[Interest of extrahospital multidisciplinary unit of neuro-psycho-geriatric intervened in nursing home: Analysis of 288 interventions]. / Intérêt d'une unité mobile multidisciplinaire extra-hospitalière de neuro-psychogériatrie intervenant en EHPAD : analyse de 288 interventions.

INTRODUCTION: Geriatrics Mobile Units are a new organisation operating in nursing homes. Their mission is to propose globally oriented neuro-psychiatric and geriatric care. The purpose of the study is to assess their activity and impact over a 21-month period. METHOD: A prospective single center study of UMNPG's data including intervention characteristics, patient characteristics, recommendations and reassessment after intervention. The Neuropsychiatric Inventory Nursing Home version (NPI-NH) was measured during intervention and reassessed after 30 days (Student's t-test). RESULTS: From March 2014 to December 2015, UMNPG conducted 288 interventions mainly for medical advices (81%), clinical assessments (54%) and health care team support (46%). The average age was 84.6±7.3years, 73.3% of whom were women. The patients were dependent (62% of GIR 1 or 2) with dementia (60%) and under several medications (83.7%). The symptoms were mainly agitation/aggression (76.4%), anxiety (75%), depression (66.7%), irritability (60.4%), aberrant motor behaviour (55.9%) and delusions (48.6%). The main proposals of UMNPG were a change in treatment (79.5%), a health care team support (85.4%) and hospitalization (8.4%). The rate of follow-up on recommendation was 83% on the 15th day and 80% on the 30th day. The rate of avoided hospitalizations was 16%. The average NPI-NH decreased (on day 0 NPI=50±19.2; on day 30 NPI=33.9±19.6, p<0.001). CONCLUSION: UMNPG-EHPAD intervenes for frail elderly residents with multiple disorders in crisis situations. Medical recommendations help to support people in nursing homes and decrease NPI-NH. UMNPG-EHPAD is part of geriatric network strengthening the city/hospital connection.

Monográfico: XXIII Jornadas de Actualización en Psicogeriatría: Barcelona, 18-19 mayo 2018 / No disponible

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Monográfico: XXII Jornadas de Actualización en Psicogeriatría: Barcelona, 19-20 de Mayo, 2017 / No disponible

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[Elderly's suicide attempt]. / Tentative de suicide de la personne âgée.

Suicide attempts among the elderly (more than 65 years old) is a topic that is scarcely studied despite its prevalence. In recent years, researchers from all over the world started to study and publishing about this phenomenon. Several research studies tried to single out elderly people's suicide risk factors, focusing particularly on neurobiological alterations linked to the aging process. Some prevention techniques have already been developed and produced convincing results. Through this literature review, we set out to give both a general and summarized view on suicide and suicide attempts among the elderly.

La tentative de suicide des personnes âgées de 65 ans et plus est un sujet encore peu étudié. Ce n'est pourtant pas un fait rare. Depuis plusieurs années, divers groupes de chercheurs à travers le monde ont commencé à étudier et à publier sur le sujet. Plusieurs études tentent de cibler les facteurs de risque du suicide du senior, notamment au niveau d'altérations neurobiologiques liées à l'âge. Des techniques de préventions ont déjà été développées et montrent des résultats probants. Au travers de cette revue de littérature, nous avons voulu donner une vision globale et résumée du suicide et de la tentative de suicide des seniors.

[Geriatric psychiatry and dementia]. / Gérontopsychiatrie et démence.

Behavioural disorders linked to dementia are common. The intertwining of psychiatric and neurodegenerative pathologies means caregivers are faced with complex situations on a daily basis. The expertise of the geriatric psychiatry teams helps to guide the clinical reasoning and to find the best nursing approach in order to understand the symptom and support the patient.

Complejidad en la valoración del dolor en personas mayores / No disponible

La población envejecida representa uno de los segmentos poblacionales de mayor crecimiento. Con el aumento de la edad la incidencia y la prevalencia de síndromes dolorosos aumenta de forma muy importante. La fragilidad y la cronicidad de enfermedades que comportan dolor, en los pacientes mayores como segmento especial, va a seguir aumentando. El dolor es frecuentemente infravalorado por el propio paciente, entrando en la creencia de ser condición propia de la edad. La clara consecuencia de esta infravaloración es el impacto negativo sobre la salud, calidad de vida, que puede acabar en trastornos del ánimo, aislamiento social, deterioro cognitivo, inmovilidad y trastornos del sueño. Una valoración exhaustiva del dolor ha de incluir una historia clínica y examen físico completo, una valoración neuropsicológica y un examen psicopatológico, test de laboratorio adecuados y pruebas de imagen. Lo más recomendable es una aproximación multidisciplinar para poder mantener un adecuado manejo del dolor, aportando las mejores opciones, que incluyen la farmacoterapia, intervenciones, rehabilitación física y soporte psicológico

