Implémentation clinique de la démarche interRAI dans les EMS vaudois : évaluation d’un projet pilote

Le canton de Vaud s’est investi depuis quelques années dans des projets pilotes visant l’amélioration de la coordination et la continuité des soins. Un Exposé des motifs et projet de décret portant sur le développement d’outils et de processus favorisant la continuité et la coordination des soins a été adopté par le Grand Conseil en décembre 2016. Ce décret prévoit notamment le déploiement du programme coRAI du Service de la santé publique (SSP). Ce programme vise à introduire un langage commun dans le domaine de l’évaluation multidimensionnelle des personnes âgées en implémentant la suite interRAI® dans différents lieux de soins. Dans ce contexte, un projet pilote a été mené dans 12 établissements médico-sociaux (EMS) volontaires pour tester l’utilisation clinique de la démarche interRAI® Soins Longue durée (ci-après iSLD), entre octobre 2017 et avril 2018. Depuis la fin des années 1990, les EMS du canton de Vaud utilisent l’outil PLAISIR© (Planification informatisée des soins infirmiers requis) à des fins d’allocation des ressources, cette méthode permettant de classer les résidents en long séjour selon l’importance de leurs besoins en soins. Cependant, les informations collectées par l’outil PLAISIR ne sont que rarement utilisées pour la prise en charge clinique. Il n’existe par ailleurs pas de pratique uniforme et standardisée, dans les EMS du canton de Vaud, pour évaluer la situation clinique (problèmes, capacités et ressources) des résidents et élaborer leurs plans de soins

The Physiological Characteristics of an 83-Year-Old Champion Female Master Runner.

To examine the cardiorespiratory, muscular, and skeletal characteristics of an 83-year-old champion female master athlete (called DL in this study) who had set multiple world running records in the 80-to-84-year-old age group. Measures of maximal oxygen uptake, maximal heart rate, maximal isometric torque for knee extensor muscles, thigh and triceps surae muscle volumes, and bone mineral density (BMD) of the proximal femur region were evaluated. Based on previously published equations, physiological age was determined for maximal oxygen uptake, maximal heart rate, and maximal isometric torque. Muscle volumes for the dominant leg were compared with previously published sex- and age-matched data using z scores. For BMD, T score and z score were calculated. DL had the highest maximal oxygen uptake (42.3 mL·min-1·kg-1) ever observed for a female older than 80 years of age, which gave her a remarkable physiological age (27 y). By contrast, she had a physiological age closer to her biological age for maximal isometric torque (90 y) and maximal heart rate (74 y). The z scores for thigh (0.4) and triceps surae (1.1) muscle volumes revealed that DL's leg muscles were affected almost as much as her sex- and age-matched peers. The T score (-1.7) for BMD showed that DL had osteopenia but no osteoporosis, and the z score (0.7) showed that DL's BMD was similar to that of females of the same age. This single case study shows that the remarkable cardiorespiratory fitness coupled with intensive endurance training observed in a female master athlete was not associated with specific preservation of her muscular and skeletal characteristics

Neural and muscular factors both contribute to plantar-flexor muscle weakness in older fallers.

Plantar-flexor muscles are key muscles in the control of postural sway. Older fallers present lower maximal plantar-flexor performance than older non-fallers; however, the mechanisms underlying this motor impairment remain to be elucidated. This study aimed to determine whether muscular and neural factors are both involved in the lower maximal plantar-flexor performance of older fallers. The maximal voluntary contraction (MVC) torque, resting twitch torque, voluntary activation level (VAL), and electromyographic (EMG) activities for the soleus, gastrocnemius medialis, gastrocnemius lateralis and tibialis anterior during plantar-flexor MVCs were recorded in 23 older non-fallers (age: 83.3 ± 3.9 years) and 25 older fallers (age: 84.0 ± 4.1 years). The maximal plantar-flexor Hoffmann reflex normalized to the maximal motor potential (H <sub>max</sub> /M <sub>max</sub> ) was measured to assess the efficacy of spinal transmission from the Ia-afferent fibers to the α-motoneurons. Older fallers presented lower plantar-flexor MVC torque, resting twitch torque, VAL and EMG activity (P < 0.05). No significant differences between older fallers and non-fallers were found for the H <sub>max</sub> /M <sub>max</sub> ratio and dorsi-flexor coactivation. The current findings showed for the first time that both neural and muscular factors associated with the plantar-flexors contributed to the specific alteration of maximal motor performance in older fallers. The lack of a difference in the H <sub>max</sub> /M <sub>max</sub> ratio indicated that the efficacy of spinal transmission from the Ia-afferent fibers to the α-motoneurons was not involved in the lower voluntary muscle activation of older fallers. This suggests that supraspinal centers are likely to be involved in the lower voluntary muscle activation observed in older fallers