Centro de dia e lar: saúde mental de idosos e capacidade para o trabalho dos seus cuidadores formais

O Envelhecimento da população é uma realidade cada vez mais presente na nossa sociedade. A investigação junto da população idosa e dos seus cuidadores requer que sejam criadas condições para que, estes grupos, possam usufruir de uma boa qualidade de vida. Propõe-se analisar a capacidade de trabalho dos cuidadores formais de idosos em contexto institucional mas com modalidades de trabalho distintas, no Centro de Dia, onde praticam um horário diurno e fixo, em paralelo com o horário por turnos rotativos diurnos/noturnos praticados no Lar. Foi proposto também analisar o estado mental dos idosos dessas mesmas instituições. A amostra deste estudo contou com 90 participantes dos quais 50 idoso e 40 cuidadores formais. Utilizou-se para a recolha de dados com os idosos o MMSE – Mini-Mental State Examination e a GDS-30 – Escala de Depressão Geriátrica, com os cuidadores a Escala de Graffar e o ICT – Índice de Capacidade para o Trabalho. Os resultados demonstraram não existirem diferenças significativas ao nível da demência e da depressão entre os idosos do Lar e do Centro de Dia. Outros resultados refletiram, para os cuidadores formais, uma capacidade para o trabalho excelente, ligeiramente superior aos dados de referência. Não foi conseguida uma relação entre a saúde mental dos idosos e a capacidade de trabalho dos seus cuidadores formais o que pode retratar o sucesso das medidas de apoio e educação desenvolvidas nesta área.

L'évaluation de l'autonomie fonctionnelle des personnes âgées : contribution de la didactique professionnelle à la formation des travailleuses et travailleurs sociaux au Québec

