Population aging is increasing the absolute number of ischemic strokes. At the same time, indications for intravenous thrombolysis and mechanical thrombectomy are expanding through patient selection based on perfusion imaging or MRI findings. Landmark trials have shown that the benefits of intravenous alteplase are maintained in very elderly patients when treatment is initiated early. Tenecteplase is also emerging as an alternative thrombolytic agent, including for older patients. In patients with proximal large-vessel occlusions, mechanical thrombectomy improves functional outcomes across all age groups, and recent trials in patients with large ischemic cores suggest a benefit in carefully selected individuals. Chronological age alone should therefore not be used as an exclusion criterion for reperfusion therapies. Decisions regarding reperfusion in older patients should integrate pre-stroke functional status (modified Rankin Scale [mRS]), frailty, comorbidities, stroke severity, imaging findings, and the patient's goals of care.
"Integrated research" appears increasingly in the biomedical literature yet is rarely defined. We describe the concept and examine its relevance to aging research. In a scoping review, PubMed was searched without date restriction for articles whose title contained the exact phrase "integrated research". Records were charted by year, field, article type and integration dimension. One hundred and six articles (1980-2026) spanned nursing, environmental science, imaging, pharmacology, oncology, infectious disease, psychiatry, public health and geriatrics. Six recurring meanings emerged: integration of research with clinical care; across disciplines; with education; with policy and management; with practice and implementation; and of data, infrastructures and methods. Few addressed aging directly, mainly via research-practice partnerships, longitudinal cohorts and community-based sites. Integrated research is a polysemous, unifying construct, not a standardized method. Montpellier's Integrated Research Center for Autonomy and Longevity (Ircal) fosters collaborative aging research uniting hospitals, care providers, health systems and economic partners.
Population ageing, the increasing burden of chronic diseases, and the growing prevalence of disability are major challenges for the French health system. These trends expose the limitations of a model that remains largely organized around disease and dependency, with fragmented coordination between healthcare, social care, and community services. This fragmentation results in disrupted care pathways, delayed identification of functional decline, territorial inequalities, and an increasing burden on patients, caregivers, and health professionals. This position paper presents the vision of the French Conference of Deans of Medical Schools for transforming the French health system through a paradigm shift: moving from the late management of dependency towards the preservation, maintenance, and restoration of functioning throughout the life course. This approach is consistent with the World Health Organization's framework on Healthy Ageing, the International Classification of Functioning, Disability and Health, and the Rehabilitation 2030 initiative. It places functioning, autonomy, participation, and environmental factors at the core of health policy and healthcare organization. Three strategic priorities are proposed: developing integrated territorial organizations to support autonomy; making the prevention of functional decline and the preservation of functioning the foundation of the health system; and strengthening the attractiveness, education, and career pathways of professionals working in the fields of autonomy, geriatrics, physical and rehabilitation medicine, rehabilitation professions, and long-term care. Drawing on their missions in education, research, healthcare, and regional engagement, universities should play a pivotal role in supporting this transformation. Establishing a national academic plan for ageing, autonomy, functioning, and rehabilitation would provide a coherent framework to coordinate existing initiatives, strengthen education, translational and health services research, and support the sustainable transformation of the French health system to better address the challenges of ageing, disability, and loss of autonomy.
Nursing home residents constitute a particularly vulnerable population in whom bacterial pneumonia is a major cause of morbidity and mortality. This study aimed to determine the incidence of bacterial pneumonia and identify its associated risk factors in a nursing home population. This retrospective observational study was conducted over a one-year period in a nursing home affiliated with a university hospital in France. The incidence of bacterial pneumonia was determined, and potential risk factors were evaluated using descriptive, univariable, and multivariable statistical analyses. A total of 392 residents were included (mean age, 84.5 years; 41.4% men and 58.6% women). Seventy-three residents (18.6%) experienced at least one episode of bacterial pneumonia during the study period. Heart failure was independently associated with an increased risk of bacterial pneumonia (odds ratio [OR] 3.22, p = 0.002), as were swallowing disorders (OR 2.11, p = 0.011). Conversely, neurocognitive disorders and a history of chronic alcohol use were associated with a lower risk of bacterial pneumonia (OR 0.22, p = 0.0002, and OR 0.27, p = 0.007, respectively). Heart failure and swallowing disorders were identified as independent risk factors for bacterial pneumonia among nursing home residents. The inverse associations observed with neurocognitive disorders and chronic alcohol use should be interpreted cautiously because they may reflect residual confounding or diagnostic bias. Although pneumococcal vaccination was not associated with a lower incidence of bacterial pneumonia in this cohort, previous studies have consistently demonstrated its effectiveness in reducing disease severity.
