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Objectives: Consideration of the need to strengthen the commitment of professionals to the good care of the older population in hospitals has been emerging over the last several years. The steering committee of the geriatric sector of the hospitals of our Hospital Consortium (HC) has structured an accreditation project to promote the commitment of professionals to the good care of older adult patients in hospitals: the "Hospital Attentive to the Elder" (HAE) accreditation. This global approach aims to better adapt care to the needs of this population in the hospital and promote positive values (eg, kindness, attentive support)., Design: The creation of the HAE accreditation required the creation of an accreditation board, a referential framework, and an accreditation procedure., Setting and Participants: The whole process was coordinated by the accreditation board, a multidisciplinary entity, representative of the hospitals of our HC., Methods: The 5-step approach of the accreditation procedure includes a commitment to the HAE, with the support of the institutional board, and an internal self-assessment phase to guide the creation of action plans, followed by an accreditation cross-evaluation visit. The HAE accreditation is awarded to departments that meet the described criteria. This accreditation process was initially initiated by our HC., Results: In June 2021, 6 of 10 hospitals of our HC and 11 departments, which mobilized 28 medical, paramedical, and quality referents, initiated the process. All 11 departments fulfilled the criteria for the accreditation, and a ceremony to hand out the certificates was organized in December 2023., Conclusions and Implications: We envisage that this accreditation process could be offered at the regional and national level to any hospital or group of hospitals with departments that receive patients aged >75 years, regardless of their specialty., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Purpose: Idiopathic Normal pressure hydrocephalus (iNPH) is an under-diagnosed in elderly patients but none of the diagnostic tests are currently sufficiently sensitive or specific. The objective of this study was to analyze the dynamics of neurofluids by PC-MRI in relation to clinical evolution as measured using the iNPH grading scale after tap-test., Method: We prospectively included patients with suspected iNPH. All these patients underwent PCMRI to assess craniospinal hemohydrodynamics with analysis of the stroke volume of the cephalospinal fluid (CSF) within the Sylvius' aqueduct, within the high cervical subarachnoid spaces and the arteriovenous stroke volume. By this means, we calculated a compliance index. Morphological analysis was carried out using the DESH score. The infusion test was measuring the resistance to CSF flow. We analysed all these parameters according to the clinical improvement of the patients., Results: 23 patients were included. Compliance index assessed by PC-MRI was significantly higher in the group of patients with improvement > 10% (p = 0.015)., Conclusions: Our study highlights the importance of investigating arteriovenous and CSF interactions in iNPH. This involves understanding the physiological and pathophysiological mechanisms related to the circulation of neurofluids. The analysis of the interactions of these neurofluids allows for a comprehensive understanding of the system., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Background and Objectives: In 2017, our French 1671-bed university hospital opened a 12-bed unit for very short stays, post-emergency (unit of transitory admission in geriatric [UTAG] area), dedicated to frail patients older than 75 years requiring short-term care. We sought to investigate whether this new organization's shortened length of stay (LOS) was associated or not with a higher rate of readmission., Methods: We conducted a retrospective descriptive study based on the daily activity of the UTAG over 6 months including all patients consecutively hospitalized in the unit via the computerized medical file of the hospital. The data collected included the Rockwood score, the primary diagnoses, the LOS and any 1-month readmission., Results: From August 2019 to January 2020, 646 older adult patients were hospitalized in the UTAG. Two-thirds of the hospitalized patients were women; the mean age of this population was 86.7 ± 6.2 years. The main causes of hospitalization were infectious pathologies (19.8%), falls and their consequences (17.3%), and cardiac pathologies (17.2%). The mean LOS was of 2.7 ± 2.0. Seventy readmissions were observed in the month after discharge. One-month readmissions were more frequent when patients had presented with acute heart failure and among nursing home residents., Conclusion: The creation of the UTAG reduced LOS and so contributed to decreased iatrogenic disabilities without putting patients at increased risk of readmission. The development of cardiac and geriatric dedicated outpatient pathways and a community-based geriatric mobile team intervening in nursing homes could optimize the care of frail older adult patients and avoid readmissions., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The subcutaneous (SC) route provides an alternative to the IV or oral route for drug administration in the elderly. The benefits of SC administration have been proven for hydration but are still debated for antibiotics because tolerance remains uncertain, especially in the frail geriatric population. Here, we aimed to improve current knowledge concerning the tolerance profile of ceftriaxone SC administration at both the systemic and cutaneous level, as well as in terms of pain., Patients and Methods: This was a prospective descriptive study of SC ceftriaxone tolerance in a geriatric department. We included all patients over 75 years of age who received a prescription for SC ceftriaxone in our hospital over a 5 month period., Methods: We evaluated the systemic and local tolerance of SC ceftriaxone. Nurses were asked about their perceptions concerning its use., Results: Among 117 patients, 57% presented with pain and 60% with a mild local adverse effect, such as the formation of oedema in one-third of patients, induration or transient erythema. Finally, there were no serious local adverse effects and two systemic adverse effects were observed (one diarrhoea and one Clostridioides difficile colitis). Pain was mainly related to the skin breach and oedema formation., Conclusions: We did not find any worrying signs concerning the use of SC ceftriaxone but this study shows that its wide use must consider pain management, which is often overlooked., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Descemet membrane endothelial keratoplasty (DMEK) restores visual acuity in patients with progressive corneal endothelial diseases such as Fuchs endothelial corneal dystrophy (FECD). However, patients often prefer to delay the surgery as long as possible, even though outcomes are poorer in advanced FECD. A recent study proposed that preoperative central corneal thickness (CCT) of ≥625 μm associated with worse best spectacle-corrected visual acuity (BSCVA) after DMEK for FECD. Since this threshold could signal to both surgeons and patients when to perform DMEK, we further explored the relationship between CCT and BSCVA with a retrospective cohort study. The cohort consisted of all patients with FECD who underwent DMEK in a tertiary-care hospital in 2015-2020 and were followed for 12 months. Extremely decompensated corneas were not included. Relationships between preoperative CCT and BSCVA on days 8 and 15 and months 1, 3, 6, and 12 were examined with Pearson correlation analyses. Eyes with preoperative CCT <625 or ≥625 μm were also compared in terms of postoperative BSCVA. Relationships between postoperative CCT and final BSCVA were also explored. The cohort consisted of 124 first-operated eyes. Preoperative CCT did not correlate with postoperative BSCVA at any timepoint. Eye subgroups did not differ in postoperative BSCVA. However, postoperative CCT at 1-12 months correlated significantly with 12-month BSCVA (r = 0.29-0.49, p = 0.020-0.001). Thus, postoperative, but not preoperative, CCT correlated with postoperative BSCVA. This phenomenon may reflect factors that distort preoperative CCT measurements but disappear after surgery. This observation and our analysis of the literature suggest that while there is a relationship between CCT and post-DMEK visual acuity, preoperative CCT measurements may not always adequately reflect that relationship and may therefore not be a reliable predictor of DMEK visual outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Moskwa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Acute geriatric units (AGUs) require efficient discharge planning tools. Risk factors for discharge from an AGU to post-acute care (PAC) have not previously been investigated in detail., Methods: The objective is to identify risk factors for PAC transfer. The DAMAGE (prospective multicenter cohort) consecutively included more than 3500 subjects aged 75 or older and admitted to an AGU. The patients underwent a comprehensive geriatric assessment (CGA) during their stay in the AGU. Only community-dwelling patients admitted to the AGU from the emergency department were included in the analysis. We recorded the characteristics of the care pathway and identified risk factors for discharge to home or to a PAC facility., Results: 1928 patients were included. Loss of functional independence (a decrease in the Katz activities of daily living (ADL) score between 1 month prior to admission and AGU admission), living alone, social isolation, a high Katz ADL score at home, a low Katz ADL on admission, and delirium on admission were risk factors for transfer to PAC. Obesity, an elevated serum albumin level, and community-acquired infection were associated with discharge to home. Neither sex nor age was a risk factor for home discharge or transfer to PAC., Conclusion: The present results might help clinicians and discharge planning teams to identify patients at risk of transfer to PAC more reliably and promptly in AGUs., Competing Interests: Professor Jean-Baptiste Beuscart reports grants from French government’s interregional hospital-based clinical research program, during the conduct of the study. No authors have any conflicts of interest to declare., (© 2022 Deschasse et al.)

