Impact of tooth replacement strategies on the nutritional status of partially-dentate elders

OBJECTIVE: To investigate the impact of tooth replacement on the nutritional status of partially dentate older patients, and, to compare two different tooth replacement strategies; conventional treatment using removable partial dentures and functionally orientated treatment based on the shortened dental arch.

BACKGROUND: Amongst older patients, diet plays a key role in disease prevention, as poor diets have been linked to numerous illnesses. Poor oral health and loss of teeth can have very significant negative effects on dietary intake and nutritional status for elderly patients. There is evidence that good oral health generally, has positive effects on the nutritional intake of older adults.

MATERIALS AND METHODS: A randomised, controlled clinical trial was designed to investigate the impact of tooth replacement on the nutritional status of partially dentate elders. Forty-four patients aged over 65 years completed the trial, with 21 allocated to conventional treatment and 23 allocated to functionally orientated treatment. Nutritional status was accessed at baseline and after treatment using the Mini Nutritional Assessment (MNA) and a range of haematological markers.

RESULTS: At baseline, relationships were observed between the number of occluding tooth contacts and some measures of nutritional status. As the number of contacts increased, MNA scores (R = 0.16), in addition to vitamin B12 (R = 0.21), serum folate (R = 0.32) and total lymphocyte count (R = 0.35), also increased. After treatment intervention, the only measure of nutritional status that showed a statistically significant improvement for both treatment groups was MNA score (p = 0.03). No significant between group differences were observed from analysis of the haematological data.

CONCLUSION: In this study, prosthodontic rehabilitation with both conventional treatment and functionally orientated treatment resulted in an improvement in MNA score. Haematological markers did not illustrate a clear picture of improvement in nutritional status for either treatment group.

Gerodontology--how big is the challenge in Ireland?

Population trends suggest that the Irish population is ageing, and that this population will have substantial treatment needs. These patients will be better informed than previous generations, and will demand treatment aimed at preserving a natural dentition. This will impact upon delivery of oral healthcare and manpower planning needs to consider how to address the increased demand for dental care. Poor oral health is associated with systemic health problems, including cardiovascular disease, respiratory disease and diabetes mellitus. It also has a negative impact upon quality of life, and the World Health Organisation has encouraged public healthcare administrators and decision makers to design effective and affordable strategies for better oral health and quality of life of older adults, which, in turn, are integrated into general health management programmes. Treatment concepts such as minimally invasive dentistry and the shortened dental arch concept are discussed in the context of these demographic changes and recommendations.

The Use of ART in Elderly Patients after 2 years

Caries experience is high in the elderly, and barriers to care for older adults include fear and cost. Access to care is especially problematic in the case of frail and homebound elderly. Objective: to compare the survival of restorations placed using Atraumatic Restorative Treatment (ART) and a conventional technique using rotary instruments and a resin-modified glass-ionomer (CT) to treat carious lesions in older patients. Methods: In this randomised clinical trial, 99 independently living adults (65-90 yrs) with carious lesions were recruited from a geriatric day hospital and a community centre and randomly allocated to receive either ART or conventional restorations. They received tailored oral hygiene instructions and scaling and polishing of teeth prior to restoration placement. The survival of restorations was assessed 6, 12 and 24 months after restoration placement by an independent examiner. Results: Ninety-nine patients participated in the trial, 46 males and 53 females, with a mean age of 73.2 (SD: 6.8). In total, 300 restorations were placed, 142 ART in 51 patients and 158 conventional restorations in 48 patients, with an average of 2.8 ART (SD: 1.83) and 3.2 conventional (SD: 2.62) restorations placed per patient. After 2 years, 88 ART and 117 conventional restorations were assessed. The restoration survival percentages were 93.1% and 94%, respectively. Conclusion: ART was found to be as effective as a conventional restorative approach to treat older adults after 2 years and could be a useful tool to provide dental care for older dentate adults.

