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Introduction: The comprehensive geriatric assessment (CGA) is recommended for assessing frailty in older cancer patients but is time-consuming. The G8 screening tool was developed to select frail patients requiring CGA to optimize resources. The Edmonton Frail Scale (EFS) is another frailty scale validated for preoperative frailty screening, but scarcely studied in the field of oncogeriatrics. In this study, we examined the added value of the EFS in older cancer patients already considered as frail by the G8, by analyzing the association of EFS with CGA adjusted for age, gender, metastatic stage and comorbidity. We also analyzed the association of EFS with the one-year mortality rate after adjusting for cancer type and metastatic stage., Methodology: This retrospective study included patients aged over 70 years old with a new diagnosis of cancer, considered as potentially frail according to the G8 and who had had a CGA ( N  = 380)., Results: The EFS identified 329 (86.58%) patients as frail and having a statistically significant predicted number of pathological components on the CGA ( r  = 0.64, p  < 0.001). When adjusted for age, sex, comorbidity, and metastatic stage, the EFS was independently associated with the CGA ( p  < 0001), as well as with comorbidity ( p  = 0.004). The patients who died in the first year (43%) had a significantly higher mean EFS score (8/17) than living patients (6/17) ( p  < 0.0001). After adjustment for cancer type and stage, EFS independently predicted one-year mortality (OR 1.17; 95% CI 1.08-1.28; pseudo R 2  = 0.228, p  < 0.001)., Discussion: The EFS is a reliable tool for predicting frailty identified by the CGA in an older cancer population pre-selected as frail by the G8. EFS is an independent predictor of one-year mortality after adjustment for confounding factors. Validation of the EFS as a screening tool for frailty in cancer requires further studies to assess its performance in patients with normal G8 scores., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 De Schrevel, Faucon, Sibille, Dumont, Herrmann, Rouvière and De Breucker.)

Objectives: Oldest-old patients may have an unusual SARS-COV2 presentation that can jeopardise diagnosis and management. The aim of this study was to compare the clinical characteristics and outcomes of oldest-old (≥85 years) and old patients (75-85 years) admitted with COVID-19 to Belgian hospitals during the first wave of the pandemic., Methods: We conducted a multicentre, retrospective, observational study in ten Belgian hospitals. We reviewed the electronic clinical records of patients ≥75 years hospitalised with COVID-19 from March to June 2020., Results: A total of 986 patients were placed on the register (old group: n = 507; oldest-old group: n = 479). Before hospitalisation, the oldest-old (OO) group presented with more geriatric syndromes including comorbidities, frailty, falls, cognitive impairment, and incontinence. At admission, the OO group presented with less cough, less headache, and less fever but significantly more delirium than old (O) group. Members of the OO group were admitted less frequently to intensive care units (ICUs). A geriatrician was consulted to help in the decision-making process more often for the OO group. The global mortality of the cohort was 47%, with no difference between the two groups. Patients in the OO group were more often institutionalised after hospitalisation and less often referred for rehabilitation., Conclusions: The OO patients presented with more geriatric syndromes that make them vulnerable to dependence and institutionalisation after a hospital stay, without having a higher mortality rate than O patients. Geriatrician expertise is necessary in the management of frail older patients.

Background & Aims: Acute illness can lead to disability and reduced quality of life in older patients. The aim of this systematic review was to evaluate the effect of nutritional rehabilitation provided during and after hospitalisation for an acute event on functional status, muscle mass, discharge destination and quality of life of older patients., Methods: The protocol for this systematic review was registered in PROSPERO (CRD42021264971). Articles were searched using Scopus, Medline, Google Scholar and Clinical., Trials: gov. For studies included in the meta-analysis, Hedges'g standardized mean difference effect size was calculated and transformed in odds ratios., Results: We identified 7383 articles, of which 45 publications (41 trials, n = 8538 participants, mean age 80.35 ± 7.01 years.) were eligible for the systematic review. Patients were hospitalized for acute medical diseases (n = 6925) and fractures (n = 1063). The interventions included supplementation with a fixed amount of oral nutritional supplements (ONS, n = 17 trials), individualized diet plan (n = 3), combination of physical exercise with nutrition therapy (n = 14 trials), combination of anabolic agents with nutrition therapy (n = 5 trials). Overall nutritional rehabilitation improved functional status (Odds ratio 1.63 [1.15; 2.3], p = 0.003) and muscle mass (Odds ratio 2.61 [1.22; 5.5], p = 0.01), but not the quality of life or the discharge destination., Conclusion: Nutritional rehabilitation was found to improve functional status and muscle mass. There is a need for larger studies involving older hospitalized patients., Competing Interests: Conflict of interest None., (Copyright © 2023 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objectives: Fatigue has been suggested as a marker of biological aging. It seems plausible that this symptom might be associated with changes in brain health. The objective of this study was to examine the associations between persistent fatigue and neuroimaging correlates in a non-disease-specific population of community-dwelling older adults., Methods: We performed a cross-sectional analysis using data from The Multidomain Alzheimer Preventive Trial (MAPT). We included 458 subjects. Persistent fatigue was defined as meeting exhaustion criterion of Fried frailty phenotype in two consecutive clinical visits six months apart between study baseline and one year. Brain imaging correlates, assessed by magnetic resonance imaging (MRI), were the outcomes. The associations between persistent fatigue and brain correlates were explored using mixed model linear regressions with random effect at the center level., Results: The mean age of the participants was 74.8 ± 4 years old, and 63% of the subjects were women. Forty-seven participants (10%) exhibited a persistent fatigue profile. People with persistent fatigue were older compared to subjects without persistent fatigue (76.2 years ± 4.3 vs.74.7 ± 3.9 p  = 0.009). Persistent fatigue was associated with higher white matter hyperintensity volume in the fully adjusted analysis. We did not find any cross-sectional association between persistent fatigue and sub-cortical volumes and global and regional cortical thickness., Conclusion: Persistent fatigue was cross-sectionnally associated with higher white matter hyperintensity volume in older adults. Further longitudinal studies, using an assessment tool specifically designed and validated for measuring fatigue, are needed to confirm our findings.

