Institutionalized Patients Research Articles

Discontinuation of Alzheimer Disease Medications in Patients Receiving Home Care Medicine.

There is no consensus on how long antidementia medications should be administered to patients with Alzheimer disease (AD). To clarify this issue, we investigated the discontinuation of antidementia medications in Japanese home care settings, including community-dwelling and institutionalized patients. Using medical records from April 2017 to March 2022 at 3 clinics in Tokyo and Chiba prefectures, we selected patients with AD who started receiving home care medicine. Forty-nine patients discontinued antidementia medications during the observation period, there was no apparent deterioration in cognitive function or new occurrence of behavioral and psychological symptoms of dementia caused by the discontinuation of medications. More aggressive discontinuation of AD medications probably is recommended for patients with activities of daily living dysfunction, such as those receiving home care medicine.

Managing COVID-19 patients with mental illness in a specialized neuropsychiatric setting: An experience from a tertiary care hospital in India.

To explore the management and outcome of COVID-19 infection in mental illness at a specialized neuropsychiatric setting. A retrospective review of the clinical profile of 100 COVID-19 patients with mental illness, admitted to the Psychiatric COVID unit (PCU) from June 2020 to June 2022, was done, with a subgroup analysis of chronic institutionalized patients (n = 36). Schizophrenia, bipolar affective disorder, and schizoaffective disorder comprised 64% of the study population. Most patients (87%) were on antipsychotics. 56% of the patients had an infection of mild severity and 38% were asymptomatic. Corticosteroids and anticoagulants were given to 33.3% and 25% of the patients, respectively. 16% of the patients encountered medical complications in the PCU, and 14% were referred to a COVID-designated hospital. Patients with diabetes mellitus and/or hypertension were more likely to be referred. The chronic institutionalized patients (n = 36) had either an asymptomatic or mild infection. Three among these patients were referred to a COVID-designated hospital. Most psychiatric patients with medical illnesses, including COVID-19, pose unique challenges including complexity of symptoms, ensuring patient safety, and the need for trained professional staff to provide specialized psychiatric interventions, which can be taken care of in psychiatric care settings.

Association between the type of dental prosthesis and the masticatory performance of institutionalized patients: A cross-sectional study.

This cross-sectional study aimed to determine the chewing ability of 97 institutionalized older adults and its relevance to their status of dentition and type of prosthetic rehabilitation. The participants were categorized according to their dental status. The chewing ability was determined by semi-quantitative evaluation of a colour-changeable chewing gum and by recording the personal perception of the participants on a similar scale. The colorimetric means of the participants was significantly lower than the perception means. One-third of the participants had at least one jaw restored with complete dentures, while 17% were restored with tooth-supported or implant-supported fixed partial dentures. Based on the colorimetric method, edentulous participants displayed significantly lower chewing performance compared to all other groups. Additionally, participants with at least one complete denture exhibited weaker chewing function than those with natural teeth or fixed partial dentures. The age and sex of the participants had no further impact on the results. As the institutionalized elderly seem to overestimate their chewing efficiency, the colour changeable chewing gum could be used in nursing homes, as a simple method to determine their real masticatory function status and improve their dental care.

Impact of SARS-CoV-2 infection on the cognitive functioning of patients institutionalized in nursing homes

BackgroundCOVID-19 disease affected the cognitive level of institutionalized patients in nursing homes, especially in the older subjects regardless of gender. This study aims to assess cognitive impairment using the Mini-Mental State Examination (MMSE) before and after COVID-19 infection, and to determine whether these changes varied based on gender.MethodsA pre- and post-COVID-19 study was conducted, involving 68 geriatric patients (34 men and 34 women) from two nursing homes. Cognitive impairment was assessed using the MMSE.ResultsCOVID-19 infection had a notable impact on the cognitive health of older adults residing in nursing homes, primarily attributed to the social isolation they experienced. This effect was more pronounced in older individuals. A comparison of the MMSE results by gender before and after contracting COVID-19 revealed significant differences in attention and calculation, with women obtaining the worst score before the virus. However, following their recovery from the virus, men demonstrated significantly lower scores in time and space orientation and evocation.ConclusionCOVID-19 has led to a decline in cognitive functioning, significantly worsening the mental state of older individuals, even after recovery from the virus. Consequently, it is crucial to implement proactive measures to prevent isolation and safeguard the cognitive well-being of this vulnerable population.

