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OBJECTIVE: To assess the accuracy of "diabetes overtreatment" proxy definitions in predicting hypoglycemia in older adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: Inclusion of patients from HYPOAGE cohort with insulin-treated T2D, aged ≥75 years, and using a continuous glycemic monitoring (CGM) device for 28 days. "Diabetes overtreatment" was defined as HbA1c <7.0% (fixed proxy definition) or as HbA1c <7.0%, 7.5%, and 8.0% according to patient's health status (individualized proxy definition). The primary outcome was time below range (TBR) ≥1%. RESULTS: Of the 134 patients included (81.6 ± 5.4 years, 59% male), 25 (19%) and 53 (40%) were overtreated, based on fixed and individualized proxy definitions, respectively. CGM data showed TBR >1% in nearly all patients regardless of overtreatment status. Both proxy definitions had low sensitivity (20% [14; 29] and 41% [32; 50]) and accuracy (27% [20; 35] and 44% [35; 53]) in predicting hypoglycemia. CONCLUSIONS: A revised definition of diabetes overtreatment is needed to better manage older insulin-treated patients and protect them from hypoglycemia. [ABSTRACT FROM AUTHOR] more...

Background: There is a lack of real‐life data regarding the frequency and predictive factors of hypoglycemia in older patients with type 2 diabetes (T2D). This study aimed to determine the frequency and predictors of hypoglycemia in older patients with insulin‐treated T2D. Methods: This prospective multicenter study included 155 insulin‐treated T2D patients aged 75 years and older with ≥2 self‐monitoring of blood glucose (SMBG) daily controls. Participants underwent a geriatric and diabetic assessment and received ambulatory blinded continuous glucose monitoring (CGM) for 28 consecutive days with FreeStyle Libre Pro® sensor. Study population (n = 141) has >70% CGM active time. Multivariable logistic regressions were used to identify factors associated with SMBG confirmed hypoglycemia (≥70 mg/dL) and with nocturnal level 2 time below range (glucose concentration <54 mg/dL during ≥15 consecutive min between 0.00 and 6.00 am). Results: The mean age of the 141 analyzed patients was 81.5 ± 5.3 years and 56.7% were male. The mean baseline HbA1c was 7.9% ± 1.0%. After geriatric assessment, 102 participants (72.3%) were considered as complex and 39 (27.7%) as healthy. The primary endpoint (confirmed SMBG <70 mg/dL) occurred in 37.6% patients. In multivariable analysis, the risk of SMBG‐confirmed hypoglycemia was positively associated with a longer duration of diabetes (OR (+1 year) =1.04, (1.00–1.08), p = 0.04) and glycemic variability assessed by CGM (CV %) (OR (+1%) = 1.12, [1.05–1.19], p = <0.001). Nighty‐two patients (65.2%) experienced nocturnal time in hypoglycemia (i.e., <54 mg/dL during ≥15 consecutive min between midnight and 6 a.m.). In multivariable analyses, cognitive impairment (OR: 9.31 [2.59–33.4]), heart failure (OR: 4.81 [1;48–15.6]), and depressive disorder (OR: 0.19 [0.06–0.53]) were associated with nocturnal time in hypoglycemia. Conclusion: Nocturnal hypoglycemia is very common and largely underdiagnosed in older patients with insulin‐treated T2D. CGM is a promising tool to better identify hypoglycemia and adapt diabetes management in this population. [ABSTRACT FROM AUTHOR] more...

Walk speed measured under dual-task conditions (neurocognitive tasks) could reflect patient performance in real-life. Rehabilitation programs are effective in increasing walk speed, but few studies have evaluated the associations between geriatric factors and rehabilitation efficacy under dual-task conditions. Our objective was to investigate the association between geriatric factors and an increase in dual-task walk speed (threshold of 0.1 m/s), after a multidisciplinary rehabilitation program. We performed a retrospective cohort study that included patients aged 75 years and over, who underwent a complete rehabilitation program and who had a neurocognitive assessment at baseline. The primary outcome was the increase in the dual-task (fluency verbal task) walking speed between pre- and post-rehabilitation assessments. In this study, 145 patients were included, with a mean age of 83.6 years old. After rehabilitation, dual-task walk speed increase in 62 (43%) patients. In multivariate analysis, the following factors were associated with an increase in dual-task walk speed: IADL (OR 2.50, 95% CI [1.26; 4.94], p = 0.009), vitamin D level (OR 0.83, 95% CI [0.72; 0.95], p = 0.008), severe sarcopenia (OR 0.00, 95% CI [0.00; 0.32], p = 0.016), depression (OR 15.85, 95% CI [1.32; 190.40], p = 0.029), number of drugs (OR 1.41, 95% CI [1.04; 1.92], p = 0.027), initial dual-fluency walk speed (OR 0.92, 95% CI [0.86; 0.98], p = 0.014) and time interval between initial and final assessments (OR 0.98, 95% CI [0.96; 1.00], p = 0.06). Identifying patients that are less resilient to rehabilitation may promote a centered-patient approach for an individualized and optimized rehabilitation care. [ABSTRACT FROM AUTHOR] more...

