Exercise Interventions With Trained Home Helpers for Preventing Loss of Autonomy and Falls in Community-Dwelling Older Adults Receiving Home Heath Physical Therapy T4H: A Randomized Controlled Pilot Study.

BACKGROUND AND PURPOSE: Older adults at risk for falls live independently in the community in their own home and have rehabilitation needs. However, little is known about whether home coaching of older adults can decrease falls at home. We sought to determine whether a novel program for preventing falls and a loss of exercise capacity, the T4H program, in which home helpers act as exercise coaches by using an information technology (IT) device, was acceptable and feasible. METHODS: Between February 2015 and October 2015, we performed a cluster randomized controlled trial in which home helpers either assisted older adults 75 years and over, to participate in the T4H program, or provided standard home help over 3 months. We assessed levels of acceptability and satisfaction among the older adults and home helpers with regard to the exercise program and the technologies used. To measure efficacy, the main outcome measures for the older adults were the absence of falls requiring medical or paramedical care, unplanned hospitalizations, walking ability in a Timed Up and Go test (TUG), and self-care ability by the Barthel Index at the 3-month follow-up visit. RESULTS AND DISCUSSION: Overall, 35 older adults were included, aged 89 years and with 68.6% women. Eighty-five percent of the respondents were pleased or very pleased to have participated in the T4H exercise program, 70% were satisfied with the IT devices, and 92% were satisfied with their home helper's level of involvement. Two of the 4 home helper respondents were satisfied or very satisfied with the exercise program, and 2 were moderately satisfied. The proportions of older adult participants with no falls or no unplanned hospitalizations were higher in the T4H group (92.3% and 85.7%, respectively) than in the control group (81.8% and 71.4%, respectively), although these intergroup differences were not statistically significant. The T4H and control groups did not differ significantly with regard to the TUG time (median [IQR]: 27.6 seconds [17.9-58.6] vs 30.7 seconds [19.7-57.2], respectively) or the Barthel Index (median [IQR]: 90 [75-95] and 90 [75-95], respectively). CONCLUSIONS: The novel T4H home help model was feasible and was associated with a high level of participant satisfaction. We observed a trend toward fewer falls and hospitalizations and better quality of life in the older adults.

[New collaborative and participatory program for malnutrition management in the elders after hospitalization]. / Nouveau programme collaboratif et participatif de lutte contre la dénutrition chez le sujet âgé en ville au sortir d'une hospitalisation.

BACKGROUND: Malnutrition in the elderly people is frequent and serious. Management of malnutrition at home after hospitalization is unsatisfactory. The objective of the study is to evaluate the feasibility and participation of a new collaborative and participative program involving the patient, the general practitioner and the dietician nutritionist, to fight against malnutrition in the elderly people at home after hospitalization. METHODS: This was a prospective and non-randomized study performed from May 2015 to February 2016, in subjects aged 75 and more, malnourished, with an MMSE score > 20 and returning homes after hospitalization. At home, a dietician worked with the patients and their general practitioner for 3 months. Patient participation and satisfaction of the 3 actors were assessed. RESULTS: Forty-four patients were included and 11.9% (n=8) benefited from the entire program. Present entourage (p=0.001), dietary education to the entourage (p=0,003), a high MMSE score (p=0.04), having an ulcer (p=0.0097), and a high weight at discharge (p=0.03) increased patients' participation. Patients (78.6%) and general practitioners (75%) were satisfied with the program. Patients criticized the lack of involvement of the general practitioner. General practitioners felt they had not acquired any knowledge of dietetics. CONCLUSION: Patient participation and collaboration between actors of the program of management of malnutrition in elderly people were considered weak.

[The occupational therapist and the assessment of the elderly person's home]. / Évaluation du domicile du sujet âgé par l'ergothérapeute.

The falls of elderly people in their home are frequently related to the environment. Plans and photographs of the home provided by the patient's relatives are useful and constitute relevant assessment tools. The home visit is even more effective as it helps to identify areas which pose a high risk of falling which cannot be picked up by the other tools.

Appropriate proton pump inhibitors use in elderly outpatients according to recommendations.

Proton pump inhibitors (PPI) are widely prescribed, particularly in elderly patients, and their side effects are underestimated. Recommendations of the french health authorities, some specific to the elderly, specify their indications. The main objective of this descriptive and prospective study was to assess in elderly patients the adequacy of PPI prescriptions to these recommendations and to the marketing authorization. METHODS: Analysis of all patients hospitalized in an acute geriatric unit over a period of 2 years for which the drug prescription on admission included a PPI. RESULTS: For the 125 patients included (mean age 84 years), the PPI treatment period exceeded one year in 68% of cases and 49.6% of PPI prescriptions were not consistent with the recommendations; not recommended indications are mainly prevention of gastroduodenal lesions in case of antiplatelet, VKA or corticosteroid treatment (24%), anemia (12%) or epigastric pain (8.5%) without prior endoscopic exploration. Only 50.4% of patients treated with PPI had an upper gastro-intestinal endoscopy, which should be systematically performed in patients over 65 years according to the recommendations. CONCLUSION: Our study confirms the low appropriateness of PPI prescriptions, particularly in elderly patients. This can be explained by controversial issues or by difficulties in adapting these recommendations in geriatric practice.

[Prescription for proton pump inhibitors in geriatrics]. / Prescription des inhibiteurs de la pompe à protons en gériatrie.

Proton pump inhibitors are widely prescribed, notably for the over 65s, despite there being significant side effects in the geriatric population. It is therefore important that doctors, caregivers and patients are fully aware of the recognised indications of PPIs and on the less well-known problems inherent to their prescription.

[Needs, uses, cons-pros, good practices and opportunities about walker in elderly with loss of autonomy]. / Besoins, usages, bénéfices-inconvénients, bonnes pratiques et perspectives en matière de déambulateurs chez les sujets âgés dépendants.

Non-use of the walker may be secondary to an initial inappropriate prescribing, a lack of adequate training, a lack of monitoring and side effects of using. Improving both stability and mobility in users is due to several biomechanical mechanisms. The benefits of walker are: general physiological effects, more confidence, better social life and decrease in the burden of care. The disadvantages of walker are: technical or practical aspects criticized by users, musculoskeletal disorders, delayed reaction time, fall risk and stigma. Few scientific data evaluating the interest of the walker concerning mobility exist, thus recommendations are low grade and are often taken from professional clinical experiences. The choice of technical walking assistance depends on the pathology and biomechanical mechanism. The walker robots are few distributed.