Participating in a fruit and vegetable intervention trial improves longer term fruit and vegetable consumption and barriers to fruit and vegetable consumption: a follow-up of the ADIT study

BACKGROUND: Fruit and vegetable (FV) based intervention studies can be effective in increasing short term FV consumption. However, the longer term efficacy of such interventions is still unclear. The aim of the current study was to examine the maintenance of change in FV consumption 18-months after cessation of a FV intervention and to examine the effect of participating in a FV intervention on barriers to FV consumption.

METHODS: A follow-up of a randomised controlled FV trial in 83 older adults (habitually consuming ≤2 portions/day) was conducted. At baseline, participants were assigned to continue consuming ≤2 portions FV/day or consume ≥5 portions FV/day for 16-weeks. We assessed FV intake and barriers to FV consumption at baseline, end of intervention and 18-months post-intervention.

RESULTS: At 18-months, mean FV intakes in both groups were greater than baseline. The 5 portions/day group continued to show greater increases in FV consumption at 18-months than the 2 portions/day group (p < 0.01). At 18-months, both groups reported greater liking (p < 0.01) and ease in consuming FV (p = 0.001) while difficulties with consuming FV decreased (p < 0.001). The 2 portions/day group reported greater awareness of FV recommendations at 18-months (p < 0.001).

CONCLUSIONS: Participating in a FV intervention can lead to longer-term positive changes in FV consumption regardless of original group allocation.

TRIAL REGISTRATION: Clinical Trials.gov NCT00858728 .

Social Ecological Constraints to Park Use in Communities with Quality Access

Evidence correlates physical activity, psychological restoration, and social health to proximity to parks and sites of recreation. The purpose of this study was to identify perceived constraints to park use in low-income communities facing significant health disparities, with access to underutilized parks. We used a series of focus groups with families, teens, and older adults in neighborhoods with similar demographic distribution and access to parks over 125 acres in size. Constraints to park use varied across age groups as well as across social ecological levels, with perceived constraints to individuals, user groups, communities, and society. Policies and interventions aimed at increasing park use must specifically address barriers across social ecological levels to be successful.

Quantification of the smoking-associated cancer risk with rate advancement periods: meta-analysis of individual participant data from cohorts of the CHANCES consortium

BACKGROUND: Smoking is the most important individual risk factor for many cancer sites but its association with breast and prostate cancer is not entirely clear. Rate advancement periods (RAPs) may enhance communication of smoking related risk to the general population. Thus, we estimated RAPs for the association of smoking exposure (smoking status, time since smoking cessation, smoking intensity, and duration) with total and site-specific (lung, breast, colorectal, prostate, gastric, head and neck, and pancreatic) cancer incidence and mortality.

METHODS: This is a meta-analysis of 19 population-based prospective cohort studies with individual participant data for 897,021 European and American adults. For each cohort we calculated hazard ratios (HRs) for the association of smoking exposure with cancer outcomes using Cox regression adjusted for a common set of the most important potential confounding variables. RAPs (in years) were calculated as the ratio of the logarithms of the HRs for a given smoking exposure variable and age. Meta-analyses were employed to summarize cohort-specific HRs and RAPs.

RESULTS: Overall, 140,205 subjects had a first incident cancer, and 53,164 died from cancer, during an average follow-up of 12 years. Current smoking advanced the overall risk of developing and dying from cancer by eight and ten years, respectively, compared with never smokers. The greatest advancements in cancer risk and mortality were seen for lung cancer and the least for breast cancer. Smoking cessation was statistically significantly associated with delays in the risk of cancer development and mortality compared with continued smoking.

CONCLUSIONS: This investigation shows that smoking, even among older adults, considerably advances, and cessation delays, the risk of developing and dying from cancer. These findings may be helpful in more effectively communicating the harmful effects of smoking and the beneficial effect of smoking cessation.

Burden of Cancer in a Large Consortium of Prospective Cohorts in Europe

BACKGROUND: Disability-adjusted life-years (DALYs) are an indicator of mortality, morbidity, and disability. We calculated DALYs for cancer in middle-aged and older adults participating in the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES) consortium.