This article provides a synthesis on the role of self-esteem and self-compassion in healthy aging. Healthy aging and successful aging are related but distinct concepts, both emphasizing positive aging trajectories. While healthy aging integrates a holistic view of physical, psychological, and social well-being, successful aging focuses on preserving functional capacities. Cognitive, motor, and sensory deficits may occur with age; however, it is now known that various lifestyle factors (physical activity, cognitive stimulation, a balanced diet, and diverse social interactions) can reduce these detrimental effects of aging and promote successful aging. A satisfactory self-perception also appears crucial for healthy aging. Optimizing self-esteem and promote self-compassion could therefore be an effective strategy to address the challenges of aging. We further explore the potential of self-perception as a tool for interventions support at enhancing the well-being of older adults.
The subjective experience of stroke in the elderly, as well as the specific support it requires, remains insufficiently explored. While much attention has been given to the psychopathological manifestations frequently observed post-stroke (such as mood disorders, agitation, and aggression), there is a risk that the potential role of the psychological dynamics may be overshadowed by a more direct symptomatic reading of the cerebral lesion. Nevertheless, stroke represents a significant existential disruption, a somatic and psychological experience whose sequelae and resulting psychological suffering profoundly impact quality of life. The aim of this article is to outline certain consequences of stroke on the psychological organization and the ways in which the individual experiences and appropriates this event. It will be shown that, alongside functional and cognitive impairments, there are multiple losses of individual and social supports that further destabilize the subject, thereby heightening vulnerability. With a commitment to supporting the psychological life of these individuals, we have implemented a therapeutic intervention in our clinical practice through drawing mediation, aimed at facilitating communication and fostering new forms of expression. Using a single-case study approach, we present the therapeutic process applied to a brain-injured nursing home resident exhibiting behavioral disorders, and its impact on the emergence of a psychological dynamic conducive to emotional relief.
The hospital environment plays a crucial role in patient recovery. Traditional hospital rooms are not fully adapted to the specific needs of older patients who face higher risks of falls, delirium, and functional decline, leading to decreased comfort, autonomy, and safety. The HospiSenior project was designed to address these issues by developing innovative, user-centered hospital rooms tailored to older patients. This study aimed to evaluate the user experience (UX) of the HospiSenior rooms among older patients, caregivers, and healthcare professionals across five university hospitals in France. A multicentric, non-interventional, descriptive study was conducted between January 2021 and January 2024. Participants included hospitalized older patients, their informal caregivers, and healthcare professionals. UX was assessed using the AttrakDiff and meCUE questionnaires, measuring global UX (UXg) and specific UX (UXs) for 14 key innovations implemented in the rooms. Safety perception was evaluated using the QUEST 2.0 scale. A total of 100 participants were enrolled. Overall, UX scores were positive, particularly among caregivers and professionals, with higher ratings for pragmatic quality and attractiveness. However, older patients reported lower UX scores, indicating usability challenges. High adoption rates were observed for the inclined bed position, sliding pocket door, and bathroom lighting (100%), while the mirror-window (10%) and connected room system (9%) were the least used features. Safety perceptions were generally positive, though concerns were noted for automatic lighting. HospiSenior rooms improve UX for older patients, caregivers, and professionals, yet some innovations require further adaptation for optimal usability. Future research should explore the long-term clinical impact of these design features, with the ongoing Hospisenior clinical trial (NCT06098534) expected to provide further insights.
Passive physical restraint is frequently used in geriatric care but is known to have detrimental effects. Its application may be influenced or worsened by structural factors, such as staffing shortages. This study aimed to explore the relationship between caregiver burden and the use of physical restraints, with particular attention to whether the caregiver was the initiator or the applier of the restraint. Fifteen caregivers assessed their perceived burden in relation to 34 residents across two different care facilities. Data collected included Neuropsychiatric Inventory (NPI) scores, Iso Resource Group (GIR) scores, Mini-Mental State Examination (MMSE) scores, the number of restraints per resident, and the duration of restraint use. Caregiver burden was significantly higher in the presence of physical restraint (β = 14.68; p = 0.005). In contrast, greater caregiver experience (β = - 0.20; p = 0.039) and higher MMSE scores (β = - 0.175; p = 0.005) were associated with reduced burden. Caregivers who physically applied the restraints reported significantly greater burden (F = 4.60; p = 0.039). Interestingly, the highest burden was observed in the facility with the lowest restraint-to-resident ratio. These findings suggest that both the use of physical restraints and being the individual who applies them contribute to an increased caregiver burden. However, the relationship between these variables appears to vary by facility and restraint duration, indicating that structural factors may influence the use of restraints and their impact on staff.
