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© The Author(s) 2017. Published by Oxford University Press on behal f of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

109Journals of Gerontology: Medical Sciences

cite as:

J Gerontol A Biol Sci Med Sci

2018, Vol. 73, No. 1, 109-116

doi:10.1093/gerona/glx068

Advance Access publication May 24, 2017

Research Article

Prevalence and Co-Occurrence of Geriatric Syndromes in People Aged 75 Years and Older in France: Results From the Bordeaux Three-city Study

Maturin Tabue-Teguo,

1 2 3 4

Leslie Grasset,

1 2

José Alberto Avila-Funes,

1 2 5

Robin Genuer,

1 2

Cecile Proust-Lima,

1 2

Karine P éres,

1 2

Catherine F éart,

1 2

Hélène Amieva,

1 2 3

Magali González-Colaço Har mand,

1 2

Catherine Helmer ,

1 2

Nathalie Salles,

6

Muriel Rainfray,

1 2 6 and Jean François Dartigues 1 2 3 1

INSERM U 1219, Université de Bordeaux, France.

2 Institut de Santé Publique d'Epidémiologie et de Développeme nt (ISPED), Université de Bordeaux, France. 3 Institut des Maladies Neurodégénératives Clinique, Centre Hospi talier Universitaire de Bordeaux, France. 4

Centre

Hospitalier Villeneuve-sur-Lot, France.

5 Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nu trición Salvador Zubirán,

Mexico City, Mexico.

6 Pôle gérontologie clinique, Centre Hospitalier Universitaire de Bo rdeaux, France.

Address correspondence to: Maturin Tabue-Teguo, MD, Centre de Recherche INSERM, U1219, 146 rue Léo Saignat, 330

76 Bordeaux cedex,

France. E-mail:

tabue.maturin@gmail.com Received: September 14, 2016; Editorial Decision Date: April 7, 2017

Decision Editor:

Stephen Kritchevsky, PhD

Abstract

Background:

Geriatric syndromes (GSs) are often the result of cumulative insults t o multiple organ systems and are considered common in

older adults. However, their frequency and co-occurrence are not well known in the elderly population. This study aimed to determine the

prevalence of several GSs and to analyze the co-occurrence of these synd romes in a general population of elderly individuals.

Methods:

A cross-sectional analysis of 630 adults aged 75 years or older participating in the 10-year follow-up of the Bordeaux sa

mple of the

French Three-City Study was conducted. The following 10 GSs were assessed: physical frailty, dementia and cognitive impairment, depressive

symptoms, polymedication, social isolation, thinness, falls, dependence, sensory de?cit, and incontinence. The prevalence of the 10 GSs was

estimated, and multiple correspondence analysis (MCA) models were used to explore the mutual associations between these GS

s.

Results:

The mean age of the participants was 83.3 years; 69% were women, and 80.5% [95% con?dence interval (CI) = 76.3-82.7] had at

least one GS. The most frequent GSs were polymedication (50.6% 95%CI = 46.7-54.5) and falls (43.1% 95%CI = 38.4-46.1). The MCA

models identi?ed two major dimensions of the 10 GSs: "Dementia-Dependence-Incontinence" and "Frailty-Depression-Isolation."

Conclusions:

GSs were very common in this French elderly population and were grouped into two major dimensions: the "Dementia- Dependence-Incontinence" and "Frailty-Depression-Isolation."

Keywords:

Geriatrics syndrome - Elderly - Epidemiology - Cohort study A geriatric syndrome (GS) is a "clinical condition taken in a very broad sense (personal history and complaints of the patient, clini cal examination, and results of complementary examinations) that does not ?t into a discrete disease category" ( 1 ) and occurs in elderly people. GSs are considered highly prevalent in older adults and thus present practical management challenges for physicians ( 2 3 ). From a practical perspective, primary care practitioners (PCPs) need to

de?ne priorities when managing elderly people's health because of the multiple cumulative comorbidities and co-occurring GSs that develop with age. However, few population-based studies have docu-mented the co-occurrence of GSs after the age of 75 years (4), despite the fact that these syndromes are associated with a poor quality of life and adverse health-related outcomes. This lack of robust data limits effective preventive and curative planning.

In the absence of consistent epidemiological data, PCPs have

used a pragmatic approach of prioritizing the management of easily Downloaded from https://academic.oup.com/biomedgerontology/article/73/1/109/3852138 by guest on 21 September 2023

treatable diseases such as diabetes, hypertensions and cardiac dis- orders, while other conditions that are more dif?cult to detect, diagnose and manage, such as dementia (approximately 50% of prevalent dementia cases are not diagnosed), suffer from a lack of appropriate care ( 5 Some methodological challenges can at least partially explain the paucity of data in the ?eld of GS ( 2 ). First, although the concept of