Résumé : Le vieillissement démographique est statistiquement indiscutable au Québec. Ce singulier trompeur masque les différentes manières de vieillir. Pour ceux qui ne parviennent pas à vieillir en santé, les solidarités familiales, comme les solidarités institutionnelles, c’est à dire publiques viennent en principe compenser ce qu’il est convenu de désigner de perte d’autonomie. Les politiques de santé publique au Québec organisent les services de soutien à domicile sous condition d’avoir estimé la situation de la personne avec l’outil d’évaluation multiclientèle (OEMC). Il est en usage dans l’ensemble du réseau de la santé et des services sociaux, et utilisé par les professionnels dont les travailleuses et les travailleurs sociaux (TS). Or, la gérontologie est peu soutenue dans la formation initiale des TS. Nous nous sommes interrogée sur les savoirs mobilisés par les TS quand ils évaluent. S’agissant des savoirs inscrits dans la pratique, nous avons orienté la recherche dans les théories de l’activité, la didactique professionnelle et le cadre conceptuel de la médiation. Nous avons étudié l’activité de professionnels en travail social expérimentés afin d’identifier certains des savoirs mobilisés pour les rendre disponibles à la formation des étudiant (e)s en travail social au Québec. Cent-cinquante heures d’observations et vingt-deux entretiens individuels et collectifs ont été réalisés avec des intervenants volontaires du service de soutien à domicile. Les résultats préliminaires de la recherche ont été présentés lors de groupes de discussion avec les TS ayant participé à la recherche, puis avec des enseignants en travail social. Nos résultats permettent de décrire les procédures de l’évaluation dans l’organisation du service d’aide à domicile et d’en différencier le processus de l’activité par laquelle le TS évalue l’autonomie fonctionnelle de la personne. Nous constatons que les savoirs mobilisés par les TS reposent premièrement sur une connaissance fine du territoire, de l’outil d’évaluation et des institutions. Un deuxième registre de savoir concerne la conceptualisation de l’autonomie fonctionnelle par l’outil OEMC comme objet et domaine d’intervention des TS. Enfin, un troisième registre se réfère aux savoirs mobilisés pour entrer en relation avec les personnes âgées, avec leur entourage. Or, ces trois registres de savoir n’apparaissent pas dans le discours des TS et résultent de notre propre analyse sur leur pratique. L’évaluation de l’autonomie fonctionnelle analysée par le concept de médiation est révélatrice du rapport aux savoirs du TS. S’agissant de savoirs de la pratique, nous constatons que leur classification entre les catégories usuelles de savoirs théoriques ou pratiques était inopérante. Nous empruntons le vocabulaire de la didactique professionnelle : celui des invariants opératoires reliés à l’autonomie fonctionnelle et celui des schèmes d’activité reliés à l’activité d’évaluation. C’est ainsi que nous avons identifié deux moments dans l’évaluation. Le premier assemble la collecte des informations et l’analyse des données. L’autonomie fonctionnelle se décline dans des conditions d’existence de la personne sur l’axe allant de la mobilité à la cognition avec comme balises d’intervention la sécurité et l’intégrité de la personne. Dans ce processus itératif, le TS identifie avec la personne ce qui nuit à son quotidien. L’évaluation formule comment résoudre cette incidence, comment la perte d’autonomie pourrait être compensée. La collecte d’information et le raisonnement du TS est alors un mouvement itératif, les deux éléments du processus sont liés et en continu. Le second moment de l’évaluation apparait si, dans le processus itératif, le TS perçoit une dissonance. Il est essentiel d’en identifier la nature pour la prendre en compte et maintenir la finalité de l’activité qui consiste à évaluer l’autonomie fonctionnelle à des fins compensatrices. Le TS doit identifier l’objet de la dissonance pour pouvoir cerner avec la personne le besoin inhérent à la perte d’autonomie et envisager d’y remédier. La prise en compte de cette dissonance vient ralentir le déroulement de l’activité. Le raisonnement qui, jusque-là, était relié à la collecte d’informations s’en dissocie pour analyser ce qui vient faire obstacle à l’activité d’évaluation à partir de la situation. Les composantes qui génèrent la dissonance paraissent reliées à la quotidienneté, aux conditions de vie à domicile de la personne (cohérence/incohérence, refus de services, autonégligence, maltraitance, agressivité). La dissonance génère une activité plus complexe pour évaluer la situation. L’autonomie fonctionnelle se décline toujours sur l’axe mobilité/cognition avec comme balises d’intervention la sécurité et l’intégrité de la personne. Or, pour ce faire, les TS raisonnent selon trois schèmes. Dans les situations où, pour décider de la suite du dossier, il faut en référer à une norme (de service, de profession, etc.) le raisonnement est déontologique. Il est aussi des situations où le TS agit au regard de valeurs et de représentations qui relèvent de sa sphère personnelle. Nous désignons ce raisonnement d’instinctuel. Enfin, le TS peut naviguer entre ces deux orientations et choisir la voie du raisonnement clinique que nous qualifions d’éthique et se rapproche alors des pratiques prudentielles qui sont marquées par l’incertitude.

Multiple myeloma and bone

International audience

La responsabilité civile dans les cas de dommages causés par les robots d’assistance au Québec

Le développement exponentiel de la technologie et le vieillissement de la population permettent d’introduire dans notre quotidien les robots d’assistance. La coexistence de l’homme avec ces robots intelligents et autonomes soulève une question fondamentale: dans l’éventualité où un robot provoquerait un accident causant un dommage à une personne ou à un bien qui serait le responsable? Aucune loi ne réglemente les activités de la robotique d’assistance dans le monde. Cette étude vise l’analyse de l’applicabilité des régimes de responsabilité du Code Civil du Québec aux cas de dommages causés par le robot d’assistance. L’analyse des régimes de responsabilité du Code civil du Québec permet de constater que deux régimes de responsabilité sont susceptibles d’être appliqués aux cas spécifiques de dommages causés par le robot d’assistance: le régime de responsabilité du fait des biens, énoncé à l’article 1465 C.c.Q., et le régime de responsabilité du fait des fabricants et vendeurs spécialisés, énoncé à l’article 1468 C.c.Q. Cela s’explique par la présence de critères et de conditions de mise en œuvre des régimes qui sont transposables aux différents aspects concernant la fabrication et l’utilisation du robot d’assistance.

