Search

Clostridioides difficile infection (CDI) represents a significant challenge due to its increasing incidence, severity, and treatment difficulty. Effective management requires a multifactorial approach that includes preventive strategies, prudent antibiotic use, and adapted therapeutic options. Ongoing research and innovation offer promising prospects for improving ICD management, making vigilance and informed practices essential among healthcare professionals. Two main complications of ICD are pseudomembranous colitis (PMC) and toxic megacolon. PMC involves severe colonic inflammation due to C. difficile toxins, leading to pseudomembrane formation. Diagnosis relies on clinical criteria, microbiological tests, and endoscopy. Toxic Megacolon is characterized by severe colonic dilation and systemic toxicity, requiring immediate medical intervention. ICD diagnosis combines clinical signs and microbiological tests. These tests include toxin tests, GDH antigen detection, PCR for toxin genes, and stool culture. Imaging techniques assess colonic inflammation and complications. Combined diagnostic criteria from the American Gastroenterological Association (AGA) and European guidelines emphasize integrating clinical and laboratory findings for accurate diagnosis. ICD treatment involves stopping the implicated antibiotics and starting specific antimicrobial therapy. Common treatments include mainly fidaxomicin and oral vancomycin. Fecal microbiota transplantation (TMF) is recommended for recurrent cases unresponsive to standard treatments. Bezlotoxumab, an antibody targeting C. difficile toxin B, is used to prevent recurrence in high-risk adults. ICD poses a major challenge due to its increasing incidence, severity, and difficulty in treatment. A multifactorial approach involving rigorous preventive strategies, prudent antibiotic management, and adapted therapeutic options is essential for controlling the infection. Ongoing research and innovations in treatment offer promising prospects for improving patient management. Healthcare professionals must remain vigilant and informed to ensure effective practices in combating this infection and utilizing available resources optimally.

The prevalence of frailty determines the proportion of the population that will experience intercurrent events and dependency. The aim was to assess the prevalence and factors associated with frailty using the modified SEGA grid., Method: This was a cross-sectional descriptive study. The primary endpoint was frailty, assessed using the modified SEGA grid., Results: The prevalence of frail and very frail people was jointly estimated at 33%. In multivariate analysis, gender, lifestyle and marital status did not appear to be associated with frailty. However, the IAVL score was associated with frailty OR=0.21 (95% CI 0.06 to 0.68; p=0.009). EVS is also associated with frailty for mild pain OR= 12.12 (95% CI 2.49 to 59.08; p=0.007)., Conclusion: Our results independently show the association between IAVL and frailty, with a one-unit increase in IAVL score being less associated with frailty.

Frailty and quality of life are concepts that emerged in the second half of the 20th century. Frailty can be defined as a clinical syndrome of decreased physiological reserves and resistance against stressful events conferring high risk for adverse health outcomes, including loss of independence, falls, hospitalization, institutionalization and mortality. However, it is considered that frailty can potentially be prevented or treated with specific modalities. Quality of life has various definitions because of its subjective nature. The World Health Organisation defined quality of life as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”. The aim of this study is to review information regarding the potential association between frailty and quality of life in the elderly, and the effects of physical activity among different parameters of these phenomena. There are few studies that investigate links between frailty, quality of life and physical activity. However, results tend to show that physical aspects of frailty syndrome are inversely proportional to the quality of life in several of its dimensions. Furthermore, community-based exercise programs involving the elderly seem to improve the quality of life. Considering that physical activity can potentially have an impact on the quality of life among frail elderly and promote healthy aging, further research will be necessary to corroborate these results.

The "syndrome de glissement" is a French term used to describe end-of-life situations where the elderly person becomes adynamic and any therapeutic intervention seems ineffective until the patient dies. It is close to failure to thrive. Although its use, which is widespread, seems appropriate to briefly describe a complex situation, it has the major disadvantage of leading to an absence of clinical and therapeutic approach, which represents a loss of chance for the patient. In clinical practice, we consider that what is referred to as a sliding syndrome is actually a situation of apathy associated with a deterioration in general condition. A diagnostic approach should therefore look for all organic pathologies that associate deterioration in general condition and apathy, and neuropsychiatric situations such as episodes of major depression that produce such symptoms. Once these diagnoses have been ruled out, the person should be considered for palliative care and benefit from the expertise that goes with this practice. Any elderly person in a situation resembling what is known as a syndrome de glissement should therefore benefit from a rigorous clinical approach, and not be considered beyond any therapeutic resources. It is a matter of dignity and quality of care.

