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Background and Objectives: Foster families for older adults could represent a transitional or alternative model to nursing homes. The aim of this study was to describe the clinical characteristics of older adults in foster families and to compare them with those of residents in nursing homes in French West Indies. Research Design and Methods: This study is a cross-sectional analysis of the KArukera Study of Aging in Foster Families (KASAF) cohort. Sociodemographic and clinical characteristics were extracted. Dependency was assessed using the Activities of Daily Living (ADL) scale and cognition using the Mini-Mental State Examination (MMSE) scale. Age, gender, ADL, and MMSE scores were compared with nursing home residents from a twin study of KASAF (nâ =â 332). Results: A total of 107 older adults (mean age 81.8 years; 61.7% women) were recruited in 56 foster families between September 2020 and May 2021. In all, 25.5% had diabetes mellitus and 45.8% suffered from hypertension. The mean MMSE score was 9.3 ± 10.1 and 76.0% had major cognitive impairment (MMSE score <18); 12.5% were diagnosed with Parkinson's disease, and 42.0% of the residents were confined to bed or in a wheelchair, with a mean ADL score of 1.5 ± 1.8. Almost all the residents (96.3%) benefited from a medical follow-up by a nurse who visited once or twice a day. Compared to older adults living in nursing homes, those in foster families were more frequently women (61.7% vs 49.4%) and had lower ADL score (1.5 vs 2.4) and lower MMSE score (9.3 vs 11.3). Discussion and Implications: The clinical profile of foster families' residents was quite similar to that of nursing home residents in terms of demographics, dementia, and dependency. Foster families might represent an interesting strategy to address the unmet clinical and social needs of dependent older adults, especially in countries where nursing homes are not sufficiently developed. Clinical Trials Registration Number: NCT04545775.
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BACKGROUND: Foster families may represent an alternative model for dependent older adults in many countries where nursing homes are insufficiently developed. This study aimed to assess the prevalence of malnutrition and its determinants in older adults living in foster families in Guadeloupe (French West Indies). METHODS: This cross-sectional study was gathered from the KASAF (Karukera Study of Ageing in Foster families) study (n = 107, 41M/66F, Mdn 81.8 years). Nutritional status was assessed with the Mini Nutritional Assessment Short-Form (MNA-SF). Clinical characteristics and scores on geriatric scales (Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Short Physical Performance Battery (SPPB), Center for Epidemiologic Studies- Depression (CESD) and Questionnaire Quality of Life Alzheimer's Disease (QoL-AD)) were extracted. Bivariate analysis and logistic models adjusted for age and gender were performed to test the association of nutritional status with socio-demographic variables and geriatric scales. RESULTS: Thirty (28.0%) older adults were malnourished (MNA-SF score ≤7). In bivariate analysis, malnutrition was associated with an increased prevalence of cardiovascular diseases (46.7% versus 19.5%, p = 0.004), the presence of hemiplegia (30.0% versus 6.5%, p = 0.003), a poorer cognitive status (MMSE score 4.7 ± 7.1versus 9.7 ± 10.7; p = 0.031), higher risk of depression (CESD score 27.3 ± 23.0 versus 13.5 ± 14.4; p = 0.035) and dependency (ADL score 1.9 ± 1.9 versus 2.3 ± 2.1; p<0.001). Malnutrition was also associated with lower caregivers'rating of QoL (QoL-AD score 21.8 ± 6.4 versus 26.0 ± 5.7; p = 0.001) but not by older adult's rating (24.1 ± 11.2 versus 28.3 ± 7.7; p = 0.156). Similar associations were observed in logistic models adjusted for age and gender. CONCLUSION: Malnutrition was common among foster families for older adults. Special attention towards the prevention and treatment of malnutrition in older adults from cardiovascular diseases, cognitive impairment, dependency and depression is necessary in this model of dependency support.
