Geriatrie et Psychologie Neuropsychiatrie De Vieillissement最新文献

Visual disorders are often under-diagnosed and under-treated in older patients. The main objective was to evaluate the percentage of patients having an ophthalmological follow-up corresponding to the recommendations of the Syndicat national des ophtalmologistes de France (SNOF). This prospective observational multicentre study included all patients aged 65 years or older presenting to their general practitioner in two medical practices from May to October 2021. Of the 113 patients included, 86 (76,1 %) had adequate ophthalmological follow-up, 14 consulted an ophthalmologist, and a therapeutic decision was made for nine patients. Follow-up of patients was generally as recommended. Screening for visual disorders for patients with no recent follow-up was beneficial. This screening must be integrated into a global approach, as the Integrated Care for Older People (ICOPE) of the World Health Organization (WHO), in order to be more relevant and effective.

Cognitive disorders are now well known in schizophrenia, but their evolution over time and particularly during aging remains poorly described. Current evidence indicates that cognitive deficits including attention, working memory, verbal learning and memory, and executive functions are present in 80% of individuals with schizophrenia, which, on average, are around two standard deviations below that in healthy controls. Cognitive impairments are important predictors of functioning in daily life, including quality of life, inability to live independently and unemployment. From a lifespan perspective, they are evident in infancy (18 months) and continually increase between infancy and adulthood (20 years) in full-scale IQ and most of cognitive domains, accelerating during the prodromal phase. Cognitive deficits are significant predictor of the psychotic transition, and they stabilize after the first psychotic episode until the age of fifty suggesting that cognitive deficits are mainly established before the prodromal phases of psychosis. Time course of cognitive impairments in elderly patients with schizophrenia appears to be more heterogeneous. While the data suggest that they are stable with advancing age, a subgroup of institutionalized older patients stands out for a significant cognitive decline, without it being possible to determine the causal direction of this association. The twofold increased risk of developing neurodegenerative dementia in this population, combined with institutionalization, could partly explain this cognitive decline in some patients. Long-term longitudinal studies in older adults with schizophrenia are clearly needed, particularly in France. Protective factors such as recovery-focused and psychosocial approaches need to be studied in this population, which has a 15-year shorter life expectancy than the general population.

Adverse drug reactions (ADRs) are a major public health issue, especially when it comes to the elderly. Potentially inappropriate prescribing (PIP) are one of the causes of ADRs in older people. A PIP can be defined as a prescription for which the benefit/risk ratio is unfavourable compared to other therapeutic alternatives. Psychotropic drugs are the second highest risk class for ADRs in the elderly. In order to reduce the prevalence of PIP, prescription assistance tools have been created. An inventory of PIP of psychotropic drugs in older patients hospitalized in psychiatry units was carried out in a French regional setting in 2019. A criteria grid was established based on 2 tools: STOPP/START criteria and Laroche's list adapted to French practice. This grid targeted each class of psychotropic drugs, drugs with a high anticholinergic burden and non-recommended combinations of psychotropic drugs. Three hundred forty-seven patients were included. A high prevalence of PPI was found for each class of psychotropic drugs. The highest prevalence of PPI was found among benzodiazepines (90.3%): long-term prescription, long half-life drugs, respiratory insufficiency or cognitive impairment condition. 56.5% of the subjects had a not-recommended combination of psychotropic drugs (prescription of drugs of the same pharmacotherapeutic class), 26% had a PIP of antipsychotics: prescription for insomnia, use of phenothiazine, 11.8% of drugs with anticholinergic properties and 7.4% of antidepressants: especially prescription of tricyclic drugs. These results obtained on a large population underline the interest of considering the specificities of prescriptions in the elderly. It shows both the interest and the limits of the current criteria defining the PIP in the context of a hospitalization in psychiatry for an acute disorder in elderly subjects.

The development of non-pharmacological interventions, including animal-assisted therapy (AAT), is an encouraging method for the care of people with Alzheimer's disease (AD). A single-center, randomized, single-blind, controlled intervention study was proposed to compare immediate well-being measured by a visual analog scale (EVIBE) as primary outcome between the intervention group (AAT combined with cognitive stimulation) and the control group (cognitive stimulation only) in AD patients. Secondary outcomes were explored, such as well-being after intervention (also with the EVIBE), cognitive performance (measured by Alzheimer's Disease Assessment Scale, cognitive part GRECO version), behavioral and psychological symptoms of dementia (with the Neuropsychiatric Inventory Behavioral Scale-Nursing Home Version), current depressive symptomatology (with the 30 items Geriatric Depression Scale [GDS 30]) and anxiety (by the State-Trait Anxiety Inventory). Forty-two patients were included, 22 in the intervention group and 20 in the control group. The mean age was 82.5 years and mean MMSE score 19.2 in the control group and 81.4 years and mean MMSE score 18.4 in the TAA group. The results show a significant effect of the intervention on well-being after four weeks (p = 0.048), but no significant effect on cognitive functioning, behavioral and psychological symptoms of dementia. This study shows a small effect of TAA on well-being four weeks after the end of the intervention. The assessment of well-being by another measurement tool and the collection of observations made by the care team could be explored in future studies, which could require a larger sample and a longer follow-up.

