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Resume A partir de deux cas cliniques frequemment rencontres dans la pratique geriatrique, nous avons revu les indications de prescription d’anticoagulants et leurs applications dans la population geriatrique. La decision d’instaurer un traitement anticoagulant chez une personne âgee est grave, les consequences pouvant en effet etre importantes. Le risque hemorragique doit etre mis en balance avec le risque embolique. L’un comme l’autre peut precipiter la degradation physique et cognitive et alterer fortement la qualite de vie. De nombreux facteurs doivent etre pris en consideration. Meme si l’utilisation des scores de risque doit etre conseillee, l’importance du travail d’equipe, de l’evaluation des fonctions cognitives et de la communication entre les intervenants medicaux et paramedicaux permettent de bien cerner le profil du patient. Le role du medecin generaliste est egalement important dans la surveillance de l’INR, meme si l’arrivee des nouveaux anticoagulants ne necessitant pas de suivi biologique resoudra peut-etre une partie du probleme de la surveillance therapeutique. Toutefois, l’utilisation de ce traitement chez les personnes âgees les plus vulnerables necessitera toujours une grande prudence. L’absence de recommandations claires pour les patients âges en fibrillation auriculaire necessite souvent des decisions au cas par cas.

Comparison of the first-generation Minimum Geriatric Screening Tools (MGST) and the third-generation interRAI Acute Care (interRAI AC). Based on a qualitative multiphase exchange of expert opinion, published evidence was critically analyzed and translated into a consensus. Both methods are intended for a multi-domain geriatric assessment in acute hospital settings, but each with a different scope and goal. MGST contains a collection of single-domain, internationally validated instruments. Assessment is usually triggered by care givers’ clinical impression based on geriatric expertise. A limited selection of domains is usually assessed only once, by disciplines with domain-specific expertise. Clinical use results in improvement to screen geriatric problems. InterRAI AC, tailored for acute settings, intends to screen a large number of geriatric domains. Based on systematic observational data, risk domains are triggered and clinical guidelines are suggested. Multiple observation periods outline the evolution of patients’ functioning over stay in comparison to the premorbid situation. The method is appropriate for application on geriatric and non-geriatric wards, filling geriatric knowledge gaps. The interRAI Suite contains a common set of standardized items across settings, facilitating data transfer in transitional care. The third-generation interRAI AC has advantages compared to the first-generation MGST. A cascade system is proposed to integrate both, complementary methods in practice. The systematic interRAI AC assessment detects risk domains. Subsequently, clinical protocols suggest components of the MGST as additional assessment This cascade approach unites the strength of exhaustive assessment of the interRAI AC with domain-specific tools of the MGST.

pnv.2011.0296 Auteur(s) : Jean Petermans President de la SBGG-BVGG Editorial Comme chaque annee, depuis 14 ans, les journees d’etudes organisees par l’aile francophone de la SBGG-BVGG se derouleront a Liege, en bord de Meuse, les 21 et 22 octobre 2011. Les differents volontaires participant a l’organisation de l’evenement n’ont pas menage leur peine pour une fois de plus, nous proposer un programme particulierement attrayant. Diverses sessions se derouleront le vendredi [...]

Swallowing disorders are common among elderly patients. Laryngeal penetration is among the most serious complications, resulting in airway obstruction, aspiration pneumonia or pneumonitis. Early diagnosis is therefore very important.The main objective of this study is to identify factors associated with anamnestic and clinical onset of laryngeal penetration.The study population is constituted of 127 consecutive patients hospitalized in our geriatric department. All following parameters were assessed: the patient's home, the reason for hospitalization, the medical history, treatment, anthropometric and biological parameters (nutritional status), a comprehensive geriatric assessment, a speech-language ability assessment and water swallow test according to DePippo method. All these parameters were correlated with the outcome of nasopharyngeal endoscopy.A total of 127 patients (mean age of 84 ± 5 years) (average score of MMSE of 22) were evaluated. Most of them came from their home. The mean values of the Katz and Lawton scales were 9 ± 5.5 and 27 ± 8, respectively. About two third of patients had mood disorders (GDS 1). A laryngeal penetration was present in 44% of cases. It occurred more frequently in patients taking neuroleptics, in those with a history of stroke, in case of extra-pyramidal syndrome or when the MMSE was pathological. The temporo-spatial disorientation, the presence of a salivary flow, the inability to perform adequately the different items of the speech-language evaluation and the failure to achieve proper water swallowing test were also related to the presence of laryngeal penetrations. With multivariate analysis, after adjusting for all significant variables, abnormal water swallowing test (P = 0.0002, OR 13) emerged as the sole independent parameter associated with laryngeal penetrations.Laryngeal penetration is associated with hospital mortality and impaired geriatric status. It could thus represent a marker of the overall frailty. In a frail geriatric population, the water-swallowing test helps to identify patients at risk of laryngeal penetration.

