[Practical review of driving in older patient: from theory to practice]. / La conduite chez la personne âgée, de la théorie à la pratique.

As the French population is ageing, the number of older people on the road is increasing all the time. For many older adults, this everyday activity remains an important way of maintaining their independence. Putting this right into question on the sole basis of age can be seen as a particularly stigmatising measure. However, this population is particularly vulnerable on the road. While behavioural factors are frequently involved in young adults, driving errors seem to be more frequently the main mechanism in older people. Driving is a succession of complex tasks that can be affected by ageing and the presence of pathologies (cognitive decline, sensory deficiencies or cardiovascular conditions that have not stabilised, etc.). As these medical conditions increase with age, it is important that healthcare professionals identify high-risk situations. When it is required, the professionals should assist patients to stop driving and find alternatives. Maintaining the mobility and ensure safety for older adults on the road remain challenging for the community. In this article, we discuss the issues surrounding the maintenance of driving in older adults. We also discuss the appropriate way to help patients stop driving when necessary.

[Suspension of geriatric admissions in France in 2023: a national PUGG survey of the French Society of Geriatrics and Gerontology]. / Fermetures de lits gériatriques en France en 2023 : une enquête nationale pratiques et usages en gériatrie et en gérontologie de la Société française de gériatrie et gérontologie.

France is experiencing exceptionally high closures of hospital geriatric beds, which increases the difficulties of access to geriatric care for the oldest and most frail French citizens. The French Society of Geriatrics and Gerontology (SFGG) conducted a national survey in January 2023 among French geriatricians and gerontologists with the aim of drawing up an inventory of the closure of hospital geriatric beds in France and the reasons for these closures. The online survey was carried out among the 1,600 members of the SFGG between January 8 and 22, 2023. The results showed that 34.7% of geriatric units were affected by bed closures in January 2023, with 25.7% of beds closed on average. All levels of hospital geriatric sectors were affected by bed closures, but rehabilitation units were the most affected ones. The most frequent reason for bed closures was the lack of nurses, then the lack of physicians, and finally the lack of nursing aids. Reopening dates were not defined in more than 90% of cases. Resolving this crisis will imply recognizing and revaluing geriatric caregivers, both financially and in terms of more appropriate caregiver/patient ratios. These measures are necessary to avoid the bankruptcy of hospitals and to preserve decent, respectful and dignified care for our seniors.

[Driving: What is the relevance and usability of the Reisberg scale in 2023?] / Conduite automobile : Quelle est la pertinence et l'utilité de l'échelle de Reisberg en 2023 ?

The publication of the decree on the care of people with neurocognitive disorders brought to the fore the Reisberg's Global Deterioration Scale, a scale that only few clinicians use in memory centers or in geriatric. This scale has a number of limitations, not least of which is that it is obsolete, since it does not take into account disease advances in scientific knowledge with biomarkers. Consequently, the stages evoked no longer correspond to current descriptions. Moreover, it only concerns Alzheimer's disease, whereas in our practice we encounter other neurodegenerative pathologies. Even if we decide to use another global assessment scale, such as the Clinical Dementia Rating or the Functional Assessment Staging, they cannot replace a personalized assessment. Indeed, it is important to stress that this decree does not take into account the relevance of personalized assessments using, for example, neuropsychological tests to estimate driving ability. A personalized assessment accompanied by a real-life driving test would be preferable than a score on a global scale. This article therefore presents the Global Deterioration Scale, highlighting its unsuitability for assessing whether or not to continue driving.

[Support and guidance in driving for patients with (or suspected of having) Alzheimer's disease or related diseases: position paper]. / Recommandations pour l'accompagnement et l'orientation pour la conduite des patients atteints (ou suspectés) d'une maladie d'Alzheimer ou de maladies apparentées : consensus des sociétés savantes françaises.

New ministerial decree restricts driving motorized vehicles for patients with Alzheimer's disease and related disorders. Reisberg stage 3, threshold used to contraindicate driving, appears to correspond to a mild stage of major neurocognitive impairment. A single scale gives an idea of the level of risk but does not provide a holistic assessment. The aim of this consensus is to put forward recommendations from several French learned societies for individualized cognitive assessments to minimize the risks associated with driving and its cessation. Fitness to drive should be raised at the earliest stages of the diagnostic process, and regularly throughout the follow-up. Consult a registered doctor is recommended to all patients wishing to continue driving. All documents must be given to the patient only. An alternative must always be offered to patients who are recommended a modal shift.

National cross-sectional survey on psychological impact on French nursing homes of the first lockdown during the COVID-19 pandemic as observed by psychologists, psychomotor, and occupational therapists.

