Indoor air pollution in old people's homes related to some health problems: a survey study.

UNLABELLED: The present research reports on a survey of 96 subjects between the ages of 60 and 95 years, living close to Paris in a social collective habitat. The aim was to show, using goodness-of-fit statistical tests (P < 0.1), how old people lifestyles can subject them to generated chemical or bacteriological indoor pollutants. Risk factors due to lifestyles were analyzed in relation to complaints and to health condition. There are many ways that old people are exposed to pollutants: difficulty in maintaining the residence, preference for staying in the kitchens, substantial use of cleaning chemicals. However, the principal risk for health problems is arguably inadequate ventilation (unclean screens, blocked air vents, etc.), which increases the concentration of indoor pollutants. These risks are amplified by ignorance about the hazards of inadequate ventilation. PRACTICAL IMPLICATIONS: The present investigation suggests that the lifestyle and the behavior of old people could be the cause of an interior air pollution of their housing. Measures realized in representative dwellings selected in relation to results must confirm that these risks would require the installation of an automatic monitoring system of the indoor air near these people.

[Cognitive aging in chronic psychotic patients]. / Vieillissement cognitif des psychotiques chroniques.

OBJECTIVE: The cognitive aging of psychotic patients is still poorly apprehended and sometimes wrongly compared with demential or pseudo-demential deterioration. We studied the impact of chronic psychosis on cognitive performance in the elderly. PATIENTS AND METHODS: We estimated cognitive performance in two groups of 15 patients each among persons on old-age pensions or living in geriatric nursing homes. One group included patients who had already showed dissociative or non-dissociative chronic psychosis and the other group persons with no previous psychotic signs. Cognitive estimations were made on the basis of Folstein's Mini Mental State (MMS) score and Signoret's Battery of Cognitive Efficacy (BEC 96). Results obtained in the two groups were compared with the Mann and Whitney non-parametric test. RESULTS: The psychiatric patients showed a significant deficiency compared with the others for memory and executive functions and also a much broader range of scores on the BEC96 that demonstrated deficiency among the psychiatric patients. DISCUSSION: Though these findings must be interpreted with caution, they do demonstrate a trend similar to that observed in young schizophrenics and also to that of the cognitive performances observed in older schizophrenics and demented subjects. Patients with dissociated or non-dissociated psychotic disorders show an apparent relative cognitive deficiency irrespective of age. The psychotic elderly appear to exhibit a cognitive clash much more than a simple pseudo-demential deficiency.

[Heparin use in geriatrics and risk profiles of treated patients. A survey in France]. / Consommation d'héparine en contexte gériatrique et profils de risque des malades traités. Une enquête en France un jour donné.

OBJECTIVES: Nursing home residents and geriatric ward patients have a high risk of venous thromboembolism. Prevention is a major challenge. We conducted a one-day audit to ascertain heparin use patterns in a large sample of geriatric facilities in France. METHODS: This one-day audit was made with a questionnaire mailed to 150 geriatric centers in France. Items were the number of subjects receiving heparin on the day of the survey, and for each of these subjects, the reason for the prescription, risk factors for venous thromboembolism and date of treatment onset. RESULTS: Ninety-six centers (63%) participated. These centers had 14,208 beds the day of the survey (short-term hospitalization, day-care hospitalization, nursing homes, retirement homes). These centers reported 1,312 subjects (9.2%) receiving heparin on the day of the survey. Their mean age was 83.4 days. Among the hospital centers, heparin had been prescribed in 33.4% of the short-term hospitalization patients, 27.3% of the day-care patients, and 5.6% of the nursing home patients. Heparin was prescribed for prophylaxis in 1,143 patients (87%)--basically low-molecular-weight heparin. These patients had on the average 3.33 risk factors. The duration of preventive treatment was more than 30 days in 481 subjects (50%) and 161 (17%) had received heparin for 6 months or more. CONCLUSION: Prevention of venous thromboembolism is a major concern in geriatric centers in France. Although the preventive efficacy has not been clearly demonstrated in geriatric medical patients, low-molecular weight heparin is widely used for this purpose with, in a large number of cases, very long treatment durations.

[Investigation of an epidemic of an extended spectrum beta-lactamase producing Escherichia coli in a geriatrics department]. / Investigation d'une épidémie à Escherichia coli à bêta-lactamase à spectre étendu dans un service de gériatrie.

An outbreak of extended-spectrum beta-lactamase-producing (ESBL) Escherichia coli urinary tract infection occurred on one floor of a department of the G. Clemenceau hospital. There were nine cases from March to August 1994, all of which resolved under antimicrobial therapy. Two further cases occurred, leading to a program of routine rectal swab cultures in all patients on the floor involved (first floor). ESBL E. coli carriage was found in six patients. Follow-up rectal swabs were obtained until September 1995 from all patients on the floor who were infected or colonized with ESBL E. coli between March and October 1994. Between March and June 1995, routine rectal swabs were also obtained from the patients on the other two floors of the department. Seven other carriers were detected and also underwent follow-up rectal swabs until September 1995. Ribotyping of the strains done at the national enteric molecular typing center (Pasteur Institute, Paris) demonstrated four patterns (CM1, CM2, CM3, and CM4). The strains from the first six carriers all shared the CM1 pattern, whereas among the seven carriers detected later, four (second and third floors) had a CM1 strain and the remaining three (first floor) each had a strain of the three other ribotypes (CM2, CM3, and CM4). ESBL E. coli can be carried in the digestive tract for several months. During the outbreak, the same strain was found in all the patients, whereas a variety of strains were found after the outbreak in patiens without clinical symptoms due to ESBL E. coli. Routine rectal swab cultures are useful for evaluating the extent of outbreaks. However, the only effective outbreak control measures are compliance with strict hygiene procedures (signalization, technical and geographic isolation) and appropriate antimicrobial therapy. These measures were effective at the G. Clemenceau Hospital since there have been no further cases of ESBL E. coli since they were implemented. The rectal swab program has therefore been stopped, whereas strict universal hygienic precautions are still adhered to faithfully.