La responsabilité civile dans les cas de dommages causés par les robots d’assistance au Québec

Le développement exponentiel de la technologie et le vieillissement de la population permettent d’introduire dans notre quotidien les robots d’assistance. La coexistence de l’homme avec ces robots intelligents et autonomes soulève une question fondamentale: dans l’éventualité où un robot provoquerait un accident causant un dommage à une personne ou à un bien qui serait le responsable? Aucune loi ne réglemente les activités de la robotique d’assistance dans le monde. Cette étude vise l’analyse de l’applicabilité des régimes de responsabilité du Code Civil du Québec aux cas de dommages causés par le robot d’assistance. L’analyse des régimes de responsabilité du Code civil du Québec permet de constater que deux régimes de responsabilité sont susceptibles d’être appliqués aux cas spécifiques de dommages causés par le robot d’assistance: le régime de responsabilité du fait des biens, énoncé à l’article 1465 C.c.Q., et le régime de responsabilité du fait des fabricants et vendeurs spécialisés, énoncé à l’article 1468 C.c.Q. Cela s’explique par la présence de critères et de conditions de mise en œuvre des régimes qui sont transposables aux différents aspects concernant la fabrication et l’utilisation du robot d’assistance.

NUEVO ORDEN DE LA GEOGRAFÍA DE LA POBLACIÓN

Este artículo analiza el nuevo orden de la Geografía de la Población, a través de cuatro etapas que hemos definido con el propósito de facilitar su estudio, abordando los contenidos, los principales representantes, los diferentes enfoques teóricos metodológicos y los paradigmas que en la evolución histórica se fueron imponiendo, en cada una de esas cuatro etapas propuestas. Se concluye, que en la actualidad ningún paradigma se impuso a los otros y que cada uno de ellos subsiste con sus respectivos seguidores.También en el artículo se incluye un segundo apartado sobre las Aplicaciones y Aportes (teóricos, metodológicos, laborales) por parte de los geógrafos y otros profesionales a nivel nacional, en el estudio de la población.Un tercer apartado desarrolla los retos que en el campo académico, investigativo y laboral se presentan en el ámbito nacional. El artículo concluye haciendo un llamado de atención sobre el proceso de envejecimiento de la población de Costa Rica que para el 2030 llegará a ser el 14% de la población nacional y el país no está preparado para afrontar ese desafío. Además se enfatiza en la necesidad de investigar los problemas más importantes que tiene la población de nuestro país y no los problemas que a través de fondos externos, a los países ricos les interesa que se investigue.Palabras  claves:  Población, Geografía  de  la  Población,  aplicaciones  en  población,  paradigmas  en población.AbstractThe object of study of  this article  is  to analyze  the new order of population geography  through four steps that we defined for the purpose of this study, addressing the contents, the principal representatives, the different theoretical methodological approaches and paradigms that were imposed in the historical development  in each of  these four proposed steps. It concludes  that at  the present  time no paradigm imposed itself on the others and that each of them subsists with their respective followers. The  article  includes  a  second  aspect  regarding  the  applications  and  contributions  (theoretical, methodological, and working) on the part of geographers and others at the national level in the study of population.A third chapter elaborates on the challenges presented in the academic, investigative and working fields at the national level. The article concludes by calling attention to the aging of the population of Costa Rica, which by the year 2030 will be 14% of the national population, and the country is not ready to face that challenge. It emphasizes the need to investigate the most important problems that the population of our country has and not the problems that through external funds are of interest to the rich countries to be investigated.Key Words: Population, population geography, population characteristics, paradigms in population.