Old age is a time of emotional, social and physiological challenges. The role of the family remains essential in coping with these challenges. This is particularly true of non-cohabiting children, who in 2020 accounted for just under half of all those helping elderly people with loss of autonomy and/or pathologies. Following on from sociological research on close caregivers, this article first looks at the level and influence of children's relationships and assistance towards their elderly parents, and then proposes the construction of a territorial indicator - in this case, a score - to measure the spatial proximity and potential availability of children. Subject to further development, this indicator represents a first milestone in the territorial understanding of children's relationships with and help for their elderly parents.

Impairment of cognitive functions is the primary reason for admission to long-term care units, with executive functions playing a pivotal role in dependency and behavioral issues. These functions pose significant challenges to nursing staff in providing care. However, the assessment of executive functions in elderly individuals residing in nursing homes often relies on tests that are both time-consuming and difficult for this demographic. In many instances, executive functions are either not assessed or only examined in broad terms., Objective: The objective of this study was to analyze the feasibility of assessing executive functions in elderly nursing home residents, specifically aiming to distinguish sub-components such as mental flexibility, working memory, planning, and inhibition. The residents included in the study underwent executive function assessments over three visits, using various tests for each sub-component., Methods: Out of 530 residents, 46 gave their consent and 38 completed the three visits, with an average age of 90±5 years (76.2% women) and a median MMSE score of 20/30. Feasibility was evaluated based on the test being executed and the frequency of interruptions due to difficulty or fatigue on the part of the resident., Results: Only four tests proved suitable for elderly individuals in nursing homes, and we propose grouping them into a battery named SETE (Screening Executive Tests for Elderly): the conflicting instructions from the FAB, the alpha test, the clock test, and the verbal span test., Conclusion: The use of these four tests would enable the construction of a map delineating executive function impairment by sub-component. Enhanced knowledge of executive functions in long-term care residents will facilitate better adapted dependency management and the implementation of non-pharmacological interventions for behavioral disorders.

Visual disorders are often under-diagnosed and under-treated in older patients. The main objective was to evaluate the percentage of patients having an ophthalmological follow-up corresponding to the recommendations of the Syndicat national des ophtalmologistes de France (SNOF). This prospective observational multicentre study included all patients aged 65 years or older presenting to their general practitioner in two medical practices from May to October 2021. Of the 113 patients included, 86 (76,1 %) had adequate ophthalmological follow-up, 14 consulted an ophthalmologist, and a therapeutic decision was made for nine patients. Follow-up of patients was generally as recommended. Screening for visual disorders for patients with no recent follow-up was beneficial. This screening must be integrated into a global approach, as the Integrated Care for Older People (ICOPE) of the World Health Organization (WHO), in order to be more relevant and effective.

Background: Falls and fall-related injuries are a major public health problem in industrialized countries. Faced with this challenge, a French national plan was launched in 2022 aiming to reduce by 20% the incidence of falls-related hospitalizations or deaths., Objectives: To describe the main pillars of the 2022-2024 French national plan against falls in older persons. Methods and assessment: The six pillars of the plan are: 1) screening and monitoring risks of falls and alert health and care workers; 2) home safety assessment and getting out safely; 3) developing technical aids for mobility and the use of assistive technologies at home; 4) appropriate physical activity, best weapon against falls; 5) tele-assistance devices for all older persons; 6) a cross-cutting pillar: Informing, raising awareness, training, and involving local actors. The plan, deployed in the 18 French regions, will provide a unique opportunity to determine the best strategies to achieve the objectives and the barriers encountered., Conclusions: The deployment of the French national plan will bring useful data for considering a long-term strategy in France and helping countries or regions wishing to implement a fall prevention plan on their territory.

