Geriatrie et Psychologie Neuropsychiatrie De Vieillissement最新文献

The geriatric failure to thrive, a controversial French concept not present in the international literature, was first characterized by Jean Carrié in 1956. It is described as a process of aging and physical and psychological decline associated with advanced age, manifesting as a pronounced overall deterioration. In this case report, we present the case of an 88-year-old patient, admitted to a general medicine service for geriatric failure to thrive, whose management eventually leads to the diagnosis of endocarditis with digestive cancer complicated by a characterized depressive episode. This case prompts us to consider the geriatric failure to thrive with extreme caution and challenges the legitimacy of such a diagnosis in the context of an aging population and the progress of medical sciences.

While it is necessary to provide « homelike » in nursing homes, the risk is to reduce it to decoration. As the aim is to reconcile care and home, we propose co-design, an approach involving users in the design of living spaces, as a solution. We propose tools and a protocol, then provide feedback from a workshop on co-designing a collective space with three residents in a nursing home in Île-de-France. We thoroughly analyse the contributions of the residents during the workshop, and then compare their proposals with the opinions of the nurses. We found that the workshop enabled participants to express concret needs that tended towards « homelike » proposals. The convergence of day-to-day expertise, through co-design, encourages design solutions that are suitable for everyone, while its role in mediation supports organisational change in the nursing home.

Ophthalmological changes have been reported in Alzheimer's patients. Our objectives were to determine whether: i) GCC (ganglion cell complex) and RNFL (retinal nerve fibre layer) thickness were associated with different stages of AD (i.e., no AD, prodromal AD, dementia-stage AD), and ii) GCC and RNFL thickness predicted disease progression in older non-demented patients with subjective memory complaints followed for four years. Ninety-one French older community-dwellers with memory complaint and without open-angle glaucoma or age-related macular degeneration (mean, 71.60 ± 4,73 years; 44% women) from the GAIT study underwent examination with HD-OCT, measuring the thickness of the macula, the macular GCC and the RNFL. They also had a complete cognitive diagnosis (i.e., cognitively healthy, prodromal AD, or dementia AD), and a cognitive follow-up 4 years later looking for a possible conversion. Age, sex, body mass index (BMI), number of comorbidities, and Instrumental activities of daily living (IADL) score were considered as potential confounders. At baseline, 37 (40.7%) patients were diagnosed as cognitively healthy, 47 (51.6%) as MCI, and 7 (7.7%) as AD. Mean GCC thickness was higher in cognitively healthy patients than in MCI patients (79.23 vs. 76.27 μm, p = 0.023), particularly in the inferior and nasal fields (p = 0.023 and p = 0.005, respectively). This difference was also found between cognitively healthy patients and others (MCI and AD) in the superior, inferior and nasal fields (p = 0.030, p = 0.014 and p = 0.002, respectively). There was no difference in RNFL thickness between the different cognitive statuses. After 4 years of follow-up, 12 patients (70.6%) of the 17 followed had not changed their cognitive status, while 5 (29.4%) had converted to a more advanced stage of AD. There were no significant differences between the two groups in either GCC thickness (p = 0.429) or RNFL thickness (p = 0.286). We found decreased CGG thicknesses in Alzheimer's patients at prodromal and dementia stages, compared with cognitively healthy participants. There was no association between RNFL thickness and cognitive status, nor between CCG or RNFL thicknesses and the risk of progressing to AD stages after 4 years of follow-up.

Depression is a prevalent mental health issue among elderly people residing in nursing homes, with significant implications for quality of life. From an initial pool of 175 articles, seven met the inclusion criteria, including four longitudinal studies, two controlled trials, and one systematic review. The findings indicate mixed outcomes regarding the impact of institutionalization on the trajectory of depression, underlining the complexity of its support. A number of risk factors appear to be associated with depression, such as gerontopsychiatric disorders, functional impairment, chronic illness and gender. Interventions such as increased exposure to natural light and psycho-educational programmes could be relevant therapeutic tools. This review emphasizes the need for more robust longitudinal research, and uniform depression assessment methods to better manage depression at the entrance of the nursing home.

Few studies have examined the relationship between life satisfaction, emotional regulation and perception of future time in the elderly. Thirty-one women and 28 men (age M = 70,51 ± 3,98) were questioned using the Gross and John's Emotion Regulation Questionnaire (2003), the Blais et al.'s Life Satisfaction Scale (1989) and the Castersen and Lang's Future Time Perception Scale (1996). The results show that there is no gender effect, and do not support the motivational theory of Carstensen, Isaacowitch and Charles (1999), which postulates a link between temporal perspective and the selection of the most efficient emotional regulation strategies. This research shows that it is the use of compensatory strategies that enables people to continue to be satisfied with their lives despite advancing age. Nor do these strategies influence the effect of gender or perception of future time on life satisfaction. Against a backdrop of an aging population, this study is helping to better define the features of well-being in the advancing age.

p-glycoprotein (P-gp) is an efflux transporter of xenobiotic and endogenous compounds across the blood-brain barrier (BBB). P-gp plays an essential role by limiting passage of these compounds into the brain tissue. It is susceptible to drug-drug interactions when interactors drugs are co-administrated. The efficiency of P-gp may be affected by the aging process and the development of neurodegenerative diseases. Studying this protein in older adults is therefore highly relevant for all these reasons. Understanding P-gp activity in vivo is essential when considering the physiological, pathophysiological, and pharmacokinetic perspectives, as these aspects seem to be interconnected to some extent. In vivo exploration in humans is based on neuroimaging techniques, which have been improving over the last years. The advancement of exploration and diagnostic tools is opening up new prospects for understanding P-gp activity at the BBB.

The "syndrome de glissement" is a French term used to describe end-of-life situations where the elderly person becomes adynamic and any therapeutic intervention seems ineffective until the patient dies. It is close to failure to thrive. Although its use, which is widespread, seems appropriate to briefly describe a complex situation, it has the major disadvantage of leading to an absence of clinical and therapeutic approach, which represents a loss of chance for the patient. In clinical practice, we consider that what is referred to as a sliding syndrome is actually a situation of apathy associated with a deterioration in general condition. A diagnostic approach should therefore look for all organic pathologies that associate deterioration in general condition and apathy, and neuropsychiatric situations such as episodes of major depression that produce such symptoms. Once these diagnoses have been ruled out, the person should be considered for palliative care and benefit from the expertise that goes with this practice. Any elderly person in a situation resembling what is known as a syndrome de glissement should therefore benefit from a rigorous clinical approach, and not be considered beyond any therapeutic resources. It is a matter of dignity and quality of care.