Les bienfaits des jardins enrichis pour les malades Alzheimer

International audienceSocietal expectations underline the importance of offering nursing home résidents an environment that is favorable to health and quality of life. Experimental studies conducted on the enriched environment have shown interesting perspectives without, however, transposing them to the living environment of the older persons. The enriched garden is an innovative concept in geriatrics, resulting from translational research that could provide encouraging answers to the question of improving the living environment in psycho-geriatric institutions.Les attentes sociétales soulignent l’importance d’offrir aux résidents en Ehpad un environnement favorable à la santé et à la qualité de vie. Les études expérimentales menées sur l’environnement enrichi ont montré des perspectives intéressantes, sans toutefois en réaliser la transposition au cadre de vie du sujet âgé;Le jardin enrichi est un concept innovant en gériatrie, issu de recherches translationnelles qui pourraient apporter des éléments de réponse encourageant sur l’amélioration du cadre de vie en institution psycho-gériatrique

Effect of Cholinesterase Inhibitors on Mortality in Patients With Dementia: A Systematic Review of Randomized and Nonrandomized Trials

International audienceBackground and objectives: Cholinesterase inhibitors (ChEIs) have cardiovascular effects in addition to their neurological activity and might alter mortality. We wanted to know if treatment with ChEIs modifies mortality in patients with dementia. Methods: We searched PubMed, EMBASE, Cochrane CENTRAL, ClinicalTrials.gov and ICRTP, from their inception to November 2021, and screened bibliographies of reviews, guidelines and included studies. We included randomized controlled trials (RCTs) and non-randomized controlled studies at lower risk of bias comparing ChEI treatment with placebo or usual treatment, for 6 months or longer, in patients with dementia of any type. Two investigators independently assessed studies for inclusion, assessed their risk of bias and extracted data, using predefined forms. Any discordance between investigators was solved by discussion and consensus. Data on all-cause and cardiovascular mortality, measured as either crude death rates or multivariate adjusted hazard ratios (HR), was pooled using a random-effect model. Information size achieved was assessed using trial sequential analysis (TSA). We followed PRISMA guidelines. Results: 24 studies (12 RCTs, 12 cohorts, mean follow-up 6 to 120 months), cumulating 79 153 patients with Alzheimer’s (13 studies), Parkinson’s (1), vascular (1) or any type (9) dementia, fulfilled inclusion criteria. Pooled all-cause mortality in control patients was 15.1 per 100 person-years. Treatment with ChEIs was associated with lower all-cause mortality (unadjusted RR 0.74, 95%CI 0.66 – 0.84; adjusted HR 0.77, 95%CI 0.70 – 0.84, moderate to high quality evidence). This result was consistent between randomized and non-randomized studies and in several sensitivity analyses. No difference appeared between subgroups by type of dementia, age, individual drug or dementia severity. Less data was available for cardiovascular mortality (3 RCTs, 2 cohorts, 9 182 patients, low to moderate quality evidence), which was also lower in patients treated with ChEIs (unadjusted RR 0.61, 95%CI 0.40 – 0.93, adjusted HR 0.47, 95%CI 0.32 – 0.68). In TSA analysis, results for all-cause mortality were conclusive, but not those for cardiovascular mortality. Discussion: There is moderate to high quality evidence of a consistent association between long-term treatment with ChEIs and a reduction in all-cause mortality in patients with dementia. These findings may influence decisions to prescribe ChEIs in those patients. Trial Registration Information: This systematic review was registered in the PROSPERO international prospective register of systematic reviews with the number CRD42021254458 (11/06/2021)

Zona des sujets ages

The varicella-zoster virus is an exclusively human herpesvirus, responsible for chickenpox. Its reactivation, after several decades, causes herpes zoster (shingles). Herpes zoster produces a rash, classically metameric, that causes acute pain and complications to elderly patients. The last, most painful, and disabling of these is postherpetic neuralgia. This neuralgia is defined as a painful syndrome lasting for more than 30 days after eruption of the rash. Today's systemic antiviral drugs can reduce the severity of the eruption, limit the pain, and diminish the incidence of postherpetic neuralgia. A recent advance in primary prevention is approval of a vaccine (Zostavax) to prevent herpes zoster and postherpetic neuralgia in subjects 60 years or older

Effects of standardized musical intervention on refusal of care and aggression during toileting in people with institutionalized neurocognitive disorders

International audienc

Risk factors for deep vein thrombosis in older patients: a multicenter study with systematic compression ultrasonography in postacute care facilities in France.

