[Characteristics of nursing home residents in the Marne department]. / Caractéristiques des résidents en Ehpad dans le département de la Marne.

A study was carried out in the Marne department with the aim of describing the comorbidities and the treatments of a representative sample of the population living in nursing homes. It reveals the most frequent pathologies and the most commonly prescribed classes of therapies thereby aiding the assessment of the care costs of elderly people and the anticipation of their needs.

[Analysis of the quality of care provided to diabetic patients]. / Analyse de la qualitéde la prise en charge médicale des patients diabétiques.

OBJECTIVE: The follow-up of diabetic patients in the northeast region of France was examined using the method recommended by the French High Health Authority. METHODS: Health insurance databases were used to analyze patient monitoring between 2006 and 2008, highlighting those doctors who were not providing adequate care according to good practice guidelines. A system based on academic detailing was recently set up between these doctors and the medical consultants working for the Health Insurance Service. Patient follow-up was also examined between 2008 and 2010 to assess the impact of academic detailing on care consumption. RESULTS: Regardless of the type of recommended examination, the number of patients who were examined at least once a year by a doctor involved in an academic detailing process significantly increased. By contrast, the follow-up of patients whose doctor was not involved in academic detailing remained unchanged. In some cases, the quality of follow-up care was poor. Other explanatory factors were also highlighted, including the type of treatment received by the patient, the fact of having a long-term illness and the area of residence of the patient. CONCLUSION: The impact of academic detailing highlighted in this study remains hypothetical because of the regression to the mean phenomenon. Further studies are needed to verify this hypothesis. Since the effectiveness of regular screening for diabetes complications is well established, medical consultants at the Health Insurance Service may be said to play a critical role.

Potentially inappropriate use of psychotropic medications in hospitalized elderly patients in France: cross-sectional analysis of the prospective, multicentre SAFEs cohort.

BACKGROUND: In France, there is evidence to suggest that 50% of elderly individuals are prescribed psychotropic medications. However, it is known that use of these agents increases the risk of falls, fractures and delirium in older people. OBJECTIVE: To study the consumption of 'potentially inappropriate medication' (PIM) among patients aged>or=75 years, paying particular attention to psychotropic drugs and the factors influencing the use of 'potentially inappropriate psychotropics' (PIPs). METHOD: This was a cross-sectional analysis of a prospective multicentre cohort of 1306 hospitalized French patients aged>or=75 years (the SAFEs [Sujet Agé Fragile: Evaluation et suivi (Frail Elderly Subjects: Evaluation and follow-up)] cohort). The present analysis involved the 1176 patients for whom there was information on the usual treatments being taken in the 2 weeks before hospitalization. The drugs were coded according to the Anatomical Therapeutic Chemical classification; the Beers list as updated in 2003 defined which medications were considered PIPs. Standardized geriatric assessment variables were recorded on inclusion in the study. Logistic regression analysis was performed to identify factors linked to use of psychotropics and PIPs. RESULTS: The mean number of drugs taken was 5.7+/-2.9 per patient. Twenty-eight percent of patients took at least one PIM. The number of patients who had taken at least one psychotropic drug in the 2 weeks before hospitalization (mean 1.6+/-0.9 psychotropics per patient) was 589 (50.1%). More than half of both the 510 patients with a depressive syndrome and the 543 patients affected by dementia were treated with psychotropics. Multivariate analysis showed that prescription of psychotropics was linked to the presence of a dementia syndrome (odds ratio [OR]=1.4; 95% CI 1.1, 1.9; p=0.03), the presence of a depressive syndrome (OR=1.7; 95% CI 1.3, 2.1; p<0.001), living in an institution (OR=2.2; 95% CI 1.5, 3.4; p<0.001), use of more than five drugs (OR=3.2; 95% CI 2.5, 4.2; p<0.001) and Charlson's co-morbidity score>1 (OR=0.6; 95% CI 0.5, 0.8; p=0.001). Nineteen percent of all psychotropics prescribed were PIPs. Of these PIPs, 66.5% were anxiolytics, 28.4% were antidepressants and 5.1% were antipsychotics. Use of PIPs in the multivariate analysis was associated only with consumption of more than five drugs (OR=1.7; 95% CI 1.1, 2.5; p=0.01). CONCLUSION: PIM use is common among hospitalized older adults in France. The most important determinant of risk of receiving a psychotropic medication or a PIP was the number of drugs being taken. The elderly, who have multiple co-morbidities, complex chronic conditions and are usually receiving polypharmacy, are at increased risk for adverse drug events. These adverse events are often linked to problems that could be preventable such as delirium, depression and falls. Regular review of prescriptions would help optimize prescription of psychotropics in the elderly. The Beers list is a good tool for evaluating PIMs but is too restrictive with respect to psychotropics; in the latter respect, the list could usefully be widened.

Factors related to use of potentially inappropriate psychotropic drugs in 2,343 residents of 19 nursing homes.

To identify factors that influence use of potentially inappropriate psychotropic drugs among elderly residents living in nursing homes (NH). Cross-sectional, multicentre study among 65+ years NH residents, based on queries performed on the PATHOS database and on prescription information from residents' medical data. Medications were coded using the Anatomical Therapeutical Chemical classification. Psychotropic agents were classed using Delay and Deniker's classification, and the Beers Criteria (Beers list 2015 update) were used to identify potentially inappropriate psychotropic drugs (PIPs). Logistic regression was performed to identify factors related to use of potentially inappropriate psychotropic drugs, and factors related to PIPs. The average number of drugs per subject (n=2,343) was 7.8±3.5. In total, 1,709 (71.6%) subjects were taking psychotropic drugs (1.8±0.9 psychotropic drugs per user). Psychotropic agents represented 17.4% of the 18,143 drugs used by the whole study population. The frequency of PIPs was 44.1%. By multivariable analysis, the use of psychotropic drug was significantly associated with behavioural disorders (OR 3.21, 95%CI [2.46-4.18]); depression (OR 8.79, 95%CI [6.64-11.6]); anxiety (OR 3.43, 95%CI [2.45-4.8]); psychosis (OR 2.05, 95%CI [1.28-3.30]), use of >4 drugs (OR 4.85, 95%CI [3.60-6.53]); and dehydration (OR 0.49, 95%CI [0.32-0.75]). PIPs was significantly associated to behavioural disorders (odds ratio (OR) 1.56, 95% confidence interval (CI) [1.89-1.29]); depression (OR 2.90, 95%CI [3.60-2.3]); anxiety (OR 1.68, 95%CI [2.32-1.22]); dementia (OR 2.43, 95%CI [2.96-1.99]); use of >4 drugs (OR 3.41, 95%CI [4.90-2.37]); dehydration (OR 0.53, 95%CI [0.76-0.37]), arthritis/arthrosis of the hip (OR 1.48, 95%CI [2.04-1.07]) and arthritis/arthrosis of the shoulder (OR 2.06, 95%CI [3.43-1.23]). Regular review of prescriptions and emphasis on non-drug therapy of behavioural disorders in elderly subjects can help to reduce the rate of prescription of psychotropic drugs and PIPs in NH residents.