Gilles Berrut

Background: Preparing healthcare systems for emergencies is crucial to maintaining healthcare quality. Nursing homes (NHs) require tailored emergency plans. This article aims to develop a typology of French private NHs and study their early COVID-19 responses and mortality outcomes. Methods: We conducted a cross-sectional survey among NHs of a French network consisting of 290 facilities during the first wave of the COVID-19 pandemic. A Hierarchical Clustering on Principal Components (HCPC) was conducted to develop the typology of the NHs. Association tests were used to analyze the relationships between the typology, prevention and control measures, COVID-19 mortality, and the satisfaction of hospitalization requests. Results: The 290 NHs vary in size, services, and location characteristics. The HCPC identified three clusters: large urban NHs with low levels of primary care (Cluster 1), small rural NHs (Cluster 2), and medium urban NHs with high levels of primary care (Cluster 3). The COVID-19 outcomes and response measures differed by cluster, with Clusters 1 and 2 experiencing higher mortality rates. Nearly all the NHs implemented preventive measures, but the timing and extent varied. Conclusions: This typology could help in better preparing NHs for future health emergencies, allowing for targeted resource allocation and tailored adaptations. It underscores the importance of primary care territorial structuring in managing health crises.

Walk speed measured under dual-task conditions (neurocognitive tasks) could reflect patient performance in real-life. Rehabilitation programs are effective in increasing walk speed, but few studies have evaluated the associations between geriatric factors and rehabilitation efficacy under dual-task conditions. Our objective was to investigate the association between geriatric factors and an increase in dual-task walk speed (threshold of 0.1 m/s), after a multidisciplinary rehabilitation program. We performed a retrospective cohort study that included patients aged 75 years and over, who underwent a complete rehabilitation program and who had a neurocognitive assessment at baseline. The primary outcome was the increase in the dual-task (fluency verbal task) walking speed between pre- and post-rehabilitation assessments. In this study, 145 patients were included, with a mean age of 83.6 years old. After rehabilitation, dual-task walk speed increase in 62 (43%) patients. In multivariate analysis, the following factors were associated with an increase in dual-task walk speed: IADL (OR 2.50, 95% CI [1.26; 4.94], p = 0.009), vitamin D level (OR 0.83, 95% CI [0.72; 0.95], p = 0.008), severe sarcopenia (OR 0.00, 95% CI [0.00; 0.32], p = 0.016), depression (OR 15.85, 95% CI [1.32; 190.40], p = 0.029), number of drugs (OR 1.41, 95% CI [1.04; 1.92], p = 0.027), initial dual-fluency walk speed (OR 0.92, 95% CI [0.86; 0.98], p = 0.014) and time interval between initial and final assessments (OR 0.98, 95% CI [0.96; 1.00], p = 0.06). Identifying patients that are less resilient to rehabilitation may promote a centered-patient approach for an individualized and optimized rehabilitation care.

Background: Studies comparing how the European nursing homes (NHs) handled the first wave of the COVID-19 pandemic remain scarce. Methods: A cross-sectional study was conducted during the first wave in a private NHs network in Belgium, France, Germany and Italy. Mortality rates were estimated, and prevention and control measures were described by country. Data from the Oxford governmental response tracker project were used to elaborate a “modified stringency index” measuring the magnitude of the COVID-19 global response. Results: Of the 580 NHs surveyed, 383 responded to the online questionnaire. The COVID-19 mortality rate was similar in France (3.9 deaths per 100 residents) and Belgium (4.5). It was almost four times higher in Italy (11.9) and particularly low in Germany (0.3). Prevention and control measures were diversely implemented: residents’ sectorization was mainly carried out in France and Italy (~90% versus ~30% in Germany and Belgium). The “modified stringency index” followed roughly the same pattern in each country. Conclusion: This study, conducted in a European network of NHs, showed differences in mortality rate which could be explained by the characteristics of the residents, the magnitude of the first wave and the prevention and control measures implemented. These results may inform future European preparedness plans.

The meaning of place and home for community dwellers and nursing home residents remains unclear. We explored the relationship between older people and their “life territory”, to propose a working definition of this concept, which could be used to orient policy decisions. Individual, semi-structured interviews were performed with older people, nursing home staff, and representatives of local institutions/elected officials in four European countries (France, Belgium, Germany, Italy). Interviews were transcribed and analysed using thematic analysis. In total, 54 interviews were performed. Five main themes emerged: (i) working definition of “your life territory” (a multidimensional concept covering individual and collective aspects); (ii) importance of the built environment (e.g., public transport, sidewalks, benches, access ramps); (iii) interactions between nursing homes and the outside community (specifically the need to maintain interactions with the local community); (iv) a sense of integration (dependent on social contacts, seniority in the area, perceived self-utility); and (v) the use of new technologies (to promote integration, social contacts and access to culture). This study found that the “life territory” of older people is a multidimensional concept, centred around five main domains, which together contribute to integrating older people into the fibre of their community.

Background: Influenza is a common viral condition, but factors related to short-term mortality have not been fully studied in older adults. Our objective was to determine whether there is an association between geriatric factors and 30-day mortality. Methods: This was a retrospective cohort design. All patients aged 75 years and over, with a diagnosis of influenza confirmed by a positive RT-PCR, were included. The primary endpoint was death within the 30 days after diagnosis. Results: 114 patients were included; 14 (12.3%) patients died within 30 days. In multivariate analysis these patients were older (OR: 1.37 95% CI (1.05, 1.79), p = 0.021), and had a lower ADL score (OR: 0.36 95% CI (0, 17; 0.75), p = 0.006), and a higher SOFA score (OR: 2.30 95% CI (1.07, 4.94), p = 0.03). Oseltamivir treatment, initiated within the first 48 h, was independently associated with survival (OR: 0.04 95% CI (0.002, 0.78), p = 0.034). Conclusions: Identification of mortality risk factors makes it possible to consider specific secondary prevention measures such as the rapid introduction of antiviral treatment. Combined with primary prevention, these measures could help to limit the mortality associated with influenza in older patients.

