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Background: Mental health in the older adults represents a public health issue, especially depression and suicide, and even more in the Brittany French region. Community Mental Health Centers (CMHC) are the front-line French psychiatric healthcare organizations, but the number, characteristics and trajectories of the older adults consulting there for the first time are unknown., Method: An exhaustive cross-sectional study from medical records about first-time consultants in any CMHC of the Guillaume Régnier Hospital Center in 2019, and quantifying and describing the 65 and over ones according to socio-demographic, clinical, geographic and trajectory criteria., Results: This population represents 9.7% of all first consulting in CMHCs. We can note that 70.5% are female, 46.8% are living alone and 31.2% are widowed. These 3 rates are higher than in the general population. The main diagnosis we found is mood disorder (35.1%). Organic mental disorders are scarce (8.2%). Most people are referred by a general practitioner (53.4%) or a specialist/hospital center (23.7%). The main referral at the end is to CMHC care (73.6%). Only 20.0% had a referral to non-psychiatric health professionals (GP, coordination support teams, geriatrics, other professionals). Significant differences in the referral at the end exist between 65 and 74, who are more referred to CMHC professionals, and 75 and over, who are more frequently referred to non-psychiatric health professionals. Significant discrepancies about who referred are found according to community area-type., Conclusion: These results align with the literature about known health-related characteristics and the importance of depression in the older people. They question the link with non-psychiatric professionals, and the need to structure a homogeneous care organization in psychiatric care for the older adults with trained professionals, especially for the 75 and over., (© 2024. The Author(s).)

Background: Antibiotics play a central role in infection management. In older patients, antibiotics are frequently administered subcutaneously. Ceftriaxone pharmacokinetics after subcutaneous administration is well documented, but little data are available on its safety., Methods: We compared the occurrence of adverse events associated with ceftriaxone administered subcutaneously versus intravenously in ≥75-year-old patients. We used data from a single-center, retrospective, clinical-administrative database to compare the occurrence of adverse events at day 14 and outcome at day 21 in older patients who received ceftriaxone via the subcutaneous route or the intravenous route at Rennes University Hospital, France, from May 2020 to February 2023., Results: The subcutaneous and intravenous groups included 402 and 3387 patients, respectively. Patients in the subcutaneous group were older and more likely to receive palliative care. At least one adverse event was reported for 18% and 40% of patients in the subcutaneous and intravenous group, respectively (RR = 2.21). Mortality at day 21 was higher in the subcutaneous route group, which could be linked to between-group differences in clinical and demographic features., Conclusions: In ≥75-year-old patients, ceftriaxone administered by the subcutaneous route is associated with less-adverse events than by the intravenous route. The subcutaneous route, which is easier to use, has a place in infection management in geriatric settings., (© 2024 The American Geriatrics Society.)

Alteration of the general state of health is a frequent clinical situation as reason for hospital admission of older adults, although there is no consensus on criteria of the diagnostic approach. Our objective was to study whether thorax, abdomen and pelvis tomography is useful for the diagnosis and determination of a specific care pathway for hospitalized patients over 80 years old with alteration of the general state without identified clinical explanation. retrospective observational monocentric study at a French University Hospital, with the inclusion of all hospitalized patients who had a tomography following for alteration of general state without identified clinical explanation between January 2019 and June 2020. The primary endpoint was the presence of a diagnosis on the tomography report. We studied 48 files of patients (aged 86.2 ± 3.4 years on average). Tomography provided a diagnosis in 60.4% of cases. Factors significantly related to usefulness of tomography were weight loss and duration of weight loss. Among the diagnosed patients, specific actions were taken for 86.2% of them. Our study suggests that thoracic-abdominal-pelvic tomography is useful to examine the alteration of general state in older patients without identified clinical explanation, particularly for those presenting with unintentional weight loss. That suggests that it is probably preferable to use the correct symptoms description instead of alteration of general state.