METHODS: A total of 90 199 participants from five European cohorts with 10 455 incident cancers and 4399 deaths were included in this study. DALYs were calculated as the sum of the years of life lost because of premature mortality (YLLs) and the years lost because of disability (YLDs). Population-attributable fractions (PAFs) were also estimated for five cancer risk factors, ie, smoking, adiposity, physical inactivity, alcohol intake, and type II diabetes.

RESULTS: After a median follow-up of 12 years, the total number of DALYs lost from cancer was 34 474 (382 per 1000 individuals) with a similar distribution by sex. Lung cancer was responsible for the largest number of lost DALYs (22.9%), followed by colorectal (15.3%), prostate (10.2%), and breast cancer (8.7%). Mortality (81.6% of DALYs) predominated over disability. Ever cigarette smoking was the risk factor responsible for the greatest total cancer burden (24.0%, 95% confidence interval [CI] = 22.2% to 26.0%), followed by physical inactivity (4.9%, 95% CI = 0.8% to 8.1%) and adiposity (1.8%, 95% CI = 0.2% to 2.8%).

CONCLUSIONS: DALYs lost from cancer were substantial in this large European sample of middle-aged and older adults. Even if the burden of disease because of cancer is predominantly caused by mortality, some cancers have sizeable consequences for disability. Smoking remained the predominant risk factor for total cancer burden.

Implications of divergences in Adult Protection legislation

Purpose – The purpose of this paper is to explore the similarities and differences of legal responses to older adults who may be at risk of harm or abuse in the UK, Ireland, Australia and the USA.
Design/methodology/approach – The authors draw upon a review of elder abuse and adult protection undertaken on behalf of the commissioner for older people in Northern Ireland. This paper focusses on the desk top mapping of the different legal approaches and draws upon wider literature to frame the discussion of the relative strengths and weaknesses of the different legal responses.
Findings – Arguments exist both for and against each legal approach. Differences in defining the scope and powers of adult protection legislation in the UK and internationally are highlighted.
Research limitations/implications – This review was undertaken in late 2013; while the authors have updated the mapping to take account of subsequent changes, some statutory guidance is not yet available. While the expertise of a group of experienced professionals in the field of adult safeguarding was utilized,
it was not feasible to employ a formal survey or consensus model.
Practical implications – Some countries have already introduced APL and others are considering doing so. The potential advantages and challenges of introducing APL are highlighted.
Social implications – The introduction of legislation may give professionals increased powers to prevent and reduce abuse of adults, but this would also change the dynamic of relationships within families and between families and professionals.
Originality/value – This paper provides an accessible discussion of APL across the UK and internationally
which to date has been lacking from the literature.

Increased physical activity and fitness above the 50th percentile prevents the institutionalization of elderly people: a cross-sectional pilot study.

Introduction Institutionalization in a nursing home restricts autonomy, most notably free will, free choice, and free action. Decreased physical activity and fitness are predictive of disability and dependence (Rikli & Jones, 2013; Tak, Kuiper, Chorus, & Hopman-Rock, 2014); however little is known about the impact of these factors on institutionalization. Thus, this study aimed to analyze the impact of physical activity and fitness and on the risk of elderly people without cognitive impairment become institutionalized. Methods This cross-sectional study involved 195 non-institutionalized (80.14.4yrs) and 186 institutionalized (83.85.2yrs) participants. Cognitive impairment was assessed using Mini-Mental State Examination, physical activity was assessed using the International Physical Activity Questionnaire, and measures of physical fitness were determined by the Senior Fitness Test. Results: Multivariate binary logistic analysis selected 4 main predictors of institutionalization in both genders. The likelihood of becoming institutionalized increased by +18.6% for each additional year of age, while it decreased by -24.8% by each fewer kg/m2 in BMI, by -0.9% for each additional meter performed in the aerobic endurance test and by -2.0% for each additional 100MET-min/wk of physical activity expenditure (p<0.05). Values ≤50th percentile (age ≥81yrs, BMI≥26.7kg/m2, aerobic endurance ≤367.6m, and physical activity ≤693MET-min/wk) were computed using Receiver Operating Characteristics analysis as cut-offs discriminating institutionalized from non-institutionalized elderly people. Conclusion The performance of physical activity, allied to an improvement in physical fitness (mainly BMI and aerobic endurance) may prevent the institutionalization of elderly people without cognitive impairment only if they are above the 50th percentile; the following is highly recommend: expending ≥693MET-min/wk on physical activity, being ≤26.7kg/m2 on BMI, and being able to walk ≥367.6m in the aerobic endurance test, especially above the age of 80 years. The discovery of this trigger justifies the development of physical activity programs targeting the pointed cut-offs in old, and very old people. References Rikli, R., & Jones, C. (2013). Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist, 53, 255-267. Tak, E., Kuiper, R., Chorus, A., & Hopman-Rock, M. (2014). Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: a meta-analysis. Ageing Res Rev, 12, 329-338.