Background: For patients with transcatheter aortic valve replacement (TAVR), increased length of stay (LOS) is associated with increased long-term mortality. The main objective of our study was to analyze the association between geriatrics factors and the hospital LOS for older patients undergoing TAVR for severe aortic stenosis. Methods: This retrospective single-center study included all patients aged ≥75 who underwent TAVR between January 2018 and January 2019. Hospital LOS and postoperative complications were analyzed regarding the geriatric factors recorded during a systematic preoperative, comprehensive geriatric assessment (CGA). The individualized-care plans established after the preoperative CGA were also analyzed. Results: median LOS of the 196 patients included was 6 days (interquartile range: 4–8), and 29% of patients had prolonged LOS. In a multivariable analysis, the preoperative factors associated with a prolonged hospital LOS were EuroSCORE I (p value = 0.02), prior major neurocognitive disorders (p value = 0.01), femoral access (p value <0.001), all complications (p value <0.001), and discharge in a rehabilitation center (p value <0.001). One-fourth (27%) of the patients had at least 1 geriatric complication. After CGA, 69 patients did not need any geriatric recommendation, whereas for the 127 other patients, an individualized-care plan was established but only 46 (36%) of them were followed up. Conclusion: Our results favor the preoperative screening for major neurocognitive disorders in order to reduce LOS. Furthermore, the proposed individual-care plans after CGA were poorly followed. Practitioners may perceive the preoperative CGA as a screening tool, but its primary objective is to develop an individualized-care plan as a prehabilitation plan in order to optimize the physical, functional, and social issues. [ABSTRACT FROM AUTHOR] more...

Simple Summary: Due to population ageing, there is an increasing number of older patients with head and neck cancers (HNC). Management of HNCs is complex. This population may be frailer than other patients with solid cancer. The Geriatric Assessment (GA) is a multidimensional diagnostic and therapeutic tool focused on frailty to propose a coordinated treatment plan and long-term follow-up. Several trials assessed the efficacy of GA-driven interventions on diverse outcomes but no recent randomized controlled trial demonstrated the impact on mortality, functional, or nutritional status as a primary outcome in this particular population. This trial highlighted several difficulties in implementation of geriatric interventions and suggested that the assessment of other models as co-management with oncologists and/or experienced practice nurses could be useful in clinical routine practice. This study assesses the efficacy of Geriatric Assessment (GA)-driven interventions and follow-up on six-month mortality, functional, and nutritional status in older patients with head and neck cancer (HNC). HNC patients aged 65 years or over were included between November 2013 and September 2018 by 15 Ear, Nose, and Throat (ENT) and maxillofacial surgery departments at 13 centers in France. The study was of an open-label, multicenter, randomized, controlled, and parallel-group design, with independent outcome assessments. The patients were randomized 1:1 to benefit from GA-driven interventions and follow-up versus standard of care. The interventions consisted in a pre-therapeutic GA, a standardized geriatric intervention, and follow-up, tailored to the cancer-treatment plan for 24 months. The primary outcome was a composite criterion including six-month mortality, functional impairment (fall in the Activities of Daily Living (ADL) score ≥2), and weight loss ≥10%. Among the patients included (n = 499), 475 were randomized to the experimental (n = 238) or control arm (n = 237). The median age was 75.3 years [70.4–81.9]; 69.5% were men, and the principal tumor site was oral cavity (43.9%). There were no statistically significant differences regarding the primary endpoint (n = 98 events; 41.0% in the experimental arm versus 90 (38.0%); p = 0.53), or for each criterion (i.e., death (31 (13%) versus 27 (11.4%); p = 0.48), weight loss of ≥10% (69 (29%) versus 65 (27.4%); p = 0.73) and fall in ADL score ≥2 (9 (3.8%) versus 13 (5.5%); p = 0.35)). In older patients with HNC, GA-driven interventions and follow-up failed to improve six-month overall survival, functional, and nutritional status. [ABSTRACT FROM AUTHOR] more...

Résumé: La prise en soin des symptômes neuropsychiatriques de patients ayant des troubles neurocognitifs est basée sur des traitements non médicamenteux. Certains auteurs suggèrent que la méthode Snoezelen pourrait être une alternative thérapeutique. L'objectif de cette revue de littérature était de faire une recherche systématique des essais contrôlés et randomisés ayant analysé l'effet de la méthode Snoezelen sur les patients âgés ayant des troubles cognitifs. Le processus de sélection a permis d'inclure 18 études, ayant des méthodologies hétérogènes. Dans plusieurs études, la méthode Snoezelen pourrait avoir un effet bénéfique, à court terme, sur les troubles du comportement, sur l'humeur, la cognition, ou les capacités fonctionnelles. Cependant, la méthode Snoezelen ne semblait pas être supérieure à d'autres interventions non médicamenteuses et certaines études montraient des résultats discordants. Finalement, le niveau de preuve d'efficacité de la méthode Snoezelen reste faible et des études mixtes (quantitatives et qualitatives) seraient intéressantes à mener pour évaluer l'intérêt de la méthode Snoezelen sur des profils spécifiques de patients ayant des troubles neurocognitifs. 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. [ABSTRACT FROM AUTHOR] more...