Objectives: The main objective was to explore the psychological impact of the French lockdown during the first wave of the COVID-19 pandemic on nursing home residents, their relatives, and healthcare teams, as observed by mental health professionals. Design: A national online cross-sectional survey was conducted from May 11 to June 9, 2020. Setting and participants: Respondents were psychologists, psychomotor therapists, and occupational therapists (mental health professionals). Results: A total of 1,062 participants responded to the survey, encompassing 59.8% psychologists, 29.2% occupational therapists, and 11% psychomotor therapists. All mental health professionals felt fear (76.1%), fatigue and exhaustion (84.5%), and inability to manage the emotional burden (78.4%). In nursing homes with COVID-19 cases, residents felt significantly sadder (83.2%), more anxious (65.0%), experienced more anorexia (53.6%), resurgence of traumatic war memories (40.2%), and were more often disoriented (75.7%). The suffering of relatives did not vary between nursing homes with and without COVID-19 cases. The nursing staff was heavily impacted emotionally and was in need of psychological support particularly when working in nursing homes in a low COVID-19 spread zone with COVID-19 cases (41.8 vs. 34.6%). Conclusion and implications: Primary prevention must be implemented to limit the psychological consequences in the event of a new crisis and to prevent the risk of psychological decompensation of residents and teams in nursing homes.

Caregiver Burden Is Reduced by Social Support Services for Non-Dependent Elderly Persons: Pre-Post Study of 569 Caregivers.

BACKGROUND: Informal care provided by family caregivers (FCGs) to elderly persons is associated with a high risk of burden and poor health status. Social support services (3S) for the elderly persons were characterized by assistance in various activities of daily living. This study aimed to analyze the impact of 3S on the burden of FCGs of elderly persons living in the community and identify factors associated with changes in their burden. METHODS: This pre-post study was performed in the southeast of France: FCGs of non-dependent elderly persons still living at home who received a 3S were consecutively included. FCG burden was assessed with the Mini-Zarit scale before the setting up of the 3S (pre-3S) and 6 months after (post-3S). RESULTS: A total of 569 FCGs were included in the study. Mean age of the FCGs was 62.9 years old (±13.3), 67% were women, 61.2% were children or stepchildren. Burden was present for 81% of FCGs. In most cases, 3S targeted household chores (95.8%); 59.8% of elderly persons and their FCGs were fully satisfied. The improvement in burden was greater for FCGs perceiving less obstacles post-3S in helping elderly persons (OR = 4.083) but also for FCGs fully satisfied with the 3S (OR = 2.809) and for FCGs whose perceived health status had improved post-3S (OR = 2.090). CONCLUSIONS: FCGs of non-dependent elderly persons experience a burden similar to those of dependent elderly persons. The implementation of a 3S in daily life helps to reduce their burden.

Family Caregiver's Loneliness and Related Health Factors: What Can Be Changed?

Background: Loneliness is a public health issue that may affect the entire population. Loneliness is associated with depression, sleep disorders, fatigue, and increased risk of obesity and diabetes. Risk factors for loneliness include having a poor social network and poor physical and mental health. The main objective was to study factors related to loneliness of family caregivers caring for independent older people. Methods: We performed a non-interventional observational cross-sectional study in south-eastern France. Family caregivers caring for people aged 70 and over and living at home were included. These older people were independent, without long-term conditions, and had applied for professional social assistance for daily living. Data were collected through a questionnaire, administered face-to-face or by telephone. Loneliness and perceived health status were measured through a single-question. Burden was assessed through the Mini-Zarit Scale, and frailty was measured through the Gerontopole Frailty Screening Tool. Results: Of the 876 family caregivers included, 10% felt lonely often or always. They reported more physical and mental health issues than those who did not feel loneliness (p < 0.001). Family caregivers with loneliness were more likely to be looking after a parent and were twice as likely to have a moderate to severe burden (OR = 2.6). They were more likely to feel anxious (OR = 5.6), to have sleep disorders (OR = 2.4), to be frail (OR = 2), and to view the status of their health as poor or bad (OR = 2). Conclusions: Loneliness has a negative impact on health, causes frailty, and places a burden on family caregivers. Means must be implemented to anticipate the consequences of the loneliness felt by family caregivers, notably by orienting them towards the relevant services.

COVID-19 pandemic and mortality in nursing homes across USA and Europe up to October 2021.

PURPOSE: We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level. METHODS: The total number of COVID-19 cases and COVID-19-related deaths in all NHs as well as the total number of NHs and NH beds were provided by representatives of 14 countries. The population level respective figures in each country were provided up to October 2021. RESULTS: There was a wide variation in prevalence of COVID-19 cases and deaths between countries. We observed a significant correlation between COVID-19 deaths in NHs and that of the total population and between the mean size of NHs and COVID-19 deaths. CONCLUSION: Side-by-side comparisons between countries allow international sharing of good practice to better enable future pandemic preparedness.