Error and uncertainty of adult age estimation of the pubic symphysis in an Australian sub-population using computed tomography

After attending this presentation, attendees will gain awareness of: (1) the error and uncertainty associated with the application of the Suchey-Brooks (S-B) method of age estimation of the pubic symphysis to a contemporary Australian population; (2) the implications of sexual dimorphism and bilateral asymmetry of the pubic symphysis through preliminary geometric morphometric assessment; and (3) the value of three-dimensional (3D) autopsy data acquisition for creating forensic anthropological standards. This presentation will impact the forensic science community by demonstrating that, in the absence of demographically sound skeletal collections, post-mortem autopsy data provides an exciting platform for the construction of large contemporary ‘virtual osteological libraries’ for which forensic anthropological research can be conducted on Australian individuals. More specifically, this study assesses the applicability and accuracy of the S-B method to a contemporary adult population in Queensland, Australia, and using a geometric morphometric approach, provides an insight to the age-related degeneration of the pubic symphysis. Despite the prominent use of the Suchey-Brooks (1990) method of age estimation in forensic anthropological practice, it is subject to intrinsic limitations, with reports of differential inter-population error rates between geographical locations1-4. Australian forensic anthropology is constrained by a paucity of population specific standards due to a lack of repositories of documented skeletons. Consequently, in Australian casework proceedings, standards constructed from predominately American reference samples are applied to establish a biological profile. In the global era of terrorism and natural disasters, more specific population standards are required to improve the efficiency of medico-legal death investigation in Queensland. The sample comprises multi-slice computed tomography (MSCT) scans of the pubic symphysis (slice thickness: 0.5mm, overlap: 0.1mm) on 195 individuals of caucasian ethnicity aged 15-70 years. Volume rendering reconstruction of the symphyseal surface was conducted in Amira® (v.4.1) and quantitative analyses in Rapidform® XOS. The sample was divided into ten-year age sub-sets (eg. 15-24) with a final sub-set of 65-70 years. Error with respect to the method’s assigned means were analysed on the basis of bias (directionality of error), inaccuracy (magnitude of error) and percentage correct classification of left and right symphyseal surfaces. Morphometric variables including surface area, circumference, maximum height and width of the symphyseal surface and micro-architectural assessment of cortical and trabecular bone composition were quantified using novel automated engineering software capabilities. The results of this study demonstrated correct age classification utilizing the mean and standard deviations of each phase of the S-B method of 80.02% and 86.18% in Australian males and females, respectively. Application of the S-B method resulted in positive biases and mean inaccuracies of 7.24 (±6.56) years for individuals less than 55 years of age, compared to negative biases and mean inaccuracies of 5.89 (±3.90) years for individuals greater than 55 years of age. Statistically significant differences between chronological and S-B mean age were demonstrated in 83.33% and 50% of the six age subsets in males and females, respectively. Asymmetry of the pubic symphysis was a frequent phenomenon with 53.33% of the Queensland population exhibiting statistically significant (χ2 - p<0.01) differential phase classification of left and right surfaces of the same individual. Directionality was found in bilateral asymmetry, with the right symphyseal faces being slightly older on average and providing more accurate estimates using the S-B method5. Morphometric analysis verified these findings, with the left surface exhibiting significantly greater circumference and surface area than the right (p<0.05). Morphometric analysis demonstrated an increase in maximum height and width of the surface with age, with most significant changes (p<0.05) occurring between the 25-34 and 55-64 year age subsets. These differences may be attributed to hormonal components linked to menopause in females and a reduction in testosterone in males. Micro-architectural analysis demonstrated degradation of cortical composition with age, with differential bone resorption between the medial, ventral and dorsal surfaces of the pubic symphysis. This study recommends that the S-B method be applied with caution in medico-legal death investigations of unknown skeletal remains in Queensland. Age estimation will always be accompanied by error; therefore this study demonstrates the potential for quantitative morphometric modelling of age related changes of the pubic symphysis as a tool for methodological refinement, providing a rigor and robust assessment to remove the subjectivity associated with current pelvic aging methods.

