This study is aimed to explore whether professional exhaustion among caregivers working in nursing homes causes an increased perception of resident aggressiveness and a lower satisfaction in the relationship between the caregiver and the resident. The data were collected from a sample of 52 nurses and caregivers working in retirement homes. We compared the perception of aggressiveness and relational satisfaction in 26 caregivers to 26 without a professional exhaustion condition, using the Maslach Burnout Inventory, Yudofsky's Manifest Aggression Scale, and Wilguski's Caregiver Satisfaction Scale. The results showthat caregivers with professional exhaustion have a much greater perception of resident aggressiessiveness. This perception of aggressiessiveness generates a relational dissatisfaction with the resident. Professional exhaustion is therefore associated with higher perception of aggressiveness and relational dissatisfaction.
A systematic review of the literature was carried out to assess the risk factors for readmission to the emergency room in people aged 75 and over. This review shows that some socio-demographic factors (high age, male gender, not being single), some underlying conditions (cardio-respiratory diseases, diabetes, cognitive impairment, cancer, depression), a recent history of falling and an impaired autonomy before admission are risk factors for readmission to the emergency room more than the cause of admission itself or its severity in people aged 75 and over. It remains to determine the best predictive readmission score in the elderly and whether a systematic identification of risk factors associated with specific management in the at-risk oldest reduce their readmission after a first visit to the emergency room.
More than a third of humanity is currently under containment due to the coronavirus pandemic. Containment has been in place in many countries for several weeks. Health authorities are on the warpath against a still mysterious virus and for which they are brought to inform the population while being confronted with many unknowns concerning the Covid-19. So what about mental health? What can generate a situation of containment with the population in quarantine? What psychological impact will this confinement have on our elderly people who are accommodated in rest and care homes in Belgium or in Ehpad in France? Currently, we are not yet aware of French-language articles already published in the medical-psychological aspects related to the coronavirus among the population. We will try, through this article, to approach the medico-psychological question of the nursing staff within the nursing homes and the psychological impact of the residents.
The SFGG (French Society of geriatrics and gerontology) stands up against ageism and fights it in all its forms of expression. The SFGG warns about the persistence of age discrimination and the emergence of new forms of ageism alongside traditional stereotypes. The SFGG has taken a position on the occasion of the 70th anniversary of the Universal Declaration of Human Rights in December 2018. In September 2020, the SFGG is again raising the alarm on the 20th anniversary of the inclusion of the Rights of the Elderly in the European Charter. It is organising a wide communication campaign against ageism, involving all the learned societies of geriatrics and gerontology as well as all the major international institutions that defend the rights of older adults.
After 12 months of viral circulation, the SARS-CoV-2 has infected millions of people around the world, leaving hundreds of thousands dead. With the lack of effective therapy and vaccination against COVID-19, focusing on the immediate repurposing of existing drugs gives hope of curbing the pandemic. Vitamin D is a possible candidate discussed in a high amount of publications. Randomized clinical trials show that vitamin D supplementation significantly reduces the risk of respiratory infections. There are also many evidences that hypovitaminosis D is an independent (and easily modifiable) risk factor for severe forms of COVID-19 and death. Vitamin D supplementation is a simple, safe and inexpensive measure, which is effective in correcting hypovitaminosis D found in 40-50% of the French population and in more than 80% of adults with COVID-19. In this position paper, we propose simple regimens (adapted to the pharmaceutical forms currently available in France) for vitamin D supplementation in adults with or without COVID-19.