Oral Health-Related Quality of Life in an Institutionalized Population with HIV+/AIDS in the Northern Region of Mexico.

Approximately 39 million people worldwide live with human immunodeficiency virus (HIV), and antiretroviral therapy (ART) has improved life expectancy for these individuals, with quality of life (QoL) being a crucial aspect. However, there is limited information on oral health-related quality of life (OHRQoL) for institutionalized patients with HIV. This study used a cross-sectional design and included 43 residents of a non-governmental institution who had a confirmed HIV diagnosis and a history of intravenous drug use. The Spanish version of the Oral Health Index Profile-14 (OHIPsp) was used to assess the OHRQoL, with the 50th percentile serving as the cutoff for good or poor quality of life. All 43 patients had one or more oral lesions, with 44.1% having AIDS-related oral lesions (AROLs). Over half of the participants (48.8%) reported a poor OHRQoL, and females experienced worse quality of life in all dimensions compared to males. Subjects with AROLs were three times more likely to have poor OHRQoL than those without AROLs (p = 0.03; OR = 3.1 IC 1.04-9.6). These results highlight the need for a comprehensive treatment plan for patients with HIV that includes oral health, particularly for women living in precarious conditions or who are institutionalized. Improving oral health can significantly enhance quality of life.

Differences in healthcare use and mortality in older adults during the COVID-19 pandemic: Exploring long-term care users' vulnerability

BackgroundThe objective of our study is to analyze the health care received by older adults with COVID-19 according to their place of residence (whether or not they live in a long-term care [LTC] facility) and to find out the effect of health care on mortality. MethodsRetrospective cohort study based in Aragón (Spain) from March 2020 to March 2021 in patients aged 65 years or older with a confirmed COVID-19 infection. The population was classified according to their place of residence (living in a LTC or not). A propensity score was used to match individuals by sex and age. The effect of living in a LTC facility on healthcare delivery and mortality was conducted using adjusted multivariate models. Varimp was used to estimate the best predictors of mortality for both groups. ResultsHealthcare services utilization varied depending on whether the patients lived in a LTC facility or not. The time to diagnosis was shorter in institutionalized patients, but the time to hospital admission was longer. Length of hospital stays, risk of ICU admission and 30-day mortality were also different and remained statistically significant in the adjusted models. The variables that were more important in the association between healthcare utilization and mortality were those associated with greater severity of COVID-19. ConclusionsThere were differences in health care for older adults diagnosed with COVID-19 according to their place of residence. There is a need to strengthen collaboration between professionals in LTC centers and health services to provide equitable health care.

Psychiatric Hospitals and the Ethics of Salutogenic Design: The Return of Moral Architecture?

Bioethicists have long been concerned with the mistreatment of institutionalized patients, including those suffering from mental illness. Despite this attention, the built environments of health care settings have largely escaped bioethical analysis. This is a striking oversight given that architects and social scientists agree that buildings reflect and reinforce prevailing social, cultural, and medical attitudes. Architectural choices are therefore ethical choices. We argue that mental health institutions are fertile sites for ethical analysis. Examining the ethics of architecture calls attention to the potential for hospitals to hinder autonomy. Additionally, such examination highlights the salutogenic possibilities of institutional design, that is to care, nurture, and enhance patient and provider well-being.

The Oropharyngeal Dysphagia Screening Test for Patients and Professionals: Validation in Cognitive Impairment and in Severe Mental Illness.