Fibromyalgia is a chronic disorder characterized by persistent widespread musculoskeletal pain. Patients with fibromyalgia have reduced physical activity and increased sedentary rate. The age-associated reduction of skeletal muscle mass and function is called sarcopenia. The European Working Group on Sarcopenia in Older People developed a practical clinical definition and consensus diagnostic criteria for sarcopenia. Loss of muscle function is common in fibromyalgia and in the elderly. The goal of this study is to determine whether the reduction of muscle function in fibromyalgia is related to sarcopenia according to the European Working Group on Sarcopenia in Older People criteria. Forty-five patients with fibromyalgia and thirty-nine healthy control female subjects were included. All the participants were assessed by Fibromyalgia Impact Questionnaire and SARC-F questionnaire. Muscle mass was evaluated by bioimpedance analysis, muscle strength by handgrip strength test and physical performance with the Short Physical Performance Battery. Fibromyalgia Impact Questionnaire and SARC-F scores were statistically significantly higher in the fibromyalgia group than in the control group, showing severe disease and a higher risk of sarcopenia in the fibromyalgia group (p < 0.001). Muscle strength and physical performance were statistically significantly lower in the group with fibromyalgia than in the control group (p < 0.001). There was no statistical difference between fibromyalgia and control groups regarding skeletal muscle mass (p = 0.263). Our study demonstrated a significant reduction in muscle function in fibromyalgia patients without any loss of muscle mass. Loss of muscle function without decrease in muscle mass is called dynapenia., (© 2021. The Author(s).)

Purpose: This study aimed to determine whether increasing the contribution of executive functions worsens dual-task performance in individuals with amnestic mild cognitive impairment (aMCI)., Methods: Fourteen individuals with aMCI (mean [SD]: 74 [4] years) and 19 control adults (71 [5] years) recalled a list of letters in the order of presentation (SPAN-O) or in alphabetic order (SPAN-A) while ascending or descending a 3-step staircase. Dual-task cost (DTC) represented the average decrement of motor and cognitive performances during dual tasks, with greater DTC indicating worse performance., Results: SPAN-A (P < 0.001) and stair descent (P = 0.023) increased the DTC in both groups compared with SPAN-O and stair ascent. Furthermore, individuals with aMCI had a greater DTC (93.4 [41.2]%) than the control group (48.3 [27.9]%) for SPAN-A (P < 0.001). Dual-task cost was also greater in descent (76.6 [42.1]%) than ascent (64.0 [34.5]%) in individuals with aMCI (P = 0.024) but not in the control group (P = 0.99). Significant negative partial correlations (β < -0.39; P < 0.05) were found between Montreal Cognitive Assessment score and DTC, while controlling for age and physical function., Discussion and Conclusions: A greater DTC in individuals with aMCI when the cognitive task requires working memory (SPAN-A) or during complex locomotor task (descent) suggests that aMCI impedes the capacity to perform 2 tasks simultaneously when higher-order cognitive processes are challenged. Furthermore, a greater DTC in our dual-task situations appears to reflect cognitive decline, as assessed by the Montreal Cognitive Assessment score. Overall, this study indicates that increasing the contribution of executive functions worsens the cognitive-motor interaction in individuals with aMCI.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A375)., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Academy of Neurologic Physical Therapy, APTA.)