Purpose: It remains unclear whether preoperative central graft thickness (CGT) contributes to visual outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK). This retrospective cohort study examined the ability of preoperative and postoperative CGT to predict 12-month best spectacle-corrected visual acuity (BSCVA) after DSAEK for Fuchs endothelial corneal dystrophy/moderate pseudophakic bullous keratopathy/second graft., Methods: All consecutive patients who underwent DSAEK in 2015 to 2018 were included. The primary end point was 12-month BSCVA. DSAEK-CGT was measured preoperatively and 6 times between postoperative day 8 and month 12. Eyes were divided according to preoperative CGT 130 μm (ultrathin-DSAEK threshold) or 6-month postoperative CGT 100 μm (mean 6-month postoperative DSAEK-CGT). The t test assessed CGT evolution of the 4 groups over time. Multivariate analyses examined whether preoperative CGT or 6-month CGT categories predicted 12-month BSCVA. Multivariate analysis assessed the preoperative/perioperative factors that predicted 6-month CGT., Results: A total of 108 eyes (68 patients) underwent DSAEK. Preoperative CGT was >130 and ≤130 μm in 87 and 21 eyes, respectively. Postoperative CGT was >100 and ≤100 μm in 50 and 58 eyes, respectively. Thin 6-month postoperative grafts thinned significantly more relative to preoperative thickness than thick grafts ( P < 0.001). Preoperative CGT subgroups did not show this difference. Six-month postoperative CGT ( P = 0.01), but not preoperative CGT, predicted 12-month BSCVA. Preoperative CGT strongly predicted 6-month CGT ( P = 0.0003)., Conclusions: Postoperative, but not preoperative, DSAEK-CGT predicted 6-month BSCVA. The correlation between preoperative and postoperative CGT and interstudy variation in preoperative CGT measurement accuracy may explain literature disparities regarding the importance of preoperative CGT in DSAEK outcomes., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Comfort care for a dying patient increases the quality of the end of life. End-of-life situations are frequently managed in acute geriatric units (AGUs), and transition to comfort care only is often necessary. However, the frequency of transition to comfort care and the latter's putative link with the end-of-life trajectory (sudden death, cancer, organ failure, and frailty with or without dementia) have not previously been studied in acute geriatric units. We sought to (1) describe end-of-life trajectories and the transition to comfort care only, and (2) analyse the relationship between the two, prior to death in an AGU., Design: A secondary analysis of a subgroup of the DAMAGE cohort (a prospective multicentre cohort of 3509 patients aged 75 years and over and admitted consecutively to an AGU)., Setting/participants: DAMAGE patients who died in an AGU after a stay of at least 48 hours., Methods: Data on the end-of-life trajectory and the transition to comfort care only were extracted from medical records., Results: Of the 177 included patients, 123 (69.5%) transitioned to comfort care only in the AGU. A frailty trajectory (in patients living with dementia or not) accounted for nearly 70% of deaths. Paradoxically, only frailty among people living without dementia was not significantly associated with a more frequent transition to comfort care [odds ratio (95% confidence interval): 1.44 (0.44-4.76), relative to a patient dying suddenly]., Conclusions and Implications: Transition to comfort care only is frequent in AGUs and is linked to the end-of-life trajectory (except for frail patients living without dementia). The frailty trajectory is one of the most frequent, and, therefore, physicians must be aware of the need to improve practice in this context., (Copyright © 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: A comprehensive analysis of routinely collected pre/perioperative demographic/clinical factors that could predict final visual acuity after primary Descemet membrane endothelial keratoplasty (DMEK) has not been conducted previously., Methods: A retrospective monocenter cohort study was performed with consecutive patients with Fuchs endothelial corneal dystrophy (FECD) who underwent DMEK or triple-DMEK (DMEK combined with cataract surgery) in 2016-2020 in a French tertiary-care hospital. DMEK-only patients were pseudophakic. Patients were followed for 12 months. Surgery was considered successful when 12-month best-corrected visual acuity (BCVA) was ≤0.1 logMAR (≥0.8). Exploratory multivariate analysis was conducted with the following routinely collected variables to determine their ability to predict 12-month BCVA: patient age and sex; graft donor age; triple DMEK; preoperative values of BCVA, endothelial cell density (ECD), central corneal thickness (CCT), and mean anterior keratometry; and rebubbling., Results: Of 100 eyes (100 patients; mean age, 72 years; 61% female), 81 achieved a 12-month BCVA of ≤0.1 logMAR. Logistic regression analysis showed that older age was a significant prognosticator for 12-month BCVA > 0.1 logMAR (Odds Ratio = 0.914, 95% confidence intervals = 0.846-0.987; p = 0.02)., Conclusions: An older age associated with worse visual acuity outcomes after DMEK. This was confirmed by our analysis of the literature and supports the notion that DMEK should be conducted without delay once symptoms appear. Patient sex, donor age, triple-DMEK, and anterior keratometry also did not predict final BCVA in the literature. Preoperative CCT, ECD, and BCVA, and rebubbling occasionally appear in the literature as BCVA predictors, possibly reflecting an underlying ECD-BCVA axis., (© 2022. The Author(s).)