Dysphagia is a symptom that appears with high prevalence in persons diagnosed with dementia, intellectual disability, or severe mental illness. Risk of aspiration pneumonia or even death is very high in these populations. However, screening for dysphagia risk in these patients is complicated by the fact that most of them suffer from cognitive impairments and behavioral manifestations that hinder the assessment process using the existing screening tests. The aim of this study was to validate the Oropharyngeal Dysphagia Screening Test for Patients and Professionals, in patients with cognitive impairment (dementia/intellectual disability) or with severe mental illness (schizophrenia and other psychotic disorders, bipolar disorder, or major depressive disorder). For this purpose, 148 institutionalized patients were evaluated by professionals responsible for their food intake. The Oropharyngeal Dysphagia Screening Test for Patients and Professionals was used to assess its validity in screening for oropharyngeal dysphagia in patients with cognitive impairments and in patients with severe mental illness. Also, the Eating Assessment Tool-10 and the Swallowing Disturbance Questionnaire were used for convergent reliability procedures. Four comparison groups were established: patients with cognitive impairment with and without oropharyngeal dysphagia, and patients with severe mental illness with and without oropharyngeal dysphagia. Results from the Oropharyngeal Dysphagia Screening Test for Patients and Professionals adequately distinguished between groups with and without dysphagia, in addition to presenting adequate levels of convergent validity and reliability. These results were obtained from other-reports (professionals responsible for patients' food intake), using a simple, quickly applied test that does not require the use of food in patients with an altered cognitive state or with severe mental illness. With this study we expand the validity of the Oropharyngeal Dysphagia Screening Test for Patients and Professionals in populations with severe cognitive deficits and mental illness in which there is a great deficiency of oropharyngeal dysphagia screening instruments.

#1689 Urosepsis and hypovolemia—the main causes of AKI in nursing home residents

Abstract Background and Aims Nursing home residents are at high risk for acute kidney injury (AKI) due to increased prevalence of comorbidities, prolonged immobilization in bed and altered cognitive function. As our nephrology department is confronted with high addressability of institutionalized adults with kidney impairment, we considered describing the epidemiology of AKI and risk factors for AKI-related mortality in this population. Method All adult patients admitted with AKI (KDIGO creatinine-based diagnostic criteria) in our nephrology department during a 6 months period (1st January-30th June 2023) were included in this study. Patients’ data (age, gender, comorbidities) and AKI-related data (causes, need for dialysis recovery of renal function, death) were compared between institutionalized and non-institutionalized patients. Factors associated with increased risk of death in AKI in nursing home residents were also analyzed. All the data was analyzed using IBM SPSS Statistics 25 (IBM, Corp.); the results were considered significant at P < 0.05. Results During the mentioned period a total of 297 patients with AKI were hospitalized: 57 nursing home residents (19.19%) and 240 patients with community-acquired AKI. The nursing-home residents were significantly older, female gender prevailed and history of stroke was significantly higher than in patients with community-acquired AKI (Table 1); no significant differences were found regarding prevalence of diabetes, chronic heart failure or previous chronic kidney disease. Chronic immobilization in bed was present in all institutionalized patients and in 21 patients with community acquired-AKI (8.75%). Multifactorial AKI, dehydration with hypovolemia and urosepsis were significantly more frequent in nursing-home residents, but there were no differences regarding other causes of AKI (Table 1). Increased prevalence of urosepsis in institutionalized patients was not associated with higher frequency of obstruction of urinary tract. Compared with community-acquired AKI, ICU admission and evolution with multiple organ failure were significantly more frequent in institutionalized patients with AKI, but there were no significant differences regarding the need for hemodialysis/hemodiafiltration, nor regarding the recovery of renal function in survivors. Analyzing factors associated with death in nursing home residents, we found that prolonged hospital stay, ICU admission, sepsis and multiorgan failure were associated with increased risk of in-hospital death (Table 2). Conclusion AKI in chronic institutionalized patients is mainly caused by dehydration and/or non-obstructive urosepsis, is often multifactorial and it is associated with increased risk of multiorgan failure, ICU admission and death. An early recognition and a better awareness of these risk factors in nursing homes can improve the epidemiology and the outcome of this severe disease.

Pharmacological treatments and medication-related problems in nursing homes in Catalonia: a multidisciplinary approach.

