Associative Network Method.

BACKGROUND: The associative network method is a technique for studying social representations of a phenomenon. Although it is little known and used, it can be widely used in nursing research, particularly to understand the representations of a population on a disease or a professional practice. OBJECTIVES: This article aims to describe the associative network method, proposed by De Rosa in 1995, through a concrete example. METHODS: The associative network is a technique that allows us to identify the content, structure, and polarity of social representations of a phenomenon. It was used with 41 participants to describe their representations of urinary incontinence. First, the data were collected following the four steps described by De Rosa. The analysis was then carried out manually and using Microsoft Excel. The different themes evoked by the 41 participants, the number of words in each theme, the rank of appearance of the themes, the indices of polarity and neutrality, and the rank of hierarchy were thus analyzed. RESULTS: We were able to describe in depth the representations of caregivers and people from the general population on urinary incontinence and, more specifically, their content and structure. The spontaneous answers of the participants allowed us to explore several dimensions of their representations. We were also able to obtain rich information, both qualitatively and quantitatively. DISCUSSION: The associative network-which is easy to understand and implement-is a method that can be adapted to various studies.

Impact of the first COVID-19 epidemic wave in a large French network of nursing homes: a cross-sectional study.

BACKGROUND: Nursing homes (NHs) have been particularly affected by COVID-19. The aim of this study is to estimate the burden of COVID-19 and to investigate factors associated with mortality during the first epidemic wave in a large French NHs network. METHODS: An observational cross-sectional study was conducted in September-October 2020. 290 NHs were asked to complete an online questionnaire covering the first epidemic wave on facilities and resident characteristics, number of suspected/confirmed COVID-19 deaths, and preventive/control measures taken at the facility level. Data were crosschecked using routinely collected administrative data on the facilities. The statistical unit of the study was the NH. Overall COVID-19 mortality rate was estimated. Factors associated with COVID-19 mortality were investigated using a multivariable multinomial logistic regression. The outcome was classified in 3 categories: "no COVID-19 death in a given NH", occurrence of an "episode of concern" (at least 10% of the residents died from COVID-19), occurrence of a "moderate episode" (deaths of COVID-19, less than 10% of the residents). RESULTS: Of the 192 (66%) participating NHs, 28 (15%) were classified as having an "episode of concern". In the multinomial logistic regression, moderate epidemic magnitude in the NHs county (adjusted OR = 9.3; 95%CI=[2.6-33.3]), high number of healthcare and housekeeping staff (aOR = 3.7 [1.2-11.4]) and presence of an Alzheimer's unit (aOR = 0.2 [0.07-0.7]) were significantly associated with an "episode of concern". CONCLUSIONS: We found a significant association between the occurrence of an "episode of concern" in a NH and some of its organizational characteristics and the epidemic magnitude in the area. These results can be used to improve the epidemic preparedness of NHs, particularly regarding the organization of NHs in small units with dedicated staff. Factors associated with COVID-19 mortality and preventive measures taken in nursing homes in France during the first epidemic wave.

Representations of English- and French-speaking Internet users on urinary incontinence: a webometric study.

Urinary incontinence is a major public health problem that affects nearly 9% of the world's population. Numerous studies have defined it, as well as its frequency, contributing factors, means of prevention and therapeutic approaches, but there are very few publications on its social representations. However, the literature raises that a better understanding of the social representations associated with this phenomenon could improve its management. This study focuses on its representations, and more specifically those of Internet users. Its ambition is to bring out some of the representations related to this phenomenon and thus provide initial factual and useful elements for the following research program. We conducted a webometric study and drew on Moliner's social representations theory. Using textual and iconographic data posted on the search engines and social networks most used by Internet users between January 1st, 2015 and October 15th, 2020, this research examined how urinary incontinence is perceived by English- and French-speaking Internet users. For quantitative data analysis, two textometric analysis software packages were used: Lexico® and Iramuteq®. For qualitative data, the analysis was carried out with ATLAS Ti® 9 software. Formerly hidden, urinary incontinence seems to be nowadays less and less a taboo subject and has been arousing growing interest for several years. However, this study also highlights the many preconceived ideas, false beliefs and the obvious lack of knowledge about this phenomenon. It also shows that urinary incontinence should not be trivialized nor the difficulty for the patients concerned to live with it. This study made it possible to understand the representations that a part of the population has on the phenomenon of urinary incontinence. It was the first of a larger research program which aims at improving the care of institutionalized elderly people suffering from urinary incontinence.

The COVID-19 Pandemic and Responses in Nursing Homes: A Cross-Sectional Study in Four European Countries.

