[The supportive environment in SRH: characteristics that promote self-determination]

Hospitalization is an important stage in the life of the elderly. All too often, this experience is accompanied by both physical and psychological decline. Based on self-determination theory, the aim was to qualitatively characterize support for self-determination in follow-up care and rehabilitation services (behaviours and attitudes of healthcare professionals, and patients' perception of them).

[Sexuality among the elderly: understanding the weight of stereotypes]

Sexuality is an integral part of health and accompanies human beings throughout their lives. It contributes to well-being and improves quality of life. The social representations conveyed by Western society modulate sexuality and can play a decisive role in the expression of seniors' sexuality.

[A post-Covid-19 approach to loneliness and isolation in old age]

The Covid-19 pandemic has accentuated loneliness and isolation among the elderly, affecting their physical and mental health. The post-Covid-19 approach needs to strengthen early detection of loneliness and isolation while promoting social engagement.

[Preventing emotional disorders in the elderly with programs based on cognitive-behavioral therapies]

The cognitive-behavioral approach is particularly well-suited to older people who are looking for a short-term therapeutic solution to many emotional problems, without necessarily resorting to psychotropic drugs. One of the major advantages of this type of psychological treatment is that it helps seniors develop coping skills that can be beneficial in both the short and long term. However, some adjustments are sometimes necessary to achieve this goal.

[Better identifying and understanding post-traumatic stress disorder in the elderly]

Post-traumatic stress disorder (PTSD) is particularly common in the elderly, including those with cognitive impairments. We need to stress the importance of early detection to better understand the specific signs of this disorder in the elderly. Psychotherapies such as cognitive-behavioral therapy and Eye Movement Desensitization and Reprocessing are being explored for their effectiveness and adaptability with the elderly. Identifying post-traumatic stress disorder should be a shared responsibility, for the mental health of the elderly.

[Meleis theory: a tool for better understanding city-hospital transitions]

Meleis' theory: a tool for better understanding the hospital/town transitions. The purpose of this article is to provide a critique of the transition theory conceptualized by Afaf Meleis. A clinical vignette is used to highlight the strengths and limitations of the theory in the care of elderly people returning home after hospitalization for heart failure. The discussion is based on Peggy Chinn and Maeona Kramer's method of critical analysis.

[Addictions in the elderly: the viewpoint of an IPA working in EMPSA]

Many elderly people live well and at home, but some require somatic and psychiatric care. Mobile psychiatric teams for the elderly are called upon to intervene with people aged 65-70 and over who are experiencing psychological distress. Among senior citizens, addictive disorders are very common, and are associated with psychiatric and geriatric co-morbidities. Alcohol, tobacco and benzodiazepine use disorders require holistic, individualized care, based on identification, prevention and referral, as well as training and coordination of professionals and caregivers.

[The nurse and psychotic disorders in neurocognitive diseases]

Psychotic disorders, such as delusions and hallucinations, cause stress for individuals, their caregivers and healthcare professionals. Attitudes, perceived as behavioral tendencies, in the presence of these symptoms, can either alleviate or exacerbate them. How should we position ourselves in the presence of these disorders? What are the most effective attitudes for calming day-to-day situations?

Perceived Quality of Online Music Therapy Sessions by Older Adults Aging at Home

Online delivery is new to the field of music therapy (MT). This research investigated older adults' perceived quality of MT online by certified music therapists. In this feasibility study, applying both process and outcome assessments, nine older adults volunteered to participate. Zoom was used, and a virtual music therapy (VMT) kit was developed as a resource. Surveys and observed technical difficulties revealed that perceived quality varied slightly by level of technical difficulty experienced; however, overall mean perceived quality was 7.2 out of 9. Post-study interviews revealed three main themes: (a) individual experiences with VMT, (b) individuals' suggestions for further development of VMT sessions, and (c) individuals' personal outcomes from VMT sessions. Participants reported overall positive experiences with VMT. Despite a slight decline in perceived quality when more technical difficulties were present, each participant reported a desire for more sessions, and they would recommend it to others.

[Se familiariser au transport en commun par l'apprentissage d'outils de planification technologiques : effets d'un programme co-construit avec des partenaires de la communauté auprès d'aînés vivant avec des incapacités]

Cette étude visait à documenter comment un programme de familiarisation à l'utilisation du transport en commun influence l'expérience de mobilité des aînés. Ce programme a été co-construit avec des partenaires clés afin d'y inclure l'usage d'outils de planification technologiques et un accompagnement personnalisé tenant compte des incapacités des participants. Une étude de cas multiples (n = 7) a été menée selon une approche mixte convergente, combinant des méthodes qualitatives (p. ex., entrevues) et quantitatives (p. ex., cartes à puces). Les participants qui ont bénéficié davantage de la formation ont rapporté une meilleure connaissance du transport en commun et une plus grande confiance à utiliser l'autobus. Ils ont aussi effectué plus de sorties. Nos résultats suggèrent d'intégrer une destination « signifiante » et l'apprentissage d'outils de planification non technologiques à la formation pour en assurer la compatibilité avec les besoins et le niveau de littératie numérique des aînés. De futures études aideront à favoriser cette option de transport en amont de la perte du permis de conduire.