Neurocognitive disorders lead to cognitive and metacognitive impairments, raising the question of whether individuals should continue driving. While cognitive abilities are essential for driving, driving performance results from an interaction between individual and environmental factors. Although driving cessation is sometimes necessary, it can have significant physical, psychological, and social consequences for patients. Currently, in France, the assessment of driving ability lacks standardization. This article presents a care pathway, offered in a geriatric day hospital, incorporating a cognitive assessment and a driving simulator assessment. This program provides a standardized evaluation of driving performance and self-awareness while maintaining an individualized approach (e.g., considering driving habits, cognitive functioning) to better support decision-making regarding driving cessation or continuation.
In Martinique, France's most aging territory in 2022, the context of medical shortages encourages reflection on the multidisciplinary nature of care, particularly in emergency departments, for elderly patients. This article reports the results of a qualitative study, for which data from 19 individual interviews with nurses were collected on their experience in caring for patients over the age of 65 who were assessed in psychiatric emergency departments. A semi-structured interview guide was used during the recorded interviews. Inductive thematic analysis identified nine themes of interest: positive aspects of care, difficulties, most memorable consultations, care of suicidal patients, cognitive disorders identified by nurses, isolation and restraint measures, exchanges with caregivers, cases of abuse, and areas for improvement suggested by nurses. The results of this study suggest that nurses perceive specific training in geriatric psychiatry, combined with the development of protocols for the care of elderly patients, as levers for improving their care. Thus, a protocol for the nursing care of elderly suicidal patients in psychiatric emergency departments has been developed.
Vaccination against SARS-CoV-2 remains the most powerful strategy to fight against the Covid-19 pandemic around the word. Nevertheless, the level of complete vaccination (including all recommended boosters) is not optimal, even in the most vulnerable population, i.e. older adults living in nursing homes (NH) and long-term care units (LTCU). In this context, the understanding of the patients' reluctance to vaccination seems particularly important and our objective was to understand the acceptance or refusal mechanisms of the Covid-19 vaccine among people living in NH and LTCU. National French cross-sectional study conducted between June and September 202 including 101 health care professionals working in NH or LTCU and represents 10,152 residents living in the respondents' establishments. The Vaccovid-Senior cohort included 323 residents (89 ± 6.5 years, 69% women, 89.2% living in NH); 179 agreed to vaccination and 144 were not vaccinated. In multivariate analysis, the only modifiable characteristics associated with the acceptance was a regular influenza vaccination (OR = 29.43; 95CI [12.11-71.53]; p < 0.001), and with refusal was receiving information from Internet and social media (OR = 0.34; 95CI [0.13-0.88]; p = 0.026). Remarkably, the interaction analysis revealed that the residents who were usually vaccinated against influenza and able to understand the information given about Covid-19 were 17,5 times more likely to accept the Covid-19 vaccination (RR = 17,5; 95CI [4,5-68,0]) compared to residents with polypharmacy but without regular influenza vaccination. Vaccine acceptance can be improved by repeated efforts to listen to and explain the vaccine to the older population, their families, and the care teams. Isolating these situations of refusal allowed us to foresee avenues of improvement such as the communication of information on the vaccine, the nudge strategy and training to give information adapted to the level of understanding.
