Digoxin-related leukocytoclastic vasculitis in a very elderly woman: A case report

International audience; Even though digoxin causes many side effects, few cases of skin involvement are recorded in the French Pharmacovigilance Database. We report a case of leukocytoclastic vasculitis (LV) very probably due to digoxin. A 91-year-old woman, hospitalized following a fall, presented cardiac decompensation in a context of rapid atrial fibrillation requiring treatment with digoxin. Eight days later, a rash appeared on her back and trunk. It was neither itchy, nor painful and persisted despite local treatment. There were no other clinical anomalies. After a few days, the rash spread with appearance of bullous lesions, ulcerations and a necrosis on lymphedema of the two legs. Am…

Influence of geriatric oncology consultation on the management of breast cancer in older women: A French population-based study

Aim The objective of the present population-based study was to assess the impact of geriatric oncology consultation on the management of elderly patients with breast cancer and to identify the predictive factors of breast cancer treatment in this population. Methods A total of 206 women aged 75 years and older with breast cancer, diagnosed from January 2007 to December 2009 were included. The independent impact of geriatric oncology consultation on treatment was analyzed using multivariate logistic regression with adjustment for the other predictive factors of treatment. Results Patients who had a geriatric oncology consultation (19.4%) had more comorbidities (Charlson Comorbidity Index ≥1;…

Effet bénéfique de la transfusion à la phase aiguë de l’infarctus du myocarde du sujet âgé : étude prospective de 3316 cas

IF 0.905; International audience; IntroductionL’anémie est fréquente dans la population âgée à la phase aiguë d’un infarctus du myocarde (IDM) et est associée à une augmentation de la mortalité à long terme. Cependant, le bénéfice de la transfusion de concentrés de globules rouges (TCGR) dans ce contexte reste incertain.Patients et méthodesTous les patients de 65 ans et plus, hospitalisés pour un IDM dans notre centre hospitalier universitaire ont été inclus prospectivement. Ils ont été séparés en deux groupes d’âges : les plus jeunes (65–79 ans) et les plus âgés (80 ans et plus) et trois sous-groupes de nadir de taux d’hémoglobine (NH) (≤ 8,8–10 et > 10 g/dL). Nous avons étudié l’associati…

Kinésithérapie gériatrique à domicile : effets sur les capacités motrices et cognitives chez des patients présentant une maladie d’Alzheimer

Resume Objectif Evaluer l’effet d’une prise en charge de kinesitherapie a domicile sur les capacites motrices et cognitives de patients âges souffrant d’une maladie d’Alzheimer (MA) de stade leger a modere. Methode Les sujets etaient inclus et divises en deux groupes, l’un sans kinesitherapie (SK) et l’autre avec kinesitherapie (AK). Pour le groupe AK, la prise en charge en kinesitherapie etait proposee entre l’evaluation initiale (T0) et l’evaluation finale (T1). A T0 comme a T1, il a ete enregistre les donnees suivantes : duree d’intervention (DI), Mini-Mental State Examination (MMSE), test de Tinetti (TT), test moteur minimum (TMM), Timed Up and Go (TUG) et vitesse de marche (VM), ainsi …

Experience of medical students mentoring in an acute geriatric unit: Use of evidence-based medicine

International audience; n a retrospective study, we studied the learning experience of second and third year undergraduate medical students in the acute geriatric unit of a University Hospital.Students who did not receive Evidence based medicine (EBM) classes had lower grades than those who did in the final theoretical and practical evaluations (p < .01).Our experience suggested that the implementation of EBM in the curriculum through small, structured semiology courses tailored to the specificities of the elderly improved Evidence based practices for undergraduate medical students. EBM should improve instruction and mentoring during undergraduate students' clinical rotation.

Purple urine bag syndrome in an elderly subject

strain. Given the absence of bothclinical signs (apart from urinary retention) and inflamma-tory syndrome, no antibiotic therapy was initiated. Six daysafterinsertingtheindwellingcatheter,purplecolorationoftheurine bag and the catheter appeared, with no modifications ofurine color (Fig. 1). Another urine microscopy and culture per-formedlongaftercatheterwithdrawal,showeddisappearanceof the

Erratum to: Development and validation of the FRAGIRE tool for assessment an older person’s risk for frailty

Background Frailty is highly prevalent in elderly people. While significant progress has been made to understand its pathogenesis process, few validated questionnaire exist to assess the multidimensional concept of frailty and to detect people frail or at risk to become frail. The objectives of this study were to construct and validate a new frailty-screening instrument named Frailty Groupe Iso-Ressource Evaluation (FRAGIRE) that accurately predicts the risk for frailty in older adults. Methods A prospective multicenter recruitment of the elderly patients was undertaken in France. The subjects were classified into financially-helped group (FH, with financial assistance) and non-financially …

Influence of the Geriatric Oncology Consultation On the Final Therapeutic Decision In Elderly Subjects With Cancer: Analysis of 191 Patients

International audience; Objectives: evaluate the impact of the Geriatric Oncology consultation on the final therapeutic management of cancer in elderly patients aged 70 and older. Design: retrospective study. Setting: the Pilot coordination unit in Geriatric Oncology of Cote d'Or, Burgundy, France. Participants: From January 2010 to December 2010, 191 patients with cancer aged 70 and older. Measurements: the concordance between the treatments proposed following the tumor Board, those proposed following the Geriatric evaluation (GE) and those actually given to the patients was evaluated using the kappa agreement test. Results: One hundred and ninety-one patients were included. Mean age was 8…

Changes in Treatment of Very Elderly Patients Six Weeks after Discharge from Geriatrics Department

We assessed the prescriptions of patients hospitalized in a geriatric unit and subsequently discharged. This prospective and observational study was conducted over a two-month period in the geriatrics department (acute and rehabilitation units) of a university hospital. Patients discharged from this department were included over a two-month period. Prescriptions were analyzed at admission and discharge from the geriatrics department (DGD), and six weeks after DGD. We included 209 patients, 63% female, aged 86.8 years. The mean number of medications prescribed was significantly higher at DGD than at admission (7.8 vs. 7.1, p = 0.003). During hospitalization, 1217 prescriptions were changed (…