BACKGROUND: Studies comparing how the European nursing homes (NHs) handled the first wave of the COVID-19 pandemic remain scarce. METHODS: A cross-sectional study was conducted during the first wave in a private NHs network in Belgium, France, Germany and Italy. Mortality rates were estimated, and prevention and control measures were described by country. Data from the Oxford governmental response tracker project were used to elaborate a "modified stringency index" measuring the magnitude of the COVID-19 global response. RESULTS: Of the 580 NHs surveyed, 383 responded to the online questionnaire. The COVID-19 mortality rate was similar in France (3.9 deaths per 100 residents) and Belgium (4.5). It was almost four times higher in Italy (11.9) and particularly low in Germany (0.3). Prevention and control measures were diversely implemented: residents' sectorization was mainly carried out in France and Italy (~90% versus ~30% in Germany and Belgium). The "modified stringency index" followed roughly the same pattern in each country. CONCLUSION: This study, conducted in a European network of NHs, showed differences in mortality rate which could be explained by the characteristics of the residents, the magnitude of the first wave and the prevention and control measures implemented. These results may inform future European preparedness plans.

Social Representations of Urinary Incontinence in Caregivers and General Population: A Focus Group Study.

Urinary incontinence (UI) is a major public health problem. Although trivialized, it affects nearly 9% of the world's population and its prevalence increases with age. It affects many people living in nursing homes. In the literature, there is a lot of information on its symptoms, risk factors and therapeutic approaches, but its social representations are rarely studied. The objective of this qualitative focus-group study is to understand the social representations of urinary incontinence of caregivers of institutionalized elderly people, but also of the general population. Seven focus groups were organized with 41 participants. The data collected were analyzed both manually and using Atlas.Ti software. For caregivers and the general population, urinary incontinence remains a misunderstood and disturbing subject: judged as too intimate, embarrassing, and shameful, it is even considered uninteresting by those who are not affected, with some going so far as to make fun of those affected. It is also represented as a real difficulty for relationships: it can be a source of conflict, but also of questioning by the role of caregiver. However, it is also represented as a means of increasing the empowerment of the residents concerned, thanks to the choice of their means of protection. This study has enabled us to gain a deeper understanding of the social representations of caregivers and the general population on urinary incontinence in the elderly, but also to highlight the various preventive and educational actions that could be taken to improve the management of this health problem. It is part of a larger research program that aims at understanding the representations of urinary incontinence of caregivers, the general population, but also of course, of residents in nursing homes and their carers.

Factors predictive of adherence to a non-pharmacological intervention in nursing home research: a substudy of the LEDEN trial / Facteurs associés à l'observance d'une intervention non médicamenteuse au cours d'une recherche menée en Établissement d'hébergement pour personnes âgées dépendantes (Ehpad) : une analyse secondaire de l'étude LEDEN

Introduction: Few older people participate in medical research, especially in the nursing home setting. The lack of evidence in this population may limit our ability to provide evidence-based treatments. This can partly be explained by difficulties in obtaining a satisfactory adherence to research in this population, especially when the practice of a physical activity is needed. In this study data from the LEDEN trial (Effects of a Long-term Exercise Program on Functional Ability in People with Dementia Living in Nursing Homes: A Cluster Randomized Controlled Trial) was used to determine the predictors of adherence to the study protocol. Methods: Retrospective cohort study based on the data from the cluster randomized, controlled LEDEN trial. The LEDEN trial aimed to compare the effects of an exercise intervention with a nonphysical intervention on the ability to perform activities of daily living. Predictors of adherence (being present at ≥ 75% of sessions of the LEDEN trial) were identified by multivariable logistic regression. Results: By univariate analysis, the EVIBE scale (EValuation Immédiate du Bien-Être ­ evaluation of instantaneous well-being) measured at baseline was associated with study adherence, whereby higher scores were associated with higher adherence: 16.7% (1/6), 44.4% (4/9), 56.5% (13/23), 48.1% (13/27) and 75.0% (15/20) respectively for EVIBE scores from 1 to 5 (P = 0.02 for trend). By multi-variable analysis, an EVIBE scale score ≥ 4 did not predict clinical trial adherence (odds ratio [OR] 1.554, 95% confidence interval [CI] 0.619­3.942). Adherence was found to be lower among persons aged ≥ 95 years (OR: 0.121, 95%CI: 0.006­0.982). Conclusion: Older age (≥ 95 years) was associated with lower adherence to the study protocol. Further studies are needed to better understand and anticipate obstacles to adherence in research, while respecting consent procedures and patient autonomy.

