Homicides-suicides within couples are rare situations but can be considered preventable deaths. Various studies have identified risk factors for these couples, regardless of their age, such as a history of domestic violence, psychiatric disorders, addictions, or substance abuse. However, it appears that homicides-suicides among elderly couples have specific characteristics unique to this population. The objective of this study is to draw on recent scientific literature and concrete cases to raise awareness and consider preventive measures for these fatal acts among older individuals. It appears that particular attention should be given in cases where the man is the primary caregiver, when there is a recent deterioration in one partner's health, when hospitalization or institutionalization is being discussed, or when a firearm is present in the household.

The 2007 French Haute Autorité de santé recommendation on the diagnosis of malnutrition in the elderly was revised in 2021. The main objective was to compare the prevalence of malnutrition according to the recommendations. The secondary objectives were to compare 3-month mortality and assess the prevalence of sarcopenia and sarcopenic obesity. The 2021 criteria were applied retrospectively to a cohort. Concordance analysis was carried out using Cohen's kappa coefficient and statistical analysis of mortality using Fisher's exact test. There were 135 patients, 60% malnourished with 35% severely malnourished according to HAS 2007, 49% malnourished with 62% severely malnourished according to HAS 2021 with moderate agreement. There were 25 cases of confirmed sarcopenia and one case of sarcopenic obesity. Moderately to severely malnourished people had an increased risk of death at 3 months (HAS 2021).

There is still much room for improving the self-advocacy of elderly female patients with breast cancer. Subjects (168 in total) were selected from elderly female patients with breast cancer who had been hospitalized from May to December 2022 using the convenience sampling method. Assessment was conducted for the status quo of self-advocacy of subjects using the Chinese version of Female Self-Advocacy in Cancer Survivorship (FSACS). The general data of patients were investigated to find out the possible related factors. The FSACS score was 79.23±10.58 points in the 168 elderly female patients with breast cancer, showing significant differences among the patients at different ages and with various levels of education, self-efficacy, perceived social support and psychological resilience (P<0.05). The following equation was acquired by multiple linear regression analysis: Y=88.762+0.881X1-2.447X2-5.763X3-1.617X4-4.259X5. An advanced age was a non-independent risk factor for the self-advocacy of elderly female patients with breast cancer (B>0, P>0.05), while high levels of education, self-efficacy, perceived social support and psychological resilience served as protective factors (B<0, P<0.05). Elderly female patients with breast cancer exhibit a medium level of self-advocacy, which may be associated with age, education level, self-efficacy, perceived social support, and psychological resilience.

The personalized prescription plan (PPP) summarizes the changes made to a patient's prescription on discharge from hospital. The aim of the present study was to evaluate 30-day medication continuity in older patients whose PPP was implemented at hospital discharge. Prospective randomized controlled trial including people aged at least 75 discharged from an acute geriatric unit. The intervention consisted of medication reconciliation and review, and standardized transmission of a PPP (explaining medication changes during hospitalization) to primary care practitioners. The control group received no specific intervention. Reasons for and rates of change in discharge prescribing by primary care practitioners were assessed 30 days after discharge. The study population comprised 109 patients, 70 of whom were selected for modified intention-to-treat analysis (intervention group 34; control group 36). The mean age (standard deviation) of patients was 87.4 (6.6) years. One month after discharge, the discharge prescription was modified for 26.7% of patients in the intervention group and 31.2% in the control group (0R = 0.80, CI(95%)=[0.25; 2.45]; p = 0.91). Reasons for change were mainly adaptation to clinical events (83.3%). Medication continuity after the implementation of a PPP is similar to that of routine care, one month after hospital discharge of the elderly.

Despite the growing deployment of the Montessori method in nursing homes, there is no instrument to measure its implementation fidelity, limiting the interpretation of results. Our aims are to i) develop an evaluation grid for the Montessori method in nursing homes; ii) explore its sensitivity to practice heterogeneity among institutions pre-training; and iii) study its sensitivity to change after the training. Based on literature and expert opinions, we created an evaluation grid. This grid was completed by 333 professionals before training in 29 nursing homes. Of these, 125 completed it again post-deployment. Before training, the degree of application of the method's principles varied. After training, effects were noted on various aspects targeted by the method. The developed grid is a valid tool for evaluating the fidelity of Montessori method implementation in nursing homes.

The objective of our work was to study the impact of a mobile health unit of geriatric psychiatry (EMGP) on the number of consultations to the emergency medical service and on the rate of readmissions. This was an observational, retrospective, single-center cohort study, which aimed to identify the number of visits to the Troyes SAU for psychiatric reasons. This in patients who have previously benefited from hospitalization in the Aube geriatric-psychiatry department called Ellipses. The "patients exposed" group was exposed by the existence of EMGP during hospitalization between January 1, 2018 and December 31, 2019. The group not exposed by the non-existence of the system between January 1, 2014 and December 31, 2015. Our results suggest that the actions implemented by the EMGP tend to reduce the frequency of visits to the emergency room after hospitalization, among people aged 65 and over (p<0.001) as well as their duration of hospitalization (p=0.003).