Description of Lifestyle, Including Social Life, Diet and Physical Activity, of People ≥90 years Living in Ikaria, a Longevity Blue Zone

A cross-sectional observational study was conducted to describe the lifestyle of people ≥90 years, living in Evdilos or Raches, two municipalities of the Greek island of Ikaria, classified a longevity blue zone. The 71 participants were interviewed and underwent the Mediterranean Islands study food frequency questionnaire (MEDIS-FFQ) and the international physical activity questionnaire (IPAQ). The frequency of social contacts was daily for 77.9% of participants, weekly for 16.1%, and monthly for 5.9%. Most participants (90.0%) believed in God, and 81.4% took part in religious events. A total of 62.0% attended Panigiria festivals. Access to primary health care was considered difficult in th…

Infections et infarctus du myocarde : étude prospective multicentrique

Introduction Un lien epidemiologique a ete demontre entre les infections aigues et l’infarctus du myocarde (IDM). Toutefois, la pathogenese et le pronostic des IDM associees aux infections n’a pas fait l’objet d’etude de grande ampleur. Materiels et methodes Tous les patients consecutifs admis pour IDM avec un diagnostic d’infection aigue ont ete prospectivement identifies a partir des donnees d’un observatoire regional des IDM. Le diagnostic d’infection aigue etait a l’appreciation du clinicien. Le diagnostic d’IDM de type 1 (rupture ou erosion de plaque) ou de type 2 (fonctionnel sur desequilibre entre apports et besoins myocardiques en oxygene) etait systematiquement adjudique selon les …

Memory of an exotic holiday

International audience

Des lésions cutanées diffuses

International audience

Is functional mobility an independent mortality risk factor in subjects with dementia?

Abstract Objective To investigate whether functional mobility is a predictor of 12-month mortality in elderly subjects with dementia. Study design Prospective multicentre study performed in nine French university hospitals. Patients aged 75 years or more and hospitalised in medical wards via the emergency department were eligible. Those with a diagnosis of dementia were considered in the analyses. Main outcome measures Patients’ characteristics obtained through comprehensive geriatric assessment performed during the first week of hospitalisation. Functional mobility was assessed using the timed “Up & Go” test. The main outcome was time to death within the 12 months of follow-up. Bivariable …

La rétropulsion du sujet âgé: mise au point sur un symptôme grave et proposition d'une échelle pour une évaluation quantifiée

Resume Propos Bien qu'il n'existe a l'heure actuelle aucune donnee epidemiologique sur la retropulsion, ce trouble postural semble relativement frequent chez le sujet âge fragile. Actualites et points forts La retropulsion se caracterise par un dejettement posterieur du tronc en position assise, une insuffisance d'avancee du tronc dont la projection du tronc au sol est situee en arriere de la base de sustentation lors du passage assis–debout et une tendance a la chute en arriere en position debout. Plusieurs situations pathologiques aussi bien somatiques (lesions cerebrales degeneratives, ischemiques, traumatiques), que psychosomatiques (syndrome de desadaptation psychomotrice, alitement pr…

Modifications de l’olfaction au cours du vieillissement et de certaines pathologies neurodégénératives : mise au point

Olfaction is a complex sensory system, and increasing interest is being shown in the link between olfaction and cognition, notably in the elderly. In this literature review, we revisit the specific neurophysiological features of the olfactory system and odorants that lead to a durable olfactory memory and an emotional memory, for which the implicit component produces subconscious olfactory conditioning. Olfaction is known to affect cognitive abilities and mood. We also consider the impairment of olfactory function due to ageing and to neurodegenerative diseases, in particular Alzheimer's disease and Parkinson's disease, through anatomopathological changes in the peripheral and central olfac…

Dénutrition protéino-énergétique extrême : un concept mal connu en EHPAD

Resume Il existe une forme particuliere de denutrition proteino-energetique (DPE) en geriatrie : la denutrition proteino-energetique extreme (DPEE). Certaines personnes entrent en etablissement d’hebergement pour personnes âgees dependantes (EHPAD) en situation de DPEE, c’est-a-dire avec un indice de masse corporelle (IMC) inferieur a 18,5 kg/m 2 . Par sa similitude avec le syndrome de renutrition inapproprie (SRI) ou refeeding syndrome , la DPEE n’est pas toujours identifiee comme une situation a risque. Or, une approche nutritionnelle ordinaire peut avoir des consequences deleteres. Nous presentons une mise au point bibliographique sur les risques de renutrition inadapte de la DPEE de la …

Prolongation du séjour hospitalier dans un service de gériatrie aiguë : identification et analyse des causes

International audience; In France, the population of very old frail patients, who require appropriate high-quality care, is increasing. Given the current economic climate, the mean duration of hospitalization (MDH) needs to be optimized. This prospective study analyzed the causes of prolonged hospitalization in an acute geriatric care unit. Over 6 months, all patients admitted to the target acute geriatric care unit were included and distributed into two groups according to a threshold stay of 14 days: long MDH group (LMDHG) and short MDH group (SMDHG). These two groups were compared. 757 patients were included. The LMDHG comprised 442 with a mean age of 86.7 years, of whom 67.65% were wome…

Analysis of the impact of a cognitive task on the posture of elderly subjects with depression compared with healthy elderly subjects

International audience; Objective: While previous studies have demonstrated that depressive elderly subjects (DES) experience difficulties in the processing of simultaneous cognitive tasks, few have examined the coupling of cognitive tasks with seemingly 'automatic' tasks, such as standing upright. Current patient management focuses on pharmacological treatments and cognitive-behavioral therapies.Methods: Healthy elderly (HES) and non-treated DES were included. Postural sway in DES was compared with that in HES while in single-task and dual-task conditions. The single-task consisted of standing upright. For the dual-task, the subjects recalled various items from memory or counted while stan…

A New Prognosis Score to Predict Mortality After Acute Pneumonia in Very Elderly Patients

International audience; Objectives: Acute pneumonia (AP) induces an excess of mortality among the elderly. We evaluated the value of a new predictive biomarker index compared to usual prognosis scores for predicting in-hospital and 1-year mortalities in elderly inpatients with AP.Design: Retrospective study in 6 clinical departments of a university hospital.Setting: Burgundy university hospital (France).Participants: All patients aged 75 and over with AP and hospitalized between January 1 and June 30, 2013, in the departments of medicine (5) and intensive care (1) of our university hospital.Measurements: A new index, which we named UBMo, was created by multiplying the uremia (U in the formu…