Summary Background/Aims: The aim of this study was to assess gait characteristics during simple and dual task in patients with mild cognitive impairment (MCI) and compare them with those of healthy elderly subjects and mild Alzheimer’s disease (AD) patients. Methods: We proposed a gait analysis to appreciate walking (simple task and dual task) in 14 MCI, 14 controls and six AD subjects who walked at their preferred speed. A 20-second period of stabilized walking was used to calculated stride frequency, stride length, symmetry and regularity. Speed walking was measured by electrical photocells. Results: Variables measured during simple and dual tasks showed an alteration of motor function as well in mild AD patients as in MCI patients. Conclusion: At the end of this preliminary study, we defined a specific gait pattern for each cognitive profile. Further researches appear necessary to enlarge the study cohort.

OBJECTIVES: To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU. DESIGN: Systematic review and meta-analysis based on literature search of multiple databases and the references lists of all identified articles and by contacting authors. SETTING: GEMUs. PARTICIPANTS: Elderly people admitted to a GEMU. MEASUREMENTS: Quality of the studies was assessed on 10 criteria. The outcome parameters were mortality, institutionalization, functional decline, readmission, and length of stay at different follow-up points. A random-effects meta-analysis was performed using Hedges' gu and variance of relative risk (RR). RESULTS: GEMUs are organized in a heterogeneous way and the included studies gave no thorough description of comprehensive geriatric assessment (CGA). Involvement of a multidisciplinary team was a key element in all GEMUs. The individual trials showed that admission to a GEMU has one or more favorable effects on the outcomes of interest, with two significant effects in the meta-analysis: less functional decline at discharge from the GEMU (RR=0.87, 95% confidence interval (CI)=0.77–0.99; P=.04) and a lower rate of institutionalization 1 year after discharge (RR=0.78, CI=0.66–0.92; P=.003). For the other outcomes in the meta-analysis, a GEMU did not induce significantly different outcomes than usual care. CONCLUSION: This meta-analysis shows a significant effect in favor of the GEMU group on functional decline at discharge and on institutionalization after 1 year. There is heterogeneity between the studies, poor quality of some randomized controlled trials, and shortage of information about CGA. Multidisciplinary CGA offered in a GEMU may add value to the care for frail older persons admitted to the hospital, but the limitations confirm the need for well-designed studies using explicit CGA and more-structured and -coherent assessment instruments such as the Minimum Data Set Resident Assessment Instrument.

This study describes the neuropsychological assessment of 34 patients with questionable Alzheimer's disease (QAD) followed up for 3 years. Several measures were selected from the California Verbal Learning Test (CVLT) and compared to other cognitive tasks to assess the best neuropsychological indices for (a) detecting early memory impairment in QAD and (b) predicting conversion to AD. Concerning detection, the results indicated that a recall measure depending on semantic categorization (short-delay cued recall) signaled a memory deficit in stable QAD patients, suggesting that episodic and semantic memory problems are involved in the early cognitive impairments of stable QAD patients. However, the conversion to AD was best predicted by the initial performance at the recency index (score reflecting high reliance on working memory), corroborating the idea that AD patients (even at the questionable stage) essentially rely on preserved phonological loop functioning in memory tasks. Finally, an additional impairment in visuospatial memory (Rey's figure) provided a good discriminant value to distinguish converters from stable QAD patients, showing that various cognitive disabilities deteriorate in AD.

Frailty is a major health condition associated with ageing. Although the concept is almost universally accepted, its operational definition remains controversial. Anyway, this geriatric condition represents a huge potential public health issue at both the patient and the societal levels because of its multiple clinical, societal consequences and its dynamic nature. Here, we review existing definitions and assessment tools for frailty, we highlight consequences of this geriatric condition and we discuss the importance of its screening and prevention to limit its public health burden.