[The nurse, recurrent cries]

Recurrent screaming and vocal agitation complicate geriatric and psychogeriatric care. They are among the psychobehavioral symptoms that accompany neurocognitive diseases. Reputedly difficult to manage, they require a comprehensive pharmacological and non-pharmacological approach. How can the care team deal with these disorders in the absence of a doctor?

[Supporting the life course of the elderly at home]

The management and support of dependency is an area of expertise deployed within care facilities and medico-social establishments. At home, however, the needs are equally great, with a high risk of caregiver burnout. A nurse working in the Occitanie region of France shares her experience of implementing a cooperation protocol entitled "Intervention of liberal nurses in the home to diagnose and initiate care for frail elderly subjects".

[Psychotropic drugs in the elderly]

The use of psychotropic drugs in the elderly is frequent, and can be problematic due to the risks associated with their inappropriate use and adverse effects. It is essential to adopt a cautious, individualized approach to prescribing psychotropic drugs, regularly assessing their efficacy and considering other non-drug approaches where possible. Collaboration between healthcare professionals and patients can contribute to more appropriate use of these drugs in the elderly.

[Two-way teaching of the elderly in the context of heart failure]

In Canada, heart failure (HF) is the second leading cause of hospitalization among the elderly. Heart failure could be improved by the teach-back approach. There are no articles in the French literature describing this educational approach, especially in the context of elderly people living with HF. The aim of this article is to provide French-speaking healthcare professionals, including nurses, with knowledge about this approach, that also includes a specific component on self-care in HF.

[Technology at the heart of vulnerability]

The ubiquitous presence of the elderly in care services raises questions about the evolution and limits of new techniques and technologies in the care relationship. We carried out a cross-sectional study in a geriatric ward, using parallel patient and carer questionnaires to assess how each felt about innovations, analyze their opportunities and evaluate their dangers in care provision.

[The place of IPA in the follow-up of elderly patients with acute myeloid leukemia]

Since 2020, a promising new treatment has been offered to elderly patients with acute myeloid leukemia. However, adverse events complicate their treatment, which is performed on an outpatient basis. The advanced practice nurse could provide assistance in the follow-up of these elderly and polypathological patients, who require regular clinical and biological monitoring, adaptation of their therapies and the establishment of city-hospital coordination likely to guarantee their maintenance at home.

[Geriatric restraints as a last resort]

Relying on the remaining abilities of elderly people at home, in hospital or in residential care facilities for the dependent elderly, allows them to maintain their autonomy and avoid restraints. If geriatric caregivers observe an elderly person who is agitated, at risk of falling, or putting themselves in danger, they suggest strategies to calm the person. As a last resort, physicians may prescribe an appropriate restraint. This is a deprivation of liberty. The multidisciplinary evaluation every twenty-four hours of this care is based on the principle of beneficence by re-evaluating the prescribed device.

["Assure" program, to improve the management of emergency situations in Ehpad]

The Assure approach (improvement of emergency care) is a project designed to improve emergency care for the 63,000 residents of homes for the dependent elderly (Ehpad) in the Ile-de-France region. By reinforcing the skills of caregivers in emergency situations and facilitating collaboration between care providers, the Assure approach is mobilizing, alongside all the Ehpad in the Ile-de-France region over a period of two years, the emergency medical assistance services, emergency physicians, mobile geriatric teams and nursing and care assistant training institutes.

[The ethical charter for the elderly in the daily life of GHSIF care providers]

The elaboration of a charter of ethics and support for the elderly, drawn up by Fabrice Gzil, places different notions of care at the center of the care of the elderly for those working in the field at the Groupe hospitalier sud Île-de-France (GHSIF). The 10 points presented are implemented on a daily basis. By highlighting these actions, the charter can be appropriated and brought to life in order to provide support adapted to the collective and individual needs of the elderly patients and residents.

[Emergency room transfers for residents of the 16th arrondissement of Paris]

Access to care for the population residing in residential facilities for dependent elderly people (Ehpad), i.e. 600,000 people in France in 2019, is a major public health issue. Description of the characteristics and pathways of the residents of Ehpad transferred to the emergency department (SAU) in the Paris 16th district.

