Gériatrie et Gérontologie

Bruxelles Woluwe

La médecine gériatrique s’intéresse à la santé, l’autonomie et qualité des soins à travers des aspects préventifs, cliniques et sociaux des maladies. Spécialité médicale hospitalière destinée aux patients âgés fragiles, elle est cependant à amenée à s’ouvrir largement à des collaborations indispensables avec la médecine et soins de première ligne et les différentes disciplines de la gérontologie qui incluent l’étude du vieillissement sous des  aspects interdisciplinaire (sociaux, sociétaux, psychologiques, éthiques, biologiques et technologiques). Ces spécificités de la médecine gériatrique expliquent son enracinement au sein de l’IRSS ainsi  que  dans le réseau interdisciplinaire L4Ageing.  Les principaux axes de recherche s’intéressent à l’évaluation de la personne âgée fragile et la qualité de la prescription médicamenteuse pour fournir des soins individualisés et intégrés.
Equipe du GREG : Benoit Boland, Pascale Cornette, Isabelle De Brauwer, Marie de Saint-Hubert, Sophie Jassogne, Florence Potier, Didier Schoevaerts, Anne Spinewine

"CAREGIVER 2 : Health assessment of caregivers: the role of clinical and biological markers"

Background: Caregiving is a stressful experience, emotionally and physically demanding. Evidence suggests that providing care for a disabled elderly may represent a risk for the health of the caregiver.
Aim: to objectify the stress load supported by spousal caregivers with a clinical and biological evaluation. The integration of the biological data in the clinical data would allow identifying the vulnerable caregivers.
Methods:  A total of eighty-two community-dwellings pousal caregivers of old patients were recruited, mainly by the geriatric outpatient clinic. Controls were people living at home with an independent spouse at the functional and cognitive level. Blood samples were taken in the morning for the biological data and brought at our partners in Namur for transcriptomic and epigenetic markers and Liege for immunity markers. We collected data about nutrition, physical performance, frailty, depression and cognitive function. A follow up is performed at 3 months and 16 months.
End date: October 2017

Equipe: Geneviève Aubouy, Florence Potier, Jean-Marie Degryse, Séverine Henrard, Florence Chainiaux (UNamur), Henri Martens (ULg), Marie de Saint-Hubert (Resp.)
Plus d'infos: Marie de Saint-Hubert , Florence Potier

"Le syndrome dysexécutif peut-il être considéré comme un facteur de fragilité chez la personne âgée?"

The executive functions comprise a set of cognitive processes whose main function is to facilitate the adaptation of the subject to complex or new situations, especially when the over-learned cognitive skills are no longer sufficient. The originality of this research is to look at the roles of these executive functions, taken in a global and distinct way, in functional decline. The methodology implements the recruitment of a prospective cohort of patients through consultation or hospitalization in geriatrics and neurology. These are evaluated on the geriatric, motor and neuropsychological level. Initial results suggest that inhibition is a cognitive process involved in the onset of DF. If these results are confirmed, this would allow specific attention to be given to patients with alterations in the inhibition processes which present an increased risk of functional decline.
End date: October 2017

Equipe: Emilie Verreckt, CHU UCL Namur, Pr Didier Schoevaerdts, CHU UCL Namur, Pr Marie de Saint-Hubert, CHU UCL Namur, Emilie Verreckt, CHU UCL Namur (resp.)
Plus d'infos: Marie de saint-Hubert; Emilie Verreckt

"Impact of anticholinergic drugs among patients under cholinesterase inhibitors: a cohort study"

The aim of that study is to measure the cognitive and clinical impact of anticholinergic load of drugs among a cohort of patients followed for dementia and under chonilesterase inhibitors. The setting is a cohort of more than 200 patients followed in the geriatric day hospital at CHU UCL Namur. With a retrospective design, the study will include potential other co-variables for adjustment like gender, age, co-morbidities, level of dementia at base-line, functional status,…A special attention will be given to inflammatory parameters at the time of diagnosis.

Equipe: Cambier E, Spinewine A, Bihin B, Schoevaerdts D
Plus d'infos: Anne Spinewine

"Prevalence and risk factors of postprandial hypotension among hospitalized patients in a geriatric evaluation and management unit, a link with sarcopenia?

The study is aimed to determine the prevalence and potential risk factors of symptomatic and asymptomatic postprandial hypotension among old persons admitted in a geriatric ward at CHU UcL Namur. Using a standardized protocol, arterial blood pressure is measured at baseline and following a standardized meal of more than 400 Kcal (every 15 minutes during at least 120 minutes). A set of demographic and clinical data are collected at inclusion in order to determine potential risk factors in order to better identify population at risk. A deep assessment of diet is also collected at the same time (caloric intake, water consumption, meal temperature, sugar load, …). A part of the study is to assess the potential link between postprandial hypotension and the presence of sarcopenia. Clinical and functional parameters according to recent published criteria are used to define sarcopenia. A last part of the study is to assess the impact of sarcopenia, postprandial hypotension and quality of life. The objective is to include more than 100 patients after stabilization of their acute condition.

