The survey identifies specific issues in order to target future research in the nursing home setting.
IMPORTANCE Dementia is often underdiagnosed in nursing homes (NHs). This potentially results in inappropriate care, and high rates of emergency department (ED) transfers in particular. OBJECTIVE To assess whether systematic dementia screening of NH residents combined with multidisciplinary team meetings resulted in a lower rate of ED transfer at 12 months compared with usual care. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster randomized trial with NHs as the unit of randomization. The IDEM (Impact of Systematic Tracking of Dementia Cases on the Rate of Hospitalization in Emergency Care Units) trial took place at 64 public and private NHs in France. Recruitment started on May 1, 2010, and was completed on March 31, 2012. Residents who were aged 60 years or older, had no diagnosed or documented dementia, were not bedridden, had lived in the NH for at least 1 month at inclusion, and had a life expectancy greater than 12 months were included. The residents were followed up for 18 months. The main study analyses were completed on October 14, 2016. INTERVENTION Two parallel groups were compared: an intervention group consisting of NHs that set up 2 multidisciplinary team meetings to identify residents with dementia and to discuss an appropriate care plan, and a control group consisting of NHs that continued their usual practice. During the inclusion period of 23 months, all residents of participating NHs who met eligibility criteria were included in the study. MAIN OUTCOMES AND MEASURES The primary end point (ED transfer) was analyzed at 12 months, but the residents included were followed up for 18 months. RESULTS A total of 64 NHs participated in the study and enrolled 1428 residents (mean [SD] age, 84.7 [8.1] years; 1019 [71.3%] female): 599 in the intervention group (32 NHs) and 829 in the control group (32 NHs). The final study visit was completed by 1042 residents (73.0%). The main reason for early discontinuation was death (318 residents [22.7%]). The intervention did not reduce the risk of ED transfers during the 12-month follow-up: the proportion of residents transferred at least once to an ED during the 12-month follow-up was 16.2% in the intervention group vs 12.8% in the control group (odds ratio, 1.32; 95% CI, 0.83-2.09; P = .24). CONCLUSIONS AND RELEVANCE This study failed to demonstrate that systematic screening for dementia in NHs resulted in fewer ED transfers. The findings do not support implementation of (continued) Key Points Question Does systematic dementia screening of nursing home residents combined with multidisciplinary team meetings result in a lower rate of emergency department transfer compared with usual care? Findings In this cluster randomized clinical trial that included 1428 residents in 64 nursing homes, 16.2% of residents in the intervention group were transferred to emergency departments vs 12.8% in the control group during the 12-month follow-up, a nonsignificant difference. Meaning This study does not suggest that systematic screening for dementia in all nursing home resid...
La bouche est une cavité naturelle complexe qui forme le segment initial du tube digestif. Elle est un acteur essentiel des fonctions vitales que sont la nutrition, le langage et la communication. L'ensemble de la bouche (dents, parodonte, muqueuses, langue) est constamment hydraté et lubrifié par la salive. À tout âge, un équilibre s'établit entre la prolifération bactérienne, le flux salivaire et la réponse tissulaire : c'est l'écosystème buccal. La régulation de cet écosystème participe à la protection du complexe buccal contre les pathologies inflammatoires et infectieuses courantes (caries, gingivites, parodontopathies, candidoses). Chez les patients âgés, la modification du flux salivaire, l'apparition de pathologies spécifiques (caries radiculaires, absence de dents, parodontopathies. . .), les conditions locales (présence de prothèses amovibles), le développement de pathologies générales telles que le diabète, l'hypertension, la baisse des défenses immunitaires, la négligence de l'hygiène quotidienne sont autant d'éléments qui vont déséquilibrer l'écosystème buccal, favoriser la formation du biofilm (plaque bactérienne) et fragiliser les tissus bucco-dentaires. Le maintien de cet écosystème est essentiel pour le patient âgé : il lui permet de s'alimenter dans de bonnes conditions et ainsi prévenir les risques de dénutrition. Les auteurs décrivent la physiopathologie buccale (flore buccale, sécrétion salivaire) et les stratégies à adopter pour préserver l'équilibre buccal chez le patient âgé.Mots clés : gérodontologie, écosystème buccal, flore buccale, flux salivaire, acidité buccale Abstract. The mouth is a complex natural cavity which constitutes the initial segment of the digestive tract. It is an essential actor of the vital functions as nutrition, language, communication. The whole mouth (teeth, periodontium, mucous membranes, tongue) is constantly hydrated and lubricated by the saliva. At any age, a balance becomes established between the bacterial proliferations, the salivary flow, the adapted tissular answer: it is the oral ecosystem. The regulation of this ecosystem participates in the protection of the oral complex against current inflammatory and infectious pathologies (caries, gingivitis, periodontitis, candidiasis). In elderly, the modification of the salivary flow, the appearance of specific pathologies (root caries, edentulism, periodontitis), the local conditions (removable dentures), the development of general pathologies, the development of general pathologies (diabetes, hypertension, immunosuppression, the insufficient oral care are so many elements which are going to destabilize the oral ecosystem, to favor the formation of the dental plaque and to weaken oral tissues. The preservation of this ecosystem is essential for elderly: it allows to eat in good conditions and so to prevent the risks of undernutrition. The authors describe the oral physiopathology (oral microflora, salivary secretion) and the strategies to be adopted to protect the balance of the oral ecosystem in geriatric p...
Our survey confirmed the feasibility of MDTM in the field of Alzheimer's disease. The overall benefit/workload ratio of the meetings was considered to be favorable for the expert physicians. The benefits of MDTM were turned out to be less appreciated by the coordinating physicians according to high workload involved.
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