Geriatrie et Psychologie Neuropsychiatrie De Vieillissement最新文献

Malnutrition is a prevalent concern among older hospitalized patients, often associated with adverse outcomes. This study aimed to determine the prevalence and identify risk factors for malnutrition in older adults admitted to the acute geriatric ward at Fann University Hospital (CHNU) in Dakar, Senegal. A retrospective analytical study was conducted on 375 patients aged 60 years and older, admitted to the acute geriatric ward between January 2021 and December 2022. Data on sociodemographic characteristics, medical history, geriatric syndromes, and nutritional status were collected from medical records. Malnutrition was assessed using the Mini Nutritional Assessment (MNA). Bivariate analysis was performed to explore the association between malnutrition and potential risk factors. The prevalence of malnutrition was 72% (n = 270). Malnutrition was significantly associated with female gender (p = 0.019), presence of multiple comorbidities (p < 0.001), functional dependence (p = 0.007), immobilization syndrome (p = 0.016), and pressure ulcers (p = 0.016). Malnutrition is highly prevalent among older adults hospitalized in the acute geriatric ward at CHNU, Dakar, Senegal. This study identified several factors significantly associated with malnutrition, highlighting the need for increased awareness and targeted interventions to address this important geriatric syndrome.

The aging population inevitably leads to an increase in the number of surgical procedures performed on older people. The effects of anesthesia coupled with surgery are recognized as precipitating a post-operative cognitive impairment whose etiology seems to be multifactorial with a predominance of the inflammatory cause related to surgery. Objectives. The main objective of our work is to determine the incidence and risk factors of cognitive decline after hip injury surgery. This is the continuation of a publication focusing on the epidemiological and evolutionary profile of the same cohort [1]. Our study, descriptive observational prospective and mono-centric, collected a sample of 89 patients. It is carried out at the orthopedic trauma department of the Annaba University Hospital Center, over a period of 24 months. The study protocol consists in evaluating the cognitive state, for each patient, preoperatively with a post-operative follow-up for a year, using four tests [the Mini-Mental State Examination (MMSE), the Dubois Test, the Clock Test (TDH) and the scale of everyday instrumental activities (Instrumental Activities of Daily Living, IADL4)]. This postoperative, longitudinal cognitive follow-up is carried out on the 1st, 3rd, 6th, 12th postoperative months. Assessment of the cognitive state in pre and postoperative by a battery of four tests, reveal a high incidence of postoperative cognitive disorders (PCD) in this surgical population, it is about 27% at one month, followed by a gradual improvement in neurocognitive abilities to complete cognitive recovery. The incidence of PCD is estimated at 17% at 3 months, 9% at 6 months and only 1% at 12 months. Out of 30 risk factors analyzed, only three are retained (after logistic regression). This is advanced age (OR = 7.135, 95% CI = 2.4-21.2), the delay in management (OR = 4.65 with a 95%CI = 1,73-12,64) and the multimodal analgesia with OR = 0.30 and 95%CI = 0,11-0,78). There is currently no curative treatment available for PCD. Only a preventive preoperative cognitive preparation approach could be considered for the management of PCD; it is based on the evaluation of the impact of PCD on patients' work and personal lives, as well as the implementation of cognitive stimulation programs.

Attempts to implement evidence-based non-pharmacological interventions (NPI) have increased in recent years. However, published nomenclatures, classifications and recommendations encouter implementation barriers in institutions. In order to apply non pharmacological strategies according to a pragmatic clinical practice, we suggest the use of an implementation and prescription grid (GRIP-INM). Based on three main categories of action, this grid helps to rationalize the place of non pharmacological strategies and enables care teams and institutions to identify available ressources in their location and anticipate any shortcomings. Following on from this categorization, we specify how facilities can mobilize their own resources, and make use of external resources.

A court of appeal refused to release an 85-year-old person suffering from total blindness from a reinforced curatorship, on the grounds that daily assistance was required to manage her affairs and maintain her home, even though she was not suffering from any mental impairment. In a ruling handed down on March 27, 2024, the French Supreme Court (Cour de cassation) censured the court of appeal, pointing out that the opening of a guardianship measure requires a finding by the judges that there has been a medically established alteration either in the mental faculties of the interested party, or in his bodily faculties such as to prevent him from expressing his wishes, and that he needs to be assisted or controlled on an ongoing basis in the important acts of civil life.

The First French Fall Prevention Day for Elderly People took place in Montpellier on October 1, 2024. This event highlighted the elderly people's interest in: i) public conference providing information on fall risk factors and general preventive measures; ii) workshops across the metropolitan area offering individual fall risk assessments, personalized advice based on identified risk levels and factors. It also highlighted healthcare professionals and training institutes interest in: i) information on the roles of various field actors in the care pathway for older individuals at moderate or high fall risk; ii) new organizational models and technologies developed to implement national and global fall prevention recommendations. This inaugural event will lead to the creation of a fall and fracture prevention group within the French Society of Geriatrics and Gerontology, establishing a specific connection with the European Geriatric Medicine Society Falls and Fracture Prevention Group, whose missions will be: i) the development of training and informational materials to support the implementation of the world recommendations and the French fall prevention plan; and ii) the support an organization of an annual National Fall Prevention Day throughout France by the National Academy of Medicine and Regional Health Agencies.

Alzheimer's and related diseases are marked by a progressive cognitive decline that affects a person's identity, values and decision-making abilities. Anticipating choices and projecting oneself into the future becomes difficult. Advance directives and the testimony of the trusted support person and loved ones can sometimes be at odds with the new choices expressed by the patient at a more advanced stage of the illness. This makes it difficult to make the right decision with or for the patient. Advance care planning is an interesting tool in this context. It makes it possible to anticipate the care and life project in a dynamic and ongoing way, ensuring communication over time and considering gradual changes in values. This narrative ethics approach helps to bridge the gap between the wishes expressed in the past and those expressed today, by involving the patient throughout the course of the illness and relying on the support of loved ones and healthcare professionals. Its implementation and deployment require training for healthcare professionals and a genuine institutional policy.

In the perioperative period, pulmonary embolism (PE) is common. PE severity is well defined, but its prevalence remains poorly understood in the hip fracture (HF) context; a surgery at high hemorrhagic risk. The main objective was to measure severe PE prevalence in the HF perioperative period in subjects aged over 75. This observational, monocentric, retrospective study was carried out in the orthogeriatric unit at Grenoble University Hospital, from January 1, 2020 to December 31, 2021. PE was considered severe if it was at an intermediate high risk or high risk of early death. The secondary objectives were to compare the characteristics of subjects with severe PE with those without severity criteria. Severe PE prevalence was 38.4% (15/39) or 4.8% (15/313) of the fractured population. Patients in the severe PE group were more likely to develop deep hematoma (33 % versus 4.2 %, p = 0.024), and required twice more transfusion of packed red blood cells (60 % versus 29 %, p 0.05). À combination of factors may explain why PE severity is linked to PE, but also to an increased risk of bleeding.

Alzheimer's disease leads family members to resort to several types of care in order to eventually cure the patient. The aim of this study is to investigate the care practices used by families in Abidjan whose relative suffers from Alzheimer's disease, despite their lack of knowledge of the symptoms and care practices involved. This saturation procedure enabled us to gather information from 20 family carers, whose main role was to provide care for the patient. Five interviews were conducted over the telephone and 15 in the patients' or caregivers' homes. This enabled us to identify the ways in which families organize themselves to cope with illness: 1) social and symbolic practices; 2) economic resources; 3) family flexibility. This study highlights the family's capacity for resilience in the face of a member's illness.