Introduction: Peu de personnes âgées participent à la recherche, notamment en Établissement d'hébergement pour personnes âgées dépendantes (Ehpad). L'absence de données scientifiques limite notre capacité à proposer des soins basés sur les preuves. L'explication est en partie liée à la difficulté à faire adhérer cette population aux interventions, surtout lorsqu'il s'agit de la pratique d'une activité physique. À partir de données de l'étude interventionnelle LEDEN (Effects of a Long-term Exercise Program on Functional Ability in People with Dementia Living in Nursing Homes : A Cluster Randomised Controlled Trial) évaluant l'effet de la pratique d'une activité physique chez des résidents d'Ehpad, nous étudions, dans ce travail, les déterminants de l'observance au protocole d'étude. Méthodes: Il s'agit d'une analyse secondaire de l'essai contrôlé randomisé LEDEN. L'intervention consistait en des séances bi-hebdomadaires d'activité physique. Les facteurs prédictifs d'une présence à 75 % des séances ont été évalués par une analyse multivariée par régression logistique. Résultats: Seul l'âge ≥ 95 ans était associé à une moins bonne observance des séances : odds ratio 0,121 (IC95% 0,006­0,982). Conclusion: Chez les résidents d'Ehpad, seul l'âge très élevé (≥ 95 ans) est apparu comme un facteur limitant l'observance au programme d'activités de la recherche.

Perceptions, representations and logics of action of urinary incontinence in institutionalised elderly people: a concurrent mixed study protocol.

INTRODUCTION: Urinary incontinence (UI) is a major public health problem. It affects many institutionalised elderly people. In the literature, the phenomenon is well defined. Its frequency, risk factors, individual and social costs, as well as the different therapeutic approaches, are described. However, there are few publications on its representations, both from the point of view of the patient and that of the carers. However, the literature shows that a better understanding of the social representations of this phenomenon could be a vector for improving care. We aim at understanding the perception of UI, to model its representations and to understand and characterise the logics of action in terms of protection. METHODS AND ANALYSIS: This will be a mixed-method concurrent study with a quantitative and a qualitative component. Data will be collected through 100 semistructured interviews, 8 focus groups and 10 000 surveys from 4 populations: institutionalised elderly people, caregivers, carers and individuals from the general population. The qualitative part will be analysed both manually and with ATLAS.Ti software, which will be used to centralise and organise all qualitative data collected. For the analysis of the quantitative part, a descriptive statistical analysis and a logistic regression type association will be carried out. These analyses will be enforced using R software. Then, an overlay and combination of quantitative and qualitative information for the triangulation analytical approach will be carried out. The study started in August 2021 and will continue until June 2022. ETHICS AND DISSEMINATION: The study protocol was approved by the Descartes ethics and research committee on 1 June 2021, with the IRB number 00012021-43. The findings will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER: This protocol was registered with the Research Registry on 12 July 2021 and is numbered researchregistry6965.

No impact of a prescription booklet on medication consumption in nursing home residents from 2011 to 2014: a controlled before-after study.

BACKGROUND: Older persons are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. We aimed to evaluate the impact on medication consumption, of a booklet designed to aid physicians with prescriptions for elderly nursing home residents. METHODS: Among 519 nursing homes using an electronic pill dispenser, we recorded the daily number of times that a drug was administered for each resident, over a period of 4 years. The intervention group comprised 113 nursing homes belonging to a for-profit geriatric care provider that implemented a booklet delivered to prescribers and pharmacists and specifically designed to aid with prescriptions for elderly nursing home residents. The remaining 406 nursing homes where no such booklet was introduced comprised the control group. Data were derived from electronic pill dispensers. The effect of the intervention on medication consumption was assessed with multilevel regression models, adjusted for nursing home status. The main outcomes were the average daily number of times that a medication was administered and the number of drugs with different presentation identifier codes per resident per month. RESULTS: 96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (- 0.05 and - 0.06). The booklet did not have a statistically significant effect (exponentiated difference-in-differences coefficient 1.00, 95% confidence interval 0.99-1.02, P = .45). CONCLUSION: We observed an overall decrease in medication consumption in both the control and intervention groups. Our analysis did not provide any evidence that this reduction was related to the use of the booklet. Other factors, such as national policy or increased physician awareness, may have contributed to our findings.

[Impact of animal-assisted interventions on the resident]. / Impact des interventions assistées d'un animal sur le résident.

Animal-assisted interventions are designed for personal well-being. The objective of this study was to evaluate the effectiveness of these interventions in the context of residential facilities for dependent elderly people. Animal-assisted therapy, which can be delivered by trained staff, could be a tool to helpinstitutionalised elderly people cope with loneliness.