Evaluation of the Suchey-Brooks method for aging Australian Caucasian Populations using multislice Computed Tomography reconstructions of the Pubic Symphyseal Surface

Establishing age-at-death for skeletal remains is a vital component of forensic anthropology. The Suchey-Brooks (S-B) method of age estimation has been widely utilised since 1986 and relies on a visual assessment of the pubic symphyseal surface in comparison to a series of casts. Inter-population studies (Kimmerle et al., 2005; Djuric et al., 2007; Sakaue, 2006) demonstrate limitations of the S-B method, however, no assessment of this technique specific to Australian populations has been published. Aim: This investigation assessed the accuracy and applicability of the S-B method to an adult Australian Caucasian population by highlighting error rates associated with this technique. Methods: Computed tomography (CT) and contact scans of the S-B casts were performed; each geometrically modelled surface was extracted and quantified for reference purposes. A Queensland skeletal database for Caucasian remains aged 15 – 70 years was initiated at the Queensland Health Forensic and Scientific Services – Forensic Pathology Mortuary (n=350). Three-dimensional reconstruction of the bone surface using innovative volume visualisation protocols in Amira® and Rapidform® platforms was performed. Samples were allocated into 11 sub-sets of 5-year age intervals and changes associated with the surface geometry were quantified in relation to age, gender and asymmetry. Results: Preliminary results indicate that computational analysis was successfully applied to model morphological surface changes. Significant differences in observed versus actual ages were noted. Furthermore, initial morphological assessment demonstrates significant bilateral asymmetry of the pubic symphysis, which is unaccounted for in the S-B method. These results propose refinements to the S-B method, when applied to Australian casework. Conclusion: This investigation promises to transform anthropological analysis to be more quantitative and less invasive using CT imaging. The overarching goal contributes to improving skeletal identification and medico-legal death investigation in the coronial process by narrowing the range of age-at-death estimation in a biological profile.

Physical Stature Decline and the Health Status of the Elderly Population in England

Few research papers in economics have examined the extent, causes or consequences of physical stature decline in aging populations. Using repeated observations on objectively measured data from the English Longitudinal Study of Ageing (ELSA), we document that reduction in height is an important phenomenon among respondents aged 50 and over. On average, physical stature decline occurs at an annual rate of between 0.08% and 0.10% for males, and 0.12% and 0.14% for females—which approximately translates into a 2cm to 4cm reduction in height over the life course. Since height is commonly used as a measure of long-run health, our results demonstrate that failing to take age-related height loss into account substantially overstates the health advantage of younger birth cohorts relative to their older counterparts. We also show that there is an absence of consistent predictors of physical stature decline at the individual level. However, we demonstrate how deteriorating health and reductions in height occur simultaneously. We document that declines in muscle mass and bone density are likely to be the mechanism through which these effects are operating. If this physical stature decline is determined by deteriorating health in adulthood, the coefficient on measured height when used as an input in a typical empirical health production function will be affected by reverse causality. While our analysis details the inherent difficulties associated with measuring height in older populations, we do not find that significant bias arises in typical empirical health production functions from the use of height which has not been adjusted for physical stature decline. Therefore, our results validate the use of height among the population aged over 50.

The importance of oral health for the systemic well being of an ageing population

The proportion of adults over the age of 60 years is expanding rapidly across European Union countries, including the Republic of Ireland. As the older population has grown faster than the total population, the proportion of older persons relative to the rest of the population has increased considerably (Figure 1). This trend mirrors the arrival of the “baby boomer� generation into early old age and will have wide ranging effects on social, political and economic spheres as well as presenting significant challenges for healthcare delivery and public healthcare policy.

New insights into the impact of Lactobacillus population on host-bacteria metabolic interplay

