The growing prevalence of class III obesity among older adults raises important challenges for accessibility in long-term care facilities. This study aimed to assess the availability of human and technical resources in nursing homes within a French department for the care of residents weighing over 150 kg. A descriptive survey was conducted in September 2024 among 137 nursing homes, exploring three key criteria: housing accessibility, availability of bariatric equipment, and the ability to mobilize two caregivers. Among the 75 responding facilities, only eight met all three criteria. The possibility of two-person mobilization was the most frequently available (80%), compared to 57% for housing accessibility and 11% for bariatric equipment. These findings highlight the need to anticipate the specific requirements of individuals with severe obesity, to adapt facility equipment accordingly, and to prevent weight-related stigma in residential care settings for older adults.

In the context of ongoing societal and legislative debates in France on end-of-life care, the French Society of Geriatrics and Gerontology (SFGG) conducted a national survey to assess the perceptions and expectations of professionals working in the field of ageing regarding assisted dying (AD). An anonymous online questionnaire was distributed in November-December 2024 to all 1,600 SFGG members. The survey collected 471 responses, 90% of which were from physicians, on knowledge of the current legal framework, positions on changes in legislation, anticipated professional impacts, and patient feedback. Among respondents, 58.6% report having a clear understanding of the current legal framework and applying it regularly, while 39.7% have only partial knowledge of it. Regarding the desired evolution of the law, 27.5% wish to maintain the current legislative framework, and 41.8% of respondents reject all proposed forms of assisted dying. This suggests that the very way the debate is framed may not align with their clinical or ethical perspectives. Should the law evolve, 25.9% would support assisted suicide supervised by a medical team, 17.8% would favor assisted suicide facilitated by an association, 9.1% would support the issuance of a lethal prescription for self-administration by the patient, and 7.2% would favor euthanasia, defined as the direct administration of a lethal substance by a healthcare professional. Only 12.5% reported not having a definitive opinion. In the event of legalization of assisted dying, 48.2% of respondents would consider invoking a conscience clause, 24.0% might consider leaving their position, and 21.9% would be willing to participate in its implementation. Finally, 68.2% believe that the SFGG should take an active part in the public debate. The national French survey highlights a wide range of opinions among geriatric professionals, reflecting both cautious support for certain forms of AD and deep ethical and professional concerns. These findings underscore the need for a well-informed, ethically grounded debate that carefully considers the specific vulnerabilities of older adults.

Malnutrition is a major public health concern, particularly among older adults and individuals with chronic illnesses. Oral nutritional supplements (ONS), rich in energy and protein, represent a useful tool in its management. This review examines clinical guidelines, regulatory frameworks, and current practices related to ONS, while highlighting the role of innovation in enhancing their effectiveness and acceptability. Although reimbursement policies influence accessibility, challenges remain regarding adherence, waste, and alignment with patient preferences. Recent developments include modified-texture products, finger-food formats, and the incorporation of pro- and prebiotics based on microbiome research. Non-medical stakeholders, such as caregivers, also contribute to the dissemination and acceptance of ONS. This review highlights the synergy among these elements, fostering a dynamic of continuous progress in the nutritional management of malnutrition.

The aim of this review was to survey scientific studies concerning the use of Virtual Reality (VR) for entertainment purposes with institutionalized elderly people, and to identify factors that may affect users' virtual experience. A systematic review using PRISMA recommendations in Pubmed and PsycInfo databases identified 149 scientific publications concerning the use of Virtual Reality with an elderly public. Included studies used Head Mounted Display with institutionalized participants aged over 60 for entertainment purposes, to improve quality of life or to enhance mental well-being. Out of the 149 identified publications, 10 studies were included in the analysis. Factors influencing users' entertainment experience included: choice of content, particularly when it prompted reminiscence; hedonic nature of activities; device ergonomics (choice of hardware). Identified limits to use (adverse effects) and possible improvements are proposed. An activity using Virtual Reality must be prepared according to the pursued objective. It must be administered carefully, as adverse effects are possible.

