The aim of the thesis was to investigate the importance of physical function for survival in very old people, and furthermore, whether physical exercise could influence physical function, cognitive function, and dependence in activities of daily living (ADLs) in older people with dementia living in nursing homes. The world’s population is ageing. Given the age-related increase in chronic disease such as dementia   and compounded by physical inactivity, the prevalence in need for assistance and are in daily activities in older people is expected to increase in the near future. Gait speed, a measure of physical function, has been shown to be associated with health and survival. However, studies of the  oldest  people  in  the  population,  including  those  dependent  in ADLs,  living  in  nursing  homes  and  with  dementia,  are  few.  Moreover,  in people  with  dementia  physical  exercise  may  improve  physical and  cognitive function and  reduce  dependence  in  ADLs.  Further large studies with high methodological quality and with designs incorporating attention control groups are needed in this population. In addition, no study has compared exercise effects between dementia types. The association between gait speed and survival was investigated in a population based cohort study of 772 people aged 85 years and over. Usual gait speed was assessed over 2.4 metres and mortality followed for five years. Cox proportional hazard regression models adjusted for potential confounders were used in analyses. Effects of physical exercise in people with dementia were investigated in a randomised controlled trial that included 186 participants with various dementia types living in nursing homes. Participants were allocated to the High-Intensity Functional Exercise  (HIFE) program or a seated control activity, which both lasted 45 minutes and held five times  fortnightly for four months. Dependence in ADLs was assessed with Functional Independence Measure and Barthel ADL Index, and balance with Berg Balance Scale. Usual gait speed was evaluated over 4.0 metres in two tests; first using habitual walking aid if any, and thereafter without walking aid and with minimum living support. Global cognitive function was assessed using the Mini-Mental State Examination, the Alzheimer’s Disease Assessment Scale-Cognitive subscale, and   executive function using Verbal fluency. Blinded testers performed assessments at baseline, four (directly after intervention completion) and seven months. Analyses used linear mixed models in agreement with the intention-to-treat principle. Gait speed was found to be an independent predictor of five-year all-cause mortality, where inability to complete the gait test or a gait speed below 0.5 iv meters per second (m/s) was associated with higher mortality risk. In analyses of exercise effects on ADLs there was no difference between groups in the complete sample. Interaction analyses showed a difference in exercise effect according to dementia type at seven months. Positive between-group exercise effects were found for dependence   in ADLs in participants with non-Alzheimer’s type of dementia (non-AD) at four and seven months. In balance, a difference between groups was found at four but not at seven months in the complete  sample, and interaction analyses indicated a difference in effect according to dementia type at four and seven months. Positive between-group exercise effects were found in participants with non-AD.  No difference between groups in gait speed was found in the complete sample, where the majority habitually walked with a walking aid. In interaction analyses exercise effects differed according to walking aid use. Positive between-group exercise effects in gait speed were found in participants that walked unsupported at four and seven months. No difference between groups in cognitive function was found in the complete sample. The effects of exercise on gait speed and cognitive function did not differ according to sex, cognitive level, or dementia type. In conclusion, among people aged 85 or older, including those dependent in ADLs and with dementia, gait speed seems to be a useful clinical indicator of health status. Inability to complete the gait test or a gait speed below 0.5 m/s appears to be associated with higher five-year mortality risk. In older people with mild to moderate dementia living in nursing homes, a four-month high-intensity functional exercise program appeared to attenuate loss of dependence in ADLs and improve balance, albeit only in participants with non-AD type of dementia. Further studies are needed to validate this result. Furthermore, exercise had positive effects on gait speed when tested unsupported, in contrast to when walking aids or minimum support were used. The result implies that the use of walking aids in the gait speed test may conceal exercise effects. The exercise program had no superior effects on global cognition or executive function when compared with an attention control activity. This thesis suggests that, in older people with dementia, exercise effects on physical function rather than cognitive function may explain effects on dependence in ADLs.

