Geriatrie et Psychologie Neuropsychiatrie De Vieillissement最新文献

Older patients are at risk of falling, making fall prevention a critical component of training for future health professionals. To understand the expectations of health students regarding falls in the elderly, four consecutive focus groups were organized at the Angers hospital. The aim was to assess students' views on the effectiveness of using an educational or serious game to complement their traditional training. From the discussions, six key themes emerged: the definition of a fall, participants' emotional responses to falls, lessons learned to enhance their knowledge, the benefits and techniques of simulation games and board games, and the role of games in everyday life. Among the game formats discussed, simulation games, including escape rooms, were the most popular.

This article comes from an academic research, conducted with old persons living in French nursing homes and doing esports workshops, led by young volunteers. With the case of a 93-year-old resident, recently introduced to technological tools, we show how the stakes of videogames competition were at first met with her fear not to be good enough. However, her involvement in the competition mustered, through afterwardness, some elements from her childhood and adolescent psychic life. More precisely, by questioning her place in esports competition, this resident mobilized both the depressiveness necessary to aging, related to the confrontation to the limits inherent to the aging process, and tried to resolve a childhood trauma reactived after 80 years. This analysis also enabled to understand how these esports workshops, beyond the opportunity for entertainment and activity in order to take the mind off a monotonous life, could become devices supporting a potential therapeutic project.

The objective of our work was to study the impact of a mobile health unit of geriatric psychiatry (EMGP) on the number of consultations to the emergency medical service and on the rate of readmissions. This was an observational, retrospective, single-center cohort study, which aimed to identify the number of visits to the Troyes SAU for psychiatric reasons. This in patients who have previously benefited from hospitalization in the Aube geriatric-psychiatry department called Ellipses. The "patients exposed" group was exposed by the existence of EMGP during hospitalization between January 1, 2018 and December 31, 2019. The group not exposed by the non-existence of the system between January 1, 2014 and December 31, 2015. Our results suggest that the actions implemented by the EMGP tend to reduce the frequency of visits to the emergency room after hospitalization, among people aged 65 and over (p<0.001) as well as their duration of hospitalization (p=0.003).

The personalized prescription plan (PPP) summarizes the changes made to a patient's prescription on discharge from hospital. The aim of the present study was to evaluate 30-day medication continuity in older patients whose PPP was implemented at hospital discharge. Prospective randomized controlled trial including people aged at least 75 discharged from an acute geriatric unit. The intervention consisted of medication reconciliation and review, and standardized transmission of a PPP (explaining medication changes during hospitalization) to primary care practitioners. The control group received no specific intervention. Reasons for and rates of change in discharge prescribing by primary care practitioners were assessed 30 days after discharge. The study population comprised 109 patients, 70 of whom were selected for modified intention-to-treat analysis (intervention group 34; control group 36). The mean age (standard deviation) of patients was 87.4 (6.6) years. One month after discharge, the discharge prescription was modified for 26.7% of patients in the intervention group and 31.2% in the control group (0R = 0.80, CI(95%)=[0.25; 2.45]; p = 0.91). Reasons for change were mainly adaptation to clinical events (83.3%). Medication continuity after the implementation of a PPP is similar to that of routine care, one month after hospital discharge of the elderly.

Despite the growing deployment of the Montessori method in nursing homes, there is no instrument to measure its implementation fidelity, limiting the interpretation of results. Our aims are to i) develop an evaluation grid for the Montessori method in nursing homes; ii) explore its sensitivity to practice heterogeneity among institutions pre-training; and iii) study its sensitivity to change after the training. Based on literature and expert opinions, we created an evaluation grid. This grid was completed by 333 professionals before training in 29 nursing homes. Of these, 125 completed it again post-deployment. Before training, the degree of application of the method's principles varied. After training, effects were noted on various aspects targeted by the method. The developed grid is a valid tool for evaluating the fidelity of Montessori method implementation in nursing homes.