Multidisciplinary management of worsening heart failure (HF) in the elderly improves survival. To ensure patients have access to adequate care, the current HF and French health authority guidelines advise establishing a clearly defined HF patient pathway. This pathway involves coordinating multiple disciplines to manage decompensating HF. Yet, recent registry data indicate that insufficient numbers of patients receive specialised cardiology care, which increases the risk of rehospitalisation and mortality. The patient pathway in France involves three key stages: presentation with decompensated HF, stabilisation within a hospital setting and transitional care back out into the community. In each of these three phases, HF diagnosis, severity and precipitating factors need to be promptly identified and managed. This is particularly pertinent in older, frail patients who may present with atypical symptoms or coexisting comorbidities and for whom geriatric evaluation may be needed or specific geriatric syndrome management implemented. In the transition phase, multi-professional post-discharge management must be coordinated with community health care professionals. When the patient is discharged, HF medication must be optimised, and patients educated about self-care and monitoring symptoms. This review provides practical guidance to clinicians managing worsening HF in the elderly.

In a context marked by negative health indicators that make structural aspects more salient, this paper aimed at understanding and explaining the processes and determinants at work that positively and negatively interfere with the professionals’ health in the French public nursing home environment. To this purpose, the qualitative approach by grounded theory was chosen. In total, 90 semi-structured interviews were recorded and 43 were transcribed; in addition, 10 observations of 46 participations in meetings and working groups were carried out in four public service and hospital establishments. Our results indicate that the role of health workers, its definition, and its execution are fundamental to the understanding of their health at work. Two protective and constructive processes are involved in the maintenance and development of the professionals’ health in this work, with considerable confrontations with death and suffering: individual and collective control of emotional and cognitive commitment, and the development of resources for formation, information, and cooperation. Nonetheless, they are jeopardized when a lasting imbalance is generated between the work’s demands and the available resources. This leads to a loss spiral in organizational, inter-individual, and individual resources that makes it difficult to sustain work.

(1) Osteoporosis and sarcopenia are frequent pathologies among the geriatric population. The interlink between these two diseases is supported by their common pathophysiology. The aim is to explore the relationship between bone mineral density (BMD) and body composition in women aged 75 or older. (2) From January 2016 to December 2019, women aged 75 or older of Caucasian ethnicity, who were addressed to perform a biphoton absorptiometry (DXA), were included in this observational study. Femoral neck T-score, lean mass, fat mass, and physical performances were measured. (3) The mean age of 101 patients included was 84.8 (±4.9) years old. Osteoporosis was present in 72% of patients. According to EWGSOP criteria, 37% of patients were sarcopenic. Osteosarcopenia was present in 34% of patients. The femoral neck T-score was significantly associated with fat mass (β = 0.02, 95% CI (0.01; 0.03), p < 0.05) in multivariable analysis. Osteosarcopenic patients had significantly lower fat mass (16.2 kg (±6.8) vs. 23.1 kg (±10.8), p < 0.001) and body mass index (BMI) (20.7 kg/m² (±2.8) vs. 26.7 kg/m² (±5.6), p < 0.001). (4) In postmenopausal women, fat mass is estimated to provide hormonal protection. While osteosarcopenia is described as a lipotoxic disease, fat mass and BMI would appear to protect against the risk of osteosarcopenia. This raises questions about the relevance of BMI and DXA.

Background: Although the interest of antibiotics is well known, antibiotics prescription is associated with side effect, especially in patients with multiples comorbidities. One way to reduce the incidence of side effects is to respect antibiotics prescriptions guidelines. Our objective was to investigated the factors associated with guidelines adherence in elderly patients with multiples comorbidities. Methods: From October 2015 to December 2016, antibiotics prescription and guidelines adherence were analyzed in two post-acute care and rehabilitation services of a 2600-bed, university-affiliated center. Results: One hundred and twenty-eight patients were included, fifty-nine (46%) patients had antibiotics prescription according to guidelines. In Multivariable logistic regression analysis, prescription of 2 antibiotics or more (OR = 0.168, 95% IC = 0.037–0.758, p < 0.05), 85 years of age and more (OR = 0.375, 95% IC = 0.151–0.931, p < 0.05) and the Charlson comorbidity index score (OR = 0.750, 95% IC = 0.572–0.984, p < 0.05) were negatively associated with antibiotics prescriptions according to guidelines. Conclusions: High comorbidity in the elderly was negatively associated with the guidelines adherence of antibiotiсs prescriptions. These criteria should be considered to optimize antibiotics prescriptions in elderly patients.

Epilepsia is a frequent disease in the elderly. Most of the time seizures are the consequence of another or other comorbidities and they are generally partial. Causal pathologies are either cerebral or general. The most common is the stroke, especially if it is haemorrhagic. If the seizure is delayed in relation to stroke, it defines vascular epilepsy and is an indication for long-term antiepileptic therapy. Neurodegenerative diseases, primarily Alzheimer's disease, are associated with epilepsy, but the pathophysiological links between the two are poorly understood. The clinical presentation of seizures is often atypical and the existence of memory disorders complicates the diagnosis because they make it difficult to reconstruct the anamnesis. Cranial trauma and tumours are the other classic brain causes of epilepsy. The general causes include metabolic and hydroelectrolytic disorders (especially hypoglycaemia and hyponatremia), drugs (either by their toxicity or by a withdrawal syndrome), and uraemic encephalopathy of renal failure. Finally, alcohol is a common cause not to be neglected, including among institutionalised patients.