Atividade física e aptidão física funcional em pessoas idosas com défice cognitivo

Objetivo: Estudar os níveis de atividade física e a aptidão física funcional de pessoas idosas com défice cognitivo. Pretendemos também estudar a velocidade de processamento da informação deste grupo de pessoas. Método: Participaram no estudo 81 pessoas idosas (82.9  7.8 anos ) institucionalizadas, de ambos os sexos, sendo que 53 pessoas tinham défice cognitivo. Os dados da atividade física foram recolhidos através da acelerometria onde foi pedido a cada participante que usasse o aparelho durante 500 minutos diários, no mínimo 3 dias. Para avaliação da atividade física funcional foi utilizado a Berg Balance Scale, o Functional Reach Test e alguns testes do Senior Fitness Test. Foi ainda avaliado o tempo de reação simples. Resultados: Os participantes não cumprem com as recomendações diárias de atividade física e apresentam um comportamento sedentário muito elevado. As pessoas idosas sem défice cognitivo apresentam melhor velocidade de processamento da informação e melhores níveis de aptidão física funcional. A maioria das variáveis da aptidão física funcional correlaciona-se positivamente com a quantidade de atividade física realizada. Conclusões: Os níveis de atividade física e de aptidão física funcional, bem como a velocidade de processamento da informação são bastante baixos nas pessoas institucionalizadas com défice cognitivo; Physical activity and functional fitness in older adults with mild cognitive impairment Abstract: Objective: Study the physical activities levels and functional fitness in older adults with mild cognitive impairment. We also intend to study the processing speed from this group. Method: Eighty two nursing home residents (82.9  7.8 years), both genders, have participated in this study. Fifty three older adults had mild cognitive impairment. The data about physical activity were collected through accelerometer where it was established that each participant would have to use at least 500 minutes a day the unit for at least 3 days. Functional fitness was evaluated by Berg Balance Scale, Functional Reach Test and some test of Senior Fitness Test. It was further evaluated simple reaction time Results: The sample of this study doesn’t accomplish the recommended standars for physical activity and they have a very high sedentary behavior. Older adults without mild cognitve impariment showed to have better results ininformation processing speed and functional fitness. Most variables of functional fitness is related positively with the amount of physical activity performed. Conclusions: The functional fitness, physical activity levels and information processing speed are too low in all nursing home residente with mild cognitive impairment.

