Geriatrie et Psychologie Neuropsychiatrie De Vieillissement最新文献

Background: Falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs.

Objective: To synthesize evidence-based and expert consensus-based 2022 world guidelines for the management and prevention of falls in older adults. These recommendations consider a person-centred approach that includes the preferences of the patient, caregivers and other stakeholders, gaps in previous guidelines, recent developments in e-health and both local context and resources.

Recommendations: All older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for communitydwelling older adults. An algorithm is proposed to stratify falls risk and interventions for persons at low, moderate or high risk. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations.

Conclusions: The core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

Introduction: Inappropriate drug prescriptions (IP) lead to a high risk of adverse effects, especially for the elderly. Their detection is essential - which can be done using therapeutic lists, including the Stopp/Start scale version 2.

Methods: Observational study - from August 1, 2016, to November 30, 2016, in an advanced geriatric unit at Rouen University Hospital - using the Stopp/Start version 2 list.

Results: Eighty-five patients were included, with a ratio of 1.36 women per every man. Sixty-one patients (71.8%) had prescriptions for more than five drugs. The average Charlson comorbidity score was 6.05. One hundred ninety-one IPs were found. Classes E and G (kidney function and respiratory system prescriptions, respectively) were not uncovered. Fifty-four Stopp criteria - 66% of Stopp criteria - never emerged during our study. Using the 34 Start criteria, 187 omissions of prescriptions were found. Classes F and G (endocrine system and urogenital system drugs, respectively) were not observed at any time. Ten criteria were never seen (B3/C1/C4/C5/E6/E7/F1/G1/G2/G3). Nineteen criteria were mentioned less than three times - i.e., in approximately 10% of omissions.

Conclusion: Our study is part of an approach to protecting the elderly. A significant number of IP and prescription drug omissions were uncovered using this Stopp/Start version 2 tool.

Older adults who are socially isolated or who feel lonely have a higher risk of morbidity and mortality. It is important to be able to assess them with efficient tools. The objective was to describe tools for assessing feelings of loneliness (FoL) and social isolation (SI) in older adults, and to estimate their prevalence. A systematic review was conducted including 18 studies. For FoL, the most frequently used tool was the UCLA Loneliness Scale. For SI, the most frequently used tool was the Lubben Social Network Scale. The median prevalences of FoL and SI were 24.1% and 42.5%, respectively. Both of these constructs will become more prominent in the coming decades; therefore, there is a need to identify the best tools.

Study of cardiovascular drugs usage, among elderly subjects admitted to the emergency department for syncopal falls in Rhône-Alpes region. Polypharmacy and cardiovascular medication usage are risk factors for falls in the elderly. This study included subjects aged 75 and over, admitted in the emergency department for falls, based on evaluation data of professional practices carried out in the Nord Alpine region by the French Network of North-Alps Emergency Departments (Réseau Nord Alpin des Urgences, RENAU). The patients included were divided into 4 groups: "syncope", "accidental falls", "repeated falls" and "other types of fall". From the emergency room admission prescriptions, we studied the consumption of cardiovascular drugs in number and quality in the "syncope" group compared to other types of falls. The main objective in this study was to highlight higher cardiovascular drug usage among the elderly patients admitted to the emergency department for syncopal falls, in comparison with other types of falls. We included 1,476 patients among whom 262 patients came for "syncopal falls". We found superior usage of cardiovascular medication among syncopal falls compared to other type of falls (p < 0,01). However, there is no statistically significant association between inappropriate cardiovascular drug prescriptions, and the type of falls. The "standardized" fall assessment whose orthostatic hypotension investigation, is not always exhaustive in the emergency room. Orthostatic hypotension diagnostic is insufficiently sought in the emergency room. This study highlights a significantly higher usage of diuretic medication within the syncope group, in comparison to the other groups, and especially loop diuretic. Antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin II receptor blockers, calcium inhibitor) are also recurrent within the syncope group compared to the others. A careful supervising of these prescriptions among elderly patients seems required. These data prompt to revise prescriptions during fall related hospitalizations, and then with the primary-care physician, or with the cardiologist.