Background: Rhabdomyolysis is a common condition in older adults, often associated with falls. However, prognostic factors for rhabdomyolysis have mainly been studied in middle-aged populations., Objective: To test the hypothesis that age influences rhabdomyolysis prognostic factors., Methods: This retrospective single-center observational study included all patients with a creatine kinase (CK) level greater than five times normal, admitted to Rennes University Hospital between 2013 and 2019. The primary endpoint was 30-day in-hospital mortality rate., Results: 343 patients were included (median age: 75 years). The mean peak CK was 21,825 IU/L. Acute renal failure occurred in 57.7% of the cases. For patients aged 70 years and over, the main etiology was prolonged immobilization after a fall. The 30-day in-hospital mortality rate was 10.5% (23 deaths). The Charlson score, number of medications and CK and creatinine levels varied according to age. Multivariate analysis showed age to be a factor that was associated, although not proportionally, with 30-day in-hospital mortality., Conclusion: Factors influencing rhabdomyolysis severity were not randomly distributed according to age. The term rhabdomyolysis encompasses various clinical realities and is associated with different mechanisms. More research is needed to better understand the physio-pathological and prognostic factors of rhabdomyolysis, especially in older adults., (© 2024. The Author(s).)

The practice of telemedicine in nursing homes is a solution to improve the quality of care for residents. Its application also seems to be beneficial for the professionals involved, but it faces obstacles. The objective of this study is to explore the effects of the implementation of teleconsultations in nursing homes on the professional practices of the stakeholders involved. A qualitative focus group study was conducted with professionals involved in the implementation of teleconsultations. The data was analyzed using an inductive approach similar to grounded theory. The 18 participants included in the study were unanimous and consensual about the benefits of telemedicine. They observed changes in work relationships, particularly the key role of caregivers in coordinating care. However, they feared a deterioration in doctor-patient relationships. The practice of telemedicine was considered time-consuming, which could hinder its dissemination. No general practitioner participated in this study, showing they had reservations about the practice. The Covid-19 pandemic had an impact on the development of teleconsultations within the institutions involved. Telemedicine is acclaimed by the nursing homes teams and the doctors required, particularly through the effects on training and the added value it can bring to their practice. Telemedicine also allows to provide care that is otherwise not available. However, the care process needs to be simplified. In addition, there are obstacles to the involvement of general practitioners, which should be studied in order to optimize the coordination of care for the residents of the nursing homes.

The use of telemonitoring solutions via wearable sensors is believed to play a major role in the prevention and therapy of physical weakening in older adults. Despite the various studies found in the literature, some elements are still not well addressed, such as the study cohort, the experimental protocol, the type of research design, as well as the relevant features in this context. To this end, the objective of this pilot study was to investigate the efficacy of data-driven systems to characterize older individuals over 80 years of age with impaired physical function, during their daily routine and under unsupervised conditions. We propose a fully automated process which extracts a set of heterogeneous time-domain features from 24-hour files of acceleration and barometric data. After being statistically tested, the most discriminant features fed a group of machine learning classifiers to distinguish frail from non-frail subjects, achieving an accuracy up to 93.51%. Our analysis, conducted over 570 days of recordings, shows that a longitudinal study is important while using the proposed features, in order to ensure a highly specific diagnosis. This work may serve as a basis for the paradigm of future monitoring systems., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Abbas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Malnutrition is related to poor outcomes. Food intake semi-quantitative assessment is helpful for malnutrition screening. Aims: to assess maintenance over one month of one-day semi-quantitative assessment of food intake (primary aim) and its performance in diagnosing malnutrition (secondary aim) in older people living in a nursing home. Food portions consumed at lunch and dinner were measured during 20 days by the Simple Evaluation of Food Intake (SEFI) ® assisted by photography (SEFI ® -AP) in 70 residents. Nutritional status was assessed in each patient during the first week of food intake monitoring according to Global Leadership Initiative on Malnutrition criteria. Food intake was decreased, i.e., SEFI ® -AP < 7, in 39% (n = 27/73) of patients. According to the methods, 36 to 48% (n = 25 to 33/73) of patients had malnutrition, and 6 to 37% (n = 4 to 25/73) sarcopenia. According to a generalized linear model on ranks with repeated measures, the SEFI ® -AP medians of lunch ( p = 0.11) and means of lunch and dinner ( p = 0.15) did not vary over time. Day 3 SEFI ® -AP anticipated decreased food intake from days 4 to 20, with a sensitivity of 78% (95% confidence interval (CI), 62-94), a specificity of 30% [95%CI, 17-44] and positive and negative predictive values of 41% [95%CI, 28-55] and 68% [95%CI, 48-89]. The performance of SEFI ® -AP for diagnosis of malnutrition using calf circumference <31 cm as a phenotypic criterion was correct: area under the curve = 0.71 [95%CI, 0.59-0.83]. SEFI ® -AP sensitivity was better if ≤9.5 than <7, and inversely for specificity. The food intake of older people living in nursing homes is stable over one month. One-day SEFI ® -AP correctly anticipates food intake during the following month and predicts diagnosis of malnutrition. Any decrease in food intake should lead to suspect malnutrition.