Background: There is a need for a mortality score that can be used to trigger advanced care planning among older patients discharged from acute geriatric units (AGUs)., Objective: We developed a prognostic score for 3- and 12-month mortality after discharge from an AGU, based on a comprehensive geriatric assessment, in-hospital events, and the exclusion of patients already receiving palliative care., Methods: Devenir Après la Médecine Aigue Gériatrique (DAMAGE) is a French multicenter, prospective, cohort study. The broad inclusion criteria ensured that the cohort is representative of patients treated in an AGU. The DAMAGE participants underwent a comprehensive geriatric assessment, a daily clinical checkup, and follow-up visits 3 and 12 months after discharge. Multivariable logistic regression models were used to develop a prognostic score for the derivation and validation subsets., Results: A total of 3 509 patients were assessed and 3 112 were included. The patient population was very old and frail or dependant, with a high proportion of deaths at 3 months (n = 455, 14.8%) and at 12 months (n = 1 014, 33%). The score predicted an individual risk of mortality ranging from 1% to 80% at 3 months and between 5% and 93% at 12 months, with an area under the receiving operator characteristic curve in the validation cohort of 0.728 at 3 months and 0.733 at 12 months., Conclusions: Our score predicted a broad range of risks of death after discharge from the AGU. Having this information at the time of hospital discharge might trigger a discussion on advanced care planning and end-of-life care with very old, frail patients. Clinical Trials Registration Number: NCT02949635., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: In the context of improved medication management of older patients, we wished to evaluate the overprescription of potentially inappropriate drugs [α1-blockers and 5α-reductase inhibitors (5-ARI)] for benign prostate hyperplasia (BPH). These drugs are considered by geriatricians to increase the risk of falls and pharmacodynamic interactions, but these properties have not yet been proven., Design: This was a descriptive study of drug prescriptions in a geriatric academic center., Setting and Participants: We included all patients older than 75 years who received a prescription for α1-blockers or 5-ARIs for 2 weeks in our hospital., Methods: We evaluated the prevalence of the potentially inappropriate prescription of α1-blockers and 5-ARI in older people during hospitalization using a new tool consisting of an 8-item list of explicit indicators developed using the most recent summary of product characteristics (SmPC) and latest European Association of Urology (EAU) guidelines., Results: A population of 117 patients (≥75 years) was included in the study. The median age was 84.5 (±6.3) years. The average time since urological medication prescription was 1.2 ± 1.6 years. According to explicit criteria, 84 patients (71.8%) received at least 1 potentially inappropriate urologic medication, 77 (91.7%) related to α1-blockers. Patients with a potentially inappropriate prescription for α1-blockers and/or 5-ARIs more frequently had urological assessments (P = .026), more frequently showed pharmacological interactions, with the risk of orthostatic hypotension (P = .005) or arrhythmia (P = .028), and experienced more falls in their history (P = .043). The misuse group was associated with an increased risk of falls, with an odds ratio of 3.22 (P = .039, 95% confidence interval 1.08-10.2)., Conclusions and Implications: In our study, potentially inappropriate prescriptions for older individuals for BPH was close to 72% and mainly involved α1-blockers. Potentially inappropriate prescriptions for BPH were associated with a threefold higher frequency of falls., (Copyright © 2021 AMDA — The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Previous comparative studies show that triple Descemet membrane endothelial keratoplasty (DMEK) (i.e. phacoemulsification followed immediately by DMEK) has either equivalent or better visual outcomes than DMEK in pseudophakic patients. To resolve this discrepancy, a retrospective cohort study was conducted. All consecutive patients with Fuchs Endothelial Corneal Dystrophy who underwent triple or pseudophakic DMEK in 2015-2019 in a tertiary-care hospital (France) and were followed for >12 months were compared in terms of best spectacle-corrected visual acuity (BSCVA), final refractive outcomes, and endothelial-cell loss at 12 months as well as rebubbling rates. The triple-DMEK (40 eyes, 34 patients) and pseudophakic-DMEK (55 eyes, 43 patients) groups were similar in terms of age and other baseline variables. They also did not differ in final BSCVA (both 0.03 logMAR), final endothelial-cell loss (54% vs. 48%), or astigmatism (-1.25 vs. -1 D). At 12 months, triple-DMEK associated with significantly smaller residual hyperopia (0.75 vs. 1 D; p = 0.04) and spherical equivalence (0 vs. 0.5 D; p = 0.02). Triple-DMEK also tended to associate with more frequent rebubbling (40% vs. 24%, p = 0.09). In conclusion, while triple-DMEK and pseudophakic-DMEK achieved similar visual acuity improvement, triple-DMEK was superior in terms of final sphere and spherical refraction but also tended to have higher complication rates., Competing Interests: The authors have declared that no competing interests exist.