A major proportion (90 %) of patients with Alzheimer's disease and related disorders develop during the disease at least one of the Behavioral and Psychological Symptoms of Dementia (BPSD). BPSD often leads to complications for patients (hospitalization, institutionalization). Caregivers are often family members, and it may be difficult for them to manage the disruptive behavior or apathy of their loved ones. This situation often generates physical and psychological symptoms. The Nice University Hospital (France) and the Bien Vieillir Nice 2030 project offer at-home non-pharmacological therapies to reduce BPSD, combined with psychoeducational sessions to improve caregiver skills. A team of psychologists went to the patients' homes 3 times per week to provide personalized non-pharmacological therapies for the patients and educational programs for their caregivers. The monocentric feasibility study was carried out among 20 patient-caregiver pairs (over 7 months). Cohen-Mansfield Inventory Scales, Zarit Burden Interviews, Caregiver Reaction Inventories, and Dementia Quality of life interviews were performed during the study. The Mederic Alzheimer Foundation (MAF) conducted an external evaluation of the project. Analysis of the results showed a significant reduction (p ≤ 0,05) in the number of BPSD on the Neuropsychiatric Inventory scale (p = 0,034). As well as a significant reduction in the behavioral symptoms of agitation on the CMAI scale (p = 0,041). A non-significant reduction in caregiver burden was also noted. Even if the results are encouraging, it is essential to conduct a medico-economic analysis to validate the feasibility of the PsyDoMa model. More clinical studies are needed to conclude.

Crohn's disease (CD) is a pathology that typically affects young people. With the aging of the population, there is an increase of its incidence in the elderly. Several studies have compared the clinical and therapeutic features of the CD in the elderly and young patients with discordant results. The objective of this work was to identify the clinical and therapeutic characteristics of elderly onset CD. The clinical presentation of CD in the elderly has some peculiarities. It seems that the disease has a less severe profile. The ileal and colic locations as well as the inflammatory phenotype are the most frequent. The treatment of elderly patients poses a real challenge to the clinician because of the field particularity and the lack of large-scale data in the literature. The frequency of comorbidities and polymedications is at the origin of the lower prescription of immunomodulators and biotherapies and the frequency of postoperative complications and immunosuppressive treatments.

In recent years, melatonin has been increasingly used in hospital settings for the treatment of sleep disorders in older patients, despite many barriers: restriction by ANSM, non-approval to healthcare facility use, and non-reimbursement. In order to describe the use of melatonin in older hospitalized patients, a survey was conducted between February and May 2022, with hospital pharmacists working in geriatric care units in France. Overall, 35 interviews were conducted with hospital pharmacists: 30 dispensed melatonin, with marketed prolonged-release melatonin medications (n = 30), and/or with immediate-release magistral or hospital preparations (n = 11). The conducted survey highlighted the criteria for using the different forms of melatonin, but also the disparities in terms of supply and management within the different establishments. Given the increasing use of melatonin in hospital settings and in order to guarantee the same accessibility to hospital teams and to patients on discharge from the hospital, a reassessment by the authorities of the melatonin-based medication status seems necessary in the light of the new available data.

Elder abuse and neglect in institutions is frequent, but is still not studied enough. This study aims to better understand the risks of elder abuse, through daily experiences of health professionals. This is a monocentric, qualitative study, with semi-structured interviews of health professionals working in a geriatric hospital. Geriatrics is a specialty at risk of abuse and neglect. There is a real taboo around this issue. The difficulty for its reporting is multifactorial (tolerance, trivialization of abusive behaviors, isolation, and apprehension of caregivers...). The lack of human, material, and educational resources provided by health institutions does not enable professionals, whoever they may be, to care for patients humanely. The guidance and support of caregivers (training, increased team cohesion, and dedicated time for multidisciplinary reflection) are aimed at improving patient care and quality of care. All health professionals are concerned with elder abuse and neglect. It is necessary to break the taboo around mistreatment, to learn to talk about it among colleagues, and to recognize and evaluate oneself in order to change, evolve, and train others to treat patients the best way possible. Health professionals have to train and learn about the specificities of geriatrics early, repetitively, and continuously during their training. Health professionals must be able to work in a stable environment, with a supportive management. Their work must be valued in a sustainable way. Better working conditions should enable a more caring and compassionate approach by healthcare professionals toward their patients.