Background: Nutritional impairment is common in cancer patients and is associated with poor outcomes. Only few studies focused on cachexia. We assessed the prevalence of cachexia in older cancer patients, identified associated risk factors, and evaluated its impact on 6 month overall mortality. Methods: A French nationwide cross‐sectional survey (performed in 55 geriatric oncology clinics) of older cancer patients aged ≥70 referred for geriatric assessment prior to treatment choice and initiation. Demographic, clinical, and nutritional data were collected. The first outcome was cachexia, defined as loss of more than 5% of bodyweight over the previous 6 months, or a body mass index below 20 kg/m2 with weight loss of more than 2%, or sarcopenia (an impaired Strength, Assistance with walking, Rise from chair, Climb stairs and Falls score) with weight loss of more than 2%. The second outcome was 6 month overall mortality. Results: Of the 1030 patients included in the analysis [median age (interquartile range): 83 (79–87); males: 48%; metastatic cancer: 42%; main cancer sites: digestive tract (29%) and breast (16%)], 534 [52% (95% confidence interval: 49–55%)] had cachexia. In the multivariate analysis, patients with breast (P < 0.001), gynaecologic (P < 0.001), urinary (P < 0.001), skin (P < 0.001), and haematological cancers (P = 0.006) were less likely to have cachexia than patients with colorectal cancer. Patients with upper gastrointestinal tract cancers (including liver and pancreatic cancers; P = 0.052), with previous surgery for cancer (P = 0.001), with metastases (P = 0.047), poor performance status (≥2; P < 0.001), low food intake (P < 0.001), unfeasible timed up‐and‐go test (P = 0.002), cognitive disorders (P = 0.03) or risk of depression (P = 0.005), were more likely to have cachexia. At 6 months, 194 (20.5%) deaths were observed. Cachexia was associated with 6 month mortality risk (adjusted hazard ratio = 1.49; 95% confidence interval: 1.05–2.11) independently of age, in/outpatient status, cancer site, metastatic status, cancer treatment, dependency, cognition, and number of daily medications. Conclusions: More than half of older patients with cancer managed in geriatric oncology clinics had cachexia. The factors associated with cachexia were upper gastrointestinal tract cancer, metastases, poor performance status, poor mobility, previous surgery for cancer, cognitive disorders, a risk of depression, and low food intake. Cachexia was independently associated with 6 month mortality. [ABSTRACT FROM AUTHOR] more...

Abstract Background Primary care physicians need a brief and accurate screening test of dementia. The objective of this study was to determine whether a short form of Mini-Mental State Examination (SMMSE) was as accurate as the Mini-Mental State Examination (MMSE) in screening dementia. Methods Based on case control design study, SMMSE and MMSE were assessed in 184 community-dwelling older adults (mean age 81.3 ± 6.5 years, 71.7% women) with memory complaint sent by their primary care physician to a memory clinic. Included participants were separated into two groups: cognitively healthy individuals and demented individuals. Results The trade-off between sensitivity and specificity of the SMMSE for clinically diagnosed dementia was 4. Based on the cut-off value ≤ 4 for SMMSE and a cut-off value ≤ 24 for MMSE, the sensitivity of both tests was similar (89.5% for SMMSE versus 90.0% for MMSE), whereas the specificity, the positive predictive values (PPV) and the negative predictive values (NPV) were higher for SMMSE compared to MMSE (85.4 versus 75.5% for specificity; 95.5% versus 92.8% for PPV; 70.0 versus 68.9 for NPV). The positive and negative Likehood Ratio (LR) of SMMSE were higher than those of MMSE (respectively, 6.1 versus 3.7; 8.1 versus 7.7). In addition, odds ratio (OR) for dementia was higher for the SMMSE compared to the MMSE (OR = 49.8 with 95% confident interval (CI) [18.0; 137.8] versus OR = 28.6 with 95% CI [11.6; 70.3]). Conclusions SMMSE seems to be an efficient short screening test for dementia among community-dwelling older adults with a memory complaint. Further research is needed to confirm its predictive values among unselected primary care older patients. more...

Introduction: Population-based studies show a significant increase in the prevalence of visual impairment in older patients. However, older patients and patients with lower Mini-Mental State Examination (MMSE) scores have few ophthalmological assessments. The main objective of our study was to evaluate the feasibility of tele-ophthalmological screening for ophthalmological diseases in older patients referred for cognitive assessment. Methods: This monocentric prospective study included patients referred to a memory clinic for cognitive assessment. All patients underwent a geriatric assessment comprising a cognitive assessment associated with tele-ophthalmological screening undertaken by an orthoptist, including undilated retinal photography. The retinal photographs were subsequently sent to an ophthalmologist. We identified patients who were not eligible for ophthalmological assessment, for patients that had to come back due to poor-quality retinal photographs and finally for detected eye diseases. The association between the geriatric variable and newly detected eye diseases was analysed in univariable and multivariable analyses. Results: The mean age of the 298 patients included was 83.5 years ± 5.65; 29.5% were male. The mean MMSE score was 20.8 ± 5.2; 66.3% of patients had a diagnosis of dementia. Eighteen patients (6.0%) were not eligible for ophthalmological examination and 13 patients (4.6%) were asked to come back owing to poor-quality retinal photographs. Forty-one patients (13.7%) had a newly detected eye disease. In multivariable analysis, patients with a lower MMSE had significantly more newly identified eye diseases. Discussion: The tele-ophthalmological screening method identified unknown ophthalmological diseases requiring specialised management in this older population with cognitive complaints. [ABSTRACT FROM AUTHOR] more...

