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Brunschwig F.-H.,Nice University Hospital Center | Sacco G.,Nice University Hospital Center | Sacco G.,University of Nice Sophia Antipolis | Sacco G.,Institute Claude Pompidou | And 2 more authors.
Cahiers de l'Annee Gerontologique | Year: 2014

Medicinal iatrogenesis is a significant cause of hospital admissions in elderly patients and is the origin of close to 20% of admissions in those patients over 80 years. The place of geriatrics in screening for and raising the awareness of the iatrogenic risk is the key, but its activity may not be effective without good coordination between hospital and outpatient care. The development of coordination tools targeting iatrogenesis is heading in the right direction; however, it appears that the biggest leaps forward in this area will be made in the years to come, through digital innovation and the sharing of healthcare information via secure and interoperable computer-based folders and networks. © Springer-Verlag 2014.

Introduction: Inappropriate association between anticholinergic and anticholinesterase (IChE) drug is frequent in nursing home, although it is known to be potentially deleterious. The objective of this study was to assess after one month the impact of an intervention from the coordinating physician to the general practitioner (GP) concerning inappropriate association between IChE and anticholinergic drug.Method: The study was an evaluation of professional practice with tracking indicator.Results: Thousand three hundred sixty-seven prescriptions were analyzed in 22 nursing homes. Fifty inappropriate prescriptions were found and transmitted to the GP. This intervention reduced inappropriate prescriptions from 50 to 16 (68%, P < 0.001).Discussion: The intervention of the medical coordinator to the general practitioner allows an important and significant reduction in the number of inappropriate drug prescriptions in nursing homes. © Springer-Verlag France 2014.

Dosa-Toader G.,Groupe MEDICA | Balard P.,Groupe ORPEA | Gonfrier S.,Nice University Hospital Center | Marro G.,Groupe MEDICA | And 4 more authors.
Cahiers de l'Annee Gerontologique | Year: 2014

Introduction: Cholinesterase inhibitor is currently one of the few drug options available in Alzheimer disease. Many drugs have an anticholinergic activity, often overlooked, which may have an antagonistic action with cholinesterase inhibitors and iatrogenic effects. The purpose of this study was to determine the prevalence of this antagonist combination in a population of nursing home residents. Method: We conducted a multicenter cross-sectional study of type "a given day". Results: 1367 prescriptions of institutionalized patients in 22 nursing homes in the south-east of France were analyzed. The average age was 86.4 years (+/-7.8 years). 23% of patients had an anticholinergic/anticholinesterase association, which represents 4% of all prescriptions. The first anticholinergic drug was hydroxyzine (Atarax), which accounted for 18% of anticholinergic/anticholinesterase associations. Conclusion: This study confirms that the combination anticholinergic/ anticholinesterase remains a frequently prescribed for institutionalized residents although it is known to be antagonistic and has iatrogenic risk. © Springer-Verlag 2014.

Wang T.,French Institute for Research in Computer Science and Automation | Merlet J.-P.,French Institute for Research in Computer Science and Automation | Sacco G.,Nice University Hospital Center | Sacco G.,University of Nice Sophia Antipolis | And 9 more authors.
Robotics and Autonomous Systems | Year: 2014

This paper proposes a new method to analyze human walking by using a 3-wheels rollator walker instrumented with encoders and a 3D accelerometer/gyrometer. In order to develop walking quality index and monitor the health state of elderly people at home, the walking patterns of 23 young adults and 25 elderly people (. >69 years) with the help of the walker, are compared. The results show that many general walking indicators such as walking speed and stride length do not present obvious difference between the two groups, but that new indicators obtained by using the walker measurements and not available otherwise are very discriminating, e.g., the lateral motion of elderly people is larger, their walking accuracy is lower, but their effort distributed on the handles is more symmetrical. We also show that this walker may have other purposes such as updating collaborative maps with sideway slopes, and location of lowered kerbs. © 2014 Elsevier B.V.

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