Abrikossoff tumor, also called granular cell tumor (GCT), is a neoplasm of the soft tissues which is most commonly a solitary, painless, and benign tumor. However, 2% of Abrikossoff tumors can be malignant. We report here the case of a 75-year-old male who presented a local recurrence of Abrikossoff tumor of the left thigh. The anatomopathological analysis concluded to a malignant GCT, and the F-18 fluorodeoxyglucose positron emission tomography showed multiple lesions in the lymph nodes and bones. The potential conversion to malignancy should alert practitioners because of the extremely poor prognosis. The diagnosis of malignant granular cell tumor should be based on a bundle of clinical and histological features and not solely on histologic features because of the challenging distinction between malignant and benign tumors due to the lack of well-defined criteria for the diagnosis of malignancy. Large size and recurrence are the most important clinical features predicting malignant behavior. Patients with a history of Abrikossoff tumor should be followed closely to monitor recurrence and malignant transformation. The apparent originality of our observation - which could lie in the evolution of a GCT tumor, initially considered as benign, to a malignant form - has to be challenged regarding the issue of classifying some cases according to the classical "benign" and "malignant" dichotomy., Competing Interests: The authors have no relevant financial or nonfinancial interests to disclose., (Copyright © 2021 by The Author(s). Published by S. Karger AG, Basel.)

The Free and Cued Selective Reminding Test (FCSRT) is a largely validated neuropsychological test for the identification of amnestic syndrome from the early stage of Alzheimer's disease (AD). Previous electrophysiological data suggested a slowing down of the alpha rhythm in the AD-continuum as well as a key role of this rhythmic brain activity for episodic memory processes. This study therefore investigates the link between alpha brain activity and alterations in episodic memory as assessed by the FCSRT. For that purpose, 37 patients with altered FCSRT performance underwent a comprehensive neuropsychological assessment, supplemented by 18 F-fluorodeoxyglucose positron emission tomography/structural magnetic resonance imaging ( 18 FDG-PET/MR), and 10 min of resting-state magnetoencephalography (MEG). The individual alpha peak frequency (APF) in MEG resting-state data was positively correlated with patients' encoding efficiency as well as with the efficacy of semantic cues in facilitating patients' retrieval of previous stored word. The APF also correlated positively with patients' hippocampal volume and their regional glucose consumption in the posterior cingulate cortex. Overall, this study demonstrates that alterations in the ability to learn and store new information for a relatively short-term period are related to a slowing down of alpha rhythmic activity, possibly due to altered interactions in the extended mnemonic system. As such, a decreased APF may be considered as an electrophysiological correlate of short-term episodic memory dysfunction accompanying pathological aging., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Puttaert, Wens, Fery, Rovai, Trotta, Coquelet, De Breucker, Sadeghi, Coolen, Goldman, Peigneux, Bier and De Tiège.)

In the autumn of 2020, the second wave of the COVID-19 pandemic hit Europe. In this context, because of the insufficient number of beds in geriatric COVID units, non-geriatric wards were confronted with a significant number of admissions of geriatric patients. In this perspective article, we describe the role of a mobile geriatric team in the framework of the COVID-19 pandemic and specifically how it assisted other specialists in the management of hospitalized geriatric patients by implementing a new approach: the systematic assessment and optimization of Intrinsic Capacity functions. For each patient, assessed by this consultative team, an individualized care plan, including an anticipated end-of-life decision-making process, was established. Intensity of care was most often not stated by considering chronological age but rather the comorbidity burden, the frailty status, and the patient's wishes. Further studies are needed to determine if this mobile geriatric team approach was beneficial in terms of mortality, length of stay, or functional, psychological, and cognitive outcomes in COVID-19 geriatric patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Angioni, Nicolay, Vandergheynst, Baré, Cesari and De Breucker.)