The publication of the decree on the care of people with neurocognitive disorders brought to the fore the Reisberg's Global Deterioration Scale, a scale that only few clinicians use in memory centers or in geriatric. This scale has a number of limitations, not least of which is that it is obsolete, since it does not take into account disease advances in scientific knowledge with biomarkers. Consequently, the stages evoked no longer correspond to current descriptions. Moreover, it only concerns Alzheimer's disease, whereas in our practice we encounter other neurodegenerative pathologies. Even if we decide to use another global assessment scale, such as the Clinical Dementia Rating or the Functional Assessment Staging, they cannot replace a personalized assessment. Indeed, it is important to stress that this decree does not take into account the relevance of personalized assessments using, for example, neuropsychological tests to estimate driving ability. A personalized assessment accompanied by a real-life driving test would be preferable than a score on a global scale. This article therefore presents the Global Deterioration Scale, highlighting its unsuitability for assessing whether or not to continue driving.

New ministerial decree restricts driving motorized vehicles for patients with Alzheimer's disease and related disorders. Reisberg stage 3, threshold used to contraindicate driving, appears to correspond to a mild stage of major neurocognitive impairment. A single scale gives an idea of the level of risk but does not provide a holistic assessment. The aim of this consensus is to put forward recommendations from several French learned societies for individualized cognitive assessments to minimize the risks associated with driving and its cessation. Fitness to drive should be raised at the earliest stages of the diagnostic process, and regularly throughout the follow-up. Consult a registered doctor is recommended to all patients wishing to continue driving. All documents must be given to the patient only. An alternative must always be offered to patients who are recommended a modal shift.

Objectives: To assess the knowledge and the use in clinical practice of the "French National Authority for Health" (HAS) 2021 recommendations on the diagnosis of malnutrition in older adults aged 70 years and above., Methods: An online survey was developed by the working Group on Geriatrics and Nutrition (GEGN) of the "Société Française de Gériatrie et de Gérontologie (SFGG)" and conducted among members of the SFGG. A self-administered questionnaire composed of 21 closed questions was used., Results: A total of 132 (10.2 %) members of the SFGG responded to the survey. The respondents were aged 43.4 ± 9.94 years old and 97 (73.5 %) were women. Almost half of them were medical doctors (n = 53 ; 40.2 %). Of the respondents, 81 % had already heard of the HAS 2021 recommendations. This percentage is higher for doctors (96 %) than for other professions (74 %). French respondents were more likely to have heard of these -recommendations (84 %) than respondents from other countries (42.9 %). However, only 41.6 % of the respondents believe they know these recommendations in detail. On a visual analogue scale from 0 (never) to 100 (always), respondents use these recommendations in their professional practice at 76.8 ± 20.2 %. However, on a scale from 0 (never difficult) to 100 (always difficult), some barriers to their use in clinical practice were highlighted. These mainly concerned the measurement of muscle mass (84.4 ± 17.2 %) and muscle strength (79.5 ± 19.9 %) in patients., Conclusion: Although the majority of respondents use the HAS 2021 recommendations in their professional practice, they often have difficulties in measuring muscle strength and muscle mass of their patients. The assessment of sarcopenia still needs to be implemented in clinical routine. Until then, better communication about simple alternatives that do not require special equipment is needed.

Background: Falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs., Objective: To synthesize evidence-based and expert consensus-based 2022 world guidelines for the management and prevention of falls in older adults. These recommendations consider a person-centred approach that includes the preferences of the patient, caregivers and other stakeholders, gaps in previous guidelines, recent developments in e-health and both local context and resources., Recommendations: All older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for communitydwelling older adults. An algorithm is proposed to stratify falls risk and interventions for persons at low, moderate or high risk. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations., Conclusions: The core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

Urinary incontinence is a major public health problem that affects nearly 9% of the world's population. Numerous studies have defined it, as well as its frequency, contributing factors, means of prevention and therapeutic approaches, but there are very few publications on its social representations. However, the literature raises that a better understanding of the social representations associated with this phenomenon could improve its management. This study focuses on its representations, and more specifically those of Internet users. Its ambition is to bring out some of the representations related to this phenomenon and thus provide initial factual and useful elements for the following research program. We conducted a webometric study and drew on Moliner's social representations theory. Using textual and iconographic data posted on the search engines and social networks most used by Internet users between January 1st, 2015 and October 15th, 2020, this research examined how urinary incontinence is perceived by English- and French-speaking Internet users. For quantitative data analysis, two textometric analysis software packages were used: Lexico® and Iramuteq®. For qualitative data, the analysis was carried out with ATLAS Ti® 9 software. Formerly hidden, urinary incontinence seems to be nowadays less and less a taboo subject and has been arousing growing interest for several years. However, this study also highlights the many preconceived ideas, false beliefs and the obvious lack of knowledge about this phenomenon. It also shows that urinary incontinence should not be trivialized nor the difficulty for the patients concerned to live with it. This study made it possible to understand the representations that a part of the population has on the phenomenon of urinary incontinence. It was the first of a larger research program which aims at improving the care of institutionalized elderly people suffering from urinary incontinence.