To evaluate the effect of clinical pharmacy interventions on the unplanned rehospitalizations rates of elderly people admitted for fall to the elderly emergency medicine (EEM) unit in a teaching hospital.DESIGN AND MEASURES:This was a longitudinal, comparative pilot study. Patients aged at least 75 who were admitted to the EEM unit for a fall and who had at least two chronic diseases and who were being treated with two or more medications were included from February 1, 2018 to June 30, 2018 and followed by 90 days. The main outcomes were the unplanned rehospitalizations rate at Limoges Teaching Hospital within the 90 days (primary outcome), 30 days and 72 hrs. The estimated cost-saving was also assessed.RESULTS:We included 252 patients. The mean age was 88.4 ± 5.8 years and the average baseline number of medications was 8.3 ± 3.4. In total, 158 pharmaceutical interventions were performed, reflecting an acceptance rate of 94.9%. We found a significant reduction of the rate of unplanned rehospitalizations at 90-day (OR = 0.45 (0.26-0.79) p = 0.005). These results were still consistent at 30-day (p = 0.035) and 72 hours (p = 0.041). We found a cost-saving of 37,770 euros related to 21 avoided rehospitalizations.CONCLUSIONS:Our results highly emphasize the positive effects of clinical pharmacy services on the prevention of unplanned rehospitalizations of old adults admitted for fall.
BACKGROUND Dementia with Lewy body (DLB) is a common neurodegenerative disease that warrants specific care, which remains largely underdiagnosed. Our objective was to assess the knowledge of DLB by health professionals in comparison with that of Alzheimer's disease (AD), to better understand the reasons of its under-diagnosis. METHODS We conducted a descriptive and analytical study processing the results of an online questionnaire submitted to French healthcare professionals between December 1, 2020 and March 1, 2021. RESULTS A total of 490 healthcare professionals responded to the questionnaire. We observed a poorer knowledge of DLB compared to AD both subjective as highlighted on the self-assessment questionnaires and objective since the diagnostic criteria and therapeutic specificities were less known for DLB compared to AD. CONCLUSIONS DLB appears as a disease that is still too poorly known by health professionals. To improve training is therefore a decisive objective in order to optimize the therapeutic care and support of patients with DLB and their relatives.
The aim of this study was to assess 1) the satisfaction of caregivers of patients with Alzheimer's disease or related diseases regarding a new collective support intervention called "Forum Passerelle"(Gateway forum), and 2) to assess the impact of "Forum Passerelle" on the implementation of services and support for patients or caregivers. This is an observational study carried out on the basis of 3 "Forum Passerelle" (between October 2018 and February 2020). Following each "Forum Passerelle", the caregivers' satisfaction was assessed and the number of services and support was counted. In total, 78 caregivers took part in these first "Forum passerelle". The satisfaction survey showed that 98% of caregivers were satisfied with the topics covered by "Forum Passerelle". The forum fully met the expectations of 61% of caregivers and partially for 39%. Among the caregivers contacted 3 or 6 months after the forum, 68% had set up a new service/support (85 new services/support for the sick relatives and 32 for caregivers) and 59% declared that these changes had taken place thanks to the "Forum Passerelle". To conclude, the first 3 "Forums Passerelle" were received very favorably by caregivers and contributed to the implementation of new services to optimize home support for the sick relative.
A growing number of studies in animal models have highlighted the link between sleep disorders and Alzheimer's disease (AD). In the absence of curative treatment, it is therefore important to consider any comorbidities that may influence the course of AD such as Obstructive sleep apnea-hyponea (OSAH) and its syndrome (OSAHS), which appear to be potentially interesting because it is frequent, treatable and often associated with cognitive impairment. The association between OSAH/OSAHS and cognition is variable across studies, but OSAH/OSAHS is more common in older patients with AD than in cognitively normal individuals. OSAH/OSAHS is often associated with the subsequent development of mild cognitive impairment and AD. Although there is no evidence that treatment of OSAH/OSAHS in AD would have a major impact on the course of the disease, treatment would appear to improve cognition in AD patients with OSAH/OSAHS. Finally, the literature suggests a link between OSAH/OSAHS and AD biomarkers. Together, these data highlight the importance of detecting and treating OSAHS in this population.
