Geriatrie et Psychologie Neuropsychiatrie De Vieillissement最新文献

Nursing homes are suffering from a shortage of medical and paramedical staff, at a time when demand for care is rising steadily and the proportion of people aged 65 and over has increased by 4.7 points in 20 years to 20.5% of the French population. This age group could reach 28.7% by 2070, exacerbating the difficulties faced by nursing homes if no measures are taken. The use of information and communication technologies (ICT) to help the elderly is a promising avenue, and its development will depend in part on future generations of general practitioners. We carried out a quantitative study, using a self-administered questionnaire and on-line survey software, to assess the knowledge of general medical interns at the Reims Faculty of Medicine about the practice of telemedicine in nursing homes. Evaluate their experiences of telemedicine, and identify obstacles and motivations, in order to highlight possible levers that could contribute to the development of this practice. Finally, we measured the impact of the Covid-19 crisis on current and future use of telemedicine in nursing homes. Since the advent of the Covid-19 pandemic, telemedicine has seen lightning growth, particularly in nursing homes. Despite some reluctance, the general practitioner remains an essential element in achieving these objectives, but this will require the training of new generations of doctors right from the start of their clerkship. The development of telemedicine in nursing homes will have to be pursued through a complex territorial medical project, taking into account the specificities of the care offer in the territory under consideration, and the existence of a well-developed and adapted financial model for both investment and operation.

This study aimed to determine the course of psychotropic drugs use since the Covid-19 pandemic onset among nursing homes (NH) residents in Brittany, France. We conducted a retrospective, observational, descriptive study, including 7 NH. We collected the data about antipsychotic, antianxiety, hypnotic and antidepressant drugs dispensed from January 2016 to June 2021, and compared their consumptions over 3 periods (1: January 2016 to December 2019; 2: January to December 2020; 3: January to June 2021) using the unit of measurement DDD. In the whole NH population, no significant changes were found. At a NH level, the results between periods 1 and 2 were very different, depending on the NH. For NH with a single nursing home-employed physician, there was an increase of antipsychotic drugs use between periods 1 and 2, and 1 and 3. During periods 2 and 3, the consumption of antipsychotic drugs was higher for NH with a single nursing home-employed physician. The course of psychotropic drugs use since the onset of the Covid-19 pandemic changed depending on the NH organization. Further studies are needed to identify the factors explaining differences between NH.

The aging of the population represents a daily challenge for the healthcare system. Post-emergency geriatric short-stay units have been created to meet the specific needs of the older patients, and particularly their frailty. The aim of this study was to assess the prevalence of severely frail patients in geriatric post-emergency units using the Clinical Frailty Scale (CFS) and to evaluate whether frailty serves as a predictive factor for all-cause mortality within a 3-month period. The CFS score at hospital admission and 3-month all-cause mortality were retrospectively evaluated in geriatric inpatients hospitalized in the Post-Emergency short stay Geriatric Unit (PEGU) of Angers hospital. Potential confounders as age, sex, Charlson Comorbidity Index, history of malignancies, excessive polypharmacy, history of hospitalization within the past month, use of anticoagulants, use of psychotropic medications, length of stay in the emergency unit, C-reactive protein (CRP) level at admission, signs of severity on initial admission were assessed and included in a Cox survival model. 701 participants (mean 88.0 years (IQR 83-92); 55.6% women; 29.2% with a CFS > 7) were included. Out of the participants, 111 (15.8%) did not survive for three months after admission. Specifically, 28.3% of the patients with a CFS score ≥ 7 did not survive, compared to 10.7% of the other patients (p < 0.001). CFS score ≥ 7 at admission was directly associated with 3-month all-cause mortality (fully adjusted HR = 2.68 (95% CI: 1.76-4.06) p < 0.001)). Those with CFS score < 7 had longer survival time than the others (log-rank P < 0.001). Severe frailty, defined by a CFS score ≥ 7 during emergency admissions, was associated with increased 3-month mortality among patients admitted to PEGU.