Background: Transcatheter aortic-valve replacement (TAVR) reduces mortality and improves quality of life in patients with severe aortic valve stenosis. One third of patients have no benefit one year after TAVR. Sarcopenia, an age-related loss of skeletal muscle mass, is associated with increased physical disability and mortality. The main purpose was to evaluate the impact of severe sarcopenia on rehospitalization one year after TAVR in older patients. Methods: All patients aged ≥ 75 referred for a TAVR in 2018 were included. Severe sarcopenia was defined by a loss of skeletal muscle mass defined on CT-scan measurement associated with a gait speed ≤ 0.8m/s. The main outcome was rehospitalization one year after TAVR. Results: Median age of the 182 included patients was 84, and 35% had an unplanned hospitalization at one year. Severe sarcopenia was diagnosed in 9 patients (4.9%). Univariable analysis showed that gait speed was a factor associated with readmission [HR=0.32, 95% CI (0.10– 0.97), p=0.04] but not severe sarcopenia. In multivariable analysis, only diabetes was significantly associated with rehospitalization [HR=2.06, 95% CI (1.11– 3.84), p=0.02]. Prevalence of severe sarcopenia varied according to different thresholds of skeletal muscle mass on CT-scan. Conclusion: Even though severe sarcopenia was not correlated with rehospitalization and mortality at one year after TAVR, our results emphasize the changes in the prevalence according to cutoff used. It highlights the need to define standardized methods and international threshold for sarcopenia diagnosis by CT-scan measurements, in general population and for patients with valvular heart disease. [ABSTRACT FROM AUTHOR] more...

Résumé: Objectifs : Le but de notre étude était d'évaluer les connaissances et les pratiques en onco-gériatrie des professionnels d'Ehpad et de les sensibiliser à cette filière. Méthode : Nous avons réalisé une enquête observationnelle d'avril à septembre 2017. Trois questionnaires ont été diffusés dans les Ehpad des Pays-de-la-Loire. Ils étaient accompagnés de documents informatifs. Résultats : Dans les 589 Ehpad des Pays-de-la-Loire, 82 médecins coordonnateurs (MC), 147 infirmiers diplômés d'État (IDE) et 240 paramédicaux ont répondu. La prévalence déclarée du cancer était de 8,75 %. La définition de l'onco-gériatrie était mal connue. Seulement 73 % des MC, 16 % des IDE et 5 % des paramédicaux connaissaient l'existence des évaluations onco-gériatriques. Seulement 50 % des MC connaissaient la grille G8, 34 % l'UCOG et 23 % l'Observatoire du cancer. Moins de 5 % des autres professionnels connaissaient cet outil et ces organismes loco-régionaux. Après information, dans l'avenir, 84 % des MC et 63 % des IDE pensent utiliser la grille G8, 82 % des MC et 67 % des IDE pensent utiliser les fiches « anticancéreux par voie orale ». Conclusion : Cette enquête montre une méconnaissance de l'onco-gériatrie en Ehpad mais suggère qu'une meilleure formation permettrait de modifier les pratiques. Objective : The increased incidence of cancer with age and rise of oral chemotherapy will affect the management of nursing home's residents. The aim of our study was to evaluate knowledge and practices in oncogeratric of nursing home's professionals from Pays-de-la-Loire and to raise awareness. Methods: In partnership with UCOG-pl, OMEDIT and Observatoire du Cancer, we realised an observational survey from April to September 2017. Three questionnaires were sent to coordonary doctors (CD), nurses and paramedics, along with informative documents. Results: In 589 nursing homes, 82 CD, 147 nurses and 240 paramedics gave an answer. The estimation of cancer's prevalence was 8,75%. Breast and prostate cancers were the most frequent. Nursing homes were an appropriate place to screen cancers by 79% of professionals. Some difficulties were reported by more than 80 % of them (coordination, residents' relationships...). At least, 20% of professionals couldn't define properly oncogeriatric. Only 73% of CD, 16% of nurses and 5% of paramedics knew about ongeriatric evaluations. Only 50% of CD knew about the G8 table, 15% of the oral cancer treatment file, 34% UCOG and 23% of the Observatoire du Cancer. Less than 5% of other professionals knew about this tool and these organisations. After information, most of the professionals think they will use them. Oral chemotherapy was already used by 90% of nurses, but the follow-up was considered inadequate. Discussion: Our survey shows a low awareness about oncogeriatric by the nursing home's professionals. This misreading and under-diagnosis of cancer in nursing homes could partly explain by the lake of training, communication and coordination with oncology professionals and the distinctive characteristics of nursing home's residents. Study suggests that raising awareness of oncogeriatric and its challenges to all professionals would improve the care of the elderly with cancer. [ABSTRACT FROM AUTHOR] more...