Neurodevelopmental disorders are frequent in the general population and are often lifelong conditions despite sometimes being masked by conscious or unconscious compensation and avoidance mechanisms. These conditions are often unknown or underestimated in adults, even when diagnosed in childhood. Neurodevelopmental disorders share similarities with and frequently interact in a complex way with neurodegenerative disorders. Considering these aspects during memory clinic assessments can provide a new perspective on lifelong neurocognitive trajectories. Assessing both neurodevelopmental and neurodegenerative dimensions is challenging but should improve diagnostic accuracy. It is therefore necessary to understand the lifelong specific neurocognitive trajectory of each patient in order to develop personalized and focused cognitive medicine and care.
To date, few studies have focused on the impact of anosognosia on patients' and caregivers' daily lives. However, in more general studies, anosognosia has been linked to increased burden of family caregivers, refusals to receive care, and increased caregivers' psycho-behavioral disorders. However, these studies did not specify the nature of the impact of anosognosia on these manifestations, often attributed to cognitive impairment which is more representative of the disease. The aim of this review is to provide an overview of the current knowledge of the impact of anosognosia on the patient-caregiver relationship and to identify possible future directions to lessening its consequences.
Frailty in elderly people is frequent and places a person at increased risk of adverse outcomes, but it is potentially reversible. Easy and quick to complete, the Gérontopôle Frailty Screening Tool (GFST) has been designed for early diagnosis of frail elderly. The answer comes from the GP's impression in front of the patient, guided by six frailty characteristic parameters. The aim of this study was to determine the proportion of frail patients among the 75-and-older population, using the GFST. Quantitative cross-sectional observational study. A Chi2 square test and a multivariate analysis have been performed. Twenty-six GPs have taken part in this study, enabling the collection of 191 tests: 42% [95% CI, 0,35-0.49] of surveyed patients are considered frail. Frailty is significantly associated with each of the GFST parameters, except "living alone". After adjusting on age, gender and other parameters, the factors most strongly associated with frailty are: difficulty with walking, memory complaint (P < 0.001) and age (P < 0.05). The prevalence observed is consistent with the literature data. Our results confirm the relationship between frailty and physical domain, and reaffirm the close interaction between frailty and cognitive domain.
The works of N.A. Bernstein on the construction of daily life movements in humans and those of P.K. Anokhin on the integrative nature of the nervous system in animals led to new descriptions of the brain functioning and behaviour, which contributed to the development of neuropsychology by A.R. Luria. Their work, which was considered as conflicting with Pavlov's reflex theory, which was sanctioned by the Soviet authorities, were for a long time disregarded in the USSR, and were unrecognised in the West due to the lack of English translations which were only produced much later. Bernstein described activity as being directed toward the resolution of a specific motor problem, programmed and guided by a copy of the desired solution constructed by the brain (a model of the future), and implemented and regulated according to the probability theory through sensory corrections carried out at different levels in the brain. Anokhin's systemic theory of brain functioning was defined by a complex integrative process with adaptive value, carried out by a system of permanent interactions between a cortical centre and the peripheric motor apparatus, regulated by reverse afferences from the periphery. These descriptions appear to be close to modern conceptions of brain functioning and continue to be of interest in the study of the relationships between psychic activity and brain function.
INTRODUCTION:The care of elderly people living in nursing homes is a medical public health issue. The objective of this study is to evaluate the number of hospitalizations and transports avoided thanks to teleconsultations and to evaluate the therapeutic and follow up consequences of these teleconsultations.METHODS:A retrospective descriptive study of cardiology and neuropsychogeriatric teleconsultations was performed in three nursing home participating in the TokTokDoc Mobile Polyclinic project between September 1st, 2020 and February 28, 2021.RESULTS:We included 77 patients who had a total of 120 teleconsultations. Sixty-seven transports (55.8%) and 12 hospitalizations (10%) were avoided. Therapeutic optimization was achieved in 38 cases (40%). Complex medical assessments were carried out in the same way as a face-to-face consultation.CONCLUSION:Telemedicine is a relevant tool for improving the healthcare circuit care of residents, by avoiding medical transport and hospitalizations. These preliminary results also show the feasibility of teleconsultations in cardiology and neuropsychogeriatrics despite the medical complexity of these two specialties.
