ABSTRACT
Post-traumatic stress disorder (PTSD) is particularly common in the elderly, including those with cognitive impairments. We need to stress the importance of early detection to better understand the specific signs of this disorder in the elderly. Psychotherapies such as cognitive-behavioral therapy and Eye Movement Desensitization and Reprocessing are being explored for their effectiveness and adaptability with the elderly. Identifying post-traumatic stress disorder should be a shared responsibility, for the mental health of the elderly.
Subject(s)
Stress Disorders, Post-Traumatic , Humans , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Post-Traumatic/psychology , Aged , Cognitive Behavioral TherapyABSTRACT
Non-drug interventions (NDIs) are recommended as a first-line treatment in gerontology to address the psychological and behavioral symptoms of dementia. This article illustrates the NMIs implemented, how they are carried out and how they are evaluated as part of the Bien vieillir project at Nice University Hospital.
Subject(s)
Dementia , Geriatrics , Mood Disorders , Humans , Aging , Mood Disorders/therapyABSTRACT
BACKGROUND: Frailty is associated with an increased risk of major neurocognitive disorders (MNCD). OBJECTIVE: This study aims to compare the Fried physical model and the CARE deficit accumulation model for their association with incident major neurocognitive disorders (MNCD), and to examine how the addition of cognitive impairment to these frailty models impacts the incidence in community-dwelling older adults. METHODS: A subset of community dwellers (nâ=â1,259) who participated in the "Quebec Longitudinal Study on Nutrition and Successful Aging" (NuAge) were selected in this Elderly population-based observational cohort study with 3 years of follow-up. Fried and CARE frailty stratifications into robust, pre-frail and frail groups were performed using the NuAge baseline assessment. Incident MNCD (i.e., Modified Mini Mental State (3MS) scoreâ<â79/100 and Instrumental Activity Daily Living (IADL) scoreâ<â6/8) were collected each year over a 3-year follow-up period. RESULTS: A greater association with incident MNCD of the CARE frail state was observed with an increased predictive value when combined with cognitive impairment in comparison to Fried's one, the highest incidences being observed using the robust state as the reference. Results with the Fried frail state were more heterogenous, with no association with the frail state alone, whereas cognitive impairment alone showed the highest significant incidence. CONCLUSION: The association of the CARE frail state with cognitive impairment increased the predictive value of MNCD, suggesting that the CARE frailty model may be of clinical interest when screening MCND in the elderly population.
Subject(s)
Cognitive Dysfunction , Frailty , Humans , Aged , Frailty/epidemiology , Cohort Studies , Longitudinal Studies , Frail Elderly/psychology , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/psychology , Independent Living , Geriatric Assessment/methodsABSTRACT
A major proportion (90 %) of patients with Alzheimer's disease and related disorders develop during the disease at least one of the Behavioral and Psychological Symptoms of Dementia (BPSD). BPSD often leads to complications for patients (hospitalization, institutionalization). Caregivers are often family members, and it may be difficult for them to manage the disruptive behavior or apathy of their loved ones. This situation often generates physical and psychological symptoms. The Nice University Hospital (France) and the Bien Vieillir Nice 2030 project offer at-home non-pharmacological therapies to reduce BPSD, combined with psychoeducational sessions to improve caregiver skills. A team of psychologists went to the patients' homes 3 times per week to provide personalized non-pharmacological therapies for the patients and educational programs for their caregivers. The monocentric feasibility study was carried out among 20 patient-caregiver pairs (over 7 months). Cohen-Mansfield Inventory Scales, Zarit Burden Interviews, Caregiver Reaction Inventories, and Dementia Quality of life interviews were performed during the study. The Mederic Alzheimer Foundation (MAF) conducted an external evaluation of the project. Analysis of the results showed a significant reduction (p ≤ 0,05) in the number of BPSD on the Neuropsychiatric Inventory scale (p = 0,034). As well as a significant reduction in the behavioral symptoms of agitation on the CMAI scale (p = 0,041). A non-significant reduction in caregiver burden was also noted. Even if the results are encouraging, it is essential to conduct a medico-economic analysis to validate the feasibility of the PsyDoMa model. More clinical studies are needed to conclude.