Context: Sarcopenia is a progressive and generalized skeletal muscle disorder associated with an increased risk of adverse outcomes such as falls, disability, and death. The Belgian Society of Gerontology and Geriatrics has developed evidence-based guidelines for the prevention and treatment of sarcopenia. This umbrella review presents the results of the Working Group on Nutritional Interventions., Objective: The aim of this umbrella review was to provide an evidence-based overview of nutritional interventions targeting sarcopenia or at least 1 of the 3 sarcopenia criteria (ie, muscle mass, muscle strength, or physical performance) in persons aged ≥ 65 years., Data Sources: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed and Web of Science databases were searched for systematic reviews and meta-analyses reporting the effect of nutritional supplementation on sarcopenia or muscle mass, strength, or physical performance., Data Extraction: Two authors extracted data on the key characteristics of the reviews, including participants, treatment, and outcomes. Methodological quality of the reviews was assessed using the product A Measurement Tool to Assess Systematic Reviews. Three authors synthesized the extracted data and generated recommendations on the basis of an overall synthesis of the effects of each intervention. Quality of evidence was rated with the Grading of Recommendations Assessment, Development and Evaluation approach., Data Analysis: A total of 15 systematic reviews were included. The following supplements were examined: proteins, essential amino acids, leucine, β-hydroxy-β-methylbutyrate, creatine, and multinutrient supplementation (with or without physical exercise). Because of both the low amount and the low to moderate quality of the reviews, the level of evidence supporting most recommendations was low to moderate., Conclusions: Best evidence is available to recommend leucine, because it has a significant effect on muscle mass in elderly people with sarcopenia. Protein supplementation on top of resistance training is recommended to increase muscle mass and strength, in particular for obese persons and for ≥ 24 weeks. Effects on sarcopenia as a construct were not reported in the included reviews., (© The Author(s) 2020. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Advanced cancers are associated with a chronic inflammation, especially high interleukin-6 (IL-6) and with various levels of adipokines (leptin and adiponectin), while ghrelin counteracts the anorexigenic effect of leptin in cancer-induced anorexia-cachexia syndrome. We aimed to understand how IL-6, adipokines and ghrelin plasma levels could be influenced by cancer on the one hand, and by age, frailty, and nutritional status in old cancer patients on the other hand. Ninety-nine patients aged 79[76-83] years old were included. Sixty-six percent had advanced stages of cancer, and 34% had cachexia. Fifty percent were at risk of malnutrition, and 10% had overt malnutrition. None of the variables studied was significantly correlated with the advanced stage, or cachexia. In multiple regression, the only parameter significantly and positively associated with age was adiponectin (p = 0.008). Despite a high prevalence of frailty in our study, we did not find any independent association of frailty (assessed by G8) with IL-6, leptin, adiponectin, or ghrelin in multivariate analysis. We observed that a low albumin level was independently associated with a higher level of IL-6 (p < 0.0001), but not with the MNA score. However, leptin showed a positive correlation with BMI (p < 0.0001), confirming the persistence of a relationship between leptin and adiposity, even in older cancer patients. Finally, high IL-6 level was associated with a higher mortality rate (p = 0.027). In conclusion, IL-6, leptin, adiponectin, and ghrelin are not associated with advanced stages of cancer or cancer-induced cachexia in older subjects with cancer, but they are significantly correlated with anthropometric factors and body composition., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background/Objectives: Delirium occurs in up to 50 % of hospitalized old patients and is associated with increased morbidity and mortality. Acute medical conditions favor delirium, but the pathophysiology is unclear. Preliminary evidence from retrospective and prospective studies suggests that a substantial minority of old patients with unexplained delirium have non-convulsive seizures or status epilepticus (NCSE). Yet, seeking epileptic activity only in unexplained cases of delirium might result in misinterpretation of its actual prevalence. We aimed to systematically investigate the role of epileptic activity in all older patients with delirium regardless of the underlying etiology. Design, Setting: Prospective observational study in a tertiary medical center. Adults >65 years with delirium underwent at least 24 h of continuous electro-encephalographic monitoring (cEEG). Background patterns and ictal and interictal epileptic discharges were identified, as well as clinical and biological characteristics. Participants: Fifty patients were included in the study. Results: NCSE was found in 6 (12%) patients and interictal discharges in 15 (30%). There was no difference in the prevalence of epileptic activity rates between delirium associated with an acute medical condition and delirium of unknown etiology. Conclusion: Epileptic activity may play a substantial role in the pathophysiology of delirium by altering brain functioning and neuronal metabolism. No clinical or biological marker was found to distinguish delirious patients with or without epileptic activity, underlining the importance of cEEG in this context.

Background Anaemia is often multifactorial in the elderly, with a frequent association between iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD). The primary objective of our study was to investigate whether baseline hepcidin measurement could be useful for identifying iron deficiency (ID) in anaemic elderly patients. The secondary objective was to assess whether baseline hepcidin concentrations correlated with the relative increase of transferrin saturation (TS) after an oral iron absorption test (OIAT). Methods Blood samples were collected between 7:30 am and 10:00 am in 328 geriatric outpatients, 102 underwent the OIAT. Types of anaemia were classified according biochemical and clinical criteria. TS and hepcidin were measured at baseline and 4 h after the iron dose. The ability of baseline hepcidin measurement to highlight ID in elderly anaemic patients was assessed using a receiver operator curve (ROC) analysis. Correlations between baseline hepcidin levels and the increment of TS following the OIAT were investigated using the Spearman coefficient. Results Among 328 included patients, 78 (23.8%) suffered from anaemia; 13 (4.0%), 19 (5.8%), 27 (8.2%) and 19 (5.8%) patients fulfilled criteria for IDA, IDA/ACD, ACD and unexplained anaemia, respectively. By multivariable analysis, creatinine, C-reactive protein, ferritin, Delta TS and Delta hepcidin were independently associated with baseline hepcidin concentrations. The area under the ROC curve (95% confidence interval) was 0.900 (0.830-0.970) for baseline hepcidin measurement. Baseline hepcidin levels correlated negatively with the relative increase in TS with a Spearman coefficient of -0.742. Conclusions Baseline hepcidin levels could be a useful tool to identify ID in anaemic elderly patients and may predict acute iron response following OIAT.