During the Covid-19 pandemic, four patients were admitted to a healthcare centre. They were treated with vitamin K antagonists (AVK). We observed a substantial increase in their International Normalised Ratio (INR). The mean age of these patients was 90 (± 8 years). All had different usual long-term therapy treatments but had fixed doses of AVK to reach a stable INR. No changes to the background regimen were implemented. One patient presented a cough whereas the three others were asymptomatic. In the context of the pandemic, a reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 was carried out for each patient. The results of the RT-PCR rests were all positive and were associated with a substantially increased INR. Mr H. was admitted with an INR of 2.25 which increased to 5.93 the day after RT-PCR positivity. AVK treatment was stopped but the INR one day after was 7.89. Ms J. presented INR values between 1.96 and 4.58, 10 days later. a PCR test was conducted and AVK treatment was stopped, but the INR still increased to 5.85. The INR of Mr R. increased from 1.82 to 8.05, 24 hours after a positive PCR result. Ms F. presented a gradual increase in INR from 1.5 to 3.36, 72 hours after a positive PCR result and three days after discontinuation of AVK. This study suggest a link between the Covid-19 infection and an increased INR. It has been established that SARS-CoV-2 infection induces hypercoagulability in severe forms. Inversely, these four cases show a haemorrhagic risk as the INR increases. There could be a risk of overdose when patients are treated with AVK and are positive for Covid-19. This raises the question of discontinuing AVK and substituting it with another anticoagulant, or performing INR checks more frequently in the context of Covid-19. Moreover, an unexpected increase in INR should indicate the need to conduct a Covid-19 RT-PCR test in the context of this pandemic context.
INTRODUCTIONWe aimed at identifying the associations of health issues managed in general practice encounters with patients aged 65 years or over, according to their sex.METHODSAncillary study of the ECOGEN study on the consultation practice of French general practitioners. We have studied the 15 most frequent health issues managed in patients aged 65 years or over and identified the pairs most frequently and strongly associated.RESULTSThe sample included 5,782 encounters corresponding to 17,182 health issues managed. Each encounter involved an average of 3.0 [2.9-3.0] health issues. The strongest associations mainly included cardio-metabolic conditions. The most frequent and strong pair (OR: 3.8 [3.3-4.4]) associated non-complicated arterial hypertension with lipid disorder. Some associations were specific to patient sex.CONCLUSIONThe remarkable associations identified may enable to improve the management of elderly patients with multimorbidity by favouring synergic treatments.
CONTEXT:The External Mobile Geriatric Team (EMGT) of the University Hospital of Grenoble-Alps (UHGA) intervenes with elderly subjects in a complex medicosocial situation at home at the request of the general practitioner (GPs).OBJECTIVE:To evaluate the satisfaction of GPs after EMGT intervention. The secondary outcomes were the follow-up of recommendations and the training request of community partners.METHOD:Retrospective monocentric satisfaction survey of the 124 GPs who used EMGT from January 2015 to December 2018.RESULTS:Participation rate of 44 %, representative of GPs liberal urban or semi-rural. Participants were "satisfied" or "very satisfied" with the responsiveness of EMGT to 84,2 % and 85,5 % respond favorably to the content of the evaluation. EMGT was described as having an expert and supportive role for GPs. The recommendations were followed more than 89 %. The participants wanted to 83,6 % that the EMGT conducts training sessions, mainly for "behavioral disorders management". Following this survey, five improvement proposals were formulated: decrease the response time by recruiting trained staff, systematically send an e-mail post-analysis of the report to the doctor-applicant, use a platform of exchange, develop the partnership with the psychiatry team, and create a dematerialized resource space.CONCLUSION:This study contributed to the improvement of the city-hospital relationship by strengthening the links between the GPs of the CHUGA sanitary territory and the EMGT.