The elderly are particularly vulnerable to medication administration errors (MAE). To prevent these errors, it is crucial to identify and understand their causes. A review of the literature using the PRISMA method was conducted. Of 2,798 articles, 15 were included in the literature review. The causes identified were divided into 4 categories: patient-related, direct drug-related, healthcare professional-related, and organizational, teamwork, and environmental causes. It was found that the causes were many and varied (n = 56). These were mostly related to physical and cognitive disorders of the patient. Few studies of causes based on empirical data were conducted on this specific subject. The majority of studies were conducted in a health care facility and institution. Therefore, this study cannot provide a comprehensive review of all the risk factors for MAE, especially in the elderly who are capable of administering their medication on their own. To study this topic, a complementary literature review on the causes of non-adherence in the elderly would be necessary.

The elderly person (EP) treated with psychotropics is at risk of iatropathology. The guidelines for the proper use of these treatments are difficult to apply and the difficulties met by hospital teams are little described in the literature. Our objective was to investigate the problem of psychotropic management in EP among the medical and care teams. Three focus groups were run consecutively in 2021 with the geriatric team at Angers Hospital, France, to highlight the difficulties met daily and to bring innovative solutions. Following a thematic analysis of the content, 10 themes were described, including 4 emerging. These 4 themes are a greater precision of the conditional prescriptions of psychotropics, the choice of the moment of administration, the route of administration in case of agitation, and the revaluation during and after hospitalization management. Among the solutions mentioned, some will be gradually implemented according to a prioritization matrix as an awareness of teams to behavioral disorders and their management, or the development of teleconsultation to check the re-evaluation of prescriptions.

During the last ten years, the Montessori method has become a popular approach for the care of older adults living with dementia, with a growing number of institutions claiming its use. In this context, this narrative review aims at summarizing the research on its effects, benefits, and potential limits. Since the end of the 90s, a growing number of researchers across the world have investigated the Montessori method applied to dementia. Most of those studied the effects of Montessori activities. A few putted their focus on Montessori as a global, person-centered model of care. In general, research shows significant positive effects of Montessori on engagement, behaviors, affects, and functional abilities, as, for example, eating abilities. Benefits for caregivers have also been demonstrated. However, an important part of this research suffers from methodological weaknesses. In the future, other research is necessary to better understand the effects and best application conditions of Montessori method, especially in French speaking countries. Qualitative studies also seem to be a promising path to better understand where this new model of care can best lead those who apply it.

Objective: This study tested whether the subjective age tends to decrease after following a fall preventive program. This study also examines whether physical abilities and psychological resources at baseline are associated with this decrease in subjective age. Finally, this study tested to what extent the evolution of subjective age is concomitant with the evolution of these physical abilities and psychological resources between the beginning and the end of the program.

Method: A sample of 42 individuals over 65 years (M = 71) took part in a program comprising 12 balance sessions. These people answered a questionnaire to assess subjective age and fear of falling, at the beginning and at the end of the program. Participants also completed Time Up and Go test, before and after the program. In addition, demographic factors, chronic diseases, subjective health, as well as depressive symptoms were assessed at baseline, and included as covariates in the analyses.

Results: Wilcoxon signed rank analyzes showed that participants felt younger after the intervention than before (W = 334; p < 0.05). Concretely, participants feeling younger from 6.43% at baseline to 9.63% at the end of the program. The multiple linear regression analyzes reveal that a more favorable perceived health as well as a better mobility function at baseline are associated with an increase of feeling younger at the end of the program. Finally, an improvement in functional mobility between the start and the end of the program is also associated with an increase of feeling younger.

Discussion: This study highlights the benefits of a fall prevention program on feeling younger for old people. In view of the benefits generated by feeling younger than one's chronological age, this study increases the interest of preventive actions to reduce the loss of functional independence in aging.

The article presents the entire project process of a residential transformation of a special care unit as well as the results of a post-occupancy evaluation. Initially, an ethnographic immersion and a consultation phase made has highlighted the various problems and issues which were the basis of the architectural project. Once the rehabilitation works was done and after a period of use of the new spaces, we wanted to assess the effects of this spatial transformation through a new immersion and a survey of users (residents, families, caregivers). Observation shows good appropriation of living spaces and participation of residents in daily life, as well as a reduction in behavioral disturbances. Caregivers expressed great satisfaction with their new work environment, better involvement and a change in their representations on residents. The families expressed great enthusiasm and satisfaction, especially because of the reduction of their feeling of guilt due to the placement of their loved one in the institution. It seems that all these improvements are linked to the fact that this new environment qualified of "beautiful", "homelike" is a source of well-being and appeasement. However, the creation of a domestic environment implies the acceptance of a risk-taking, not always assumed, which generates fear to some caregivers, what ends with prohibitions towards residents. Beyond architectural aspects, creating the conditions for people to feel at home involves thinking about values and support methods.