[Geriatric units at the beginning of the 2020 COVID-19 epidemic in France]. / Les unités de gériatrie au début de l'épidémie du Covid-19 de 2020 en France.

The COVID-19 epidemic that started in November in China became a national epidemic from March 16, 2020 with the declaration of population containment in order to reduce the spread of the virus in France. From March 17 to March 27, 2020, the monitoring unit of the French society of geriatrics and gerontology decided to conduct a survey to analyze the implementation of the mobilization of geriatric units, given that this epidemic had shown that it resulted in excess mortality mainly among the elderly. The survey was able to bring together the response of 34 services, nine of which were located in a high epidemic cluster zone. Dedicated acute geriatric units for patients infected with COVID-19 were present in eight facilities, only outside the cluster zones. Nine geriatric follow-up and rehabilitation services were dedicated, an additional telemedicine activity concerned 35% of the facilities, and family listening and tablet communication facilities concerned 36% of the facilities. This survey is a snapshot of an initial moment in the epidemic. It provides an opportunity to describe the context in which this epidemic occurred in terms of geriatric policy, and to assess the responsiveness and inventiveness of these services in meeting the needs of the elderly.

[Caregivers' perceptions and coping strategies in Ehpad]. / Ressentis et stratégies d'adaptation des soignants en Ehpad.

The increasing number of residents suffering from neurocognitive diseases, in nursing homes, makes care complex. Behavioral disorders, associated with these pathologies, generate many feelings among professional caregivers which can influence care practices.

European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique.

BACKGROUND: the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations. METHODS: under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators. RESULTS: the final recommendations include four different domains: 'General Considerations' on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), 'Knowledge in patient care' (36 sub-items), 'Additional Skills and Attitude required for a Geriatrician' (9 sub-items) and a domain on 'Assessment of postgraduate education: which items are important for the transnational comparison process' (1 item). CONCLUSION: the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.

[Restraint in geriatric care, an overview]. / La contention en gériatrie, état des lieux.

Restraint is a deprivation of liberty which in certain, clearly codified situations is a necessary part of the care process. The multidisciplinary objective evaluation of the risk/benefit ratio must take into consideration the person's dignity. The situation is often encountered in geriatric care where the fundamental principles are the maintaining of autonomy or the functional improvement of the patient or resident.

Impact of an awareness of the doctors treating on the decrease of the prescriptions of antipsychotics in the demented residents in Ehpad.

BACKGROUND: Despite the context of several national warnings, antipsychotics drugs are commonly used to treat behavioural and psychological symptoms in dementia (BPSD). AIM: To observe a decrease of antipsychotic drug prescription, in old NH (nursing homes) residents with dementia, after an awareness of their general practitioner. METHODS: Observational, prospective, multicenter study. The study population corresponds to NH residents with dementia, and antipsychotic drug consumption, in nursing homes volunteered to participate. Awareness-raising is carried out through information documents. The evaluation criteria is the proportion of residents under antipsychotics after sensitization. RESULTS: out of the 30 nursing homes included, 26.7% of the patients were prescribed at least one antipsychotic and 15% were both demented and under antipsychotics. A total of 317 residents with dementia and antipsychotics were included 15% of the total NH population. Psychotropic drug co-prescriptions was very frequent 43.2% also used benzodiazepines, 37.2% anxiolytics and 33.1% antidepressants. Agitation, aggressiveness, opposition to care and wandering were the most commonly BPSD encountered. After a first sensitization, we obtained a 15.5% decrease of antipsychotic prescriptions. CONCLUSION: A personalized sensitization towards GP allowed a reduction of antipsychotic drugs prescription in NH residents with dementia and BPSD.

Setting competencies and standards for a European Leadership Program in Geriatric Medicine: "The European Academy for Medicine of Ageing (EAMA) reloaded".

BACKGROUND: The European Academy for Medicine of Ageing (EAMA) was founded in 1995 as an "Advanced Postgraduate Course in Geriatric Medicine", in order to train future key opinion leaders in geriatric medicine. Recent changes across European Healthcare systems have changed the needs for leadership competences for geriatricians. Therefore, it became mandatory to further develop EAMA's learning objectives catalogue. MATERIALS AND METHODS: Following a comprehensive needs assessment among students and visiting professors of the EAMA, a template containing seven key domains derived from the needs assessment was developed. EAMA professors had the chance to feedback learning objectives aligned with the seven domains. Feedbacks were transcribed into a first draft of a learning objectives catalogue during this meeting. This first draft was reflected with EAMA network members (former EAMA students) and finalized following a second focus group among board members. RESULTS: 24 learning objectives which cover the spectrum of knowledge, skills and attitudes necessary to develop leadership roles in geriatric medicine are included in the new EAMA learning objectives catalogue. Rate of agreement achieved in open ratings was > 90% for all selected items among the board members. CONCLUSIONS: The recently developed learning objectives catalogue of EAMA presented within this publication reflects a clear shift from knowledge-based education and training towards a comprehensive programme design for leadership development.