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Desnutrição , Estado Nutricional , Humanos , Masculino , Feminino , Desnutrição/epidemiologia , Desnutrição/psicologia , Estudos Transversais , Idoso , Idoso de 80 Anos ou mais , Guadalupe/epidemiologia , Avaliação Geriátrica , Prevalência , Atividades Cotidianas , Qualidade de Vida , Avaliação Nutricional , Depressão/epidemiologiaRESUMO
Background: Ethnic variations have been reported in allelic frequencies of the leptin receptor gene (LEPR) with population-specific effects. We aimed to explore the association of LEPR polymorphisms with obesity, metabolic syndrome (MetS), and leptin levels in Afro-Caribbean nondiabetic subjects. Methods: Genotypic analysis of three LEPR polymorphisms (K109R, Q223R, and K656N) was performed using TaqMan allelic discrimination assays. Associations were measured with phenotypic variables, including body mass index (BMI), waist circumference (WC), and leptin levels. Linear and logistic regressions were performed to evaluate the effects of single-nucleotide polymorphisms (SNPs). Results: Mean age was 46 ± 12 years. Among the 375 participants, 29.3% were obese, 36.3% had abdominal obesity, and 18.1% had MetS. Significant association between BMI (P < 0.002) and WC (P < 0.005) was observed for K656N, whereas the associations were not statistically significant for the other two SNPs. No association was found with leptin levels for the three SNPs. The variant allele frequencies for LEPR 109R, 223R, and 656N were 0.16, 0.46, and 0.20, respectively. In dominant models, the variant allele 656N (GC/CC vs. GG) was associated with prevalence of obesity [odds ratio (OR) 1.82; P = 0.012] and abdominal obesity (OR 2.00; P = 0.007), but not significantly with prevalence of MetS (OR 1.72; P = 0.029). Individuals carrying four variant alleles of the three SNPs had a significantly higher risk of obesity (OR 2.86; P = 0.032) than those carrying none variant allele. Conclusion: Our results suggest an influence of K656N polymorphism in the LEPR gene on obesity and abdominal obesity in this Afro-Caribbean population.
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Síndrome Metabólica/genética , Obesidade/genética , Polimorfismo de Nucleotídeo Único , Receptores para Leptina/genética , Adulto , África , Alelos , População Negra , Índice de Massa Corporal , Região do Caribe , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Guadalupe/epidemiologia , Humanos , Leptina/sangue , Modelos Lineares , Masculino , Síndrome Metabólica/etnologia , Pessoa de Meia-Idade , Obesidade/etnologia , Obesidade Abdominal/genética , Sobrepeso/genética , Fenótipo , Análise de Regressão , Circunferência da CinturaRESUMO
Context: The population of Guadeloupe Island exhibits a high prevalence of obesity. Objective: We aimed to investigate whether rare genetic mutations in genes involved in monogenic obesity (or diabetes) might be causal in this population of Afro-Caribbean ancestry. Design and Setting: This was a secondary analysis of a study on obesity conducted in schoolchildren from Guadeloupe in 2013 that aimed to assess changes in children's profiles after a lifestyle intervention program. Through next-generation sequencing, we sequenced coding regions of 59 genes involved in monogenic obesity or diabetes in participants from this study. Participants and Interventions: A total of 25 obese schoolchildren from Guadeloupe were screened for rare mutations (nonsynonymous, splice-site, or insertion/deletion) in 59 genes. Main Outcome Measures: Correlation between phenotypes and mutations of interest. Results: We detected five rare heterozygous mutations in five different children with obesity: MC4R p.Ile301Thr and SIM1 p.Val326Thrfs*43 mutations that were pathogenic; SIM1 p.Ser343Pro and SH2B1 p.Pro90His mutations that were likely pathogenic; and NTRK2 p.Leu140Phe that was of uncertain significance. In parallel, we identified seven carriers of mutations in ABCC8 (p.Lys1521Asn and p.Ala625Val) or KCNJ11 (p.Val13Met and p.Val151Met) that were of uncertain significance. Conclusions: We were able to detect pathogenic or likely pathogenic mutations linked to severe obesity in >15% of this population, which is much higher than what we observed in Europeans (â¼5%).