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Un groupe de travail de l’International Academy on Nutrition and Aging (IANA,
M. Houles,
G. Abellan van Kan,
Y. Rolland,
S. Andrieu,
P. Anthony,
J. Bauer,
O. Beauchet,
M. Bonnefoy,
M. Cesari, [......],
S. Gillette-Guyonnet, M. Inzitari,
I. Jurk,
F. Nourhashemi,
E. Offord-Cavin,
G. Onder,
P. Ritz,
A. Salva,
M. Visser,
B. Vellas
[show abstract]
[hide abstract]
ABSTRACT: IntroductionLe recours à un outil d’évaluation simple et rapide pour repérer les personnes âgées fragiles vivant à domicile serait une
aide précieuse en gériatrie. L’objectif de cet article est de rapporter les conclusions d’un groupe de travail (formé au sein
de l’International Academy on Nutrition and Aging) sur la vitesse de marche en tant qu’outil de repérage de la fragilité.
MéthodeLe groupe a réalisé une revue systématique de la littérature scientifique sur le sujet, permettant l’écriture d’un document
écrit débattu par la suite lors d’une réunion de deux jours.
RésultatsLa vitesse de marche à allure normale apparaît comme étant un facteur de risque significatif de perte d’autonomie, d’institutionnalisation,
de chutes et/ou de décès. Pour prédire la survenue d’événements péjoratifs, la vitesse de marche semble au moins aussi sensible
que les outils composites (Fried’s criteria, Short Physical Performance Battery).
ConclusionLa vitesse de marche semble un outil intéressant et utile en pratique clinique pour identifier parmi les personnes autonomes
vivant au domicile, celles qui sont à risque d’événements péjoratifs. L’évaluation sur 4 m est la méthode la plus utilisée
dans la littérature.
IntroductionThe use of a simple, safe and easy to perform assessment tool, like gait speed, to evaluate vulnerability to adverse outcomes
in community-dwelling older people is appealing, but its predictive capacity is still questioned. The present manuscript summarises
the conclusions of an expert panel (from International Academy on Nutrition and Aging) in the domain of physical performance
measures and frailty in older people.
MethodsA systematic review of literature was performed prior to the meeting (Medline search and additional pearling of reference
lists and key-articles supplied by Task Force members). Manuscripts were retained for the present revision and reviewed and
discussed during a 2-day meeting.
ResultsGait speed at usual pace was found to be a consistent risk factor for disability, cognitive impairment, institutionalization,
falls, and/or mortality. In predicting these adverse outcomes over time, gait speed was at least as sensible as composite
tools (Fried’s criteria, Short Physical Performance Battery).
ConclusionAlthough more specific surveys need to be performed, there is sufficient evidence to state that gait speed identifies nondisabled
community-dwelling older people at risk of adverse outcomes and can be used as a single-item assessment tool. The assessment
at usual pace over 4 m was the most often used method in literature and might represent a quick, safe, inexpensive, and highly
reliable instrument to be implemented.
Mots clésVitesse de marche-Épidémiologie-Événement péjoratif-Sujet âgé-Facteur de risque
KeywordsGait speed-Epidemiology-Adverse outcome-Older adult-Risk factor
Les cahiers de l année gérontologique 04/2012; 2(1):13-23.
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Gabor Abellan Van Kan,
Y. Rolland,
S. Andrieu,
J. Bauer,
O. Beauchet,
M. Bonnefoy,
M. Cesari,
L.M. Donini,
S. Gillette-Guyonnet, M. Inzitari,
F. Nourhashemi,
G. Onder,
P. Ritz,
A. Salva,
M. Visser,
B. Vellas
[show abstract]
[hide abstract]
ABSTRACT: IntroductionThe use of a simple, safe, and easy to perform assessment tool, like gait speed, to evaluate vulnerability to adverse outcomes
in community-dwelling older people is appealing, but its predictive capacity is still questioned. The present manuscript summarises
the conclusions of an expert panel in the domain of physical performance measures and frailty in older people, who reviewed
and discussed the existing literature in a 2-day meeting held in Toulouse, France on March 12–13, 2009. The aim of the IANA
Task Force was to state if, in the light of actual scientific evidence, gait speed assessed at usual pace had the capacity
to identify community-dwelling older people at risk of adverse outcomes, and if gait speed could be used as a single-item
tool instead of more comprehensive but more time-consuming assessment instruments.
