[Comparative study of two on aged care-based occupational (professional) training in medical home for aged and dependent patients with neuropsychiatric behaviors]. / Évaluation comparative de deux dispositifs de formation professionnelle axés sur l'accompagnement des résidents d'Ehpad présentant des troubles psycho-comportementaux.

BACKGROUND: Neuropsychiatric behaviours of the elderly is the main issue for caregivers' distress, burn out and high turn-over. This situation will steadily worsen with longer lifetime. AIM OF THE STUDY: Specialised training of medical staff may decrease their distress: we compare both training programs Humanitude® et Formadep® outcomes. METHODS: A comparative open multicentric non randomised study included 459 elderlies of 9 EHPAD of Korian Company into 3 training groups: Humanitude®, Formadep® and a group control, with 29 weeks follow-up. We studied the scoring NPI-ES (FG and R), BMS-10, ECPA and GIR, medications, caregivers' burn out/absences/turn-over levels. Statistical significance were done by Wilcoxon signed-rank test, Ancova and linear regression. RESULTS: 320 caregivers and 3 groups of nearly 150 elderlies each, with around 50% dementia. In Formadep® group : lower scoring for a short time of total NPI-R (p<0.05), sustained lower scoring of NPI-FG « agitation/agressivity¼ (p=0.035) but transitional for its NPI-R (p<0.05), sustained higher scoring of NPI-FG «apathy/indifference¼ (p=0.002) but transitional for its NPI-R (p=0 .003), sustained lower scoring of NPI-R (p=0.0039) for Motor Aberrant Behaviours (MAB). In Humanitude® group: transitional higher scoring of NPI-R (p=0.025) for MAB et transitional lower scoring NPI-R (p=0.0032) for depression (Alzheimer Disease sub-groupe). No change for other parameters. CONCLUSION: Despite high variability of the neuropsychiatric behaviours in elderly, Formadep® training has shown a positive impact on the global distress and on three main challenging behaviours, compared to Humanitude®: this may be depend on their own philosophy. But caregivers' burden in dementia is not a one-factor problem.

'Faster counting while walking' as a predictor of falls in older adults.

OBJECTIVE: To establish whether changes in a spoken verbal task performance while walking compared with being at rest could predict falls among older adults. DESIGN: Prospective cohort study of 12 months' duration. SETTING: Twenty-seven senior housing facilities. PARTICIPANTS: Sample of 187 subjects aged 75-100 (mean age 84.8 +/- 5.2). During enrollment, participants were asked to count aloud backward from 50, both at rest and while walking and were divided into two groups according to their counting performance. Information on incident falls during the follow-up year was monthly collected. MEASUREMENTS: The number of enumerated figures while sitting on a chair and while walking, and the first fall that occurred during the follow up year. RESULTS: The number of enumerated figures under dual-task as compared to single task increased among 31.5% of the tested subjects (n = 59) and was associated with lower scores in MMSE (P = 0.034), and higher scores in Geriatric Depression Scale (P = 0.007) and Timed Up & Go (P = 0.005). During the 12 months follow-up, 54 subjects (28.9%) fell. After adjusting for these variables, the increase in counting performance was significantly associated with falls (adjusted OR = 53.3, P < 0.0001). Kaplan-Meier distributions of falls differed significantly between subjects who either increased or decreased their counting performance (P < 0.0001). CONCLUSIONS: Faster counting while walking was strongly associated with falls, suggesting that better performance in an additional verbal counting task while walking might represent a new way to predict falls among older adults.