Background: Aging correlates with increased frailty, multi-morbidity, and chronic diseases. Furthermore, treating the aged often entails polypharmacy to achieve optimal disease management, augmenting medication-related problems (MRPs). Few guidelines and tools address the problem of polypharmacy and MRPs, mainly within the institutionalized elderly population. Routine pharmacological review is needed among institutionalized patients. This pharmacological review may improve with a multidisciplinary approach of a collaboration of multiple health professionals. This study aimed to describe institutionalized patients, systematically review their medication plans, and then give recommendations and identify MRPs. Methods: A cross-sectional study was performed using data obtained from patients living in five nursing homes in the northern area of Barcelona, Spain. The inclusion criteria comprised institutionalized patients with public health coverage provided by the Health Department of Catalonia. A detailed description of the clinical characteristics, chronic diseases, pharmacological treatments, recommendations, incomplete data, and MRPs, such as potential drug-drug interactions, therapeutic duplications, contraindications, and drugs deemed inappropriate or of doubtful efficacy, was made. The clinical pharmacologist was the medical doctor specialist who acted as the coordinator of the multidisciplinary team and actively reviewed all the prescribed medications to make recommendations and detect MRPs. Results: A total of 483 patients were included. Patients had a mean age of 86.3 (SD 8.8)years, and 72.0% were female individuals. All patients had at least three health-related problems, with a mean of 17.4 (SD 5.6). All patients, except one, had a minimum of one prescription, with a mean of 8.22 drugs prescribed (SD 3.5) per patient. Recommendations were made for 82.4% of the patients. Of these recommendations, verification of adequate use was made for 69.3% and withdrawal of a drug for 49.5%. Conclusion: This study demonstrates a high prevalence of health-related problems and several prescribed drugs in nursing homes in Catalonia. Many recommendations were made, confirming the increased proportion of polypharmacy, MRPs, and the need for standardized interventions. A multidisciplinary team approach, including general practitioners, geriatric assessments, a clinical pharmacist, and a clinical pharmacologist, should address this problem.

Use of Abzolem ® in Pressure Injuries: Experience of an Exploratory Study

Introduction: Pressure injuries represent a significant and prevalent public health problem in bedridden and institutionalized patients. The correct management of pressure injuries is essential for preventing complications, enhancing patient well-being, and reducing the overall burden on healthcare systems. It underscores the importance of a holistic and patient-centered approach to wound care. Preventive measures and the action of a multidisciplinary team are essential to the correct treatment of pressure injuries. There are multiple active dressings and topical solutions to treat and protect the wounds, among them the hyperoxygenated fatty acids, such as Abzolem®. Objective: Evaluate and verify the effectiveness and safety of the use of Abzolem® in the treatment of patients with pressure injuries grade I and II. Materials and methods: an exploratory study was carried out on 6 patients residing in a long-term establishment in Santiago of Chile with grade I and II pressure injuries in which Abzolem® was used for twice-daily dressings. Results: The use of Abzolem® led to a significant improvement in grade I pressure injuries in 10 ± 3 days and grade II pressure injuries in 15 ± 3 days, without related adverse events and with good tolerance by patients. Conclusion: The use of hyperoxygenated fatty acids, such as Abzolem® corresponds to a safe therapeutic alternative, easy to apply, and effective in the treatment of grade I and II pressure injuries.

P7: Institutionalization and Psychotropics

Introduction:Psychobehavioral symptoms are one of the main causes of institutionalization. After the first months of institutionalization, it could be a good opportunity to consider deprescribing psychotropics, at the same time person-centered non-pharmacological measures should be implemented. Also, if dementia stage is moderate or advanced, acetylcholinesterase- olyph-inhibitor (AchEI) should be deprescribed.Objectives:To evaluate the difference between the number of psychotropic drugs in institutionalized patients and those who are at home.Materials and Methods:We selected all the patients admitted in the Acute Geriatric Unit of “Hospital Universitario de Navarra” during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as delirium predisposing factors, drugs on admission and discharge and Drug-Burden-Index (DBI). A descriptive study was carried out and our hypothesis was analyzed.Results:658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia and 22% were Institutionalized. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities: arterial hypertension (81%), Osteoarthritis (55%), heart failure (51%), dislipemia (47%), chronic kidney disease (42%), auricular fibrillation (39%), osteoporosis (33%) and diabetes (31%). Regarding geriatric syndromes: polypharmacy (87,5%), sleep disturbances (48%), hearing loss (43%), chronic pain (41,5%), visual loss and constipation (38%) and depression (33%). The main delirium predisposing factors were: age more than 80 (93.5%), olypharmacy, neurological disease (47%), altered senses, chronic pain and depression. Comparing psychotropic use between institutionalized and non institutionalized: psychotropics (78%vs69%), night psichotropics (72%vs63%), neuroleptics (37%vs18,5%), AchEI (13%vs6,5%), antiepileptics (21%14%). All of them p<0.05. However, there were no statistically significant differences in the use of benzodiazepines, antidepressant or antiparkinsonian.Conclusion:Nowadays, institutionalized patients have more phsychotropic drugs than non-institutionalized ones, especially neuroleptics. Moreover, they are more frequent in patients with severe dementia. Maybe, the explanation is DEPRESCRIPTION AVOIDANCE due to an acute fear of a behavioral decompensation. We recommend educating in non-pharmacological measures and insisting on an adequacy of pharmacological prescriptions periodically.