Background: Nursing home (NH) residents accounted for half of the deaths during the 2020 spring wave of the coronavirus disease 2019 (COVID-19) epidemic in France. Our objective was to identify structural and managerial factors associated with COVID-19 outbreaks in NHs., Methods: We conducted in July 2020 a retrospective study by questionnaire addressed to NH directors in the Brittany region of France. The questions related to structural characteristics of the establishment, human resources, and crisis management decisions. The primary endpoint was the occurrence of at least one confirmed case of COVID-19 among residents between March 1, 2020 and May 31, 2020. The secondary endpoint was total mortality during this period. We used multivariate regressions to identify factors associated with these outcomes., Results: Responses were collected from 231 NHs hosting 20,881 residents, representing a participation rate of 47%. In 24 (10%) NHs, at least one resident presented confirmed COVID-19. NHs often implemented stringent protective measures, with 65% of them choosing to confine residents to their rooms. In multivariate analysis, factors associated with a reduced risk of case occurrence were in-room meal service, early ban of family visits, and daily access to an outdoor space. No association was found between mortality and the factors studied. Our results show an early and strict implementation of lockdown measures, with good epidemiological results in a context of shortage of personal protective equipment (PPE) and non-vaccination. Nevertheless, it raises ethical questions concerning respect of residents' wellbeing and rights., Conclusion: Cessation of communal dining seems to be the main measure likely to be effective in preventive terms. It does not seem that room lockdown and cessation of group activities should be recommended, particularly if mask wearing is possible., (© 2022 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Workplace violence is frequent, especially in long-term care, but often unreported., Aims: The aim of this study is to identify workers experiences and coping strategies when they face physical aggression from residents and assess the value of incident reports for violence follow-up., Methods: This mixed method study is based on incident reports collected over 3 years from two different long-term care geriatric facilities in France and thematic analysis of 20 semi-structured interviews of nurses and nursing assistants., Results: The reported frequencies of physical aggression among respondents range from none to daily aggression. Only 76 incident reports were submitted. Aggressions were under-reported by caregivers who often felt guilty for not having avoided them. Coping strategies included banalization and seeking support from colleagues. Incident reports can constitute a warning signal for the management team but are not a reliable tool for workplace violence follow-up., Conclusions: Our study emphasizes the complexity of workplace violence prevention in long-lerm care settings. Proposals can be formulated to train and support caregivers, but a shift from a task-oriented organisation to a patient-centred approach seems necessary to reduce violence., Implications for Nursing Management: Situations to be reported should be better defined, aggression reporting encouraged and judgmental attitudes toward reports discouraged., (© 2022 The Authors. Journal of Nursing Management published by John Wiley & Sons Ltd.)

