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Simple Summary: Decisions on cancer treatment for older patients take into account not only comorbidities but also physical and cognitive resources. Comprehensive geriatric assessment (CGA) in older patients assesses geriatric frailties but does not include standardized biological tests. The B12/CRP index (BCI) was first intended as a prognosis tool to predict 90-day mortality after advanced cancer diagnosis. This study shows the prognostic link between BCI value and overall cancer survival time in older people, and the association between BCI value and geriatric frailty before cancer treatment in this population. Background: While comprehensive geriatric assessment (CGA) in older patients treated for cancer assesses several related domains, it does not include standardized biological tests. The present study aimed to: (1) assess the prognosis value of the B12/CRP index (BCI) in a population of systemically treatable older patients with cancer and (2) analyze the association between BCI value and pre-existing geriatric frailty. Method: We conducted a retrospective observational study between January 2016 and June 2020 at Marseille University Hospital. All consecutive cancer patients aged 70 years and over before initiating systemic therapy were included. Results: Of the 863 patients included, 60.5% were men and 42.5% had metastatic stage cancer. Mean age was 81 years. The low-BCI group (≤10,000) had a significantly longer survival time than the mid-BCI (10,000 < BCI ≤ 40,000) and high-BCI (BCI > 40,000) groups (HR = 0.327, CI95% [0.26–0.42], p-value = 0.0001). Mid- and high-BCI (BCI > 40,000) values were associated with impaired functional status and malnutrition. Conclusion: A BCI > 10,000 would appear to be a good biological prognostic factor for poor survival times and pre-existing geriatric impairment in older cancer patients before they initiate systemic treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Androgen Deprivation Therapy (ADT) combined with radiotherapy is recommended for a duration of 6 months in unfavorable D'Amico intermediate-risk (IR) prostate cancer and a duration of 18 to 36 months in D'Amico high-risk (HR) prostate cancer. However, as patients ≥80 years are excluded from phase III trials combining radiotherapy and ADT, there is no consensus in this population regarding the combination of these treatments. So, we aimed to report the oncological results and morbidity radiotherapy +ADT in 101 ≥ 80 years patients with IR/HR localized prostate cancers in Marseille University Hospital. The tolerance of ADT in association to radiotherapy was acceptable in this study. There was no increase in the incidence of cardiovascular events compared to the general population, whatever the duration of ADT. The absence of significant difference in biochemical recurrence-free survival or distant metastasis-free survival between 6 and 15 months of ADT in the HR group of patients raise the question of the optimal duration of ADT in this older population. However cardio-vascular evaluation and surveillance are mandatory, especially for men over 82 years old. Purpose/objective: The association of 3D Conformal External Beam Radiotherapy (3D-CEBRT) with adjuvant Androgen Deprivation Therapy (ADT) proved to treat patients with intermediate- and high-risk localized prostate cancer (IR and HR). However, older patients were underrepresented in literature. We aimed to report the oncological results and morbidity 3D-CEBRT +ADT in ≥80 years patients. Material and Methods: From June 1998 to July 2017, 101 patients ≥80 years were included in a tertiary center. The median age was 82 years. ADT was initiated 3 months prior 3D-CEBRT in all patients, with a total duration of 6 months for IR prostate cancer (group A; n = 41) and 15 months for HR prostate cancer (group B; n = 60). Endpoints included overall survival (OS), metastasis-free survival (DMFS), biochemical recurrence-free survival (BRFS) and toxicity. Results: Five years-OS was 95% and 86.7% in groups A and B, respectively. Cardiovascular events occurred in 22.8% of ≥80 years patients with no impact on OS. In the multivariate analysis, age <82 years, Karnofsky index and normalization of testosterone levels were significantly associated with better OS. Conclusion: Age ≥80 years should not be a limitation for the treatment of IR and HR prostate cancer patients with 3D-CEBRT and ADT, but cardiovascular monitoring and prevention are mandatory. [ABSTRACT FROM AUTHOR]

The Chibanis represent the population of aging former immigrant workers who arrived in France in the 1970s in order to take up employment. Most of them still live in immigrant hostels, which are not appropriate for an older population. This anthropological study was conducted on Chibanis living in an immigrant hostel in the 15th arrondissement of Marseille. The objectives were to assess the medical, economic, and social characteristics of this population, to understand their access to health care, and to measure their adherence to the prevention actions of an association. 67 Chibanis aged 65 and over were included, with a median age of 77: 91% had access to a general practitioner, and 86.6% had more than two chronic diseases. More than half of the Chibanis complained of dental problems, and 20% complained of ophthalmological problems. Only 32.8% of the Chibanis included agreed to follow-up care with the nurses from the association. The population of Chibanis are isolated geographically from their families, live in poor socio-economic conditions, and often have insufficient medico-social coverage. They must “manage” their chronic diseases, as well as costly health problems such as dental or ophthalmic diseases. Improving care pathways for this population requires us to identify their specificities and all the factors hindering prevention actions.