Analysis of acenocoumarol and levofloxacin interaction in elderly institutionalized patients

ObjectiveTo analyze the interaction between acenocoumarol and levofloxacin in the elderly. We also assessed how hypoalbuminemia affects international normalized ratio variation. MethodRetrospective study carried on elderly institutionalized patients who were prescribed levofloxacin concomitantly with acenocoumarol. International normalized ratio variation during levofloxacin treatment was analyzed with the t-Student test. Correlation between albuminemia and international normalized ratio variation was calculated using Pearson's correlation coefficient. ResultsThe mean international normalized ratio previous to treatment with levofloxacin was 2.5 (standard deviation: 0.6) and during treatment it was 4.7 (standard deviation: 1.9) (p < 0.05). In 54.3% of the cases, the international normalized ratio value was equal to or greater than 4.5. Not linear association between albuminemia and international normalized ratio increase was found using Pearson's test (R = –0.16). ConclusionsIn more than half of the occasions international normalized ratio raised to clinically rellevant values (≥ 4.5). No influence of hypoalbuminemia in the increase in international normalized ratio was shown.

Health-Related Caretaking in an Institutionalized Setting

Health-related caretaking was provided to individuals institutionalized in the Mississippi State Asylum (MSA), Jackson, MS (AD 1855–1935). However, because of limited associated documentary evidence on caretaking in the MSA and a general dearth of academic knowledge about caretaking in asylums in the Southern United States, information on caretaking and its efficacy in the MSA is limited. Accordingly, we apply a modified Bioarchaeology of Care (BoC) approach and associated web-based Index of Care to a single deceased individual from the MSA, referred to here as their burial designation—Burial 1—integrated with available documentary information, to generate direct insights into caretaking in the MSA. Burial 1’s skeleton exhibits recidivistic cranial trauma (i.e., cranial depression fractures) and substantial entheseal changes in the upper extremities. This trauma, paired with subsequent traumatic brain injury, suggests that Burial 1 may have experienced physical impairment and disability. Further, the disability Burial 1 experienced likely increased their risk of being institutionalized and created complications for them in the MSA. However, the lack of identifying information for individuals buried at the MSA complicates interpretations of the caretaking they may have received, both before and after institutionalization, as well as the efficaciousness of the caretaking and insights from the caretaking into patient and staff communities in the MSA and Burial 1’s social identity and agency. Despite this, findings affirm that future research applying the modified BoC approach could generate otherwise inscrutable information about the lived experiences of institutionalized patients with impairments and disability within historic institutions of care.