Analgesic consumption in nursing homes: observational study about 99 nursing homes.

Few analgesics' studies in nursing homes are available. Quantitative and qualitative analgesic consumption evaluation in nursing homes in 2012. Multicenter, descriptive, retrospective and observational study about French Korian Nursing homes' residents, using Medissimo solution, and under at least one analgesic treatment during 2012. We considered as chronic prescription a duration greater than or equal to 28 days and as short prescription a duration less than 28 days. Population studied is 10.818 residents. 62% consumed at least one analgesic, 51% had a chronic analgesic consumption, 11% had a short analgesic consumption and 25% had an analgesic consumption both short and chronic. 47% residents under analgesic treatment received at least one prescription of painkillers "when require". Short prescription represents 19% of analgesic prescriptions: 57% are level 1 only, 20% are level 3 only and 16% are level 2 only. Chronic prescription represents 81% of analgesic prescriptions: 68% are level 1 only, 13% are level 2 only and 5% are level 3 only. 18 INNs were prescribed in nursing homes: paracetamol in 74% of cases, tramadol in 13% of cases, opioids and NSAIDs in 8% of cases. Our study reveals an analgesic consumption sometimes inappropriate with respect to paracetamol, tramadol and NSAIDs consumptions in addition to an overuse of fentanyl patch consumption. Residents in nursing homes are high analgesics consumers, often chronic. Paracetamol is the reference molecule.

[Alzheimer's disease today]. / La maladie d'Alzheimer aujourd'hui.

As a result of the development of neurodegenerative diseases our societies are faced with a major challenge. More than 850 000 people in France are affected by Alzheimer's disease or a related disorder. The huge impact of these diseases on the quality of life of the patients and their carers requires a concerted effort to provide high-quality support at every stage of the disease.

Long-term use of antipsychotics in community-dwelling dementia patients: prevalence and profile accounting for unobservable time bias because of hospitalization.

The aim of this study was to assess the prevalence of long-term antipsychotic (AP) use in community-dwelling patients with dementia considering hospitalization periods as AP exposure or not. A retrospective study was carried out from 2009 to 2012 on a PACA-Alzheimer cohort (which included 31 963 patients in 2009 and 36 442 in 2012 from 5 million inhabitants). Three groups of patients were identified according to the longest exposure to APs without interruption: nonusers, short-term users (≤3 successive months without discontinuation), and long-term users. Sensitivity analyses on hospitalization periods were carried out. The percentage of patients with at least one AP dispensing was stable over the study period (25.6% in 2009 vs. 26.5% in 2012). In 2012, 27.6% were AP long-term users. This increased to 46.7% when hospitalization periods were counted as AP exposure. In comparison with nonusers, AP users took more benzodiazepines and antidepressants. Short-term users were men [odds ratio (OR)=1.2, 95% confidence interval (CI) (1.1-1.3)] older than 85 years old [OR=1.2, 95% CI (1.1-1.2)]. Long-term users were more exposed to benzodiazepines [OR=1.2, 95% CI (1.1-1.4)]. This study showed that long-term use of AP remained frequent in community-dwelling patients with dementia. It also showed that the prevalence of long-term users almost doubled when hospitalization periods were counted as AP exposure. This underlines the need to consider hospitalization periods when assessing medication exposure in populations with frequent periods of hospitalization.

Difficulties encountered by general practitioners during acute behavioral disturbances of their dementia patients.

Alzheimer diseases and related disorders (ADRD) remain a major public health issue. The progression of the disease is dominated by behavioral and psychological symptoms of dementia (BPSD) which are frequent and burdensome for caregivers. The aim of our survey was to study how the general practionner managed these behavioral disturbances (particularly agitation and aggressiveness) in community living patients with ADRD and support of their main caregivers. We based our study on a medical survey sent to all general practitioners (GP) practicing in four districts in Marseille near from a secure unit. Ninety five out of 260 answered to the survey and 57 had already been exposed to patients' behavioral decompensation. For these BPSD management, atypical neuroleptics and benzodiazepines were mostly prescribed, and according to the literature and guidelines. Half of the GP's recognized the weak effectiveness of this strategy. Almost all of them are interested in having a document summarizing the main strategy to be set up or a possibility to call a specialized mobile team with doctors and professionals caregivers. A few dedicated consultations were devoted to informal caregivers whereas GP were aware of negative effects of these decompensations on them. This study point out difficulties for GP to provide appropriate management for their patients with ADRD living at home and for their informal caregivers, particularly during acute behavioral disturbance, despite their practical knowledges.