[Screening for frailty in the elderly subject]

The identification of frailty can be done by any health professional. This assessment allows corrective measures to be taken in order to act early on reversible elements.

[Undernutrition in the elderly, a syndrome with multiple deleterious consequences]

The prevalence of undernutrition is 4-10% in elderly people living at home, 15-38% in those living in institutions. Fifty percent of hospitalized elderly are undernourished and 40% are hospitalized for the consequences of undernutrition. This is a major problem in geriatrics.

Changes in Cognition and Brain Function After 26 Weeks of Progressive Resistance Training in Older Adults at Risk for Diabetes: A Pilot Randomized Controlled Trial

OBJECTIVES

Type 2 diabetes is associated with deficits in cognition and brain health. Individuals with at least 1 risk factor for diabetes (i.e. obesity, prediabetes) already experience some neurocognitive impairment and are at risk for further decline. One way to combat these deficits is through exercise, but its is unknown whether resistance exercise can improve these functions in this at-risk group.

METHODS

This study was a pilot randomized controlled trial. Participants were 60 to 80 years of age and had prediabetes (fasting capillary glucose 6.1 to 6.9 mmol/L) and/or were overweight or obese (body mass index ≥25). Participants completed resistance training or balance and stretching exercise (control) thrice weekly for 6 months. Neuropsychological tests were used to assess cognitive ability, whereas functional magnetic resonance imaging was used to examine brain activation patterns.

RESULTS

Resistance training led to improvements in task-switching, attention and conflict resolution, as well as improved patterns of brain activation that may mimic healthy older adults.

CONCLUSIONS

Resistance exercise may serve as an effective behavioural strategy to improve neurocognition in older adults at risk for type 2 diabetes. A large-scale powered trial is needed to further explore these findings.

[Inappropriate admissions of Ehpad residents to emergency departments]

After a review of inappropriate admissions of residents of residential care facilities for the dependent elderly (Ehpad) to the emergency room, we propose ways to reduce them. They include giving the coordinating physician a clinical role, organizing continuity and permanence of care in all Ehpad, signing agreements between Ehpad and hospital for direct hospitalization and collaboration with mobile teams and geriatric hotlines, generalizing the level of medical intervention in Ehpad, and deepening the training of Ehpad caregivers in geriatrics.

[Management of congestive heart failure in the elderly after hospitalization for acute decompensation Interest of a dedicated territorial geriatric network ; the GERICCO-78 study]

AIMS

Heart failure (HF) is the leading cause of hospitalisation in the elderly in France. Early rehospitalisations are common, often through an emergency department. The aim of this study was to assess the impact of a primary care-hospital coordination network, with interventions by coordination nurses (IDEC), on the rehospitalisations after a first hospitalisation for acute decompensation in frail elderly HF patients.

METHODS

From 01/10/2019 to 01/10/2021, 237 patients aged > 75 years with frailty criteria, hospitalised in 8 departments of 5 private or public hospitals in the Yvelines Sud health territory were followed by an IDEC (hospital visit, telephone contacts, home visit(s)) within 3 months of their return home. This prospective observational study analysed the rate of consultations to the emergency room, rehospitalisations (total and for acute HF), and the number of events avoided at 90 days after discharge.

RESULTS

The mean age of the patients was 87 years, 54% were women, 68% had a left ventricular ejection fraction > 40%, and 70% had atrial fibrillation. Non-cardiac comorbidities were very frequent. At 3-month follow-up, mortality was 9.3% (22/237), only 27 patients (11.3%) consulted the emergency room for acute HF, and the rehospitalisation rate for HF was 19.8%, without difference according to left ventricular ejection fraction. A consultation to the emergency room or a rehospitalisation for heart failure could be avoided for 10% of patients.

CONCLUSION

This study suggests that a primary care-hospital coordination network with dedicated coordination nurses is useful for the management of very elderly frail patients following hospitalisation for heart failure, limiting visits to the emergency room and rehospitalisations.

[Care pathways and family caregivers]

In recent years, a number of actions have been carried out to develop assistance for caregivers in France. This assistance can be coordinated with the help of social services, which can be difficult for both the elderly person and their caregiver, for psychological reasons. If an adapted and rehabilitated care pathway is not put in place, the caregiver may be exposed to psychosocial risks.

[Depression in the elderly and the environment]

Depression in the elderly is difficult to identify because it is often masked by other pathological features. It is therefore important for everyone involved to be vigilant and to be able to ask for help from a qualified professional. The individual interacts with his or her human and material environment. The environment can be depressogenic. The quality of life of the person intervenes in the course of the depression.

