[Clostridioides difficile infections: Update and therapeutic guidelines]. / Infections à Clostridioides difficile : mise au point et repères thérapeutiques.

Clostridioides difficile infection (CDI) represents a significant challenge due to its increasing incidence, severity, and treatment difficulty. Effective management requires a multifactorial approach that includes preventive strategies, prudent antibiotic use, and adapted therapeutic options. Ongoing research and innovation offer promising prospects for improving ICD management, making vigilance and informed practices essential among healthcare professionals. Two main complications of ICD are pseudomembranous colitis (PMC) and toxic megacolon. PMC involves severe colonic inflammation due to C. difficile toxins, leading to pseudomembrane formation. Diagnosis relies on clinical criteria, microbiological tests, and endoscopy. Toxic Megacolon is characterized by severe colonic dilation and systemic toxicity, requiring immediate medical intervention. ICD diagnosis combines clinical signs and microbiological tests. These tests include toxin tests, GDH antigen detection, PCR for toxin genes, and stool culture. Imaging techniques assess colonic inflammation and complications. Combined diagnostic criteria from the American Gastroenterological Association (AGA) and European guidelines emphasize integrating clinical and laboratory findings for accurate diagnosis. ICD treatment involves stopping the implicated antibiotics and starting specific antimicrobial therapy. Common treatments include mainly fidaxomicin and oral vancomycin. Fecal microbiota transplantation (TMF) is recommended for recurrent cases unresponsive to standard treatments. Bezlotoxumab, an antibody targeting C. difficile toxin B, is used to prevent recurrence in high-risk adults. ICD poses a major challenge due to its increasing incidence, severity, and difficulty in treatment. A multifactorial approach involving rigorous preventive strategies, prudent antibiotic management, and adapted therapeutic options is essential for controlling the infection. Ongoing research and innovations in treatment offer promising prospects for improving patient management. Healthcare professionals must remain vigilant and informed to ensure effective practices in combating this infection and utilizing available resources optimally.

Preparedness of Nursing Homes: A Typology and Analysis of Responses to the COVID-19 Crisis in a French Network.

BACKGROUND: Preparing healthcare systems for emergencies is crucial to maintaining healthcare quality. Nursing homes (NHs) require tailored emergency plans. This article aims to develop a typology of French private NHs and study their early COVID-19 responses and mortality outcomes. METHODS: We conducted a cross-sectional survey among NHs of a French network consisting of 290 facilities during the first wave of the COVID-19 pandemic. A Hierarchical Clustering on Principal Components (HCPC) was conducted to develop the typology of the NHs. Association tests were used to analyze the relationships between the typology, prevention and control measures, COVID-19 mortality, and the satisfaction of hospitalization requests. RESULTS: The 290 NHs vary in size, services, and location characteristics. The HCPC identified three clusters: large urban NHs with low levels of primary care (Cluster 1), small rural NHs (Cluster 2), and medium urban NHs with high levels of primary care (Cluster 3). The COVID-19 outcomes and response measures differed by cluster, with Clusters 1 and 2 experiencing higher mortality rates. Nearly all the NHs implemented preventive measures, but the timing and extent varied. CONCLUSIONS: This typology could help in better preparing NHs for future health emergencies, allowing for targeted resource allocation and tailored adaptations. It underscores the importance of primary care territorial structuring in managing health crises.

Reliability of a 2D-Panoramic Ultrasound System for the Determination of Muscle Volume in Older Hospitalized Patients.

ABSTRACT: Reliability of muscle thickness assessed in B-mode ultrasound has been confirmed in adults but remains a less direct assessment of muscle mass than muscle volume (MV). The aim of this prospective monocentric study was to assess the interday reliability of MV determined by the 2D-panoramic ultrasound in older hospitalized patients.Ten participants hospitalized in geriatric ward (mean age = 84) underwent 2 sessions of panoramic ultrasound scanning 1 week apart for MV assessment and DXA for leg lean mass (LLM) assessment when it was possible. The interday reliability of MV assessed using the intraclass correlation coefficient (ICC) was excellent, whatever was the muscle analyzed: ICC = 0.99 for tibialis anterior; ICC = 0.99 for vastus lateralis; ICC = 1 for rectus femoris. The pilot analysis of its association with leg lean mass revealed a good association between the vastus lateralis MV and LLM, but this needs to be confirmed on a larger number of participants (Pearson correlation coefficient = 0.91, P = 0.03).The 2D-panoramic ultrasound system for the determination of MV was reliable in older hospitalized patients with measurements performed on the patient's bed. MV seemed to be more correlated to LLM than muscle thickness. Future research will need to reduce the data processing time maybe with automation of data measurement.

