Geriatrie et Psychologie Neuropsychiatrie De Vieillissement最新文献

Alzheimer's disease leads to an alteration of decision-making abilities which may increase risk-taking behaviours, particularly associated anosognosia. Anticipating the progression of the disease raises a number of questions, particularly in relation to aging in place. Our qualitative study aimed to identify the arguments used by older patients with Alzheimer's disease when choosing a place to age. The study included 22 older adults, living at home, and diagnosed as mild dementia. The patients' arguments in favour of ageing in place were based mainly on the preservation of internal security, through the familiarity of places and relations as well as the maintenance of their independence and their lifestyle habits, allowing stability in their daily lives. Despite the identification of memory loss, the associated risks were minimized or hidden from the reflection on the choice of the place to age.

The publication of the decree on the care of people with neurocognitive disorders brought to the fore the Reisberg's Global Deterioration Scale, a scale that only few clinicians use in memory centers or in geriatric. This scale has a number of limitations, not least of which is that it is obsolete, since it does not take into account disease advances in scientific knowledge with biomarkers. Consequently, the stages evoked no longer correspond to current descriptions. Moreover, it only concerns Alzheimer's disease, whereas in our practice we encounter other neurodegenerative pathologies. Even if we decide to use another global assessment scale, such as the Clinical Dementia Rating or the Functional Assessment Staging, they cannot replace a personalized assessment. Indeed, it is important to stress that this decree does not take into account the relevance of personalized assessments using, for example, neuropsychological tests to estimate driving ability. A personalized assessment accompanied by a real-life driving test would be preferable than a score on a global scale. This article therefore presents the Global Deterioration Scale, highlighting its unsuitability for assessing whether or not to continue driving.

New ministerial decree restricts driving motorized vehicles for patients with Alzheimer's disease and related disorders. Reisberg stage 3, threshold used to contraindicate driving, appears to correspond to a mild stage of major neurocognitive impairment. A single scale gives an idea of the level of risk but does not provide a holistic assessment. The aim of this consensus is to put forward recommendations from several French learned societies for individualized cognitive assessments to minimize the risks associated with driving and its cessation. Fitness to drive should be raised at the earliest stages of the diagnostic process, and regularly throughout the follow-up. Consult a registered doctor is recommended to all patients wishing to continue driving. All documents must be given to the patient only. An alternative must always be offered to patients who are recommended a modal shift.

Introduction: Incidentaloma is the result of the medical problem created by the development of imaging. Without a universal definition, incidentaloma describes any incidental finding revealed by a medical examination performed for another indication, and which will be the origin of a questioning intended to give it a clinical meaning. The frequency of incidentalomas is very variable depending on the imaging technique, the organ affected and the definition used. The aim of this study was to investigate the frequency of incidentalomas on computed tomography (CT) scans in a geriatric hospitalised population.

Methods: In an observational, retrospective, monocentric study, we analysed, for a full year, all the planned CT scans performed, during a hospitalisation in acute and subacute care service of a Parisian geriatric hospital in search of incidentalomas.

Results: 113 patients were included in the study, with a mean age of 87,4 years. The frequency of incidentalomas on CT scans in this population was 53 %, with an average of two incidentalomas per patient. Eight percent of the incidentalomas required further examination, specialist advice or treatment. We found incidentalomas in half of the brain and abdomino-pelvic CT scans and in a quarter of the chest CT scans. Age was not associated with the presence of incidentalomas.

Discussion: Incidentaloma has become an important part of current medical practice. The geriatrician must know how to anticipate it and propose to his patient an adapted management.

Ehpad are French establishments intended to elderly people in a situation of physical and/or psychological loss of autonomy. Institutionalization in Ehpad is often synonymous with the disruption of social ties. In this context, different group activities are likely to favour the residents' relationships. Among these activities, animal mediation is an emerging approach that is gradually being introduced in these establishments. The aim of this research is to study the benefits of animal mediation on the social bond of Ehpad residents, according to animal mediation practitioners and professionals working in these establishments. Semi-directive interviews were carried out with nine professionals working in Ehpad in daily contact with the residents and who had attended collective sessions. These professionals were invited to give their views on the interactions between residents and on the benefits of the sessions. At the same time, fifty animal mediation practitioners responded to a questionnaire aimed at determining the place given to the development of social links in their practices. The professionals working in Ehpad described animal mediation as a practice that facilitates interactions during the sessions but also outside. For residents for whom verbalization is difficult or even impossible, animal mediation is presented as facilitating non-verbal communication. These comments converge with the discourse of animal mediation practitioners who place the creation of social links and the development of social skills at the heart of their practices. They highlight the central role of the animal which facilitates interactions and provides an emotional exchange.

Objectives: To assess the knowledge and the use in clinical practice of the "French National Authority for Health" (HAS) 2021 recommendations on the diagnosis of malnutrition in older adults aged 70 years and above.

Methods: An online survey was developed by the working Group on Geriatrics and Nutrition (GEGN) of the "Société Française de Gériatrie et de Gérontologie (SFGG)" and conducted among members of the SFGG. A self-administered questionnaire composed of 21 closed questions was used.

Results: A total of 132 (10.2 %) members of the SFGG responded to the survey. The respondents were aged 43.4 ± 9.94 years old and 97 (73.5 %) were women. Almost half of them were medical doctors (n = 53 ; 40.2 %). Of the respondents, 81 % had already heard of the HAS 2021 recommendations. This percentage is higher for doctors (96 %) than for other professions (74 %). French respondents were more likely to have heard of these -recommendations (84 %) than respondents from other countries (42.9 %). However, only 41.6 % of the respondents believe they know these recommendations in detail. On a visual analogue scale from 0 (never) to 100 (always), respondents use these recommendations in their professional practice at 76.8 ± 20.2 %. However, on a scale from 0 (never difficult) to 100 (always difficult), some barriers to their use in clinical practice were highlighted. These mainly concerned the measurement of muscle mass (84.4 ± 17.2 %) and muscle strength (79.5 ± 19.9 %) in patients.

Conclusion: Although the majority of respondents use the HAS 2021 recommendations in their professional practice, they often have difficulties in measuring muscle strength and muscle mass of their patients. The assessment of sarcopenia still needs to be implemented in clinical routine. Until then, better communication about simple alternatives that do not require special equipment is needed.