OBJECTIVES: To identify risk factors for deep vein thrombosis (DVT) in older patients with restricted mobility or functional disability. DESIGN: Cross-sectional. SETTING: Forty-two postacute care departments in France. PARTICIPANTS: Eight hundred twelve patients aged 65 and older. MEASUREMENTS: Twenty-two predefined characteristics were investigated, including medical and surgical risk factors, dependence in six basic activities of daily living (ADLs) rated using the Katz index, mobility, the reported value of the Timed Up and Go Test, and pressure ulcers. All patients underwent lower limb ultrasonography on the day of the cross-sectional study. RESULTS: DVT was found in 113 patients (14%, 33 proximal DVTs (4%) and 80 isolated distal DVTs (10%)). A positive trend was found in the odds of DVT for higher values on the Timed Up and Go Test for patients who were not bedridden or confined to a chair (P=.007). In two-level multivariable analysis adjusting for prophylaxis against venous thromboembolism, independent risk factors for DVT were aged 80 and older (adjusted odds ratio (aOR)=1.71, 95% confidence interval (CI)=1.05-2.79), previous history of venous thromboembolism (aOR=2.03, 95% CI=1.06-3.87), regional or metastatic-stage cancer (aOR=2.71, 95% CI=1.27-5.78), dependence in more than three ADLs (aOR=2.18, 95% CI=1.38-3.45), and pressure ulcers (aOR=1.85, 95% CI=1.05-3.24). CONCLUSION: Severe dependence in basic ADLs and higher Timed Up and Go Test score are associated with greater odds of DVT in older patients in postacute care facilities in France

STOPP-START: adaptation en langue francaise d'un outil de detection de la prescription medicamenteuse inappropriee chez la personne agee

OBJECTIVE: STOPP-START is a screening tool for detecting inappropriate prescriptions in older people. Recently validated in its English-language version, it is a reliable and easy-to-use tool, allowing assessment of prescription drugs often described as inappropriate (STOPP) or unnecessarily underused (START) in this population. An adaptation of the tool into French language is presented here. METHOD: A translation-back translation method, with validation of the obtained version by French-speaking experts from Belgium, Canada, France and Switzerland, has been used. An inter-rater reliability analysis completed the validation process. Fifty data sets of patients hospitalized in an academic geriatrics department (mean age +/- standard deviation: 77.6 +/- 7.9 years; 70% were women) were analyzed independently by one geriatrician and one general practitioner. RESULTS: The adaptation in French considers the 87 STOPP-START criteria of the original version. They are all organized according to physiological systems. The 50 data sets involved 418 prescribed medications (median 8; inter-quartile range 5-12). The proportions of positive and negative inter-observer agreements were 99% and 95% respectively for STOPP, and 99% and 88% for START; Cohen's kappa-coefficients were 0.95 for STOPP and 0.92 for START. These results indicated an excellent inter-rater agreement. CONCLUSION: Therefore, this French language version of STOPP-START is as reliable as the original English language version of the tool. For STOPP-START to have tangible clinical benefit to patients, a randomized controlled trial must be undertaken to demonstrate efficacy in the prevention of adverse clinical events connected with inappropriate prescriptions

Effectiveness of a guideline for venous thromboembolism prophylaxis in elderly post-acute care patients: a multicenter study with systematic ultrasonographic examination.

