Our findings support the hypothesis that cognitively stimulating leisure activities may delay the onset of dementia in community-dwelling elders.

The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care.

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OBJECTIVES The wish to die may be different in geriatric patients than in younger terminally ill patients. This study aimed to develop and validate instruments for assessing the wish to die in geriatric patients. DESIGN Cross‐sectional study. SETTING Geriatric rehabilitation unit of a university hospital. PARTICIPANTS Patients (N = 101) aged 65 years or older with a Mini‐Mental State Examination score of 20 or higher, admitted consecutively over a 5‐month period. MEASUREMENTS The Schedule of Attitudes Toward Hastened Death (SAHD) was adapted to the older population (SAHD‐Senior). A second tool was developed based on qualitative literature, the Categories of Attitudes Toward Death Occurrence (CADO). After cognitive pretesting, these instruments were validated in a sample of patients admitted to a geriatric rehabilitation unit. RESULTS The SAHD‐Senior showed good psychometric properties and a unifactorial structure. In the studied sample, 12.9% had a SAHD‐Senior score of 10 or higher, suggesting a significant wish to die. Associations were observed between high levels of the SAHD‐Senior and advanced age, high levels of depressive symptoms, lower quality of life, and lower cognitive function. The CADO allowed for passive death wishes to be distinguished from wishes to actively hasten death. According to the CADO, 14.9% of the sample had a wish to die. The two instruments showed a concordance rate of 90.1%. CONCLUSION The wish to die in older patients admitted to rehabilitation can be validly assessed with two novel instruments. The considerable proportion with a wish to die warrants investigation into concept, determinants, and management of the wish to die. J Am Geriatr Soc 68:1202–1209, 2020.

Background: In view of population aging, a better knowledge of factors influencing the type of long-term care (LTC) among older adults is necessary. Previous studies reported a close relationship between incontinence and institutionalization, but little is known on opinions of older citizens regarding the most appropriate place of care. This study aimed at evaluating the impact of urine and/or fecal incontinence on preferences of communitydwelling older citizens. Methods:We derived data from the Lausanne cohort 65+, a population-based study of individuals aged from 68 to 82 years. A total of 2974 community-dwelling persons were interviewed in 2017 on the most appropriate place of LTC delivery for three vignettes displaying a fixed level of disability with varying degrees of incontinence (none, urinary, urinary and fecal). Multinomial logistic regression analyses explored the effect of respondents' characteristics on their opinion according to Andersen's model. Results: The level of incontinence described in vignettes strongly determined the likelihood of considering institutional care as most appropriate. Respondents' characteristics such as age, gender, educational level, being a caregiver, knowledge of shelter housing or feeling supported by family influenced LTC choices. Self-reported incontinence and other indicators of respondents' need, however, had no significant independent effect.Conclusion: Among older community-dwelling citizens, urinary and fecal incontinence play a decisive role in the perception of a need for institutionalization. Prevention and early initiation of support for sufferers may be a key to prevent this need and ensure familiar surrounding as long as possible.

Background Legal dispositions for advance care planning (ACP) are available but used by a minority of older adults in Switzerland. Some studies found that knowledge of and perception of those dispositions are positively associated with their higher usage. The objective of the present study is to test the hypothesis of an association between increased knowledge of ACP dispositions and a more positive perception of them. Methods Data collected in 2014 among 2125 Swiss community-dwellers aged 71 to 80 of the Lausanne cohort 65+ (Lc65+), a population-based longitudinal study on aging and frailty. Data collection was conducted through a questionnaire on knowledge, use and perception of lasting power of attorney, advance directives and designation of a health care proxy. Covariables were extracted from the Lc65+ database. Bivariable and multivariable regression analyses assessed the association between level of knowledge and perception. Results Half the participants did not know about legal dispositions for ACP; filing rates were 14% for advance directives, 11% for health care proxy and 6% for lasting power of attorney. Level of knowledge about the dispositions was associated with a more positive perception of them, even when adjusting for confounding factors. Conclusion Although the direction of the association’s causality needs more investigation, results indicate that better knowledge on ACP dispositions could improve the perception older people have of them. Communication on dispositions should take into account individual knowledge levels and address commonly enunciated barriers that seem to diminish with increased knowledge.

Although affective and spiritual states may share some common clinical features, the precise nature of the relationship between depression and spirituality is still unclear. We tested the hypothesis that two instruments that measure depressive symptoms and spiritual distress describe similar dimensions.Patients admitted to geriatric rehabilitation (N = 185; mean age 81.3 ± 6.9 years) had depressive symptoms assessed with the 15-item Geriatric Depression Scale (GDS-15) and spiritual distress evaluated with the Spiritual Distress Assessment Tool (SDAT).A principal components analysis pooling GDS-15 and SDAT resulted in a 6-factor solution, with only one factor shared by both dimensions.Depressive symptoms and spiritual distress measured by the two instruments appeared only moderately correlated and corresponded to distinct dimensions.

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