Impact of an ambulatory physical activity program on balance and motor abilities of retirees: a prospective study

International audience; BACKGROUND:Given the public health problem generated by posture and gait disorders, a preventive approach is essential.OBJECTIVE:We investigated the impact of an ambulatory physical activity program (APAP) on the motor skills of retirees.METHOD:Retirees ≥ 60 years were recruited in this prospective study. The APAP was supported by a French regional health insurance plan. Between inclusion (T0) and 12 weeks (T1), subjects participated in an APAP (1 hour/week) that included strengthening muscular exercises, balance work, joint flexibility exercises, one-leg-balance test (OLB), stimulation of the foot arch, and rise-from-the-floor (RFF). Timed-up-and-go test (TUG) durat…

What could have caused this weight loss?

International audience; Achalasia is rare and often diagnosed late.It is characterized by functional gastro-oesophageal sphincter obstruction.Aspiration pneumonia may complicate the achalasia.Intrasphincteric botulinum toxin injection is one of the main treatments for achalasia.

PSYCHOBEHAVIORAL DISORDERS, ORTHOSTATIC HYPOTENSION, AND FALLS RELATED TO A PHEOCHROMOCYTOMA IN A VERY ELDERLY SUBJECT: A CASE REPORT

Syndrome démentiel du sujet âgé lié à un traitement par acide valproïque : à propos d’un cas

In addition to the usual adverse effects, the chronic use of the valproic acid can entail dementia syndrome. We describe the case of a 68-year-old woman who had presented a dementia syndrome due to the use of valproic acid for one year. This drug was prescribed in order to prevent a potential convulsive crisis after an ischemic stroke in a patient who did not have a history of epilepsy. This case shows that each clinician must be careful about all medications consumed by the patient in the face of cognitive disorders.

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Platelet aggregation inhibitors (PAI) have widely proven their efficiency for the prevention of ischemic cardiovascular events. We aimed to describe PAI prescription in an elderly multimorbid population and to determine the factors that influence their prescription, including the impact of age, comorbidities and frailty, evaluated through a comprehensive geriatric assessment. This cross-sectional study included all patients admitted to the acute geriatric department of a university hospital from November 2016 to January 2017. We included 304 consecutive hospitalized patients aged 88.7 &plusmn

AN ATYPICAL CASE OF GIANT CELL ARTERITIS (HORTON'S DISEASE) ASSOCIATED WITH FACIAL SWELLING, CONFUSION, AND PERICARDITIS IN AN ELDERLY WOMAN

''Motor Resonance Mechanisms Are Preserved In Alzheimer's Disease Patients''

Bisio, A. | Casteran, M. | Ballay, Y. | Manckoundia, P. | Mourey, F. | Pozzo, T.; International audience; ''This study aimed to better characterize the sensorimotor mechanisms underlying motor resonance, namely the relationship between motion perception and movement production in patients suffering from Alzheimer's disease (AD). This work first gives a kinematic description of AD patients' upper limb movements, then it presents a simple paradigm in which a dot with different velocities is moved in front of the participant who is instructed to point to its final position when it stopped. AD patients' actions, as well as healthy elderly participants, were similarly influenced by the dot veloc…

Shifts in Key Time Points and Strategies for a Multisegment Motor Task in Healthy Aging Subjects

International audience; In this study, we compared key temporal points in the whole body pointing movement of healthy aging and young subjects. During this movement, subject leans forward from a standing position to reach a target. As it involves forward inclination of the trunk, the movement creates a risk for falling. We examined two strategic time points during the task-first, the crossover point where the velocity of the center of mass (CoM) in the vertical dimension outstripped the velocity in the anteroposterior dimension and secondly, the time to peak of the CoM velocity profile. Transitions to stabilizing postures occur at these time points. They both occurred earlier in aging subje…

Autoimmune Myopathy Due To Statin Treatment In An Elderly Woman

International audience

Analysis of postural control in elderly subjects suffering from Psychomotor Disadaptation Syndrome (PDS).

PDS is a geriatric affliction, described in 1999, characterized by postural impairments, including backward disequilibrium, freezing, a deterioration in the ability to anticipate postural adjustments, anxiety and fear of falling, inducing loss of autonomy. This study compared 10 subjects suffering from PDS, aged 87.3+/-4.9 years, with 10 control subjects, aged 85.4+/-7.9 years concerning postural control (body sway amplitude). In all participants, postural control was assessed using the SwayStar system in natural (spontaneous) and standardized stances, eyes open and eyes closed over a period of 40 s. It was found that: (1) with eyes open, subjects with PDS showed greater body sway amplitude…

Successful management of heparin-induced thrombocytopenia using argatroban in a very old woman: a case report.

Thrombosis due to heparin-induced thrombocytopenia (HIT) is rare but has a severe prognosis. Its management is not always easy, particularly in old patients with renal insufficiency. A 95-year-old woman was hospitalized for dyspnea. Curative treatment with unfractionated heparin was started because pulmonary embolism was suspected. Disseminated intravascular coagulation was then suspected because of thrombocytopenia, hypoprothrombinemia, hypofibrinogenemia, and a positive ethanol gelation test. The first immunoassay for HIT was negative. On the 12th day of hospitalization, bilateral cyanosis of the toes occurred associated with recent deep bilateral venous and arterial thrombosis at duplex …

Peripheral Neuropathy and VIth Nerve Palsy Related to Randall Disease Successfully Treated by High-Dose Melphalan, Autologous Blood Stem Cell Transplantation, and VIth Nerve Decompression Surgery

Randall disease is an unusual cause of extraocular motor nerve (VI) palsy. A 35-year-old woman was hospitalized for sicca syndrome. The physical examination showed general weakness, weight loss, diplopia related to a left VIth nerve palsy, hypertrophy of the submandibular salivary glands, and peripheral neuropathy. The biological screening revealed renal insufficiency, serum monoclonal kappa light chain immunoglobulin, urinary monoclonal kappa light chain immunoglobulin, albuminuria, and Bence-Jones proteinuria. Bone marrow biopsy revealed medullar plasma cell infiltration. Immunofixation associated with electron microscopy analysis of the salivary glands showed deposits of kappa light chai…

Blood Transfusion in Elderly Patients with Acute Myocardial Infarction: Data from the RICO Survey.

