How are emergencies managed in the elderly nursing homes in the Northern of France? [Prise en charge de lUrgence dans les établissements dhébergement de personnes âgées. Enquête régionale dans le Nord-Pas-de-Calais]
Wiel E.,Pole de lUrgence |
Wiel E.,University of Lille Nord de France |
Wiel-Fournier V.,Pole de Geriatrie |
Mauriaucourt P.,Pole de lUrgence |
And 2 more authors.
Revue de Geriatrie | Year: 2014
Context: The incidence of elderly population is increasing. Older people are at risk of disability that needs to develop nursing homes. The medical care of elderly people with age-related diseases is complex, especially in case of emergency setting for nursing homes staff. Objective: The goal of this regional Northern France study is to describe human, material and network difficulties of nursing homes staff in front of a case of emergency in older people. Method: A descriptive, prospective, regional multicenter and non-comparative study was performed in 4 areas. We collected data by questionnaires (administrative staff and nursing staff). Results: 103 elderly nursing homes on 166 participated (62% of response rate). The mean age of resident was 83.5 ans. The GMP score was 639 (698 for nursing homes). 103 «administrative staff» questionnaires and 903 «nursing staff» questionnaires were collected. An emergency registry existed in 15.4% of cases and 70.2% of nursing homes developed emergency care procedures. Nursing staff in case of emergency called the MICU-emergency department (83%), the general practitioner (66.3%), the medical care (63.1%) and the fire department (62.9%) mostly for traumatic reasons (59.5%). Discussion: This study demonstrated that nursing staff called mainly the MICU-Emergency department in case of emergency encountered in elderly people for traumatic reasons. Conclusion: This study revealed different lacks, difficulties and questioning expressed by nursing staff of elderly nursing homes. They brought some areas of development to improve emergency care in such population. © La Revue de Gériatrie.
Prospective and observational study on the use of cerebrospinal fluid biomarkers for Alzheimers disease [Étude rétrospective observationnelle sur lusage des biomarqueurs du liquide céphalorachidien de la maladie dAlzheimer]
Weill F.,Hopitaux Universitaires Of Strasbourg |
Kiesmann M.,Hopitaux Universitaires Of Strasbourg |
Bousiges O.,Hopitaux Universitaires Of Strasbourg |
Trivalle C.,Pole de geriatrie |
And 4 more authors.
NPG Neurologie - Psychiatrie - Geriatrie | Year: 2016
Objective: The titration of biomarkers in cerebrospinal fluid (CSF) is not included in the recommendations for the diagnostic approach to Alzheimer's disease (AD) in France. We set out to assess its interest in daily clinical practice. Materials and method: A retrospective observational study of all prescriptions for CSF biomarker titration between 1st November 2010 and 30th September 2012 in a day hospital (HDJ) and a Department of Geriatric Internal Medicine (SMIG) in the Centre mémoire de ressources et de recherche (CMRR) in the Strasbourg University Hospital (Alsace, France). Results: Ninety-seven patients (women: 60.8 %, mean age 80 ± 6.5 years) were considered. In HDJ (n = 50), the biomarkers were used for the positive diagnosis of AD (64.0 %) or differential diagnosis among other dementias (36.0 %). In SMIG (n = 47), the titration was performed to confirm AD (19.1 %), to look for a cognitive disorder underpinning delirium (17.0 %) or to diagnose dementia in patients with psychiatric disorders (29.8 %). For 49.5 % of the patients, the diagnosis of AD was confirmed, while the biomarkers contributed to confirming this aetiology in 9.2 % of cases. Uncertainty between MA and another aetiology remained for 10 patients. Comparative analyses of the levels of different biomarkers showed that the tau protein was observed at a significantly higher level in AD compared to vascular dementia (P = 0.003) and at a value close to significance for Parkinson's disease (P = 0.06). The profile observed with Ptau was similar, but significant in patients with Parkinson's dementia (P = 0.01). Regarding the Aβ1-42, the average levels were highest in vascular and Lewy body dementia (P < 0.0001 and < 0.01), and they were lower in Parkinson's dementia, without reaching significance (P = 0.12). Conclusion: This study explored of the use of AD biomarker measures in clinical practice. While their implementation is currently focused on the diagnosis of AD at a mild stage, these biomarkers showed their usefulness in situations where the clinical diagnosis is made difficult by a psychiatric disorder and/or delirium, or when neuropsychological investigations are unfeasible. © 2015 Elsevier Masson SAS.