Background: Older patients often experience adverse drug events (ADEs) after discharge that may lead to unplanned readmission. Medication Reconciliation (MR) reduces medication errors that lead to ADEs, but results on healthcare utilization are still controversial. This study aimed to assess the effect of MR at discharge (MRd) provided to patients aged over 65 on their unplanned rehospitalization within 30 days and on both patients' experience of discharge and their knowledge of their medication., Methods: An observational multicenter prospective study was conducted in 5 hospitals in Brittany, France., Results: Patients who received both MR on admission (MRa) and MRd did not have significantly fewer deaths, unplanned rehospitalizations and/or emergency visits related to ADEs (OR = 1.6 [0.7 to 3.6]) or whatever the cause (p = 0.960) 30 days after discharge than patients receiving MRa alone. However, patients receiving both MRa and MRd were more likely to feel that their discharge from the hospital was well organized (p = 0.003) and reported more frequently that their community pharmacist received information about their hospital stay (p = 0.036)., Conclusions: This study found no effect of MRd on healthcare utilization 30 days after discharge in patients over 65, but the process improved patients' experiences of care continuity. Further studies are needed to better understand this positive impact on their drug care pathway in order to improve patients' ownership of their drugs, which is still insufficient. Improving both the interview step between pharmacist and patient before discharge and the transmission of information from the hospital to primary care professionals is needed to enhance MR effectiveness., Trial Registration: NCT04018781 July 15, 2019., (© 2022. The Author(s).)

There is a consensus that the use of comprehensive geriatric assessment (CGA) is good clinical practice for older patients with solid tumors or hematological malignancies. To be complete, a CGA must include a geriatric assessment and an intervention plan. According to the SIOG consensus, a CGA should assess several domains: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and the presence of geriatric syndromes. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients in each domain mentioned in the SIOG consensus. An online search of the PubMed database was performed using predefined search algorithms specific for each domain of the CGA. Eligible articles had to have well-defined interventions targeting specific domains of the CGA. We screened 1864 articles, but only a few trials on single-domain interventions were found, and often, these studies involved small groups of patients. This review highlights the scarcity of published studies on this topic. The specific impacts of CGA-based interventions have not yet been demonstrated. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain. New studies are necessary in multiple care contexts, and innovative designs must be used to balance internal and external validity. An accurate description of the intervention and what "usual care" means will improve the external validity of such studies.

Objective: The main objective was to assess the feasibility of the trigger tool method for the retrospective detection of adverse drug reactions (ADRs) in the Rennes University Hospital. The secondary objective was to describe the performance of the method in terms of positive predictive values (PPVs) and severity or preventability of ADRs., Methods: Using the Rennes University Hospital clinical data warehouse, pharmacovigilance experts performed a retrospective review of a random sample of 30 inpatient hospital medical records per month using the triggers "fall" and "delirium" to identify related ADRs among patients 65 years and older in 2018 in the geriatrics department. Using the Z test, we compared the proportion of medical records with a positive (identified) trigger related to an ADR, which were reviewed within 20 minutes using the reference of 50% reviewed within 20 minutes., Results: Among the 355 medical records reviewed, 222 had at least 1 trigger and 98 at least 1 related ADR. Among the 222 positive trigger medical records, 99.6% were reviewed in under 20 minutes (P < 0.001). The pharmacovigilance assessment took 3 months. The PPVs reached 53.9% (46.0%-61.7%) for falls and 21.0% (14.3%-27.5%) for delirium. Among the ADRs, 80% were serious and 53% were preventable., Conclusions: Given the low PPV of the triggers used and the considerable need for technical and human resources, the trigger tool method cannot be used as a routine tool at the pharmacovigilance center. However, it could be implemented occasionally for specific purposes such as monitoring the impact of risk minimization measures to prevent ADRs., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: We analyze here major changes over the last decade in the French healthcare system for older people, in terms of the integrated care concept., Policies: During this period, the major theme of public policies was "care coordination." Despite some improvements, the multiplication of experimental programs and the multiplicity of stakeholders distanced the French healthcare system from an integrated care model. Professionals and organizations generally welcomed these numerous programs. However, most often, the programs were insufficiently implemented or articulated, notably at a clinical level, because of the persistence of a high level of fragmentation of governance, despite the creation of regional health agencies 10 years ago. The COVID-19 crisis has highlighted this fragmentation. Moreover, we still lack data on the impact of these programs on people's health trajectories and personal experiences., Conclusion: The French healthcare system seems more fragmented in 2020 than in 2010, despite improvements in the culture of professional collaboration. The future health reform is an opportunity to capitalize upon this progress and to implement "integrated care." This implies a strong and continuous national leadership in governance and change management., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2021 The Author(s).)