Frailty is a state of being physically weak and vulnerable, with reduced functional reserve and resilience, while prefrailty represents an intermediate reversible stage. However, the association between serum α-klotho levels and frailty or prefrailty, particularly in prefrail individuals, remains uncertain. This study aimed to investigate the potential relationship between serum klotho levels and the prevalence of frail or prefrail among adults in the USA. Cross-sectional data from individuals aged 40-79 years who participated in the NHANES between 2007 and 2016 were analyzed. Multivariate logistic regression models were employed to assess the association between klotho and frailty or prefrailty. Restricted cubic splines were used to explore potential non-linearity relationships and dose-response association. Additionally, stratified and interaction analyses were performed to evaluate the stability of the relationship in different subgroups. The study included 6868 participants, with 52.9% (3630/6868) classified as -prefrail. Compared to individuals in the lower ln(klotho) consumption quartile (Q1,≤6.462), the adjusted OR values for ln(klotho) and prefrailty in Q2 (6.463-6.666), Q3 (6.667-6.882), and Q4 (>6.882) were 0.75 (95% CI: 0.64-0.87, p<0.001), 0.87 (95% CI: 0.75-1.01, p=0.063), and 0.81(95% CI: 0.70-0.95, p= 0.008), respectively. An L-shaped curve between ln(klotho) and prefrailty was observed (p=0.001). In two piecewise regression models, the adjusted OR for prefrailty was 0.41 (95% CI: 0.28-0.60; p<0.001) when ln(klotho)<6.68, while no association was found with ln(klotho)≥6.68. Subgroup and stratified analyses consistently confirmed the strength of the relationship. The findings of this study reveal an L-shaped relationship between serum klotho and prefrailty, indicating a significant inflection point at approximately 6.68. These results suggest that integrating the assessment of prefrailty into clinical practice could offer clinicians a valuable tool for early identification and management of this condition.

This literature review examines preventive nutritional interventions for community-dwelling older adults, based on the analysis of 26 selected articles published between 2010 and 2023. The most effective interventions combine: specific nutritional advice, adapted physical activity recommendations, and practical workshops. The majority of studies (19/20) included dietary counselling, with some targeting specific aspects such as fruit and vegetable consumption or the Mediterranean diet. Fourteen studies combined this advice with physical activity recommendations, with programs ranging from 10 minutes several times a day to 150 minutes of moderate activity per week. Intervention formats were either in-person (9/20), hybrid (10/20) combining face-to-face and telemonitored follow-up, or entirely telemonitored (1/20). Practical workshops, present in 11 interventions, included cooking workshops, discussion sessions, food diversification exercises and supervised physical activities. Results suggest that specific dietary advice is more effective than general recommendations, particularly when personalized and combined with physical activity. The hybrid format shows promising results for improving eating behaviors and physical activity. This review emphasizes the importance of adapting interventions to individual needs and the psychosocial context of older adults to ensure their engagement and program effectiveness.

This bicentric study evaluates the user experience of an inclusive virtual museum in nursing homes, developed by Hello Art-Up, involving residents and healthcare professionals. Despite diverse user profiles, the results show excellent acceptance, strong positive emotions, and a clear intention to reuse the tool. It fosters self-expression, social connection, and identity recognition. Suggestions were made to enhance intergenerational and regional outreach. Although all levels of immersion could not be tested, the solution appeared promising, with potential benefits for mental well-being and quality of life in nursing homes.

Verb anomia is a key symptom in individuals with post-stroke aphasia, yet its assessment tools remain limited. The Action Naming Test With Videos (T-DAV) had not yet been validated for this population. This study aims to validate the T-DAV in individuals with post-stroke aphasia by exploring the effects of lexical frequency and phonemic cues on naming performance. Discriminant validity was examined by comparing the performance of 18 individuals with post-stroke aphasia with that of healthy participants. The effect of lexical frequency was also analyzed. The T-DAV accurately differentiated the performance of patients and healthy participants, showing good discriminant validity. A frequency effect was observed, and phonemic cues improved performance in individuals with post-stroke aphasia. The T-DAV addresses a need in the French-speaking assessment of verb anomia in post-stroke aphasia, thereby facilitating more targeted therapeutic interventions.