[Prevalence and factors related to frailty dwelling home elderly -subjects using a modified SEGA scale: a study in primary care]. / Prévalence et facteurs associés à la fragilité chez des sujets âgés vivant à domicile à l'aide de la grille SEGA modifiée : une étude en soins primaires.

The prevalence of frailty determines the proportion of the population that will experience intercurrent events and dependency. The aim was to assess the prevalence and factors associated with frailty using the modified SEGA grid. METHOD: This was a cross-sectional descriptive study. The primary endpoint was frailty, assessed using the modified SEGA grid. RESULTS: The prevalence of frail and very frail people was jointly estimated at 33%. In multivariate analysis, gender, lifestyle and marital status did not appear to be associated with frailty. However, the IAVL score was associated with frailty OR=0.21 (95% CI 0.06 to 0.68; p=0.009). EVS is also associated with frailty for mild pain OR= 12.12 (95% CI 2.49 to 59.08; p=0.007). CONCLUSION: Our results independently show the association between IAVL and frailty, with a one-unit increase in IAVL score being less associated with frailty.

[An attempt to deconstruct the French "syndrome de glissement"]. / Essai de déconstruction du syndrome de glissement.

The "syndrome de glissement" is a French term used to describe end-of-life situations where the elderly person becomes adynamic and any therapeutic intervention seems ineffective until the patient dies. It is close to failure to thrive. Although its use, which is widespread, seems appropriate to briefly describe a complex situation, it has the major disadvantage of leading to an absence of clinical and therapeutic approach, which represents a loss of chance for the patient. In clinical practice, we consider that what is referred to as a sliding syndrome is actually a situation of apathy associated with a deterioration in general condition. A diagnostic approach should therefore look for all organic pathologies that associate deterioration in general condition and apathy, and neuropsychiatric situations such as episodes of major depression that produce such symptoms. Once these diagnoses have been ruled out, the person should be considered for palliative care and benefit from the expertise that goes with this practice. Any elderly person in a situation resembling what is known as a syndrome de glissement should therefore benefit from a rigorous clinical approach, and not be considered beyond any therapeutic resources. It is a matter of dignity and quality of care.

[Sociological and geographical markers in favour of a distance and potential availability score for the children of the very elderly]. / Jalons sociologiques et géographiques en faveur d'un score de distance et de disponibilité potentielle des enfants de personnes très âgées.

Old age is a time of emotional, social and physiological challenges. The role of the family remains essential in coping with these challenges. This is particularly true of non-cohabiting children, who in 2020 accounted for just under half of all those helping elderly people with loss of autonomy and/or pathologies. Following on from sociological research on close caregivers, this article first looks at the level and influence of children's relationships and assistance towards their elderly parents, and then proposes the construction of a territorial indicator - in this case, a score - to measure the spatial proximity and potential availability of children. Subject to further development, this indicator represents a first milestone in the territorial understanding of children's relationships with and help for their elderly parents.

[Faisabilité de l'exploration des fonctions exécutives des résidents d'établissement d'hébergement pour personnes âgées]. / Feasibility of exploring executive functions in long-term care residents, the Screening Executive Tests for Elderly.

Impairment of cognitive functions is the primary reason for admission to long-term care units, with executive functions playing a pivotal role in dependency and behavioral issues. These functions pose significant challenges to nursing staff in providing care. However, the assessment of executive functions in elderly individuals residing in nursing homes often relies on tests that are both time-consuming and difficult for this demographic. In many instances, executive functions are either not assessed or only examined in broad terms. OBJECTIVE: The objective of this study was to analyze the feasibility of assessing executive functions in elderly nursing home residents, specifically aiming to distinguish sub-components such as mental flexibility, working memory, planning, and inhibition. The residents included in the study underwent executive function assessments over three visits, using various tests for each sub-component. METHODS: Out of 530 residents, 46 gave their consent and 38 completed the three visits, with an average age of 90±5 years (76.2% women) and a median MMSE score of 20/30. Feasibility was evaluated based on the test being executed and the frequency of interruptions due to difficulty or fatigue on the part of the resident. RESULTS: Only four tests proved suitable for elderly individuals in nursing homes, and we propose grouping them into a battery named SETE (Screening Executive Tests for Elderly): the conflicting instructions from the FAB, the alpha test, the clock test, and the verbal span test. CONCLUSION: The use of these four tests would enable the construction of a map delineating executive function impairment by sub-component. Enhanced knowledge of executive functions in long-term care residents will facilitate better adapted dependency management and the implementation of non-pharmacological interventions for behavioral disorders.