Decisional algorithm to prescribe vitamin K antagonist in geriatric patients with atrial fibrillation [Algorithme décisionnel pour la prescription dantivitamine K dans la fibrillation atriale du patient gériatrique]
Sibai M.-S.,Pole de Geriatrie |
Bellarbre F.,Pole de Geriatrie |
Ghazali N.,Pole de Geriatrie |
Bureau M.-L.,Pole de Geriatrie |
And 4 more authors.
Geriatrie et Psychologie Neuropsychiatrie du Vieillissement | Year: 2014
Preventing atrial fibrillation (AF) complications relies mainly on anticoagulant therapy. Still it is difficult to prescribe vitamin K antagonists (VKA) in geriatric patients with AF. In order to improve anticoagulation decision in this disease, we set up an algorithm. Charts of all patients with AF hospitalized between February and May 2012 were reviewed. Patients treated with anticoagulation for another indication (venous thromboembolism disease, prosthetic valve) were excluded. Algorithm was built-up with 6 criteria (past bleeding with VKA autonomy (GIR score), MMSE score, risk of falls, co-morbidities index). Each criterion had a score (0, 0.5, 1 point) according to an intensity scale (light, moderate, high). The final algorithm composite score led to the prescription or not of VKA. Patients were followed-up during 6 months after discharge. One hundred and fifty-three patients were included, mean age 86.1 ±5.6 years; 67.3% had a GIR score ≤3, 70.6% MMSE score < 23, and 83.7% a moderate risk of falls. According to the algorithm, 92 patients (60.1%) had a VKA prescription. Prescription was significantly less prescribed in the oldest old (p=0.02). Follow-up showed 4 bleeding events without any link with VKA prescription. Thirty-four patients died (22.2%), among 24 (34.4%) who did not have VKA (p=0.005). The algorithm improves VKA prescription according to an objective evaluation and probably prevents the prescription in the patients with the worse short term prognosis.
Noblet-Dick M.,Pole de Geriatrie |
Balandier C.,Direction Generale de lOffre de Soin |
Demoures G.,Etablissement de Psychogeriatrie Le Verger des Balans |
Drunat O.,Pole de Geriatrie |
And 2 more authors.
Geriatrie et Psychologie Neuropsychiatrie du Vieillissement | Year: 2013
Through a national survey, the SFGG's UCC Task Force worked and liaised with the DGOS as to establish a national inventory of the UCCs in France. 43 of the 55 newly opened UCCs in 2011 filled up the survey. These UCCs largely supported patients meeting the admission criteria's from the book of specifications edited by the public department. Those patients were demented, valid and with disruptive behavior disorders. Earnings for the stay were commonly measured by a reduced NPI (32 to 18). Body therapies, cognitive and sensory were mainly performed, even if a quarter of the UCCs also provided acute missions (diagnosis and management of acute diseases). Medical staff and caregivers were very different. Nearly half of the UCCs reported an insufficient staffing and a third of them reported a lack of training. Among the most often claimed difficulty (81% of UCCs), the release of patients is noted, with an average length of stay of 36 days. From an architectural point of view and even if the amount of beds was by the book (in average: 11), 58% of the UCCs proposed only single rooms. The lack of homogeneity shown with this survey tells us to share more our practice.
Paccaun M.,Pole de Geriatrie |
Belmin J.,University Pierre and Marie Curie
Revue de Geriatrie | Year: 2013
Lower respiratory tract infections are frequent in patients living in nursing homes. It is very important to distinguish the pneumonia from the bronchitis in order to give the most appropriate treatment and to increase the rational use of antibiotics. We propose herein a decision tree to help the therapeutic challenge.
Hequette-Ruz R.,CHRU de Lille |
Paccalin M.,Pole de Geriatrie |
Guery B.,Service Gestion du Risque Infectieux
Revue de Geriatrie | Year: 2015
The incidence and severity of Clostridium difficile-associated diarrhea (CDAD) has increased for the last fifteen years. Age is one of the main risk factor for Clostridium difficile infection (CDI); it is also associated with adverse outcomes (death, complicated course or recurrence). CDI treatment is based on general measures to reduce transmission, contributing factors elimination and antibiotic stewardship. Antibiotic therapy depends on CDI severity, number of previous episodes and risk factors of recurrence. Three molecules are currently available: metronidazole, vancomycin and fidaxomicin. Non-drug strategies such as fecal microbiota transplantation can be proposed to patients with multiple recurrences. © La Revue de Gériatrie.
