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Giant cell arteritis (GCA) or Horton’s disease is a segmental and focal inflammation of large and medium-sized arteries mostly seen in patients of 50 years and older. There is also a peak frequency in individuals between the ages of 70 and 80. However, clinical data is scarce in this age group and especially in patients over 80.A retrospective study comprised of patients diagnosed with Horton’s arteritis between 2012 and 2017, according to the American Society of Rheumatology, was conducted at Reims University Hospital. Patients were assigned to two groups according to age (≤ 75 and75) in order to evaluate and compare the impact of age on diagnosis, treatment and prognosis.A total of 67 patients were studied. The mean age upon diagnosis was 75,85 ±8.5 years; 36 patients (53.7%) 75 years or younger and 31 patients older than 75. There was a female predominance (43 patients), 22 patients aged 75 years or younger and 21 older than 75. The mean follow up duration was 43.02 months in patients aged 75 years or younger and 30.99 in patients older than 75. This represents a difference of more than one year in terms of follow up, but is not statistically significant (p = 0.620). Eleven patients (16.4%) died during follow up: 5 patients (13.9%) aged 75 years or younger and 6 patients (19.4%) older than 75 (p = 0.547). Aortitis was significantly less seen in patients older than 75 (p = 0.0410).Our study showed no significant difference in either age group. However, aortitis was less seen in patients older than 75 years. Patients aged 75 or younger seemed more prone to relapses, but their follow up periods were shorter.L’artérite à cellules géantes (ACG) ou maladie de Horton est une artérite inflammatoire segmentaire et focale des artères de gros et moyen calibre du sujet de plus de 50 ans, avec un pic de fréquence chez le sujet très âgé entre 70 et 80 ans. Dans cette classe d’âge et au-delà de 80 ans, les données cliniques concernant l’AGC sont peu nombreuses. Notre objectif est de documenter ces dernières à travers une étude monocentrique menée sur une population avec une AGC avérée.Nous avons mené une étude rétrospective, monocentrique sur les dossiers médicaux de patients diagnostiqués artérite de Horton selon les critères de l’ASR entre 2012 et 2017 au CHU de Reims. Pour évaluer l’influence de l’âge sur le plan diagnostic, thérapeutique, du suivi et du pronostic, nous avons comparé des patients de 75 ans et moins (≤ 75 ans) à ceux de plus de 75 ans (75 ans) sur ces différents points.Soixante-sept patients ont été inclus. L’âge moyen au diagnostic de ces patients était de 75,85 ± 8,5 ans ; 36 patients (53,7 %) étaient âgés de 75 ans ou moins (dont 22 femmes) et 31 patients (46,3 %) étaient âgés de plus de 75 ans (dont 21 femmes). La médiane de suivi était de 43,02 mois chez les patients ≤ 75 ans et de 30,99 mois chez les75 ans, soit près d’un an de différence, mais non significative (p = 0,620). Onze patients (16,4 %) étaient décédés au cours du suivi, 5 (13,9 %) chez les patients ≤ 75 ans et 6 (19,4 %) chez les patients de75 ans (p = 0,547). Les patients75 ans avaient significativement moins d’aortite (p = 0,0410). Il y avait une tendance à moins de rechute chez les patients de75 ans (p = 0,067). Pour les autres symptômes ou anomalies biologiques, les résultats de la biopsie d’artère temporale, la prise en charge thérapeutique, les complications iatrogènes et les décès, aucune différence significative n’était mise en évidence entre les deux groupes (p = ns).Notre étude montre peu de différence en ce qui concerne l’AGC entre les patients75 ans et ceux ≤ 75 ans. Toutefois, les patients75 ans ont moins d’aortite que les sujets plus jeunes. Il semble également y avoir une tendance à davantage de rechute chez les sujets les plus jeunes, sous réserve d’une durée de suivi plus courte d’un an, cliniquement pertinente, chez les sujets les plus âgés.