[D-Nut, an experiment to better identify and prevent undernutrition in the elderly]

Approximately one in ten elderly people living at home is undernourished. Undernutrition is, among other things, a factor in loss of autonomy and hospitalization. If identified and treated early, it can be "cured". This is the principle behind the D-Nut program, which has been tested in the Pays de la Loire region. When a registered nurse (Idel) visits an elderly patient during a treatment, she can perform a nutritional test via a mobile application. Once the patient has agreed, a four- to six-month assessment and multi-professional management phase is implemented in the patient's home, coordinated by the nurse.

[Select and combine tools to assess the risk of an elderly person falling]

Falls are a major problem in the elderly population. It is important to be able to effectively estimate the risk in order to implement appropriate actions. The large number of existing tools and the sometimes divergent or contradictory data make clinical assessment of this risk difficult. A review of the literature helps to determine the most relevant methods.

[The right of elderly people in old people's homes to have a fulfilling emotional and sexual life]

The sexual life of elderly people living in residential institutions for the dependent elderly (Ehpad) is a sensitive subject that is rarely discussed. Particular difficulties sometimes arise when they have cognitive problems. Affectivity and sexuality in old people's homes must be approached with tact and maturity by the carers. Sexuality belongs to private life, but its excesses are difficult to reconcile with collective life. Some proposals can be made on ethical issues and on the relationship with residents and their families.

[Nursing expertise in wounds and healing of the elderly in complex care situations]

The appearance of a wound in the elderly has a strong impact on the somatic, functional and psycho-social aspects. It can significantly alter their quality of life. The role of the clinical nurse specialist, in partnership with the multidisciplinary team, is fundamental for a global individualized care. The construction of the therapeutic project is defined from a multidimensional evaluation of the patient and his wound.

[Caring for the patient to the end of life and beyond]

The relationship with death has evolved. Funeral rites are becoming less common, while deaths in hospital are more frequent. This societal evolution has led the hospital and the nursing staff to have to adapt and organize themselves to better support patients at the end of life and their families.

[The use of a derivative of hypnosis in care]

Polymedication leads to undesirable effects that are often deleterious for elderly people with comorbidities. Complementary non-medicinal approaches should be favored to help patients better control their pain, thus increasing their comfort and autonomy.

[Taking care of the elderly at home, the role of home care workers]

Maintaining very young or elderly, sick or handicapped people at home requires the ability to help them with the activities of daily living. Home support workers are trained to provide attention, presence and care adapted to each individual. This organization is orchestrated by personal services companies such as Maison et compagnie.

[Implementation of a support system for isolated elderly people to limit the consequences of the Covid-19 epidemic in Buenos Aires]

The Covid-19 pandemic with its associated quarantine and isolation has had a dramatic impact on the elderly. In order to mitigate this, the National University of La Plata and the Agence Universitaire de la Francophonie set up a health surveillance and early warning project for the elderly in Buenos Aires, Argentina. This interventional study, has included 1,964 people. A general health and quality of life questionnaire was completed by all participants at the beginning of the isolation, and another time a year later.

[Continuity of medication after hospitalisation in geriatric follow-up and rehabilitation care]

After one year of practice, the medication reconciliation approach in follow-up and rehabilitation care was evaluated. The aim of the activity was to identify changes in treatment (CT). Three hundred and two patients benefited from the process. Some 82.2% of drug lines had voluntary TCs at discharge and all of patients had at least one TC at discharge. What are the consequences of so many TCs and what are the levers to limit these effects?

[Sexuality of elderly people living in CHSLDs in Quebec, between neglect and recognition]

Despite the popular belief that sexuality disappears with age, research shows that it is an important focus for many people over 60. Contemporary realities observed among this population reveal real needs for affection and sexual desires that translate into various practices. This does not exclude residents of long-term care centres (CHSLD). However, a certain number of barriers to the expression of sexuality by elderly people in institutions keep the staff and the residents themselves in the perception of implicit asexuality. Since the mission of a CHSLD is to provide a temporary or permanent substitute living environment whose guiding principles relating to integrity, freedom and dignity help to prevent phenomena often associated with collective residential environments, the protection of personal spaces is a first step in recognising residents' sexual needs.

[Management of suicidal crisis in general practice: evaluation of care practices according to patient age]

Nearly 800,000 people die by suicide each year worldwide. Up to 75% of suicidal patients consulted their general practitioner in the months preceding their attempt. A study, conducted among 167 practitioners in Champagne-Ardenne in 2016-2017, aims to evaluate the practices of general practitioners in the management of suicidal crisis, particularly according to the age of the patient. It provides elements for reflection on their role in suicide prevention.

