[Collaborative work between coordinating physicians, geriatric EMGE physicians and emergency physicians]. / Un travail collaboratif entre médecins coordonnateurs, médecins gériatres des EMGE et médecins urgentistes.

The medical summary section (VSM) was formalized in 2011 with its content defined in 2013. In residential facilities for dependent elderly people (Ehpad), the VSM is almost non-existent and is requested by the majority of doctors who have to take medical care of a resident, often in an emergency situation. Following the health crisis and under the aegis of the regional and national associations of coordinating physicians, a working group was set up in 2021 to create a unique VSM that meets the needs of the field. This document was created and tested with very favorable feedback from users. This VSM is currently being deployed in the Ehpad of the Île-de-France region.

Home care aides' observations and machine learning algorithms for the prediction of visits to emergency departments by older community-dwelling individuals receiving home care assistance: A proof of concept study.

BACKGROUND: Older individuals receiving home assistance are at high risk for emergency visits and unplanned hospitalization. Anticipating their health difficulties could prevent these events. This study investigated the effectiveness of an at-home monitoring method using social workers' observations to predict risk for 7- and 14-day emergency department (ED) visits. METHODS: This was a prospective cohort study of persons ≥75 years, living at home and receiving assistance from home care aides (HCA) at 6 French facilities. After each home visit, HCAs reported on participants' functional status using a smartphone application that recorded 27 functional items about each participant (e.g., ability to stand, move, eat, mood, loneliness). We recorded ED visits. Finally, we used machine learning techniques (i.e., leveraging random forest predictors) to develop a 7- and 14-day predictive algorithm for the risk of ED visit. RESULTS: The study included 301 participants, and the HCA made 9,987 observations. Over the mean 10-month follow-up, 97 participants (32%) had at least one ED visit. Modeling techniques identified 9 contributory factors from the longitudinal records of the HCA and developed a predictive algorithm for the risk of ED visit. The predictive performance (i.e., the area under the ROC curve) was 0.70 at 7 days and 0.67 at 14 days. INTERPRETATION: For frail elders receiving in-home care, information on functional status collected by HCA helps predict the risk of ED visits 7 to 14 days in advance. A survey system for real-time identification of risks could be developed using this exploratory work.

[Managing infarctions in elderly people]. / Prise en charge de l'infarctus chez la personne âgée.

Coronary disease is frequent and serious after the age of 80. The management of the elderly person's care depends on whether or not there is associated multiple pathology. After a global geriatric assessment, revascularisation techniques can also be used in this context. Caution must however be taken when introducing a pharmacological treatment.

Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial.

OBJECTIVES: To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents. DESIGN: Pair-matched cluster-randomized trial. SETTING: Forty nursing homes matched for size, staff vaccination coverage during the previous season, and resident disability index. PARTICIPANTS: All persons aged 60 and older residing in the nursing homes. INTERVENTION: Influenza vaccine was administered to volunteer staff after a face-to-face interview. No intervention took place in control nursing homes. MEASUREMENTS: The primary endpoint was total mortality rate in residents from 2 weeks before to 2 weeks after the influenza epidemic in the community. Secondary endpoints were rates of hospitalization and influenza-like illness (ILI) in residents and sick leave from work in staff. RESULTS: Staff influenza vaccination rates were 69.9% in the vaccination arm versus 31.8% in the control arm. Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm (odds ratio=0.86, P=.08), although multivariate-adjusted analysis showed 20% lower mortality (P=.02), and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents (correlation coefficient=-0.42, P=.007). In the vaccination arm, significantly lower resident hospitalization rates were not observed, but ILI in residents was 31% lower (P=.007), and sick leave from work in staff was 42% lower (P=.03). CONCLUSION: These results support influenza vaccination of staff caring for institutionalized elderly people.

[Pressure sores in a university hospital]. / Escarres dans un hôpital universitaire de court séjour.

OBJECTIVES: To determine the prevalence of pressure sores, their risk factors, and the responsible microbial agents in an acute-care hospital and to evaluate their management. METHOD: A prevalence survey was conducted from 5 July through 9 July 2004. Investigators completed a standardized questionnaire for each hospitalized patient, including demographic data (age, sex, previous hospitalizations, etc.) and Braden scale risk factors (sensory perception, humidity, activity, mobility, nutrition, and friction and shear). Two experts in skin care detected pressure sores by physical examination of the patients. Each pressure sore was swabbed and inoculated on selective media. Management was evaluated by reviewing the clinical charts of each patient with a pressure sore. RESULTS: The study included 535 adult patients (aged 59 +/- 19 years): 75 ulcer sores were observed in 37 patients (prevalence=6.9%). Stage I sores accounted for 24% of the total, stage II for 29%, stage III 31%, and stage IV 16%. The most frequent site was the heel (41%), followed by the sacrum (20%), elbow (11%), back (7%) and ischial tuberosities (7%). Sixty (80%) were acquired while hospitalized. Age-adjusted multivariate analyses found that the risk factors significantly associated with pressure sores were Braden score< or =15 (OR=5.9, 95% CI: 2.4-13.7, p<0.0001) and previous pressure sores (OR=5.0 95% CI: 2.2-11.6, p<0.0001). Eleven sores (24.5%), mostly stage III and IV, were colonized by multiple-drug-resistant bacteria (i.e., methicillin resistant Staphylococcus aureus, extended spectrum beta-lactamase Enterobacteriaceae). Seven (9.3%) of the 75 ulcers were diagnosed only during the survey, by the experts; of the 68 diagnosed before the survey, 57 (83.8%) had been under treatment. Treatment was considered inappropriate according to French guidelines in 31.6% of the cases. CONCLUSION: This prospective prevalence study resulted in better awareness of the patients at risk for pressure sores. It also made the recently created mobile geriatrics unit better known within the hospital.

Prognosis of patients aged 80 years and over admitted in medical intensive care unit.

OBJECTIVE: To determine the prognostic indicators of long-term survival after admission to a medical intensive care unit (MICU) for patients aged 80 years and over. DESIGN. Prospective cohort study. SETTING: A 14-bed MICU in a 970-bed, acute care, tertiary, university hospital in Paris, France. PATIENTS: A total of 233 patients aged 80 years and over discharged from a MICU during a 2-year period. MEASUREMENTS AND MAIN RESULTS: Severity at admission was estimated using the Simplified Acute Physiology Score. The underlying condition was classified using the MacCabe classification. The functional status was assessed using the Knaus classification. The outcome after MICU discharge was determined after a median 2-year follow-up. The functional outcome was assessed by telephone interviews, employing the Instrumental Activities of Daily Living (IADL). The in-MICU mortality was 19.5% including death occurring during the 2 days following discharge. The long-term survival rates for patients admitted to the MICU were 59% at 2 months, 33% at 2 years, and 29% at 3 years. The multivariate analysis identified two prognostic factors of death after discharge: presence of an underlying fatal disease (HR 1.7; 95% CI 1.1-2.6) and severe functional limitation (HR 1.7; 95% CI 1.2-2.6). The IADL was excellent or good for 56% of the surviving patients. CONCLUSION: Long-term survival after MICU is mainly related to the underlying condition, whereas known factors for in-MICU survival do not influence long-term prognosis.