Prevenção do tabagismo: um caminho na prestação de cuidados de saúde

Esta tese é constituída por dois estudos. O estudo de prevenção primária é experimental, ensaio clínico randomizado, cujo programa de intervenção “Para- Par sem Tabaco” é baseado na metodologia da formação pelos pares, com o objectivo de avaliar a sua eficácia. A amostra é constituída por 310 estudantes que frequentam o 7º e 8º Anos das Escolas Básicas e Secundárias de Oliveira de Azeméis por amostragem aleatória em conglomerados (turmas). 153 estudantes constituíram o grupo de controlo e 157 o grupo experimental. A observação foi feita antes, no final e passado um ano da intervenção. Foram construídas e validadas três escalas, que apresentaram bons argumentos de fidelidade e validade. Dos resultados ressaltam os benefícios na redução do consumo de cigarros por semana, a perspectiva futura menos associada ao consumo de tabaco; uma evolução na concordância sobre o alto risco face à auto-estima, comportamentos e tabaco; e alguma consistência nas suas percepções sobre o tabaco e as motivações dos fumadores. Verificou-se uma maior eficácia no sexo masculino. Nos dois grupos, com o aumento da idade, aumentou a idade de experimentação tabágica, o número de cigarros consumidos semanalmente e o número de amigos fumadores. No grupo experimental, constata-se que os adolescentes filhos de pais fumadores consomem mais cigarros por semana e têm mais amigos fumadores. O estudo de prevenção secundária e terciária do tabagismo foi efectuado com o objectivo de avaliar a eficácia e identificar os factores que interferem nas consultas de cessação tabágica. Tratando-se de um estudo descritivocorrelacional retrospectivo e de coorte. A amostra (probabilística aleatória – K=4) foi constituída por 395 elementos inscritos na consulta de cessação tabágica de 12 Centros de Saúde do Distrito de Aveiro entre 2004 a 2009 (pesquisa de arquivo). A avaliação foi feita em três momentos: na última consulta, aos três e seis meses de seguimento. Conclui-se que os elementos com mais habilitações académicas, que consomem menos cigarros e com menor grau de dependência tabágica, são os que apresentam maior sucesso na cessação tabágica aos três meses de seguimento. Os sujeitos que referem, na primeira consulta, conseguir reduzir menos cigarros e os que apresentam maior motivação, na primeira consulta, são os que apresentam mais sucesso na cessação tabágica na última consulta e aos três meses de seguimento. Os elementos com mais idade, sem apoio familiar, que apresentam um maior tempo sem fumar, em tentativas anteriores e os que mais utilizaram as consultas, foram os que conseguiram mais sucesso na cessação tabágica aos três e seis meses de seguimento. Os elementos que não fizeram tratamento específico não têm sucesso. Os elementos da amostra obtiveram ganho ponderal com redução nos valores da pressão arterial sistólica e diastólica. Destes estudos foram retiradas algumas linhas orientadoras para a prestação de cuidados de saúde nesta complexa área de intervenção.