Frailty and intrinsic capacity (IC) decline are associated with worse clinical trajectories and poorer outcomes in Alzheimer's disease. However, few studies focused on dementia with Lewy bodies (DLB). The aim of this study is to analyze the factors associated with frailty in DLB by investigating the association between frailty phenotype and clinical features of DLB, IC, and their associations with cognitive and functional decline. A monocentric longitudinal retrospective study was carried out between 2014 and 2023, including patients with probable DLB who underwent a comprehensive geriatric assessment. Frailty was assessed according to the Fried phenotype criteria. The IC were evaluated using the ICOPE tools proposed by the WHO: the Short Physical Performance Battery (SPPB) for locomotion, the Mini Nutritional Assessment (MNA) for nutrition, the 4-items Geriatric Depression Scale (GDS) for psychology, and the Hearing Vision Equilibrium and Cognitive (HVEC) questionnaire for hearing. Multivariate linear and logistic regression models were performed, adjusted for age and gender. Fifty-five patients were included, with a mean age of 80.2 years. Twenty-nine patients were frail (52.7%) and only 6 were robust (10.9%). Frailty was associated with a decrease in nutritional IC (mean MNA score 20.8 versus 24.2, p-value = 0.004) and locomotor IC (mean SPPB score 4.28 versus 8.96, p-value = 0.001). Among the disease characteristics, only parkinsonism was associated with the risk of frailty (OR 5, 95% CI [1.09-29.27]) and a decrease in nutritional and locomotor IC. The exploratory longitudinal analysis did not show a significant association between frailty or IC decrease at baseline and cognitive or functional decline. This study shows that patients with DLB are at high risk of frailty and decreased IC, particularly among those with parkinsonism, requiring early identification and care of frailty and loss of IC in this population.

This one-year longitudinal study examined the relationship between caregivers' perceptions of their caregiving role and their psychological health when supporting individuals with Lewy body disease. The findings indicate that a lack of time and family support significantly affects caregivers' psychological health. Additionally, prioritizing emotion-focused coping strategies over problem-focused strategies is associated with a deterioration in psychological health over time. The study also identified distinct caregiver profiles based on variations in the financial consequences of caregiving, self-esteem evolution, and perceived family support over time. These findings highlight the necessity of personalized interventions tailored to the specific needs of caregivers of individuals with Lewy body disease. Overall, this study emphasizes the dynamic and complex nature of caregiving for individuals with Lewy body disease and underscores the importance of long-term support strategies to mitigate stress and promote caregivers' psychological health. Effective support programs should not only promote adaptive coping strategies but also foster intrafamilial communication to improve recognition of caregiving constraints. Given the heterogeneous nature of caregiving experiences, interventions should be adapted to different caregiver profiles.

Emergency department (ED) visits are frequent among nursing home residents, with one in four admitted at least once a year and one in ten admitted at least twice. The main objective of this study was to analyze ED visits by nursing home residents and to assess the concordance between the opinions of a geriatrician and an emergency physician This was a monocentric, retrospective, descriptive study conducted at the Rouen University Hospital ED. All elderly patients referred from nursing homes between January 1 and March 31, 2018, were included. The mean age of patients was 87.6 years, with a female-to-male ratio of 2.08. A Charlson comorbidity index >6 was found in 73% of cases, and only three medical records mentioned advance directives. Polypharmacy (≥7 medications) was present in 34% of cases, and dementia in 70%. The most common reason for ED referral was cardio-respiratory failure. The mean length of stay in the ED exceeded seven hours. Concordance analysis showed almost perfect agreement between geriatricians and emergency physicians, with a Cohen's kappa coefficient of 0.84. Overall, 68% of visits were deemed appropriate, 26.4% inappropriate, and 5.6% indeterminate. Chi-square analysis revealed a significant difference between the two groups regarding the FRENCH triage scale (p<0.01). Patients whose transfer was judged appropriate were significantly more likely to present with pain (p<0.01). The implementation of a relevance score could improve the evaluation of nursing home resident transfers to the ED, a decision that carries significant clinical consequences.

This study aimed at determining the impact of cognitive stimulation workshops on various psychological variables on people with Alzheimer's disease (AD). Forty-eight participants, divided into three groups (control, memory workshop group, reminiscence workshop group), completed: 1) the self-concept clarity questionnaire; 2) the anxiety and depression questionnaire; 3) the loneliness questionnaire; 4) the subjective well-being questionnaire; 5) the self-esteem questionnaire; 6) the reminiscence function questionnaire. Participants attended the cognitive stimulation workshops performed better on all variables than control participants (ps < 0.05). The reminiscence workshops were more effective than the memory workshops on all variables (ps < 0.05), except for the overall reminiscence functions score, differing only the reminiscence from the control group (p = 0.009). These results highlight the interest of reminiscence in the care of patients suffering from AD.