Background and Objective: E-health is a growing research topic, especially with the expansion of the Internet of Things (IoT). Miniaturized wearable sensors are auspicious tools for biomedicine and healthcare systems. In this paper, we present D-SORM, a sensor fusion-based digital solution intended to assist clinicians and improve their diagnosis by providing objective measurements and automatic recognition. The aim is to supply an interface for remote monitoring to the medical staff., Methods: D-SORM platform estimates the wearable device attitude based on its acquired data, and visualizes it in real-time using a graphical user interface (GUI). It also integrates two modules which serve two different medical applications. The first one is arm tele-rehabilitation, where sessions are done online. The practitioner gives the instructions while wearing the device, and the patient has to reproduce the gestures. A processing unit is dedicated to compute statistical features and calculate the success rate. The second one is human motion tracking for elderly care. A novel machine learning architecture is proposed, based on feature fusion, to predict the activities of daily living., Results: The rehabilitation mechanism was tested under supervised conditions, by performing a set of movements. D-SORM provides extra information and objective measurements, thus facilitates the diagnosis of clinicians. The human activity recognition is also validated using a public dataset. With D-SORM, an efficiency ranging from 97.7% to 99.65% is ensured under unsupervised conditions., Conclusions: The proposed design constitutes a digital clinical tool for medical teams allowing remote health monitoring. It overcomes geographical barriers while providing faster and highly accurate assessment., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: This study aims to develop and validate a simple score to estimate survival in the older population suffering from malignant hemopathies., Methods: We prospectively recruited 285 patients, aged ≥65 years, admitted to receive chemotherapy. At inclusion, a geriatric assessment was performed. Cox proportional hazards models were performed to assess correlations between vulnerabilities and one-year survival. We developed a frailty score, HEMA-4, based on the most powerful prognostic factors. It was externally confirmed with an independent cohort., Results: In the development cohort, 206 patients were evaluable. Mean age was 76 years (range 65-90). The HEMA-4 score was created based on four independent predictive factors for survival: cognitive impairment (MMSE<27), comorbidities (≥2 on Charlson comorbidity index), CRP (≥10 mg/L) and low albumin level (<35 g/L). The population was stratified into three groups: good prognosis (score = 0-1, n = 141), intermediate prognosis (score = 2, n = 37) and poor prognosis (score = 3-4, n = 28). Their respective one-year survival was 74%, 51% (HR = 2.30; 95% CI =1.31-4.05; p < 0.01) and 36% (HR = 3.95; 95% CI =2.23-6.98; p < 0.01). In the validation cohort (n = 25), the one-year survival was 78% in the good prognosis group (n = 9) and 50% in the intermediate prognosis group (n = 6). The poor prognosis group had a median survival of four months in the development cohort and six months in the validation cohort (n = 10)., Conclusion: The HEMA-4 score is a simple score that combines cognitive impairment, comorbidities, inflammation and low albumin level. Our data suggest that it predicts survival among older patients suffering from malignant hemopathies referred to receive chemotherapy regardless of their chronological age., Competing Interests: Declaration of competing interest None., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Fall detection systems are designed in view to reduce the serious consequences of falls thanks to the early automatic detection that enables a timely medical intervention. The majority of the state-of-the-art fall detection systems are based on machine learning (ML). For training and performance evaluation, they use some datasets that are collected following predefined simulation protocols i.e. subjects are asked to perform different types of activities and to repeat them several times. Apart from the quality of simulating the activities, protocol-based data collection results in big differences between the distribution of the activities of daily living (ADLs) in these datasets in comparison with the actual distribution in real life. In this work, we first show the effects of this problem on the sensitivity of the ML algorithms and on the interpretability of the reported specificity. Then, we propose a reliable design of an ML-based fall detection system that aims at discriminating falls from the ambiguous ADLs. The latter are extracted from 400 days of recorded activities of older adults experiencing their daily life. The proposed system can be used in neck- and wrist-worn fall detectors. In addition, it is invariant to the rotation of the wearable device. The proposed system shows 100% of sensitivity while it generates an average of one false positive every 25 days for the neck-worn device and an average of one false positive every 3 days for the wrist-worn device.