Purpose: This retrospective cohort study assessed the evolution of corneal transplantation and its indications in the last 21 years (2000-2020) in a specialized ophthalmology department in a tertiary referral center in France., Methods: The surgical techniques and indications, patient age and sex, and postoperative best-corrected visual acuity (BCVA) 6 months after keratoplasty were extracted., Results: In total, 1042 eyes underwent keratoplasty in 2000-2020. Annual numbers of corneal transplantations increased by 2.2-fold. Penetrating keratoplasty (PKP) was the sole technique for the first 11 years. Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) were introduced in 2011 and 2014, respectively. Cases of both quickly increased, accounting for 28% and 41% of cases in 2015-2020, respectively. Eventually, DSAEK and DMEK were respectively used for most pseudophakic bullous keratopathy (PBK) and all Fuchs endothelial cell dystrophy (FECD) cases. PKP cases declined to 27%. Deep anterior lamellar keratoplasty (DALK) was rare (3% of all cases). These changes associated with rises in PBK and particularly FECD cases, and a strong decline in keratoconus, causing FECD, PBK, and keratoconus to move from being the 4th, 1st, and 3rd most common indications to the 1st, 2nd, and 6th, respectively. On average, BCVA improved by 0.1-0.3 logMAR. Patient age dropped steadily over time. Female predominance was observed., Conclusions: The invention of DSAEK and then DMEK precipitated an enormous change in clinical practice and a large expansion of keratoplasty to new indications. This study confirms and extends previous findings in other countries., Competing Interests: The authors have declared that no competing interests exist.

Low postoperative endothelial-cell density (ECD) plays a key role in graft failure after Descemet-membrane endothelial keratoplasty (DMEK). Identifying pre/perioperative factors that predict postoperative ECD could help improve DMEK outcomes. This retrospective study was conducted with consecutive adult patients with Fuchs-endothelial corneal dystrophy who underwent DMEK in 2015-2019 and were followed for 12 months. Patients underwent concomitant cataract surgery (triple-DMEK) or had previously undergone cataract surgery (pseudophakic-DMEK). Multivariate analyses assessed whether: patient age/sex; graft-donor age; preoperative ECD, mean keratometry, or visual acuity; triple DMEK; surgery duration; surgical difficulties; and need for rebubbling predicted 6- or 12-month ECD in the whole cohort or in subgroups with high/low ECD at 6 or 12 months. The subgroups were generated with the clinically relevant threshold of 1000 cells/mm2. Surgeries were defined as difficult if any part was not standard. In total, 103 eyes (95 patients; average age, 71 years; 62% women) were included. Eighteen eyes involved difficult surgery (14 difficult graft preparation or unfolding cases and four others). Regardless of how the study group was defined, the only pre/perioperative variable that associated significantly with 6- and 12-month ECD was difficult surgery (p = 0.01, 0.02, 0.05, and 0.0009). Difficult surgery also associated with longer surgery duration (p = 0.002). Difficult-surgery subgroup analysis showed that difficult graft dissection associated with lower postoperative ECD (p = 0.03). This association may reflect endothelial cell loss due to excessive graft handling and/or an intrinsic unhealthiness of the endothelial cells in the graft that conferred unwanted physical properties onto the graft that complicated its preparation/unfolding., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Patients over 80 years of age are more prone to develop severe symptoms and die from COVID-19. Antibiotics were massively prescribed in the first days of the pandemic without evidence of super infection. Antibiotics may increase the risk of mortality in cases of viral pneumonia. With age and antibiotic use, the microbiota becomes altered and less protective effect against lethal viral pneumonia. Thus we assessed whether it is safe to prescribe antibiotics for COVID-19 pneumonia to patients over 80 years of age., Method: We conducted a retrospective monocentric study in a 1240-bed university hospital. Our inclusion criteria were patients aged ≥ 80 years, hospitalized in a COVID-19 unit, with either a positive SARS-CoV-2 RT-PCR from a nasopharyngeal swab or a CT scan within 72 h after or prior to hospitalization in the unit suggestive of infection., Results: We included 101 patients who received antibiotics and 48 who did not. The demographics in the two groups were similar. Overall mortality was higher for the group that received antibiotics than for the other group (36.6% vs 14.6%,). According to univariate COX analysis, the risk of mortality was higher (HR = 1.98 [0.926; 4.23]) but non-significantly for the antibiotic group. In multivariate analysis, independent risk factors of mortality were an increased leukocyte count and decreased oxygen saturation (HR = 1.097 [1.022; 1.178] and HR = 0.927 [0.891; 0.964], respectively)., Conclusion: This study raises questions about the interest of antibiotic therapy, its efficacy, and its effect on COVID-19 and encourages further research., (Copyright © 2022. Published by Elsevier Masson SAS.)