Physical activity and its performance in the elderly remain a major problem. Numerous studies have shown physical and psychological benefits on quality of life and mortality. Maintaining regular physical activity is a key to maintain the functional abilities necessary for activities of daily living and preserve the quality of life of the elderly.

Type 2 diabetes in the elderly remains a major concern for all healthcare professionals, this disease being considered a real global «pandemic». Its prevalence is high and will continue to increase in the years to come, becoming significant in the elderly and the very old. We offer you a general summary and a focus on diabetes in the elderly with the GERODIAB study.Le diabète de type 2 chez le sujet âgé reste une préoccupation majeure pour l’ensemble des professionnels de santé, cette maladie étant elle-même considérée comme une réelle «pandémie» mondiale. Sa prévalence est élevée et continuera de s’accroître dans les années à venir, devenant prégnante chez le sujet âgé et très âgé. Nous proposons ici une synthèse générale et un focus sur le diabète du sujet âgé avec l’étude GERODIAB.

The frailty syndrome is a dynamic and evolving geriatric concept, involving many dimensions of everyday life and leading to a risk of developing a loss of daily life and autonomy. Although there is no consensual definition, the consequences remain major : risk of functional decompensation, multiplication of hospitalizations, dependence in the activities of the daily life, institutionalization and increase of the mortality.La fragilité de la personne âgée est un concept gériatrique dynamique et évolutif, impliquant de nombreuses dimensions de la vie courante et entraînant un risque de développer une perte d’autonomie. Bien qu’il n’y ait pas de définition consensuelle, les conséquences restent majeures : risque de décompensation fonctionnelle, multiplication des hospitalisations, dépendance dans les actes de la vie quotidienne, institutionnalisation et hausse de la mortalité.

We presented a case of a 73-year-old woman presenting to the emergency department with a spinal cord compression secondary to a T2 mass lesion and needing emergency surgery. The lesion was consistent with a papillary thyroid carcinoma. The patient had a previous history of thyroidectomy in a setting of a multinodular goiter 6 years before. A rereading of the previous anatomopathological thyroid tissue confirmed the presence of a papillary thyroid carcinoma that was initially misdiagnosed.Nous présentons le cas clinique d’une femme âgée de 73 ans se présentant au service des Urgences avec une compression de la moelle épinière secondaire à une lésion de masse au niveau de la vertèbre T2 et nécessitant une intervention chirurgicale d’urgence. La lésion est compatible avec un carcinome papillaire de la thyroïde. La patiente avait bénéficié d’une thyroïdectomie dans un contexte de goitre multinodulaire 6 ans auparavant. Une relecture de la pièce anatomopathologique confirme la présence d’un carcinome papillaire de la thyroïde non diagnostiqué au départ.

Screening and management of frail elderly patients is essential in general practice.This study aims to describe and evaluate the knowledge about frailty, its screening tests and management in a population of general practice interns.A prospective, descriptive and mono-centric study using an online survey was conducted. The 2018's promotion of general practice interns in Rouen's University participated. Evaluation of the general knowledge (e.g diagnostic criteria) and specific knowledge (e.g ranking different conditions such as: undernourishment leading to asthenia) and management algorithm (e.g to address the patient for geriatric evaluation) Results: 90 questionnaires were analyzed. Ten interns (11%) stated to know at least one screening test or to know a set of 4 major frailty criteria. Thirty four interns knew at least 4 frailty criteria (major or minor) and 46 interns had partial knowledge. Fried's phenotype was the most known. Seventy-five interns (83%) stated to know the frailty syndrome. However, 88% of the interns had little knowledge about its pathophysiology. Concerning frailty management, 78% (70 interns) stated to know how to screen frailty and prescribe first line treatments. Thirty-one among them knew how to reassess initial treatment if failure. In 59 interns (65%), identifying frailty would have led to a geriatric consultation. Seventy-nine interns (87%) were favorable to go through further training on frailty.These general practice interns were able to identify frailty criterion but, in contrast, global understanding of the syndrome was missing. Further training about this topic seems to be necessary.

