Geriatrie et Psychologie Neuropsychiatrie De Vieillissement最新文献

Background: Falls and fall-related injuries are a major public health problem in industrialized countries. Faced with this challenge, a French national plan was launched in 2022 aiming to reduce by 20% the incidence of falls-related hospitalizations or deaths.

Objectives: To describe the main pillars of the 2022-2024 French national plan against falls in older persons. Methods and assessment: The six pillars of the plan are: 1) screening and monitoring risks of falls and alert health and care workers; 2) home safety assessment and getting out safely; 3) developing technical aids for mobility and the use of assistive technologies at home; 4) appropriate physical activity, best weapon against falls; 5) tele-assistance devices for all older persons; 6) a cross-cutting pillar: Informing, raising awareness, training, and involving local actors. The plan, deployed in the 18 French regions, will provide a unique opportunity to determine the best strategies to achieve the objectives and the barriers encountered.

Conclusions: The deployment of the French national plan will bring useful data for considering a long-term strategy in France and helping countries or regions wishing to implement a fall prevention plan on their territory.

Fractures of the upper end of the femur (FUEF) are a serious complication for the elderly, affecting 1,3 million patients a year worldwide (1). Studies dedicated to the post-operative follow-up of patients operated on for hip fracture in the long term are rare. The aim was to determine the epidemiological and evolutionary profile focusing on morbidity and mortality (survival and functional and cognitive decline) in the year following surgery for FUEF in patients aged over 65. Methods: Prospective observational study. Geriatric data were collected at the time of surgical management of FUEF with postoperative assessment of vital, functional and cognitive status. Results: Over a period of 24 months, 119 patients underwent surgery in the Orthopaedics-Traumatology Department of the University Hospital of Annaba. The patients were initially all independent (Instrumental Activities of Daily Living [IADL] 4 ≥ 3) and had no pre-operative cognitive disorders. There were 32 men and 87 women. The mean age was (77,4 ± 8,2) years with extremes of 65 and 100 years. All lesions were unilateral, with a predominance on the right. Most were trochanteric fractures (72 %). The most common aetiological circumstances were falls following domestic accidents. Eighty-seven patients received spinal anaesthesia, 19 received a general anaesthetic and 13 received an epidural. The average intervention time was 5,11 ± 4,17 days, with extremes of zero and 18 days. Depending on the treatment performed, 14 Dynamic hip Screw (DHS), three centro-medullary nailings, 33 plate blades and 24 plate nails and 15 gamma nails, 28 Moore's prosthesis, 2 screwings. The average length of stay was seven days. The one-year mortality rate for the 119 patients was 19,3 %. Patients who died after one year were malnourished (13,2 %, p = 0,05) with high comorbidity (ASA 2(78 %) and ASA 3(13 %) (p < 0,01 and p = 0,05). Of the survivors, 27 % had postoperative cognitive decline. Death occurred on average at 82,17 days. Conclusion: FUEF remains a real public health problem in terms of its prevalence, prognosis and cost. The mortality rate of patients aged over 65 years at one year post-operatively following an ESF was 19 %, which calls for the creation of a specialised orthogeriatric unit.

Vaccination coverage is insufficient for influenza, pneumococcus, and herpes zoster in people over the age of 65 in France, even though these are common infectious diseases. Using a computerised questionnaire, the aim of our study was to assess the knowledge of general practitioners, geriatricians, infectious diseases specialists and interns in the Loire region about the vaccination against these three diseases in elderly subjects, to identify the obstacles to vaccination, and to evaluate whether the provision of knowledge modifies the prescriptions and vaccination recommendations made to patients. Of the 125 responses from doctors and interns, 90.2 % are correct for influenza, 69.2 % for pneumococcus, and 32.8 % for herpes zoster, with no significant difference between specialities. By providing information, practitioners are more willing to vaccinate their patients against influenza (99 %), pneumococcus (93 %), and herpes zoster (39 %). The main obstacles to vaccination are the patient's refusal (85 %), the doctor's lack of knowledge and time (70 % and 41 % respectively), doubts about the vaccine's effectiveness (28 %), and fear of side effects (21 %).

Background: Management of depression in the elderly is a growing public health issue in France. The objective of this study was to compare practitioners' perception of depression severity (i.e., intensity and suicidal risk) and clinical practice (i.e., clinical assessment and medication choice) in elderly versus younger adult patients with major depression.