Introduction: Older people living in nursing homes (NH) are at a higher risk of preventable drug-related adverse events because of age-related physiological changes, polypathology, and polypharmacy. NH residents are particularly exposed to potentially inappropriate medications (PIMs). Many strategies have been developed to improve the quality and the safety of drug prescription in NH, including medication reviews (MRs). Methods: In the context of the application of telemedicine, we developed and are currently implementing a novel hospital expert-based MRs through tele-expertise (or "telemedication review," telemedication reviews hereafter [TMR]) in French NH residents. The impact of these TMR on unplanned hospitalizations 3 months after implementation is assessed. TMR consider all available sociodemographic, clinical, biological, and pharmaceutical data pertaining to the patient and are performed in accordance with their health care objectives. Results: The preliminary results for the 39 TMRs performed to date (September 2021) showed that a total of 402 PIMs were detected, and all residents had at least one PIM. We also present the feasibility and the usefulness of this novel TMR for NH, illustrating these preliminary results with two concrete TMR experiences. Among the 39 TMR performed, the average acceptance rate of expert recommendations made to general practitioners (GP) working in NH was ∼33%. Discussion and Conclusions: The success of this novel TMR depends on how the proposed prescription adjustments made by the hospital expert team are subsequently integrated into health care practices. The low acceptance rate by GP highlights the need to actively involve these professionals in the process of developing TMR, with a view to encouraging them to act on proposed adjustments.

Background: Centenarians are known to be successful agers compared to other older adults., Objective: The objective of the present study was to compare coronavirus disease (COVID-19) symptoms and outcomes in centenarians and other residents living in nursing homes. Design-Setting-Subjects-Methods: A retrospective multicenter cohort study was conducted using data from 15 nursing homes in the Marseille area. Older residents with confirmed COVID-19 between March and June 2020 were enrolled. The clinical and biological characteristics, the treatment measures, and the outcomes in residents living in these nursing homes were collected from the medical records., Results: A total of 321 residents were diagnosed with COVID-19 including 12 centenarians. The median age was 101 years in centenarians and 89 years in other residents. The most common symptoms were asthenia and fever. Three centenarians (25%) experienced a worsening of pre-existing depression (vs. 5.5% of younger residents; p = 0.032). Mortality was significantly higher in centenarians than in younger residents (50% vs. 21.3%, respectively; p = 0.031). A quarter of the younger residents and only one centenarian were hospitalized. However, 33.3% of the centenarians received treatment within the context of home hospitalization., Conclusion: Worsening of pre-existing depression seems to be more frequent in centenarians with COVID-19 in nursing homes. This population had a higher mortality rate but a lower hospitalization rate than younger residents.

Background: Polymorbidity induces polypharmacy in older patients may lead to potential drug-drug interactions (DDI) which can modify the tolerance and safety of oncological treatments and alter the intended therapeutic effect. The objective of our study was to describe the decision-making process for oncological treatment and related outcomes, in a population of older adults undergoing a comprehensive geriatric assessment (CGA) associated to a comprehensive medication reconciliation (CMR) prior to initiating oncological treatment., Methods: ChimioAge is a prospective observational study conducted between 01/2017 and 07/2018 at Marseille University Hospital and approved by the French National Ethics Committee. It comprised all consecutive patients aged 70 years and over who were referred for a CGA as part of CMR, before initiating systemic treatment., Results: One hundred and seventy-one cancer patients were included. Mean age was 79.2 years, over half had metastatic cancers, 75% had an ECOG performance status zero or one, and two-thirds were independent in daily activities. Two-thirds of the patients had polypharmacy and the CMR identified potential DDI with systemic treatment in 43.3% of patients. Following the CGA, the CMR and the hospital oncologists decision, 30% of the patients received adapted systemic treatment with reduced doses at initiation. They presented fewer toxicities - irrespective of grade and type - than patients who received standard treatment (p<0.001) and had comparable overall survival (Log rank p=0.21)., Conclusion: This is one of the first studies to highlight the value in conducting CMR and a CGA simultaneously before initiating systemic treatment in older patients with cancer. These two evaluations could give oncologists decisive information to personalize cancer treatment of older patients and optimize treatment dose to offer the best efficacy and minimize toxicity., Competing Interests: Laurent Greillier reports personal fees and non-financial support from ABBVIE, ASTRA-ZENECA, BOEHRINGER INGELHEIM, BMS, MSD, and ROCHE and personal fees from TAKEDA, outside the submitted work. The authors report no other potential conflicts of interest for this work., (© 2020 Couderc et al.)

The Marseille gerontology network consists of a geriatric team providing support in patients' homes across the Marseille urban area. It forms an integral part of the geriatric care sector ensuring that elderly people living at home benefit from a global medical-psychological-social assessment. The aim is to enable elderly people to continue living and receiving care in their home., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Given the prevalence of anaemia in elderly people and its consequences in terms of morbidity and mortality, transfusions are common procedures in geriatrics. A survey was carried out of 41 nurses working in geriatrics to discover the conditions in which these transfusions are carried out and the particularities of a transfusion in an elderly person.