[Staff hebdomadaire qualité et gestion des risques en gériatrie: un outil d'appropriation de la démarche qualité pour le management des unités]. / Staff hebdomadaire qualité et gestion des risques en gériatrie : un outil d'appropriation de la démarche qualité pour le management des unités.

The quality approach has become essential in geriatric hospital services, but also in the medico-social sector. This process is continuous and shared by all those in charge of the care units, to facilitate unit management and support caregivers in this approach. The weekly structured quality staff meeting is a relevant tool to facilitate the understanding and appropriation of this approach by the medical and nursing managers of the care units.

[Barriers to entry into Ehpad since the Covid-19 crisis: a qualitative study of people over 65 in Marseille]. / Freins à l'entrée en Ehpad depuis la crise Covid-19 : étude qualitative auprès de personnes âgées de plus de 65 ans à Marseille.

From the outset of the Covid-19 health crisis, residential care facilities for the dependent elderly (Ehpad) were faced with health and safety challenges. Strict infection prevention measures, such as visiting restrictions and the implementation of sanitary protocols, have been essential to protect residents. While Ehpad occupancy rates were stable before the health crisis, they fell sharply in the aftermath of Covid-19.

[Prescription of split doses in a nursing home: Contribution of an automated dose-dispensing machine]. / Prescription de demi-doses en établissement d'hébergement pour personnes âgées dépendantes : apport d'un automate de préparation de doses à administrer.

OBJECTIVES: The territorial pharmacy of the West of Paris carries out an automated dose dispensing for a nursing home. The machine overpacks dry oral forms in unit doses and dispenses them in named pillboxes. Tablets prescribed in fractions are currently dispensed in whole unit doses, fractioned in advance by a nurse, then administered by a caregiver. These operations present a number of risks, including a break in dose identification right through to administration. The objective was therefore to extend the automated dose dispensing to split tablets by repackaging. METHODS: The development of this new process, its software qualification and its evaluation after six months of routine use are described. RESULTS: This process is composed of three steps, secured by pharmaceutical controls: manual production of fractions in the preparatory area, automated repackaging using a barrel and automated dispensing in pillboxes. In total, 2000 fractions were produced in six months with a non-compliance rate lower than 5% and a negligible financial loss. Following the assumption of this activity by the pharmacy, the care team declares themselves satisfied by the gain in time and safety. CONCLUSIONS: Automated dispensing of unit doses in fractions ensures identification of the dose from prescription to administration, thus limiting administration errors.

[A geriatric perspective on the sixth IPCC synthesis report]. / Un point de vue gériatrique sur le sixième rapport de synthèse du Giec.

Climate change brings with it many foreseeable consequences for ecosystems and populations, including health consequences that could have a particular impact on older populations. Extreme climatic events, including heat waves, are associated with higher morbidity and mortality among the elderly. Air pollution has a deleterious effect on illnesses associated with aging, or which become more frequent with age. The health consequences of climate change must be anticipated, as they will require the adaptation of healthcare systems, which could be of particular interest to geriatric medicine.

[Validation of the French version of the Assessment Tool for Hospital Admissions Related to Medications (AT-HARM10) to detect drug-related hospitalizations]. / Validation d'une version française de l'outil AT-HARM10 pour la détection des hospitalisations liées au médicament.

Admissions of the elderly related to medication errors are frequent in hospital, more than half would be avoidable, but there is currently no validated method in French to identify them. The objective of this work was to validate the French version of the AT-HARM10 tool in order to use it for patients admitted in our healthcare facilities. The tool has 10 questions. A positive response to any of the first 3 questions identify admissions that are unlikely to be drug-related. A positive response to one of the following 7 questions identify possible medication-related admissions. For semantic and linguistic validation, we performed cross-validation with forward-backward translation. To clinically validate the method, we conducted a retrospective study including patients over 65 admitted to short-stay units (UHCD) and to orthopedic surgery units in two French hospitals. Two hundred and sixty-six (266) patients were included ; 166 patients admitted to UHCD (mean age 86.0±5.7 years; sex ratio 0.66; mean number of drugs prescribed 7.7±3.8) and 100 patients admitted to orthopedic units (mean age 85.2±6.1 years; sex ratio 0.43; mean number of prescribed drugs 6.4±3.6). We identified 55 % of admissions probably related to medication in UHCD and 76 % in orthopedic units (p<0.05). The most represented item was P5 in both groups (Might [side] effects of the medications the patient was taking [prescribed or not prescribed] prior to hospitalization have caused the admission [including over-treatment] ? The validated AT-HARM10 tool is now integrated into our clinical pharmacy practices and medication reviews are offered as a priority to patients admitted for iatrogenic reasons.

[Rules of good practice for the elderly]. / Les règles de bonne pratique chez le sujet âgé.

The treatment of infectious diseases in geriatric medicine is a complex subject. Diagnosis is often difficult, as is the correct indication for antibiotic therapy. To combat antibiotic resistance, we need to limit unnecessary antibiotic prescriptions and prevent the onset of bacterial infections, notably through vaccination.

