[Pilot study on the effects of an adapted physical activity program focused on the quality of life and risk indicators for falls in independent dwelling-women over 65 years]. / Étude pilote portant sur les effets d'un programme d'activités physiques adaptées sur la qualité de vie et les indicateurs du risque de chute chez des femmes autonomes âgées de plus de 65 ans.

Falls can have multiple detrimental consequences in the elderly, and this is particularly relevant for women. To prevent the risk of falling, intervention programmes based on physical exercises focusing on balance appear to be the most efficient, which explains the multiplication of this type of action at the local level. However, these actions are very rarely evaluated. METHODS: Our sample consists of 26 women (75.0 ± 6.7 years old), randomly assigned to two groups: an intervention group (GI) that has benefited from a balance-oriented adapted physical activity (APA) program focused on balance and conducted in an associative structure; and a control group (GC). Our study aims to evaluate different parameters such as physical (functional mobility, balance), subjective (balanced confidence) and health (quality of life) indicators in women over 65 years of age, living independently at home. RESULTS: In people completing the program, we observed an improvement in equilibrium capabilities (significant increase in POMA score; p < 0.05), in balance and functional mobility (significant decrease in TUG score; p < 0.01) and in balance confidence (significant increase in ABC-S; p < 0.05). CONCLUSION: The implementation of a short programme by the associative structure seems to be an interesting approach for the prevention of falls in autonomous elderly women.

Young onset demented patients in French cognitive-behavioral specialized units.

The number of patients with young onset dementia (YOD) (first symptoms beginning before the age of 60 years) is estimated around 5,000 in France. On account of the usual severity of behavioral symptoms in these patients, the need for cognitive-behavioral specialized unit (UCC) is expected. To determine the number and characteristics of YOD patients cared for in UCC in France during the year 2013. A specific questionnaire was sent to the 84 French UCC. The questionnaire was completed by 55 UCC (65%), whose 33 received 179 YOD patients. The diagnosis was Alzheimer's disease in 50% of the cases and frontotemporal dementia in 30%. The main reasons for the hospitalization in UCC were the severity of behavioral symptoms in 86% of cases, the need to alleviate the caregiver burden in 31% and the waiting for a place in a nursing home in 23%. Mean duration of hospitalization was 40.4 ± 20.5 days. At the end of hospitalization 51% of the patients returned to their original living accomodation and 39% entered into a nursing home. The main reason of YOD patients hospitalization reject was the care team's fear in the UCC without experience. The severity of the behavioral troubles was the major issue while the necessary ethical reflection raised by the YOD patients management was a positive aspect. The teams rated how ready do they feel about taking care of YOD patients on a scale from 0 to 100, the median was 35. The welcoming of YOD patients in UCC is necessary, however the severity of the behavioral troubles and the care teams fear prompt to set up specific education and to increase of the number of staff for YOD patients management.

[Description of cognitive-behavioral specialized units in France: results of a national investigation]. / État des lieux des unités cognitivo-comportementales (UCC) : résultats d'une enquête nationale.

Through a national survey, the SFGG's UCC Task Force worked and liaised with the DGOS as to establish a national inventory of the UCCs in France. 43 of the 55 newly opened UCCs in 2011 filled up the survey. These UCCs largely supported patients meeting the admission criteria's from the book of specifications edited by the public department. Those patients were demented, valid and with disruptive behavior disorders. Earnings for the stay were commonly measured by a reduced NPI (32 to 18). Body therapies, cognitive and sensory were mainly performed, even if a quarter of the UCCs also provided acute missions (diagnosis and management of acute diseases). Medical staff and caregivers were very different. Nearly half of the UCCs reported an insufficient staffing and a third of them reported a lack of training. Among the most often claimed difficulty (81% of UCCs), the release of patients is noted, with an average length of stay of 36 days. From an architectural point of view and even if the amount of beds was by the book (in average: 11), 58% of the UCCs proposed only single rooms. The lack of homogeneity shown with this survey tells us to share more our practice.

[Wandering in dementia]. / La déambulation chez les patients déments.

Wandering is a frequent behavior disorder in demented patients. However, it remains ill defined and insufficiently studied. It is characterized by repeated, prolonged and sometimes compulsive need to walk, with or without aim. Its frequency increases with the severity of dementia among institutionalized subjects and Alzheimer's disease patients. It may result in severe consequences for the patient who may get lost, become exhausted and suffer from traumas. It also represents a burden for patient's family and care providers, especially in case of running away. Multiple hypotheses may be formulated to explain this symptom, going from an occupational or automatic activity to a finalized activity, inscribed into the subject's mental life. The badly codified treatment requires sometimes medications (modest effect of low-doses antipsychotic drugs), but it is mainly based on varied and multiple non-medicinal approaches. Unfortunately, these ones are insufficiently assessed. More studies are needed to bring out a better definition of wandering, and improve its analysis, comprehension and the assessment of its caring.

[The end of life of patients with dementia]. / La fin de vie du dément.

The end of life among patients affected by dementia may occur at any stage of the disease. It has an influence on care, nursing team and family. Death usually results from associated pathologies, mainly cardio-vascular and infectious diseases. Pain must be carefully searched for because its expression is altered by dementia. The measurement of pain is based on behavior scales such as the Doloplus 2 scale. End-of-life care for demented patients leads to many ethical questions, specific to palliative situations. Medical decisions can be difficult to take because both excessive care and lack of must be avoided. Nursing and relation-care must be perfect, even when the patient no longer communicates. Families also need assistance. Mobile palliative care teams are useful. The most important thing is to keep the value of caring.

Spontaneous osteoporotic fractures of the sacrum causing neurological damage. Report of three cases.

Although osteoporotic fractures of the sacrum seem to be a well-known entity, their associated rate of neurological complications has not been assessed in the literature. The authors report three such cases of nerve root compromise in elderly women and conduct a literature review. Based on their review, they estimate the incidence to be approximately 2%. The true incidence is probably higher because many case reports provide only scant information on symptoms; furthermore, sphincter dysfunction and lower-limb paresthesias are the most common symptoms and can readily be overlooked or misinterpreted in elderly patients with multiple health problems. The neurological manifestations were delayed in some cases. A full recovery is the rule. The characteristics of the sacral fracture are not consistently related with the risk of neurological compromise. In most reviewed cases the authors found no displacement and in many the foramina were not involved. The pathophysiology of the neurological manifestations remains unclear. The authors suggest that patients with sacral osteoporotic fractures should be carefully monitored for neurological manifestations.