Many geriatric syndromes are associated with poor prognosis after transcatheter aortic valve replacement (TAVR) in patients aged 75 and older. But none has yet focused on patients with mild cognitive impairment (MCI), especially dysexecutive MCI (d-MCI). The main objective was to evaluate the impact of d-MCI on death or hospitalisation one year after a TAVR procedure. All patients aged > 75 with a normal Katz and Lawton's instrumental activities of daily living index referred for a TAVR between 2012 and 2018 at the Nantes University Hospital were included. Dysexecutive syndrome was defined by a frontal assessment battery (FAB) under 16. One-year mortality and hospitalisation were recorded. A multivariable analysis was conducted to analyse the prognostic value of d-MCI. Among the 494 patients included (median age=85), 18% were hospitalised or died in the first year after the TAVR procedure. In a multivariable logistic regression model, only the Charlson comorbidity index [OR=1.36, 95% CI (1.20-1.56), p<0.001], the mean aortic transvalvular pressure gradient [OR=0.98, 95% CI (0.97-1.00), p=0.04] and a history of chronic respiratory failure (CRF) [OR=1.98, 95% CI (1.03-3.8), p=0.04] were significantly associated with poor outcomes. There was no association between d-MCI and rehospitalisation or death 1 year after a TAVR procedure. However, this study confirmed the prognostic importance of Charlson comorbidity index and mean aortic transvalvular pressure gradient before TAVR.

Neurocognitive disorders are a major public health challenge but medications' effectiveness for this disease are limited and have been poorly documented. In the same time, non-medicinal support for older adults living with neurocognitive disorders are beginning to develop but remain few in number. This lack of support can lead to social isolation. Artistic activities, such as theatre and music, are being developed to help combat this isolation. Few studies have looked at the link between regular participation in these workshops and the extent to which social ties are forged. The aim of this study was to explore the relationship between social ties and participation in these workshops among elderly people with neurocognitive disorders living in institutions. Eighteen older adults were separated into two groups, the theatre group (experimental groupe) and the music group (control group). They self-assessed their anxiodepressive symptoms, feelings of loneliness, social provision and recognition orientation before and after taking part in the workshops. The two workshops took place over a period of 6 weeks at the rate of one workshop per week. The links highlighted by this study suggest that theatre workshops have an effect on the social ties of elderly people with mild to moderate neurocognitive impairment. This study provides clues as to how to set up non-medicinal mediation for older adults with these disorders.

This study explores an individualized therapeutic intervention designed to support the transition of Mrs. F., a 78-year-old patient hospitalized in a medical rehabilitation center, to a nursing home. Using a single-case protocol, the intervention consisted of four sessions: pre-tests, three intervention sessions, and post-tests. A clinical analysis and assessments focusing on psychological flexibility, depressive and traumatic symptoms, as well as self-concept clarity, were conducted. The results revealed an improvement in psychological flexibility, supporting better emotional regulation. Additionally, depressive and traumatic symptoms associated with entering a nursing home decreased, as evidenced by pre- and post-intervention measures. While self-concept clarity remained stable, Mrs. F. showed progress in identifying and reflecting on her personal needs and values. This included exploring her creativity, which emerged as an important aspect of her evolving self-perception. The study highlights the role of therapeutic interventions in addressing the emotional and psychological changes older adults face during transitions such as entering a nursing home. By focusing on psychological flexibility and helping individuals reconnect with their values and identity, these approaches provide practical strategies to support transitions. These findings underscore the importance of developing interventions that not only address immediate psychological symptoms but also promote a holistic understanding of the patient's emotional and identity-related needs. Such personalized care has the potential to enhance overall well-being and promote a more integrated, patient-centered approach within geriatric healthcare systems.

Population aging is a worldwide phenomenon. Social isolation and loneliness are common factors of social vulnerability among older people and are associated with morbidity and mortality. Loneliness is a subjective state and cannot be directly measured by objective criteria such as marital status or living alone, although the latter may have an indirect link to feeling lonely. The main aim of this study was therefore to investigate the association between loneliness, living alone and survival in a nationwide French cohort including adults aged 75 years or older who are admitted to hospital via the emergency department. Data were extracted from the SAFE cohort, a multicenter study of patients aged ≥75 hospitalized after emergency department visits (March 2001-January 2002). Data included socio-demographic, clinical variables, and living arrangements. Loneliness was assessed via CES-D. Survival at 1, 2, and 3 years was analyzed using Cox proportional hazards models. Bivariable and multivariable analyses were performed using Cox logistic regression models. A total of 1,306 patients were included in the SAFES cohort, with an average age of 85.0±5.9 years, and almost two-thirds women (65%). Among the persons who lived alone (N=467), 45% did not feel lonely. Among those who did not live alone, 34% did feel lonely. By multivariable analysis, after adjustment, we found that individuals who lived alone had longer survival than those who did not live alone. Our findings show that social isolation protects against mortality in this population. Loneliness, on the other hand, remains simply an indicators of vulnerability, but was not significantly associated with mortality. This is a clinical reality that should be identified as early as possible in order to implement appropriate strategies and management in a pluridisciplinary context.