Red blood cell transfusion benefit during acute myocardial infarction remains unclear in the elderly. We aimed to assess the transfusion impact on 1-year mortality in acute myocardial infarction patients aged ≥65 years, according to their age and hemoglobin nadir.We included 3316 consecutive patients with acute myocardial infarction aged ≥65 years from the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey. They were categorized according to their hemoglobin nadir (≤8,8 to ≤10, and10 g/dL) and age (80 or ≥80 years).A total of 1906 patients (57%) were 65-79 years old, and 1410 (43%) were aged ≥80 years, of whom 103 (5%) and 145 (10%) patients received red blood cell transfusion, respect…

''Alterations with Movement Duration in the Kinematics of a Whole Body Pointing Movement''

Casteran, Matthieu | Manckoundia, Patrick | Pozzo, Thierry | Thomas, Elizabeth; International audience; ''Our aim was to investigate how the organization of a whole body movement is altered when movement duration (MD) is varied. Subjects performed the same whole body pointing movement over long, normal and short MDs. The kinematic trajectories were then analyzed on a normalized time base. A principal components analysis (PCA) revealed that the degree of coordination between the elevation angles of the body did not change with MD. This lack of significant differences in the coordination was interesting given that small spatial and temporal differences were observed in the individual kinemati…

Aging affects the mental simulation/planning of the "rising from the floor" sequence.

We investigated the effect of aging on the ability to mentally simulate/plan a complex sequential action of the whole body, namely "rising from the floor". Forty-four non-demented elderly people (mean age: 85.2±5.5 years) and 20 young people (mean age: 26.6±4.9 years) were included in the study. They were required to put in order six images representing the main movements necessary to get up from a sitting position on the floor. We showed that older subjects had poorer performance-both in terms of proportion of success and response time-than their younger counterparts. These results are in line with previous findings showing age-related alterations in action simulation/action planning proce…

''A case of meningitis due to Achromobacter xylosoxidans denitrificans 60 years after a cranial trauma''

International audience; ''Background: Achromobacter xylosoxidans (AX) is a non-fermentative aerobic Gram-negative bacillus. It is an opportunistic pathogen and the causative agent of various infections. We report an original case of late posttraumatic meningitis due to AX denitrificans. Case Report: An 83-year-old man was hospitalized for acute headache, nausea and vomiting. The emergency brain computer tomography (CT) scan did not reveal any anomaly. In his medical history, there was an auditory injury due to a cranial trauma incurred in a skiing accident 60 years earlier. Cytobiochemical analysis of the cerebrospinal fluid (CSF) revealed increased levels of neutrophils and proteins. The C…

Faut-il réaliser un « Mini-Mental State Examination » chez tout sujet âgé hypertendu ?

Hypertension constitutes a recognized risk factor of vascular dementia but also of Alzheimer-type dementia. Various longitudinal studies showed that midlife blood pressure level is one of the factors conditioning the onset of dementia syndrome in late life. The high risk of dementia is linked to leukoaraiosis, vascular rigidity, microcirculation disorders, oxidative stress, blood pressure fluctuations including orthostatic hypotension and strokes, all of those being associated with hypertension. Numerous clinical trials showed the positive effect of effective treatment of hypertension on the prevention of cognitive disorders and dementias. Thus, screening and early management of dementia an…

Alzheimer's disease associated with sporadic cerebral amyloid angiopathy in an elderly patient

Impact of ambulatory physiotherapy on motor abilities of elderly subjects with Alzheimer's disease

AimWe investigated the impact of ambulatory physiotherapy (AP) on motor abilities in elderly subjects with Alzheimer's disease (AD). MethodsSubjects with mild to moderate AD were included and divided into physiotherapy group (PG) and no physiotherapy group (NPG) according to whether or not they received AP between inclusion (T0) and the second time of assessment, between 15 and 36months after inclusion (T1). The follow-up duration, Mini-Mental State Examination, Tinetti and mini motor test (MMT) scores, Timed Up & Go test (TUG), gait speed (GS), one-leg balance (OLB), history of falls within the last 6months (HF), ability to rise from the floor (RFF) and the use of a walking aid (UWA) were …

Potentially inappropriate use of furosemide in a very elderly population: An observational study

International audience; ObjectiveLittle is known about furosemide prescription modalities in elderly people. We describe furosemide prescription in ambulatory elderly patients.MethodsAll patients aged over 80 years, affiliated to Mutualité Sociale Agricole de Bourgogne, a French regional health insurance plan, with a medical prescription delivered in March 2015, were retrospectively included.ResultsAmong 15 141 patients with a median age of 86 years, comprising 61.3% of women, 3937 patients (26%) had a prescription for furosemide. Severe heart failure was the most common chronic comorbidity (27.7%). Furosemide was considered a long-term therapy for almost all patients (98.7% with prescripti…

Th1 and Th17 lymphocytes expressing CD161 are implicated in giant cell arteritis and polymyalgia rheumatica pathogenesis.

International audience; OBJECTIVE: Giant cell arteritis (GCA) is the most frequently occurring vasculitis in elderly individuals, and its pathogenesis is not fully understood. The objective of this study was to decipher the role of the major CD4+ T cell subsets in GCA and its rheumatologic form, polymyalgia rheumatica (PMR). METHODS: A prospective study of the phenotype and the function of major CD4+ T cell subsets (Th1, Th17, and Treg cells) was performed in 34 untreated patients with GCA or PMR, in comparison with 31 healthy control subjects and with the 27 treated patients who remained after the 7 others withdrew. RESULTS: Compared with control subjects, patients with GCA and patients wi…

[Psychomotor disadaptation syndrome].

