Pascal Couturier

Telesurveillance of elderly patients by use of passive infra-red sensors in a 'smart' room

We have developed an automated surveillance system based on passive infra-red sensors. Eight sensors were installed in a hospital room. A computer automatically captured data from the sensors every night from 21:00 until 06:00 the following morning. The sensors were polled twice per second and when a sensor was activated by movement, the event and time were recorded in a data file. At the end of the surveillance period the program analysed the data and generated a report showing the activities taking place in the room and their times. Four elderly patients were observed for a total of 97 nights. A total of 1637 possible sequences of movements by the patient and the hospital staff were detected. The computer was able to identify 1450 sequences (89%) correctly, in comparison with manual analysis. Only 10 movements (0.6%) were undetected by the system; all were very short sequences (five or six activations of the sensors). The system was generally capable of detecting and classifying all major movements in the room.

Non-invasive monitoring of the activities of daily living of elderly people at home--a pilot study of the usage of domestic appliances.

We conducted a feasibility study of a system for non-invasive monitoring of subjects at home. Electrical activity was recorded from room lights and from electrical domestic appliances; this was translated into the probability of physical activity or a particular Activity of Daily Living (ADL). Thirteen volunteer subjects were monitored for a period of 6.4 months (range 3–8). The mean age of the subjects was 80 years and they all lived alone at home; one had moderate Alzheimers disease. A one-week validation was carried out to ascertain whether the recorded activity actually occurred. The results showed that daily and nocturnal activity could be well differentiated. The probability of having eaten, taken a bath and going to the toilet could be calculated each day. Eating was the most accurately measured ADL; toileting and bathing results were less accurate. The system appears to be a promising component of home telecare.

A preliminary study of the feasibility of wound telecare for the elderly

We have developed a method for remote wound assessment in the elderly. Wound images were taken with a digital camera at a resolution of 640×480 pixels. JPEG compression was then used to produce images of about 100 kByte. Selected clinical data were transmitted by email, together with standardized digital images of wounds. The remote physician then read the clinical data and viewed the digital images on a 38 cm colour display monitor, at a resolution of 800×600 pixels, in 16-bit colour, using standard software. Three elderly inpatients with pressure sores or leg ulcers had both bedside and remote examinations, by different physicians. The diagnosis and therapeutic recommendations proposed after each of the two examinations were compared qualitatively. There was reasonable agreement between the two physicians in the assessment of wound size, anatomical classification, wound bed and status of infection. However, the lack of palpation represented a major limitation to remote wound assessment, despite the use of probes to delineate the depth of any opening in the wound bed.

Sécurité à domicile des personnes démentes : étude préliminaire sur les situations à risque en consultation mémoire de gériatrie en France

Community-dwelling people with Alzheimers 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.

Feasibility of psychological consultation with elderly demented patients

Theobjectives of thepresent studywere toexplore the feasibilityof conductinga telepsychological assessment with demented elderly patients, andtodefine theadvantages and limitations of remoteconsultations. Remoteconsultations werecomparedwithface-to-face consultations inthe samepatients. Eachconsultationconsistedof aninitial interviewandtwoshort psychometrictests (Mini-Mental StateExaminationandthe ClockFace Test). Observationschedules of patient behaviour werecompleted bythe interviewingpsychologist andalsobytheobserver psychologist inthe twoconsultationsituations. Theremote interviews werecarriedout using tworooms inthe hospital linkedbya coaxial cable. Eachroomwas equippedwitha mobilecamera,amicrophone,atelevisionscreenandavideorecorder. Twenty-five hospitalizedelderlypeopleparticipated inthestudy. Tenof thepatients werediagnosedas demented (DSMIVcriteria) and15hadnoknowncognitivedeficits. Thevideo-linkedconsultationtooklongerthantheface-tofaceconsultationfordementedpatients(26minvs20min). However, fornon-dementedpatients, theremoteinterviewwas shorter(18minvs22 min).Thetestscoresobtainedbythe dementedpatientsweresimilarinthetwotypesofconsultation. However, fornon-dementedpatients, thescoresobtainedwere significantlylowerintheremotesituation(P<0.003).Theratings ofpatientbehaviourbythetwopsychologistsindicatedthat dementedpatientsweremoreateasewiththevideo-linkthanthe non-dementedpatients.Teleconsultationisthereforepossible withdementedpatients,withlittledistortionofthetestresults.

