Lived experience, perceptions, and expectations of close relatives of nursing home residents and strengths-based nursing: a phenomenological approach.

Conflicts between residents' families and professionals are frequently described in nursing homes. This phenomenological study aims to describe and understand the experience, expectations and needs of residents' relatives. Forty-three interviews were conducted in six selected nursing homes. The main expectations voiced by the 43 relatives was that the nursing home respect the "humanity" of their loved one and improvements in communication between the family and staff. This study yielded original findings that are poorly described in the literature, namely the need for psychological assistance for relatives when loved ones enter a nursing home. Relatives wanted the administrative formalities to be separated in time from the time when their loved one entered the home. They wanted psychological support and training to better understand their loved one's illness. Finally, relatives strove to be a collaborative partnership with the staff team in the nursing home. These expectations fit the strengths-based philosophy. Training professionals, directors and leaders to apply this paradigm shift could improve the relationship between relatives and nursing home care.

[Lived experience, perceptions, and expectations of close relatives of nursing home residents and strength-based nursing, a phenomenological approach]. / Les soins fondés sur les forces : expérience vécue, perceptions et attentes des familles des résidents en Ehpad, une approche phénoménologique.

Dissensions between residents' families and professionals are frequently described in nursing homes. This phenomenological study aims to describe and understand experience, expectations and needs of residents' relatives. Forty-three interviews were conducted in the 6 selected nursing homes. The main expectations from the 43 relatives was the respect of "humanity" of their loved one by the nursing home and improving family-staff communication. This study yielded original findings that are poorly described in the literature, namely the need for psychological help for relatives when their love one enters the nursing home. Relatives wanted the administrative formalities to be separated in time from the moment of their loved one's admission. They wanted psychological support and training to better understand their loved one's illness. Finally, relatives aimed to be a collaborative partnership with the team in the nursing home. These expectations fit the Strengths-Based philosophy. Thus, training professionals, directors and leaders to apply this paradigm shift could improve the relationship between relatives and nursing home care.

Expectations and Needs of Families in Nursing Homes: An Integrative Review.

A better understanding of the expectations and needs of the families of nursing home residents is needed for a constructive and sustainable relationship of mutual trust. The objective of this study was to understand the expectations of families of nursing home residents described in the literature. A systematic integrative review of the literature was conducted. After a rigorous selection made by two researchers, independently, 53 articles were selected out of 1,094 results. The expectations of families are quality care, consideration complying with human dignity of the resident, collaboration, honesty, and mutual confidence that ties together families, staff, and physicians. This study reveals that families consider themselves as a strength for a resident's support services, in line with Gottlieb's strength-based approach. This approach offers promising implications for practice and for a new type of management in nursing homes based on strong values.

[Ethics and Covid-19 in nursing homes, a return of experience]. / Éthique et Covid-19 en Ehpad, retour d'expérience.

Covid epidemic and containment have generated numerous ethical dilemmas. Autonomy is the most frequently jeopardized ethical principle. Continued commitment has run into specific funerary rules of deceased residents. Professional proficiency has been eroded by omnipresent feelings of fear and powerlessness, and by medicalized daily activity. Decontainment and after-crisis raise specific ethical questionnings.

Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis.

Falling is the second most prevalent cause of accidental death in the world. Currently available clinical tests to assess balance in older people are insufficiently sensitive to screen for fall risk in this population. Laboratory tests that record the center of pressure (COP) trajectory could overcome this problem but despite their widespread use, the choice of COP trajectory features for use as a biomarker of fall risk lacks consensus. This systematic review and meta-analysis aimed at identifying the best COP characteristics to predict risk of falling in older adults. More than 4000 articles were screened; 44 (7176 older adults) were included in this study. Several COP parameters emerged as good indices to discriminate fallers from non-fallers. From sensitivity analysis, Sway area per unit time, anteroposterior mean velocity, and radial mean velocity were the best traditional features. In this study, identification of older people with a high fall risk was demonstrated using quiet-standing recordings. Such screening would also be useful for routine follow-up of balance changes in older fallers in clinical practice.