Background: Coronavirus disease 2019 (COVID-19) is associated with increased morbidity and mortality in older adults. Although the advent of the first vaccines has significantly reduced these rates, data on older adults in clinical trials are scarce., Objectives: We quantified and compared the humoral response in individuals with vs. without pre-existing seropositivity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in a cohort of 69 patients living in a nursing home and who had received the recommended two doses of the Comirnaty (Pfizer-BioNTech®) vaccine., Results: All 69 patients (100%) tested positive for antibodies against SARS-CoV-2 at 2 months post-vaccination. Residents with a pre-vaccination infection had significantly higher titers of anti-spike 1 IgG than those with no prior infection (median [interquartile range]: 55,726 [14463-78852] vs. 1314 [272-1249] arbitrary units, respectively; p < 0.001). The same result was observed for neutralizing antibodies titers (704 [320-1280] vs. 47 [20-40] respectively; p < 0.001). Between the pre-vaccination and post-vaccination periods, for IgG and neutralizing antibodies, we observed a 49 and 8-fold increase respectively. In comparison to the wild-type Receptor Binding Domain (RBD), the binding capacity of these vaccine sera was significantly decreased on the B.1.351 and P.1 variants RBD but not decreased with respect to the B.1.1.7 RBD. Although all nursing home residents developed a humoral response following Comirnaty vaccine, its intensity appeared to depend on the pre-vaccination serological status., Conclusion: Our results raise the question of how many doses of vaccine should be administered in older and how long the protection will be effective., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: Elderly residents of nursing homes (NHs) and long-term care units (LTCUs) have been shown to have a high risk of mortality and morbidity in cases of SARS-CoV-2 infection. The objective of this study was to examine the kinetics of neutralizing antibodies (NAbs) directed against the SARS-CoV-2 virus in residents of the NH and LTCU units of our University Hospital who were identified with positive serology after the first epidemic outbreak., Materials and Methods: The participants included were sampled every three months for qualitative serological testing, as well as quantitative testing by neutralization tests using retroviral particles containing the S glycoprotein of SARS-CoV-2. Vaccination using the Comirnaty (Pfizer BNT162b2) vaccine begun before the last serological follow-up., Results: The median NAb titer in June 2020 was 80 [40; 60] versus 40 [40; 160] three months later, showing a statistically significant decline (p < 0.007), but remained stable between the three- and six-month timepoints (p = 0.867). By nine months after vaccination, we observed a significant difference between vaccinated residents known to have positive serology before vaccination (SERO+, Vacc+) and those vaccinated without having previously shown COVID-19 seroconversion (SERO-, Vacc+), the latter group showing similar titers to the SERO+, Vacc- participants (p=0.166). The median antibody titer in SERO+, Vacc+ patients increased 15-fold following vaccination., Discussion: Humoral immunity against SARS-CoV-2 appears to be persistent in elderly institutionalized patients, with a good post-vaccination response by residents who had already shown seroconversion but a notably diminished response by those who were seronegative before vaccination. To evaluate immunity in its entirety and elaborate a sound vaccination strategy, the cellular immune response via T cells specific to SARS-CoV-2 merits analysis, as this response is susceptible to being affected by immunosenescence., Competing Interests: The authors declare no conflict of interest.

Introduction: Since December 2019, an emerging infectious viral disease triggered by SARS-CoV-2 has caused a global pandemic. Elderly people, being more fragile, are the most affected by the severity and lethality of this disease. The residential care facility for dependent elderly people (Ehpad) and the long-term care facilities at the Amiens University Hospital registered their first COVID-19 cases in February 2020, which lead to the opening of a dedicated COVID-19 unit and aspecific protocol for isolation., Methods: This descriptive study analysed the prevalence of COVID-19 seroconversion within the Ehpad and the long-term care facilities at the Amiens University Hospital. Both this screening test and the nasopharyngeal swab PCRs were used to assess the impact of the COVID-19 epidemic on the residents of the Ehpad and the long-term care facilities., Results: On 15 and 16 June 2020, the serological tests for COVID-19 were positive for 146 (66.1%) of the residents tested. The seroconversion rate was significantly different (p < 0.001) between the Ehpad (88.7%) and the long-term care facility (45.6%)., Discussion: During the epidemic, there was no excess mortality index within the Ehpad and the long-term care facility services of the Amiens University Hospital. Among frail patients, the role of immunosenescence can be evoked to account for the absence of this inflammatory reaction. This study showed that isolating the infected patient in a dedicated unit significantly reduces the risk of seroconversion and contamination compared to isolating them within their own unit.

Background: Studies suggest that transepithelial photorefractive keratectomy (TransPRK) with the all-surface laser ablation (ASLA)-SCHWIND platform is effective and safe for both low-moderate myopia and high myopia. In most studies, mitomycin-C is administered immediately after surgery to prevent corneal opacification (haze), which is a significant complication of photorefractive keratectomy in general. However, there is evidence that adjuvant mitomycin-C induces endothelial cytotoxicity. Moreover, a recent study showed that omitting adjuvant mitomycin-C did not increase haze in low-moderate myopia. The present case-series study examined the efficacy, safety, and haze rates of eyes with high myopia that underwent ASLA-SCHWIND TransPRK without adjuvant mitomycin-C., Methods: All consecutive eyes with high myopia (≤-6 D) that were treated in 2018-2020 with the SCHWIND Amaris 500E® TransPRK excimer laser without adjuvant mitomycin-C in a tertiary-care hospital (France) and were followed up for 6 months were identified. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and spherical equivalent (SE) were recorded before and after surgery. Postoperative haze was graded using the 4-grade Fantes scale. Efficacy rate (frequency of eyes with 6-month UCVA ≤0.1 logMAR), safety rate (frequency of eyes that lost <2 BSCVA lines), predictability (frequency of eyes with 6-month SE equal to target SE±0.5 D), efficacy index (mean UCVA at 6 months/preoperative BSCVA), and safety index (BSCVA at 6 months/preoperative BSCVA) were computed., Results: Sixty-nine eyes (38 patients) were included. Mean preoperative and 6-month SE were -7.44 and -0.05 D, respectively. Mean 6-month UCVA and BSCVA were 0.00 and -0.02 logMAR, respectively. Efficacy rate and index were 95.7% and 1.08, respectively. Safety rate and index were 95.7% and 1.13, respectively. Predictability was 85.5%. Grade 3-4 haze never arose. At 6 months, the haze rate was zero., Conclusions: ASLA-SCHWIND TransPRK without mitomycin-C appears to be safe as well as effective and accurate for high myopia., Competing Interests: The authors have declared that no competing interests exist.