Malnutrition, a common condition in older patients hospitalized in geriatric rehabilitation units (GRU), increases the risks of morbidity and hospital mortality, The consumption of oral nutritional supplements (ONS) can quickly lead to disgust explaining their low adherence. To evaluate the effect of adding high-protein mini-cakes (HP-HC) on the caloric and protein intakes of patients hospitalized in GRU who are malnourished or whose target dietary intakes are not reached with an enriched diet and traditional ONS. HP-HC mini-cakes were made available in addition to prescribed meals and ONS for 5 days (period 2) in patients aged over 65 whose clinical situation had been deemed stable for 3 days (period 1), Comparison of dietary intakes between periods 1 and 2 used the Wilcoxon test for paired data. Mean daily caloric and protein intakes were significantly higher in period 2 (1,529.1 ± 563.8 kcal/day and 69.4 ± 28,0 g/day, respectively) than in period 1 (1,234.5 ± 495.7 kcal/day and 53.7 ± 28.4 g/day, respectively) (p < 0,01), Moreover, the addition of minicakes did not significantly change caloric and protein intakes of meals and other ONS. No adverse effects were observed. The positive effect on caloric and protein intakes provided by HP-HC mini-cakes, new in their softness and new flavor, suggests their interest in the diversification of CNO prescribed in malnourished patients hospitalized in GRU.

As the French health authority (Haute Autorité de santé, HAS) diagnostic criteria for malnutrition have changed in 2021, moving closer to international criteria (GLIM), prevalence data for malnutrition in geriatric acute geriatric units (GACU) need to be updated. In a cohort of 235 consecutively admitted patients (average age 86 y.o.), malnutrition was diagnosed according to HAS 2007, 2021 and GLIM criteria, including screening for confirmed sarcopenia (CS). The phenotypic criteria were weight loss (23%), BMI < 22 (33%) and CS (51%). The prevalence of malnutrition was 65% (33% severe) according to HAS 2021, 46% (16% severe) according to HAS 2007 and 73% (24% severe) according to GLIM. In comparison with the HAS 2021 criteria, agreement between the HAS 2021 and 2007 criteria was poor (k = 0.278), and good with GLIM (k = 0.707). The HAS 2021 criteria identify more malnourished patients than the 2007 criteria in GACU with a high prevalence of CS.

In January 2023, 14.5 millions people were over 65 (21.3%) and 600,000 people live in nursing homes. A 2018 study showed that 30 % of visits to the emergency room were "avoidable". Measure 5 of the 2019-2022 emergency overhaul pact is to generalize routes dedicated to the elderly to avoid recourse to emergencies. The EMGE (Mobile Extra-Hospital Geriatrics Team) is a key mechanism in coordination between nursing homes and emergency reception services. Objective: Study the reasons why elderly people residing in nursing home go to emergency. We prospectively identified and described emergency transfers of residents of 4 nursing homes, from January 1 to March 31, 2022. Then, retrospectively, we requested a panel of 9 expert in order to judge if the transfer to the emergency was appropriate, based on a questionnaire. 50 (75,6%) transfer were assessed as suitable by at least 5 of the 9 experts. The average age of transferred residents was 91.7±6.4 years. In 35 % of cases, the symptoms motivating the transfer had been present for more than 48 hours. The main reason for 2 transfers was a fall (35%). A nurse was at the origin of 40 transfers (61%). This study shows that 76% of visits to the emergency room were considered suitable. The management of emergency situations in nursing homes is a real public health issue, and the pivotal role of a GMT is to secure, optimize and streamline the care of elderly people in nursing homes, and to limit as much as possible the transfer to emergencies.