ABSTRACT
In recent years integrative medicine has been the subject of growing interest among the overall population as well as the medical and scientific community. According to the Swiss health survey, approximately 40 % of the Swiss population regularly use complementary therapies. The fields of application of integrative medicine in geriatrics seem large (pain, cognitive disorders, end-of-life support, anxiety, etc.). Although scientific evidence is progressing in this area, studies targeting the population > 65 years old are still limited. The aim of this article is to expose some examples of complementary medicine applications in in geriatric care and the potential for rapprochement between integrative medicine and geriatric.
La médecine intégrative fait l'objet d'un intérêt accru au sein de la population et de la communauté médicale et scientifique ces dernières années. Selon l'Enquête suisse sur la santé, environ 40 % de la population suisse a régulièrement recours à des thérapies complémentaires. Les domaines d'application des médecines intégratives dans les soins gériatriques semblent vastes (douleurs, troubles du sommeil, accompagnement de fin de vie, anxiété, etc.). Les études ciblant spécifiquement la population de 65 ans et plus dans ce domaine restent encore limitées à notre connaissance. Cet article a pour but de présenter quelques exemples d'applications de médecine complémentaire dans la prise en charge des syndromes gériatriques et sensibiliser au potentiel de rapprochement entre la médecine intégrative et la gériatrie.
Subject(s)
Cognition Disorders , Geriatrics , Integrative Medicine , Humans , Aged , Anxiety , Anxiety DisordersABSTRACT
The assessment of vital prognosis in the palliative setting is essential to provide care adapted to the patient's needs. The objective of this research was to compare the survival of patients in our specialized palliative care unit with that estimated by the "Palliative Performance Scale" (PPSv2) described in the literature, in order to better define the therapeutic project. Our results are comparable to those of the selected studies up to the PPSV level of 30%. From 40% onwards, our values are lower, probably due to the admission criteria of our unit, which select complex and unstable patients. The use of a tool to estimate survival can provide a basis for reflection and dialogue with the patient and his relatives, based on easily observable criteria.
L'évaluation du pronostic vital dans le contexte palliatif est essentielle pour proposer des soins adaptés aux besoins du patient. L'objectif de cette recherche était de comparer la survie des patients de notre unité de soins palliatifs spécialisés avec celle estimée par la « Palliative Performance Scale ¼ (PPSv2) décrite dans la littérature, afin de définir au mieux le projet thérapeutique. Nos résultats sont comparables à ceux des études sélectionnées jusqu'au palier de PPS de 30 %. À partir de 40 %, nos valeurs sont inférieures, probablement en raison des critères d'admission dans notre unité sélectionnant des patients complexes et instables. L'utilisation d'un outil pour estimer la survie peut constituer une base de réflexion et de dialogue avec le patient et ses proches, en s'appuyant sur des critères facilement observables.
Subject(s)
Hospitalization , Palliative Care , Humans , Palliative Care/methods , PrognosisABSTRACT
The increasing life expectancy, the earlier detection of terminal illnesses and the increasing complexity of care pathways led us to propose an innovative response within the Neuchâtel Hospital Network (RHNe), in the form of a mixed intra-hospital mobile team (GSPmob), composed of doctors and nurses from geriatrics and palliative care. Through geriatric and palliative assessment, we are able to highlight the patient's different medical problems. Our team, after two years of existence, has met our patients' needs as well as the hospital teams' needs. And yet we encountered certain challenges. Our current objective is to describe our experience by presenting our results and difficulties.
L'augmentation de l'espérance de vie, la détection plus précoce de maladies terminales et la complexification des parcours de soins nous ont amenés à proposer une réponse innovante au sein du Réseau hospitalier neuchâtelois, sous forme d'une équipe mobile mixte intrahospitalière, de médecins et infirmiers issus de la gériatrie ou des soins palliatifs (équipe mobile mixte de gériatrie et de soins palliatifs). Grâce aux évaluations gériatriques et palliatives, cette équipe permet la détection et la prise en charge de différentes problématiques spécifiques chez les patients. Depuis près de 2 ans d'existence, malgré les défis qui restent à relever, notre équipe répond à un réel besoin des patients et des équipes soignantes. L'objectif est ici de décrire notre expérience en présentant nos résultats et nos difficultés.
Subject(s)
Geriatrics , Palliative Care , Aged , Hospitals , Humans , Life Expectancy , Patient Care TeamABSTRACT
Falls in old persons are now considered as a "true" geriatric syndrome, because are frequent, multi-factorial with severe outcomes: increased morbidity, functional inabilities and mortality. In our current health care system, the primary care physician is the first to detect the fall and indeed to manage and coordinate the various interventions of the multiple healthcare professionals. To be effective, he needs simple screening tools, and also structured procedures as well as the support of specialized networks of care. However the current offer is highly variable from one canton to another. This article tries to provide validated screening tools to the primary care physician and useful contact addresses of public associations and services able to favor home care support.
Subject(s)
Accidental Falls , Wounds and Injuries/diagnosis , Wounds and Injuries/therapy , Aged , Decision Trees , Humans , Practice Guidelines as Topic , Wounds and Injuries/etiologyABSTRACT
During a prospective open survey over 12 months of hospitalized patients, 44 death demands were registered for 39 patients (25 cancer, 6 cardiovascular disorder, 2 Parkinson's disease, 3 arthritis, 1 COPD, 1 dementia and 1 severe depression). 14 patients were also depressed. 28 requested euthanasia, 16 suicide assistance. At 1 month, 3 persisted, 16 had abandoned, 16 had died and 4 were not questioned. At 6 months, 7 were alive but had abandoned and 2 had committed suicide at their home. The majority of death demands correspond to euthanasia which is a murder according to the penal code. In front of such demand, realistic short-term objectives must be established. Many patients give up their project. This indicates great uncertainty in front of care and greatest ambivalence in front of life.
Subject(s)
Euthanasia , Palliative Care , Patient Participation , Suicide, Assisted , Aged , Female , Humans , Male , Prospective Studies , SwitzerlandABSTRACT
Efficacy of treatments used in patients at the end-of-life must be evaluated according to ethical issues and specificities of the palliative population, i.e.: major vulnerability, difficulties to obtain informed consent, fragility of balance between research and clinical role, problems to evaluate risks and benefits of palliative care research. Improvements in the use of opioids have come from clinical research. Treatment of delirium has improved thanks to clinical trials conducted in cancer and AIDS patients. Emerging themes in palliative medicine now come with alleviating moral distress and utility of psychotherapeutic approach as well as the place of spirituality measured through quality-of-life evaluation.
