RESUMO
INTRODUCTION: Depression symptoms, frequently diagnosed in older patients with cancer, impacts on oncological treatment feasibility. The Francophone Society of Geriatric Oncology (SOFOG) has initiated a systematic review on depression treatment in older patients with cancer, to advocate guidelines. DATA SOURCES: Medline via PubMed, Embase, CENTRAL. METHODS: We included randomized and non-randomized controlled trials, reviews and meta-analysis, retrospective and prospective cohort studies, qualitative studies, and guidelines published between January 2013 and December 2018 that involved depression with cancer in which the entire sample or a sub-group aged 65 and above. Efficacy and tolerance of depression treatment were examined, as a primary or secondary outcome, among articles published in French or English. RESULTS: Of 3171 references, only seven studies met our eligibility criteria. This systematic review reveals a lack of evidence-based knowledge in this field, preventing from making any recommendations on drug and non-drug therapies. It has highlighted the need for multidisciplinary collaboration with the French and Francophone Society of Psycho-Oncology. CONCLUSION: In clinical practice, we advise health professionals to use the screening process not as a result but rather as an opportunity to engage with the patient and also to question the need for antidepressants and non-drug therapies.
Assuntos
Depressão/etiologia , Depressão/terapia , Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/terapia , Neoplasias/psicologia , Fatores Etários , Idoso , Antidepressivos/uso terapêutico , Depressão/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Humanos , Metanálise como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos RetrospectivosRESUMO
The Alzheimer's plans have led to significant progress in the care management of elderly people suffering from Alzheimer's disease or other forms of dementia, but the medical and social network remains fragmented in geriatrics. We have proposed to caregivers a monthly videoconference combining expert presentations and discussion of clinical cases. Several health professions were represented. The main positive point was the time saved. The videoconferencing improved multidisciplinary exchanges, especially for patients with complex problems and their families.
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Doença de Alzheimer , Geriatria , Idoso , Cuidadores , Psiquiatria Geriátrica , Humanos , Comunicação por VideoconferênciaRESUMO
OBJECTIVES: The growing number of elderly people is challenging the reorganization of European health care systems. In France, there is an overlap between geriatric and psychiatric care of the elderly. This study was designed to describe the features of these patients, managed in both geriatric and geriatric psychiatry inpatient units. METHODS: We used The Programme Médicalisé de Système d'Information for the period 2009-2014. We focused on psychiatric disorders and dementia. RESULTS: 11.17% and 25% of patients have psychiatric disorders without dementia in geriatric and geriatric psychiatry units, respectively. Depression is the main mental illness. Their characteristics do not differ from those observed in other patients, apart from age. CONCLUSION: A part of the elderly psychiatric population is managed in the geriatric care system. Our results underline the importance of more integrated care between geriatric and psychiatry to prevent exclusion of patients from the health care system. Depression in elderly without dementia could justify the creation of specific inpatient units.
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Demência/epidemiologia , Hospitalização , Transtornos Mentais/epidemiologia , Idoso , Idoso de 80 Anos ou mais , França/epidemiologia , Hospitais Especializados , HumanosRESUMO
OBJECTIVE: To examine the diagnostic ability of the Lawton Instrumental Activities Daily Living (IADLs) scale and the Activities Daily Living (ADLs) scale as a sensitive tool to Alzheimer's disease (AD) in community-dwelling elderly people. DESIGN: In an old age memory outpatient center, among patients with a clinical diagnosis of AD dementia or no dementia supported by at least 6 months of follow-up, we looked back at the baseline Lawton IADL scale (short version IADL-4 item), ADL scale, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MOCA) values. RESULTS: There were 109 patients with AD and 53 nondemented individuals (81.4 ± 4.6 years). The sensitivity of ADL scale or IADL-4 item or the MMSE was low (52%-57%). The most efficient AD classification used both the IADLs-4 item and the MOCA with a threshold score of 20. Besides age and memory scores, the main correlates of IADLs scale or ADLs scale were executive, neuropsychiatric, vascular, and extrapyramidal scores. CONCLUSION: Our results suggest that the Lawton IADLs-4 item scale and ADLs scale lack sensitivity to AD dementia in elderly people and support a better sensitivity of MOCA rather than MMSE and IADLs-4 item/ADLs at the expense of specificity.