Evaluation of antithrombotic treatment in institutionalized geriatric patients with nonvalvular atrial fibrillation

ObjectiveThe goals of this study were to analyze the type of antithrombotic treatment administered to institutionalized patients with nonvalvular atrial fibrillation (and any ensuing complications) and to evaluate the degree of anticoagulation control achieved with vitamin K antagonists. MethodThis was a prospective observational follow-up study carried out in seven elderly care facilities during 2016. Patients with nonvalvular atrial fibrillation were evaluated for their antithrombotic therapy and any embolic or hemorrhagic events, as well as for mortality. Subjects on anticoagulation treatment with VKAs were evaluated for anticoagulation control, with control considered poor if the mean time in therapeutic range was < 65% when measured with Rosendaal's method or < 60% when determined by the direct method. ResultsOf the 699 residents evaluated, 20.6% had a diagnosis of NVAF. Average age was 85.83 years. Both the cardioembolic (mean CHA2DS2-VASc score: 4.79), and the hemorrhagic (mean HAS-BLED score: 3.04) risk were high. Fifty percent received anticoagulation treatment, mainly with vitamin K antagonists, of whom at least 56% were not within the therapeutic range. Sixteen percent of the residents, the oldest and most functionally and cognitively dependent ones, had not been prescribed any antithrombotic therapy. A higher frequency of hospital admissions induced by cardiovascular and bleeding events was found in these residents, although differences were not statistically significant. ConclusionsHalf of institutionalized geriatric patients with nonvalvular atrial fibrillation are anticoagulated, a third on antiplatelet therapy, and some without any antithrombotic treatment. This study showed that as functionality decreases, treatment strategies are increasingly aimed at therapeutic deintensification. Given that the degree of anticoagulation control with vitamin K antagonists is inadequate in 56% of cases, it is essential to monitor the time in therapeutic range to optimize treatment as needed.

Prevalence of the Minimally Conscious State Among Institutionalized Patients in the Netherlands: A Nationwide Study.

The minimally conscious state (MCS) is a prolonged disorder of consciousness (pDoC) and one of the most severe outcomes of acquired brain injury. Prevalence data are scarce. The aim of this study was to establish the nationwide point prevalence of institutionalized patients in MCS in the Netherlands. This was a descriptive cross-sectional study in which all 86 Dutch hospitals, all 5 specialized pDoC rehabilitation facilities, and all 274 nursing homes were asked whether they were treating patients with a pDoC on the point prevalence date of September 15, 2021. Each patient's legal representative provided informed consent for their inclusion. Patient level of consciousness was verified using the Coma Recovery Scale-Revised (CRS-R) in a single assessment session performed in the facility of residence by an experienced physician. Data on patient demographics, etiology, level of consciousness, facility of residence, and clinical status were collected from a questionnaire by the treating physician. The prevalence of institutionalized patients in MCS of per 100,000 members of the Dutch population was calculated, based on actual census data. Seventy patients were reported to have a pDoC, of whom 6 were excluded. The level of consciousness was verified for 49 patients while for 15, it could not be verified. Of the patients verified, 38 had a pDoC, of whom 32 were in MCS (mean age 44.8 years, 68.8% male). The prevalence of institutionalized patients in MCS is 0.2-0.3 per 100,000 Dutch inhabitants. Traumatic brain injury was present in 21 of 32 patients (65.6%). Specialized pDoC rehabilitation was received by 17 of 32 patients (53%), with the rest admitted to nursing homes. The most frequent signs of consciousness on the CRS-R were visual pursuit, reproducible movement to command, and automatic motor response. This nationwide study revealed a low prevalence of institutionalized patients in MCS in the Netherlands. These findings are now being used to organize pDoC care in this country.

People with intellectual disability at the Grahamstown Lunatic Asylum: humanizing photographs, stories and narratives from the casebooks, 1890–1920

In the medical literature of South Africa in the early twentieth century, Dr Thomas Duncan Greenlees published a dehumanized portrayal of people with intellectual disability (PWID) who were institutionalized at the Grahamstown Lunatic Asylum. To restore the humanity of the institutionalized patients, the asylum’s casebooks provide a valuable resource. To this end, the article investigates the casebook entries and photographs to explore the humanity of PWID. The investigation of the casebooks follows Ariella Azoulay’s call for us to engage with, and retrieve, the stories of the photographed PWID that tell of times before and after their admittal to the asylum, of multiple spaces in and beyond the asylum, and by including the various roles and positions that they performed in the asylum’s body politic. These stories are enriched by adopting a disability mode of analysis.

Social cognition and apathy between two cognitive subtypes of schizophrenia: Are there the same or different profiles?

