[Screening risk and protective factors of nursing home admission]. / Repérage des facteurs influençant le risque d'admission en établissement médico-social.

Many aged adults want to stay as long as possible in their own homes. Hence, it is important to identify factors that can predict nursing home admission, in order to prevent this admission and maintain people at home. Several studies have investigated the risk factors of nursing home admission but syntheses are still rare. The present study aimed to identify risk and protective factors for nursing home admission for aged adults. A literature review was conducted using the PubMed search engine. Of 177 relevant reports, 27 were analyzed. We have included studies, literature reviews and meta-analyses that have highlights 59 potential factors. Falls, especially when fall causes serious injuries, cognitive impairment, activities daily living dependencies and stroke were identified as the highest risk factors. In contrast, living with spouse, having adult children, receiving a home care program based on case management or being homeowner were identified as protectives factors. This knowledge of risk and protective factors can help our prevention strategies to delay or find alternatives to nursing home admission.

[Six-months outcomes after admission in acute geriatric care unit secondary to a fall]. / Devenir à 6 mois après une hospitalisation en court séjour gériatrique à la suite d'une chute.

UNLABELLED: Fall in elderly subject is a main event by its medical and social consequences, but few studies were dedicated to the prognosis from hospitalization in geriatric acute care unit. AIM: Describe the outcome of elderly subjects hospitalized after a fall in geriatric acute care unit. METHODS: Longitudinal study of 6 months follow-up, 100 patients of 75 and more years old hospitalized after a fall in acute care geriatric unit. RESULTS: On a total of 128 patients hospitalized for fall, 100 agreed to participate in the study, 3 died during the hospitalization, so 97 subjects were able to be followed. During 6 months after the hospitalization, 14 patients died (14.9%), 51 (58%) have fallen again (58%) and 11 (22%) of them suffer from severe injuries. Thirty seven (39.7%) were rehospitalized and 10 of them related to fall. Among the patients coming from their home, 25 had been institutionalized. The main risk factor which have been identified to be associated with a new fall during the follow-up was a known dementia at the entry. CONCLUSION: The medical and social prognosis of an elderly subject hospitalized in an acute care unit is severe. The main comorbidity which influences the medical and social outcome is a known dementia, in addition to a history of previous fall.

[Analysis of iatrogenic risk related to anticholinergic effects using two scales in acute geriatric inpatient unit]. / Analyse du risque iatrogénique lié aux effets anticholinergiques à l'aide de 2 échelles en court séjour gériatrique.

UNLABELLED: Anticholinergic medications are responsible for most frequent adverse drug effects. Two scales have been elaborated as tools for prescribers: the Anticholinergic Drug Scale (ADS) of Carnahan et al., and the Anticholinergic Risk Scale (ARS) of Rudolph et al. The objective of this study was to analyze the diagnostic performance of both scales for predicting signs related to an anticholinergic effect. METHOD: Medical records of 1379 patients aged 75 years or older hospitalized in a geriatric acute care unit between 2002 and 2005 were studied. The analyze was made retrospectively, but data were collected prospectively. RESULTS: Risk of appearance of total anticholinergic signs (ADS : OR 1,45, CI 95% [1,03-2,03], p=0,037 and ARS : OR 1,98, CI 95% [1,19-3,28] p<0,01) and peripheral signs (ADS: OR 1,66, CI 95% [1,22-2,26], p<0,01 and ARS : OR 1,81, CI 95% [1,19-2,75], p<0,01) increased when score was ≥ 3 with both scales, which wasn't the case for central signs. CONCLUSION: Both scales permitted to detect an increased risk of appearance of total and peripheral anticholinergic signs, but not the centrals as delirium. Interest of total anticholinergic burden remains to be demonstrated, especially for delirium risk assessment.

[Modalities of hospitalization in emergency of institutionalized patients]. / Modalités d'hospitalisations en urgence des sujets âgés hébergés en établissements pour personnes âgées dépendantes.

BACKGROUND AND AIM: Institutionalized people represent 9 to 37% of the patients hospitalized in emergency. The aim of this study is to clarify practical conditions of decision and realization of an hospitalization in emergency from an institution. PATIENTS AND METHOD: This is a prospective and descriptive longitudinal study of the hospitalizations in emergency of institutionalized elderly during six months, from 11 nursing homes. RESULTS: The patients hospitalized in emergency are old (86.7 ± 7.3 years), more than 80% are women, widows and dependent (GIR 3). Main reasons for hospitalization in emergency are falls in a third of cases and cardio-pulmonary failure (27%). The alert is given by nurses and auxiliary nurses in 60% of cases. The decision of hospitalization is medical in more than 80% of cases. The medical opinion is only on phone in 24.4% of cases. After hospitalizations, 85% of patients came back straight to their institution and 10% died during their stay at the hospital. CONCLUSION: The terms of hospitalization in emergency of institutionalized patients must be improved. Nursing homes are an integral part of the geriatric network.

Withholding or withdrawing dialysis in the elderly: the perspective of a western region of France.

BACKGROUND: In the US and Canada, dialysis discontinuation is one of the more frequent causes of death in elderly patients on haemodialysis, particularly after the age of 75. The aim of this study was to analyse the practices of some French nephrologists, 17 of whom (in six nephrology units) were interviewed for this study. METHODS: A questionnaire was formulated on the basis of a bibliographical search of the topic. A series of questions, initially open and then more targeted, regarding scientific and non-scientific factors influencing the decision to discontinue or refuse haemodialysis in elderly patients, were put to nephrologists. RESULTS: Psychological and physical deterioration emerged as the principal factors governing decisions to refuse or discontinue treatment. The interviewees felt that severe dementia (15 out of 17 nephrologists), irreversible neurological sequelae of a CVA (11 out of 17) and, paradoxically, patient refusal (10 out of 17) were factors to be taken into account in the decision to discontinue haemodialysis. Although the main reasons for refusing dialysis were cognitive disorders, severe dementia and irreversible neurological conditions, none of these factors where actually found to be in and of themselves decisive. CONCLUSIONS: This study has shown that refusing or discontinuing dialysis are practices accepted by the vast majority of nephrologists in one region of France. Patient refusal is not a basis for denial or discontinuation of dialysis in elderly patients. Our investigation has demonstrated a consensus regarding decisions to refuse or discontinue dialysis.