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With aging worldwide population and the high incidence of cancer in the population of people over 75 years old, there is a need for oncologists and geriatricians to strengthen their collaboration to improve elderly patients care. Complexity of cancer and aging issues must be considered simultaneously to establish a personalized care plan. Thus, the G8 is a screening tool that allows to identify patients who should benefit from a geriatric assessment, which is a key step in the management process. This specific evaluation offers a multidisciplinary approach to functional, psychological, nutritional, cognitive and social status and has demonstrated its prognostic value in terms of choice of treatment but also in terms of patient survival. In nearly 20% of cases, the geriatric assessment leads to a change in the choice of treatment, and at one year the initial care plan is not carried out in a quarter of cases. The presence of malnutrition and functional impairment leading to dependence on basic activities of daily living had a significant impact on this change in therapeutic choice. Survival is not only impacted by malnutrition and functional impairment but also by the presence of severe comorbidities and thymic and neurocognitive impairment. The patient's choice must remain at the center of the elaboration of the care plan with the oncologists and geriatricians in order to propose the most appropriate treatment for his or her situation., (Copyright © 2021 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Background: Urinary tract infections (UTI) are the second cause of community-acquired bacterial infections in the elderly. Distinguishing symptomatic UTI from asymptomatic bacteriuria is problematic, as older adults are less likely to present with localized urinary symptoms. We evaluated characteristics of patients presenting UTI among elderly with sepsis. Moreover, we aimed to evaluate the sensibility and specificity of urine dipstick tests in the diagnosis of UTI in geriatric population., Patients and Method: We led a prospective, monocentric, observational study between April 2017 and January 2018. We included patients hospitalized in geriatric wards, who were prescribed urine culture for UTI symptoms or/and infection without primary sites for which a urine culture was prescribed. Dipstick urinalyses were performed for all patients. Clinical and biological characteristics of all patients were compared according to the final diagnosis of UTI. Moreover, results of dipstick tests were evaluated for the diagnosis of UTI in this population., Results: Among 165 patients, 67 (40.6 %) had a UTI and 98 (59.4 %) had another diagnosis. These two groups were comparable for age and daily-living activities. In the UTI group, the proportion of women was higher than in the other group (P<0.05), and mean MMSE score was lower (P<0.05). Positive urine dipstick test for leukocytes and/or nitrites had high sensitivity (92 %), but low specificity (50 %). Negative predictive value of this test was high (91 %)., Conclusion: For suspicion of UTI among elderly, few criteria are specific. Negative dipstick tests can suggest an absence of UTI due to its high negative predictive value., (Copyright © 2019 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Background: Octogenarians are considered at high surgical risk for the treatment of abdominal aortic aneurysms (AAA). The laparoscopic aortic surgery (LAS) and the endovascular treatment (EVAR) are 2 minimum invasive techniques whose objective is to limit the operative traumatism. The objective of this study was to compare our results with short- and medium-term results with these 2 techniques in the octogenarians., Methods: Between January 2002 and December 2012, the data of 674 operated consecutive AAA (315 LAS, 172 EVAR, and 187 open surgeries) were collected prospectively. Eighty-seven patients aged ≥80 years presenting a favorable anatomy were treated by LAS or EVAR. Twenty-five patients aged ≥85 years with a favorable anatomy were excluded because we generally did not propose LAS to them. Statistical analysis compared the demographic data and the results of the 2 groups. The principal criterion of judgment (PCJ) was the combined rate of mortality and severe systemic complications (MSSC) at 30 days. An uni/multivariate model was used to determine the factors associated with the occurrence of the PCJ. The data were expressed as means and standard deviations. A P value ≤0.05 was considered significant., Results: Sixty-two patients (90% men, age 81.8 ± 1.4 years) were included. There were 31 EVAR and 31 LAS. The 2 groups were comparable concerning the demographic data, the comorbidities, and the aneurysmal anatomies. There was a nonsignificant tendency to higher rates of mortality (9.7 vs. 3.2%, P = 0.3) and MSSC at 30 days (16.1 vs. 3.2%, P = 0.09) in the LAS group. During the operation, LAS was associated with a longer operative time (289 ± 85 vs. 152 ± 57 min, P < 0.0001), more blood losses (1,073 ± 763 vs. 148 ± 194 mL, P < 0.0001), and more transfusions (2.0 ± 3.0 vs. 0.9 ± 1.1 units, P = 0.048). In the postoperative period, the patients operated by LAS had longer reanimation and hospitalization stays (12.9 ± 13.1 vs. 7.0 ± 2.5 days, P = 0.02; and 3.3 ± 4.4 vs. 0.6 ± 0.7 days, P = 0.002; respectively). However, in multivariate analysis, an operative duration >300 min was the only variable associated with the PCJ (P = 0.05). With a follow-up of 9.0 ± 10.7 month, there were 2 reinterventions in the EVAR group, whereas with a follow-up of 38.0 ± 23.9 month, no reintervention was observed in the LAS group., Conclusions: In the short run, EVAR significantly reduces the operative traumatism in comparison with LAS in the octogenarian presenting an AAA with a favorable anatomy. However, the choice of the technique is not independently predictive of MSSC at 30 days. When a durable repair is desirable, LAS remains a possible option in the octogenarian with a good general condition presenting a favorable aneurysmal anatomy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Few data are available on management of very elderly colon cancer patients, especially concerning the parameters of therapeutic decisions and the role of geriatricians., Methods: We retrospectively reviewed the charts of patients over 80 years of age who underwent surgery for a localised colon cancer in a French academic hospital., Results: A total of 176 patients underwent surgery (postoperative morbidity and mortality rates: 25% and 6.7%). Adjuvant chemotherapy was discussed at a multidisciplinary team meeting for 91% of stage III patients, but only 13.5% of them were treated. Twenty-five patients relapsed: 19 were discussed at the multidisciplinary meeting and 16 were treated (5 had a metastasectomy). Despite their increase with time, geriatric assessments were infrequent, 17% (33% after 2006), and had no impact on postoperative morbi-mortality. Median overall survival and recurrence-free survival were 65.3 months and 65.1 months, respectively. Age, emergency surgery, and Charlson comorbidity index were independent prognostic factors., Conclusion: Selected elderly colon cancer patients have significant access to surgery. However, postoperative morbi-mortality rates remain high and adjuvant chemotherapy rarely prescribed. Perioperative geriatric assessment, especially before surgery, should be routinely proposed to these patients to evaluate its impact on postoperative morbi-mortality and prescription of adjuvant treatment., (Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