Postadychute-AG, Detection, and Prevention of the Risk of Falling Among Elderly People in Nursing Homes: Protocol of a Multicentre and Prospective Intervention Study.

Introduction: While falls among the elderly is a public health issue, because of the social, medical, and economic burden they represent, the tools to predict falls are limited. Posturography has been developed to distinguish fallers from non-fallers, however, there is too little data to show how predictions change as older adults' physical abilities improve. The Postadychute-AG clinical trial aims to evaluate the evolution of posturographic parameters in relation to the improvement of balance through adapted physical activity (APA) programs. Methods: In this prospective, multicentre clinical trial, institutionalized seniors over 65 years of age will be followed for a period of 6 months through computer-assisted posturography and automatic gait analysis. During the entire duration of the follow-up, they will benefit from a monthly measurement of their postural and locomotion capacities through a recording of their static balance and gait thanks to a software developed for this purpose. The data gathered will be correlated with the daily record of falls in the institution. Static and dynamic balance measurements aim to extract biomechanical markers and compare them with functional assessments of motor skills (Berg Balance Scale and Mini Motor Test), expecting their superiority in predicting the number of falls. Participants will be followed for 3 months without APA and 3 months with APA in homogeneous group exercises. An analysis of variance will evaluate the variability of monthly measures of balance in order to record the minimum clinically detectable change (MDC) as participants improve their physical condition through APA. Discussion: Previous studies have stated the MDC through repeated measurements of balance but, to our knowledge, none appear to have implemented monthly measurements of balance and gait. Combined with a reliable measure of the number of falls per person, motor capacities and other precipitating factors, this study aims to provide biomechanical markers predictive of fall risk with their sensitivity to improvement in clinical status over the medium term. This trial could provide the basis for posturographic and gait variable values for these elderly people and provide a solution to distinguish those most at risk to be implemented in current practice in nursing homes. Trial Registration: ID-RCB 2017-A02545-48. Protocol Version: Version 4.2 dated January 8, 2020.

Center of pressure characteristics from quiet standing measures to predict the risk of falling in older adults: a protocol for a systematic review and meta-analysis.

BACKGROUND: Falling is the most common accident of daily living and the second most prevalent cause of accidental death in the world. The complex nature of risk factors associated with falling makes those at risk amongst the elderly population difficult to identify. Commonly used clinical tests have limitations when it comes to reliably detecting the risk of falling, but existing laboratory tests, such as force platform measurements, represent one method of overcoming this lack of a test. Despite their widespread use, however, Center of Pressure (COP) signal analysis techniques vary and there is currently no consensus on which features should be used diagnostically. Our objective is to identify, through a systematic review and meta-analysis, the COP characteristics of older adults (≥ 60 years old) during quiet bipedal stance which will allow fallers to be distinguished from non-fallers. METHODS: The systematic review will include both prospective and retrospective articles. Five databases will be searched: PubMed, Cochrane CENTRAL, EMBASE, and ScienceDirect. In addition, a search of gray literature will be performed using Google Scholar and ClinicalTrials.gov. Searches will be circumscribed to include only older adults (aged over 60 years) who underwent a bipedal quiet standing measure of their balance and for whom the number of falls was reported. Two authors will independently assess the risk of bias for each included article using a 26-item checklist. Funnel plots will be drawn to attest of possible publication biases for each COP parameters. The results will be synthesized descriptively and a meta-analysis will be undertaken. When trial methodological heterogeneity is too great for pooling of the data into a meta-analysis, evidence strength will be evaluated using best evidence analysis. DISCUSSION: Despite the numerous advantages of posturography, the diversity of studies exploring balance in older fallers has led to uncertainty regarding the method's ability to reliably identify fall-prone older adults. It is expected that the findings from this systematic review will help clinicians use bipedal quiet standing measures as a diagnostic test and allow researchers to explore COP characteristics to create better models for fall prevention care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018098671.

