[Evaluation of the perspectives and experiences regarding lumbar puncture in cognitively impaired older adults over 70, their relatives and the care teams].

INTRODUCTION

Lumbar puncture (LP) is an essential diagnostic procedure, which raises major concerns in older adults. Some patients may be denied LP because of the fear of complications in healthcare teams which are not familiar with the procedure. The objectives of our work were to analyze the perspectives and the experiences regarding scheduled LP in cognitively impaired older adults, as well as in their relatives, and the healthcare teams from geriatric day hospitals.

METHODS

We conducted a qualitative, observational and multicentric study, based on semi-directive interviews of patients aged over 70 years with cognitive complaints undergoing a scheduled LP in a day hospital. Patients were interviewed before and after LP. Their relatives and the involved healthcare teams were also interviewed to analyze their expectations and perspectives regarding the procedure. The full interviews were transcribed and analyzed using interpretative phenomenological analysis.

RESULTS

Ten patients (mean age 80.2 ± 7.2), five relatives and four healthcare teams were included. The goals and operating procedure of LP were poorly understood by several patients. Some individuals feared irreversible neurological consequences or LP-related pain, which was often overestimated with regards to the post-LP interviews. The patients' major expectation was to establish an accurate and early diagnosis of their cognitive disorder to provide optimal care plan. Relatives reported similar fears of major adverse events. They also expected an accurate diagnosis with biomarkers. The perspectives and experiences of the healthcare teams were heterogeneous, according to their level of practice of LP, but seemed in line with current scientific guidelines.

CONCLUSION

This study highlighted the existence of false beliefs and poor knowledge regarding the LP procedure and its associated risks. The post-LP patients' feedbacks were better than their expectations, especially in day hospitals with solid experience in LP. Better patient information may be a key to improve our practice.