The elderly population is growing in our societies. Prevention policies are strongly supported by public authorities and one of them is the promotion of physical activity. We propose to detail, through a literature review, the impact of physical activity on the main geriatric criteria.La population âgée est en augmentation croissante dans nos sociétés. Les politiques de prévention sont fortement soutenues par les pouvoirs publics et l’une d’entre elles est la promotion de l’activité physique. Nous détaillons, au travers d’une revue de littérature, l’impact de l’activité physique sur les principaux critères gériatriques.

The thyroid gland is usually resistant to infections due to its anatomy. However, suppurative thyroiditis could be found in immunocompromised patients or those with previous thyroid diseases. We report a case of thyroid abscess secondary to Salmonella enteritidis infection in an immunocompetent patient. We were not able to establish the source of infection. Clinical improvement was achieved under antibiotic treatment without complications. Early diagnosis is important as thyroid abcess may be a life threatening condition.La thyroïde est une glande endocrine généralement résistante aux infections en raison de sa localisation et présentation anatomique. Cependant, une thyroïdite suppurée est susceptible de survenir chez des patients immunodéprimés ou ayant déjà présenté un dysfonctionnement thyroïdien. Nous rapportons un cas d’abcès thyroïdien consécutif à une infection à Salmonella enteritidis chez un patient immunocompétent. Nous n’avons pas pu établir la source de l’infection. Une amélioration clinique a été obtenue sous traitement antibiotique sans complications. Un diagnostic précoce est essentiel afin d’éviter toutes complications graves mettant en jeu le pronostic vital.

The objective of this study was to compare in general practice, patients aged 65 years and over: the MMSE, screening tools for cognitive disorder recommended by the HAS and the Codex.53 patients were included between June and October 2017 at La Charmille general practice in Limpiville in rural areas during an observational study. Patients over 65 years of age were included following a consultation with their general practitioner. The MMSE and the Codex were compared on their results, intrinsic variables, the time of handover. Geriatric comorbidity factors are compared between groups of patients "with" and "without" cognitive disorders detected.Of the 53 patients, 94% CI 95% [4.10; 20.25] had cognitive impairment, at an average age of 74.15 years. The predominance is female with 30 patients (57%). The passage time of the Codex is on average 1min 43s, significantly faster (p = 4,29*10Codex appears to be a rapid, reliable, reproducible cognitive impairment screening tool adapted to the general practice consultation format. An important axis to work, awareness, education of doctors at the university and continuing education on the screening and management of dementia syndromes and fragility.

The objective of the GER-e-TEC™ project is to provide a personalised medical follow-up of residents in nursing homes with the aid of a telemedicine intelligent platform. It will assist the nursing staff by automatically processing information obtained from sensors and questionnaires in order to give an early warning about high-risk situations. This telemedicine tool will enable health professionals to optimise residents' care.

Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatism in adults. The objective of our study was to analyze the clinical, biological and therapeutic characteristics in subjects over 60 years old.We performed a retrospective, monocentric, descriptive study on medical records consultations. The data collection concerned subjects over 60 years of age who had been diagnosed with "rheumatoid arthritis" in the rheumatology and internal medicine departments of CHU Reims over a period stretching from 2010 to 2015.Thirty-two patients were included in our study for this period. The mean age of diagnosis was 66.6 years, for a median age of 67.5 years (min: 60 years, max: 88 years). There were 22 female (69%) and 10 male (31%) patients, with a sex ratio H/F of 2.2. The mean duration of symptom progression before diagnosis was 33.2 months. What dominates our series is the inaugural involvement of the interphalangeal proximal, wrists, shoulders and metacarpophalangeal for the vast majority of cases. Oral corticosteroids were used in 27 patients and were the only treatment in 3 patients. Methotrexate (MTX) was introduced in 27 patients. Nine patients received biotherapy: it was tocilizumab (Roactemra®) for 5 patients, adalimumab (Humira®) for 2 patients, abatacept (Orencia®) for 2 patients, etanercept (Enbrel®) for 2 patients, golimumab (Simponi®) for 1 patient and infliximab (Remicade®) for one patient. In our series, 7 patients are over 75 years old at the time of diagnosis of RA.The rheumatoid arthritis of the elderly remains a common condition and constitutes a diagnostic and therapeutic challenge. Because of the co-morbidities, the clinician's perception of the patient's overall condition and the inaccuracies in the use of certain molecules in these patients, under-treatment may, on the contrary, weaken a patient whose remission will be postponed. This was not the case in our series, with a methodical use of methotrexate as well as effective dose biotherapies.