Neuropsychiatric disorders are one of the frequent complications of neurocognitive disease, and have an impact on the quality of life of patients and caregivers. Non-phamacologic interventions are recommended as first-line treatment. The Snoezelen method is a multisensory stimulation method based on the assumption that acting on sensoriality can improve neuropsychiatric symptoms and thus quality of life, but its level of evidence is controversial. To explore this, we performed a systematic literature review of randomized controlled articles focusing on the use of the Snoezelen method in patients with cognitive disorders. Eighteen studies were included. The clinical outcomes studied were multiple (behavior, mood, cognition, functional capacities and biomedical parameters). When the Snoezelen method was compared to the “standard activities” group, it appears to be effective on short-term behavior. This was more negligible when the method was compared to others non-pharmacological interventions. Although the Snoezelen method could be effective on mood, cognition, and functional abilities, its level of evidence remains low. Furthers mixed studies (quantitative and qualitative) would be an interesting approach to delve into this topic in the most holistic way by integrating the patients, the caregivers and the cost of the method.

Introduction: Few older people participate in medical research, especially in the nursing home setting. The lack of evidence in this population may limit our ability to provide evidence-based treatments. This can partly be explained by difficulties in obtaining a satisfactory adherence to research in this population, especially when the practice of a physical activity is needed. In this study data from the LEDEN trial (Effects of a Long-term Exercise Program on Functional Ability in People with Dementia Living in Nursing Homes: A Cluster Randomized Controlled Trial) was used to determine the predictors of adherence to the study protocol., Methods: Retrospective cohort study based on the data from the cluster randomized, controlled LEDEN trial. The LEDEN trial aimed to compare the effects of an exercise intervention with a nonphysical intervention on the ability to perform activities of daily living. Predictors of adherence (being present at ≥ 75% of sessions of the LEDEN trial) were identified by multivariable logistic regression., Results: By univariate analysis, the EVIBE scale (EValuation Immédiate du Bien-Être – evaluation of instantaneous well-being) measured at baseline was associated with study adherence, whereby higher scores were associated with higher adherence: 16.7% (1/6), 44.4% (4/9), 56.5% (13/23), 48.1% (13/27) and 75.0% (15/20) respectively for EVIBE scores from 1 to 5 (P = 0.02 for trend). By multi-variable analysis, an EVIBE scale score ≥ 4 did not predict clinical trial adherence (odds ratio [OR] 1.554, 95% confidence interval [CI] 0.619–3.942). Adherence was found to be lower among persons aged ≥ 95 years (OR: 0.121, 95%CI: 0.006–0.982)., Conclusion: Older age (≥ 95 years) was associated with lower adherence to the study protocol. Further studies are needed to better understand and anticipate obstacles to adherence in research, while respecting consent procedures and patient autonomy.

Résumé L'amylose cardiaque dite sénile, également dénommée « sauvage », était considérée comme une maladie rare. Actuellement, grâce à des moyens diagnostiques non invasifs et à partir d'études autopsiques, nous estimons la prévalence à environ 10 à 20 % des sujets de plus de 80 ans. De même, l'amylose était un diagnostic sans conséquence thérapeutique, mis à part le traitement de l'insuffisance cardiaque et des troubles de conduction. De nouveaux traitements permettent de stabiliser le tétramère de transthyrétine et de diminuer la production d'oligomères, sources des dépôts d'amylose, en cas de formes héréditaires et sauvage d'amylose à transthyrétine. Deux médicaments bloquant la production de transthyrétine (anti-sens et oligonucléotides) sont également en phase d'essais cliniques dans les amyloses cardiaques. Ainsi, le diagnostic et la prise en charge de l'amylose cardiaque deviennent des démarches diagnostiques de pratique clinique et doivent être connus des cardiologues, mais également des gériatres qui permettront une prise en charge précoce et donc plus efficace. Abstract So-called senile cardiac amyloidosis was considered rare. Nowadays, thanks to non-invasive diagnostic means and autopsy studies, we estimate the prevalence to be about 20% of subjects over 75 years of age. Similarly, amyloidosis was a diagnosis with no therapeutic consequences, apart from the treatment of heart failure and conduction disorders. New treatments make it possible to stabilise the transthyretin tetramer and to reduce the production of oligomers that are the source of amyloid deposits, by acting in a non-genetic way and therefore adapted to the "wild" transthyretin forms of so-called senile cardiac amyloidosis. Thus, the diagnosis and management of cardiac amyloidosis are becoming diagnostic procedures in clinical practice and must be known by cardiologists, but also by geriatricians, who will allow early and therefore more effective management.

