Précarité, vieillissement cognitif et fragilité : approche épidémiologique

Abstract : Precariousness is associated with higher morbi-mortality. This phenomenon is less studied among the elderly than it is among adults. Yet, the aging of the population, as well as the increasing precariousness of the population, implies that a growing number of people in France are experiencing both conditions of aging and precariousness. The objective of this thesis is to better characterize the links between precariousness - defined with a psychosocioeconomic approach - and two issues related to aging: cognition and frailty. We first studied cognitive aging over 25 years within the Paquid cohort study. This study reported an accelerated cognitive decline and an increased risk of dementia for the precarious elderly. Then, this study was completed by including a measure of geographical deprivation and by applying a statistical methodology taking into account the competing risk of death. The results confirmed the association between psychosocioeconomic precariousness and the risk of dementia, but did not show any effects of geographical deprivation. In link with previous scientific literature, these two works have been the basis of a literature review on the impact of precariousness on cognitive aging submitted for publication. A final study examined the relationship between psychosocioeconomic precariousness, frailty and death. Based on the 14 years of follow-up of the 3 Cities cohort study, the results showed that both precariousness and frailty increased the risk of death but independently. This thesis contributes to a better understanding of the impact of precariousness on aging and in particular, it emphasizes the influence of the psychosocial determinants of precariousness on health in terms of survival and better cognition.
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Camille Ouvrard. Précarité, vieillissement cognitif et fragilité : approche épidémiologique. Psychologie. Université de Bordeaux, 2017. Français. ⟨NNT : 2017BORD0683⟩. ⟨tel-01677350⟩

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