Therapeutic Intervention Code in a Cognitive Geriatric Unit

Study Overview
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Brief Summary
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The diagnostic and therapeutic progresses, associated with modifications in lifestyle and socio-cultural level of populations, have led to a remarkable increase in life expectancy. At the same time, the increasing medicalization of the individual has eroded the traditional boundaries between health and illness, normal and pathological state. This leads to the patient losing his sense of ownership of his own death. If most patients died at home before the Second World War, 75% of the population dies in hospital or institution at the present date. Most hospitals and care institutions have developed codes, in multidisciplinary internal consultation, to address the interruption or lack of implementation of treatments that make no sense from a medical point of vue. This avoids therapeutic relentlessness.The code in place within the CHU Brugmann is: code A: no therapeutic restriction code B: not to be resuscitated code C: not to be intensively treated (no escalation in therapeutic treatments) code D: best palliative care (progressive de-escalation in therapeutic treatments). These codes are established in consultation with the patient or his legal representative and are re-evaluated in a multidisciplinary way every week. Planning a care path and therefore establishing a therapeutic code is particularly important for people with cognitive impairment and dementia because the progressive loss of cognitive abilities complicates the process of decision making. A large part of the admissions are made via the emergency department. For these patients, no therapeutic plan has been established beforehand. However, the perception of the functional and cognitive status of the patient directly influences the intensity of care provided. Cognitive disorders are a risk factor for the exclusion of access to palliative care for the elderly patient. The objectives of this study are: To establish a record of the therapeutic limitation codes in an acute cognitive geriatric unit To correlate the therapeutic limitation code with the comorbidities of the patients

Official Title
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Therapeutic Intervention Code in a Cognitive Geriatric Unit: Retrospective Analysis

Conditions
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Cognitive Impairment

Intervention / Treatment
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* Other: Medical File consultation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Elderly patients with cognitive impairment admitted in the geriatric unit 83 within the CHU Brugmann between 01-01-2016 and 31-12-2016. Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cognitive impairment<br>Geriatric patients with a cognitive impairment | Other: Medical File consultation<br>* Medical File consultation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Therapeutic code | Therapeutic code | From 01-01-2016 till 31-12-2016 | 
| Cumulative Illness Rating Scale for Geriatrics | This scoring system measures the chronic medical illness (morbidity) burden while taking into consideration the severity of chronic diseases in 14 items representing individual body systems. The cumulative final score can theoretically vary from 0 to 56. | From 01-01-2016 till 31-12-2016 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Age | Age | From 01-01-2016 till 31-12-2016 | 
| Sex | Sex | From 01-01-2016 till 31-12-2016 | 
| Ethnicity | Ethnicity | From 01-01-2016 till 31-12-2016 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Therapeutic code, Geriatry