Background: The prescription of ceftriaxone should be limited to patients with biliary tract infections and those lacking intravenous access. A specific training session for prescribers about the clinical relevance and economic value of prescribing cefotaxime instead of ceftriaxone might decrease the use of the latter in geriatric medicine., Objectives: To determine the clinical and economic impact of a training session for prescribers on the subsequent prescription of third-generation cephalosporin, that is, the percentage of appropriate prescriptions and the cost of third-generation cephalosporin administration before and after the training session., Methods: In a preliminary observational quasi-experimental, open-label study, appropriateness of cefotaxime and ceftriaxone prescription over a 4-week period immediately before the training session were compared with those during a 4-week period immediately afterwards., Key Findings: For 46 patients (29 before the training session and 17 afterwards), the proportion of cefotaxime prescriptions increased (from 3% to 35%; P = 0.007), and the proportion of appropriate prescriptions increased at the start of treatment (from 45% to 76%; P = 0.064) and at the end (from 76% to 88%; P = 0.450). The daily per-patient cost of treatment was €8 for cefotaxime and from €1.63 to €3.42 for ceftriaxone, depending on the administration route., Conclusions: A training session for prescribers was associated with a decrease in ceftriaxone prescriptions encouraging further studies to improve the training session and then evaluate medico-economic impact through randomized clinical trials., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background and Purpose: Travel therapy can reduce anxiety symptoms in elderly adults with cognitive disorders. The objective of this pilot study was to evaluate the use of a rail-travel simulator in this purpose., Materials and Methods: The study was a prospective, single centre cohort survey. Our study population consisted of persons either from the nursing home, the cognitive and behavioural unit or the day-care centre of our university hospital. Participants were accompanied on a virtual trip using a film projection in a replica of train compartment. Participants were interviewed before and after each session using a short questionnaire developed by a multi-disciplinary team., Results: Forty-two participants performed sessions. While only 58.3% of the participants reported being relaxed before the session, this rate increased significantly to 87.5% by the end of the trip. A majority of participants gave their personal impressions and half of the group reported memories evoked by the experience., Conclusion: The majority of elderly persons who completed the virtual trip replied positively about the experience. We need now to confirm the efficacy of our simulator using a randomised controlled trial., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To analyze the impact of the number of hospital readmissions on the risks of further hospital readmission and death after adjustment for a range of risk factors., Methods: We performed a multicentre prospective study of the DAMAGE cohort in the Hauts-de-France region of France. Patients aged 75 and over hospitalized initially in an acute geriatric unit (AGU) were included and followed up for 12 months. The risk of hospital readmission was analyzed using a Cox model, and its extension for recurrent events and the risk of death were analyzed using a Cox model for time-dependent variables., Results: A total of 3081 patients were included (mean (SD) age: 86.4 (5.5)). In the multivariate analysis, the relative risk (95% confidence interval [CI]) of hospital readmission rose progressively to 2.66 (1.44; 5.14), and the risk of death rose to 2.01 (1.23; 3.32) after five hospital admissions, relative to a patient with no hospital readmissions. The number of hospital readmissions during the follow-up period was the primary risk factor and the best predictor of the risk of hospital readmission and the risk of death., Conclusion: Hospital readmission is the primary risk factor for further hospital readmissions and for death in older subjects discharged from an AGU., Competing Interests: Professor Jean-Baptiste Beuscart reports grants from French government’s inter-regional hospital-based clinical research programme, during the conduct of the study. The authors report no other conflicts of interest in this work., (© 2021 Visade et al.)

Since December 2019, an emerging infectious viral disease implicating a coronavirus SARS-CoV-2 has caused a global pandemic. Elderly people, being more fragile, are the most affected by the severity and lethality of this disease. The NH and LTCU of the Amiens University Hospital registered their first Covid-19 cases in February 2020, which lead to the opening of a Covid-19 dedicated unit and of specific protocol for confinement. This descriptive study was analyzing the prevalence of Covid-19 seroconversion within the NH and the LTCU of the Amiens University Hospital. Both this screening test and the nasopharyngeal swab PCRs were in order to assess the impact of the Covid-19 epidemic in NH and LTCU. On June 15th and 16th, the serological tests for Covid-19 were positive for 146 (66.1%) of the residents tested. The seroconversion rate was significantly different (p < 0.001) between the NH (88.7%) and the LTCU (45.6%). During the epidemic, there was no excess mortality index within the NH and LTCU services of the Amiens University Hospital. Among frail patients, the role of immunosenescence can be discussed to account for the absence of this inflammatory reaction. This study showed that isolating the infected patient in a dedicated unit significantly reduces the risk of seroconversion and contamination compared to isolating them within their own unit.

The COVID-19 epidemic that started in November in China became a national epidemic from March 16, 2020 with the declaration of population containment in order to reduce the spread of the virus in France. From March 17 to March 27, 2020, the monitoring unit of the French society of geriatrics and gerontology decided to conduct a survey to analyze the implementation of the mobilization of geriatric units, given that this epidemic had shown that it resulted in excess mortality mainly among the elderly. The survey was able to bring together the response of 34 services, nine of which were located in a high epidemic cluster zone. Dedicated acute geriatric units for patients infected with COVID-19 were present in eight facilities, only outside the cluster zones. Nine geriatric follow-up and rehabilitation services were dedicated, an additional telemedicine activity concerned 35% of the facilities, and family listening and tablet communication facilities concerned 36% of the facilities. This survey is a snapshot of an initial moment in the epidemic. It provides an opportunity to describe the context in which this epidemic occurred in terms of geriatric policy, and to assess the responsiveness and inventiveness of these services in meeting the needs of the elderly.