MethodsA systematic review of literature was performed prior to the meeting (Medline search and additional pearling of reference
lists and key-articles supplied by Task Force members). Manuscripts were retained for the present revision only when a high
level of evidence was present following 4 pre-selected criteria: a) gait speed, at usual pace, had to be specifically assessed
as a single-item tool, b) gait speed should be measured over a short distance, c) at baseline, participants had to be autonomous,
community-dwelling older people, and d) the evaluation of onset of adverse outcomes (i.e. disability, cognitive impairment,
institutionalisation, falls, and/or mortality) had to be assessed longitudinally over time. Based on the prior criteria, a
final selection of 27 articles was used for the present manuscript.
ResultsGait speed at usual pace was found to be a consistent risk factor for disability, cognitive impairment, institutionalisation,
falls, and/or mortality. In predicting these adverse outcomes over time, gait speed was at least as sensible as composite
tools.
ConclusionsAlthough more specific surveys needs to be performed, there is sufficient evidence to state that gait speed identifies autonomous
community-dwelling older people at risk of adverse outcomes and can be used as a single-item assessment tool. The assessment
at usual pace over 4 meters was the most often used method in literature and might represent a quick, safe, inexpensive and
highly reliable instrument to be implemented.
The Journal of Nutrition Health and Aging 04/2012; 13(10):881-889. · 2.69 Impact Factor
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M Inzitari,
E Doets,
B Bartali,
V Benetou,
M Di Bari,
M Visser,
S Volpato,
G Gambassi,
E Topinkova,
L De Groot,
A Salva
[show abstract]
[hide abstract]
ABSTRACT: The transition from independence to disability in older adults is characterized by detectable changes in body composition and physical function. Epidemiologic studies have shown that weight loss, reduced caloric intake and the reduced intake of specific nutrients are associated with such changes. The mechanisms underlying these associations remain unclear, and different hypotheses have been suggested, including the reduction of the antioxidant effects of some nutrients. Changes in muscle mass and quality might play a central role in the pathway linking malnutrition, its biological and molecular consequences, and function. A different approach aims at assessing diets by dietary patterns, which capture intercorrelations of nutrients within a diet, rather than by selective foods or nutrients: epidemiologic evidence suggests that some types of diet, such as the Mediterranean diet, might prevent negative functional outcomes in older adults. However, despite a theoretical and empirical basis, intervention studies using nutritional supplementation have shown inconclusive results in preventing functional impairment and disability. The present work is the result of a review and consensus effort of a European task force on nutrition in the elderly, promoted by the International Association of Gerontology and Geriatrics (IAGG) European Region. After the critical review of different aspects related to the role of nutrition in the transition from independence to disability, we propose future lines for research, including the determination of levels of inadequacy and target doses of supplements, the study of interactions (between nutrients within a diet and with other lifestyle aspects), and the association with functional outcomes.
The Journal of Nutrition Health and Aging 08/2011; 15(8):599-604. · 2.69 Impact Factor
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[hide abstract]
ABSTRACT: Mostly because of comorbidity and drugs consumption, older persons are often exposed to an increased risk of sub-optimal prescribing (SP). At present, few studies investigated the association between SP and long-term health outcomes. We examined the relation between SP and the risk of mortality and hospitalization in Italian older community-dwellers.
Older (65+ years) community-dwelling residents of a small town in Tuscany were enrolled in a longitudinal study. SP was defined as polypharmacy (use of 5+ drugs), prescription of inappropriate drugs (ID) according to Beers' criteria, and of potentially interacting drugs (PID), evaluated in 1995 and 1999. These three forms of SP were entered as time-dependent exposures into multivariable Cox regression analysis models, whose outcomes were mortality and hospitalizations through 2003.
Of 1022 participants (mean age 73.0 +/- 6.8, 57% women), 220 were evaluated in 1995, 234 in 1999 and 568 in both waves. In univariate analysis, mortality was two-fold higher in participants with polypharmacy (73.4/1000 person/years, 95% CI 58.2-92.4 vs. 34.1, 95% CI 29.7-39.2; p < 0.001) or PID (72.7/1000 person/years, 95% CI 46.3-113.9 vs. 38.0, 95% CI 33.5-43.1; p < 0.001), whereas it was unrelated to the presence of ID. Hospitalization rates were independent of any form of SP. In multivariable models, polypharmacy, ID, and PID were no longer associated with an increased risk of death, and ID predicted a slightly increased risk of hospitalizations (HR 1.03, 95% CI 1.0-1.06, p = 0.048).