There is still much room for improving the self-advocacy of elderly female patients with breast cancer. Subjects (168 in total) were selected from elderly female patients with breast cancer who had been hospitalized from May to December 2022 using the convenience sampling method. Assessment was conducted for the status quo of self-advocacy of subjects using the Chinese version of Female Self-Advocacy in Cancer Survivorship (FSACS). The general data of patients were investigated to find out the possible related factors. The FSACS score was 79.23±10.58 points in the 168 elderly female patients with breast cancer, showing significant differences among the patients at different ages and with various levels of education, self-efficacy, perceived social support and psychological resilience (P<0.05). The following equation was acquired by multiple linear regression analysis: Y=88.762+0.881X1-2.447X2-5.763X3-1.617X4-4.259X5. An advanced age was a non-independent risk factor for the self-advocacy of elderly female patients with breast cancer (B>0, P>0.05), while high levels of education, self-efficacy, perceived social support and psychological resilience served as protective factors (B<0, P<0.05). Elderly female patients with breast cancer exhibit a medium level of self-advocacy, which may be associated with age, education level, self-efficacy, perceived social support, and psychological resilience.

People suffering from a neurodegenerative disease, at a stage still allowing physical activity, encounter more difficulties to access to re-education and rehabilitation care. A trial unit specialized in medical care and rehabilitation (SMR) was created to handle these patients, who suffered a morbid intercurrent event not related to the neurocognitive disorder. The trial unit was created thanks to a dedicated funding from the Brittany Health Regional Agency (ARS) following-up a call for projects in October 2021. A retrospective monocentric descriptive study focusing on the overall evolution of the patient. To describe the social and medical characteristics of admitted patients and access the benefits regarding the patients regain of independence. Results: One hundred forty-nine patients (55 men, 94 women) were included, average age 85 ± 6.5 years. The average length of stay was 24 ± 11 days and the rehabilitative load was high (scores RR 275,2 ± 175,2). A significant improvement in the autonomy of patients was noted, of their physical dependence scores (p < 0,001) and cognitive dependence scores (p < 0,001), of their overall physical condition at SPPB (p<0,001) as well as a decrease in the use of psychotropic drugs (p < 0,001); their nutritional status was unchanged (p = 0.2). One in two patients went home. Our work seems to confirm the importance of specialized units in the care of patients suffering from neurodegenerative disease in SMR.

Clostridioides difficile infection (CDI) represents a significant challenge due to its increasing incidence, severity, and treatment difficulty. Effective management requires a multifactorial approach that includes preventive strategies, prudent antibiotic use, and adapted therapeutic options. Ongoing research and innovation offer promising prospects for improving ICD management, making vigilance and informed practices essential among healthcare professionals. Two main complications of ICD are pseudomembranous colitis (PMC) and toxic megacolon. PMC involves severe colonic inflammation due to C. difficile toxins, leading to pseudomembrane formation. Diagnosis relies on clinical criteria, microbiological tests, and endoscopy. Toxic Megacolon is characterized by severe colonic dilation and systemic toxicity, requiring immediate medical intervention. ICD diagnosis combines clinical signs and microbiological tests. These tests include toxin tests, GDH antigen detection, PCR for toxin genes, and stool culture. Imaging techniques assess colonic inflammation and complications. Combined diagnostic criteria from the American Gastroenterological Association (AGA) and European guidelines emphasize integrating clinical and laboratory findings for accurate diagnosis. ICD treatment involves stopping the implicated antibiotics and starting specific antimicrobial therapy. Common treatments include mainly fidaxomicin and oral vancomycin. Fecal microbiota transplantation (TMF) is recommended for recurrent cases unresponsive to standard treatments. Bezlotoxumab, an antibody targeting C. difficile toxin B, is used to prevent recurrence in high-risk adults. ICD poses a major challenge due to its increasing incidence, severity, and difficulty in treatment. A multifactorial approach involving rigorous preventive strategies, prudent antibiotic management, and adapted therapeutic options is essential for controlling the infection. Ongoing research and innovations in treatment offer promising prospects for improving patient management. Healthcare professionals must remain vigilant and informed to ensure effective practices in combating this infection and utilizing available resources optimally.