The elderly population comprises the fastest growing segment of the world’s population. As patients age, the incidence and prevalence of certain pain syndromes increase. Frailty and chronic diseases associated with pain will likely increase. Pain may be underreported as some elderly patients incorrectly believe that pain is a normal process of aging. The elderly are often either untreated or undertreated for pain. Consequences of under treatment for pain can have a negative impact on the health and quality of life of the elderly, resulting in depression, anxiety, social isolation, cognitive impairment, immobility, and sleep disturbances. A comprehensive pain assessment includes a thorough medical history and physical examination, neuropsychological and psychopathological examination, pertinent laboratory results and imaging studies. A multidisciplinary approach is recommended to investigate all possible options for optimal management, including pharmacotherapy, interventional procedures, physical rehabilitation, and psychological support

[Trialogical Evaluation of a Gerontological Psychiatric Consulting and Liaison Service]. / Trialogische Evaluierung eines gerontopsychiatrischen Konsiliar- und Liaisondienstes.

Objective: The presented project shows the effects of a gerontological psychiatric consulting and liaison service (C&L) on nursing home residents and the care team. Methods: The implementation of the C&L was evaluated using a quasi-experimental design in longitudinal section of residents', nursing, medical and family perspective using quantitative and qualitative methods. Results/Conclusion: The results provide evidence for the positive effects of C&L especially in relation to the "common action" within the care team.

[Innovative healthcare strategies in geriatric psychiatry and psychotherapy]. / Innovative Versorgungsstrategien in der Gerontopsychiatrie und -psychotherapie.

BACKGROUND: The development of efficacious treatment strategies in older adults with mental illnesses is necessary. The growing number of homebound patients and the incidence of physical comorbidities and impairment of activities of daily living are important factors for interdisciplinary treatment strategies in old age and there is a need for home-based services providing medical and psychosocial interventions. OBJECTIVE: Recent studies have provided information on home-based and collaborative treatment strategies in mentally ill elderly patients. METHODS: This article provides an overview on selected randomized controlled trials (RCT) conducted with mentally ill older adults. RESULTS: Studies have shown promising effects when applying stepped care interventions, collaborative care and assertive community treatment in old patients suffering from mental diseases when compared to usual care. Long-standing home-based mental health programs have been designed and successfully implemented showing improved identification, treatment and ongoing care of mental health problems. In-home tele-psychotherapy has been shown to be efficacious in homebound older adults with limited access to evidence-based psychotherapy and showed a sustained effect in one study. CONCLUSION: Collaborative care models, stepped care interventions in primary care settings and an enhanced inter-professional approach to patient care in old age psychiatry is necessary to improve detection, treatment and ongoing care. Tele-mental health services may become important parts of the provision of mental health services and the effectiveness revealed for in-home tele-health problem solving therapy in old age depression may be an approach to make psychotherapy available to a large number of underserved elderly patients with mental illness.

XVIII Jornadas de actualización en psicogeriatría / No disponible

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The Role of Psychogeriatrics in Healthy Living and Active Ageing.

A healthy and active life is a key issue for elderly citizens, above all when psychological complications such as depression and anxiety disorders, late delusion or loneliness can be observed. Moreover, medical pathologies in elderly patients often have a multi-factorial etiology and many psychopathological dimensions and psychosocial risk factors are underestimated. From the perspective of clinical health psychology, psychogeriatrics could play an important role in promoting active ageing and a healthy lifestyle in elderly persons through tailored clinical approaches based on specific research and advanced professional training in this area. More research is needed in order to study which determinants affect the process of an active and functional ageing. Possible research ageing areas are: 1) evaluation of psychosocial risk-protective factors related to the individual's biography and personality. 2) Evaluation of enrichment programs and clinical protocols focused on the management of different topics such as health system areas, behavioral areas, social and physical environment areas, psychological factors and economic determinants. The goal of Psychogeriatrics endeavors to develop and evaluate interventions designed to stimulate improvement in friendship, self-esteem and subjective well-being, as well as to reduce loneliness among older citizens. 3) Evaluation of self-management programs in chronic disease conditions (such as obesity, diabetes, hypertension, poor nutrition, physical inactivity, alcohol abuse and tobacco smoking), that could enhance risk factors for health in elderly citizens. Typical key elements of self-management, such as decision making, problem solving, motivation, self-efficacy, resource utilization, and citizen's empowerment have to be studied.