We aimed at evaluating the association between intestinal Lactobacillus sp. composition and their metabolic activity with the host metabolism in adult and elderly individuals. Faecal and plasma metabolites were measured and correlated to the Lactobacillus species distribution in healthy Estonian cohorts of adult (n=16; <48 y) and elderly (n=33; >65 y). Total cholesterol, LDL, C-reactive protein and glycated hemoglobin were statistically higher in elderly, while platelets, white blood cells and urinary creatinine were higher in adults. Aging was associated with the presence of L. paracasei and L. plantarum and the absence of L. salivarius and L. helveticus. High levels of intestinal Lactobacillus sp. were positively associated with increased concentrations of faecal short chain fatty acids, lactate and essential amino acids. In adults, high red blood cell distribution width was positively associated with presence of L. helveticus and absence of L. ruminis. L. helveticus was correlated to lactate and butyrate in faecal waters. This indicates a strong relationship between the composition of the gut Lactobacillus sp. and host metabolism. Our results confirm that aging is associated with modulations of blood biomarkers and intestinal Lactobacillus species composition. We identified specific Lactobacillus contributions to gut metabolic environment and related those to blood biomarkers. Such associations may prove useful to decipher the biological mechanisms underlying host-gut microbial metabolic interactions in an ageing population.

Population dynamics of the infaunal bivalve, Soletellina alba

The population dynamics of the infaunal bivalve Soletellina alba was investigated at three sites situated within close proximity to the mouth of the Hopkins River estuary. The initial study design was planned to examine the importance of winter flooding to the persistence of this bivalve mollusc within the Hopkins estuary, since mass mortalities have been observed during previous years coincident with periods of winter flooding. Unfortunately, the climatic conditions experienced during this study were atypical compared to the long-term average, so detailed sampling was limited to two, unanticipated, non-flood years rather than two, highly anticipated, flood years. This hampered my ability to conduct complete tests of the importance of winter flooding. Patterns of river discharge and the frequency and duration of mouth opening and closing differed greatly from that expected. Unexpectedly, periods of mouth closure were not always associated with periods of minimal river discharge; low salinities were another unexpected result during an extended period of mouth closure during 1998. As expected, salinities varied considerably with increasing water depth when the estuary mouth was open. Mouth closure lead to salinities becoming more uniform between water depths but hypoxic and anoxic conditions became evident via stratification in the water column at 1 m below the Australian Height Datum (AHD). Other than trends associated with increased water depth, significant variation was not evident between measurements of salinity taken from three sites within close proximity of the estuary mouth (approximately 500 m), or during changes in tide. The most pertinent anomaly was the absence of winter flooding. The distribution and abundance of juvenile and adult S. alba was variable across all Dates, Sites and Channel elevations (i.e. water depths) sampled during this study. An experimental test comparing the recruitment of juveniles at different channel elevations and in sediments of varying particle size was conducted during an exceptionally successful period of recruitment during 1999. The results of these tests showed that recruitment was greatest at the shallowest channel elevation used, and there was little evidence that sediment particle size influenced recruitment. In contrast to 1999, recruitment during 1997 or 1998 was extremely poor. Growth rates were monitored using tagged individuals held in caged and uncaged plots, which revealed that growth was highly variable among individuals, but not between Sites. These tests also revealed that growth was negligible during the colder, winter months, and that the fastest growing individuals were capable of growing 0.2 mm/day. Mixed results were obtained for tests of potential cage artifacts and the influence of handling. Caging and differing amounts of handling did not appear to influence growth, but there was evidence that cages and handling influenced bivalve condition and number of mortalities. These direct tests appeared to be the most appropriate method for determining growth rates of this species, since attempts to analyse length-frequency data were made difficult by the apparent convergence of cohorts, and shell aging is difficult due to the thin, fragile nature of the shell. As expected, mass mortalities were observed during the flood of 1996, but not during the two non-flood years of 1997 and 1998. There were, however, some considerable declines in abundances at some channel elevations during the two non-flood years. However, these declines were attributable to the complete disappearance of individuals, rather than the sudden presence of numerous, recently dead individuals that typify observed declines during winter flooding. The complete disappearance of individuals suggest that S. alba may be capable of post-settlement emigration, or that they were consumed by an unknown predator. Salinity tolerance tests showed that bivalves exposed to low salinities (≤6 ppt), exhibited poorer condition and took longer to re-burrow into sediments than those exposed to greater salinities (≥14 ppt), while death of bivalves exposed to salinities ≤1 ppt occurred after 8 days of exposure. These tests provide evidence that low salinities are probably the principal cause of mass mortalities during winter flooding, although the interaction between salinity, temperature and turbidity also deserve consideration. The results of this study indicate that certain aspects of winter flooding, especially salinity, are responsible for the mass mortalities of S. alba rather than the result of a short-lived life history. I hypothesise that the survival of very young juveniles (between 0.5 and 1 mm shell length) and rapid growth rates are important features of the life history of S. alba that explain its successful persistence within the Hopkins River estuary. The rapid rates of growth suggest that it may be possible for juveniles that survive winter flooding to grow, reach sexual maturity, and reproduce before the onset of the next flood event. Unfortunately, the increased survivorship of juveniles during periods of winter flooding was not demonstrated by this study because of the absence of winter flooding and also relatively poor recruitment. It is highly likely that this species is capable of completing it entire life cycle within the estuary since the absence of other nearby populations, together with periods of mouth closure, are likely to greatly limit the potential contribution made by larvae entering from the surrounding marine environment. This study has added considerably to our knowledge of how infauna cope with life in the intermittently closing estuaries that typify semi-arid coastlines in the Southern Hemisphere.

