An optimization-simulation approach for long term care structure assignment problem for elderly people

International audienceThe growing number of elderly people is one of the most important problems for the next years. This part of the population is often dependent and does not tolerate environment changes so that long term care structure assignment should be well prepared. This paper proposes a new optimization-simulation approach to (i) solve the long term care structure assignment problem for a population of elderly people and (ii) validate and calibrate the model depending on stakeholders objectives and territory special features. A Mixed-Integer Linear Program is proposed to solve the tactical assignment problem, while a stochastic simulation is used to assess the key performance indicators relevant for elderly on the long term

Une vulnérabilité cachée et méconnue du sujet âgé : le syndrôme de Diogène

National audienceLes acteurs de la gérontologie sont confrontés à des situations extrêmes qui témoignent d’une importante vulnérabilité des sujets âgés, dont le syndrome de Diogène est un des exemples les plus emblématiques. Le syndrome de Diogène reste une entité mal définie. Le diagnostic est clinique. Il ne se réduit pas à la seule accumulation d’objets (syllogomanie) et peut revêtir des formes cliniques variées avec un important retard diagnostique. Le but de l’étude est de décrire un profil type à partir de vingt et un patients rencontrés porteurs du syndrome de Diogène, en analysant rétrospectivement les informations cliniques et environ-nementales recueillies et de fournir des outils ou signes cliniques permettant de les repérer. Les cliniciens et les chercheurs utilisent souvent de manière synonyme le terme de fragilité et celui de vulnérabilité pour décrire ces situations cliniques spécifiques. Le syndrome de Diogène représente un tableau caractéristique de l’intrication de ces deux concepts bien distincts

La démocratie française sous tension

Avec le soutien de Solène Compingt, consultante sur la participation citoyenne et le pouvoir d'agir

French Democracy Under Strain

UMR 5600, coordinators of the UNESCO chair "Urban policies and citizenship". With the help of Solène Compingt, consultant on citizen participation and empowerment.Avec le soutien de Solène Compingt, consultante sur la participation citoyenne et le pouvoir d'agir

IMPACT OF COVID-19 EPIDEMICS ON BED REQUIREMENTS IN A HEALTHCARE CENTER USING DATA-DRIVEN DISCRETE-EVENT SIMULATION

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[Prophylactic treatment of venous thromboembolic disease in palliative care. A survey about four different clinical cases]

International audienceThere are no specific studies evaluating the benefit/risk of antithrombotic prophylactic treatment in patients hospitalised in a palliative care unit. So, the aim of this study was to evaluate the clinicians attitudes about antithrombotic prophylaxis for patients in palliative care units and the elements which determined their decisions. METHODS: The clinical data of 4 terminally ill patients were extracted from database of a Palliative Care Unit in France. These 4 patients were selected as they represented several different situations according to the presence or not of major thrombotic risk factors, bleeding risk factors, and request of compassionate care. Through an open questionnaire, fourteen clinicians usually in charge of palliative care patients were individually interviewed about antithrombotic prophylactic therapy for each case of patients. RESULTS: except in the case of a patient with major thrombotic risk factors, no bleeding risk factor and wishing to receive active care, both the attitudes of clinicians to initiate or continue a prophylactic therapy and the elements which lead to their decisions were heterogeneous at least. CONCLUSION: the absence of recommendations based on validated clinical trials evaluating the efficacy and safety of thromboembolism prophylactic treatment in palliative care patients lead to uncertain decisions for clinicians. Added to an objective evaluation of thrombotic and hemorrhagic risks factors, the wish of patient to receive or not active care is probably the most important element to consider

Can maintaining cognitive function at 65 years old predict successful ageing 6 years later? The PROOF study

Methods: nine hundred and seventy-six questionnaires were sent by mail to a sample of healthy and voluntary French pensioners. Successful ageing was defined through health status and well-being. Cognitive abilities had been assessed 6 years earlier according to an objective method (Free and Cued Selective Recall Reminding Test (FCSRT), the Benton visual retention test and the similarities subtest of the Wechsler Adult Intelligence Scale-Revised) and a subjective one (Goldberg's anxiety scale, Mac Nair's scale and a Visual Analogue Scale to evaluate memory abilities change in the last 5 years). Results: six hundred and eighty-six questionnaires could be analysed. The mean age was 72.9 +/- 1.2 years old with 59% of women and 99% lived at home. Well-being was negatively correlated with the FCSRT (r = -0.08, P = 0.0318) but positively related with the Benton (r = 0.09, P = 0.0125) and the similarities tests (r = 0.09, P = 0.0118). There is a negative correlation between anxious and cognitive complaints measured at baseline, and successful ageing indicators 6 years later. Conclusion: preservation of cognitive abilities at the age of retirement can predict a successful ageing 6 years later. ClinicalTrials.gov Identifier: NCT00759304

Objets chauds et objets froids au coeur des TIC

Article grand public sur lemonde.fr dans le supplément partenair

Chapter 5.1.3 The Adour-Garonne basin

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REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors (REMEDI[e]S): French implicit and explicit criteria

International audiencePurpose To establish a consensus on both explicit and implicit criteria in order to identify potentially inappropriate prescribing (PIP) in French older people aged 75 years and over or 65 years and over with multimorbidity. Methods Fifteen experts in geriatrics, general practice, pharmacy, and clinical pharmacology were involved in a two-round Delphi survey to assess preliminary explicit and implicit criteria based on an extensive literature review and up-to-date evidence data. Experts were asked to rate their level of agreement using a 5-level Likert scale for inclusion of criteria and also for rationale and therapeutic alternatives. A consensus was considered as reached if at least 75% of the experts rated criteria as "strongly agreed" or "agreed." Results The new tool included a seven-step algorithm (implicit criteria) encompassing the three main domains that define PIP (i.e. overprescribing, underprescribing, and misprescribing) and 104 explicit criteria. Explicit criteria were divided into 6 tables related to inappropriate drug duplications (n = 7 criteria), omissions of medications and/or medication associations (n = 16), medications with an unfavourable benefit/risk ratio and/or a questionable efficacy (n = 39), medications with an unsuitable dose (n = 4) or duration (n = 6), drug-disease (n = 13), and drug-drug interactions (n = 19). Conclusion The REMEDI[e]S tool (REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors) is an original mixed tool, adapted to French medical practices, aimed at preventing PIP both at the individual level in clinical practice and the population level in large-scale studies. Therefore, its use could contribute to an improvement in healthcare professionals' prescribing practices and safer care in older adults