Geriatrie et Psychologie Neuropsychiatrie De Vieillissement最新文献

The ageing of the French population is accompanied by an increase in the number of elderly people living in nursing homes (Ehpad). Quality of life in these institutions is becoming a major issue as a marker of well-being and perceived health. Nevertheless, its definition and assessment in the specific context of nursing homes raise multiple questions. In this narrative review, we will take stock of quality of life models applicable to the nursing home context, highlighting their clinical contributions. We will then identify the various tools available to investigate quality of life in this particular context, and the recommendations in the scientific literature guiding its assessment. This overview will help to suggest possible directions for future research in these areas. On a clinical level, it will aim to raise awareness and inform professionals working in these establishments, with a view to continuously improving the support offered to the elderly living there.

To identify stereotypes and preconceived ideas about aging and the attractiveness of geriatrics among medical students, and to assess the impact of a clinical placement in geriatrics on these perceptions. This observational, prospective, multicenter cohort study was conducted from November 2023 to June 2024. Medical students from the 2nd to the 6th year were asked to complete two questionnaires: one on the first day of their geriatrics internship and another on the last day. The surveys assessed preconceived notions about aging and the specialty, with results compared before and after the internship. Of the 190 students who completed the first questionnaire, 134 responded to the second. Seventy-five percent of respondents were women, and 72% were in their 4th year, with 28% having prior experience in geriatrics. Initially, 78% of students believed that age limited medical care, compared to 41% after the internship (p < 0,001). The percentage of students who attributed older adults' health problems to natural aging decreased from 59% to 37% (p < 0,001). Before the internship, 27% thought all complementary tests could be performed on the older adults, rising to 49% afterward (p = 0,01). Sixteen percent of students initially had a negative image of older adults, compared to 6.8% after the placement (p < 0,01). Regarding the specialty itself, 31% considered geriatrics boring before the internship, which dropped to 9.7% afterward (p < 0,001). The perception of geriatrics as focused on chronic diseases decreased from 40% to 25% (p = 0,024). Overall, 85% of students saw their perception evolve, and 92% felt that early exposure to geriatrics was beneficial, up from 83% (p < 0,001). The intention to choose geriatrics increased from 10% to 16%, though without statistical significance. The study highlights key misconceptions about aging and demonstrates that clinical internships in geriatrics can significantly shift perceptions, making the specialty more appealing to medical students.

The 2007 French Haute Autorité de santé recommendation on the diagnosis of malnutrition in the elderly was revised in 2021. The main objective was to compare the prevalence of malnutrition according to the recommendations. The secondary objectives were to compare 3-month mortality and assess the prevalence of sarcopenia and sarcopenic obesity. The 2021 criteria were applied retrospectively to a cohort. Concordance analysis was carried out using Cohen's kappa coefficient and statistical analysis of mortality using Fisher's exact test. There were 135 patients, 60% malnourished with 35% severely malnourished according to HAS 2007, 49% malnourished with 62% severely malnourished according to HAS 2021 with moderate agreement. There were 25 cases of confirmed sarcopenia and one case of sarcopenic obesity. Moderately to severely malnourished people had an increased risk of death at 3 months (HAS 2021).

A quarter of nursing home residents dies in hospital. Few data are available about early in-hospital deaths of nursing home residents. The aim of the study was to describe the characteristics of early in-hospital deaths of nursing home residents after an admission in emergency department and to identify factors associated with a decision of limitation of care in emergency department. This retrospective monocentric descriptive study included all nursing home residents hospitalized and who died early (less than 3 days) after being admitted to the emergency department between 2017 and 2019. Patients' characteristics were collected in the medical record. These characteristics were compared by a logistic regression according to the existence or not of a limitation of care. 12,440 admissions of nursing home residents were identified and 332 patients died early in hospital. Half of them died in the emergency department. The first reason for admission was dyspnea (57.4%) and the main cause of death was pneumonia (41.7%). A limitation of care at emergency department was reported in 66.7% of cases. The factors independently associated with a limitation of care were the existence of active cancer (OR=5.34 [1.35-39.2], p=0.041) and severe dependence (OR=16.1 [1.60-415], p=0.034). Early in-hospital deaths of nursing home residents are common and most often related to pneumonia, dyspnea motivating the transfer. The anticipation of the care project and especially of end of life is mandatory in these patients.

Odors are known to entertain a special link with memory: once the meaning of an odor has been learned, it naturally acts as a retrieval cue of the learning context, along with the emotions and behaviors associated with it. The existence of this link has for several years inspired the study of olfactory function in Alzheimer's disease (AD), known for the memory disorders it causes. The aim of this review is to summarize the current scientific knowledge on the almost paradoxical dual role played by odors in the management of AD, as both screening and therapeutic tools. In fact, while the existence of a specific olfactory deficit is confirmed in AD - as is its ability to screen for the disease - its properties do not prevent from taking advantage of the link between odors and memory to stimulate cognition and behavior in these patients. Current scientific data, albeit limited and with sometimes inconsistent results, suggest that this idea seems relevant. However, interventions based on impaired processing in AD, such as the recognition and naming of olfactory stimuli, must be avoided.

Homicides-suicides within couples are rare situations but can be considered preventable deaths. Various studies have identified risk factors for these couples, regardless of their age, such as a history of domestic violence, psychiatric disorders, addictions, or substance abuse. However, it appears that homicides-suicides among elderly couples have specific characteristics unique to this population. The objective of this study is to draw on recent scientific literature and concrete cases to raise awareness and consider preventive measures for these fatal acts among older individuals. It appears that particular attention should be given in cases where the man is the primary caregiver, when there is a recent deterioration in one partner's health, when hospitalization or institutionalization is being discussed, or when a firearm is present in the household.

The risk of herpes zoster (HZ) and postherpetic neuralgia (PHN) increases rapidly after the age of 50 years old. The incidence of herpes zoster and PHN appears to be correctly measured albeit irregularly and the immediate and long-term complications are so poorly measured that the perception of a benign disease remains entrenched among professionals and in the general population. Because acute-phase treatments are only marginally effective in reducing the severity and duration of complications, zoster vaccines have been developed over the last twenty years. The first available vaccine was a live attenuated vaccine recommended in France in 2013 in very specific age groups, and in the absence of an implementation campaign, vaccine coverage has remained less than 1%. A second vaccine that can reduce the incidence of shingles by 90%, even in the oldest age groups and that can also be used in immunosuppressed members of the population, has been recommended since March 2024 by the French Haute Autorité de santé (HAS). However, it requires two injections, two and six months apart, and side effects are frequent, although mostly local. The implementation strategy for this new vaccine will need to be complemented by awareness campaigns among both health care professionals and users if we want to reduce the incidence of shingles as we should hope.