[The proper use of carboxymaltose iron and its economic impact in the geriatric wards of a French university hospital]. / Bon usage du fer carboxymaltose et impact économique dans les services gériatriques d'un CHU.

The proper use and economic impact of carboxymaltose iron were evaluated for patients hospitalized in the geriatric wards of a French university hospital from November 2019 to April 2020. Martial supplementation was recommended for 75.7% of the 173 patients who received carboxymaltose iron: 43.4% had a real indication for carboxymaltose iron, while 14.4% could have received sucrose iron and 17.9% could have received per os iron. Compliance with the recommendations would have generated savings of 10,345.80 euros (32.1%).

[Technology at the heart of vulnerability]. / La "techné" au cœur de la vulnérabilité.

The ubiquitous presence of the elderly in care services raises questions about the evolution and limits of new techniques and technologies in the care relationship. We carried out a cross-sectional study in a geriatric ward, using parallel patient and carer questionnaires to assess how each felt about innovations, analyze their opportunities and evaluate their dangers in care provision.

[Implementation of an EMG IPA in the emergency department]. / Implantation d'une IPA de l'EMG au service d'accueil des urgences.

An advanced practice nurse from the Bretonneau-Bichat (AP-HP) hospitals' mobile geriatric outpatient team works in the emergency department (SAU). Its mission is to facilitate the identification, evaluation and referral of frail elderly patients discharged home after a visit to the emergency department. Description of the implementation of this project, its progress, and one-year assessment.

[Caregiver in a mobile geriatric team, a new profession]. / Aide-soignante en équipe mobile de gériatrie, un nouveau métier.

The caregiver plays a key role in the mobile geriatric team. She has a very varied activity. She performs geriatric assessments, evaluates toilets, transmits geriatric culture, maintains the city-hospital link, intervenes in residential facilities for dependent elderly people (Ehpad), performs post-emergency telephone interviews and provides training to paramedics. Testimonial.

[Coordinated primary care of older patients with complex needs. The perspective of family doctors in the light of a case management project within practice networks of independent physicians in Germany]. / Koordinierte Versorgung geriatrischer Patientinnen und Patienten aus ärztlicher Sicht: Erfahrungen aus einem kontrollierten Modellversuch in zertifizierten Praxisnetzen.

BACKGROUND: Cross-sectoral and interdisciplinary care and case management can contribute to an improved integration of the primary care for patients with geriatric characteristics. Following this approach, the pilot study RubiN (Regional ununterbrochen betreut im Netz / Continuous Care in Regional Networks) implemented a specific geriatric Care and Case Management (CCM) in five certified practice networks of independent physicians in different regions in Germany. As part of the accompanying process-based evaluation of the project, a survey was conducted among general practitioners and other specialists from these networks in order to find out how, in their view, collaboration with case managers can improve medical care of geriatric patients and contribute to closing possible gaps in primary care structures. METHODS: The overall project RubiN, which was designed as a pragmatic controlled trial, compared patients from five practice networks where CCM has been implemented (intervention networks), with patients from three networks where the intervention was not taking place (control networks). Physicians of all eight participating practice networks were included in the present survey. The survey was conducted via a self-developed questionnaire. RESULTS: A total of 111 physicians participated in the survey, 76 of whom were part of an intervention network and 35 part of a control network. The calculated response rate was 15.4% (networks reported a total of approx. 720 members). 91,1% of the participants from intervention networks, who had joined RubiN with their patients, reported satisfaction with their collaboration with case managers (n=41 of 45). 87.0% of the physicians from intervention networks stated that care for geriatric patients had improved as a result of their participation in the pilot study (n=40 of 46). When asked about the overall quality of care provided for their geriatric patients, the assessments of participants from intervention networks were more positive than those of the participants from control networks (MV 3.48 vs. 3.27 on a scale of 1=poor to 5=very good). Agreement with whether external case managers could provide certain services was higher among participants from intervention networks compared to participants from control networks. This was the case, in particular, of services related to medical data collection and test procedures. Overall, both comparison groups showed a high level of willingness to delegate tasks to a CCM. DISCUSSION: Delegation of tasks to geriatric case managers seems to be more readily accepted by physicians in intervention networks than by their colleagues from the control networks, especially as regards medical assessment methods and advanced advisory tasks. The results suggest that interventions in this domain were able to convince physicians of the value that case managers can bring to medical practice and help resolve reservations and skepticism. Especially, the implemented CCM seemed to be an effective way of generating geriatric anamnestic data and fostering the flow of general patient-centered information. CONCLUSION: From the point of view of general practitioners and other specialists participating in the intervention, CCM has been successfully implemented in their practice networks and seems to be a worthwhile approach that will help provide better coordinated and more team-oriented care to their geriatric patients.

[Polypharmacy and Delirium in the Elderly]. / Polypharmazie und Delir bei alten Menschen.

Polypharmacy and Delirium in the Elderly Abstract: Delirium often occurs in elderly hospitalized patients. Multimorbidity and associated polypharmacy are known risk factors for developing delirium. Moreover, delirium itself often leads to the prescription of additional drugs. This article aims to enlighten the interrelation of delirium and polypharmacy in the context of recent evidence. It also tries to show possibilities of deprescribing.