Avaliação do perfil de cuidado de enfermagem geriátrico em hospitais de Portugal

A transição demográfica e epidemiológica da população portuguesa tem e terá um enorme impacto na utilização dos recursos de saúde. Atualmente, as pessoas idosas representam um dos grupos etários com taxas de internamento hospitalar mais significativos. Contudo, os dados sobre a hospitalização destas pessoas têm demonstrado resultados de saúde negativos, nomeadamente, o declínio funcional e cognitivo e o risco elevado de eventos adversos. Os/as enfermeiros/as têm um papel crucial na mudança desta realidade. Deste modo, a associação entre o contexto no qual decorre o cuidado de enfermagem geriátrica e os resultados deste cuidado relativos a/os utentes, enfermeiros/as e organizações têm sido proficuamente documentados. Algumas estratégias para promover a qualidade do cuidado geriátrico e a segurança das pessoas idosas hospitalizadas consistem em avaliar e (re)criar o ambiente de trabalho geriátrico dos/as enfermeiros/as (AGTE) e capacitar e treinar estes/as profissionais no cuidado à pessoa idosa. Embora, internacionalmente, os dados demonstrem a associação entre as características de hospitais e/ou enfermeiros/as e o AGTE, não existem estudos em Portugal nesta área, bem como sobre o conhecimento e as atitudes destes profissionais no contexto hospitalar. Por conseguinte, este estudo teve como objetivos: 1) traduzir, adaptar culturalmente e validar as escalas que compõem o questionário Geriatric Institucional Assessment Proflie (GIAP) para a população portuguesa; 2) analisar o AGTE (fatores intrínsecos e extrínsecos) que apoiam ou dificultam a adoção das melhores práticas geriátricas em hospitais portugueses; 3) analisar as atitudes e conhecimento de enfermeiros/as acerca de quatro síndromes geriátricas (úlceras de pressão, distúrbio do sono, contenção física e incontinência), destacando as boas práticas e os problemas encontrados nos hospitais portugueses; 4) analisar a relação entre as variáveis demográficas, profissionais e as características dos hospitais e as escalas que compõem o GIAP – versão portuguesa; 5) conhecer as perceções de enfermeiros/as acerca do cuidado às pessoas idosas hospitalizadas e dos obstáculos enfrentados para desenvolver um cuidado de boa qualidade; e 6) analisar a relação entre a perceção de enfermeiros/as sobre o AGTE e o conhecimento e atitudes geriátricas destes profissionais em função da região e unidade de internamento. Este estudo foi desenvolvido com base num método quantitativo do tipo exploratório-descritivo, transversal, prospetivo e correlacional. A amostra foi constituída por 1.068 enfermeiros/as de cinco hospitais da região norte e centro do país. A recolha de dados foi desenvolvida através de autopreenchimento do GIAP – versão portuguesa. De entre os principais resultados destacam-se: 1) a obtenção de um instrumento válido e fiável para avaliar o AGTE e conhecimentos e atitudes geriátricas; 2) a perceção de enfermeiros/as sobre o cuidado às pessoas idosas como sendo predominantemente negativa; 3) a perceção de enfermeiros/as sobre o apoio insuficiente dos líderes hospitalares para promover um AGTE favorável; 4) o cuidado a pessoas idosas com comportamentos inadequados e o uso de recursos geriátricos como os principais fatores que influenciam a eficácia e a qualidade do cuidado geriátrico; 5) a lacuna de conhecimento e atitudes negativas de enfermeiros/as acerca das quatro síndromes geriátricas; 6) a conceptualização de um modelo sobre a associação das características de enfermeiros/as, dos hospitais do estudo e das perceções destes/as profissionais sobre o cuidado geriátrico com o AGTE e o conhecimento e atitudes geriátricos; 7) a falta de apoio familiar, a descontinuidade e a escassez de tempo para o cuidado como principais obstáculos no cuidado à pessoa idosa hospitalizada; e 8) o perfil de cuidado geriátrico nos hospitais da região norte e centro de Portugal como tendencialmente homogéneo. Os resultados deste estudo sustentam a necessidade de um maior investimento dos decisores políticos, administradores hospitalares e docentes de Enfermagem na capacitação dos/as enfermeiros/as para o cuidado geriátrico e na promoção de um AGTE mais favorável. Também oferece recomendações significativas nos domínios da decisão política, da gestão institucional e da prática profissional que devem ser alvo de uma discussão alargada entre os vários agentes com responsabilidade nestes domínios. Espera-se que este estudo possa contribuir para a promoção de um contexto favorável ao desenvolvimento de um cuidado de enfermagem geriátrica de boa qualidade às pessoas hospitalizadas.

Profiles of ageing in the South of Portugal: education and cognitive functioning in elderly persons living in institutionalized and community contexts

The region of the Algarve shows huge differences between the coastline where population in the urban areas grows, and the inland rural areas, in some cases very isolated, which frequently have high ageing indexes. This general scenario, with an elderly population with very different economic and social conditions, frames the ongoing PhD research designed as a cross-sectional study of an intentional sample of elderly persons. The basic theoretical framework departs from the perspective of developmental psychology of life-span and the model of selection, optimisation and compensation for optimal ageing (Baltes & Baltes, 1990; Freund & Baltes, 2002). The present study is a first step in the analysis of empirical data collected in the PhD sample (N=156; age range 65 to 97 years; M = 80.4 years; SD = 7.2 years). Its purpose is to assess the cognitive functioning of participants, screening for cognitive impairment and examine the relations between the cognitive status of the subjects and a number of selected variables including educational level, age, physical activity and living contexts of the subjects. We accessed the cognitive status of the participants with the Portuguese version of Mini Mental State Examination (MMSE) finding a 10.3% prevalence of positive cases with cognitive impairment. The results also show significant relationships between the cognitive status accessed by the MMSE and educational level, professional qualification, age, living arrangement and activity level of the participants. The relationship verified between educational level and cognitive status of the participants was the largest correlation found in the study with the variability in educational level accounting for 44.8% of the variability in MMSE score. This results points in the same direction of several lines of research that corroborate the strong intercorrelation between education and cognitive functioning in old age.