[Olfactory workshops to renew the links between scents and memory]

Smells and memories are closely linked with a particular emotional status. Most smells are imprinted in our memory from childhood. Based on this observation, a professional from the perfume industry has created olfactory workshops for residents of retirement homes. The workshops focus on well-being and the cognitive perception of odours. Testimonial.

[Step 1 screening: experimentation in Occitania with nurses and pharmacists]

Screening with the step 1 tool is the principal modality of entry into the ICOPE program. This preliminary step is particularly an initiative of primary care health professionals, who are daily caring older people. In Occitania, as part of the deployment of ICOPE program, nurses and pharmacists, were invited to integrate the step 1 in their practices. They benefited, if they wished, from a free webinar training.

[Content and application of Icope step 2: feedback from nurses]

With the ICOPE programme, the nurses received specific, theoretical and practical, training, that enabled them to broaden their field of competence. This approach has enabled them to expand and consolidate professional cooperation networks and to consolidate their, crucial, position in prevention in the broad sense of the term with the elderly. The aim of the Icope programme is to offer long-term monitoring of the senior citizen, as part of his or her life project.

[Needs and feelings of caregivers in oncogeriatrics, usefulness of a serious game]

Faced with an ageing population, carers are real allies and partners who are essential to the smooth running of the care of elderly patients. The objective of this study was to analyse their needs in oncogeriatrics, in order to verify the relevance of developing a serious game to support them. Although the need for better support for carers in oncogeriatrics was recognized, they especially value the need for human exchanges.

[Effects of make-up on mood and walking in elderly women]

The increase in longevity makes it necessary to take care of the quality of life of senior citizens. Ageing is accompanied by alterations leading to an increased risk of falling. A study conducted at the Charité Hospital in Saint-Etienne (42) showed that a cosmetic procedure with an impact on the appearance could improve the mood and the walking capacity of the senior citizen, but also have an effect on stress and immunity.

[Safe staffing and falls in hospitals, systematic review of the literature]

Safe nursing staffing and patient safety are closely related. A systematic review of the literature was carried out, comparing the number of falls in elderly inpatients in medical-surgical wards with these staffing levels. A review of scientific articles, selected through a keyword search of several electronic databases, showed a direct, although not significant, association between improved nurse staffing and a decrease in the number of falls in elderly inpatients.

[Geriatric pathways and organisation in response to the needs of EDS]

The emergency department remains the main method of admission for older people to hospital. The management of old elderly in these departments is a complex subject. It's particularities and the specificities of the evaluation of their health contribute to the difficulties of the care teams. For the elderly, a visit to the emergency room is a significant medical event in the care process that can have repercussions on their functional decline. The promotion of a geriatric culture in emergency departments is essential and can be done in different ways, but collaboration between emergency physicians and geriatricians remains essential for successful care adapted to the specific characteristics of elderly patients.

[A pragmatic approach to iatrogenic risk in the emergency room]

The links between the emergency department (ED) and drug-related harm are close. In practice, it is necessary to ask systematically if an iatrogenic accident is possible and to evaluate a new prescription carefully so as not to create iatrogenia during the visit to the emergency department. Any situation in which a nurse takes charge of an emergency room must be subject to precautions. Simple measures should be put in place during any hospitalisation of an elderly person.

[EDS and diagnosis of cardiogenic pulmonary oedema]

Acute cardiogenic pulmonary oedema in the elderly does not differ fundamentally from that seen in the young patient. Appropriate pathways must be established, with regular nursing follow-up, to enable rapid detection and treatment of episodes of acute heart failure. The paramedical team plays an essential role in liaising with families, providing nursing care and listening to the patient at the bedside.

[The power of words]

Storytelling is a medium with extraordinary powers. It is an art of speech that addresses the imagination, opens the door to memories and emotions, and brings about a "well-being" and a sense of calm. A storyteller from the association Âge d'or de France talk about her experience in residential institutions for dependent elderly people, in the open or protected sector.

[Memory(ies) at risk…]

When an elderly person suffers from severe memory problems, it is useful to look at the behaviour of those around him or her. Serious "absences" can be observed, revealing an intergenerational memory at risk.

[Storytelling and support]

Lynn Vivier-Foucart testifies here to her dual experience as a volunteer storyteller for the association Âge d'or de France and as a palliative care attendant. It is a question of transmitting and giving, of receiving and restoring that which, through natural empathy with elderly people in residential homes for the dependent elderly, can contribute, if not to awaken memories, at least to give pleasure. And to listen to the person accompanying them.