Although elderly people are one of the major target groups for telemedicine applications, they remain under‐represented in studies of teleconsultation. Videolinks appear to be easily used by many ...elderly people as a means of communicating with health‐care staff, including psychologists and doctors. To date, studies of psychometric teleconsultation have been confined to screening tests, or have used very small numbers of patients. There is a need to examine the reliability of more complex psychometric batteries and to use larger samples of older people. Some recommendations for conducting clinical interviews and psychometric tests are presented, based on clinical experience and a review of the literature. The importance of ergonomic considerations, patient comfort and professional preparation are explained.
Even though the efforts in research have detailed further the physiopathology and the dynamics of the frailty process an operational definition of frailty is still far from being unequivocal. Studies ...carried out from the SAFEs cohort study allowed a pragmatic approach in the identification of the at-risk groups for the lost of independency during the hospital stay and factors influencing their future at short-, mid- and long-term. Based upon these results, we propose to discuss the relevance of the current operational indicators of frailty in order to show that clinical markers or indicators are insufficient to differentiate the frailty process from normal ageing. Finally we give rise to the imperative necessity to detect frailty at a preclinical stage with the help of biological and more particularly inflammatory markers.
The use of telemedicine in delivering psychological services to the elderly was investigated. Psychological teleconsultation is feasible with many elderly people, provided that patients do not have ...marked sensory impairments, that the equipment used is reliable and that a routine procedure is established in advance for welcoming the patient and conducting the assessment.
The aim of this study was to identify early indicators of prolonged hospital stays by elderly patients.
This prospective pilot study, conducted at Strasbourg University Hospital, included patients ...aged 75 years or older who were hospitalized via the emergency department (SAFES cohort: Sujet Agé Fragile: Evaluation et suivi, that is, Frail Elderly Subjects: Evaluation and Follow-up). A gerontologic evaluation of these patients during the first week of their hospitalization furnished the data for an exact logistic regression. Two definitions were used for prolonged hospitalization: 30 days and a composite number adjusted for diagnosis-related group according to the French classification (f-DRG).
The analysis examined 137 hospitalizations. More than two thirds of the patients were women (73%), with a mean age of 84 years. Twenty-four hospitalizations (17%) lasted more than 30 days, but only 6 (4%) lasted beyond the DRG-adjusted limit. No social or demographic variables appeared to affect the length of stay, regardless of the definition of prolonged stay. No indicator was associated with the 30-day limit, but clinical markers were linked to prolongation assessed by f-DRG adjustment. A "risk of malnutrition" (OR=14.07) and "mood disorders" (OR=2,5) were both early markers for prolonged hospitalization. Although not statistically significant, "walking difficulties" (OR=2.72) and "cognitive impairment" (OR=5.03) appeared to be associated with prolonged stays. No association was seen with either the variables measured by Katz's Activities of Daily Living Index or its course during hospitalization.
Our study shows that when generally recognized indicators of frailty are taken into account, a set of simple items enables a predictive approach to the prolongation of emergency hospitalizations of the elderly.
The aim of this study was to identify early indicators of prolonged hospital stays by elderly patients.
This prospective pilot study, conducted at Strasbourg University Hospital, included patients ...aged 75 years or older who were hospitalized via the emergency department (SAFES cohort:
Sujet Âgé Fragile: Évaluation et suivi, that is, Frail Elderly Subjects: Evaluation and Follow-up). A gerontologic evaluation of these patients during the first week of their hospitalization furnished the data for an exact logistic regression. Two definitions were used for prolonged hospitalization: 30 days and a composite number adjusted for diagnosis-related group according to the French classification (f-DRG).
The analysis examined 137 hospitalizations. More than two thirds of the patients were women (73%), with a mean age of 84 years. Twenty-four hospitalizations (17%) lasted more than 30 days, but only 6 (4%) lasted beyond the DRG-adjusted limit. No social or demographic variables appeared to affect the length of stay, regardless of the definition of prolonged stay. No indicator was associated with the 30-day limit, but clinical markers were linked to prolongation assessed by f-DRG adjustment. A “risk of malnutrition” (OR
=
14.07) and “mood disorders” (OR
=
2,5) were both early markers for prolonged hospitalization. Although not statistically significant, “walking difficulties” (OR
=
2.72) and “cognitive impairment” (OR
=
5.03) appeared to be associated with prolonged stays. No association was seen with either the variables measured by Katz's Activities of Daily Living Index or its course during hospitalization.