The aim of this thesis was to study the biomarker homocysteine and other novel potential vascular risk factors for dementia. In an out-patient based study of a cohort of 926 consecutive subjects referred to our Memory Unit during 1996―2000, serum-folate was lower and total plasma homocysteine (tHcy) and serum methyl malonate were higher in subjects being prescribed with B12. In the subgroup diagnosed with dementia and with a positive family history of dementia, tHcy was higher than in the subgroup diagnosed as non-demented. It is necessary to supplement subjects with vitamin B12 deficiency with B12, but our results indicate that it is not sufficient with B12 alone because this gives rise to intracellular folate deficiency. We also found indications of a genetic component in dementia because tHcy was higher in the group with a positive family history of dementia. These findings prompted further studies of homocysteine metabolism. The frequency of mutations in the gene for folate receptor-α (FOLR-1), and the fibrinolytic pattern in dementia and non-dementia were studied in the two cohorts DGM (n=300) and AS (n=389). The DGM cohort is a consecutive series of subjects attending our Memory Care Unit for investigation of suspected cognitive problems or dementia between 2003 - 2007. The AS (= active seniors) cohort comprises retired, apparently healthy subjects from central Sweden, actively participating in study circles. A rare haplotype in the FOLR-1, with mutations in two nearby loci, was discovered, possibly associated with lower serum-folate and higher tHcy concentrations and was more frequent in the DGM group. The transport of folate to the CSF was studied in the DGM-cohort. Dementia with a vascular component was associated with a lower CSF to serum folate ratio indicative of reduced transport of folate to the CSF and further to the brain. The vascular endothelial derived fibrinolytic markers tPA, tPA/PAI-1-complex, and vWF were not only higher in vascular dementia (VaD) but also in Alzheimer’s Disease (AD) when compared to the AS group. The impaired fibrinolytic activity in both vascular dementia and in AD is a novel finding, signifying a vascular component in the development of dementia. In conclusion we found that both hereditary and nutritional background factors were linked to dementia and furthermore that a dysregulated fibrinolysis was linked to both VaD and AD.

La presbyacousie est une maladie qui concernerait plus de 12 millions de Français mais qui reste peu connue. Si elle n'est pas traitée tôt, elle peut entraîner de graves complications comme des troubles de la communication, de la dépression et des troubles cognitifs. Le constat actuel est que très peu de presbyacousiques sont traités, et lorsqu'ils le sont, le résultat semble insuffisant. L'objet de cette thèse est de proposer à partir des connaissances actuelles, des solutions adaptées aux besoins de ces patients, du dépistage à la réadaptation. Trois études ont été menées : l'étude « AcoumAudio », déclinée en trois volets a montré que l'acoumétrie vocale était un bon test de dépistage de la surdité chez les personnes âgées, d'évaluation du degré de perte auditive et de mesure du gain auditif fonctionnel après réhabilitation ; l'étude 1 intitulée « Privation sensorielle auditive et fonctionnement cognitif chez le sujet âgé (ACADem) » a montré que le port d'un appareillage auditif pouvait préserver d'une dégradation cognitive ; et l'étude 2 intitulée « Faisabilité d'une Réhabilitation Conjointe Audioprothétique et Orthophonique pour les Presbyacousiques (FRéCAOP) » a montré qu'il était possible de proposer une prise en charge plus complète et efficiente de la presbyacousie, dans un circuit de l'audition du GRAPsanté, incluant nécessairement un Aidant / Presbycusis is a disease that occurs in more than 12 million French people, but which is still not well known. If it is not treated early, it can lead to serious complications such as communication disorders, depression and cognitive impairment. The current situation is that very few presbycusic patients are treated, and when they are, the result seems insufficient. The purpose of this thesis is to propose using current data, solutions tailored to the needs of these patients, from screening to rehabilitation. Three studies were conducted: the "AcoumAudio" Study, available in three components showed that the vocal acoumetry was a good hearing test to screen elderly people, to evaluate the degree of hearing disorders and to measure functional auditory gain after rehabilitation; Study 1 entitled "Auditory deprivation and cognitive functioning in the elderly" showed that wearing hearing aids could preserve from cognitive deterioration; and Study 2 entitled "Feasibility of a Conjoint Rehabilitation involving audiology and speech therapy for presbycusis (FRéCAOP)" showed that it was possible to offer a more complete and efficient management of presbycusis, in the hearing circuit of GRAPsanté, necessarily including a caregiver

