Search

Background and Aim: Hospitalizations of elderly people are responsible for psychological and physical unbalance and must be limited. The aim of the study is to determinate if there are predictive factors of hospitalizations in emergency for institutionalized patients., Patients and Method: It is a controlled study of 12 months about hospitalizations in emergency from nursing homes. A resident hospitalized in emergency has been matched with a non-hospitalized one. The residents have been matched on age, sex, GIR and nursing-home., Results: During the study, 51 subjects have been recruited and matched with 51 other non hospitalized. Residents are mainly females (88%), old (86,9±6,7 years), and disabled (GIR: 2,6±1,3). The patients who have already been hospitalized in the last six months have more risks to be hospitalized again. Pre-intercurrent events, somatic or psychological, and co-morbidities are not predictive factors of emergency admission. About 30% of patients are return to its institution after a 24-hours hospitalization., Conclusion: No medical or environmental factor predicts the hospitalization of geriatric resident. Build a process of decision should be an important factor to decreasing emergency admission.

Comprehensive geriatric assessment (CGA) is a validated method but is time consuming and must be performed by several professional. It is useful to elaborate a screening tool, which allows the elderly to CGA. The aim of this study is to validate the Geriatric Warning Test (GWT), a 6-questions form: 1) Did your patient consult or did hospitalize for a fall in the last 3 months? 2) Did your patient lose weight or did he loose the appetite? 3) Has your patient difficulties to see or listen? 4) Does your patient need help in the everyday life? 5) Has your patient a change of the cognitive functions? 6) Does your patient need a geriatric evaluation for one or several any reason that those cited previously? During a prospective observational study, a doctor non-geriatrician practitioner informed the GWT during a consultation of vascular medicine. All the patients aged 70 or more years old had an EGS after the consultation. An EGS was considered as necessary if 2 propositions and essential if 3 propositions were present from a 10 propositions list. The relevance of the TAG was analysed when one then 2 questions were informed during the consultation. The CGA was judged as necessary with a positive predictive value (PPV) of 81,8% and a negative predictive value (NPV) of 87,5%, when a single question is sufficient to indicate the CGA, and respectively of 76,5 and 53,9% when 2 questions of the GWT are taken into account. For an essential CGA (3 propositions), the PPV and NPV are 40,9 and 100%, by taking a single question of the GWT and 47,1 and 92,3% with 2 questions. A single positive question of the GWT must be used to propose an EGS during a non geriatric consultation.

Background and Aim: Institutionalized people represent 9 to 37% of the patients hospitalized in emergency. The aim of this study is to clarify practical conditions of decision and realization of an hospitalization in emergency from an institution., Patients and Method: This is a prospective and descriptive longitudinal study of the hospitalizations in emergency of institutionalized elderly during six months, from 11 nursing homes., Results: The patients hospitalized in emergency are old (86.7 ± 7.3 years), more than 80% are women, widows and dependent (GIR 3). Main reasons for hospitalization in emergency are falls in a third of cases and cardio-pulmonary failure (27%). The alert is given by nurses and auxiliary nurses in 60% of cases. The decision of hospitalization is medical in more than 80% of cases. The medical opinion is only on phone in 24.4% of cases. After hospitalizations, 85% of patients came back straight to their institution and 10% died during their stay at the hospital., Conclusion: The terms of hospitalization in emergency of institutionalized patients must be improved. Nursing homes are an integral part of the geriatric network.

Levodopa remains the most effective treatment for Parkinson's disease (PD). However, the use of this drug is complicated by several adverse effects, in particular motor fluctuations and dyskinesias. Drugs providing more continuous dopaminergic stimulation and surgical approaches, such as deep-brain stimulation, have an important ameliorative effect on these problems. Despite these advances, the progression of the disease remains unaffected and strategies that slow or stop the neurodegenerative process are currently not available. Nevertheless, several compounds or surgical procedures are candidates for being neuroprotective and some of them are under evaluation.