In this cohort, SP was not associated with an excess risk of poor health outcomes.
Pharmacoepidemiology and Drug Safety 09/2010; 19(9):954-60. · 2.53 Impact Factor
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G Abellan van Kan,
Y Rolland,
S Andrieu,
J Bauer,
O Beauchet,
M Bonnefoy,
M Cesari,
L M Donini,
S Gillette Guyonnet, M Inzitari,
F Nourhashemi,
G Onder,
P Ritz,
A Salva,
M Visser,
B Vellas
[show abstract]
[hide abstract]
ABSTRACT: The use of a simple, safe, and easy to perform assessment tool, like gait speed, to evaluate vulnerability to adverse outcomes in community-dwelling older people is appealing, but its predictive capacity is still questioned. The present manuscript summarises the conclusions of an expert panel in the domain of physical performance measures and frailty in older people, who reviewed and discussed the existing literature in a 2-day meeting held in Toulouse, France on March 12-13, 2009. The aim of the IANA Task Force was to state if, in the light of actual scientific evidence, gait speed assessed at usual pace had the capacity to identify community-dwelling older people at risk of adverse outcomes, and if gait speed could be used as a single-item tool instead of more comprehensive but more time-consuming assessment instruments.
A systematic review of literature was performed prior to the meeting (Medline search and additional pearling of reference lists and key-articles supplied by Task Force members). Manuscripts were retained for the present revision only when a high level of evidence was present following 4 pre-selected criteria: a) gait speed, at usual pace, had to be specifically assessed as a single-item tool, b) gait speed should be measured over a short distance, c) at baseline, participants had to be autonomous, community-dwelling older people, and d) the evaluation of onset of adverse outcomes (i.e. disability, cognitive impairment, institutionalisation, falls, and/or mortality) had to be assessed longitudinally over time. Based on the prior criteria, a final selection of 27 articles was used for the present manuscript.
Gait speed at usual pace was found to be a consistent risk factor for disability, cognitive impairment, institutionalisation, falls, and/or mortality. In predicting these adverse outcomes over time, gait speed was at least as sensible as composite tools.
Although more specific surveys needs to be performed, there is sufficient evidence to state that gait speed identifies autonomous community-dwelling older people at risk of adverse outcomes and can be used as a single-item assessment tool. The assessment at usual pace over 4 meters was the most often used method in literature and might represent a quick, safe, inexpensive and highly reliable instrument to be implemented.
The Journal of Nutrition Health and Aging 01/2009; 13(10):881-9. · 2.69 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Cerebral white matter changes, termed leukoaraiosis (LA), appearing as areas of increased signal intensity in T2-weighted MR images, are common in elderly subjects, but the possible correlation of LA with cognitive or motor deficit has not been established. We hypothesized that histogram and voxel-based analyses of whole-brain mean diffusivity (MD) and fractional anisotropy (FA) maps calculated from diffusion tensor imaging (DTI) could be more sensitive tools than visual scales to investigate the clinical correlates of LA.
Thirty-six patients of the Leukoaraiosis and Disability Study were evaluated with fluid-attenuated inversion recovery for LA extension, T1-weighted images for volume, and DTI for MD and FA. The extent of LA was rated visually. The normalized total, gray, and white matter brain volumes were computed, as well as the 25th percentile, 50th percentile, kurtosis, and skewness of the MD and FA maps of the whole brain. Finally, voxel-based analysis on the maps of gray and white matter volume, MD, and FA was performed with SPM2 software. Correlation analyses between visual or computerized data and motor or neuropsychologic scale scores were performed using the Spearman rank test and the SPM2 software.
The visual score correlated with some MD and FA histogram metrics (P<.01). However, only the 25th and 50th percentiles, kurtosis, and skewness of the MD and FA histograms correlated with motor or neuropsychologic deficits. Voxel-based analysis revealed a correlation (P<.05 corrected for multiple comparisons) between a large cluster of increased MD in the corpus callosum and pericallosal white matter and motor deficit.
These results are consistent with the hypothesis that histogram and voxel-based analyses of the whole-brain MD and FA maps are more sensitive tools than the visual evaluation for clinical correlation in patients with LA.
American Journal of Neuroradiology 08/2007; 28(7):1313-9. · 2.93 Impact Factor
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ABSTRACT: To estimate prevalence and incidence of distal symmetric neuropathies (DSN) in the Italian elderly, and to evaluate the accuracy of our procedure to screen for DSN.