Introduction: Older people suffer more often and from more severe infections than do younger people. Several studies have shown a correlation between higher white blood cell count (WBCC) and the presence of infection. The usefulness of increased WBCC to assess the presence of infection in geriatric patients is debated. To answer this question, we investigated the correlation between the total and differential WBCC and documented infection in hospitalized geriatric individuals., Population and Methods: Clinical data (medical history, comorbidities, treatments, geriatric syndromes) and biological parameters were collected from 166 hospitalized geriatric patients (67-106 yrs) presenting with acute inflammation (C-reactive protein (CRP) > 10 mg/l) and were compared according to the presence/absence of infection., Results: The mean WBCC was not significantly different (p = 0.71) according to the presence of infection or not, although the mean CRP level was higher in the infected group compared to the non-infected group (p = 0.0019). In regression analyses, the presence of infection was not associated with an increase in total and differential WBCC. Additionally, we found a positive correlation between cardiovascular risk factor and diseases (CVRF & diseases) and WBCC., Conclusion: In geriatric patients, WBCC is not a reliable biomarker for infection; however, combined with CRP, it represents a marker of cardiovascular disorders., (Copyright © 2018 Elsevier Inc. All rights reserved.)

We describe here the case of a 73-year-old woman who presented a recurrent macular rash, acute respiratory distress, and hemoptysis. Chest CT scan showed diffuse ground-glass opacities that were suggestive of alveolar hemorrhage. With the development of severe acute kidney injury and nephrotic-range proteinuria (creatininemia 2.6 from 1.9 mg/dL with overt proteinuria 34 from 2.1 g/g creat), a kidney-lung syndrome was evoked. Skin biopsy revealed leukocytoclastic vasculitis with IgA deposits. Blood tests showed an increased IgA level. Those findings were consistent with a rare form of IgA vasculitis (formerly Henoch-Schönlein syndrome), the originality of the case lying in the occurrence of a kidney-lung syndrome in an elderly patient.

We designed and synthesized a new series of fatty acid synthase (FASN) inhibitors with potential utility for the treatment of cancer. Extensive SAR studies led to highly active FASN inhibitors with good cellular activity and oral bioavailability, exemplified by compound 34. Compound 34 is a potent inhibitor of human FASN (IC 50  = 28 nM) that effectively inhibits proliferation of A2780 ovarian cells (IC 50  = 13 nM) in lipid-reduced serum (LRS). This cellular activity can be rescued by addition of palmitate, consistent with an on-target effect. Compound 34 is also active in many other cell types, including PC3M (IC 50  = 25 nM) and LnCaP-Vancouver prostate cells (IC 50  = 66 nM), and is highly bioavailable (F 61%) with good exposure after oral administration. In a pharmacodynamics study in H460 lung xenograft-bearing mice, oral treatment with compound 34 results in elevated tumor levels of malonyl-CoA and decreased tumor levels of palmitate, fully consistent with the desired target engagement., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: In the past few years numerous mobile games have been developed to train the brain. There is a lack of information about the relation between the scores obtained in these games and the cognitive abilities of the patients., Objective: The aim of this study was to determine whether or not mobile games can be used to assess cognitive abilities of elderly., Methods: Twenty healthy young adults, 29 old patients with cognitive impairments (Mini-Mental State Exam (MMSE) [20- 24]) and 27-aged controls participated in this study. Scores obtained in 7 mobile games were correlated with MMSE and the Addenbrooke's Cognitive Evaluation revised (ACE-R)., Results: Statistically significant differences were found for all games between patients with cognitive impairments and the aged controls. Correlations between the average scores of the games and the MMSE and ACE-R are significant (R = 0.72 [p < 0.001] and R = 0.81 [p < 0.001], respectively)., Conclusion: Scores of cognitive mobile games could be used as an alternative to MMSE and ACE-R to evaluate cognitive function of aged people with and without cognitive impairment at least when MMSE is higher than 20/30.

Objectives: The comprehensive geriatric assessment (CGA) can detect geriatric problems and potentially improve survival, physical, and cognitive state of patients, as well as increase an older person's chances of staying at home longer. In older people, the number and severity of comorbidity increase with age and are an important determinant of survival. The aim of the study was to assess to which extent CGA and comorbidities could be seen as determinants of survival., Materials and Methods: This study analyzed data from two hospitals that included geriatric assessments of patients aged 70 years and more with cancer linked to mortality. Logistic regression was used to model survival predictors., Results: Two hundred and five various cancer patients (47% females) with a median age of 79 were included. They presented with a lot of undiagnosed geriatric problems. Screening scales (G8, SEGA), cognitive, and psychological disorders, and low albumin levels appeared to be independent survival factors. A frailty profile classification was associated with higher mortality. The average comorbidity was graded 2 according to the Charlson scale. By the geriatric cumulative illness rating scale (CIRS-G), the arithmetic average number of affected organ systems was 5 (range 0-10) in all patients. Cardiovascular disorders were the most common comorbidity. Renal insufficiency and anaemia were negatively associated with survival., Conclusion: Old cancer patients present a lot of comorbidities and newly diagnosed geriatric problems. Several tools provide determinants of survival in old cancer patients. Prospective trials evaluating the utility of a CGA to guide interventions to improve quality of cancer care in older adults are justified.

Oncogeriatrics has made huge progress due to the numerous studies published in the fields of geriatric assessment, recommendations by experts of the International Society of Geriatric Oncology (SIOG) concerning the evaluation and treatment of a large number of solid and haematological forms of cancer, and of the intervention on geriatric syndromes. This article is a review of the most important publishings in the field of oncogeriatrics, among them the Belgian publishings, brought out in the last five years.