Sarcopenia is defined as a progressive and generalised loss of muscle strength, muscle mass and physical performance with advancing age. Among the multiple consequences of sarcopenia, the reduction in the quality of life associated with it can undeniably be considered as a major consequence. Quality of life is measured via generic or specific questionnaires. Current research, mainly using so-called "generic" questionnaires, has identified a reduced quality of life in patients with primary age-related sarcopenia, mainly in areas related to functional status and physical performance. A specific quality of life questionnaire could, in combination with a generic questionnaire, provide more precise data on the impact that sarcopenia has on patient's quality of life. The first quality of life questionnaire specific to sarcopenia, the SarQoL ® , was developed in 2015. Psychometric validation of the SarQoL ® has been carried out in several international patient populations indicating excellent internal consistency, reliability and convergent validity and sensitivity to change, as well as an absence of floor and ceiling effects. In combination with a generic questionnaire, this specific questionnaire is therefore suitable for measuring the quality of life of populations suffering from sarcopenia, both in research and in clinical practice and in the context of both observational or interventional evaluations.

Frailty and quality of life are concepts that emerged in the second half of the 20 th century. Frailty can be defined as a clinical syndrome involving decreased physiological reserves and resistance against stressful events conferring a high risk of adverse health outcomes, including loss of independence, falls, hospitalisation, institutionalisation and mortality. However, it is considered that frailty can potentially be prevented or treated in specific ways. There are various definitions of "quality of life" due to its subjective nature. The World Health Organization defines quality of life as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns". The aim of this study is to review information regarding the potential association between frailty and quality of life in the elderly, and the effects of physical activity among the various parameters of these phenomena. Few studies investigate the links between frailty, quality of life and physical activity. However, results tend to show that the physical aspects of frailty syndrome are inversely proportional to several aspects of quality of life. Furthermore, community-based exercise programmes involving the elderly seem to improve their quality of life. Considering that physical activity can potentially have an impact on quality of life among frail elderly people and can promote healthy ageing, further research will be necessary to corroborate these results.

The French Society of Geriatrics and Gerontology (SFGG) stands against ageism and strives to combat it in all its forms. The SFGG has warned about the persistence of age discrimination and the emergence of new forms of ageism alongside traditional stereotypes. The SFGG took a position on the occasion of the 70 th anniversary of the Universal Declaration of Human Rights in December 2018. In September 2020, the SFGG again raised the alarm, on the 20 th anniversary of the inclusion of the Rights of the Elderly in the European Charter. It has organised a wide-reaching communication campaign against ageism, involving learned societies of geriatrics and gerontology as well as all the major international institutions working to defend the rights of older adults.

Glucose and sodium tubular reabsorption inhibitors, or gliflozins, are a new therapeutic class. Their novel mechanism of action involves inhibition of a glucose and Na+ reabsorption co-transporter in the renal proximal tubule. They reduce blood glucose levels by reducing renal glucose reabsorption. They therefore cause glycosuria, which constitutes an energy loss and ultimately leads to a weight loss of around 2 to 3 kg. They reduce sodium load and lower blood pressure. This class improves HbA1c by about 0.7%. Empagliflozin has been shown to reduce all-cause mortality in type 2 diabetic patients at high cardiovascular risk and to reduce episodes of cardiac decompensation and is nephroprotective in diabetic and non-diabetic subjects. Empagliflozin, like other gliflozins, does not induce hypoglycaemia as it does not directly stimulate insulin secretion. Due to the high prevalence of type 2 diabetes, heart failure and renal failure in the elderly, gliflozins will become part of geriatric prescriptions. Their advantages and use must be known, especially as their role will be extended to numerous indications in the field of chronic diseases.