Résumé: Les inhibiteurs de la réabsorption tubulaire du glucose, ou gliflozines, sont une nouvelle classe thérapeutique. Leur mécanisme d'action original passe par l'inhibition d'un co-transporteur de réabsorption du glucose et Na+ dans le tube contourné proximal rénal. Ils réduisent la glycémie en réduisant la réabsorption rénale du glucose. Ils entraînent donc une glycosurie qui constitue une perte énergétique et aboutit, in fine, à une perte de poids de l'ordre de 2 à 3 kg. Ils réduisent la charge sodée et diminuent la pression artérielle. Cette classe améliore l'HbA1c d'environ 0,7 %. L'empagliflozine a montré une diminution de la mortalité toutes causes confondues chez les patients diabétiques de type 2 à haut risque cardiovasculaire, ainsi qu'une diminution des épisodes de décompensation cardiaque et une néphroprotection chez les sujets diabétiques ou non. L'empagliflozine, comme les autres gliflozines, n'induit pas d'hypoglycémie puisqu'ils ne stimulent pas directement la sécrétion d'insuline. Par la prévalence élevée du diabète de type 2, de l'insuffisance cardiaque et de l'insuffisance rénale chez le sujet âgé, les glifozines vont intégrer les prescriptions de gériatrie. Leur avantage et utilisation doivent être connus, d'autant plus que leur place est amenée à s'étendre à de nombreuses indications dans le champ des maladies chroniques. 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 the 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 place will be extended to numerous indications in the field of chronic diseases. [ABSTRACT FROM AUTHOR] more...

Résumé: Le potassium est un ion essentiel pour le fonctionnement cellulaire, il détermine le voltage et l'excitabilité des myocytes. Son homéostasie est dépendante de l'apport alimentaire et de son élimination rénale prédominante. Le système rénine angiotensine-aldostérone (SRAA) en régule l'élimination. L'hyperkaliémie aiguë et chronique est un facteur de risque de mortalité d'origine cardiaque. L'insuffisance rénale chronique et l'insuffisance cardiaque sont les principales comorbidités. Les traitements inhibiteurs du SRAA sont les principaux facteurs iatrogéniques de l'hyperkaliémie. Environ 90 % des patients qui présentent une hyperkaliémie ont plus de 50 ans et 43 % ont plus de 75 ans. Seuls 4,9 % des hyperkaliémies ont une prise en charge thérapeutique par résines. Un tiers des patients ont 3 comorbidités, et 14 % ont 5 comorbidités ou plus. Les principales comorbidités sont une hypertension artérielle (74,0 %), une dyslipidémie (56,3 %), une insuffisance rénale (55,2 %), un diabète (44,7 %), une maladie coronarienne telle que l'angor et l'infarctus du myocarde (23,3 %) et une insuffisance cardiaque (12 %). Il est à noter que les deux tiers des patients recevant des résines, recevaient également des ISRAA et présentaient une tendance à avoir plus de comorbidités. L'hyperkaliémie est sous-estimée et nécessite une surveillance stricte chez les patients présentant une insuffisance rénale ou une insuffisance cardiaque. Les résines ne sont pas adaptées à une bonne observance au long cours et de nouveaux traitements tels que le patiromer, permettraient de réduire le risque d'hyperkaliémie. 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. [ABSTRACT FROM AUTHOR] more...

Résumé: L'épidémie de Covid-19 qui avait débuté en novembre en Chine est devenue une épidémie en France à partir du 16 mars 2020 avec la déclaration du confinement de la population afin de diminuer la propagation du virus. Dès le 17 mars et jusqu'au 27 mars 2020, la cellule de veille de la Société française de gériatrie et gérontologie décide de mener une enquête pour analyser la mise en place de la mobilisation des structures de gériatrie, étant donné que cette épidémie avait montré qu'elle entraînait une surmortalité majoritairement chez les personnes âgées. L'enquête a pu réunir la réponse de 34 structures, dont neuf étaient situées en zone cluster de forte épidémie. Des services de court séjour gériatriques dédiés pour les patients infectés par le Covid-19 étaient présents dans huit établissements, uniquement hors des zones clusters. Neuf soins de suite et de rééducation gériatriques ont été dédiés, une activité supplémentaire de télémédecine concernait 35 % des établissements, et des moyens d'écoute des familles, d'animation et de communication par tablettes concernaient 36 % des établissements. Cette enquête est une photographie d'un moment initial de l'épidémie. Elle donne l'occasion de décrire le contexte dans lequel cette épidémie est survenue en ce qui concerne la politique gériatrique, et d'apprécier la réactivité et l'inventivité de ces services pour répondre aux besoins des personnes âgées. 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. [ABSTRACT FROM AUTHOR] more...