Our study shows that when generally recognized indicators of frailty are taken into account, a set of simple items enables a predictive approach to the prolongation of emergency hospitalizations of the elderly.
Identifier les indicateurs précoces de durée de séjour prolongée chez des patients âgés hospitalisés en service de court séjour de médecine.
Une étude pilote prospective a été réalisée au CHRU de Strasbourg incluant des sujets âgés de 75 ans ou plus hospitalisés en service de court séjour de médecine depuis un service d'accueil et des urgences (cohorte SAFEs
: Sujet âgé fragile
: évaluation et suivi). Les données analysées par une régression logistique exacte ont été recueillies lors d'une évaluation gériatrique des patients réalisée dans la première semaine d'hospitalisation. Deux bornes ont été utilisées pour définir un séjour de durée prolongée. La première était une borne fixée à 30 jours. La seconde était ajustée sur le Groupe homogène de malades (Ghm).
Cent trente-sept séjours ont été analysés. Les femmes représentaient les 2/3 de l'échantillon (64
%). La moyenne d'âge était >
84 ans. Vingt-quatre séjours (17
%) avaient une durée >
30 jours; 6 séjours (4
%) se prolongeaient au-delà de la borne ajustée sur le Ghm. Aucune variable sociodémographique n'apparaissait associée à une durée prolongée des séjours et ce, quelle que soit la borne utilisée. Aucun indicateur n'a été identifié avec la borne de 30 jours. Après ajustement sur le Ghm, un “risque de malnutrition” (
odds ratio OR
=
14,07) et les “troubles de l'humeur” (OR
=
2,5) apparaissaient comme des indicateurs de séjours prolongés. Sans toutefois atteindre la significativité, les “troubles de la marche” (OR
=
2,72) et la “détérioration cognitive” (OR
=
5,03) semblaient favoriser la prolongation. Le niveau de dépendance et son évolution, mesurés par les ADL (
Activities of Daily Living) de Katz, n'ont pas été retrouvés comme des marqueurs pertinents.
Notre étude a montré que lorsqu'on prenait en considération les paramètres habituellement reconnus comme associés à la fragilité, un ensemble d'items simples pouvait permettre une approche prédictive des séjours de durée prolongée chez des patients âgés hospitalisés en urgence.
Community-dwelling people with Alzheimer's disease are exposed to situations-at-risk at home, but this phenomenon has rarely been studied empirically. The purpose of this pilot study was to describe ...the safety problems experienced at home in a sample of patients with dementia seen in a memory clinic, and also to identify the factors associated with these situations-at-risk. Study participants were 38 demented persons who were living at home, and assessed in a memory clinic with a caregiver-relative. Caregiver-relatives took part in a semi-structured interview in which they completed a French version of the Safety Assessment Scale (Poulin de Courval et al., 2006). The results show that all people with dementia were exposed to risks at home. Patients living alone were perceived to be more at risk at home than those living with someone. The most commonly reported risks concerned fire, nutrition and polymedication. The assessment gathers interesting information, addressing a wide range of risks at home. The Safety Assessment Scale is a useful tool to detect the risks at home and to focus the interview with the caregivers towards their prevention, since improvements are likely to enhance safety.
We present a study of modelling and the first steps of an experiment of a smart room for hospitalised elderly people. The system aims at detecting falls and sicknesses, and implements four main ...functions: perception of patient and environment through sensors, reasoning from perceived events and patient clinical findings, action by way of alarm triggering and message passing to medical staff, and adaptation to various patient profiles, sensor layouts, house fixtures and architecture. It includes a physical multisensory device located in the patient's room, and a multi-agent system for fall detection and alarm triggering. This system encompasses a perception agent, and a reasoning agent. The latter has two complementary capacities implemented by sub-agents: deduction of type of alarm from incoming events, and knowledge induction from recorded events. The system has been tested with a few patients in real clinical situation, and the first experiment provides encouraging results which are described in a precise manner.
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