Since 2017, geriatric medicine has been available as a postgraduate specialty to French year 7 medical students. We investigated the incentives of the 171 French medical students who opted for geriatric medicine as a postgraduate specialty subsequent to year 6 national qualifying examinations in 2017. A prospective quantitative survey-based study was conducted by means of a questionnaire compiled online and sent by email between December 2017 and May 2018. The questionnaire comprised 43 questions, including 14 single or multiple choice questions, 28 scaled questions evaluating factors of influence using a 5-point Likert scale, and one open-ended contingency question. Of the 171 students, 139 responses were received. The national response rate to this questionnaire was 81.2%. One hundred fourteen students (82.6%) had previous experience of training in geriatric medicine, which for 95 (84.0%) students took place between years 3 and 6 of medical training. This training influenced the choice of 102 respondents (90.2%). Factors reported as having exerted a strong or very strong influence were in particular the rewards of working with older adults; positive personal encounters with older adults in the past; the appeal of interprofessional teamwork; the challenge of cases involving complex diagnostic and therapeutic decisions; the challenge of patients with chronic conditions. The present study is the first to focus on the reasons why French students choose to specialise in geriatric medicine. The results emphasise the importance of training programs in geriatric medicine to promote enthusiasm for this specialty., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Frailty in old age is defined as the individual intrinsic susceptibility of having bad outcomes following a health problem. It relies on sarcopenia, mobility and activity. Recognizing and monitoring a range of physical activities is a necessary step which precedes the analysis of this syndrome. This paper investigates the optimal tools for this recognition in terms of type and placement of wearable sensors. Two machine learning procedures are proposed and compared on a public dataset. The first one is based on deep learning, where feature extraction is done manually, by constructing activity images from raw signals and applying convolutional neural networks to learn optimal features from these images. The second one is based on shallow learning, where hundreds of handcrafted features are extracted manually, followed by a novel feature selection approach to retain the most discriminant subset.Clinical relevance- This analysis is an indispensable prerequisite to develop efficacious way in order to identify people with frailty using sensors and moreover, to take on the challenge of frailty prevention, an actual world health organization priority.

The COVID-19 epidemic that started in November in China became a national epidemic from March 16, 2020 with the declaration of population containment in order to reduce the spread of the virus in France. From March 17 to March 27, 2020, the monitoring unit of the French society of geriatrics and gerontology decided to conduct a survey to analyze the implementation of the mobilization of geriatric units, given that this epidemic had shown that it resulted in excess mortality mainly among the elderly. The survey was able to bring together the response of 34 services, nine of which were located in a high epidemic cluster zone. Dedicated acute geriatric units for patients infected with COVID-19 were present in eight facilities, only outside the cluster zones. Nine geriatric follow-up and rehabilitation services were dedicated, an additional telemedicine activity concerned 35% of the facilities, and family listening and tablet communication facilities concerned 36% of the facilities. This survey is a snapshot of an initial moment in the epidemic. It provides an opportunity to describe the context in which this epidemic occurred in terms of geriatric policy, and to assess the responsiveness and inventiveness of these services in meeting the needs of the elderly.