Effectiveness of a Multimodal Intervention Program for Older Individuals Presenting to the Emergency Department After a Fall in the Northern French Alps Emergency Network

OBJECTIVE Fall-related visits to emergency departments (EDs) are common among older individuals. We aimed to assess effectiveness of a healthcare intervention program for the management of elderly patients admitted to EDs after a fall. METHODS Using a before-after observation method, we investigated ED healthcare staff practices related to fall-related injuries in 2010 (period 1) and 2012 (period 2) in 13 centers participating in the Northern French Alps Emergency Network. Following the identification of initial weaknesses, several information and training tools were introduced between the two periods to improve patient management. All individuals aged 75 years or over who presented to an ED after a fall were included in the study. We reviewed the completeness and quality of medical records during both periods and compared the rate of clinical-paraclinical check-ups performed, geriatric evaluation/assessment in the ED, and the 1-month recurrence of visits to the ED for the same reason. RESULTS During period 1, a total of 2,425 falls were recorded, while 2,684 were reported in period 2. The 2012 medical charts contained significantly more information about risk factors than those of 2010. An electrocardiogram (64% vs. 53%; p < 0.001), biologic check-up (65% vs. 57%; p < 0.001), balance, orthostatic hypotension, and cognitive impairment tests were more often performed in 2012. There was no change in the hospitalization rate, although short-duration hospitalization in the ED was more frequent in 2012. Geriatrists were more often consulted by patients in 2012 (18% vs. 13%; p < 0.001) and more involved in ED evaluation and hospitalization. The intervention program had a beneficial impact on the fall recurrence rate (n = 29 [3.6%] in period 1 and n = 17 [2.0%] in period 2; odds ratio = 0.52; p = 0.037), which significantly decreased between 2010 and 2012. CONCLUSIONS The intervention program was associated with a decrease of fall recurrence. Further efforts should be made in EDs to ensure a sustained level of satisfactory and long-lasting management of the elderly.

Assessing productive behaviour in daily life of patients diagnosed with dementia. Contribution of the revised Functional Behaviour Profile (FBP)

(RUD-lite), and the DS summated score were examined using univariate and multivariate analysis. Results: Data from 213 participants with concurrent DS and CRA evaluations were included in the analysis. Significant correlations between the CRA-Disrupted schedule (r1⁄40.55; p<0.0001), Lack of family support (r1⁄40.32, p<0.0001), Health problems (r1⁄40.28, p<0.0001), Financial problems scores (r1⁄40.23, p<0.001) and the DS sum scores were observed. Disrupted schedule (adj-R Square 1⁄4 0.35, p< 0.0001) and Lack of family support scores (adj-R square1⁄40.20, p<0.0001) were significantly associated with DS sum after adjusting for care recipient age and gender, caregiver age and gender, care recipient living arrangements, relationship to care recipient and caregiver mental and physical health (SF-36-MCS,-PCS). No significant association was observed between CRA-Self-esteem scores and DS sum. In all multivariate regression models, where CRA subscale was the dependent variable, caregiver SF-36-MCS was a significant predictor. For the Self-esteem subscale, SF-36-MCS was the only significant predictor. Caregiver time was significantly correlated with DS sum (r1⁄40.44; p<0.0001). The association held after adjusting for the same set of factors (adj-R Square1⁄40.20; p<0.0001). Conclusions: Caregivers report experiencing increased disruption in daily schedules, greater lack of family support and higher caregiver time as care recipient dependence on others increases. Caregiver self esteem is influenced by caregiver mental health status and not by patient dependence on others.

Qualité de la prise en charge aux urgences des patients âgés chuteurs

BACKGROUND recurrent falls are a major public health problem associated with high morbidity and mortality as well as increased dependence. Multifactorial intervention has been shown to reduce recurrence by 20% (Profet study). The French Health Authority (Haute autorité de santé or HAS) recommends since 2009 a systematic screening for and assessment of risk factors as well as the implementation of preventive measures. OBJECTIVES to examine whether the management of falls in older patients discharged home from the emergency department is consistent with the HAS guidelines. METHODS descriptive retrospective analysis of 1238 medical records of patients over 75 years, who consulted for falls from April to October 2010 in the emergency department of in 13 centers in the North-Alps region. The study is part of a program to improve the quality of care led by the French Network of North-Alps Emergency Departments (Réseau nord alpin des urgences, RENAU). RESULTS Screening of risk factors for falls was documented in varying rates: electrocardiogram 29%, cognitive impairment 25%, functional assessment 16%, walking difficulties 11%, postural hypotension 5%. A comprehensive geriatric assessment was undertaken for 3.8% of the patients. CONCLUSION risk factors for falls are insufficiently documented in elderly patients discharged home from the emergency room after a fall-related visit. Completeness rates are similar to those found in previous studies. A standardized protocol for older fallers, specifically adapted to the work routine in the emergency department could be useful. The RENAU has proposed an algorithm to streamline the orientation of older fallers and promote the use of geriatric network.

Impact of functional status on the onset of nosocomial infections in an acute care for elders unit

Objective To assess the role of functional status as a risk factor for nosocomial infections in the elderly.