[Cognitive-behavioral specialized units: predictive factors of readmissions within three months]. / Unité cognitivo-comportementale : facteurs prédictifs de réadmission à 3 mois.

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are frequent and belong to the natural evolution of the disease. Specialized cognitive-behavioral units (Unités cognitivo-comportementales) were created, in France (plan Alzheimer 2008-2012), to cope with this problem. Despite a stay in such a unit, some patients have to be rehospitalized. The main aim of the current study was to highlight the predictive factors of readmissions. METHOD: Descriptive, retrospective study of demented patients ≥75 years, hospitalized between January 2010 and April 2011. We compared patients that had to be rehospitalized within 3 months (group 1), with the patients that did not need to be rehospitalized or after 3 months of time (group 2). Patients characteristics included: basic daily living activities (French GIR score), MMSE score, neuropsychiatric inventory score, type of BPSD, length of stay and antipsychotropic drugs. RESULTS: Two hundred thirty-five patients were included including, 147 women (62.5%), with mean age of 82.74±7.13 years. SPCD was the main reason for hospitalization. Thirty patients (12.77%) belonged to group 1. The mean number of psychotropic treatments increased during the stay (p=0.02), particularly in group 2 (p=0.01). The NPI score decreased during the hospitalization in both groups. Linear regression analysis showed that behavioral type of symptoms (OR: 3.18; 95% CI 1.32-7.65) and association of antidepressant and antipsychotic drugs (OR: 4.77; 95% CI 1.35-16.83) were significantly predictive of an early readmission. The risk of readmission also significantly decreased as the length of stay increased. CONCLUSION: This work confirms the specificity and the need for such units. The results will help improving the outcome of demented patients with BPSD and treated with different antipsychotropic drugs.

[Adequacy between prescriptions and CHADS(2) score recommendations in geriatric patients]. / Adéquation entre les prescriptions réalisées et les recommandations CHADS(2) dans un service de gériatrie.

UNLABELLED: Atrial fibrillation (AF) is a major risk factor for stroke. Thromboprophylaxis with anticoagulant reduces the incidence of stroke and is warranted by the CHADS(2) recommendations when score ≥2. But such therapy remains underused particularly among elderly patients. The aim of our study was to evaluate the adequacy between prescriptions and CHADS(2) recommendations in geriatric hospitalised patients with AF. METHOD: retrospective study set in the Geriatrics Department of the University hospital of Poitiers (France), of patients >75 y with AF, between July and December 2009. The description of the patients taken into the count: epidemiological data, functional daily activities (score GIR), cognitive assessment, antithrombotic treatment, and evaluation of the CHADS(2) and HEMORR(2)HAGES scores. RESULTS: in this study161 hospitalisations were analysed, mean age of the patients was 87.4 ±â€Š5.4 years. Antithrombotic treatment was prescribed in 84% of cases. The overall conformity to CHADS(2) recommendations was 44%. Most of hospitalisations (88.9%) included patients with CHADS(2) score ≥2. Non-conformity rate was up to 60% in this group with 5 significant variables: MMSE score <26 (OR: 3.17 [95%IC: 1.23-8.17]), high risk of bleeding (2.88 [1.28-6.47]), dementia (2.46 [1.01-5.95]), functional impairment (GIR score ≤4) (2.43 [1.23-4.84]) and history of fall (2.42 [1.13-5.17]). Still, the variables explained only 19% of the non-conform prescriptions and no variable was significantly relevant on multivariate analysis. DISCUSSION: our study show 56% of prescriptions that are non-conform to CHADS(2) recommendations, particularly in the elderly with a predictive embolic score ≥ 2. Antithrombotic treatment seems to be all the less conform as patients appear to be more vunerable. Due to the new score CHA(2)DS(2)-VASc, physicians really have to discuss the benefit-risk balance at an individual level.