Multiple factor analysis of eating patterns to detect groups at risk of malnutrition among home-dwelling older subjects in 2015.

OBJECTIVE: We aimed to describe eating patterns among home-dwelling older subjects to establish typologies of eaters at higher or lower risk of malnutrition. DESIGN: Cross-sectional study between June and September 2015 using a standardised questionnaire. The questionnaire was given to home-help employees (responsible for delivering meals to home-dwelling older persons and helping them to eat). The employees were asked to complete the questionnaire three times during the same week, for the same older adults, in order to identify the totality of their food intake. SETTING: Registered customers of the home meal delivery company 'Azaé' (France). PARTICIPANTS: 605 older home-dwelling persons were randomly selected among customers served by the home meal delivery company. OUTCOMES: Multiple factor analysis was used to understand the different modes of food consumption and to establish eating profiles. Hierarchical classification was performed to construct eating profiles corresponding to the dietary habits of the respondents. RESULTS: Average age of the older adults was 85.3 years; 73.5% were women. Overall, 59% of participants reported that they ate out of habit, while 33.7% said they ate for pleasure. We identified four different groups of eaters, at varying levels of risk for malnutrition. Individuals in group 4 had the highest food intake in terms of quantity; and were less dependent than individuals in group 1 (p=0.05); group 1 was at highest risk of malnutrition. CONCLUSION: Improved understanding of eating habits can help detect risky behaviours and help caregivers to promote better nutrition among home-dwelling older subjects.

Six-month observational follow-up on activities of daily living in people with dementia living in nursing homes after a 6-month group based on either exercise or social activities.

BACKGROUND: Studies have demonstrated changes in activities of daily living after an exercise intervention in people with dementia (PWD) living in nursing homes (NH). However, some discrepancies are shown during follow-up. AIMS: Our objective was to measure activities of daily living (ADL) performance during a 6-month observational follow-up after a 6-month exercise or social activity intervention in PWD living in NH. METHODS: After cluster randomisation, 91 PWD living in NH performed a 6-month structured exercise intervention (n = 44) or a social activity intervention (n = 47). After the intervention, 85 PWD were assessed for post-intervention follow-up. Instrumental and basic activities of daily living (IADL, ADL) were measured at 6-month observational follow-up after the intervention using the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory for Severe Alzheimer's Disease (ADCS-ADL-sev) scale (scores ranging from 0 to 51, higher is better). RESULTS: Compared to participants in the social activity, those who participated to the exercise intervention had a significant decrease of their ADCS-ADL-sev score (between-group adjusted mean difference: 4.6 points, p = 0.001) with IADL having the most decrease (2.8 points, p = 0.004). DISCUSSION: Unexpectedly, exercisers declined sharply in the performance of ADLs and IADLs, whereas participants in the social intervention group maintained their levels. The potential mechanisms to explain these findings remain still to be elucidated.

Effect of Exercise on Behavioral Symptoms and Pain in Patients With Dementia Living in Nursing Homes.

OBJECTIVES: Examine the effects of a 6-month exercise intervention on neuropsychiatric symptoms, pain, and medication consumption in older people with dementia (PWD) living in nursing homes (NH). METHODS: Ninety-one older PWD living in NH performed a 6-month structured exercise intervention (n = 44) or a social activity intervention (n = 47). Neuropsychiatric symptoms were measured by the neuropsychiatric inventory (NPI), pain was assessed using the Algoplus scale, and dementia-related drug prescriptions were obtained for all participants. RESULTS: Between-group analysis found a nonsignificant difference that could be of clinical relevance: a 4-point difference in the NPI and 1.3-point difference in the reduction of the number of medications favoring exercisers. No significant differences were found for pain, and a trend was found for an increase in medication consumption in the social group. CONCLUSION: Exercise effects did not differ from social intervention effects on neuropsychiatric symptoms, pain, and medication consumption in older PWD living in NH.

[Elderly people and new technologies: friends or enemies?] / Les personnes âgées en Ehpad et les nouvelles technologies.

Faced with the ageing of the French population, it is essential to envisage new technologies to improve the living conditions of elderly people and enable them to communicate more effectively. A study sought to understand the views of senior citizens and the caregivers who look after them regarding these new tools, their appropriation, the support required and their uses. This analysis highlights areas to reflect upon and improve in terms of the services which need to be provided to overcome the reticence of certain users.

Exercise or Social Intervention for Nursing Home Residents with Dementia: A Pilot Randomized, Controlled Trial.