Background: Medication reconciliation (MR) is a systematic and comprehensive review of all medication a patient is taking. In this study, a discharge medication sheet (DMS) is given to patients upon discharge: it contains discharge prescription and any changes made to admission prescription with justifications. The aim of this study is to explore general practitioners' (GP) perceptions of this DMS in order to suggest improvements., Methods: In this prospective observational study, individual semi-directed interviews were conducted with GPs who received a DMS following the hospitalization of one of their patients. Answers were grouped by topic and subjected to descriptive analysis., Results: Between October 2015 and July 2016, 33 DMS were completed. Among the 33 GPs, 16 had seen their patients with their DMS and agreed to be interviewed. The DMS was very appreciated and improved care pathway. However, this study highlights transmission difficulties for this sheet, attributed in particular to a lack of information of practitioners and patients and to the paper format, which appears to be inadequate. The main suggested improvement is real-time transmission of the DMS via email., Conclusion: Practitioners' opinion is in favor of the use of a DMS. Certain specific points need to be improved, such as better information of practitioners and patients, and transmission of the DMS via a secure email system., (Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Objective: Healthcare centres (CDS) are mono- or multidisciplinary ambulatory healthcare services staffed by salaried personnel, designed to facilitate access to affordable healthcare. New healthcare centres have been created over recent years in order to attract general practitioners (GP). In order for healthcare centres to constitute a solution to physician shortages, the motivations of doctors working in these centres must be defined in order to determine whether it is possible to extend this process. This study tried to determine the reasons why physicians choose this type of practice and their motivations., Methods: A qualitative study based on semi-structured interviews was conducted with GPs working in health centres in the Brittany and Pays de la Loire regions. Thematic analysis was used to study the data obtained., Results: Twelve GPs were interviewed. The main incentives were salary and benefits, and good working conditions. Often informal professional exchanges were considered to be particularly important. Other motivations were also revealed during the interviews: physicians emphasized the service provided to the population, the accessibility of healthcare centres, and their feeling of being able to provide good quality of care., Conclusion: The motivations of GPs working in healthcare centres can be classified as external and internal. In order to extend the healthcare centre model and recruit and retain physicians, administrators, in addition to providing good working conditions, should also develop public health actions, and improve their communication to raise awareness about these centres.

Background: The French National Alzheimer Plan 2008-2012 created specialized Alzheimer teams, which provide up to 15 sessions of cognitive rehabilitation in the patient's home for 3 months. Sessions are conducted by an occupational therapist and a gerontological nursing assistant., Objectives: As the patient's experience is one determinant of successful implementation, we explored the usefulness of these teams as viewed by the patient and his or her main caregiver., Methods: Thirteen patients and their caregiver, previously assisted by a specialized Alzheimer team, were individually given semi-structured interviews (n = 26, duration 20 to 180 minutes)., Results: Our study showed that although patients and caregiver had no initial expectations, most of them appreciated the support provided by the specialized Alzheimer teams. Patients valued the "human" component, and favored interventions that improved quality of life over those intended to maintain functional capacities. Caregivers observed improved mood and behavior in patients. Those involved in sessions felt empowered by contact with a specialized Alzheimer team. We discuss how patients' and caregivers' feedback influenced the implementation process through comprehensive use of the five dimensions of the RE-AIM framework., Conclusion: Whereas intervention by specialized Alzheimer teams was largely accepted by health care professionals, patients, and caregivers, its effectiveness is questioned in view of its deviation from the evidence-based model. Interviews with patients and caregivers shed light on some reasons for this deviation, as what they value in the intervention differs from the functional focus of the model.