A quarter of nursing home residents dies in hospital. Few data are available about early in-hospital deaths of nursing home residents. The aim of the study was to describe the characteristics of early in-hospital deaths of nursing home residents after an admission in emergency department and to identify factors associated with a decision of limitation of care in emergency department. This retrospective monocentric descriptive study included all nursing home residents hospitalized and who died early (less than 3 days) after being admitted to the emergency department between 2017 and 2019. Patients' characteristics were collected in the medical record. These characteristics were compared by a logistic regression according to the existence or not of a limitation of care. 12,440 admissions of nursing home residents were identified and 332 patients died early in hospital. Half of them died in the emergency department. The first reason for admission was dyspnea (57.4%) and the main cause of death was pneumonia (41.7%). A limitation of care at emergency department was reported in 66.7% of cases. The factors independently associated with a limitation of care were the existence of active cancer (OR=5.34 [1.35-39.2], p=0.041) and severe dependence (OR=16.1 [1.60-415], p=0.034). Early in-hospital deaths of nursing home residents are common and most often related to pneumonia, dyspnea motivating the transfer. The anticipation of the care project and especially of end of life is mandatory in these patients.

This article comes from an academic research, conducted with old persons living in French nursing homes and doing esports workshops, led by young volunteers. With the case of a 93-year-old resident, recently introduced to technological tools, we show how the stakes of videogames competition were at first met with her fear not to be good enough. However, her involvement in the competition mustered, through afterwardness, some elements from her childhood and adolescent psychic life. More precisely, by questioning her place in esports competition, this resident mobilized both the depressiveness necessary to aging, related to the confrontation to the limits inherent to the aging process, and tried to resolve a childhood trauma reactived after 80 years. This analysis also enabled to understand how these esports workshops, beyond the opportunity for entertainment and activity in order to take the mind off a monotonous life, could become devices supporting a potential therapeutic project.

People suffering from a neurodegenerative disease, at a stage still allowing physical activity, encounter more difficulties to access to re-education and rehabilitation care. A trial unit specialized in medical care and rehabilitation (SMR) was created to handle these patients, who suffered a morbid intercurrent event not related to the neurocognitive disorder. The trial unit was created thanks to a dedicated funding from the Brittany Health Regional Agency (ARS) following-up a call for projects in October 2021. A retrospective monocentric descriptive study focusing on the overall evolution of the patient. To describe the social and medical characteristics of admitted patients and access the benefits regarding the patients regain of independence. Results: One hundred forty-nine patients (55 men, 94 women) were included, average age 85 ± 6.5 years. The average length of stay was 24 ± 11 days and the rehabilitative load was high (scores RR 275,2 ± 175,2). A significant improvement in the autonomy of patients was noted, of their physical dependence scores (p < 0,001) and cognitive dependence scores (p < 0,001), of their overall physical condition at SPPB (p<0,001) as well as a decrease in the use of psychotropic drugs (p < 0,001); their nutritional status was unchanged (p = 0.2). One in two patients went home. Our work seems to confirm the importance of specialized units in the care of patients suffering from neurodegenerative disease in SMR.

Older patients are at risk of falling, making fall prevention a critical component of training for future health professionals. To understand the expectations of health students regarding falls in the elderly, four consecutive focus groups were organized at the Angers hospital. The aim was to assess students' views on the effectiveness of using an educational or serious game to complement their traditional training. From the discussions, six key themes emerged: the definition of a fall, participants' emotional responses to falls, lessons learned to enhance their knowledge, the benefits and techniques of simulation games and board games, and the role of games in everyday life. Among the game formats discussed, simulation games, including escape rooms, were the most popular.

The growing prevalence of the Alzheimer's disease (AD) is an increasing public health concern that led to French recommendations for timely AD diagnosis and patient management as well as a territorial coverage of specialized structures [Memory Centers including Resources and Memory Research Centers (RMRC) and Memory Consultations (MC)]. In view of the potential availability of Disease Modifying Therapies (DMTs), this French observatory aimed to describe the current organization of the Memory Centers, and the care pathway of patients suffering from early AD. Overall, 12 of the 28 RMRC and 44 of the 250 MC solicited by the Federation of Memory Centers participated in this study. RMRC and MC differed in the practicing specialists (neurologists in 100 % and 41 % of the structures, respectively; geriatricians in 58 % and 95 %), and in the median yearly number of patients with early AD (192 and 99). The majority of patients were referred to RMRC and MC by a general practitioner (42 % and 51 %, respectively) or a private neurologist (19 % and 6 %). The time between referral and the first visit to the Memory Center was shorter in MC compared to RMRC (<3 months: 51 % versus 34 %). Cerebrospinal fluid biomarkers were assessed in the majority of patients in 75 % of RMRC and 14 % of MC. A care plan was proposed for the majority of patients whatever the Memory Center was (RMRC: 91 %, MC: 84 %) unlike psychological support (21 % and 29 %, respectively) and therapeutic education (14 % and 9 %). According to more than 2/3 of the RMRC the referral delays, the number of patients with early AD, and the monitoring schedule (including MRIs and clinical assessments) will be very impacted by the potential availability of DMTs. A similar impact was only perceived by around half of the MC. This study highlighted the key challenges raised by these new therapies.

Metacognition, the ability to monitor and regulate one's own cognitive processes, is subject to varying degrees of modification in patients suffering from neurodegenerative diseases. The literature suggests the existence of dissociations within metacognitive abilities, with some patients exhibiting, for example, specific impairments in self-assessing their memory (and not other cognitive domains). The specific assessment of metacognition in patients' social-cognitive abilities is underdeveloped, although it has significant implications for both clinical and theoretical purposes. This narrative review aims to (i) list the main tools for assessing metacognition, underlining the presence (or absence) of social cognition items in particular; (ii) highlight the issues involved in this type of assessment, both from a clinical point of view, to support patients and their families, and from a theoretical perspective, concerning advances in cognitive modeling. Recommendations regarding the most appropriate tools for clinical practice are formulated and perspectives are discussed.