Frailty in elderly people is frequent and places a person at increased risk of adverse outcomes, but it is potentially reversible. Easy and quick to complete, the Gérontopôle Frailty Screening Tool (GFST) has been designed for early diagnosis of frail elderly. The answer comes from the GP's impression in front of the patient, guided by six frailty characteristic parameters. The aim of this study was to determine the proportion of frail patients among the 75-and-older population, using the GFST. Quantitative cross-sectional observational study. A Chi 2 square test and a multivariate analysis have been performed. Twenty-six GPs have taken part in this study, enabling the collection of 191 tests: 42% [95% CI, 0,35-0.49] of surveyed patients are considered frail. Frailty is significantly associated with each of the GFST parameters, except "living alone". After adjusting on age, gender and other parameters, the factors most strongly associated with frailty are: difficulty with walking, memory complaint (P < 0.001) and age (P < 0.05). The prevalence observed is consistent with the literature data. Our results confirm the relationship between frailty and physical domain, and reaffirm the close interaction between frailty and cognitive domain.

Sarcopenia is defined as a progressive and generalized loss of muscle strength, muscle mass and physical performance with advancing age. Among the multiple consequences of sarcopenia, the reduction in the quality of life associated with it can undeniably be considered as a major consequence. Quality of life is measured via generic or specific questionnaires. Current research, mainly using so-called "generic" questionnaires, identifies a reduced quality of life in patients with primary age-related sarcopenia, mainly in areas related to functional status and physical performance. A specific quality of life questionnaire could, in combination with a generic questionnaire, provide more precise data on the impact that sarcopenia has on the quality of life of patients. It was in 2015 that the first quality of life questionnaire specific to sarcopenia, the SarQoL®, was developed. Psychometric validation of the SarQoL® has been carried out in several international patient populations indicating excellent internal consistency, reliability and convergent validity and sensitivity to change as well as an absence of floor and ceiling effects. In combination with a generic questionnaire, this specific questionnaire is therefore suitable for measuring the quality of life of populations suffering from sarcopenia, both in research and in clinical practice, both in the context of observational or interventional evaluations.

Discharge from hospital is a key moment in the care of patients over 75 years of age. The organisation of the transition from hospital to home by home help and care management networks can be effective. Our aim was to evaluate impact of a case management program on 30 days rehospitalisation rates. Retrospective study of the multicentre cohort type carried out on patients monitored by the MAIA of Aube between 2018 and 2020. The risk of re-hospitalisation was significantly lower at 30 days among MAIA patients (1.6% vs. 19.5%; p < 0.0001), as well as at 90 days (4.8 % vs. 35.8 %; p < 0.0001). On the other hand, lengths of stay were longer in this group (20.9 vs. 11 days; p = 0.005) and the patients consulted the emergency department more often (40.8 % vs. 17.1 %; p < 0.0001). We could not conclude on mortality and falls. A positive impact of the Aube MAIA scheme on early and late readmission to hospital was shown.

The SFGG (French Society of geriatrics and gerontology) stands up against ageism and fights it in all its forms of expression. The SFGG warns about the persistence of age discrimination and the emergence of new forms of ageism alongside traditional stereotypes. The SFGG has taken a position on the occasion of the 70th anniversary of the Universal Declaration of Human Rights in December 2018. In September 2020, the SFGG is again raising the alarm on the 20th anniversary of the inclusion of the Rights of the Elderly in the European Charter. It is organising a wide communication campaign against ageism, involving all the learned societies of geriatrics and gerontology as well as all the major international institutions that defend the rights of older adults.