Background/objectives: Geriatric patients are highly susceptible to infections. While reduced lymphocyte count has been associated with age, other studies found no change in WBC counts with age. Increased circulating white blood cell (WBC) count has been associated with cardiovascular (CV) diseases and frailty but there are discrepancies. Frailty, geriatric conditions, cardiovascular diseases and WBC count have also been associated with low grade inflammation. Association between geriatric conditions and WBC has been scarcely studied. The aim of the study is to assess the association between WBC and geriatric conditions, CV diseases, and seric IL-6 levels., Design, Setting, Participants, Measurements: We recruited 100 subjects in the general population and hospitalized for chronic medical conditions (age, 23-96years). We collected information on clinical status (medical history, comorbidities, treatments and geriatric syndromes), biological parameters (hematological tests, cytomegalovirus serology) and cytokine production (basal IL-6). Using stepwise backward multivariate analyses, we defined which set of clinical and biological variables could be predictive of increased total and differential WBC counts., Results: We found that low-grade inflammation is independently associated with total WBC, monocyte and neutrophil counts, but not geriatric conditions. CV diseases were the only significant associated factor for high monocyte count., Conclusion: In this study, we observed that differential and total WBC counts do not seem to be associated with geriatric conditions but with CV diseases, low-grade inflammation and telomere length., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The prevalence of malnutrition in nursing homes varies between 50% and 90% in Belgium. There are multiple causes of malnutrition and one of the consequences is the impact on the workload of nursing home staff. The purpose of this study is to better understand the knowledge and the practices of the nursing home staff who would influence the nutritional status of elderly in nursing homes. This study is divided into a quantitative approach with a self-administered questionnaire and a qualitative approach by non-participant observation. We observed that 29% of nursing home staff have good knowledge about the malnutrition and that 64% have good practices in providing nutrition to the elderly. People with good knowledge tend to have better practices. 38% of the nursing home staff engage in continued professional development in the field. There is no systematic screening, nutritional assessment and nutritional intervention in nursing homes. It is of great importance to ensure nursing home staff are aware of this problem through training.

Background/aim of the Study: Low-grade systemic inflammation was suggested to participate to the decline of physiological functions and increased vulnerability encountered in older patients. Geriatric syndromes encompass various features such as functional dependence, polymorbidity, depression and malnutrition. There is a strong prevalence of cardiovascular diseases and related risk factors and chronic cytomegalovirus infections in the geriatric population. As these underlying conditions were proposed to influence the inflammatory state, the aim of this study was to assess their potential contribution to the association of geriatric syndromes with inflammatory parameters., Methodology: We recruited 100 subjects in the general population or hospitalized for chronic medical conditions (age, 23-96 years). We collected information on clinical status (medical history, ongoing comorbidities, treatments and geriatric scales), biological parameters (hematological tests, cytomegalovirus serology) and cytokines production (basal and alum-induced interleukin (IL)-1β and IL-6 levels). Using stepwise backward multivariate analyses, we defined which set of clinical and biological variables could be predictive for increased inflammatory markers., Principal Findings: We confirmed the age-associated increase of circulating IL-6 levels. In contrast to geriatric scales, we found history of cardiovascular diseases to be strongly associated for this parameter as for high IL-6 production upon ex vivo stimulation with alum., Conclusions: Association between low-grade inflammation and geriatric conditions could be linked to underlying cardiovascular diseases.

Aging is associated with progressive alterations of immune functions, leading to higher susceptibility to bacterial and viral infections and reduced vaccine responses. Data concerning cytokine production in response to Toll-like receptor (TLR) ligands are highly variable in old people, reflecting the heterogeneity of the geriatric population. The aim of our study was to define the relative contribution of age and clinical status on TLR-induced interleukin (IL)-12p70 and IL-23 production as these cytokines play an important role in the protection against intracellular and extracellular pathogens, respectively. For this purpose, we recruited 100 subjects (aged 23-96 years) in the general population or hospitalized for chronic diseases. We collected information on clinical status (medical history, ongoing comorbidities, treatments and geriatric scales), biological parameters (biochemical and hematological tests, telomere length determination, cytomegalovirus serology). Whole blood samples were stimulated with a combination of TLR4 and TLR7/8 ligands. We performed univariate and stepwise backward multivariate analyses regression to define which set of clinical variables could be predictive for IL-12p70 and IL-23 production in these conditions. Our results indicated that age was not correlated with TLR-mediated IL-12p70 and IL-23 production. In contrast, poor nutritional status and frailty in subjects >75 years were associated with decreased IL-12p70 and IL-23 production. By intracytoplasmic staining, we confirmed that production of IL-12/23p40 by conventional dendritic cells (DCs) upon TLR ligation was decreased in frail patients. However, proportion of DCs and monocytes subsets, phenotypic maturation and proximal signaling events were found to be comparable in frail and healthy old subjects. These results suggest the importance of age-associated clinical parameters and not age by itself in the alteration of innate immune responses in old individuals and emphasis the importance of innate immune responses in the susceptibility of frail geriatric patients to infections.