OBJECTIVES: To compare the effects of exercise with those of a structured nonphysical intervention on ability to perform activities of daily living (ADLs) and physical and cognitive function of persons with dementia (PWDs) living in nursing homes (NH). DESIGN: Cluster-randomized pilot-controlled trial. SETTING: Seven French NHs. PARTICIPANTS: PWDs living in NHs. MEASUREMENTS: NHs were randomized to an exercise group (4 NHs, n = 47) or structured social activity group (3 NHs, n = 50) for a 24-week intervention performed twice per week for 60 minutes per session. The main endpoint was ADL performance (Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory for Severe Alzheimer's Disease Scale (ADCS-ADL-sev); range 0-54, higher is better); secondary endpoints were overall cognitive function (Mini-Mental State Examination (MMSE)) and performance-based tests of physical function (Short Physical Performance Battery (SPPB), usual gait speed). RESULTS: Ninety-one participants with at least one postbaseline ADL assessment were included in efficacy analysis. Groups differed at baseline in terms of sex, neuropsychiatric symptoms, and nutritional status. Multilevel analysis adjusted for baseline differences between groups found no significant difference between effects of exercise and social activity (group-by-time interaction), with adjusted mean differences at 6 months of 1.9 points for ADCS-ADL-sev and 0.55 points for MMSE favoring social activity and 0.6 points for SPPB and 0.05 m/s favoring exercise. Adverse events did not differ between groups, except that the social activity group had more falls than the exercise group. CONCLUSION: A larger, longer trial is required to determine whether exercise has greater health benefits than nonphysical interventions for institutionalized PWDs.

Polypharmacy and potentially inappropriate medications: a cross-sectional analysis among 451 nursing homes in France.

PURPOSE: The quality of drug therapy is an important issue for nursing homes. This study aimed to assess the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a large sample of nursing home residents by using the data recorded during the preparation of pill dispensers. METHODS: This is a cross-sectional study that included 451 nursing homes across France. Information about the medications received by the 30,702 residents (73.8% women) living in these nursing homes was extracted from the system that assists in the preparation of pill dispensers in pharmacies. The anonymized database included age, sex, and medications prescribed to residents, as well as nursing home characteristics (capacity, legal status). Factors associated with excessive polypharmacy (≥10 different drugs) and PIMs according to the Laroche list were studied using multilevel regression models. RESULTS: The average number of drugs prescribed was 6.9 ± 3.3, and excessive polypharmacy concerned 21.1% of the residents (n = 6468). According to the Laroche list, 47.4% of residents (n = 14,547) received at least one PIM. Benzodiazepines (excessive doses, long-acting benzodiazepines, and combination of benzodiazepines) and anticholinergic medications (hydroxyzine, cyamemazine, alimemazine) accounted for a large part of PIMs. Individual characteristics (age, gender) influenced the risk of receiving PIMs whereas nursing home characteristics (capacity, legal status) influenced the risk of excessive polypharmacy. CONCLUSIONS: This study shows that polypharmacy and PIMs remain highly prevalent among nursing home residents. Main PIMs concerned psychotropic and anticholinergic medications.

Effects of a long-term exercise programme on functional ability in people with dementia living in nursing homes: Research protocol of the LEDEN study, a cluster randomised controlled trial.

BACKGROUND: Exercise may lead to improvements on functional ability, physical function, and neuropsychiatric symptoms (particularly depression) in people with dementia (PWD). However, high-quality randomised controlled trial (RCT), controlling for the socialisation aspect of group-based exercise interventions, and designed to delay the declines on the functional ability of PWD in the nursing home (NH) setting is almost inexistent. This article describes the protocol of the LEDEN study, an exercise RCT for PWD living in NHs. METHODS/DESIGN: LEDEN is a cluster-randomised controlled pilot trial composed of two research arms: exercise training (experimental group) and social/recreational activity (control group). Both interventions will be provided twice a week, for 60 min, during the 6-month intervention. The total duration of the study is 12 months, being six months of intervention plus six months of observational follow-up. Eight French NHs volunteered to participate in LEDEN; they have been randomised to either exercise intervention or social/recreational intervention in a 1:1 ratio. RESULTS: The primary objective is to investigate the effects of exercise, compared to a social/recreational intervention, on the ability of PWD living in NHs to perform activities of daily living (ADL). Secondary objectives are related with the cost-effectiveness of the interventions, and the effects of the interventions on patients' physical function, neuropsychiatric symptoms, pain, nutritional status, and the incidence of falls and fractures. DISCUSSION: LEDEN will provide the preliminary evidence needed to inform the development of larger and more complex interventions using exercise or non-exercise social interventions.