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study aimed to highlight the disciplines of the courses of Medicine, Nursing, Dentistry, Social Service, Physical Education and Psychology at the Federal University of Sergipe, which programs present subjects related to aging. It also identifies if during these courses the senior was focused as a biopsychosocial being, if these professionals felt the need for training in their area after higher education, if there was training and where it was performed. In this research, a qualitative and quantitative methodology was employed, characterized as a cross-sectional study, exploratory, descriptive and documentary. The following instruments were used: self-applied questionnaire with objective and subjective questions, and spreadsheet for analysis of the disciplines programs. In the qualitative analysis, it was used categorical analysis, and found subcategories were presented. In the quantitative analysis was calculated the frequency of appearance of the subcategories in the responses. For analyze the needs of the elderly, it was used the theory of hierarchy of human basic needs described by Maslow. The research was conducted at the Federal University of Sergipe UFS, hospitals and Basic Health Units UBS of the city of Aracaju-SE. Participated in this survey 265 graduated professionals by UFS and that serve the elderly, and of these, 91 were doctors, 71 nurses, 47 dentists, 32 social workers, 14 physical educators and 12 psychologists. It was obtained as a result that the training of health professional participants did not contribute significantly to the performance of these with the elderly population, according to their responses. It was observed that although formations are still focused on the treatment and prevention of diseases, except in the Social Service course that is more focused on the safety of the elderly, the elderly people needs on being esteemed and loved were seen by these professionals during their academic backgrounds. As additional results of this study were, it was obtained suggestions for improvement of the training, it were been shown that teamwork has hardly existed and that the failure in the education of professionals was reflected in difficulties in the practice of care for the elderly, except the psychologists who, despite having reported failures in their training, connected their difficulties to the physical limitations of the elderly. It was also observed that, despite the need for training of most of professionals, the few were trained and the most of the conducted trainings was organized by the Health Department of the Municipality of Aracaju, only for professionals working in their own UBS. . / Este estudo teve como objetivo evidenciar as disciplinas dos cursos de Medicina, Enfermagem, Odontologia, Serviço Social, Educação Física e Psicologia da Universidade Federal de Sergipe, que apresentam em seus programas assuntos referentes ao envelhecimento. Identifica, também, se durante a realização destes cursos o idoso foi enfocado como um ser biopsicossocial, se estes profissionais sentiram necessidade de capacitação na área após sua formação superior, se houve capacitação e onde estas foram realizadas. Nesta pesquisa, foi empregada uma metodologia qualiquantitativa, sendo a mesma caracterizada como estudo de corte transversal, de caráter exploratório, descritivo e documental. Como instrumentos, foram utilizados: questionário autoaplicável, com questões objetivas e subjetivas, e planilha para análise dos programas das disciplinas. Na análise qualitativa, foi utilizada análise categorial, na qual subcategorias encontradas foram apresentadas. Para análise quantitativa foi calculada a frequência de aparecimento das subcategorias nas respostas. Por sua vez, para análise das necessidades dos idosos, foi utilizada a teoria da hierarquia das necessidades humanas básicas descrita por Maslow. A pesquisa foi realizada na Universidade Federal de Sergipe UFS, em hospitais e em Unidades Básicas de Saúde UBS da cidade de Aracaju-SE. Participaram desta pesquisa 265 profissionais graduados pela UFS e que atendem idosos, sendo que destes, 91 são médicos, 71 enfermeiros, 47 odontólogos, 32 assistentes sociais, 14 educadores físicos e 12 psicólogos. Obteve-se como resultado nesta pesquisa que a formação dos profissionais de saúde participantes desta muito pouco contribuiu para a atuação destes junto à população idosa, conforme suas respostas. Observou-se que, apesar das formações ainda estarem voltadas para o tratamento e prevenção de doenças, à exceção do curso de Serviço Social, que está mais voltado à segurança do idoso, as necessidades do idoso de estima e de amor foram vistas por estes profissionais durante suas formações acadêmicas. Como resultados adicionais deste trabalho, foram obtidas sugestões para a melhoria da formação dos profissionais, foram mostrados que o trabalho em equipe praticamente não tem existido e que a falha na formação superior dos profissionais refletiu-se em dificuldades na prática do cuidado ao idoso, à exceção dos psicólogos que, apesar de terem referido falhas em sua formação, relacionaram suas dificuldades às limitações físicas do idoso. Observou-se ainda que, apesar da necessidade de capacitação da maioria dos profissionais, poucos foram os que se capacitaram, e que a maioria das capacitações realizadas foi organizada pela Secretaria de Saúde do Município de Aracaju, apenas para os profissionais que trabalham em suas próprias UBS.