Affections dermatologiques et troubles dépressifs : leur association chez les personnes âgées du Québec

Résumé : Les liens entre les maladies dermatologiques et les troubles de santé mentale, dont la dépression, sont reconnus depuis longtemps. Cependant, peu d’études de population ont examiné cette problématique et aucune n’a été faite auprès des aînés. Le but de ce mémoire est d’explorer l’association entre les affections dermatologiques et les troubles dépressifs chez les personnes âgées vivant à domicile. Pour ce faire, deux études ont été réalisées. La première visait à décrire les caractéristiques dermatologiques de la population à l’étude et la deuxième avait pour but de tester l’hypothèse d’une association bidirectionnelle entre les problèmes mentionnés. Il s’agit d’une analyse secondaire des données de l’Enquête sur la Santé des Aînés (ESA) qui a été menée auprès d’un échantillon représentatif de la population âgée (≥ 65 ans) vivant à domicile au Québec. Des mesures répétées à un an d’intervalle (T1 et T2) ont été obtenues auprès de 2 cohortes successives fixes. Les données de l’enquête ESA ont été appariées à celles des registres de la Régie de l’assurance maladie du Québec (RAMQ). Les troubles dépressifs ont été définis en se basant sur les critères du DSM-IV et les affections dermatologiques ont été mesurées à partir de deux sources de données (enquête et registres administratifs de la RAMQ). Des modèles autorégressifs bivariés ont été utilisés pour tester l’hypothèse d’association bidirectionnelle entre les affections dermatologiques et les troubles dépressifs. Nos résultats ont montré que près de 13% et 21% des répondants ont rapporté des affections dermatologiques auto-rapportées ou avaient été diagnostiqués selon les registres de la RAMQ. En plus, près de 6% des participants rapportaient un trouble dépressif probable au T1 et au T2. Nos résultats suggèrent la présence d’une association synchronique (transversale) entre les affections dermatologiques et les troubles dépressifs. Ce projet souligne l’importance d’évaluer et d’explorer la cooccurrence de ces deux pathologies afin d’améliorer la prise en charge des individus atteints simultanément par ces deux problèmes. Nous suggérons l'inclusion des affections dermatologiques dans les futures études épidémiologiques visant à explorer les liens entre les troubles de santé mentale et de santé physique chez les personnes âgées.//Abstract : The relationship between skin conditions and mental health disorders, which includes depression, has long been recognized. However, few population - based studies have examined this issue and none were carried out in older - adults. The aim of this project was to explore the associations between skin conditions and depressive disorders affecting the elderly living at home. To do this, two studies were conducted; the first aimed to describe the dermatological features of the study population. The second was designed to test the hypothesis of a bidirectional association between the conditions mentioned above. We carried out secondary data analyses from data collected in the Study on the Health of Seniors (ESA ) survey, which consisted of a representative sample of the elderly population (≥ 65 years) living at home in Quebec. Two repeated measurements one year apart (T1 and T2) were obtained from two fixed successive cohorts. Participants in both phases of the investigation and with available health service information from Quebec’s health insurance plan agency (Régie de l'assurance maladie du Québec - RAMQ) were selected for this project. Depressive disorders were defined based on DSM - IV criteria and dermatological conditions were measured from two data sources (survey and administrative records). Cross - lagged panel models were used to test the hypothesis of association between the two mentioned conditions. Our results showed that nearly 13% and 21% of respondents have self - reported and diagnosed skin conditions, respectively. In addition, about 6% of participants reported symptoms that were consistent with a probable depressive disorder on T1 and T2. Our results suggested the presence of synchronous (cross - sectional) associations between skin conditions and depressive disorders in the elderly. This research highlights the importance of assessing and exploring the co - occurrence of these two conditions to improve the management of individuals who are affected. We suggest the inclusion of dermatological conditions in future/further studies exploring the comorbidity between mental and physical health in the older adults.

Construção e validação da tabela nacional de funcionalidade para as doenças crónicas

© Ordem dos Médicos 2016