Equipe: Dorendeu JB, Dubuy A, Cremer G, Bihin B, Schoevaerdts D
Plus d'infos: Didier Schoevaerts

"Validation of the Elly Device in detecting falls among old persons at risk"

Falls are frequent adverse events among old persons with high event-rates within nursing homes and in the hospital setting. Delay between event and first intervention may be sometimes high. Alarm systems to alert healthcare workers or caregivers may help to reduce time for intervention. The study is a pilot study to validate the Elly device in order to detect falls of old persons. The device is a silicone small transdermal patch (ISO10993). This part of the study is aimed to collect mobility data during a 24h period of observation concomitantly with video-record. Patients with the three following criteria will be included: a history of fall as a main diagnosis for hospital admission, the presence of at least 3 risk factors for fall and a Tinetti score less than 19. This pilot study is the first step of a research program before starting a clinical intervention study.

Equipe: De Rudder C, Fion A, Schoevaerdts D
Plus d'infos: Didier Schoevaerts

"Knowledge of experienced practitioners and students  in physiotherapy about the potential benefits of physical activity among old persons with dementia"

The study is aimed to determine knowledge of physiotherapists about the potential clinical benefits of exercise and physical activity among old persons suffering from dementia of Alzheimer type. Using a standardized on-line questionnaire, experienced Belgian physiotherapists or students will answer to a set of questions based on evidence-based literature. Knowledge will be compared to three other neurodegenerative diseases like Parkinson disease, Multiple sclerosis and motor neuron disease.

Equipe: Freund M, Vergnes T, Schoevaerdts D, Mikolajczak MP
Plus d'infos: Didier Schoevaerts

"Optimizing care for the elderly admitted to the emergency department"

Care for the older patients (OP) in the emergency department (ED) represents both quantitative and qualitative challenges. Promising interventions, based on comprehensive geriatric assessment, have been described in the literature. They however focus mainly on improving transitional care between ED and the community, but do not usually address other aspects of quality of care during the ED stay, including for the high proportion of OP who will be hospitalized. Moreover, the identification of frail OP -those who will benefit most from those complex interventions - suffers from a lack of effective screening tools.
The general objective of the thesis is to optimize the management of OP (³75years) hospitalized through the ED, as soon as their ED admission. More specifically, it aims to better understand the structure and processes existing in the ED in order to better fine-tune the procedures of management of this population. It also examines the performance a screening tool for frailty by OP hospitalized after their ED stay.
Key words: older people, emergency department, qualitative and quantitative methods
End date: 2017

Equipe: De Brauwer Isabelle (leader) MD, PhD student ; Cornette Pascale, MD, PhD (prom.) ; D’Hoore William, MD, PhD, (co-prom.)
Plus d'infos : Isabelle De Brauwer

"Medication Reconciliation: Iterative development and implementation of an electronic tool (Title of my thesis)"

Continuity of medicationuse is particularly important as older people are the most vulnerable when it comes to medication discrepancies (polypharmacy, multimorbidities, multiple caregivers, cognitive disabilities…). This project is part of a project called SEAMPAT and supported by the LDRI. SEAMPAT aims to develop an electronic tool for Medication Reconciliation (MedRec) that gives the opportunity to the patient to validate his medications’ list. This tool is made of 2 APPLICATIONS. One for the patient: the patient application. One for the Health Care Professional: the MedRec application.
For each application (Patient-application and MedRec Application) we started with a state of the art and a needs assessment. Literature advises to start with a first sketchy and incomplete prototype (= low-fidelity prototype) and to further adapt the tool with users feed-back. It is called an iterative participatory design process. This design is used for both applications. My specific role is to evaluate usability and satisfaction. Besides, the accuracy of the information collected with the high-fidelity prototype will be evaluated.
End date: 30/09/2017

Equipe : Catherine Forget, Research Centre in Information, Law and Society, CRIDS, UNamur; Delphine Legrand, Louvain Drug research Institute, UCLouvain; Pierre Pagazc, Research Centre in Information, Law and Society, CRIDS, UNamur; Ravi Ramdoyal, Software and system engineering, Centre d’Excellence en Technologies de l’Information et de la Communication, Charleroi ;Valery Ramon, Software and system engineering, Centre d’Excellence en Technologies de l’Information et de la Communication, Charleroi ; Anne Spinewine (Resp.), Louvain Drug research Institute, UCLouvain - Pharmacy, CHU UCL Namur
Plis d'infos: Sophie Marien