Geriatric "failure to thrive" (French "syndrome de glissement") remains used in practice despite limited nosological validity. Objective. To describe care pathways and the clinical, social and biological profiles of older adults hospitalized for "failure to thrive", and to identify factors associated with short-term mortality. Retrospective, observational, single-center study including 419 patients aged ≥ 75 years admitted between 2019 and 2023 to the Assistance Publique-Hôpitaux de Marseille. Cases were retrieved from the French hospital discharge database using ICD-11 R54. We extracted demographics, comorbidities, geriatric syndromes, medications and admission laboratories; outcomes were in-hospital death and 30-day post-discharge death. Descriptive statistics and multivariable logistic regression were performed. Median age was 86; patients were markedly frail (mean Clinical Frailty Scale 6.0) with high comorbidity burden (mean Charlson 7.3). Malnutrition affected 48.9%; polypharmacy (≥ 5 drugs) 64%; psychotropic use was common (antidepressants 33.4%, benzodiazepines 31.3%). Mean length of stay was 14 days. Frequent associated diagnoses included infections (57.5%), electrolyte disorders (47%) and cardiovascular diseases (33.9%). Mortality was 22% in-hospital and 36% within 30 days post-discharge. In multivariable analysis, 30-day mortality was independently associated with severe frailty (CFS ≥ 7; adjusted OR 1.89; 95%CI 1.20-2.95), malnutrition (1.72; 1.10-2.68) and CRP > 50 mg/L (1.63; 1.04-2.56), whereas admission to a geriatric unit was protective (0.58; 0.35-0.95). Patients coded as "failure to thrive" represent an extremely vulnerable group with high early mortality rate. Findings support replacing this label with standardized multidimensional geriatric assessment, systematic nutritional management, medication review (including psychotropic deprescribing), and safer care transitions through dedicated geriatric pathways and early post-acute follow-up.
Escape games are attracting growing interest in the educational field. Few studies have been carried out with medical students, and none on undergraduate students about falls. Assess the user experience of 3rd and 4th year medical students participating in an escape game. A qualitative, monocentric, descriptive study was carried out. User experience was assessed using the meCUE scale, participant investment using the ICAPD and escape game satisfaction using a Likert scale. Seventeen students were included, 15 of them in the 3rd year of medicine. Fifteen of the participants were active, constructive or interactive during the escape game. Participants' satisfaction with the puzzles has a minimum score of 7 out of 10 for each of them. No similar study has yet been carried out in medical students. This study highlights the need to develop new pedagogical approaches in the field of falls, which are popular with students.
Non-motor symptoms in the very elderly Parkinson's disease (PD) population are poorly described. Our study (PPMI cohort and literature review), in two possible situations (late-onset PD (MPDT, > 70 years), and classic onset PD (MPDC, < 70 years) focused on (1) a cross-sectional comparison of patients seen > 70 years and (2) a longitudinal comparison based on duration of progression (< 3 years, 3-6 years, ≥ 6 years). A total of 1,188 PD patients were included (950 MPDC, 238 MPDT). MPDT patients showed faster progression, with greater motor severity (UPDRS III) and daily functional impairments (UPDRS I-II) at all stages, greater involvement of axial signs, gait disorders and postural instability. Non-motor disorders are more common, including earlier and more marked cognitive decline and more frequent daytime sleepiness. Dysautonomic symptoms (urinary disorders, constipation, hypotension, hypersalivation) are also more frequent. These results highlight the need for close cognitive monitoring and individualized management of these late-onset forms and may reflect different underlying pathophysiological mechanisms depending on age.
Population aging leads to an increase in emergency hospitalizations among older adults, particularly those living in nursing homes (EHPAD). To help prevent such hospitalizations, the GER-e-TEC device was developed to provide home-based medical telemonitoring by collecting various physiological parameters. The aim of this study was to evaluate the user experience (UX) of the device among patients, caregivers, and healthcare professionals. The study included nine patients, nine healthcare professionals, and ten caregivers who had used GER-e-TEC for at least four weeks. UX was assessed using the AttrakDiff questionnaire, which measures both pragmatic and hedonic qualities of the device. The usability of the MyPredi application was evaluated with the DEEP questionnaire, while older adults' acceptance of technologies was assessed with the S-STAM scale. Descriptive statistical analyses and qualitative feedback were also used to complement the evaluation. The study revealed an overall positive UX. Patients and caregivers appreciated the user-friendliness and relevance of the device, although heterogeneous responses were observed. Healthcare professionals expressed concerns about usability, particularly the lack of clear guidance on procedures to follow in the event of an alert. The MyPredi application was generally well received, although some caregivers reported technical difficulties. GER-e-TEC was generally well accepted, especially by patients who found it reassuring. However, improvements are needed, particularly regarding the clarity of procedures and communication between healthcare professionals and the coordination unit. Despite these limitations, the device appears effective in improving home medical monitoring and preventing avoidable hospitalizations.