Delirium is common in older people. It is a crucial diagnosis because it raises the morbidity and the mortality. Diagnostic tools like Mini Mental State Examination (MMSE), the confusion assessment method (CAM), and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV), can help with the diagnosis. We report a case of a woman with neurological symptoms which look like dementia. We diagnosed systemic lupus erythematosus (SLE). The apparition of late-onset SLE is more insidious, which leads to misdiagnosis. We will discuss about the difficulty of the differential diagnosis between delirium, depression and dementia in our patient and the difficulty to manage treatment of neurolupus in older people., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Anticoagulation therapy with anti-vitamin K (AVK; vitamin K antagonist) for the prevention of thromboembolism in patients with atrial fibrillation (AF) is based on information derived from numerous well constructed, randomized controlled trials. Despite this conclusive evidence of efficacy, several studies have shown that 'real world' use of AVK in patients with AF is suboptimal. Our hypothesis was that geriatric characteristics (functional impairment, cognitive disorders, malnutrition, risk for falls, depression) could be an explanation for the underprescription of AVK in older patients with AF., Objective: To analyse the barriers to the prescription of AVK therapy, with special attention on geriatric characteristics., Methods: This was a retrospective study of 768 consecutive geriatric patients admitted to an acute geriatric unit of an academic hospital between April 2006 and November 2008. Data from comprehensive geriatric assessments were collected from computerized medical charts., Results: Analysis of data from the 768 medical charts showed that 111 patients (14%) presented with AF. Among the 111 patients (72% women), 45% were living in an institution before admission. These patients presented a high prevalence of geriatric syndromes: cognitive disorders 59%, malnutrition risk 59%, incontinence 35%, depression 37%, and falls 61%. Ninety percent of the patients had an Identification of Seniors At Risk (ISAR) questionnaire score ≥2, which indicates an increased risk of frailty and functional decline during hospitalization. The prevalence of conditions measured by the CHADS(2) (congestive heart failure, hypertension, age >75 years, diabetes mellitus and previous stroke or transient ischaemic attack [TIA]) clinical prediction scale was as follows: heart failure 19%, hypertension 79%, age >75 years 95%, diabetes 15% and stroke 24%. The mean ± SD number of daily classes of drugs received at admission was 7.1 ± 3.3 (median 7, range 0-20). Forty-nine percent of patients had not received any AVK treatment before admission. The level of functional dependence for basic and instrumental activities of daily living did not differ between patients receiving AVK before admission and those not receiving AVK. Similarly, the proportion of geriatric problems (cognitive, malnutrition, depression and falls) did not differ between these two groups. To determine whether the decision to administer AVK therapy before admission was influenced by the risk of an embolic stroke, determined by the presence of CHADS(2) conditions, we compared the proportions of patients who fulfilled those conditions in each group: again, no difference was found., Conclusions: Almost half of the patients presenting with AF did not receive any AVK therapy before admission. In this population, in which most patients had multiple impairments, no single impairment or geriatric characteristic was identified as a barrier to AVK use. It is possible that combinations of impairments and geriatric characteristics were barriers to the prescription of AVK therapy across the whole of this population. More research is needed to identify and clarify the relative importance of patient-, physician- and healthcare system-related barriers to the prescription of AVK therapy in older patients with AF.

Comprehensive geriatric assessment (CGA) represents a multidisciplinary comprehensive evaluation of an older individual's functional status, comorbid medical conditions, cognition, psychological state, social support, nutritional status, and a review of the patient's medications. Initially, the use of a CGA in the care of older patients with cancer was based on an extrapolation of its ability to predict morbidity and mortality in the general geriatric population. More recently, however, accumulating data show the benefits of using a CGA particularly in patients with cancer to predict morbidity and mortality. Prospective trials evaluating the utility of a CGA to guide interventions to improve the quality of cancer care in older adults are justified.

Geriatric teams are more and more in front of patients presenting Parkinson syndromes. The frailty of the geriatric patient could be responsible of the non recognition of the diagnosis of the Parkinson and related diseases. A diagnostic approach is proposed in order to better define a care plan and to target the priorities. In collaboration with the general practitioner, the neurologist and the caregivers, an appropriate diagnosis allows to optimize and/or to adapt the treatment, to prevent the functional decline, to decrease the caregiver's burden, and eventually to improve the end of life.