Résumé: Le coronavirus disease 2019 (Covid-19) est une maladie infectieuse secondaire au severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Le lien entre les maladies cardiovasculaires et l'infection par SARS-CoV2 entraînant le Covid semble double. Tout d'abord, les patients présentant des facteurs de risque cardiovasculaire ou des pathologies cardiovasculaires préexistantes seraient plus à risque de développer des formes graves de l'infection par Covid-19. De plus, l'infection par SARS-CoV2 peut se compliquer de lésions cardiovasculaires potentiellement mortelles, et dont les séquelles cardiorespiratoires à moyen terme demeurent inconnues. Malgré l'évolution rapide des données sur cette pandémie, cet article a pour objectif de résumer les liens entre Covid-19 et les pathologies cardiovasculaires que ce soit en tant que comorbidités incluant le questionnement de la place des bloqueurs du système rénine angiotensine ou que ce soit lié aux complications cardiovasculaires aiguës. 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. [ABSTRACT FROM AUTHOR] more...

Résumé: L'espérance de vie globale des personnes vieillissantes avec le VIH (PVVIH) tend à rejoindre celle des patients non infectés, grâce notamment à l'accès à des traitements antirétroviraux efficaces et de mieux en mieux tolérés et à l'amélioration de la prise en charge pluridisciplinaire. Certaines comorbidités ou l'exposition prolongée à un état inflammatoire lié au virus VIH lui-même pourraient être parmi les principaux déterminants physiologiques du phénotype de fragilité chez les PVVIH. La prévalence du phénotype de fragilité chez les PVVIH est fréquente (de 5 % à 28 % selon les études) et précoce (à 50 ans, cette prévalence serait identique à celle des plus de 65 ans en population générale). Le phénotype « pré-fragile » concernerait presque la moitié des patients infectés par le VIH avant 50 ans. L'intérêt de l'intégration de la mesure de la fragilité dans la prise en charge quotidienne des PVVIH n'est pas connu même si les premières données de faisabilité et de prédiction sont encourageantes. L'objectif du repérage précoce de la fragilité chez les PVVIH serait de permettre la mise en place d'interventions ciblées susceptibles d'améliorer l'état de santé globale et de retarder l'entrée dans la dépendance ou la mortalité précoce. The life-span of people aging with HIV (PHIV) tends to reach people without infection, reflecting the effectiveness and tolerance of antiretroviral treatment and improvement of multidisciplinary management. Comorbidities or HIV-inflammaging seems to be the main determinants of frailty phenotype in PHIV. Prevalence of frailty in PHIV is frequent (5% from 28%) and appears earlier than in general population (50 versus 65 years). Almost half of people with HIV present prefrail phenotype before 50 years. The usefulness of integrate routinely measures of frailty phenotype is not yet known but several data are encouraging in terms of feasibility and prediction. Early determination of frailty in PHIV could lead to target interventions to improve global health and decrease adverse outcomes such as incapacities and early death. [ABSTRACT FROM AUTHOR] more...

• PA is recommended as an intervention strategy in older patient with cancer. • GA could help finding factors associated with PA. • IADL was associated with the risk of physical inactivity. • GA could help to promote PA in older patients with cancer. [ABSTRACT FROM AUTHOR] more...

Résumé: Le vieillissement est considéré comme un facteur de risque majeur dans la survenue de nombreux cancers. Ces dernières années, des études ont montré des modifications de la composition du microbiote intestinal avec l'avancée en âge. De plus, des études épidémiologiques, expérimentales et cliniques rigoureusement menées suggèrent que le microbiote serait impliqué d'une part dans la survenue de cancer et, d'autre part, jouerait un rôle dans l'efficacité et la tolérance des traitements oncologiques, notamment la survenue d'effets indésirables gastro-intestinaux et infectieux. L'objectif de cette revue est de mettre en lumière les principales études qui se sont intéressées aux modifications de la composition du microbiote dans un contexte de vieillissement, de cancer et de prise en charge oncologique, afin de discuter des perspectives de prise en charge spécifiques, notamment adaptées aux patients âgés, en tenant compte de l'analyse du microbiote intestinal. Finalement, nous faisons l'hypothèse que de prochaines études pourront confirmer le rôle de la composition du microbiote intestinal comme un biomarqueur de fragilité et permettant l'optimisation de la prise en charge globale de la personne âgée en oncologie. Aging is a major risk factor of cancers. In recent years, several studies highlighted a change in the diversity and the abundance of the intestinal microbiota associated with aging. Moreover, epidemiological studies, experimental and clinical studies have suggested that the microbiota is implicated in cancer physiopathology and could modulate the efficacy and the tolerance of oncological treatments, for example the incidence of gastrointestinal toxicity and infectious disease. In this review, our objective was first to described the main studies that have focused on the composition of the microbiota associated with aging, cancer and during cancer therapies. Second, we discussed challenges and perspectives on cancer management and research, in elderly patients. Finally, we assume that further studies will confirm that the composition of the intestinal microbiota could be considered as a biomarker of frailty that could be used to optimize cancer management in elderly patients. [ABSTRACT FROM AUTHOR] more...

