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Introduction: Le diabète du sujet âgé tient une place importante en milieu hospitalier en Occident tandis qu’en Afrique les données sont rares. L’objectif de notre travail a été de comparer les caractéristiques diabétologiques et gériatriques du sujet diabétique âgé hospitalisé à Abidjan ou à Marseille. Matériels et méthodes: A Abidjan, une étude transversale dans l’unique Service de Diabétologie a porté sur 478 patients âgés diabétiques de 65 ans et plus. À Marseille, nous avons étudié 145 diabétiques sur 1 309 gérontes. Nous avons comparé les deux populations noire et caucasienne sur leurs caractéristiques diabétologiques et gérontologiques. Résultats: Dans la population noire l’âge moyen était de 71,8 ans, le sex-ratio à 1, la majorité était des indigents (84,3 %). Le pied diabétique représentait 27,4 % des complications, l’hyperosmolarité 9,4 %, l’albuminurie 49 % des cas et les infections bucco-dentaires 45 % des cas. L’évaluation gériatrique sommaire a noté la dépression chez 22,8 %; la démence et la dénutrition respectivement chez 15,3 et 11,3 %. Les affections oculaires 32 % et les anémies 27,8 %. La mortalité a concerné 13 %. Les causes de décès étaient dominées par la septicémie 47 % et les cardiopathies décompensées 21 %. Dans la population blanche, l’âge moyen était à 79,6 ans avec une prédominance féminine ¾ de patients dépendants de leur entourage. les chutes et les pathologies cardio-vasculaires étaient de fréquents motifs d’hospitalisation. L’évaluation gériatrique standardisée a permis de retrouver un déficit cognitif et une dépendance plus importante respectivement 61,5 % et 60,7 %. Un état dépressif 43,4 % et une dénutrition 25,5 %. Les co-morbidités étaient dominées par l’insuffisance cardiaque et les escarres. Conclusion: Cette étude comparative montre des différences diabétologiques et gérontologiques entre les deux groupes de gérontes. Des tests d’évaluation gérontologiques, spécifiques et adaptés aux sujets Africains doivent être mis en place pour mieux apprécier ces caractéristiques notamment l’autonomie, la dépression et le déficit cognitif. [Copyright &y& Elsevier]

Purpose: Despite the high morbidity and mortality rate of osteoporosis, the proportion of patients who receive appropriate diagnosis and treatment remains very low. A specific osteoporosis program increased the percentage of patients receiving diagnosis and/or treatment for osteoporosis. We set up a program to improve diagnosis and treatment of patients with low-trauma fractures or suspicion of osteoporosis., Methods: Two geriatricians were especially designated for this program. The program included patients admitted to the emergency room, inpatients and outpatients from the orthopedic department or the internal medicine/geriatric department. The assessment was performed over two visits and included an evaluation of risk factors for osteoporosis and falls, a physical examination, a collection of biological parameters, and Dual-energy X-ray absorptiometry. In the second visit the physician prescribed, if appropriate, anti-osteoporotic treatment., Results: During a two-year period, 156 patients were included in the program; 85.4 % were women. Hip fracture was the most common fracture, followed by vertebral and arm (respectively 28.6%, 11.5%, and 7.6%). While half the patients had a personal history of low-trauma fractures, only 17% received osteoporosis treatment. Anti-osteoporotic treatments were prescribed for 49% of the patients (p<0.001). It was mainly vitamin D (35%), calcium supplementation (31.2%), and oral bisphosphonate (23.6%). Inclusion in our program increased the number of patients receiving anti-osteoporotic treatment from 17.2 to 49.7%. All fallers received falls - prevention counseling based on written materials and oral information., Conclusion: A specific program increases the percentage of patients receiving diagnosis and treatment for osteoporosis for patients with low-trauma fractures or suspicion of osteoporosis. Our next objectives are to develop this program to other health care's professionals.

Introduction: In the elderly, both the presence of a multiple pathology and multiple medication have been shown to be frequent risk factors for adverse drug events. However, a few studies only have included parameters of standardized geriatric assessment for the purpose of identifying other risk factors. Our study compared the parameters of standard geriatric assessment, in the presence or absence of adverse drug events and evaluated the prevalence of adverse drug events in elderly inpatients, the symptoms, and the drugs involved., Methods: A total of 823 patients were studied during a two-year period. Two groups of patients were identified, according to the presence or absence of an adverse drug event. Eight fields of geriatric assessment were compared: comorbidities, number of drugs, functional status, nutritional status, mobility, mood, neurosensory disorders, and cognition. For patients who experienced an adverse drug event, we also analyzed the drugs involved and the symptoms of the adverse drug events., Results: One hundred and twelve patients (13.6%) aged 82 years+/-7.5 experienced 144 adverse drug events. Significant differences between the two groups were observed in the following: symptoms of depression, problems of mobility, risk of malnutrition (respectively p=0.001, p=0.002, p=0.007), the female sex, number of drugs, number of comorbidities, and the administration of diuretics. Cardiovascular (23.2%), psychotropic (17.9%) and anti-infectious (17%) medicines were the most frequently involved. The symptoms that occurred most frequently were orthostatic hypotension (14.6%), gastrointestinal disorders (12.5%), and neuropsychological (10.4%) disorders., Conclusion: Elderly patients with multiple pathology and multiple medication are at high risk for adverse drug events. Other lesser known factors, such as depression, problems of mobility, and malnutrition must be researched, as they are evidence of the underlying the frailty of the elderly population.

Background: Cancer is predominantly a disease in the population aged 65 years and older. Previous studies have suggested that older cancers patients seen in oncology departments are healthy with few comorbidities. Relatively little is known about the health and functional status of older cancer inpatients, especially outside oncology units. The purpose of this study is to compare the health and functional status of older cancer and noncancer inpatients admitted to a geriatric/internal medicine unit., Methods: A retrospective chart review was conducted on inpatients 65 years old and older, who had been hospitalized during a period of 2 years in the geriatric/internal medicine unit. The health and functional status of 144 inpatients with active cancer was compared to that of 682 inpatients without active cancer. Eight domains were compared: functional status, comorbidity, medication, nutritional status, neurosensory deficits, cognition, mood, and mobility. The hospitalization measures (length of stay, death, need for palliative care) were also compared., Results: We found that inpatients with active cancer were younger, had less comorbidity and less cognitive impairment, but were more depressed and at greater risk for malnutrition than patients without cancer. These two groups were similar in terms of functional status, neurosensory deficit, and mobility. Cancer patients had a significantly shorter length of stay, required more palliative care, and were more likely to die during hospitalization., Conclusion: These findings indicate that older cancer patients admitted to a geriatric/internal medicine unit present with multiple active geriatric problems, have characteristics distinct from those of traditional geriatric patients, and require specific care and management.