Falls are one of the most common problems that threaten the independence of older individuals. They usually occur when impairments in multiple domains compromise the compensatory ability of the individual, as is the case for many geriatric syndromes. A number of the physical conditions and environmental situations predispose to falls. The medical risk factors of falls are reviewed. Falls in older individuals are rarely due to a single cause. Mechanisms that maintain postural stability are altered with aging (balance, gait speed, cardiovascular function). Female gender, past history of a fall, cognitive impairment, lower extremity weakness, balance problems, psychotropic drug use, arthritis, history of stroke, orthostatic hypotension, dizziness, and anemia represent the most frequent causes of risk of falls. Physical examination should focus upon the above mentioned risk factors and also on the presence of orthostatic hypotension, visual acuity, hearing assessment, examination of the extremities for deformities or neuropathies, and carotid sinus hypersensitivity which contributes to falls in people with unexplained falls. In conclusion, assessment of older individual at risk of falls or who fall present medical specificities. However, these latter specificities should be included in a comprehensive assessment which focus on intrinsic and extrinsic factors. Interventional strategies including comprehensive and interdisciplinary assessment lead to effective prevention.

A 18-year old patient presents abdominal pains associated with nausea and vomiting six weeks after a multiple trauma leading to paraplegia. Esophagitis, urolithiasis, and acalculous cholecystitis were diagnosed. This report illustrates two rare abdominal complications of a multiple trauma with immobilisation: acalculous cholecystitis, hypercalcaemia, coralliform urolithiasis following urinary infection and bacteriurie with Enterobacter Cloacae. The interpretation of the abdominal semiology of a multiple trauma's patient presenting long-term immobilization may be misleading.

Fear of falling and poor physical performance are prominent symptoms in many older people. The prevalence of fear of falling in community-living elderly ranges between 12 % and 65 %, and is higher in women than men. It commonly occurs after falls, but it also occurs without a previous fall history. One of the major consequences of fear of falling is the restriction and avoidance of activities. However, not all elderly with fear of falling avoid activities in daily life. Some elderly only become cautious, which may be functional in preventing falls. Only a small percentage of elderly show a pattern of excessive fear and restriction of activities. The consequences of this pattern may, however, be debilitating and devastating. Excessive fear and avoidance may compromise the quality of life, and may result in a decline of physical capabilities and, ultimately, in an increased risk of falls, which may further fuel fear and avoidance. Future research should investigate whether individualised intervention strategies are efficient in preventing falls and activity-related fear of falling within this population in order to improve her quality of life.

In a cross sectional study we determined prevalence of hypertension among institutionalized old subjects. Prevalence of hypertension was 69%. Among detected hypertensive patients, 76% received an antihypertensive drug treatment. 61% of the declared hypertensive patients and 80% of the treated hypertensive patients had their blood pressure controlled. The general practitioners should better detect and treat this common geriatric problem associated with a high comorbidity.

Hypertension is the most common chronic condition for which elderly people see a health provider and is increasing in prevalence as people age. The most powerful risk factor for death, cardiovascular death, and hypertension in large populations is age. In the very elderly patient the most common abnormality is elevated systolic blood pressure, which is much more predictive of stroke and heart disease death. With the exception of the Antihypertensive and Lipid Lowering to prevent Heart Attack Trial (ALLHAT), recent trials have emphasized the overriding importance of lowering blood pressure rather than the specific agent chosen to begin therapy. A metaanalysis of 7 clinical trials that enrolled 1.670 subjects > 80 years od age indicated that active antihypertensive drug therapy significantly reduce stroke by 34% and heart failure by 39% was associated with a non significant 6 increase in mortality. The Hypertension in the Very Elderly Trial (HYVET) will enrol 2.100 patients > 80 years of age and will compare 2 groups randomized to indapamide +/- perindopril versus placebo +/- placebo for incident stroke during 5 years follow-up. This study should answer lingering question about whether active antihypertensive therapy is associated with a major and significant reduction in cardiovascular morbidity and mortality in this age group as it clearly does in younger hypertensives. For frail patients, further studies are needed to assess the potential risks associated to antihypertensive therapy according to the characteristics of the geriatric patient.

Shiga-like toxin (SLT)-producing Escherichia coli (SLTEC) is the leading cause of acute renal failure among children. SLTEC are most commonly ingested from contaminated food, and because cattle are a major reservoir, ground beef and milk have been a significant source of contamination associated with multiperson outbreaks. While serotype O157:H7 has been principally identified in the United States there are many other SLTEC serotypes associated with human disease. We have therefore examined the utility of an enzyme immunoassay (EIA) for Shiga-like toxins as a means of detecting the presence of low levels of multiple SLTEC serotypes in ground beef and milk. In the present study we demonstrated that it is possible to detect low levels (approximately 1 SLTEC per g of ground beef) in both small-scale (2 g of beef per 5 ml) and standard large-scale (25 g of beef per 225 ml) food microbial cultures. The EIA was also capable of allowing detection of SLTEC in nonspiked retail ground beef samples: we were able to recover SLTEC isolates (O113:Hu; O22:H-; O82:H8) from 3 of 12 ground beef samples. The EIA detected SLTs produced in spiked milk samples when as few as 1 SLTEC per ml was added. Overall the EIA proved to be a highly sensitive way to detect the presence of SLTEC in either ground beef or milk samples after overnight enrichment culturing in an appropriate broth and should provide a rapid and convenient method for the detection of multiple pathogenic SLTEC serotypes.