Use of vitamin K antagonist therapy in geriatrics: a French national survey from the French Society of Geriatrics and Gerontology (SFGG).

OBJECTIVE: We aimed to evaluate the quality and determinants of vitamin K antagonists (VKA) control among very elderly patients in geriatric settings. METHODS: A national cross-sectional survey was conducted among patients aged ≥80 years who were hospitalized in rehabilitation care or institutionalized in a nursing home and who were treated by VKA. Time in therapeutic range (TTR) was computed according to Rosendaal's method. RESULTS: A total of 2,633 patients were included. Mean [± standard deviation (SD)] age was 87.2 ± 4.4 years and 72.9 % were women. The main indication for VKA therapy was atrial fibrillation (AF; 71.4 %). Mean (±SD) TTR was 57.9 ± 40.4 %. After backward logistic regression, poorer VKA control (TTR <50 vs. ≥50 %) was associated with being hospitalized in rehabilitation care [odds ratio (OR)(rehab. vs. nursing home) = 1.41; 95 % CI 1.11-1.80], the indication for VKA treatment (OR(prosthetic heart valve vs. AF) = 4.76; 95 % CI 2.83-8.02), a recent VKA prescription (OR(<1 vs. >12 months) = 1.70; 95 % CI 1.08-2.67), the type of VKA (OR(fluindione vs. warfarin) = 1.22; 95 % CI 1.00-1.49), a history of international normalized ratio >4.5 (OR = 1.50; 95 % CI 1.21-1.84), a history of major bleeding (OR = 1.88; 95 % CI 1.00-3.53), antibiotic use (OR = 1.83; 95 % CI 1.24-2.70), and falls (OR(≥2 falls during the past year vs. <2) = 1.26; 95 % CI 1.01-1.56). CONCLUSION: Overall, VKA control remains insufficient in very old patients. Poorer VKA control was associated with taking VKA for a prosthetic heart valve, a recent VKA prescription, the use of other VKAs than warfarin, a history of overcoagulation and major bleeding, antibiotic use, and falls.

Effects of different learning methods for instrumental activities of daily living in patients with Alzheimer's dementia: a pilot study.

We examined whether errorless learning (EL) and learning by modeling (LM) were more advantageous than trial and error learning (TEL) in the acquisition of instrumental activities of daily living (IADL) in Alzheimer's dementia (AD) patients (n = 14). Using a counterbalanced within-subject design, participants performed 3 learning conditions. EL consisted of straightforward prompts before any action, LM focused on the modeling of each step of the tasks and standard TEL without cues was used as a control condition. The participants had to (re)learn 3 IADL. Repeated-measure analyses during learning and follow-up assessments were performed 1 and 3 weeks after learning. The LM and the EL procedures resulted in significantly better learning compared to TEL, with effect sizes (partial eta squared) of 0.42 and 0.35, respectively. This is the first controlled study to show that (re)learning of IADL is possible in patients with AD using an error-reduction approach.

Non-pharmacological management of behavioural symptoms in nursing homes.

BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD) are often reported in institutions for the elderly. OBJECTIVE: To evaluate the effectiveness of a staff education intervention to manage BPSD in older people with a diagnosis of dementia. METHODS: The trial was conducted in 16 nursing homes; 306 patients with a diagnosis of dementia and presenting BPSD were selected. Nursing homes were randomly allocated to an intervention group or a control group. An 8-week staff education and training programme was conducted in the nursing homes in the intervention group. The main outcome measures were the Cohen-Mansfield Agitation Inventory (CMAI) and an Observation Scale (OS) score. Assessments were done at baseline (W0), at the end of the 'intervention' period (W8) and 12 weeks after (W20). RESULTS: There was a significant decrease in the global CMAI score between baseline and W8 (-7.8; p > 0.01) and between baseline and W20 (-6.5; p > 0.01) in the intervention group but not in the control group. Results of mixed linear models showed that the CMAI global score, the CMAI physically non-aggressive behaviours subscale score and verbally non-aggressive behaviours subscale score significantly decreased in the intervention group (p < 0.001) although there was no significant evolution in the control group. Direct assessment with the OS produced the same pattern of results, with a significant decrease only in the intervention group. CONCLUSION: The intervention reduced BPSD in severely demented nursing home residents and this effect was still present 3 months after the end of the programme.