prévio. No estudo de revisão sistemática com meta-análise, foi possível verificar que dos 274 estudos identificados, 10 foram incluídos na análise qualitativa, e 6 foram elegíveis para a meta-análise. A prevalência média de sarcopenia foi de 10,5%. O comprometimento cognitivo foi observado em 269/673 idosos com sarcopenia (40%), em comparação com 1,616/6,372 idosos não-sarcopênicos (25,3%). A sarcopenia foi significativamente associada ao comprometimento cognitivo (RR agrupado = 2,50; IC95% = 1,26-4,92; p = 0,008). A heterogeneidade entre os estudos foi alta e significativa (I² = 84%). O estudo empírico é referente à segunda onda de coleta de dados do estudo Fragilidade em Idosos Brasileiros (FIBRA), com dados coletados junto a 285 idosos da comunidade com 80 anos e mais de idade (M= 84.4 ± 3.9 anos; 68,8% feminino). A sarcopenia foi avaliada pelo instrumento SARC-F + CP e a cognição foi avaliada pelo MEEM e pela M-ACE. A média do escore do MEEM e da M-ACE foi significativamente mais baixa entre os idosos sarcopênico (13.99 ± 6.74) do que os não sarcopênicos (16.14 ± 6.29). Nas análises de regressão logística, a sarcopenia e a idade estiveram significativamente associadas ao comprometimento cognitivo no MEEM e a sarcopenia e a escolaridade estiveram significativamente associadas ao comprometimento da M-ACE. É necessário realizar mais estudos longitudinais para verificar os possíveis mecanismos entre a sarcopenia e a cognição, e também se a sarcopenia pode se fator de risco para o comprometimento cognitivo em idosos / The relationship between sarcopenia and cognitive impairment has not yet been fully evaluated, especially among the oldest old. Therefore, a systematic review with meta-analysis study and an empirical study were developed and compose the present dissertation. The objectives of the studies were: 1) to identify previous studies that have investigated the association between cognition and sarcopenia in the elderly; 2) to identify the relationship between cognition and sarcopenia in the oldest old participants of a previous study in the community. In the systematic review with meta-analysis study, 274 studies were identified, 10 were included in the qualitative analysis, and 6 were eligible for the meta-analysis. The average prevalence of sarcopenia was 10.5%. Cognitive impairment was observed in 269/673 elderly patients with sarcopenia (40%), compared with 1,616/6,372 non-sarcopenic elderly (25.3%). Sarcopenia was significantly associated with cognitive impairment (pooled OR = 2.50, 95% CI = 1.26-4.92, p = 0.008). The heterogeneity among the studies was high and significant (I² = 84%). The empirical study refers to the second wave of data collection from the Fragility in Brazilian Elderly study (FIBRA). Data were collected from 285 elderly in the community aged 80 years and over (M = 84.4 ± 3.9 years, 68.8% female). Sarcopenia was assessed by the SARC-F scale plus calf circumference, and cognition was assessed by MMSE and M-ACE. The mean MMSE and M-ACE scores were significantly lower among the sarcopenic elderly (13.99 ± 6.74) than the non-sarcopenic ones (16.14 ± 6.29). In the logistic regression analyses, sarcopenia and age were significantly associated with cognitive impairment in MMSE, and sarcopenia and schooling were significantly associated with M-ACE impairment. Further longitudinal studies are needed to verify the possible mechanisms between sarcopenia and cognition, and also whether sarcopenia may be a risk factor for cognitive impairment in the older people

MSc (Med), Population-Based Field Epidemiology, Faculty of Health Sciences, University of the Witwatersrand / Introduction: As people age, they become more vulnerable to ill‐health from acute and increasingly chronic diseases. This has elevated health care demand and utilisation in the elderly especially in the developed countries. In developing countries, ageing so far has not been a serious public health concern because of smaller number of older people in these countries. Recently however, the number of older adults in Sub‐Saharan Africa has increased rapidly, projected to stand at 130 million by 2050 from 30 million in 2000. This increase mirrors health related problems and has obvious public health implications. Thus, there is an urgent need to recognise and respond to health needs of the ageing populations in Africa. Objectives: To describe health care utilisation, health status and compare the proportions of adults aged 50+ years with moderate and poor health status to those with good health status. Another objective was to identify factors associated with health care utilisation among the elderly population in Kassena‐Nankana district, Ghana in 2007. Methods: Secondary analysis was performed on a cross‐sectional dataset collected between February and July 2007 through face‐to‐face interviews within the settings of the Navrongo DSS in Ghana. A total of 594 adults aged 50+ years participated in this study. The outcome variable was health care utilisation occurring in the last three years. Explanatory variables were grouped as predisposing, enabling and need‐related factors according to the behavioural model of health services utilisation. The predisposing variables were age, sex, marital status, ethnic background, education and smoking or use of smokeless tobacco. Occupation and financial position were included