The elderly represent a large percentage of patients seen in departments of vascular surgery. Delirium is a frequent perioperative complication in this population and contributes to increased morbidity and mortality. Prevention of problems associated with mental confusion rests in identifying comorbidities, their severity, and the risk factors associated with delirium syndrome. The aging of our population implies management of increasing numbers of older patients who often have concomitant pathologies and, consequently, polypharmacy. Optimization of their management rests on collaboration between surgeons, anesthetists, and geriatrists., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Hepatitis E is currently diagnosed after all other causes of hepatitis have been excluded. Moreover, HEV testing is not performed to prevent blood transmission in developed countries. We report here on the case of a patient with acute hepatitis while receiving potentially hepatotoxic medications for autoimmune disorders, with low-level autoimmune markers and negative "standard" viral markers; it was finally determined that he was suffering from transfusion-transmitted hepatitis E., (Copyright © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Medical ethics is concerned with practices of care, their purposes, their feasibility. It raises questions about taking care of elderly patients with cancer. The decision criteria of exploration in search of cancer or treatment of confirmed cancer are numerous. Some are medical criteria (benefit on survival, polypathology, impact on the body, the prognosis associated with comorbidities), others are more subjective (quality of life, difficulty of patient's information, longer hospitalisation, ageism). Age appears to be the first lock, the second is cognitive disorders. Overexpenditure of current assumptions seems necessary to improve the care of elderly patients with cancer. Especially since many publications indicate that cancer treatments are generally well supported and beneficial to advanced ages.

Purpose: The high prevalence of dementia, particularly of Alzheimer's disease, the increase of their incidence with age, and the population aging make this group of diseases a major problem for public health. Nevertheless, diagnosis is difficult because it depends on evolution of disturbances that patients often cannot precisely relate, on complex neuropsychological explorations, and on pathological examination difficult to obtain. Today in France, geriatricians are fully implicated in the diagnosis of dementia and all the physicians who give care to elderly, should lead easily a diagnosis of dementia., Current Knowledge and Key Points: In February 2000 ANAES (French governmental agency for accreditation and evaluation of health system) published recommendations called "practical recommendations for the diagnosis of Alzheimer's disease". These recommendations allow physicians to standardize their practices and consist of a rigorous clinical history and examination, a neuropsychological analysis, standard investigations and application of diagnostic criteria already widely diffused and used., Future Prospects and Projects: Deepening of knowledge, in particular in the domains of neuropsychology and functional cerebral imagery, should allow physicians to diagnose early dementia. These early diagnosis should allow to initiate a multidisciplinary, preventive and effective care for patients. Specific drugs, that will be available, will be intended mostly for patients with early diagnosis, ideally at a pre-dementia state.

Purpose: Twice out off three, patients with Alzheimer's disease (AD) are aged 80 and older. Very old patients are more frail, have social precariousness and have often polypathology. Few data are available about these elderly patients. The aim of our study was to analyse characteristics of AD patients aged 80 and older., Material and Methods: This is a prospective, multicentric French study (REAL.FR) of a cohort of ambulatory AD patients, with Mini-Mental State values between 10 and 26. Clinical and social data at inclusion of patients aged 80 and older and patients younger were compared., Results: Six hundred eighty nine patients (488 women, 201 men) were included between April 2000 and June 2002. The mean age was 77.8 +/- 6.9 years. Two hundred sixty four patients (38%) were aged 80 and older. Those patients were more dependant for Activities of Daily Living (ADL) than younger patients (ADL score of Katz: 5.2 +/- 1.07 et 5.6 +/- 0.74 respectively; p < 0.001 and IADL (Instrumental Activities of Daily Living) score of Lawton: 7.3 +/- 3.57 et 9.3 +/- 1.57 respectively; p < 0.001). Duration of evolution of the disease were comparable between older and younger patients., Conclusion: In our cohort, AD patients aged 80 and older had a weakest autonomy for the ADL than younger patients with the same stage of the disease. Results has implications on care. Following the cohort will permit to specify evolution of data.

Introduction: There is no validated method to predict the daily maintenance dosage of oral anticoagulation treatment by fluindione in the elderly patients. The aim of our prospective study was to look for a relation between INR at day 2 after a fixed dosage of fluindione and the daily maintenance dosage of fluindione necessary to obtain an INR value between 2 and 3., Patients and Methods: Ten milligrams of fluindione were administered on first and second day of treatment. INR was determined the third day., Results: From this value, we were able to determine the daily dosage of fluindione (+/- 5mg) that maintained a steady state INR value between 2 and 3., Conclusion: In these very elderly patients, there was a relation between INR at the third day after a fixed dosage of fluindione and the daily maintenance dosage of fluindione necessary to obtain an INR value between 2 and 3.