We describe the psychomotor disadaptation syndrome and report the last findings on its physiopathology and therapeutic. This syndrome was first described by Pr Gaudet's team in 1986 and named "psychomotor regression syndrome". This name has been recently changed into "psychomotor disadaptation syndrome".The psychomotor disadaptation syndrome is a decompensation of postural function, gait and psychomotor automatisms due to the alteration of the posture and motor programming. That alteration is linked to subcortical-frontal lesions. Clinically, the psychomotor disadaptation syndrome is characterized by postural impairments (retro-propulsion or backward disequilibrium), non-specific gait disor…

Évaluation de la prescription des inhibiteurs de la pompe à protons chez la personne âgée de 75 ans et plus dans un service de gériatrie aiguë

Resume Introduction et objectifs Les inhibiteurs de la pompe a protons (IPP) sont tres prescrits en France et seraient responsables d’effets indesirables non negligeables surtout chez la personne âgee (PA). Afin de limiter leur mesusage et un surcout pour la securite sociale, la Haute Autorite de sante (HAS) a edite des recommandations de prescription strictes. Nous avons conduit une etude chez la PA dont l’objectif principal etait d’evaluer le taux de prescription d’IPP hors recommandations de la HAS. Methode Il s’agissait d’une etude prospective, monocentrique et observationnelle portant sur des PA de 75 ans et plus admises dans un service de geriatrie aigue, sur une periode de 6 mois. La…

Giant cell arteritis (Horton's disease) in very elderly patients aged 80 years and older: A study of 25 cases

Aim Analysis of the characteristics of very elderly patients with giant cell arteritis (GCA). Methods Patients aged 80 years and older diagnosed with GCA in our department between 1 January 2002 and 31 July 2008 were retrospectively included. For each patient, we recorded general characteristics, reason(s) for hospitalization, specialty of the physician or department that referred the patient to us, medical history, treatment at admission, GCA clinical features, time to diagnosis of GCA, biological screening and GCA treatment. Results We analyzed 25 clinical records, 18 women and seven men with a mean age of 83.9 years. General weakness, visual loss and inflammatory syndrome were the princi…

Gastric Dilation due to a Neuroleptic Agent in an Elderly Patient: A Case Report

Neuroleptics may cause side effects, some of which are little known. We describe here a case of gastric dilation related to treatment with a neuroleptic in an elderly man. To our knowledge, such a case has never been reported in the literature. A 76-year-old man, living in a nursing home, was hospitalized for general weakness and abdominal pain. He had dementia with behavioral disorders treated with cyamemazine, a sedative and anxiolytic neuroleptic. Given a clinical suspicion of intestinal occlusion, an abdominopelvic computerized tomography scan was performed before the patient was admitted to our hospital. This computerized tomography scan did not show intestinal occlusion and there was …

Syndrome de désadaptation psychomotrice

Resume Propos Nous decrivons le syndrome de desadaptation psychomotrice et rapportons les recentes avancees concernant sa physiopathologie et sa therapeutique. Il y a 20 ans, l'equipe du Pr Gaudet le decrivait sous l'appellation « syndrome de regression psychomotrice » avant d'etre rebaptise sous sa nouvelle denomination a la fin des annees 1990. Actualites et points forts Le syndrome de desadaptation psychomotrice represente une decompensation de la fonction posturale, de la marche et des automatismes psychomoteurs, liee a une perturbation de la programmation posturomotrice suite a une deterioration des structures sous-corticofrontales. Il associe des troubles posturaux (retropulsion), des…

Type 2 Myocardial Infarction: A Geriatric Population-based Model of Pathogenesis

International audience; Distinction between type 2 myocardial infarction (T2MI), defined as an imbalance between oxygen supply and demand without atherothrombosis, and type 1 myocardial infarction (T1MI), due to plaque disruption, is often a clinical challenge in frail elderly patients. We aimed to identify the characteristics and underlying causes of T2MI using a comprehensive geriatric approach. From a multicentre population-based prospective study in coronary care units, we adjudicated 4572 consecutive patients hospitalized for an acute T1MI or T2MI, according to the 3rd universal definition and a prespecified geriatric model of T2MI pathogenesis. In total, 3710 (81%) had T1MI and 862 (1…

Évaluation de la prescription des antalgiques de palier II chez la personne âgée de 75 ans en médecine générale

Although step-2 analgesics (S2A) are recommended when step-1 analgesics (S1A) are ineffective or in cases of moderate to severe pain, their efficacy varies. This study evaluated the place attributed by general practitioners (GPs) to S2A in the treatment of nociceptive pain in elderly persons (EP). Descriptive, transversal and declarative study conducted among GPs in Burgundy. In total, 115 GPs took part in the survey. Among these, 60.8% had at least one consultation/day for pain. After paracetamol, which was systematically preferred, 56.4% prescribed S2A for EP. The reasons for prescribing S2A included pain not relieved by S1A in 93% of cases, another medical treatment or not (42.6%), or th…

Évaluation de la prescription du furosémide chez la personne âgée de 75 ans et plus dans un service de gériatrie aiguë

Resume Introduction Le furosemide est tres prescrit en France. Il serait responsable d’effets indesirables non negligeables surtout chez la personne âgee. Afin de limiter son mesusage et un surcout pour la securite sociale, la Societe europeenne de cardiologie a edite des recommandations de prescription strictes. Nous avons conduit une etude dans une population âgee dont l’objectif principal etait de determiner le taux de prescription du furosemide chez la personne âgee hors recommandations. Methode Il s’agissait d’une etude prospective, monocentrique et observationnelle portant sur des personnes d’âge ≥ 75 ans, admises dans un service de geriatrie aigue sur une periode de 6 mois. La preval…

Marche et démences

Resume Objectifs Decrire les troubles de la marche (TM) au cours des demences primitives, leurs consequences et l’interet de leur prevention et reeducation. Methode Analyse des articles les plus pertinents disponibles sur Medline concernant la marche et la demence. Resultats La prevalence des TM et de l’equilibre dans la demence de type Alzheimer varie de 9 a 52 %. Les marches frontale et apraxique y sont decrites. Dans la demence vasculaire, les TM a type de marches hemiparetique, frontale et unsteady, sont observes chez plus de 71 % de patients et sont probablement un marqueur precoce de cette demence. Bien qu’en pratique clinique les TM semblent frequents dans la demence a corps de Lewy …

Réhospitalisation précoce des personnes âgées d’au moins 75 ans admises dans un service de médecine polyvalente post-urgence : taux et facteurs prédictifs

Resume Introduction Compte tenu des implications de la rehospitalisation a l’echelon individuel et societal, le depistage des personnes âgees (PA) a risque apparait fondamental. Nous avons analyse les facteurs predictifs de rehospitalisation precoce des PA d’au moins 75 ans hospitalisees en medecine. Methodes Etude retrospective monocentrique ayant inclus des PA d’au moins 75 ans hospitalisees en medecine polyvalente via le service d’accueil des urgences. Les patients decedes durant l’hospitalisation, mutes et hospitalises le mois precedent etaient exclus. L’influence sur la rehospitalisation a un mois de donnees sociodemographiques, administratives et biomedicales a ete analysee. Resultats…

Diabète de type 2 chez le sujet âgé : quelles spécificités ?