as enabling factors. Medical history of chronic conditions, self‐reported health status, difficulty with self‐care (e.g. bathing, washing, dressing etc), difficulty with picking up things in the last 30 days and cognitive impairment were grouped as need‐related factors. Logistic 382128 v univariate and multivariate regression analyses were conducted. STATA 10 statistical software was used to carry out this process. Results: The proportion of study participants reporting poor, moderate and good health status were 14.2%, 43.3% and 42.5% respectively. About one‐third (31%) of the study participants reported to have utilised health care services in the last 3 years. The following factors were identified as determinants of health care utilisation among the elderly rural Ghanaians: a medical history of at least one chronic condition (OR = 2.36; 95% CI = [1.49 – 3.75]; p < 0.001), self‐perceived health (OR = 2.00; 95% CI = [1.11 ‐ 3.59]; p = 0.021), age group (OR = 1.68; 95% CI = [1.07 ‐ 2.64]; p = 0.025), cognitive impairment (OR = 1.26; 95% CI = [1.02 – 1.56]; p = 0.032) and difficulty with picking up things in the last 30 days (OR = 0.76; 95% CI = [0.61 ‐ 0.96]; p = 0.021). Conclusion: Medical history of at least one chronic condition and poor perceived health status were the most pervasive determinants of health care utilisation. In addition, age group (60‐69 years), severe cognitive impairment and severe difficulty with picking up things in the last 30 days presented a significant influence on health care utilisation among the elderly population in rural Ghana. Recommendations: Provision of home‐based health care services could facilitate their accessibility for the elderly especially those with various difficulties. These factors could help health policy makers and health service providers identify and understand the situation of the elderly rural Ghanaians and consequently create conducive environment for providing appropriate health care services.

L'âge, les facteurs de risque vasculaire, l'inactivité physique sont connus comme facteurs de risque des syndromes démentiels.Le sommeil joue un rôle majeur dans la physiologie cérébrale. Le syndrome d'apnée du sommeil (SAS) est une pathologie fréquente chez les sujets âgés, surtout chez ceux souffrant de pathologie démentielle. Les études chez les patients atteints d'hypertension, et/ou de fibrillation atriale montrent une prévalence 2 à 3 fois plus élevée de SAS. Le cerveau et sa vascularisation forment un ensemble avec le coeur et les poumons qui fournissent l'apport en énergie et en oxygène. Une dynamique harmonieuse entre ces trois organes est nécessaire au fonctionnement physiologique du cerveau et un dysfonctionnement de cet ensemble pourrait engendrer une altération cognitive. Ce travail a pour but d'analyser les liens entre l'altération du débit vasculaire de la macro-circulation témoin de l'activité cardiaque, la pulsatilité du liquide céphalospinal reflétant l'hydrodynamique cérébrale, les paramètres respiratoires en lien avec les apnées du sommeil, et le statut cognitif du sujet âgé. En nous basant sur les résultats des bilans clinique, biologique, neuropsychologique, de l'imagerie par résonnance magnétique (morphologie et flux), des holters tensionnel et rythmique dans une population de 95 patients âgés cognitivement altérés, nous avons analysé les relations entre les paramètres concernant le cerveau, le coeur et les poumons. Cette approche révèle une relation entre ces trois systèmes et la cognition. La découverte d'une prévalence de plus de 70% de SAS dans cette population associée à d’autres résultats inattendus devrait faire l'objet de travaux ultérieurs / Age, vascular disorders, and lack of physical activity are known risk factors for dementia syndromes. Sleep has an important role in cerebral physiology. Sleep apnea syndrome (SAS) is common in elderly patients, especially in those with dementia. It was reported that the prevalence of SAS is 2 to 3 times higher in patients with arterial hypertension and/or atrial fibrillation. The brain and its vascular system cannot be considered separately from the heart and the lungs, which provide energy and oxygen supply. Cognitive alterations do not reflect the function of the brain only, and balanced dynamics between all these organs is necessary to maintain neurological functions. Therefore, the aim of this dissertation was to analyze the impact of altered cerebral blood flow in macrocirculation reflecting cardiac activity, pulsatility of the cerebrospinal fluid reflecting cerebral hydrodynamics, and SAS reflecting respiratory function on the cognitive status of elderly patients. Based on a clinical examination, geriatric and neuropsychological assessment, blood tests, structural magnetic resonance imaging, phase-contrast magnetic resonance imaging, 24-hour ambulatory blood pressure measurement, and 24-hour electrocardiogram in the population of 95 elderly patients aged 75 years and older, and suffering from neurodegenerative diseases, we analyzed the correlations between the neurological, cardiac, and respiratory parameters. This approach allowed an identification of associations between the abnormalities in these 3 systems and cognitive function. An unexpected finding, among some other abnormalities, was the prevalence of SAS exceeding 70%, which will be the subject of future research