Onen F.,Service de geriatrie |
Onen F.,French Institute of Health and Medical Research |
Onen H.,Pole de geriatrie
Psychologie et NeuroPsychiatrie du Vieillissement | Year: 2010
Obstructive Sleep Apnea Syndrome (OSAS) is characterized by repeated episodes of upper airway obstruction during sleep that result in intermittent hypoxemia and arousal. The prevalence of OSAS increases with aging, occurring in up to 25% of older adults and up to 48% in patients with Alzheimer's disease. OSAS causes hypoxia, fragmented sleep, daytime sleepiness, cognitive dysfunction, functional decline, and brain damage resulting from reduced cerebral blood flow, ischemic brain lesions, microvascular reactivity, white matter lesions, and grey matter loss. OSAS is considered as an independent risk factor for hypertension, stroke and mortality. The treatment of choice for OSAS is continuous positive airway pressure (CPAP). OSAS-related cognitive dysfunction has been shown in a variety of domains including attention, executive functioning, motor efficiency, working memory, and long-term episodic memory. Proposed mechanisms include hypoxemia, sleep fragmentation and inflammatory process, but it remains unclear which mechanisms underlie the relationship between OSAS and disturbances in the different cognitive domains. Recent studies suggest that OSAS may exacerbate cognitive functioning in dementia and that CPAP therapy can be applied to these patients and iimprove cognitive functioning.
Paccaun M.,Pole de Geriatrie |
Bautrant T.,Pole de Geriatrie
Revue de Geriatrie | Year: 2011
Dementia concerns up to 70% of nursing homes residents. This data underlines all the necessary skills to be acquired by doctors and nursing staff. Beside non medicinal care, specific treatment of Alzheimer's disease could be one of the most prevalent prescriptions in nursing home. In France, in the following years, the cost due to this prescription will be integrated in the daily care cost of the patient. It is, then, important to know the benefits than can be expected by the specific treatment for Alzheimer's disease in nursing homes. © La Revue de Gériatrie, Tome 36 No3 Suppl A - MARS 2011.
PubMed | University of Poitiers and Pole de Geriatrie
Type: Journal Article | Journal: Aging clinical and experimental research | Year: 2016
To assess the factors associated with orthostatic hypotension (OH) in hospitalized elderly patients.Prospective observational single center study.A French academic center.One hundred and thirty-one patients without OH symptoms who underwent OH testing.The OH test was performed when the patient was able to get out of the bed and was no longer receiving parenteral fluids. The blood pressure was measured after a 10-min rest while the patients were sitting and then standing at 1 and 3min. Demographic data, co-morbidities, current medications and biological parameters were recorded.The mean patient age was 84.37years. The mean CIRS-G score was 10.63.8. The OH test was performed 6.33.9days after admission and was positive in 39 (29.8%) patients (95% confidence interval (CI) 22, 38) and positive at 1min in 87.2% of the cases. Multivariate analysis showed that OH prevalence correlated with diabetes (odds ratio (OR)=4.23; 95% CI 1.10, 16.24; P=0.03), serum 25-hydroxyvitamin D <20ng/ml (OR=3.38; 95% CI 1.36, 8.42; P=0.008), use of tranquilizers (anxiolytic and hypnotic) (OR=2.96; 95% CI 1.18, 7.4; P=0.02), CIRS-G score (OR=1.15; 95% CI 1.01, 1.31; P=0.03) and lack of diuretics (OR=0.20; 95% CI 0.06, 0.63; P=0.005).In older adults, OH is often misdiagnosed because it is asymptomatic. As practitioners may be reluctant to perform the OH test because of time constraints, targeting a subgroup of patients with a higher risk of OH should be worthwhile to prevent further OH complications.
PubMed | Pole de Geriatrie
Type: Case Reports | Journal: Gerontology | Year: 2010
Left ventricular aneurysm can complicate acute myocardial infarction. Clinical and electrocardiogram features are not specific. We describe a case with asymptomatic left ventricular aneurysm diagnosed by computerized-tomography angiography.