[Sleep, an issue for nurses and patients]. / Le sommeil, un enjeu pour les soignants et les patients.

A three-day training programme on sleep in hospitals was created in 2008 on the initiative of the national association for the continuing training of hospital staff, in collaboration with the French ministry of health. 448 nurses have been trained thanks to a participative programme integrating new, interactive pedagogical tools.

[Nutrition and Alzheimer's disease]. / Nutrition et maladie d'Alzheimer.

Weight loss is frequent in Alzheimer's disease. Its severity increases with the progression of the disease and may be a predictor of patients' mortality. Weight loss often precedes the diagnosis and may be considered as a feature of the disease itself. With the progression of the disease, disorders of eating behavior occur and result in weight loss and decreasing energy intake. Descriptive tools such as the Blandford Scale are helpful to assess eating disorders. Some hypotheses exist to explain the weight loss associated with Alzheimer's disease: atrophy of internal temporal cortex, increase of energy expenditure, biologic factors or modifications of body composition. Tools such as the Mini Nutritional Assessment allow assessment of nutritional status, diagnosis of malnutrition, cause identification and proposals for its correction. Patients' caregivers play a central role in prevention and management of nutritional disorders. Information programs for caregivers may reduce caregiver burden and improve patients' health status.

Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer's disease at risk of malnutrition: a prospective randomized study.

OBJECTIVES: To study the effects of oral nutritional supplements (OS) on body weight, body composition, nutritional status, and cognition in elderly patients with Alzheimer's disease (AD). DESIGN: Prospective, randomized, controlled study. SETTING: Geriatric wards and day care centers in the Toulouse area, France. PARTICIPANTS: Ninety-one subjects with AD aged 65 and older at risk of undernutrition as evaluated using the Mini Nutritional Assessment. INTERVENTION: After randomization, 46 patients (intervention group) received 3-month OS. The other 45 patients (control group) received usual care. MEASUREMENTS: Weight, body composition (evaluated using dual-energy x-ray absorptiometry), cognitive function, activities of daily living, eating behavior, and dietary intakes were evaluated at the beginning of the study and at 3 months and 6 months. Supplement compliance was recorded each day. RESULTS: Between baseline and 3 months, energy and protein intakes significantly improved in the intervention group, resulting in a significant increase in weight and fat-free mass, but no significant changes were found for dependence, cognitive function, or biological markers. The nutritional benefit was maintained in the intervention group after discontinuation of OS at 3 months. CONCLUSION: Three-month daily OS significantly improves body weight. It is practicable and effective, and the patients accepted it well. The improvement that was observed even in the control group showed that caregiver education is an important factor in maintaining the nutritional status of patients with AD. Moreover, regular courses of OS may help to maintain the increase in fat-free mass and improve the nutritional status of these patients.

Cognitive function and caregiver burden: predictive factors for eating behaviour disorders in Alzheimer's disease.

BACKGROUND: Patients with Alzheimer's disease (AD) commonly develop aversive feeding behaviours. These behaviours lead to weight loss and frequently to physicians using tube feeding. Little is known about factors correlated with feeding difficulties during AD. OBJECTIVE: To investigate predictors of aversive feeding behaviours (AFBs) which occurred during a one-year interval among AD patients living at home with a caregiver. METHOD: One-year study initiated in January 1998 with 224 AD patients and their caregivers. MAIN OUTCOME MEASURES: all patients underwent a nutritional, psychologic and functional evaluation at baseline and one year later. Feeding difficulties were assessed using the Feeding Dependency Scale and the Aversive Feeding Behaviour Inventory. The Burden Interview was also done to assess the material and emotional burden. RESULTS: Initial feeding difficulties were significantly associated with the age of the caregiver, the severity of the disease and the initial patient's autonomy and psychological functioning (mood and behaviour disorders). AD patients, who lived with a more affected caregiver at baseline, developed feeding difficulties and AFBs during the follow-up. Logistic regression analysis showed a positive association between AFBs worsening and the initial caregiver's burden after controlling for confounding factors. On the other hand, memory impairment was inversely associated with AFBs. CONCLUSIONS: Both cognitive impairment and family stress can help in predicting which AD patients living at home will develop AFBs. Nutritional information and support to families are probably the best strategies to prevent AFBs during AD and to improve consequently the patient's and caregiver's quality of life.

Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment.

In more than 10,000 elderly persons, the mean prevalence of malnutrition is 1% in community-healthy elderly persons, 4% in outpatients receiving home care, 5% in patients with Alzheimer's disease living at home, 20% in hospitalized patients, and 37% in institutionalized elderly persons. In community-dwelling elderly persons, the MNA detects risk of malnutrition and life-style characteristics associated with nutritional risk while albumin levels and the BMI are still in the normal range. In outpatients and in hospitalized patients, the MNA is predictive of outcome and cost of care. In home care patients and nursing home residents, the MNA is related to living conditions, meal patterns, and chronic medical conditions and allows targeted intervention. The MNA has been used successfully in follow-up evaluation of outcome, nutritional intervention, nutritional education programs, and physical intervention programs in elderly persons. The MNA-SF allows quick screening to determine a person's risk of malnutrition. Early detection of malnutrition is important to allow targeted nutritional intervention and should be a key component of the geriatric assessment. The MNA test is a simple, noninvasive, well-validated screening tool for malnutrition in elderly persons and is recommended for early detection of risk of malnutrition. The MNA, as a two-step procedure (screening with the MNA-SF followed by assessment, if needed, by the full MNA), is reliable and can be easily administered by general practitioners and by health professionals at hospital or nursing home admission for early detection of risks of malnutrition. The MNA has the following characteristics: * The MNA is a two step procedure: (1) the MNA-SF to screen for malnutrition and risk of mainutrition; (2) assessment of nutritional status with the full MNA. * The MNA is an 18-item questionnaire comprising anthropometric measurements (BMI, mid-arm and calf circumference, and weight loss) combined with a questionnaire regarding dietary intake (number of meals consumed, food and fluid intake, and feeding autonomy), a global assessment (lifestyle, medication, mobility, presence of acute stress, and presence of dementia or depression), and a self-assessment (self-perception of health and nutrition). The MNA-SF comprises 6 items from the 18. * The MNA is well validated. It correlates highly with clinical assessment and objective indicators of nutritional status (albumin level, BMI, energy intake, and vitamin status). * A low MNA score can predict hospital-say outcomes in older patients and can be used to follow up changes in nutritional status. * Because of its validity in screening and assessing the risk of malnutrition, the MNA should be integrated in the comprehensive geriatric assessment. * In more than 10,000 elderly persons, the prevalence of undernutrition assessed by the MNA is 1% to 5% in community-dwelling elderly persons and outpatients, 20% in hospitalized older patients, and 37% in institutionalized elderly patients.