Type 2 diabetes, whose prevalence has increased among elderly aged over 75 years, has a number of specific features which differ from that in young people: heterogeneous population, association with other cardiovascular risk factors and several comorbidities, different therapeutic constraints and risks, and lower life expectancy. By using a standardized geriatric assessment it is possible to determine therapeutic and glycemic goals for each patient. In the elderly, main complications of diabetes are hypoglycemia and foot lesions. In order to avoid malnutrition, lifestyle and dietary rules should not be too strict. Recommendations for the prescription of oral antidiabetic agents are the same…

Clinical determinants of failure in balance tests in elderly subjects

We assessed the role of clinical and biological parameters on performance in four balance tests in elderly subjects. An observational study was conducted in the Center for Preventive Medicine of Nancy (France) in 2368 community-living elderly subjects aged 60 and older. Body mass index (BMI), Mini-Mental State Examination (MMSE), clock test, "Health score" and use of psychotropic drugs (UPD) were assessed. Participants performed four balance tests: "one-leg-stand" (OLS), "timed-up-and-go" (TUG), "rise-from-the-floor" (RFF) and "sit-to-stand" (STS). The statistical analysis showed that women were almost twice as likely to fail balance tests as men. In both women and men, the following determ…

COVID-19-Related French Lockdown: Impact on the Physical and Psychological Health of Older Adults

Multidisciplinary management in geriatric day-hospital is beneficial for elderly fallers: A prospective study of 28 cases

We determined whether management including medical, psychological, and physiotherapeutic approaches, over a period of 6 weeks, has a beneficial effect on motor abilities, psychological status, and independence of elderly fallers with psychomotor disadaptation syndrome (PDS). We included 28 subjects (mean age 81.4 years). They were assessed from a medical, motor, and psychological point of view at both the inclusion and the end of the multidisciplinary intervention. A follow-up was conducted with multidisciplinary assessment at 6 and 9 months after the beginning of the study in order to evaluate duration of benefits of the management. The statistical analysis concerned only subjects who took…

ATYPICAL CASE OF ALZHEIMER'S DISEASE MIMICKING CREUTZFELDT-JAKOB DISEASE: INTEREST OF CEREBROSPINAL FLUID BIOMARKERS IN THE DIFFERENTIAL DIAGNOSIS

Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy

Abstract Objectives To determine the rate of inappropriate admissions to emergency departments (EDs) and to identify determinants of these admissions. Design Prospective multicenter study. Setting Burgundy (France), EDs and medical nursing homes (MNHs). Participants 1000 Burgundy MNH residents admitted to EDs, from April 17 to June 20, 2013. Measurements For each subject, a questionnaire was completed. Data included age, gender, type of health professional who referred the resident to the ED (THP), whether or not a medical dispatcher organized the transfer to the ED, transport mode, reason for admission to the ED, level of independence according to the Groupes Iso-Ressource score (GIRS), an…

Blood pressure and pulse wave velocity values in the institutionalized elderly aged 80 and over: baseline of the PARTAGE study.

The aim of the longitudinal study PARTAGE (predictive values of blood pressure and arterial stiffness in institutionalized very aged population) was to determine the predictive value of blood pressure (BP) and arterial stiffness for overall mortality, major cardiovascular events and cognitive decline in a large population of institutionalized patients aged 80 and over. In the study herein, we present the baseline data values of this study.A total of 1130 patients were recruited (878 women), living in French and Italian nursing homes. Clinical and 3-day self-measurements of BP were conducted. Aortic and upper limb pulse wave velocity were obtained using a PulsePen tonometer.Of this populatio…

Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients Aged 80 Years and Older.

The effectiveness of direct oral anticoagulants (DOAC) is non-inferior to vitamin K antagonists (VKA) to treat atrial fibrillation and venous thromboembolism (VTE). In this cross-sectional study, we compared older persons taking DOACs to those taking VKAs. We included ambulatory individuals ≥80 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for a medical prescription in September 2017. The demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs were compared in the DOAC group and VKA group. Of the 3190 included individuals, 1279 (40%) were prescribed DOACs and 1911 (60%) VKAs. Individuals taking VKAs were older than…

Utilisation des antidépresseurs chez les sujets âgés déments : données actuelles

Resume La depression et les symptomes comportementaux et psychologiques de la demence (SCPD) ont un impact important sur l’evolution de la maladie dementielle car ils favorisent l’acceleration du declin cognitif et influencent le pronostic fonctionnel et vital. Le prescripteur doit etre particulierement prudent dans le maniement des antidepresseurs chez le sujet âge car la plupart des etudes ont certes inclus des patients âges d’au moins 65 ans, mais rarement de plus de 75 ans ; ces patients etant en outre selectionnes sur l’absence de tout critere de fragilite. Ainsi, les inhibiteurs de la recapture selectifs de la serotonine (IRSS), qui semblaient initialement ne comporter que peu de risq…

Prognostic impact of systolic blood pressure in acute heart failure with preserved ejection fraction in older patients

