[Medicines and elderly patients: abuse, dependency or attraction?] / Médicaments et sujets âgés : abus, dépendance ou attirance ?

Psychotropic medicines represent, after alcohol, the second class of substances most susceptible to abuse by elderly people. It can be particularly difficult for caregivers to understand such behaviour as these are prescription-only medicines. This misuse is partly a result of older people tending to trivialise and overrate pharmaceutical drugs, ignoring the potential of non-medicinal methods and psychotherapeutic treatments. The boundaries between prescribed use, overuse, self-medication, excessive use, dependency or addiction to prescription drugs are blurred in older people. Alongside withdrawal methods, prevention must be prioritised by respecting the recommendations of medicine prescriptions in geriatrics and deprescription.

[Alcohol in care homes for the elderly]. / L'alcool en établissement pour personnes âgées.

The majority of those living in care homes for the elderly are very old, with multiple pathologies and taking multiple forms of medication. They are therefore more fragile and vulnerable in the face of alcohol, both with occasional consumption or with addictive behaviour. Far from anecdotal, these situations arise almost on a daily basis for the frontline caregivers. They are sometimes difficult to detect by other professionals who do not have such prolonged contact with the residents. Addressing the risk as well as the misuse of alcohol in a nursing home is a matter for the whole institute and must involve all the players, professionals, families and residents, in a cross-disciplinary and coherent approach. Addiction treatment, in the particular case of nursing home residents, as for the general population, considers all methods of consumption and actions, from prevention to the reduction of risks or harmful effects, to curative treatment, including alcohol withdrawal.

[A joint committee to fight against pain]. / Mutualisation d'un comité de lutte contre la douleur.

The crucial need to take into account the pain felt by elderly people is sometimes difficult to implement on the scale of small or medium-sized institutions. The pooling of resources which a joint committee to fight against pain could offer is an interesting avenue to explore.

[Acute alcoholic intoxication in subjects over 75 years of age: a clinical situation far to be uncommon]. / Intoxication éthylique aiguë après 75 ans : une situation clinique loin de l'anecdote à l'hôpital.

Acute ethylic intoxication (AEI) or alcoholic drunkenness is not only a youth-specific disorder. It also occurs at advanced ages of life. Diagnosis is not easy, at times made in excess, but more often underestimated, then leading to the negligence of a risk situation and suffering. AEI represents about 3% of all hospitalizations. In 2005, 973 alcohol tests taken at the hospital of Mâcon (France) were positive. The rates ranged from 0.10 g/L to 6.26 g/L (m = 2.06 +/- 1,18). 41 subjects were aged over 75 (5%). The alcohol rates found were lower after 75 years (1.34 +/- 1.1 g/L) than before 75 years (2.11 +/- 2,1; p<0,001). Subjects were referred to the Emergency unit for a fall in 61% of the cases, and dizziness in 34%. Among the aged subjects, 30% received external care and 70% were hospitalized. According to the DSM-IV, misuse of alcohol was found in 87% of subjects (abuse in 67%, addiction in 20%) and temperance in 13%. Drinking alcohol is not a pathology in itself. However, if it causes suffering or has negative consequences on health or lifestyle, care is required. Aging doesn't change anything to this reality. AEI, in truth, requires even more specific care and attention, in the elders.

[Bipolar disorders and dementia: fortuitous association or filiation? A case-report and review of the literature]. / Troubles bipolaires et démence: association fortuite ou filiation?

The prevalence of bipolar disorders is about 4% of the population. Among the patients the emergence of cognitive disorders has been identified. These disorders can sometimes result in authentic dementia-like syndromes. The neuropsychological characteristics of the cognitive impairment include disorders of the steady attention, executive functions, memory and language. This group of cognitive disorders leads to a subcorticofrontal syndrome. Different neuroanatomical bases have been suggested. The most common etiopathogenic hypothesis retains a cumulative neurological toxicity of the thymic episodes (depression or mania). The role of psychoactive treatments must be taken into account. The secondary cognitive effects of psychoactive drugs usually used in bipolar disorder (lithium, antiepileptics, antidepressants, antipsychotics or tranquillizers) are similar to the cognitive impairment associated with the disease. Differentiation between cognitive disorders related to the pathology and those related to its treatment is difficult. The optimal use of the therapeutic drug classes, preferring antipsychotics of second generation and avoiding products with anticholinergic effect, is essential. There is no specific pharmacological treatment for this dementia syndrome. Psychological approaches offer an alternative way of care, which remains to be investigated and validated. Prevention of iatrogenic effects of drugs constitutes, presently, the main therapeutic intervention.