Purpose: To describe the evolution of best spectacle-corrected visual acuity (BSCVA) after Descemet stripping automated endothelial keratoplasty (DSAEK) for very advanced pseudophakic bullous keratopathy (PBK) and to determine whether the thickness of corneal grafts in DSAEK surgery for advanced PBK correlates with BSCVA 6 months postoperatively., Methods: In a prospective, single-center, observational study, 141 eyes treated with DSAEK surgery were studied, from patients requiring posterior lamellar transplantation for advanced PBK. Graft thickness was measured during the surgery and in vivo 6 months later. The primary end point was BSCVA in LogMAR at 6 months., Results: BSCVA 6 months after surgery was slightly correlated with 6 months graft thickness (r = 0.24, P = 0.01), but not with preoperative graft thickness (r = 0.01, P = 0.93). After adjusting for preoperative BSCVA, a better 6 months BSCVA was best associated with thinner grafts at 6 months (P < 0.01), but not with preoperative graft thickness (P = 0.80)., Conclusions: BSCVA after DSAEK was significantly related to graft thickness measured 6 months after surgery, suggesting that better BSCVA after DSAEK is related to a decrease in graft thickness after surgery and not to the use of a thinner graft during surgery. This decrease may be because of the good health of the endothelium, but this result may be biased because of the intrastromal scars inherent in severe PBK. This study shows that DSAEK is a good option for advanced PBK but has low visual acuity potential recovery because of stromal scarring. Therefore, a penetrating keratoplasty may be indicated to obtain maximal recovery of visual acuity or for monocular patients.

Purpose: The aim of this study was to evaluate the possibly protective link of smoking in keratoconic patients treated with accelerated cross-linking., Methods: A telephone survey was conducted among 80 KC patients treated by accelerated cross-linking (A-CXL). The questions focused on general history, possible atopy and smoking habits. Results were compared to those of the general population by indirect standardization by age and sex according to the French national INPES survey., Results: Sixty-two patients with KC were analyzed. The mean age at diagnosis was 22 years (SD 5). The mean age at which A-CXL was performed was 23 years (SD 6). Daily smokers represented 19 %, occasional smokers 8 %, ex-smokers 21 % and non-smokers 52 %. The mean age at which the patients began smoking was 17 (SD 2) years. Ex-smokers quit at a mean age of 24 (SD 4) years. The observed rates and expected rates of daily smokers were 19 % and 39 % respectively at the time of the survey (P=0.01), 24 % and 35 % at the time of the A-CXL treatment (P=0.10) and 31 % and 35 % at the time of diagnosis (P=0.58). The decrease in the rate of observed daily smokers over time was significant (P=0.02)., Discussion: Our data does not appear to suggest a significant protective effect of smoking on the occurrence of KC. It shows a lesser proportion of smokers in KC patients after A-CXL, but this difference did not exist at the time of KC diagnosis., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: While there is a general consensus of the impact of an orthogeriatric organisation in terms of elderly patient mortality post hip fracture, it is unclear which, among these various care models, is the most optimal., Methods: A systematic review of the literature was undertaken using the keywords "Femoral fractures or total hip replacements or Accidental, falls" and "Aged, 80 and over" and "Mortality". The review is presented following PRISMA guidance., Results: Eighteen studies were identified, published between 1988 and 2015. The number of elderly subjects participating in these studies was between 37 and 951; their mean age was 82.6 ± 7.4 years, and average mortality in these studies was 17.7%. The odds ratio (OR) and 95% CI for association between implementation of the orthogeriatric model and mortality in all patients studied were 0.85 (0.74-0.97). In the analysis by subgroup on the type of orthogeriatric model, the group "Orthogeriatric ward" gave homogenous results, with ORs and 95% CIs of 0.62 (0.48-0.80) unlike other models: "Shared care by orthopaedists and geriatricians "and "Geriatric advice in orthopaedic ward"., Conclusions: Elderly patients with hip fracture admitted early into any sort of orthogeriatric models or more specifically to a dedicated orthogeriatric ward had reduced long-term mortality. This study has to be completed by RCT showing the efficacy of orthogeriatric ward compared to other models using outcomes such as quality of life or functional recovery.

What Is Known and Objective: Behavioural disorders are difficult to manage in elderly demented patients because of the lack of appropriate drugs or difficulties surrounding the route of administration. The tolerability of Midazolam is well described in the emergency management of agitation for young patients, when administered intramuscularly or intravenously. However, very little data are available on the use of oral Midazolam for this indication and in the elderly population., Methods: A literature review was conducted, and studies were included if involving adults, receiving Midazolam, alone or in combination, whatever the route, dosage or indication and if they reported adverse events related to the use of Midazolam., Results and Discussion: Forty-one articles were included. Eleven different adverse events were identified from the studies. Hypotension and desaturation were the two most frequent adverse events reported. Adverse reactions appear to be more common in older patients but also when Midazolam was used in combination with other drugs. The frequency of these adverse effects was lower than those reported for neuroleptic drugs., What Is New and Conclusion: The oral route appears to be appropriate to provide a rapid and well-tolerated response. Further studies will be needed to confirm the good tolerance of oral Midazolam in the management of acute agitation in elderly demented patients., (© 2019 John Wiley & Sons Ltd.)