Abstract Aims Recent guidelines recommend a systolic blood pressure (SBP) target below 130 mmHg in heart failure patients with preserved ejection fraction (HFpEF), whatever their age. We investigated whether this intensive SBP control was associated with better survival in very old adults hospitalized for acute HFpEF. Methods and results We conducted an observational study in an acute geriatric unit: all consecutive patients discharged from hospital for acute heart failure from 1 March 2019 to 29 February 2020 with a diagnosis of HFpEF were included. Re‐hospitalization and all‐cause mortality at 1 year were compared according to the mean SBP at discharge (patients with a mean SBP < 130 mmHg…

The Prescription of Vitamin K Antagonists in a Very Old Population: A Cross-Sectional Study of 8696 Ambulatory Subjects Aged Over 85 Years

We compared very elderly people taking vitamin K antagonists (VKA) and those not taking VKA (noVKA). Individuals were included in the noVKA group if there was no VKA on their reimbursed prescriptions during the study period. We also compared three subgroups, constituted by VKA type (fluindione, warfarin, or acenocoumarol). We included individuals aged over 85 years, affiliated to Mutualit&eacute

''Assessment of the use of hypolipidemic agents (HAs), mainly statins, in elderly subjects aged 80 years and more in Burgundy: Analysis of 13,211 patients''

Manckoundia, Patrick | Lorenzini, Mathieu | Disson-Dautriche, Anne | Petit, Jean-Michel | Lorcerie, Bernard | Debost, Emmanuel | Menu, Didier | Pfitzenmeyer, Pierre; International audience; ''Only few studies have investigated the use of HA in elderly subjects and there are no data in very elderly subjects. We assessed the prescription of HA and analyzed the relationship between such prescriptions and frailty markers among persons aged 80 and more in an observational study. We recorded the prescriptions for 13,211 patients aged 80-109 years and affiliated to the "Mutualite-Sociale-Agricole (MSA)'' of Burgundy over a 1-month period. The prescription of a HA among all included patients, and t…

Is Persistent Thick Copious Mucus a Long-Term Symptom of COVID-19?

Introduction The typical clinical picture of COVID-19 is gradually becoming clearer, both in the acute phase and in the long-term. However, new symptoms are gradually being identified. We describe a long-term symptom that has not yet been reported. Case description A 49-year-old man consulted for persistent asthenia. The general practitioner found a fever (39.2°C), and COVID-19 was confirmed by the polymerase chain reaction test. Further symptoms appeared, notably thick, white, painless tracheal hypersecretion for 3 months before diminishing, without disappearing. Conclusion Non-inflammatory tracheal hypersecretion, not yet reported in COVID-19, may be an additional long-term symptom. The h…

Is backward disequilibrium in the elderly caused by an abnormal perception of verticality? A pilot study

International audience; OBJECTIVE: We hypothesised that backward disequilibrium (BD), defined by a posterior position of the centre of mass with respect to the base of support, could be caused by a backward tilt in the perception of verticality. METHODS: The relationship between BD, the perception of verticality, and the history of falls in 25 subjects aged 84.5+/-7.4 years was analysed. An original ordinal scale, the BD scale (BDS), was used to quantify BD. Postural (PV) and haptic verticals (HV) were measured in sagittal plane. RESULTS: BDS scores closely correlated with the number of falls (r = 0.81, p =10(-5)). The more the PV was tilted backward, the greater the BDS scores (r = -0.95, …

Impact d’une tâche cognitive sur la posture du sujet âgé dépressif comparé au sujet âgé non dépressif

Enhancement of Anticipatory Postural Adjustments by Virtual Reality in Older Adults with Cognitive and Motor Deficits: A Randomised Trial.

Background: Postural activities involved in balance control integrate the anticipatory postural adjustments (APA) that stabilize balance and posture, facilitating arm movements and walking initiation and allowing an optimal coordination between posture and movement. Several studies reported the significant benefits of virtual reality (VR) exercises in frail older adults to decrease the anxiety of falling and to induce improvements in behavioural and cognitive abilities in rehabilitation processes. The aim of this study was thus to test the efficiency of a VR system on the enhancement of the APA period, compared to the use of a Nintendo Wii system. Methods: Frail older adults (n = 37) were i…

Management of elderly patients suffering from cancer: Assessment of perceived burden and of quality of life of primary caregivers

International audience; Objective: To evaluate the perceived burden and the quality of life (QoL) at 3 and 6 months of the primary caregiver (PC) of patients aged 70 and over suffering from cancer and the predictors of QoL in this population.Methods: In this prospective observational study, 98 patients aged 70 and older with cancer and 96 PCs were included between 01/06/2014 and 18/03/2015. The Medical Outcomes Study 12-item Short Form Health Survey (SF-12) was used to assess the QoL of PCs and the Zarit Burden Interview (ZBI) was used to measure the perceived burden at 3 and 6 months. The major determinants of QoL were identified using mixed linear models for the dimensions of the SF-12 th…

Comment on "Factors Associated with Potentially Inappropriate Transfer to the Emergency Department Among Nursing Home Residents".

La couverture vaccinale contre la grippe saisonnière du personnel soignant en gériatrie : mise au point

Resume Position du probleme La vaccination antigrippale des professionnels de sante semble representer l’une des actions preventives des plus efficaces face a une pathologie a haut risque d’epidemie nosocomiale et potentiellement grave en milieu geriatrique. Ce travail avait pour objectif de faire une mise au point sur le statut vaccinal antigrippal chez le personnel soignant en geriatrie et les raisons expliquant leur reticence vis-a-vis de cette vaccination, afin d’emettre des propositions d’amelioration de la couverture vaccinale. Methode Une recherche bibliographique des articles publies depuis 2000 dans le domaine de la geriatrie, des maladies infectieuses ou de la pneumologie a ete re…

Décompensation cardiorespiratoire au cours d’une polyarthrite rhumatoïde

Rheumatoid arthritis (RA) may include rare extra-articular manifestations, and particularly cardiopulmonary involvement. We report a 83-year-old woman, with RA, who presented with both pulmonary and heart failures that were related to the RA, resulting from the presence of mediastinal and axillary lymph nodes, and pleural and pericardial effusions. This was confirmed by the dramatic improvement after a specific treatment of RA.