Applicant and Match Trends to Geriatric-Focused Postgraduate Medical Training in Canada: A Descriptive Analysis.

Physicians with postgraduate training in caring for older adults-geriatricians, geriatric psychiatrists, and Care of the Elderly family physicians (FM-COE)-have expertise in managing complex care needs. Deficits in the geriatric-focused physician workforce coupled with the aging demographic necessitate an increase in training and clinical positions. Descriptive analyses of data from established matching systems have not occurred to understand the preferences and outcomes of applicants to geriatric-focused postgraduate training. This study describes applicant and match trends for geriatric-focused postgraduate training in Canada. In this retrospective cohort study, data from the Canadian Resident Matching Service and FM-COE program directors were analysed to examine program quotas, applicants' preferences, and match outcomes by medical school and over time. Based on their first-choice specialty ranking, applicants to geriatric medicine and FM-COE signalled a preference to pursue these programs and tended to match successfully. The proportion of unfilled training positions has increased in recent years, and the number of applicants has not increased consistently over time. There is a disparity between applicants to geriatric-focused training and the health human resources to meet population-level needs. Garnering interest among medical trainees is essential to address access and equity gaps.

[What are the barriers to private practice in geriatrics?] / Quels sont les freins à l'exercice libéral de la gériatrie ?

Liberal geriatrics is not developed in France. However, given the aging of the population and the benefits of specialized care for elderly patients, the increase in this activity could be beneficial. For a liberal activity in geriatrics to be established, it would be necessary to better define the role of the geriatrician in the follow-up of patients, to inform during the studies of this possibility of exercise and that a real adapted nomenclature be put in place.

[Private geriatrics: an experience in Guadeloupe]. / Gériatrie libérale : une expérience vécue en Guadeloupe.

Although geriatric medicine is now commonplace in university hospitals, it is less common in private practice. In Guadeloupe, a geriatric medicine service operating as a weekday hospital has been created in a polyclinic to support patients and general practitioners. This activity is an example of private practice in geriatric medicine and completes the care offer of the geriatric network.

[Telemedicine, a medical solution in under-resourced areas]. / La télémédecine, une solution médicale en zone sous-dotée.

Maintaining the growth of rural areas and providing patients with the best possible support in the context of a coordinated healthcare pathway is a challenge that has been met thanks to teleconsultation. An experiment in Nouvelle-Aquitaine is benefiting patients at a hospital and residents of a home for the elderly, allowing them to be monitored by their primary care physician or a specialist from a distance. Nursing professionals are enriching their practice, integrating new information and communication technologies with all the guarantees in terms of security of practices.

[Excess mortality in nursing homes during the first wave of the Covid-19 pandemic]. / Surmortalité dans les Ehpad pendant la première vague de la pandémie de la Covid-19.

Overall mortality in France is 147 568 deaths since the first wave. Although accounting for nearly 20% of deaths in France, the excess mortality in long-term care facilities compared to previous years has not been fully studied. The Covid-19 pandemic has highlighted the vulnerability of residents in long-term care facilities, with highly dependent elderly patients being the most exposed to the risk of death, with deleterious effects linked to the effects of confinement, which in Ehpad has resulted in major isolation of residents and the appearance by care teams of cognitive disorders appearing or deteriorating in residents, as well as a significant loss of autonomy.

[Care pathways, care of the pathway: the underside of a debate]. / Parcours de soins, soins du parcours : les dessous d'un débat.

The coordinated care pathway consists of entrusting the attending physician with the coordination of care of the patient for the realization of medical follow-up with the ethical concern of a responsible consultation of the caregivers. This, so that medical practices and care devices are turned towards efficient care but also integrative, a qualitative search for life combining continuity of care and promotion of global health. This evolution towards greater respect for patients' rights requires that decisions taken be intelligently regulated in a context where caregiving interventions are still very prevalent and potentially intrusive in regard to the privacy of the persons being cared for.

[Acupuncture, a non-drug approach to the management of chronic pain in geriatrics]. / L'acupuncture, une approche non médicamenteuse pour la prise en charge des douleurs chroniques en gériatrie.

It is recognized that multimodal management of chronic pain is necessary. This management requires the use of both drug and non-drug approaches. Acupuncture is a non-medicinal approach that has been shown to be effective in treating chronic musculoskeletal and arthritic pain. It has few side effects and contraindications. Its use should be developed in geriatrics as a complement to usual analgesics and other non-drug approaches.

[Intention of geriatric interns to train and go into private practice]. / Intention des internes de gériatrie à se former et à s'installer en libéral.

Geriatrics is a recent medical specialty in France, and private practice, possible, is still a minority. The specialized studies diploma, created in 2017, provides for the possibility of completing a semester of internship in private practice. According to our study, 62% of geriatric interns in training would consider doing a semester outside the hospital and 42.7% would consider setting up in private practice. Proportions which vary according to the year in which the national qualifying tests were taken and the internship subdivision.