Fragility and quality of life, the benefits of physical activity for the elderly / Fragilité et qualité de vie, les apports de l'activité physique chez la personne âgée

Frailty and quality of life are concepts that emerged in the second half of the 20th century. Frailty can be defined as a clinical syndrome of decreased physiological reserves and resistance against stressful events conferring high risk for adverse health outcomes, including loss of independence, falls, hospitalization, institutionalization and mortality. However, it is considered that frailty can potentially be prevented or treated with specific modalities. Quality of life has various definitions because of its subjective nature. The World Health Organisation defined quality of life as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns". The aim of this study is to review information regarding the potential association between frailty and quality of life in the elderly, and the effects of physical activity among different parameters of these phenomena. There are few studies that investigate links between frailty, quality of life and physical activity. However, results tend to show that physical aspects of frailty syndrome are inversely proportional to the quality of life in several of its dimensions. Furthermore, community-based exercise programs involving the elderly seem to improve the quality of life. Considering that physical activity can potentially have an impact on the quality of life among frail elderly and promote healthy aging, further research will be necessary to corroborate these results.

La fragilité et la qualité de vie sont des concepts qui font leur apparition dans la deuxième moitié du XXe siècle. La fragilité se situe entre le vieillissement usuel et pathologique. Il reflète une diminution de la faculté de l'organisme à résister à un stress, favorisant la survenue d'évènements péjoratifs de santé. Il s'agit d'un syndrome clinique multifactoriel potentiellement réversible via des actions de prévention. La qualité de vie est un concept très large et multifactoriel correspondant à la perception qu'un individu a de sa place dans la vie. Ce travail a pour double objectif d'étudier l'existence d'un lien potentiel entre fragilité et qualité de vie, et d'évaluer les bénéfices de la pratique d'une activité physique sur ces phénomènes. Les recherches dans ce domaine tendent à montrer que la présence d'une fragilité chez la personne âgée induit une altération des différents domaines de la qualité de vie, notamment en termes d'état de santé perçu. Les résultats d'études interventionnelles incluant des programmes d'activité physique indiquent un bénéfice à la fois sur les paramètres physiques de la fragilité, mais également sur la qualité de vie. Toutefois, le niveau de preuve reste faible et de futures recherches seront nécessaires.

[Anti-fall plan for the elderly in France 2022-2024: objectives and methodology]. / Plan antichute des personnes âgées France 2022-2024 : objectifs et méthodologie1.

BACKGROUND: Falls and fall-related injuries are a major public health problem in industrialized countries. Faced with this challenge, a French national plan was launched in 2022 aiming to reduce by 20% the incidence of falls-related hospitalizations or deaths. OBJECTIVES: To describe the main pillars of the 2022-2024 French national plan against falls in older persons. Methods and assessment: The six pillars of the plan are: 1) screening and monitoring risks of falls and alert health and care workers; 2) home safety assessment and getting out safely; 3) developing technical aids for mobility and the use of assistive technologies at home; 4) appropriate physical activity, best weapon against falls; 5) tele-assistance devices for all older persons; 6) a cross-cutting pillar: Informing, raising awareness, training, and involving local actors. The plan, deployed in the 18 French regions, will provide a unique opportunity to determine the best strategies to achieve the objectives and the barriers encountered. CONCLUSIONS: The deployment of the French national plan will bring useful data for considering a long-term strategy in France and helping countries or regions wishing to implement a fall prevention plan on their territory.

[Knowledge and application of the HAS recommendations concerning the diagnosis of undernutrition in people aged 70 and above: an international online survey among members of the "Société Française de Gériatrie et de Gérontologie"]. / Connaissances et application des recommandations HAS concernant le diagnostic de la dénutrition chez la personne de 70 ans et plus : une enquête menée en ligne auprès des membres de la Société française de gériatrie et de gérontologie.