Comparison of motor strategies in sit-to-stand and back-to-sit motions between healthy and Alzheimer’s disease elderly subjects

We studied the kinematics of shoulder displacement during sit-to-stand and back-to-sit in 6 healthy elderly subjects and six elderly subjects with mild to moderate Alzheimer's disease in order to elucidate the impact of Alzheimer's disease on motor planning and control processes. During sit-to-stand, Alzheimer's disease subjects reduced their forward displacement and started their upward displacement earlier than healthy elderly subjects. Furthermore, shoulder path curvatures were more pronounced for upward compared with downward displacement in healthy elderly group, in contrast with Alzheimer's disease group. Temporal analysis found that: 1) for both groups, profiles of velocity of sit-to…

Iléite à cytomégalovirus chez une personne âgée non immunodéprimée : à propos d’une observation

Resume Introduction Les ileites a cytomegalovirus surviennent rarement chez l’immunocompetent. Observation Une femme, âge de 88 ans, presentait une douleur intense de la fosse iliaque droite. La C-reactive proteine etait elevee et associee a une hyperleucocytose a polynucleaires neutrophiles. La coloscopie revelait un aspect tres ulcere et inflammatoire de la muqueuse ileale terminale. L’analyse anatomopathologique des biopsies retrouvait un effet cytopathogene typique avec cellules ballonisees et inclusions intranucleaires, confirme par un immunomarquage positif a l’anticorps anti-cytomegalovirus. La recherche de cytomegalovirus par PCR dans le plasma etait positive. L’evolution clinico-bi…

Post-Infectious Myocardial Infarction: New Insights for Improved Screening

Acute infection is suspected of involvement in the onset of acute myocardial infarction (MI). We aimed to assess the incidence, pathogenesis and prognosis of post-infectious MI. All consecutive patients hospitalized for an acute MI in coronary care units were prospectively included. Post-infectious MI was defined by a concurrent diagnosis of acute infection at admission. Type 1 MI (acute plaque disruption) or Type 2 MI (imbalance in oxygen supply/demand) were adjudicated according to the universal definition of MI. From the 4573 patients admitted for acute MI, 466 (10%) had a concurrent acute infection (median age 78 (66–85) y, 60% male), of whom 313 (67%) had a respiratory tract infection.…

Assessment of the interest of the geriatric oncology consultation among French general practitioners

International audience; OBJECTIVE: We assessed the interest of the geriatric oncology (GO) consultation (GOC) among general practitioners (GPs). MATERIALS AND METHODS: We conducted a survey among GPs whose patients had had a GOC in 2012. A questionnaire was sent to GPs. The 1st part collected GPs' characteristics including medical education in geriatrics and GO, and knowledge of GOC. The following parts concerned the GOC and included the cancer type, GOC report and care plan. RESULTS: One-hundred twenty-six questionnaires corresponding to 94 GPs were collected. Concerning the GPs' characteristics, age range 50-59 (44.7%), men (62.8%) and urban practice (79.8%) were the most represented, 80.…

Post-infectious myocardial Infarction: Does percutaneous coronary intervention improve outcomes? A propensity-score matched analysis

Acute infection is a frequent trigger of myocardial infarction (MI). However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis is a major but unsolved issue. In this prospective multicenter study from coronary care units, we performed propensity score-matched analysis to compare outcomes in patients with and without PCI for post-infectious MI with angiography-proven significant coronary stenosis (&gt

Late-Onset Sarcoidosis in a 77-Year-Old Man

International audience

The caregiver/patient relationship at the heart of health : A qualitative study

National audience

The prescription of direct oral anticoagulants in the elderly: An observational study of 19 798 Ambulatory subjects.

International audience; Objective Direct oral anticoagulants (DOACs) are increasingly prescribed to elderly people, but the epidemiologic data for this population remains scarce. We compared the elderly population taking DOACs and those not taking DOACs (noDOAC). Method We included individuals over 75 years old, affiliated to Mutualite Sociale Agricole of Burgundy (a French regional health insurance agency), who had been refunded for a prescribed DOAC between 1st and 30th September 2017. The DAOC group (DAOCG) and noDOAC group (noDOACG) were compared in terms of demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs. In the DOACG, we compared the…

Type 1 or Type 2 Myocardial Infarction in Patients with a History of Coronary Artery Disease: Data from the Emergency Department

A type 2 myocardial infarction (T2MI) is the result of an imbalance between oxygen supply and demand, without acute atherothrombosis. T2MI is frequent in emergency departments (ED), but has not been extensively evaluated in patients with previously known coronary artery disease (CAD). Our study assessed the incidence and characteristics of T2MI compared to type 1 (T1MI) in CAD patients admitted to an ED. Among 33,669 consecutive patients admitted to the ED, 2830 patients with T1MI or T2MI were systematically included after prospective adjudication by the attending clinician according to the universal definition. Among them, 619 (22%) patients had a history of CAD. Using multivariable analys…

Development and validation of the FRAGIRE tool for assessment an older person’s risk for frailty

International audience; Background: Frailty is highly prevalent in elderly people. While significant progress has been made to understand its pathogenesis process, few validated questionnaire exist to assess the multidimensional concept of frailty and to detect people frail or at risk to become frail. The objectives of this study were to construct and validate a new frailty-screening instrument named Frailty Groupe Iso-Ressource Evaluation (FRAGIRE) that accurately predicts the risk for frailty in older adults.Methods: A prospective multicenter recruitment of the elderly patients was undertaken in France. The subjects were classified into financially-helped group (FH, with financial assista…

Bedside chest ultrasound to distinguish heart failure from pneumonia‐related dyspnoea in older COVID‐19 patients

Abstract Aims In the older population, acute heart failure is a frequent, life‐threatening complication of COVID‐19 that requires urgent specific care. We aimed to explore the impact of point‐of‐care chest ultrasound (CUS) use in older bedridden inpatients during the COVID‐19 pandemic as a tool to distinguish between cardiogenic pulmonary oedema and isolated viral pneumonia‐related dyspnoea. Methods and results This prospective series included 16 patients aged 75 or older, hospitalized for acute dyspnoea in an acute geriatric unit of a university hospital and testing positive for a SARS‐Cov2 infection. We collected demographic characteristics, medical history, biological screening, clinical…

En EHPAD, repérer les petits mangeurs et adapter leur alimentation : quel impact sur la prise alimentaire et l'état nutritionnel ?

National audience