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Doença de Alzheimer/diagnóstico , Demência/diagnóstico , Inquéritos e Questionários/normas , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/psicologia , Demência/psicologia , Feminino , Seguimentos , Humanos , Masculino , Memória , Testes Neuropsicológicos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Midazolam is a short-acting benzodiazepine approved for sedation and anesthesia induction. Recent data suggested that midazolam may also be used in off-label indications such as treatment of behavioral and psychological disturbances in older people. Given the scarcity of published data and a lack of evidence in older people in such indications, midazolam raises concern because it may also cause serious-related adverse events. To provide a better understanding of its real-life use in geriatrics, we examined the prescribing practices of midazolam in French older inpatients. Of the 460 patients aged 65 years and over hospitalized at the time of the study, 21 had a prescription of midazolam (5%) which was mainly prescribed for anxiolysis (n = 12), premedication before painful procedures (n = 5), and agitation (n = 4). Midazolam was often prescribed "as required," and the median duration of prescription was 6 months. This work results in a better knowledge and information about the use of midazolam in older people. These prescribing practices, which are not anecdotal, also plead for age-specific guidelines for the treatment of behavioral and psychological disturbances.
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Analgésicos/uso terapêutico , Ansiolíticos/uso terapêutico , Geriatria , Pacientes Internados , Midazolam/uso terapêutico , Uso Off-Label , Idoso , Idoso de 80 Anos ou mais , Analgésicos/efeitos adversos , Anestésicos/uso terapêutico , Ansiolíticos/efeitos adversos , Prescrições de Medicamentos , Uso de Medicamentos , Feminino , França , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Midazolam/efeitos adversos , Padrões de Prática MédicaRESUMO
ABSTRACTWe aimed to understand clinical decision-making processes that influence the orientation of older patients after hospital discharge. We compared discharge decisions (i.e., discharge home, or nursing home stay) of the hospital team with those of an expert panel. Both panel and hospital team made their decisions independently. The blind study included 102 patients (mean age: 83.13 ± 6.74). There is a statistically significant difference between expert and hospital team decisions (p < .001; kappa coefficient: 0.468). Panel decisions were more closely associated with isolation (p = .018), reliable caregivers (p = .004), social problems (p = .001), and behavioural symptoms perceived as aggressive (p = .001). Both decision processes considered refusal of care (p = 0,025 and 0.016 respectively) and social problems (p = .001 and < 0.001 respectively). Discharge planning models differ depending on the country, team and patient's condition. Our study suggests more precise evaluation of patients' needs.
Assuntos
Tomada de Decisão Clínica , Avaliação Geriátrica , Alta do Paciente , Encaminhamento e Consulta/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Método Simples-Cego , Fatores SocioeconômicosRESUMO
Elderly hospitalized patients have uncertain or questionable capacity to make decisions about their care. Determining whether an elderly patient possesses decision-making capacity to return at home is a major concern for geriatricians in everyday practice. To construct and internally validate a new tool, the dream of home test (DROM-test), as support for decision making hospitalization discharge destination for the elderly in the acute or sub-acute care setting. The DROM-test consists of 10 questions and 4 vignettes based upon the 4 relevant criteria for decision-making: capacity to understand information, to appreciate and reason about medical risks and to communicate a choice. A prospective observational study was conducted during 6 months in 2 geriatric care units in Bretonneau Hospital (Assistance publique, Hôpitaux de Paris). We compared the patient decision of DROM-test regarding discharge recommendations with those of an Expert committee and of the team in charge of the patient. 102 were included: mean age 83.1 + 6.7 [70; 97], 66.67% females. Principal components analysis revealed four dimensions: choice, understanding, reasoning and understanding. The area under the ROC curve was 0.64 for the choice dimension, 0.59 for the understanding, 0.53 for the reasoning and 0.52 for the apprehension. Only the choice dimension was statistically associated with the decision of the committee of experts (p=0.017). Even though Drom-test has limitations, it provides an objective way to ascertain decision-making capacity for hospitalised elderly patients.