The COVID-19 pandemic is particularly severe in older adults. Our objective was to identify, from international literature, the most common symptoms met in older adults infected with the SARS-CoV-2 virus. This systematic review of the literature was conducted using MEDLINE from December 1, 2019 to April 13, 2020. The analysis of methodological quality used a method dedicated to case series and case reports. Out of 260 articles initially identified, only two studies were finally included in the qualitative analysis. The mean age was relatively low, between 71 and 74 years on average. The symptoms of COVID-19 were as follows: fever, dry cough, dyspnea, asthenia, anorexia, chest tightness, diarrhea, and to a lesser extent myalgia, pharyngitis, nausea, dizziness, headache, abdominal pain and finally vomiting. Lymphopenia was found in the complete blood count. In conclusion, this systematic review of the international literature reveals a lack of data about the semiology of COVID-19 in older adults, especially in the frail oldest-old ones who commonly define the geriatric population. The national survey conducted by the French Society of Geriatrics and Gerontology will help fill this semiological gap.

The coronavirus disease-2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. The link between cardiovascular disease and COVID-19 appears to be twofold. First, some reports of data indicate that certain groups of patients are more at risk of COVID-19. This includes patients with cardiovascular risk factors or pre-existing cardiovascular conditions and older patients. In addition, these patients incur disproportionately worse outcome. Second, SARS-CoV2 infection can be complicated by life-threatening cardiovascular acute diseases. Despite the rapid evolution of data on this pandemic, this review aims to highlight the cardiovascular considerations related to COVID-19 whether as comorbidities including concerns and uncertainty regarding the effect of renin-angiotensin-aldosterone system (RAAS) inhibitors on angiotensin conversion enzyme 2 or related to acute cardiovascular complications.

The COVID-19 pandemic affects older adults particularly severely. Our objective was to identify from the international literature the symptoms most commonly experienced by older adults infected with SARS-CoV-2. This systematic literature review was conducted using MEDLINE between 1 December 2019 and 13 April 2020. The methodological quality analysis used a method dedicated to case series and case reports. Of the 260 articles initially identified, only two studies were ultimately included in the qualitative analysis. The mean age was relatively low, between 71 and 74 years on average. COVID-19 symptoms were as follows: fever, dry cough, dyspnoea, asthenia, anorexia, chest tightness, diarrhoea and, to a lesser extent, myalgia, pharyngitis, nausea, dizziness, headache, abdominal pain, and vomiting. Lymphopenia was noted from complete blood counts. In conclusion, this systematic review of the international literature reveals a lack of data about the semiology of COVID-19 in older adults, especially in very elderly frail people, who are normally considered to constitute the geriatric population. The national survey conducted by the Société Française de Gériatrie et Gérontologie will help bridge this semiological gap.

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.

Coronavirus disease 2019 (COVID-19) is a secondary infectious disease caused by severe acute respiratory syndrome coronavirus 2. The link between cardiovascular disease and COVID-19 appears to be twofold. First, some reports indicate that certain groups of patients are at greater risk of COVID-19, including patients with cardiovascular risk factors, pre-existing cardiovascular conditions and older patients. In addition, the outcomes these patients face are disproportionately more severe. Second, SARS-CoV-2 infection can be complicated by life-threatening acute cardiovascular diseases. Despite the rapid ongoing evolution of information about this pandemic, this review aims to highlight cardiovascular pathologies related to COVID-19 as either comorbidities, including concerns and uncertainty regarding the effect of renin-angiotensin-aldosterone system (RAAS) inhibitors on angiotensin conversion enzyme 2, or cardiovascular complications.

Potassium is involved in the voltage and excitability of the myocytes. Its homeostasis is dependent on dietary intake and its predominant renal elimination. The renin-angiotensin-aldosterone system regulates its elimination. Acute and chronic hyperkalemia is a risk factor for cardiac mortality. Chronic renal failure and heart failure are the major comorbidities. RAAS inhibitor therapies are the major iatrogenic factors in hyperkalemia. Approximately 90% of patients with hyperkalemia are over 50 years of age and 43% are over 75 years of age. Only 4.9% of hyperkalemias are managed with resin therapy. One-third of patients have 3 comorbidities, and 14% have 5 or more comorbidities. The main comorbidities are hypertension (74.0%), dyslipidemia (56.3%), renal failure (55.2%), diabetes (44.7%), coronary artery disease such as angina and myocardial infarction (23.3%) and heart failure (12%). It should be noted that 2/3 of the patients receiving resins were also receiving ARBSIs and tended to have more co-morbidities. Hyperkalemia is underestimated and requires strict monitoring in patients with renal failure or heart failure. Resins are not suitable for long-term adherence and new therapies such as patiromer would reduce the risk of hyperkalemia.