Impact of the first COVID-19 epidemic wave in a large French network of nursing homes: a cross-sectional study.

BACKGROUND: Nursing homes (NHs) have been particularly affected by COVID-19. The aim of this study is to estimate the burden of COVID-19 and to investigate factors associated with mortality during the first epidemic wave in a large French NHs network. METHODS: An observational cross-sectional study was conducted in September-October 2020. 290 NHs were asked to complete an online questionnaire covering the first epidemic wave on facilities and resident characteristics, number of suspected/confirmed COVID-19 deaths, and preventive/control measures taken at the facility level. Data were crosschecked using routinely collected administrative data on the facilities. The statistical unit of the study was the NH. Overall COVID-19 mortality rate was estimated. Factors associated with COVID-19 mortality were investigated using a multivariable multinomial logistic regression. The outcome was classified in 3 categories: "no COVID-19 death in a given NH", occurrence of an "episode of concern" (at least 10% of the residents died from COVID-19), occurrence of a "moderate episode" (deaths of COVID-19, less than 10% of the residents). RESULTS: Of the 192 (66%) participating NHs, 28 (15%) were classified as having an "episode of concern". In the multinomial logistic regression, moderate epidemic magnitude in the NHs county (adjusted OR = 9.3; 95%CI=[2.6-33.3]), high number of healthcare and housekeeping staff (aOR = 3.7 [1.2-11.4]) and presence of an Alzheimer's unit (aOR = 0.2 [0.07-0.7]) were significantly associated with an "episode of concern". CONCLUSIONS: We found a significant association between the occurrence of an "episode of concern" in a NH and some of its organizational characteristics and the epidemic magnitude in the area. These results can be used to improve the epidemic preparedness of NHs, particularly regarding the organization of NHs in small units with dedicated staff. Factors associated with COVID-19 mortality and preventive measures taken in nursing homes in France during the first epidemic wave.

[Impact of Geriatric Drug Guidelines on the Quality Requirement of Elderly Patients]. / Impact d'un livret thérapeutique sur la qualité des prescriptions médicamenteuses des résidents d'EHPAD.

OBJECTIVE: Elderly with several pathologies are usually treated with many drugs, and are exposed to a majored risk of drug-induced adverse effects. A network of local nursing homes (EHPAD) in the south Seine-Saint-Denis area (France) created a geriatric drug guidelines to improve the quality of the drugs prescriptions. This study assesses the conformity of prescriptions in elderly patients prior and after the distribution of the booklet. METHODS: This before and after design study focused on the drug prescriptions for patients in eight EHPAD followed for two randomly given days in 2012 (n = 503) and 2013 (n = 334). The geriatric drug guidelines included a list of medicines suitable for the elderly (conformity list) and recommendations for prescription and monitoring. Data collection was conducted from medical records and interviews with coordinators doctors and nursing staff in nursing homes. A 6 items-quality score was calculated, ranging from 0 (lowest quality) to 6 (highest quality). RESULTS: Median age, weight and creatinine level were respectively 88 years, 61.0 kg, and 74.9 µmol/L (prior) and 88 years, 59.6 kg, and 77.0 µmol/L (after). Median times of latest serum creatinine dosage were 112 days (prior) and 108 days (after). The median number of prescribed drugs was 8 per resident during the two period of study. The conformity rate of prescription was better prior the distribution of the guidelines, respectively 87.5% and 80.0% (p<10⁻³). The average formal quality score was better after the distribution of the booklet increasing form 4.23 to 4.40 points (p<10⁻4). For high risk inducing drugs, monitoring was prescribed in 34.2% (prior) and 32.4% (after). CONCLUSIONS: This study shows that the drug geriatric guidelines does not improve prescription conformity and monitoring for high risk drugs, but it does significantly improve the median formal quality score.

[Medical treatment of the elderly in residential care: a multicenter cross-sectional study]. / Prescriptions médicamenteuses chez les personnes âgées en EHPAD: une étude transversale multicentrique.

OBJECTIVE: To retrospectively assess the quality of prescriptions in elderly patients prior the distribution of guidelines for geriatric drug prescriptions. METHODS: A cross-sectional study was conducted for one day in 2012 to investigate the quality of the prescriptions in 495 residents of 8 nursing homes. A 6 items-quality score was calculated, ranging from 0 (lowest quality) to 6 (highest quality). RESULTS: The median number of prescribed drugs was 8,5 per resident. Over a total of 4311 prescribed drugs, the average quality score was 4,96 ± 0,45; 4,54 ± 0,70 in computerized orders and 3,4 ± 1,02 in handwritten orders. Among 939 drugs considered as at high risk of inducing serious adverse reactions, monitoring was prescribed 154 times only (16,4%). CONCLUSIONS: A lack of drug monitoring was highlighted, especially for high risk drugs. The quality of prescription may be improved by the use of computerized orders.

[Geriatric sector and psychogeriatric resources]. / Filière gériatrique et ressources gérontopsychiatriques.

Faced with the expected growth of the population aged 75 and over between now and 2020, hospital structures must be prepared to adapt and organise themselves in order to meet the specific needs of elderly patients. This article present the measures implemented for the elderly patients in the south east territory of Seine-Saint-Denis.