It is essential to carry it out in the emergency unit in order to improve the care of the elderly subject in a hospital setting. In this context, the role of nurse host organiser seems essential in order to optimize this care, reduce the duration of the hospital stay and anticipate possible risks of decompensation of geriatric syndromes.

The rheumatoid arthritis remains a common condition and constitutes a diagnostic and therapeutic challenge, especially in the elderly. Rheumatoid arthritis is known to be associated with increased mortality, including coronary and cerebrovascular atherosclerosis. A literature review is conducted on the role of rheumatoid arthritis as a cardiovascular risk factor.La polyarthrite rhumatoïde demeure une affection courante et constitue un défi diagnostique et thérapeutique, notamment chez le sujet âgé. Il est établi que la polyarthrite rhumatoïde est associée à une augmentation de la mortalité, notamment par athérosclérose coronaire et cérébrovasculaire. Une revue de littérature est réalisée sur le rôle de la polyarthrite rhumatoïde comme facteur de risque cardiovasculaire.

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The use of physical restraint with the elderly remains a much-debated topic. Its use remains criticised and is also something of a paradox given its practice in this kind of facilities. All health professionals may use it in their daily practice, in a wide variety of situations.

The objective of this study was to evaluate frailty by the use of the modified SEGA grid in a population aged 75 years and older. This cross-sectional study was carried out in Marne (Champagne Ardenne), including subjects aged 75 years or more, who can go to medical general practitioners consultation. Frailty was assessed by the modified SEGA tool. In total between May 02, 2016 and May 08, 2017, 64 patients were included, aged 80 years ± 3.87, with a majority of women (58 %). The mean frailty score was 6.3 ± 3.6, with an average time of 3 minutes 55 seconds ± 1.13. The SEGAm grid had a good discriminating capacity for age (p = 0.041), comorbidities (p = 0.016), MMS (p = 0.011), presence of home helpers (p = 2.9e-05). There was also good agreement between the obtained SEGAm score and the subjective opinion of the general practitioners with a Cohen Kappa score of 0.66. The modified SEGA grid proves to be a good tool for frailty screening for the general practitioners, allowing preventive strategies and a personalized care project to be set up for each patient.L’objectif de cette étude était d’évaluer la fragilité par la grille SEGA («Short Emergency Geriatric Assessment») modifiée sur une population de sujets âgés de 75 ans ou plus. Etude transversale réalisée dans la Marne (Champagne Ardenne), incluant des sujets âgés de 75 ans ou plus, pouvant se rendre en consultation. La fragilité a été évaluée par l’outil SEGA modifiée. Entre le 02 mai 2016 et le 08 mai 2017, 64 patients ont été inclus, âgés en moyenne de 80 ans ± 3,87, avec une majorité de femmes (58 %). Le score moyen de fragilité était de 6,3 ± 3,6, avec un temps moyen de réalisation de 3 minutes 55 secondes ± 1,13. La grille SEGAm avait une bonne capacité discriminante pour l’âge (p = 0,041), le niveau de comorbidités (p = 0,016), le MMS («Mini Mental State») (p = 0,011), la présence d’aides à domicile (p = 2,9e - 05). Il y avait également une bonne concordance entre le score SEGAm obtenu et l’avis subjectif du médecin traitant, avec un score Kappa de Cohen à 0,66. La grille SEGA modifiée se révèle être un bon outil de dépistage de la fragilité pour le médecin généraliste, permettant de mettre en place des stratégies préventives et un projet de soin personnalisé.

