Geriatrie et Psychologie Neuropsychiatrie De Vieillissement最新文献

Can the SEGA scale, implemented in the emergency department, effectively predict morbidity and mortality? A prospective study was conducted from January 30, 2018, to July 16, 2018, at the Emergency Department of Chaumont Hospital. Patients aged over 65 were included, while those under 65, in palliative care, or in a life-threatening emergency were excluded. The SEGAm score was calculated for each included patient, and their outcomes were assessed at the end of the emergency department visit and one year later. A total of 278 subjects were included. Vital status at one year was known for all subjects, with no loss to follow-up or censoring. At one year, 56 patients out of 278 (20.1%, 95% CI 15.6% to 25.3%) had died, with less than half of these deaths (n = 25) occurring after readmission to the emergency department or during the emergency visit. The average age was 82 ± 8.2 years, with 158 women and 120 men. Regarding living arrangements, 130 (46.8%) lived at home without caregivers, 100 (36%) lived at home with caregivers, and 48 (17.3%) lived in nursing homes. The average Charlson Comorbidity Index was 5.49 ± 1.99, with an average number of medications of 7.52. The primary methods of referral were as follows: C15 for 144 patients (51.8%), general practitioner for 59 patients (21.2%), spontaneous consultation for 58 patients (20.9%), and family referral for 8 patients (2.9%). The main reasons for admission were falls for 55 patients (19.8%), dyspnea for 33 patients (11.9%), and other reasons for 60 patients (21.6%). Post-emergency department disposition included hospitalization for 167 patients (60.1%) and discharge for 111 patients (39.9%), with no deaths occurring during this period. The SEGAm frailty score (grid A) had an average completion time of 8.18 min ± 3.64. A score of ≤ 8 was found for 85 patients (30.6%), a score between 9 and 11 for 51 patients (18.3%), and a score ≥ 12 for 142 patients (51.1%). In this geriatric population, the risk of death at 12 months was estimated at 31% (95% CI 23.5% to 39.3%) for subjects with a SEGA score exceeding 12, compared to approximately 10% for those with lower SEGA scores. The risk of death or readmission was 52.8% (95% CI 44.3% to 61.2%) for subjects with a SEGA score exceeding 12, compared to 20% to 30% for those with lower SEGA scores. The SEGA score provides valuable prognostic information that is not fully captured by the Charlson score or reason for hospitalization.

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.

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.

Lewy body dementia (LBD) is the second most frequent neurodegenerative disorder after Alzheimer disease (AD). In this study, we compared functional decline between LBD and AD patients, considering motor dysfunction, over an 18-month follow-up period. We included all patients >70 years of age, with initial MMSE ≥ 20 and a diagnosis of possible or probable LBD or AD, who consulted at the memory centre of the Pitié-Salpêtrière hospital. Statistical analyses were performed using univariate tests and multivariate linear regression. Thirty-seven AD and 36 LBD patients were included, with a median age of 81 and a median MMSE score of 24/30. Global ADL Katz score decreased significantly for LBD people, compared to AD patients: -0.40 ± 0.75 versus 0 ± 0.24; p=0.003. Global IADL score decreased in the two populations but without a significant difference between the two groups: -1.71 ± 2.19 in LBD versus -1.32 (± 1.55); p=0.38. This study shows a significant decrease in autonomy in LBD patients over time that was faster than that in AD patients, related, in particular, to bathing, dressing and personal care.

Shared decision-making allows older people to discuss and change their care with informal caregivers and healthcare professionals. When opinions differ, an older person's decision-making ability can be compromised by many factors. The objective of this qualitative pilot study was to study the dynamics of shared decision-making in home care support for vulnerable older people. Observations were carried out at the older people's homes during appointments with the network's healthcare professionals. Semi structured interviews were then conducted with older people, caregivers and healthcare professionals observed. When opinions differ, negotiation dynamics then develop between older people, caregivers and healthcare professionals. Using a dedicated negotiation framework, we identified four types of negotiation between the stakeholders in home care decision-making, influenced by various articulations of individual, collective and environmental factors.

Prospective memory allows us to remember to perform an action in the future in response to environmental cues (event-based) or predetermined times (time-based). It is often impaired in individuals with mild cognitive impairment. These deficits are related to various cognitive functions such as episodic memory and executive functions and are particularly affected in pathological ageing. In this article, we propose a literature review of non-pharmacological interventions with the elderly with MCI and neurodegenerative diseases. This article explores different strategies for managing prospective memory, including cognitive training, mnemonic strategies, and external aids. In all cases, it is important to design personalized interventions that take account of patients' individual characteristics. Research into the long-term effectiveness of these strategies is still limited, and further studies are needed to properly assess their benefits.

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.