OBJECTIVES: To assess the knowledge and the use in clinical practice of the "French National Authority for Health" (HAS) 2021 recommendations on the diagnosis of malnutrition in older adults aged 70 years and above. METHODS: An online survey was developed by the working Group on Geriatrics and Nutrition (GEGN) of the "Société Française de Gériatrie et de Gérontologie (SFGG)" and conducted among members of the SFGG. A self-administered questionnaire composed of 21 closed questions was used. RESULTS: A total of 132 (10.2 %) members of the SFGG responded to the survey. The respondents were aged 43.4 ± 9.94 years old and 97 (73.5 %) were women. Almost half of them were medical doctors (n = 53 ; 40.2 %). Of the respondents, 81 % had already heard of the HAS 2021 recommendations. This percentage is higher for doctors (96 %) than for other professions (74 %). French respondents were more likely to have heard of these -recommendations (84 %) than respondents from other countries (42.9 %). However, only 41.6 % of the respondents believe they know these recommendations in detail. On a visual analogue scale from 0 (never) to 100 (always), respondents use these recommendations in their professional practice at 76.8 ± 20.2 %. However, on a scale from 0 (never difficult) to 100 (always difficult), some barriers to their use in clinical practice were highlighted. These mainly concerned the measurement of muscle mass (84.4 ± 17.2 %) and muscle strength (79.5 ± 19.9 %) in patients. CONCLUSION: Although the majority of respondents use the HAS 2021 recommendations in their professional practice, they often have difficulties in measuring muscle strength and muscle mass of their patients. The assessment of sarcopenia still needs to be implemented in clinical routine. Until then, better communication about simple alternatives that do not require special equipment is needed.

[Driving: What is the relevance and usability of the Reisberg scale in 2023?] / Conduite automobile : Quelle est la pertinence et l'utilité de l'échelle de Reisberg en 2023 ?

The publication of the decree on the care of people with neurocognitive disorders brought to the fore the Reisberg's Global Deterioration Scale, a scale that only few clinicians use in memory centers or in geriatric. This scale has a number of limitations, not least of which is that it is obsolete, since it does not take into account disease advances in scientific knowledge with biomarkers. Consequently, the stages evoked no longer correspond to current descriptions. Moreover, it only concerns Alzheimer's disease, whereas in our practice we encounter other neurodegenerative pathologies. Even if we decide to use another global assessment scale, such as the Clinical Dementia Rating or the Functional Assessment Staging, they cannot replace a personalized assessment. Indeed, it is important to stress that this decree does not take into account the relevance of personalized assessments using, for example, neuropsychological tests to estimate driving ability. A personalized assessment accompanied by a real-life driving test would be preferable than a score on a global scale. This article therefore presents the Global Deterioration Scale, highlighting its unsuitability for assessing whether or not to continue driving.

[Support and guidance in driving for patients with (or suspected of having) Alzheimer's disease or related diseases: position paper]. / Recommandations pour l'accompagnement et l'orientation pour la conduite des patients atteints (ou suspectés) d'une maladie d'Alzheimer ou de maladies apparentées : consensus des sociétés savantes françaises.

New ministerial decree restricts driving motorized vehicles for patients with Alzheimer's disease and related disorders. Reisberg stage 3, threshold used to contraindicate driving, appears to correspond to a mild stage of major neurocognitive impairment. A single scale gives an idea of the level of risk but does not provide a holistic assessment. The aim of this consensus is to put forward recommendations from several French learned societies for individualized cognitive assessments to minimize the risks associated with driving and its cessation. Fitness to drive should be raised at the earliest stages of the diagnostic process, and regularly throughout the follow-up. Consult a registered doctor is recommended to all patients wishing to continue driving. All documents must be given to the patient only. An alternative must always be offered to patients who are recommended a modal shift.

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.

[Synthesis in French of the 2022 global recommendations for the management and prevention of falls in the elderly]. / Synthèse en langue française des recommandations mondiales 2022 pour la prise en charge et la prévention des chutes chez les personnes âgées.

BACKGROUND: Falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. OBJECTIVE: To synthesize evidence-based and expert consensus-based 2022 world guidelines for the management and prevention of falls in older adults. These recommendations consider a person-centred approach that includes the preferences of the patient, caregivers and other stakeholders, gaps in previous guidelines, recent developments in e-health and both local context and resources. RECOMMENDATIONS: All older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for communitydwelling older adults. An algorithm is proposed to stratify falls risk and interventions for persons at low, moderate or high risk. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. CONCLUSIONS: The core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

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.