The digital transformation of healthcare, which has been continuously evolving for over two decades, has recently paved the way for major innovations, notably through the emergence of the digital twin (DT) concept. Originating from self-supervised machine learning, the DT involves creating a virtual replica (virtual product) of a patient, organ, or healthcare system (real product) to predict its evolution based on real-life data. It is based on clinical, biological, environmental data, as well as data from sensors and medico-administrative databases (e.g., SNDS) and relies on various digital technologies. Initially applied in aerospace, industry, and agriculture, DTs have recently gained traction in healthcare, particularly for the personalization of care plans and pathways. In geriatrics, DTs could help model the functional or clinical evolution of older adults, optimize healthcare resources, and adapt therapeutic protocols. The development of DTs in geriatrics involves addressing several major challenges, including older adults' acceptance of technology, building multidisciplinary teams, accurately modelling the complexity of aging, and considering the environmental impact of DT technologies. In summary, the digital twin represents a promising tool to support healthy aging and care pathways, provided its clinical integration and social acceptability are strengthened.

Health is "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity". Health must therefore be considered in its entirety. To begin with, however, it is vital to move swiftly from the concept of holistic health to its practical implementation. This is what the first Digital Health Network symposium proposed on May 30 and 31, 2024. The Digital Health Network was originally set up by a group of players from the healthcare sector, industry, research and elected representatives, with the aim of pooling feedback from experience as close as possible to local realities. The following points were addressed: i) rebalancing the curative approach with a greater emphasis on prevention and health promotion; ii) rebalancing the genetic approach with a greater emphasis on exposomics; iii) insufficient use of digital technology to improve the health of local populations; iv) governance and organizational challenges from the point of view of local decision-makers and observers, with a focus on research; and v) the ambitions of the Digital Health Network. The symposium provided an opportunity to share case studies of public health challenges in local areas, and possible responses in terms of infrastructure and stakeholder participation: citizens, patients, healthcare professionals, service providers, experts and other stakeholders. The challenges of ageing and geriatric frailty underline the importance of a global, preventive and multidisciplinary approach to promote successful, independent ageing.

This real-life study aims to describe and compare the characteristics of patients who do or do not receive speech therapy after a memory consultation. Socio-demographic and medical data from the MEMORA cohort were matched with speech therapy reimbursement data from the French caisse primaire d'assurance maladie. Univariate analyses showed that speech therapy was more frequent in men, in patients with higher or secondary education, in patients suffering from Alzheimer's disease (AD) and having a higher MMSE. The multivariate model showed that only the diagnosis of AD remained strongly associated with the presence of speech therapy. The diagnosis of AD is the characteristic associated with the highest probability of future speech therapy. Female gender, lower level of education and lower cognitive efficiency appear to be associated with a lower probability of speech therapy.

Catatonia is a syndrome combining a variety of psychomotor and behavioral symptoms. It is underdiagnosed in the elderly and associated with significant morbidity and mortality. Little is known about the links between catatonia and dementia. We propose a "real-life" case series of five patients with dementia and catatonia, in order to explore the links between catatonia and dementia. Major depression was strongly associated with catatonia in our cases (4/5) and two patients had bipolar disorder. Iatrogenicity was linked to catatonia in three patients, particularly with antipsychotics. Two patients had dementia with Lewy bodies and one was suspected with frontotemporal degeneration. These are the two dementia most frequently associated with catatonia. Catatonia had been mistaken for confusional syndrome in one of our patients. It is important to look for it and treat it in this context.

Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) have frequent psychological and behavioral symptoms (PBS). Treatment of these PBS is variably validated We carried out a review of the treatment of PBS in DLB and PDD from 2009 to 2023. Where the literature allowed, we made treatment recommendations. When the literature was insufficient, we used the Delphi method. The following proposals were made: for pervasive and criticized hallucinations, donepezil or rivastigmine; for delusion, and Capgras syndrome (Delphi), low doses of clozapine; for depression, sertraline, venlafaxine or mirtazapine (Delphi); for RBD, immediate-release melatonin; for frontal syndrome, sertraline or paroxetine first then trazodone (Delphi); for catatonia, lorazepam. Our group's proposals should help to improve the care of DLB and PDD PBS, and thus enhance the quality of life of patients and caregivers.

The aging of the French population raises new challenges. The search for effective interventions to preserve autonomy and to decrease the risk of physical and cognitive disorders represents a priority. Several studies have suggested that multidomain training involving physical, motor, and cognitive stimulation could benefit maintaining cognitive vitality. In particular, exergames, active video games, could be effective for training purposes. This narrative review aims to provide an overview of the effects of different types of stimulation (aerobics, muscle strengthening, complex motor skills, open activities, combined training) and associated mechanisms, focusing on active video games as well as a new generation of exergames assisted by an immersive and interactive wall. These new technologies are promising and motivational tools for multidomain training (i.e., physical, motor, cognitive) for older adults.