Subject(s)
Alzheimer Disease , Apathy , Humans , Caregivers , Alzheimer Disease/therapy , Feasibility Studies , Quality of LifeABSTRACT
Objectives: The main objective was to explore the psychological impact of the French lockdown during the first wave of the COVID-19 pandemic on nursing home residents, their relatives, and healthcare teams, as observed by mental health professionals. Design: A national online cross-sectional survey was conducted from May 11 to June 9, 2020. Setting and participants: Respondents were psychologists, psychomotor therapists, and occupational therapists (mental health professionals). Results: A total of 1,062 participants responded to the survey, encompassing 59.8% psychologists, 29.2% occupational therapists, and 11% psychomotor therapists. All mental health professionals felt fear (76.1%), fatigue and exhaustion (84.5%), and inability to manage the emotional burden (78.4%). In nursing homes with COVID-19 cases, residents felt significantly sadder (83.2%), more anxious (65.0%), experienced more anorexia (53.6%), resurgence of traumatic war memories (40.2%), and were more often disoriented (75.7%). The suffering of relatives did not vary between nursing homes with and without COVID-19 cases. The nursing staff was heavily impacted emotionally and was in need of psychological support particularly when working in nursing homes in a low COVID-19 spread zone with COVID-19 cases (41.8 vs. 34.6%). Conclusion and implications: Primary prevention must be implemented to limit the psychological consequences in the event of a new crisis and to prevent the risk of psychological decompensation of residents and teams in nursing homes.
Subject(s)
COVID-19 , Occupational Therapists , Humans , Cross-Sectional Studies , Pandemics , COVID-19/epidemiology , Communicable Disease Control , Nursing HomesABSTRACT
BACKGROUND: This study examines and compares CARE and Cardiovascular Health Study (CHS) frailty states (i.e., robust, prefrail and frail) for their association with incident adverse health outcomes, including falls, depression, cognitive and functional decline, major neurocognitive disorders, hospitalization and mortality in community-dwelling older adults living in the province of Quebec (Canada). METHODS: A subset of individuals (n = 1098) who participated in "Nutrition as a determinant of successful aging: The Quebec longitudinal study" (NuAge), which is an elderly population-based observational cohort study with 3 years of follow-up, were selected. CARE and CHS frailty states were determined using the NuAge baseline assessment. Incident falls (i.e., ≥1, ≥2 and severe falls), depression (i.e., 30-item Geriatric Depression Scale score > 10/30), decline in cognition (i.e., Modified Mini Mental State (3MS) score < 79/100) and functionality (i.e., Activity Daily Living (ADL) score ≤ 3/4 and an Instrumental Activity Daily Living (IADL) score ≤ 6/8), major neurocognitive disorders (i.e., 3MS score < 79/100 and IADL score < 6/8), hospitalization and mortality were annually recorded over a 3-year follow-up period. RESULTS: 66.8% and 23.6% of participants were classified as pre-frail and frail with CARE respectively, whereas this distribution of frailty states differed with CHS (47.9% and 8.4%). There were significant associations of CARE pre-frail and frail states with all incident adverse health outcomes, the lowest odds ratio (OR) being reported with falls and the highest with cognitive decline (OR ranging from 1.63 to 12.85 with P ≤ 0.032). All ORs of the CARE frailty states were greater than those of the CHS, except for frail participants with IADL decline (OR = 4.92 for CARE versus OR = 9.62 for CHS). CONCLUSIONS: CARE frail states were associated with incident adverse health outcomes and these associations were greater than with CHS, suggesting that the CARE scale is of clinical interest when screening for frailty and related adverse health outcomes in the elderly population.
Subject(s)
Frailty , Telemedicine , Activities of Daily Living , Aged , Cohort Studies , Frail Elderly , Frailty/diagnosis , Frailty/epidemiology , Geriatric Assessment , Humans , Longitudinal Studies , Outcome Assessment, Health CareABSTRACT
Non-medicinal interventions (NMI) are recommended as a first-line treatment in gerontology in response to a behavioural disorder. The Théra Berce pilot study at the Nice University Hospital aims to determine whether the NMI corresponding to rocking in a comfort chair allows a reduction in disruptive behavioural disorders in people with neurocognitive disorders. Benefits and limitations.
Subject(s)
Dementia , Problem Behavior , Humans , Neurocognitive Disorders , Pilot ProjectsABSTRACT
Behavioural disorders in residential care facilities for dependent seniors are particularly common in residents with Alzheimer's and related diseases. Verbal agitation is one of the most disruptive behavioural disorders. The use of techniques from Eye Movement Desensitisation and Reprocessing therapy in gerontology, its applications and research perspectives may be illustrated.