Materials and method: The method consisted of an online questionnaire completed by general practitioners and psychiatrists. Respondents'answers to a fictive case of a patient with major depression were randomized according to the patient's age, if the patient'age was either 40 or 70 years old. We assessed the perceived intensity of the depression, the perceived suicidal risk, the prescription of biological tests and cerebral imaging, and of antidepressive or other psychotropic medications. 102 completed forms were included. Data indicate that there were no significant differences in terms of perceived depression intensity and suicidal risk according to the patients'age. The prescription of biological tests was systematic in both groups, but a significant difference was observed in terms of prescription of brain imaging (71% of respondents for the 70-year-old patient versus 43% for the 40-year-old patient, p < 0.005), use of tetracyclic antidepressant (33% if aged 70 years versus 2% if aged 40 years, p < 0.001) and other psychotropic non-antidepressant medications (69% if aged 70 years versus 85% if aged 40 years, p < 0.05). This study did not show any significant difference in the perception of depression according to age. However, it highlights differences in terms of practical care according to age. These results suggest a partial gap between clinical practice and guidelines for the management of major depression in older adults, reflecting the need to favor the dissemination of guidelines and strengthen research for this population.

People aged 75 and over, frail or dependent are the most frequently hospitalized, particularly via the emergency department, and are sometimes readmitted to hospital less than a month after their discharge. Article 70 of the 2012 social security financing act has set up experiments aimed at improving the care pathway for the elderly. In this context, Marseille University Hospital has developed a table of help and grid for identifying the risk of aggravation of the elderly (Tagravpa). Comprising nine medical-psycho-social items, the grid enables the identification of the risk of aggravation to which is associated a score for identifying the risk of early re-hospitalization for the modeling of care pathways. A study was conducted in two departments. In cardiology for readmission at 1 month the results showed a grid positivity threshold of 6 for sensitivity measured at 56,6% (95% CI: 22,7-84,7) and specificity of 61,5% (95% CI: 40,7-79,1). In Emergency Department the results showed a positivity threshold of 4 for sensitivity at 83,3% (95% CI: 57,7-95,6) and specificity at 45,5% (95% CI: 36,8-54,3). This grid, called TAGRAVPA appears as a simple tool for identifying the risk of early re-hospitalization. It is applicable in a hospital environment, whatever the department and allows the initiation of an adapted path for the elderly person hospitalized or returning home from the emergency department.

Background: Falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs.

Objective: To synthesize evidence-based and expert consensus-based 2022 world guidelines for the management and prevention of falls in older adults. These recommendations consider a person-centred approach that includes the preferences of the patient, caregivers and other stakeholders, gaps in previous guidelines, recent developments in e-health and both local context and resources.

Recommendations: All older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for communitydwelling older adults. An algorithm is proposed to stratify falls risk and interventions for persons at low, moderate or high risk. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations.

Conclusions: The core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

Introduction: Inappropriate drug prescriptions (IP) lead to a high risk of adverse effects, especially for the elderly. Their detection is essential - which can be done using therapeutic lists, including the Stopp/Start scale version 2.

Methods: Observational study - from August 1, 2016, to November 30, 2016, in an advanced geriatric unit at Rouen University Hospital - using the Stopp/Start version 2 list.

Results: Eighty-five patients were included, with a ratio of 1.36 women per every man. Sixty-one patients (71.8%) had prescriptions for more than five drugs. The average Charlson comorbidity score was 6.05. One hundred ninety-one IPs were found. Classes E and G (kidney function and respiratory system prescriptions, respectively) were not uncovered. Fifty-four Stopp criteria - 66% of Stopp criteria - never emerged during our study. Using the 34 Start criteria, 187 omissions of prescriptions were found. Classes F and G (endocrine system and urogenital system drugs, respectively) were not observed at any time. Ten criteria were never seen (B3/C1/C4/C5/E6/E7/F1/G1/G2/G3). Nineteen criteria were mentioned less than three times - i.e., in approximately 10% of omissions.

Conclusion: Our study is part of an approach to protecting the elderly. A significant number of IP and prescription drug omissions were uncovered using this Stopp/Start version 2 tool.

Older adults who are socially isolated or who feel lonely have a higher risk of morbidity and mortality. It is important to be able to assess them with efficient tools. The objective was to describe tools for assessing feelings of loneliness (FoL) and social isolation (SI) in older adults, and to estimate their prevalence. A systematic review was conducted including 18 studies. For FoL, the most frequently used tool was the UCLA Loneliness Scale. For SI, the most frequently used tool was the Lubben Social Network Scale. The median prevalences of FoL and SI were 24.1% and 42.5%, respectively. Both of these constructs will become more prominent in the coming decades; therefore, there is a need to identify the best tools.