ObjectiveCognitive impairment is an essential feature of schizophrenia, and it involves a broad array of nonsocial and social cognitive domains. This study aimed to examine whether there are the same or different social cognition profiles between two cognitive subtypes of schizophrenia. MethodThere were one hundred and two chronic and institutionalized patients with schizophrenia from two referral tracks. One group is “Cognitively Normal Range” (CNR) (N = 52), and another group is “Below Normal Range” (BNR) (N = 50). We assessed or collected their apathy, emotional perception judgment, facial expression judgment, and empathy by the Apathy Evaluation Scale, the International Affective Picture System, the Japanese and Caucasian Facial Expression of Emotion, and the Interpersonal Reactivity Index, respectively. ResultsWe found different impairment profiles depending on the cognitive subtypes of the patient with schizophrenia. Surprisingly, the CNR presented impairments in apathy, emotional perception judgment, facial expression judgment, and empathy and feature impairment in empathy and affective apathy. In contrast, even though the BNR had significant neurocognition impairments, they had almost intact empathy with significantly impaired cognitive apathy. Both groups' global deficit scores (GDSs) were comparable, and all reached at least a mild impairment level. ConclusionsThe CNR and the BNR had similar abilities in emotional perception judgment and facial emotion recognition. They also had differentiable deficits in apathy and empathy. Our findings provide important clinical implications for neuropsychological pathology and treatment in schizophrenia.

A psycho-educational program for family caregivers of people with Alzheimer's disease entering an institution

The caregiver of a loved one suffering from a chronic pathology (Alzheimer's disease, Parkinson's disease, stroke, etc.) can be in psychological distress at all stages of the disease, including when the loved one enters an institution. We have designed and implemented a psycho-educational program for family caregivers of institutionalized patients. A preliminary study showed that this program was feasible, gave satisfaction to the caregivers and improved their understanding of the functioning of the institution, their communication with the professionals of the institution and their relationship with their relative in the institution. The program allowed caregivers to find their place within the institution by redefining their role.

Total Hip Arthroplasty or Hemiarthroplasty for Displaced Femoral Neck Fractures?: Commentary on an article by Mina Tohidi, MD, FRCS(C), PhD, et al.: "Comparative Effectiveness of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fracture. A Propensity-Score-Matched Cohort Study".

Commentary This Canadian study involves a subject of continued controversy1,2. It describes the outcomes of a large matched group of patients ≥60 years old with a displaced femoral neck fracture treated with total hip arthroplasty (THA) or hemiarthroplasty (HA). The 2 groups had similar revision and readmission rates, but those treated with THA had higher dislocation rates. Patients treated with HA had higher mortality rates, but they tended to be older and had higher rates of dementia and institutionalization. These findings are not new or unexpected, so what are surgeons to take away from this study? The major strength of this study is the use of a well-matched cohort with a large sample size (9,224). Most previous studies involved far fewer patients or performed meta-analyses of such studies3. Its major weakness is that surgeon and technical factors could not be taken into account. Who performs the surgery and how it is done are very important but were not captured in the data. In clinical practice, a femoral neck fracture is a devastating but common injury. Treatment should be based on shared decision-making involving the surgeon and the patient, family, or individual who has the power of attorney. These other individuals will ultimately rely heavily on the surgeon’s recommendations. The surgeon should clearly explain why a particular treatment is being recommended, along with the specific risks and benefits involved with each treatment. There are also many confounding factors that can influence the surgeon’s recommendation. These can include surgeon experience and comfort with the procedure, as well as institutional support for performing it at less than convenient hours (holidays, weekends). Age, comorbidities, anticipated life expectancy, approach, femoral component head size, use of a dual-mobility construct, bone quality, and use of cement all need to be taken into account. An institutionalized patient with Parkinson disease will be treated very differently from an active 70-year-old who lives at home. Some studies have not found significant differences between these 2 treatments, or have questioned the clinical importance of better quality-of-life scores after THA than after HA4. However, the pendulum is clearly swinging toward the use of THA for this injury5,6. This study provides further evidence that THA is a reasonable treatment for many displaced femoral neck fractures, but reinforces the need to consider factors that will reduce dislocation rates.