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) more...

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) more...

Introduction: Radiotherapy can diminish quality of life (QoL) for prostate cancer patients. Our objective was to evaluate the effect of radiotherapy on QoL in men aged 75 years or older treated with radiotherapy for a localized prostate cancer, and to identify predictors of reduced QoL. Patients and methods: We prospectively administered a battery of geriatric (MNA, GDS, Get up and Go Test, CIRS-G, ADL, IADL, MMSE), toxicity (IPSS; IIEF 5), and QoL (QLQ C30) screening tests in 100 elderly patients before and two months after prostate cancer radiotherapy (NCT 02876237). Patients ≥ 75 years undergoing radiotherapy with a curative intent for localized prostate cancer with or without androgen deprivation therapy (ADL) were eligible for study inclusion. Correlations between patient-assessed QoL and tumor characteristics, radiotherapy treatment or CGA parameters were sought using the Fisher or the Mann and Whitney tests. Changes in QoL parameters over time were analyzed using the Wilcoxon signed-rank test. Results: At study entry, scores for IADL impairments were present in 51%, reduced autonomy in activities of daily living in 16%, cognitive impairment found in 20%, depression-related symptoms in 31%, and 66% of patients had significant co-morbidities. Eight percent were judged to be at risk of fall and 2% were found to be undernourished. Severely impaired (IPSS ≥ 20) urinary function was observed in 11.2% and 13.5% of patients before and two months after completion of radiotherapy respectively. Significantly decreased QoL (> 20 points) at two months after treatment was found in 13% of patients and a moderate but clinically relevant reduction (10 to 20 points) in 17% of patients. No tumor characteristic, treatment, or oncogeriatric parameter was predictive of reduced QoL following prostate cancer radiotherapy. Conclusion: Despite sometimes markedly diminished oncogeriatric parameters, prostate cancer radiotherapy was generally well tolerated in these elderly patients. We found no predictive factor to determine which patients would experience impaired quality of life following radiotherapy. [ABSTRACT FROM AUTHOR] more...

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) more...

Background: Comprehensive Geriatric Assessment (CGA) is the gold standard to help oncologists select the best cancer treatment for their older patients. Some authors have suggested that the concept of frailty could be a more useful approach in this population. We investigated whether frailty markers are associated with treatment recommendations in an oncogeriatric clinic. Methods: This prospective study included 70 years and older patients with solid tumors and referred for an oncogeriatric assessment. The CGA included nine domains: autonomy, comorbidities, medication, cognition, nutrition, mood, neurosensory deficits, falls, and social status. Five frailty markers were assessed (nutrition, physical activity, energy, mobility, and strength). Patients were categorized as Frail (three or more frailty markers), pre-frail (one or two frailty markers), or not-frail (no frailty marker). Treatment recommendations were classified into two categories: standard treatment with and without any changes and supportive/palliative care. Multiple logistic regression models were used to analyze factors associated with treatment recommendations. Results: 217 patients, mean age 83 years (± Standard deviation (SD) 5.3), were included. In the univariate analysis, number of frailty markers, grip strength, physical activity, mobility, nutrition, energy, autonomy, depression, Eastern Cooperative Oncology Group Scale of Performance Status (ECOG-PS), and falls were significantly associated with final treatment recommendations. In the multivariate analysis, the number of frailty markers and basic Activities of Daily Living (ADL) were significantly associated with final treatment recommendations (p<0.001 and p = 0.010, respectively). Conclusion: Frailty markers are associated with final treatment recommendations in older cancer patients. Longitudinal studies are warranted to better determine their use in a geriatric oncology setting. [ABSTRACT FROM AUTHOR] more...

Objectives: To determine whether there is an association between overprescription of proton pump inhibitors (PPIs) and multimorbidities in older patients. Design: Multicenter prospective study. Setting: Acute geriatric medicine at the University Hospital of Nantes and the Hospital of Saint-Nazaire. Participants: Older patients aged 75 and over hospitalized in acute geriatric medicine. Measurements: Older patients in acute geriatric medicine who received proton pump inhibitors. Variables studied were individual multimorbidities, the burden of multimorbidity evaluated by the Cumulative Illness Rating Scale, age, sex, type of residence (living in nursing home or not), functional abilities (Lawton and Katz scales), nutritional status (Body Mass Index), and the type of concomitant medications (antiaggregant, corticosteroids’, or anticoagulants). Results: Overprescription of proton pump inhibitors was found in 73.9% older patients. In the full model, cardiac diseases (odds ratio [OR] = 4.17, p = 0.010), metabolic diseases (OR = 2.14, p = 0.042) and corticosteroids (OR = 5.39, p = 0.028) were significantly associated with overprescription of proton pump inhibitors. Esogastric diseases (OR = 0.49, p = 0.033) were negatively associated with overprescription of proton pump inhibitors. Conclusion: Cardiac diseases and metabolic diseases were significantly associated with overprescription of proton pump inhibitors. [ABSTRACT FROM AUTHOR] more...