Mental health of the elderly: perceptions related to aging

To understand the elderly's perception of their current condition. Methodology. Study undertaken in 2012 using the qualitative method of Minayo and the thematic analysis according to Bardin's suggestions. Data were collected through semi-structured interviews that took place in the homes of the elderly people. The guiding question was: At this point in your life, how do you feel? Tell me. Results. The elderly who were satisfied stated that this was due to the good relationship with their family, spouse, to the fact of having autonomy and respect from the society. Those who were shown to be dissatisfied reported lack of family support, physical limitations imposed by age and the presence of illnesses as the main causes. Conclusion. The adult population requires the use of care technologies that cover all the stages of life, including old age. Nursing professionals should be prepared for the increasing care demand of these people.

The Integrated European Project "GEHA - GEnetics of Healthy Aging": recruitment, health status assessment and survival of the Italian 90+ sibpairs

The present study is part of the EU Integrated Project “GEHA – Genetics of Healthy Aging” (Franceschi C et al., Ann N Y Acad Sci. 1100: 21-45, 2007), whose aim is to identify genes involved in healthy aging and longevity, which allow individuals to survive to advanced age in good cognitive and physical function and in the absence of major age-related diseases. Aims The major aims of this thesis were the following: 1. to outline the recruitment procedure of 90+ Italian siblings performed by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The procedures related to the following items necessary to perform the study were described and commented: identification of the eligible area for recruitment, demographic aspects related to the need of getting census lists of 90+siblings, mail and phone contact with 90+ subjects and their families, bioethics aspects of the whole procedure, standardization of the recruitment methodology and set-up of a detailed flow chart to be followed by the European recruitment centres (obtainment of the informed consent form, anonimization of data by using a special code, how to perform the interview, how to collect the blood, how to enter data in the GEHA Phenotypic Data Base hosted at Odense). 2. to provide an overview of the phenotypic characteristics of 90+ Italian siblings recruited by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The following items were addressed: socio-demographic characteristics, health status, cognitive assessment, physical conditions (handgrip strength test, chair-stand test, physical ability including ADL, vision and hearing ability, movement ability and doing light housework), life-style information (smoking and drinking habits) and subjective well-being (attitude towards life). Moreover, haematological parameters collected in the 90+ sibpairs as optional parameters by the Bologna and Rome recruiting units were used for a more comprehensive evaluation of the results obtained using the above mentioned phenotypic characteristics reported in the GEHA questionnaire. 3. to assess 90+ Italian siblings as far as their health/functional status is concerned on the basis of three classification methods proposed in previous studies on centenarians, which are based on: • actual functional capabilities (ADL, SMMSE, visual and hearing abilities) (Gondo et al., J Gerontol. 61A (3): 305-310, 2006); • actual functional capabilities and morbidity (ADL, ability to walk, SMMSE, presence of cancer, ictus, renal failure, anaemia, and liver diseases) (Franceschi et al., Aging Clin Exp Res, 12:77-84, 2000); • retrospectively collected data about past history of morbidity and age of disease onset (hypertension, heart disease, diabetes, stroke, cancer, osteopororis, neurological diseases, chronic obstructive pulmonary disease and ocular diseases) (Evert et al., J Gerontol A Biol Sci Med Sci. 58A (3): 232-237, 2003). Firstly these available models to define the health status of long-living subjects were applied to the sample and, since the classifications by Gondo and Franceschi are both based on the present functional status, they were compared in order to better recognize the healthy aging phenotype and to identify the best group of 90+ subjects out of the entire studied population. 