In eight Italian municipalities, a population-based sample was directly evaluated both at baseline (1992) and after a 3-year follow-up. Cohort members who had died were studied. DSN diagnosis and subtyping were made according to specified diagnostic criteria.
Our screening procedure proved accurate (sensitivity 94.7%, specificity 70%, positive predictive value 18.9%), and provided an adjusted prevalence of 7.0 (95% CI, 6.9 to 7.0). Women outnumber men both in the oldest age groups and as a whole. Rates increase with increasing age in both genders. Among the 2,845 individuals re-screened at the follow-up and the 221 deceased subjects with reliable information, we identified 100 incident cases of DSN. Adjusted annual incidence rate (per 1,000 person-years) in the population 65 to 84 years of age is 7.9 (95% CI, 6.3 to 9.5), and for the nondiabetic DSN is 5.76 (95% CI, 4.3 to 7.3). Age significantly predicted the onset of DSN both in diabetic individuals (for every increasing year of age RR = 1.07; 95% CI, 1.01 to 1.14) and in the entire study population (RR = 1.05; 95% CI, 1.02 to 1.09).
We provide the first population-based distal symmetric neuropathies incidence data, as well as prevalence rates from an unselected sample of Italian elderly. Distal symmetric neuropathies are an age-associated condition, but the frequency of diabetic distal symmetric neuropathies declines with age, coincident with an increase in nondiabetic cases.
Neurology 06/2007; 68(18):1460-7. · 8.31 Impact Factor
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ABSTRACT: To estimate prevalence and progression to dementia of cognitive impairment, no dementia (CIND), mild cognitive impairment (MCI), and relative subtypes, evaluating the relationships with daily functioning, cardiovascular diseases and vascular risk factors.
We evaluated CIND and MCI in the Italian Longitudinal Study on Aging. The neuropsychological battery assessed global cognitive function, memory and attention. Two thousand eight hundred thirty participants were examined at baseline and after a mean follow-up of 3.9 +/- 0.7 years.
The prevalence was 9.5% for CIND and 16.1% for MCI. Prevalence rates for CIND subtypes were 1.8% for amnestic, 2.3% for single nonmemory, 1.5% for multidomain, and 3.9% for CIND defined only on global cognitive function. The prevalence was 7.0% for amnestic, 7.8% for single nonmemory, and 1.3% for multidomain MCI. Incidence of dementia (per 1,000 person-years) was 7.63 in the total sample, 21.37 in CIND, and 13.59 in MCI. In MCI, rates ranged from 8.74 in amnestic to 40.60 in multidomain subtype. The highest incidence of 56.02 per 1,000 person-years was found in multidomain CIND. Both CIND and MCI increased by almost three times the risk of dementia at follow-up. Among baseline variables, only previous stroke and impairment in instrumental activities of daily living significantly increased the risk of dementia at follow-up.
Both cognitive impairment, no dementia and mild cognitive impairment are frequent in the Italian elderly (2,955,000 prevalent cases expected) and significantly predict progression to dementia. Individuation of subgroups with different risk factors and transition rates to dementia is required to plan early and cost-effective interventions.
Neurology 06/2007; 68(22):1909-16. · 8.31 Impact Factor
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M. Houles,
G. Abellan Van Kan,
Y. Rolland,
S. Andrieu,
P. Anthony,
J. Bauer,
O. Beauchet,
M. Bonnefoy,
M. Cesari,
L.-M. Donini,
S. Gillette-Guyonnet, M. Inzitari,
I. Jurk,
F. Nourhashemi,
E. Offord-Cavin,
G. Onder,
P. Ritz,
A. Salva,
M. Visser,
B. Vellas
[show abstract]
[hide abstract]
ABSTRACT: Export Date: 23 March 2012, Source: Scopus, doi: 10.1007/s12612-009-0036-6, Language of Original Document: French, Correspondence Address: Houles, M.; Gérontopôle Service de Gériatrie, CHU de Purpan, 170, avenue de Casselardit, F-31059 Toulouse cedex 09, France; email: mathieuhoules@gmail.com, References: Abellan Van Kan, G., Rolland, Y., Bergman, H., Frailty assessment of older people in clinical practice. Expert opinion of a geriatric advisory panel (2007) J Nutr Health Aging, 12, pp. 29-37;
Cahiers de l'Annee Gerontologique. 2(1):13-23.