Background: Comprehensive geriatric assessment (CGA) is a multi-dimensional, multi-disciplinary diagnostic and therapeutic process conducted to determine the medical, mental, and functional problems of older people with frailty so that a co-ordinated and integrated plan for treatment and follow-up can be developed. This is an update of a previously published Cochrane review., Objectives: We sought to critically appraise and summarise current evidence on the effectiveness and resource use of CGA for older adults admitted to hospital, and to use these data to estimate its cost-effectiveness., Search Methods: We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 5 October 2016; we also checked reference lists and contacted study authors., Selection Criteria: We included randomised trials that compared inpatient CGA (delivered on geriatric wards or by mobile teams) versus usual care on a general medical ward or on a ward for older people, usually admitted to hospital for acute care or for inpatient rehabilitation after an acute admission., Data Collection and Analysis: We followed standard methodological procedures expected by Cochrane and Effective Practice and Organisation of Care (EPOC). We used the GRADE approach to assess the certainty of evidence for the most important outcomes. For this update, we requested individual patient data (IPD) from trialists, and we conducted a survey of trialists to obtain details of delivery of CGA. We calculated risk ratios (RRs), mean differences (MDs), or standardised mean differences (SMDs), and combined data using fixed-effect meta-analysis. We estimated cost-effectiveness by comparing inpatient CGA versus hospital admission without CGA in terms of cost per quality-adjusted life year (QALY) gained, cost per life year (LY) gained, and cost per life year living at home (LYLAH) gained., Main Results: We included 29 trials recruiting 13,766 participants across nine, mostly high-income countries. CGA increases the likelihood that patients will be alive and in their own homes at 3 to 12 months' follow-up (risk ratio (RR) 1.06, 95% confidence interval (CI) 1.01 to 1.10; 16 trials, 6799 participants; high-certainty evidence), results in little or no difference in mortality at 3 to 12 months' follow-up (RR 1.00, 95% CI 0.93 to 1.07; 21 trials, 10,023 participants; high-certainty evidence), decreases the likelihood that patients will be admitted to a nursing home at 3 to 12 months follow-up (RR 0.80, 95% CI 0.72 to 0.89; 14 trials, 6285 participants; high-certainty evidence) and results in little or no difference in dependence (RR 0.97, 95% CI 0.89 to 1.04; 14 trials, 6551 participants; high-certainty evidence). CGA may make little or no difference to cognitive function (SMD ranged from -0.22 to 0.35 (5 trials, 3534 participants; low-certainty evidence)). Mean length of stay ranged from 1.63 days to 40.7 days in the intervention group, and ranged from 1.8 days to 42.8 days in the comparison group. Healthcare costs per participant in the CGA group were on average GBP 234 (95% CI GBP -144 to GBP 605) higher than in the usual care group (17 trials, 5303 participants; low-certainty evidence). CGA may lead to a slight increase in QALYs of 0.012 (95% CI -0.024 to 0.048) at GBP 19,802 per QALY gained (3 trials; low-certainty evidence), a slight increase in LYs of 0.037 (95% CI 0.001 to 0.073), at GBP 6305 per LY gained (4 trials; low-certainty evidence), and a slight increase in LYLAH of 0.019 (95% CI -0.019 to 0.155) at GBP 12,568 per LYLAH gained (2 trials; low-certainty evidence). The probability that CGA would be cost-effective at a GBP 20,000 ceiling ratio for QALY, LY, and LYLAH was 0.50, 0.89, and 0.47, respectively (17 trials, 5303 participants; low-certainty evidence)., Authors' Conclusions: Older patients are more likely to be alive and in their own homes at follow-up if they received CGA on admission to hospital. We are uncertain whether data show a difference in effect between wards and teams, as this analysis was underpowered. CGA may lead to a small increase in costs, and evidence for cost-effectiveness is of low-certainty due to imprecision and inconsistency among studies. Further research that reports cost estimates that are setting-specific across different sectors of care are required.

Background: Blood transfusion in chronic anemia is not covered by guidelines specific to older adults. When they consider that this treatment is necessary in elderly patients, French general practitioners (GPs) contact a hospital specialist to plan a transfusion., Methods: Twenty French GPs were questioned individually regarding their approach to blood transfusion using semi-structured interviews. Each interview was recorded, typed up verbatim and then coded using an inductive procedure by theme, in a cross-over design (two researchers) in two phases: analysis and summary, followed by grouping of the recorded comments., Results: The criteria for transfusion were hemoglobin level < 8 g/dL and cardiac comorbidities. Some geriatric issues, such as cognitive disorder or dependence, were considered, either as aspects of frailty favoring transfusion or as markers of reduced life expectancy that limit care. Falls and fear of an unpleasant death from anemia prompted GPs to order blood transfusion. The patient's family provided guidance, but the patient was not routinely consulted. The specialists were rarely asked to participate in decision making. GPs' perceptions were ambivalent: they considered transfusion to be extraordinary and magical, but also pointless since its effects are transient., Conclusion: The decision to give a transfusion to an elderly patient with chronic anemia is deemed complex, but GPs seem to take it alone, sometimes guided by the patient's family. The drawing up of an advance care plan could help involve the patient in decision making.