4. to investigate the concordance of health and functional status among 90+ siblings in order to divide sibpairs in three categories: the best (both sibs are in good shape), the worst (both sibs are in bad shape) and an intermediate group (one sib is in good shape and the other is in bad shape). Moreover, the evaluation wanted to discover which variables are concordant among siblings; thus, concordant variables could be considered as familiar variables (determined by the environment or by genetics). 5. to perform a survival analysis by using mortality data at 1st January 2009 from the follow-up as the main outcome and selected functional and clinical parameters as explanatory variables. Methods A total of 765 90+ Italian subjects recruited by UNIBO (549 90+ siblings, belonging to 258 families) and ISS (216 90+ siblings, belonging to 106 families) recruiting units are included in the analysis. Each subject was interviewed according to a standardized questionnaire, comprising extensively utilized questions that have been validated in previous European studies on elderly subjects and covering demographic information, life style, living conditions, cognitive status (SMMSE), mood, health status and anthropometric measurements. Moreover, subjects were asked to perform some physical tests (Hand Grip Strength test and Chair Standing test) and a sample of about 24 mL of blood was collected and then processed according to a common protocol for the preparation and storage of DNA aliquots. Results From the analysis the main findings are the following: - a standardized protocol to assess cognitive status, physical performances and health status of European nonagenarian subjects was set up, in respect to ethical requirements, and it is available as a reference for other studies in this field; - GEHA families are enriched in long-living members and extreme survival, and represent an appropriate model for the identification of genes involved in healthy aging and longevity; - two simplified sets of criteria to classify 90+ sibling according to their health status were proposed, as operational tools for distinguishing healthy from non healthy subjects; - cognitive and functional parameters have a major role in categorizing 90+ siblings for the health status; - parameters such as education and good physical abilities (500 metres walking ability, going up and down the stairs ability, high scores at hand grip and chair stand tests) are associated with a good health status (defined as “cognitive unimpairment and absence of disability”); - male nonagenarians show a more homogeneous phenotype than females, and, though far fewer in number, tend to be healthier than females; - in males the good health status is not protective for survival, confirming the male-female health survival paradox; - survival after age 90 was dependent mainly on intact cognitive status and absence of functional disabilities; - haemoglobin and creatinine levels are both associated with longevity; - the most concordant items among 90+ siblings are related to the functional status, indicating that they contain a familiar component. It is still to be investigated at what level this familiar component is determined by genetics or by environment or by the interaction between genetics, environment and chance (and at what level). Conclusions In conclusion, we could state that this study, in accordance with the main objectives of the whole GEHA project, represents one of the first attempt to identify the biological and non biological determinants of successful/unsuccessful aging and longevity. Here, the analysis was performed on 90+ siblings recruited in Northern and Central Italy and it could be used as a reference for others studies in this field on Italian population. Moreover, it contributed to the definition of “successful” and “unsuccessful” aging and categorising a very large cohort of our most elderly subjects into “successful” and “unsuccessful” groups provided an unrivalled opportunity to detect some of the basic genetic/molecular mechanisms which underpin good health as opposed to chronic disability. Discoveries in the topic of the biological determinants of healthy aging represent a real possibility to identify new markers to be utilized for the identification of subgroups of old European citizens having a higher risk to develop age-related diseases and disabilities and to direct major preventive medicine strategies for the new epidemic of chronic disease in the 21st century.