Background: 'Personal Emergency Response Systems' (PERS) can provide a solution for raising the alert after a fall but no criteria are available to enable us to estimate whether a population which is set to benefit from a PERS will be able to use the device., Objective: To describe the profile differences of purchasers and non-purchasers of a PERS and to explore the population of users and non-users of these devices., Methods: The study was part of an observational cohort survey of elderly fallers which took place in the emergency department of our University urban hospital., Results: 413 patients were included. 115 of them were purchasers of a PERS, presented a lower index of independence in daily activities, greater fall history and a tendency to live alone. Only 18 purchasers used their PERS to alert and they were significantly more likely to live alone, showed a trend to be younger and less demented. This subgroup spent less time on the ground and with a lower 6-months mortality., Conclusions: The subjects who had and had not purchased a PERS presented no significant differences in terms of time on the ground or consequences. However it was more relevant to focus on the users and non-users of those PERS to isolate a frailer population. Indeed the consequences of falls were more devastating in the group of purchasers who had not used their device to alert. This group may benefit the most from new generations of PERS which do not require control by the subject., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To test the hypothesis that post-traumatic stress disorder (PTSD) can appear after a fall and try to identify predictive factors for its development in older fallers., Methods: Systematic literature review and meta-analyses of studies on PTSD post fall in older subjects., Results: One hundred seventy-seven indexed articles were identified, of which three had complete data on PTSD post fall in older subjects. Only the odds ratio of the association between history of fall and occurrence of PTSD was significant (odds ratio = 2.79 (95% CI, 1.03-7.53)., Conclusion: The trend in our results, even though limited, reveals two groups of subjects: frail subjects that are at risk of developing PTSD and subjects who seem to be resistant to its development. A clear description of these two groups may help us identify the population at risk for delayed PTSD who could then benefit from dedicated treatment. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

Objective: To investigate the relationship between the response to influenza vaccination and the ability to produce proinflamatory cytokines in elderly subjects., Methods: Whole blood samples from 25 elderly subjects collected before influenza vaccination were stimulated with the influenza vaccine in order to evaluate the secretion of five specific cytokines: TNFα, IFNα, IFNγ, IL2 and IL10. The results were correlated with the increased HAI antibody titres two weeks after vaccination., Results: Only 30% of elderly individuals seroconverted after vaccination. Although 50 to 70% of the cohort did not produce TNFα, IFNα, IFNγ, IL2 or IL10, all of the individuals who seroconverted were able to produce TNFα. Furthermore production of IFNγ, with or without production of IFNα/β, was not associated with a better response to the vaccine., Conclusion: Production of TNFα appears to be primordial for an efficient vaccine response, and may provide a predictive marker for the humoral response to vaccination. It may also provide the basis for evaluating agents designed to rescue TNFα-producing cells. This study emphasises a need to rescue TNF-producing cell function.

Background: A fall in elderly subjects can lead to serious psychological consequences. These symptoms can develop into Fear of Falling with behavioural disorders comparable to PTSD that may severely limit autonomy. Virtual reality training (VRT) could be seen as a worthwhile therapeutic approach for this syndrome since it has been shown to be a useful tool for motor rehabilitation or combat-related PTSD. We thus developed a training scenario for VRT with psychomotor therapists., Objective: To test the feasibility and acceptability of VRT when used by elderly adults for fall rehabilitation., Methods: Our population of 8 patients older than 75 years, with a Mini Mental Score Examination greater than 18/30 performed sessions of VRT and answered a questionnaire on the feasibility and acceptability of it., Results: This sample showed a highly favourable response to the prototype of VRT. They found it easy to use, enjoyed the experience, and thought it realistic and helpful., Conclusion: The conclusions of our study are limited by sample size. However, applications with VRT can offer the potential of an acceptable technique for elderly subjects. The next step will be to show the efficacy of this method in the management of post-fall PTSD.

A geriatric mobile team was created in the emergency department of Cochin Hospital in Paris, in 2005. This key player in the multi-disciplinary management of elderly patients in the emergency department and in the geriatric care pathway, showed, during its 10-year of existence, its utility., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

There are a number of causes of falls in the elderly. The psychological trauma following a fall can be significant and require early care management. There are multidisciplinary prevention strategies which must be adapted to each case., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Improving care and health course for hospitalized elderly patients is one of the tasks set out in the "Rapport du parcours de santé des PAERPA" (elderly people with or at risk of functional decline). Identification of the needs of a mobile geriatric team (MGT) intervention for the patients remain difficult in emergency department and in medical surgical units. A screening tool is needed and should be simple and fast to use. Its implementation implies that it is efficient and previously validated. The aim of our study was to evaluate the validity and predictive performances of the Triage risk stratification tool (TRST) for identify patients aged over 75 years, requiring the intervention of the MGT. This is a prospective, national, multicenter study including consecutive patients aged 75 years and older, hospitalized in emergency services and medical-surgical units in September and October 2013. The TRST was considered positive when the score was greater than 2 of 5 points. A supplementary question with binary answer (yes/no) was asked to MGT, in order to define if MGT intervention was useful. This issue has served as a "gold standard" for assessing the validity and predictive test performance. In emergency departments, the TRST was performed in 427 patients, 347 were positive. Results showed high sensitivity (79%), and poor specificity (19%) of the test in emergency units, showing that TRST did not permit to identify patients requiring MGT intervention. In contrast, the TRST seems more performant in medical-surgical (n=63 patients) units with good predictive performances (positive predictive value 90% and negative predictive value 87%). The specificity of TRST in emergency services is insufficient to generalize its use. However, performances of the TRST in other units are encouraging to propose a validation as part of a national research project.

Background and Objectives: Elderly subjects are still poorly represented in clinical trials, because of unjustified upper age limits. The prejudged reluctance of elderly patients to participate in trials could also be a barrier to their inclusion. The objective of this pilot study was to clarify the position of elderly subjects on their motivations and the reasons for their ultimate refusal to participate in clinical trials., Method: A questionnaire survey was administered to 150 elderly subjects, aged 70 years or over, living at home, in long-term care units, or hospitalized., Results: Only 44 % of the sample population answered that they would agree to participate in a trial that afforded personal benefit. These results did not depend on age but rather on health condition and sex. Motivations were mostly altruistic rather than based on personal concerns. The main reasons for refusal were fear that the experiment could damage their health and that they thought they were too old., Conclusion: Elderly subjects are not inclined to participate in clinical trials. In the future, we should aim to increase the information on clinical trials for older patients and train researchers appropriately if we wish to increase the participation levels of this age group in such trials. More research is needed on a larger sample.