GS is not new (

6 ), efforts to clearly de?ne the term for application in epidemiological studies are relatively recent ( 7 ). Despite these efforts, several GSs are not well distinguished from speci?c diseases or other syndromes such as dementia and delirium, frailty, and depression. Several syndromes can also interact, and in some instances, the pres ence of one entity can essentially exclude the presence of another 8 9 ); for example, with moderate to severe dementia and physical frailty, several criteria for frailty are not valid when the subject has moderate to severe dementia, particularly exhaustion or mobility. Thus, it can be dif?cult to de?ne the numerator and denominator in studies on the prevalence of these syndromes. Second, data on most GSs have not been routinely collected in population-based health care registries, and when collected, such as for dementia or depres sion, the proportion of undiagnosed cases can be very high. Third, obtaining a representative sample of elderly people from the general population remains challenging due to refusals or lack of ability to participate. The 10-year follow-up evaluation (2010) conducted by the Three-City cohort study in Bordeaux (3C Bordeaux) provided an opportunity to assess the prevalence of several GSs. The objective of the present study was to determine the prevalence of 10 previously evaluated GSs and to analyze the co-occurrence of these syndromes to de?ne clusters of syndromes and subsamples of the population that require simultaneous management of several GSs by PCPs.

Methods

Subjects

The present research is an ancillary study of the Three-City (3C) Study, a French prospective cohort study that aimed to evaluate the risk of dementia and cognitive impairment attributable to vascular risk factors. A detailed description of the 3C study has been provided elsewhere ( 10 ). Brie?y, the baseline sample included 9,294 commu nity dwellers, aged 65 years or more, who were randomly selected between 1999 and 2000 from the electoral registries of three French cities: Bordeaux, Dijon, and Montpellier. Since the baseline visit in

1999, the participants have received up to four home visits by a

trained psychologist after 2, 4, 7, and 10 years. The psychologists col lected information including socio-demographic and lifestyle charac teristics, educational level, self-reported chronic diseases, depressive symptoms, and functional status during face-to-face interviews. In addition, participants underwent a comprehensive evaluation of cog nitive and physical function. The 3C study was speci?cally designed to collect information on four GSs (dementia and cognitive impair- ment, disability, depressive symptoms, and polymedication), and data on six other GSs were also obtained (social isolation, thinness, falls, physical frailty, sensory de?cits, and incontinence). The present study analyzed a subsample of 630 subjects, all liv ing in the city of Bordeaux, who were seen at the 10-year follow- up (data collected in 2009). The study assessed only the subsample from Bordeaux for two reasons: ?rst, data on frailty and falls were not collected in Dijon and Montpellier, and second, in the Bordeaux

area, only the subsample of subjects from Bordeaux city was representative of the general population. In the suburbs of Bordeaux (Cenon, Floirac, Merignac, Pessac, and Talence), there was an insuf-?cient number of participants (200 each) to study representativenes

s. The Ethical Committee of the University Hospital of Kremlin- Bicêtre (Paris, France) and Sud-Mediterranée 3 (Nimes, France) approved the 3C study, and all participants signed an informed consent.

Geriatric Syndromes and Their Measurement

At 10-year follow-up of the 3C Bordeaux cohort living in Bordeaux,

1,104 persons were contacted: 324 were dead, 86 refused, 64 moved

away, and 630 were seen at home by a psychologist. Missing data were observed only for depression, frailty, and social isolation. The 10 GSs were assessed according to common GS de?nitions and data availability ( 1 ). The following GSs were of interest in this study: frailty, dementia and cognitive impairment, depressive symp toms, polymedication, social isolation, thinness, falls, dependence, sensory de?cit, and urinary incontinence.

Physical frailty

Physical frailty was de?ned according to the ?ve components pro posed by Fried and colleagues ( 11 ). Recent and unintentional weight loss of ≥ 3 kg was identi?ed, and body mass index (BMI) was cal culated. Participants who answered "yes" to weight loss or had a

BMI < 21 kg/m

2 were considered frail for this component ( 12 13 Exhaustion was identi?ed according to two questions from the Center for Epidemiological Studies Depression Scale (CES-D): "

I felt

that everything I did was an effort " and "

I could not get going.

Slowness was determined by a score in the lowest quintile on the timed 4-meter gait speed test adjusted for sex and height. Participants scoring in the weakest quintile of the grip strength test were cat egorized as frail for weakness. Low physical activity was de?ned as not performing daily leisure activities such as walking, gardening or exercising at least once a week. Participants who met three or more criteria were classi?ed as frail; those meeting one or two criteria, prefrail; and those meeting none of the criteria, non-frail.

Dementia and cognitive impairment

The diagnosis of dementia was assessed at each of the follow-up vis its. A trained psychologist administered an interview and a battery of neuropsychological tests. At the follow-up visits, a neurologist exam ined participants who were suspected of incident dementia based on the neuropsychologist's suspicion and decline in Mini-Mental State Examination (MMSE) score. Finally, an independent committee of neurologists reviewed all potential cases of dementia to obtain a con sensus on the diagnosis according to the Diagnostic and Statisticalquotesdbs_dbs25.pdfusesText_31

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