Frailty is a transient and reversible condition that can lead to significant morbidity and mortality and to the loss of autonomy. It is one of the key issues in public health and the prevention of addiction. Physical activity is often described as a protective factor against addiction and as a factor in limiting frailty. Our goal is to analyze the relationship between physical activity and frailty among the elderly METHODS: A cross-sectional observational study was carried out in three general practice clinics located in the French department of Eure. Patients aged 65 and over were included during a consultation with their GP. Dependent patients under the ADL scale were excluded. Level of physical activity was assessed by the Ricci and Gagnon questionnaire, which defines an active profile as a score≥18 points. Frailty was sought out by the Fried scale and the SEGA A grid. Multivariate analysis was performed to adjust frailty scores to age, gender, and level of physical activity.Out of the 70 patients included, 36 were active (51%) and 34 inactive (49%). They were predominantly female with 47 women (67%). Average age was 75.3years. Twelve patients were diagnosed as frail (17%) with the Fried scale and 24 (34%) with the SEGA A grid. Bivariate analysis revealed a greater frailty according to the Fried criteria in the inactive than in the active patients (mean for active patients 0.56 IC95 [0.31; 0.80], compared to 1.76 [1.21; 2.32] in the inactive patients, p0.0001). The difference in mean was likewise significant regarding the SEGA A score (6.42 IC95 [5.34, 7.49] in the active population, as opposed to 8.65 IC95 [7.15, 10.15] among the inactive, p=0.017). In multivariate analysis, the Fried scale was primarily influenced by age and ADL, while the SEGA score was impacted by female gender and level of physical activity.Physical activity seems to have a positive effect on frailty. It would be interesting to propose systematic screening for frailty in general medicine and to institute preventive measures, including physical activity. Initiatives encouraging and promoting seniors' physical activity should be strengthened.

At present, it is recognized that screening for frailty in the elderly is a major public health issue. Frailty screening in emergency unit is essential to optimize the management of elderly patients in hospital. Ideally, the role of a mobile geriatric team seems essential, taking over the frailty screening carried out in the emergency department, in order to optimize intra-hospital management and consequently reduce further intra-hospital visits and possible risks of decompensation of geriatric syndromes.A l’heure actuelle, il est acquis que le dépistage de la fragilité chez le sujet âgé est un enjeu majeur de santé publique. Le dépistage de la fragilité dès l’admission au service des Urgences est indispensable afin d’optimiser la prise en charge du sujet âgé en milieu hospitalier. Idéalement, le rôle d’une équipe mobile de gériatrie (EMG) nous paraît essentiel, prenant le relais du dépistage de la fragilité réalisé aux Urgences (Infirmière d’Accueil/Urgentistes). Cette approche permettrait d’optimiser au mieux la prise en charge intra-hospitalière du patient et de réduire, en conséquence, son passage intra-hospitalier et d’éventuels risques de décompensation de syndromes gériatriques.

The sleep apnoea syndrome (SAS) is a public health problem particularly due to its involvement in cardiovascular and metabolic disorders. The aim of this study was to investigate the epidemiological characteristics of the affected population in order to facilitate screening for SAS.The study was retrospective, monocentric and observational. It was undertaken at the Château-Thierry hospital from 01/01/2010 to 31/12/2014. Several epidemiological parameters were collected. Two groups were created according to the apnoea/hypopnoea index (AHI) and compared with the R software.In all, 629 patients were included and separated into two groups with a division at an AHI limit of 15/h: 425 sick patients (AHI15/h) and 204 healthy (AHI15/h). Differences in sex were observed (more sick men, P0.05), of age (sick patients were older P0.001), obesity (sick patients were on average 5kg heavier, P0.05) and of cardiovascular history (hypertension P0.05, coronary disease P0.05 and arhythmic heart disease P0.05). We found no difference using the Epworth scale, nor in benzodiazepine consumption or the presence of dementia.This study highlights several risk factors for sleep apnoea in this population but also shows that the Epworth scale is not a good screening tool.