Despite current advancements in the field, management of older prostate cancer patients still remains a big challenge for Geriatric Oncology. The International Society of Geriatric Oncology (ISGO) has recently updated its recommendations in this area, and these have been widely adopted, notably by the European Association of Urology. This article outlines the principles that should be observed in the management of elderly patients who have recently undergone prostatectomy for malignancy or with a biochemical relapse following prostatectomy. Further therapeutic intervention should not be considered in those patients who are classified as frail in the geriatric assessment. In patients presenting better health conditions, salvage radiotherapy is to be preferred to adjuvant radiotherapy, which is only indicated in certain exceptional cases. Radiotherapy of the operative bed presents a higher risk to the elderly. Additionally, hormone therapy clearly shows higher side effects in older patients and therefore it should not be administered to asymptomatic patients. We propose a decision tree based on the ISGO recommendations, with specific modifications for patients in biochemical relapse. [ABSTRACT FROM AUTHOR] more...

Background: Given the prevalence of non-valvular atrial fibrillation in the geriatric population, thromboembolic prevention by means of vitamin K antagonists (VKA) is one of the most frequent daily concerns of practitioners. The effectiveness and safety of treatment with VKA correlates directly with maximizing the time in therapeutic range, with an International Normalized Ratio (INR) of 2.0-3.0. The older population concentrates many of factors known to influence INR rate, particularly concomitant medications and concurrent medical conditions, also defined as comorbidities. Objective: Determine whether a high burden on comorbidities, defined by a Charlson Comorbidity Index (CCI) of 3 or greater, is associated a lower quality of INR control. Study-Design: Cross-sectional study. Settings: French geriatric care units nationwide. Participants: 2164 patients aged 80 and over and treated with vitamin K antagonists. Measurements: Comorbidities were assessed using the Charlson Comorbidity Index (CCI). The recorded data included age, sex, falls, kidney failure, hemorrhagic event, VKA treatment duration, and the number and type of concomitant medications. Quality of INR control, defined as time in therapeutic range (TTR), was assessed using the Rosendaal method. Results: 487 patients were identified the low-quality control of INR group. On multivariate logistic regression analysis, low-quality control of INR was independently associated with a CCI ≥3 (OR = 1.487; 95% CI [1.15; 1.91]). The other variables associated with low-quality control of INR were: hemorrhagic event (OR = 3.151; 95% CI [1.64; 6.07]), hospitalization (OR = 1.614, 95% CI [1.21; 2.14]). Conclusion: An elevated CCI score (≥3) was associated with low-quality control of INR in elderly patients treated with VKA. Further research is needed to corroborate this finding. [ABSTRACT FROM AUTHOR] more...

Background: The aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS. Methods: Based on a prospective observational cohort design, 1254 inpatients (mean age ± standard deviation, 84.9±5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age ≥85years, male gender, polypharmacy (i.e., ≥5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry. Results: Area under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from 0.50 to 0.57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio >1.16 with P>0.010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (P<0.003). Prognostic value for prolonged LHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4) and a low likelihood ratio of positive test under 5.6. Conclusion: Combinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients. [ABSTRACT FROM AUTHOR] more...

Background: Breast cancer with oestrogen receptor expression is common in older women. Several factors, such as age and reproductive hormone exposure, have been associated with oestrogen receptor expression in breast cancer. However, the association between comorbidities and the oestrogen receptor expression has been poorly studied. We hypothesized that there was an association between burden comorbidity and breast cancer with oestrogen receptor expression in older women. Objective: To determine whether oestrogen receptor expression in breast cancer was associated with burden comorbidity in community-dwelling women. Methods: A total of 1,707 women with breast cancer registered on the list of a breast cancer registry were included. The recorded data included: age, Charlson Comorbidity Index score≥1, breast cancer characteristics (coded according to the International Classification of Diseases for Oncology), and breast cancer pathological stage (the pathological-tumour-node-metastasis, Scarff Bloom Richardson, and hormonal status of oestrogen receptor, progesterone receptor, and human epidermal growth factor receptor). Results: Breast cancer with oestrogen receptor expression was identified in 1,378 patients (80·7%). The fully-adjusted logistic regression showed that oestrogen receptor expression was associated with Charlson Comorbidity Index score≥1 (odds ratio [OR] = 1·91,95%confidence interval [CI] = [1.01–3.61], P = 0·048), progesterone receptor expression (OR = 16·64, 95%CI = [11.62–23.81], P<0·001), human epidermal growth factor receptor (OR = 0·54, 95%CI = [0.34–0.84], P = 0·007), age (OR = 1.02, 95%CI = [1.00–1.03], P = 0.008), Scarff Bloom Richardson grade II and grade III (OR = 0·21with 95%CI = [0.10–0.44] and OR = 0·06 with 95%CI = [0.03–0.12], P<0·001). Conclusion: Our findings provide new data showing an independent positive association between burden comorbidity and breast cancer with oestrogen receptor expression. This result confirms that evaluation of oestrogen receptor expression in breast cancer should not be limited to hormonal factors stratified by age. [ABSTRACT FROM AUTHOR] more...