International audienceBACKGROUND: Thromboprophylaxis in elderly patients, including post-acute care patients, is at variance with scientific evidence. The purpose of this study was to determine whether a multifaceted intervention was followed by a decrease in deep venous thrombosis (DVT). METHODS: A prospective preintervention-postintervention study was conducted in 1373 patients (preintervention phase, n = 709; postintervention phase, n = 664), aged 65 years or older, enrolled in 33 hospital-based post-acute care facilities in France. An evidence-based guideline addressing pharmacologic and mechanical prophylaxis was implemented through a multifaceted intervention. The main outcome measure was any DVT diagnosed at routine comprehensive ultrasonography performed by registered angiologists. RESULTS: A DVT was found in 91 patients (12.8%) in the preintervention phase and in 52 patients (7.8%) in the postintervention phase (P = .002). The decrease in DVT involved the calf (7.1% vs 3.6%; P = .005) and the proximal venous segments (5.8% vs 4.2%; P = .18) and remained significant after adjusting for risk factors (adjusted odds ratio of any DVT, 0.58; 95% confidence interval, 0.39-0.86). Pharmacologic prophylaxis with either low-molecular-weight heparin at the high-risk dose, unfractionated heparin, and vitamin K antagonist was similar in the 2 study groups, whereas patients in the postintervention group were more likely to use graduated compression stockings (27.4% vs 34.6%; P = .004) and less likely to receive low-molecular-weight heparin at the low-risk dose (24.7% vs 18.5%; P = .006), which was not recommended by our guideline. CONCLUSIONS: A multifaceted intervention addressing venous thromboembolism prophylaxis in post-acute care patients can be followed by a significant decrease in the rate of any DVT in elderly patients. More active interventions are needed to enforce compliance with evidence-based guidelines

Expert consensus of the French Society of Geriatrics and Gerontology and the French Society of Cardiology on the management of atrial fibrillation in elderly people

SummaryAtrial fibrillation (AF) is a common and serious condition in the elderly. AF affects between 600,000 and one million patients in France, two-thirds of whom are aged above 75 years. AF is a predictive factor for mortality in the elderly and a major risk factor for stroke. Co-morbidities are frequent and worsen the prognosis. The management of AF in the elderly should involve a comprehensive geriatric assessment (CGA), which analyses both medical and psychosocial elements, enabling evaluation of the patient's functional status and social situation and the identification of co-morbidities. The CGA enables the detection of “frailty” using screening tools assessing cognitive function, risk of falls, nutritional status, mood disorders, autonomy and social environment. The objectives of AF treatment in the elderly are to prevent AF complications, particularly stroke, and improve quality of life. Specific precautions for treatment must be taken because of the co-morbidities and age-related changes in pharmacokinetics or pharmacodynamics. Preventing AF complications relies mainly on anticoagulant therapy. Anticoagulants are recommended in patients with AF aged 75 years or above after assessing the bleeding risk using the HEMORR2HAGES or HAS-BLED scores. Novel oral anticoagulants (NOACs) are promising treatments, especially due to a lower risk of intracerebral haemorrhage. However, their prescriptions should take into account renal function (creatinine clearance assessed with Cockcroft formula) and cognitive function (for adherence to treatment). Studies including frail patients in “real life” are necessary to evaluate tolerance of NOACs. Management of AF also involves the treatment of underlying cardiomyopathy and heart rate control rather than a rhythm-control strategy as first-line therapy for elderly patients, especially if they are paucisymptomatic. Antiarrhythmic drugs should be used carefully in elderly patients because of the frequency of metabolic abnormalities and higher risk of drug interactions and bradycardia

Good performance in the management of acute heart failure in cardiogeriatric departments: the ICREX-94 experience

International audienceContext: A growing number of elderly patients hospitalized for Acute Heart Failure (AHF) are being managed in cardiogeriatrics departments, but their characteristics and prognosis are poorly known. This study aimed to investigate the profile and outcome (rehospitalization at 90 days) of patients hospitalized for AHF in cardiogeriatrics departments in the Val-de-Marne area in the suburbs of Paris, and to compare them to AHF patients hospitalized in cardiology departments in the same area.Methods: Observational study, ICREX-94, conducted in seven cardiology departments in France and three specific cardiogeriatrics departments in Val-de-Marne.Results: A total of 308 patients were hospitalized for AHF between October 2017 and January 2019. During the 90 days following discharge, 29.6% patients were readmitted to the hospital. Compared with patients hospitalized in cardiology departments, patients in cardiogeriatrics departments were older (p < 0.001), less independent (living more often alone or in an institution) (p < 0.001), more often depressed (p < 0.001), had more often major neurocognitive disorder (p < 0.001), had a higher Human Development Index (HDI, p < 0.001), and were less often diagnosed with amyloidosis (p < 0.001). There was no difference in outcome whether patients were discharged from cardiology or cardiogeriatrics departments. The most frequent precipitating factors underlying AHF decompensation between the first and second hospitalization were arrhythmia and infection.Conclusion: AHF patients discharged from cardiogeriatrics departments, compared to cardiology departments, showed clinical differences but had the same prognosis regarding AHF rehospitalization at 90 days