No description available.

Background: Management of atrial fibrillation (AF) is complex and requires active patient engagement in shared decision making to achieve better clinical outcomes, greater medication adherence, and increased treatment satisfaction. Efficacy in patient-physician interactions is a critical component of patient engagement, but factors associated with efficacy in older AF patients have not been well-characterized. Methods: We performed a cross-sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) study, a cohort study of older adults (age ≥ 65) with non-valvular AF and CHA2DS2-VASc score ≥ 2. Participants were classified according to their Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) score (lower: 0-44; higher: 45-50). Logistic regression analysis was used to identify sociodemographic, clinical (AF type, AF treatment, medical comorbidities), and geriatric (cognitive impairment, sensory impairment, frailty, independent functioning) factors associated with lower reported efficacy. Results: Participants (n = 1209; 49% female) had a mean age of 75. A majority (66%) reported higher efficacy in their interactions with physicians. Lower efficacy was associated with persistent AF (adjusted odds ratio [aOR] = 1.52; 95% confidence interval [CI] = 1.13-2.04) and with symptoms of depression (aOR = 1.67; CI = 1.20-2.33) or anxiety (aOR = 1.40; CI = 1.01-1.94). Decreased odds of lower efficacy were observed in participants with chronic kidney disease (aOR = 0.68; CI = 0.50-0.92) and those classified as pre-frail compared to those classified as not frail (aOR = 0.71; CI = 0.53-0.95). Conclusion: Older patients with persistent AF or symptoms of depression or anxiety have decreased efficacy in patient-physician interactions. These individuals merit greater attention from physicians when engaged in shared decision making.

Le vieillissement s’accompagne d’une altération globale des fonctions physiologiques notamment celles de l’immunité :on parle « d’immunosénescence ». Ce processus se traduit entre autre par l’installation d’un état inflammatoire chronique caractérisé par une augmentation des taux sériques de cytokines telles que l’interleukine(IL)-6 et des protéines de la phase aigüe. Cet état proinflammatoire serait incriminé dans le déclin des fonctions physiologiques, la fragilité et les syndromes gériatriques. Par ailleurs, les maladies cardiovasculaires, la dépression et l’infection chronique par le Cytomégalovirus (CMV) sont également associés à un état inflammatoire chronique. La prévalence de ces comorbidités étant importante chez les patients gériatriques, ces maladies pourraient donc contribuer à l’association observée entre marqueurs de l’inflammation et les syndromes gériatriques.<p>Les infections représentent un problème majeur en gériatrie. Les cellules du système immunitaire inné jouent un rôle important dans les défenses contre les agents pathogènes. La reconnaissance de ceux-ci par les cellules dendritiques, les macrophages ou les monocytes fait intervenir une série de molécules telles que les récepteurs de la famille Toll (TLR). Certains travaux suggèrent que la fonction des cellules de l’immunité innée pourrait être perturbée chez les individus âgés mais ces données restent controversées.<p>Dans ce travail, nous souhaitons aborder les hypothèses suivantes :<p>•\ / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

Höftfrakturer är en vanlig ortopedisk orsak till sjukhusvård hos äldre. Att vara äldre och drabbas av höftfraktur är förknippat med hög risk för död. Stora fysiologiska avvikelser preoperativt samt försenad operation är kopplat till ökad risk för komplikationer och död. Äldre, sköra patienter har små marginaler och kan i samband med operation av höftfraktur behöva intensivvård. Det har uppmärksammats på ett sjukhus i Västra Götaland att denna patientgrupp vid ankomst till preoperativ avdelning ibland ej bedöms vara i operabelt skick, vilket medför ett förehavande där patienten förs till postoperativa intensivvårdsavdelningen för optimering inför operation. Syftet med studien är att undersöka hur det postoperativa förloppet hos äldre patienter med akuthöftfraktur påverkas efter införande av preoperativ optimering, stöttat av intensivvårdssjuksköterskan, på vårdavdelning. Studien har en kvantitativ ansats med en kombination av kvantitativ retroperspektiv registerstudie och en kvantitativ prospektiv interventionsstudie. Sammanställningen påvisar en minskning av den totala vårdtiden från 9 dagar till 6 dagar i median. Sammanfattningsvis betonas att intensivvårssjuksköterskan tillsammans med övriga professioner i teamet runt patienten har betydelse för att förbättra den äldre patientens möjlighet att återhämta sig efter akut höftfraktur.