[Occupational burnout in geriatrics, an Echo complex]. / L'épuisement professionnel en gériatrie, un complexe d'Écho.

Caregivers in nursing homes are exposed to numerous risk factors of occupational burnout. Lack of time, work overload, caring for frail people, an imbalance between hierarchical demands and the amount of decision-making power accorded to them, as well as insufficient resources: it is difficult to provide individualised care to patients in these conditions. There are, however, ways to improve this situation.

Associations between morningness/eveningness and psychopathology: an epidemiological survey in three in-patient psychiatric clinics.

OBJECTIVE: This study aims to examine the association between the chronotype (morningness/eveningness) and specific mental disorders. METHODS: Cross-sectional epidemiological study conducted in three in-patient clinical settings. A total of 1468 consecutive in-patients who gave their written consent were enrolled. On the admission day, patients filled sleep questionnaires and a nurse filled a Clinical Global Impressions scale. Hospitalization reports and ICD-10 diagnoses were collected. RESULTS: Sleep/wake schedule was similar between the psychiatric diagnoses. On the other hand, morning type patients had an earlier bedtime, earlier wakeup time and shorter sleep duration than the other chronotype regardless of the diagnosis. In multivariate models, patients with a depressive disorder or a psychosis were more likely to be morning type. Patients with an anxiety disorder, addiction disorder or personality disorder were more likely to be evening type. CONCLUSIONS: Age and sleep/wake schedule are contributing factors for the chronotype but mental disorders too appeared to modulate chronotype preferences.

3-(2,4-dimethoxybenzylidene)-anabaseine: a promising candidate drug for Alzheimer's disease?

3-(2,4-dimethoxybenzylidene)-anabaseine is an analog of the paralytic alkaloid, anabaseine, from the ribbon worms Amphiporus sp., that shows numerous properties, in particular an agonist activity on alpha 7 nicotinic acetylcholine receptors. This article reviews these properties and explains to what extent they could be valuable to control symptomatology and/or neurodegeneration in Alzheimer's disease.

[Cardiovascular disease and aircraft transportation: specificities and issues]. / Maladie cardiovasculaire et voyage aérien : particularités et enjeux.

With the development of air transport and travel to distant destinations, the number of passengers and elderly passengers on board increases each year. In this population, cardiovascular events are a major concern. Among medical incidents occurring in-flight they are second-ranked (10%) behind gastrointestinal disorders (25%). Their occurrence may involve life-threatening events and require resuscitation, difficult to perform during flight or in a precarious health environment. Coronary heart disease and pulmonary thromboembolic disease are the most serious manifestations. They are the leading cause of hospitalization in a foreign country and sudden cardiac death occurring during or subsequent to the flight. Their occurrence is explained on aircraft by hypoxia, hypobaria and decreased humidity caused by cabin pressurization and upon arrival by a different environmental context (extreme climates, tropical diseases). Moreover, the occurrence of a cardiovascular event during flight can represent for the air carrier a major economic and logistic problem when diversion occurred. Furthermore, the liability of the practitioner passenger could be involved according to airlines or to the country in which the aircraft is registered. In this context, cardiovascular events during aircraft transportation can be easily prevented by identifying high risk patients, respect of cardiovascular indications to travel, the implementation of simple preventive measures and optimization of medical equipment in commercial flights.

Screening of patients with cognitive impairment when entering a rehabilitation unit.

AIM: The objective of this study is to evaluate the feasibility of an early screening of cognitive impairment in rehabilitation units, and the proportion of cognitive impairments (in particular, Alzheimer's disease) among this population. METHODS: This is a multicentric, non-interventional, epidemiological, transverse, projective and comprehensive study of five French rehabilitation units. RESULTS: This study on 279 people over 75 years found 105 new cases of cognitive impairments, among which 62 cases of dementia. CONCLUSION: These findings show the interest of generalizing cognitive impairments screening when entering a rehabilitation unit, in coordination with memory consultations and general practitioners.