Ce travail de thèse présente une approche clinique et thérapeutique visant à fournir de nouvelles techniques de soins pour les patients atteints de troubles neurocognitifs et notamment de maladie d’Alzheimer. Les serious exergames sont des jeux vidéo sérieux intégrant une activité physique. Ils peuvent constituer des outils de production d’environnement enrichi pour les utilisateurs, en associant notamment exercice physique et entraînement cognitif. L’objectif de cette thèse est d’explorer en quoi les serious exergames peuvent contribuer à la prise en charge non médicamenteuse des troubles neurocognitifs. Dans ce travail, nous avons réalisé deux types de contribution. Les premières contributions sont générales, l’une présente notre approche clinique intégrative combinant exercice physique et entraînement cognitif via l’utilisation de serious exergames, et l’autre présente des recommandations concernant l’usage des serious games. Les secondes contributions sont de nature expérimentale. La première expérimentation vise à vérifier une des bases théoriques de notre approche clinique. Les deux expérimentations suivantes constituent une évaluation de la mise en œuvre de notre approche. / This thesis presents a clinical and therapeutic approach aiming to create new care for patients with neurocognitive disorder. Serious exergames are serious video games integrating physical activity. Serious exergames could be tools to product enriched environment associating physical exercise and cognitive training. The aim of this thesis is to investigate whether serious exergames can contribute to the non-pharmacological management of neurocognitive disorders. In this thesis we have made two types of contributions. The first type are general contributions. One presents our integrative clinical approach associating physical exercise and cognitive training using serious exergames. The other one presents recommendations concerning the use of serious exergames. The second type of contributions are experimental. The first one aims to confirm a theoretical base of our clinical approach. The two other experiments assess the implementation of our approached in a population of patients with neurocognitive disorder.

En el presente trabajo se desarrolló un proyecto de negocio, el cual lleva por título “Sonrío Contigo”, donde se busca que los estudiantes de primeros ciclos de carreras como psicología, geriatría y enfermería puedan tomar cuidado y pasar tiempo con adultos mayores. La mayoría de ellos son padres de personas que no tienen suficiente tiempo en el día o que por alguna razón no los pueden dejar solos. Es importante mencionar que, se plantearon y desarrollaron diferentes hipótesis, las cuales desencadenaron en los experimentos con el propósito de validar el modelo de negocio. Así, también se desarrolló un plan concierge de varias semanas para conocer la respuesta del público objetivo hacia nuestro servicio. Finalmente, el presente trabajo cuenta con planes financieros para las diferentes áreas de la empresa y para los próximos tres años. De esta manera, se busca que el proyecto pueda ser sostenible y de desarrollo en el mediano y largo plazo. Cabe precisar que, también se tomó en cuenta los diferentes factores que aqueja la realidad hoy en día con el fin de poder determinar si el proyecto genera valor. / In the present work, a business project was developed, which is entitled "Sonrío Contigo", where it is sought that students in the first cycles of careers such as psychology, geriatrics and nursing can take care and spend time with older adults. Most of them are parents of people who don't have enough time in the day or who for some reason can't leave them alone. It is important to mention that different hypotheses were raised and developed, which were triggered in the experiments with the purpose of validating the business model. Thus, a concierge plan for several weeks was also developed to know the response of the target audience to our service. Finally, this work has financial plans for the different areas of the company and for the next three years. In this way, it is sought that the project can be sustainable and developmental in the medium and long term. It should be noted that the different factors that affect reality today were also taken into account to determine if the project generates value. / Trabajo de investigación