L’esperance de vie dans l’Union europeenne (UE) et dans le monde est en croissance permanente. Dans ces conditions, le nombre de patients plus âges presentant les besoins medicaux complexes se developpe rapidement [1]. Par consequent, la connaissance des principes geriatrique et gerontologie dans toutes les disciplines des soins de sante est indispensable, de meme qu’une professionnalisation et une specialisation en medecine geriatrique sont devenues obligatoire [2]. L’Organisation [...]

Introduction et but de l’etude La sarcopenie est definie par une perte progressive et generalisee de la masse musculaire et de la fonction musculaire avec l’avancee en âge. L’objectif de notre etude et d’evaluer l’etat nutritionnel de sujets atteints de sarcopenie et d’identifier les composantes de la sarcopenie pouvant etre correlees a l’etat nutritionnel. Materiel et methodes Des sujets de plus de 65 ans ont ete recrutes a la polyclinique Lucien-Brull a Liege en Belgique. La sarcopenie a ete diagnostiquee selon l’algorithme propose par l’European Working Group in Sarcopenia in Older People (EWGSOP). La masse musculaire a ete mesuree par un examen d’absorptiometrie biphotonique a rayons X (DXA), la force musculaire a ete mesuree par un dynamometre hydraulique a main et la performance physique a ete mesuree par le test du Short Physical Performance Battery (SPPB test). L’etat nutritionnel a, quant a lui, ete mesure par le Mini-Nutritional Assessment (MNA). Ce questionnaire comprend deux parties. Un score de minimum 12 points a la premiere partie indique un bon etat nutritionnel du sujet. En revanche, si le score est inferieur a 12 points, la seconde partie du questionnaire doit etre completee. Un score de minimum 24 points sur 30 points indique un bon etat nutritionnel, un score compris entre 17 et 23,5 points indique un risque de malnutrition et un score inferieur a 17 points indique une malnutrition du sujet. Resultats et analyse statistique Au total ; 534 sujets d’un âge moyen de 73,5 ± 6,16 ans ont ete recrutes pour cette etude. La prevalence de la malnutrition s’elevait a 1,87 %. Par ailleurs, 67 sujets (12,5 %) ont egalement ete diagnostiques a risque de malnutrition. Dans la population recrutee, 73 patients etaient atteints de sarcopenie. Chez ces patients, 6,85 % etaient atteints de malnutrition (contre 1,08 chez les sujets non sarcopeniques, p Conclusion Meme si la prevalence de la malnutrition reste faible dans notre population, elle est neanmoins plus frequemment observee chez des sujets atteints de sarcopenie. De plus, la malnutrition semble correlee a la performance physique des sujets atteints de sarcopenie. Il est donc important de tenir compte du parametre nutritif dans la prise en charge multidisciplinaire de la sarcopenie.

Objective: to prevent the occurrence of weight loss during hospitalisation and following discharge by daily oral supplementation. Design: in a prospective, randomised, controlled study of 80 patients aged 75 or more, and at risk of undernutrition based on their initial Mini Nutritional Assessment score, patients were randomised into a control group or one receiving oral supplementation. The intervention was a prescription of 200 ml sweet or salty sip feed twice daily (500 kcal, 21 g protein per day) throughout hospitalisation and convalescence. Nutritional status was assessed at baseline and after 2 months using Mini Nutritional Assessment and body weight record. Results: compliance with oral supplementation was good and daily extra energy intake was 407"184 kcal. On day 60, significant weight loss from upon admission was observed in the control group (1.23"2.5 kg; P=0.01), but not in the supplemented group (0.28"3.8 kg; NS). At the end of the study, Mini Nutritional Assessment scores were higher in the supplemented group than in the control group (23.5"3.9 versus 20.8"3.6; P-0.01). Conclusion: use of daily oral supplementation during and after hospitalisation maintains body weight and increases Mini Nutritional Assessment score in patients at risk of undernutrition.

Summary: This consensus article reviews the diagnosis and treatment of osteoporosis in geriatric populations. Specifically, it reviews the risk assessment and intervention thresholds, the impact of nutritional deficiencies, fall prevention strategies, pharmacological treatments and their safety considerations, the risks of sub-optimal treatment adherence and strategies for its improvement. Introduction: This consensus article reviews the therapeutic strategies and management options for the treatment of osteoporosis of the oldest old. This vulnerable segment (persons over 80years of age) stands to gain substantially from effective anti-osteoporosis treatment, but the under-prescription of these treatments is frequent. Methods: This report is the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores some of the reasons for this and presents the arguments to counter these beliefs. The risk assessment of older individuals is briefly reviewed along with the differences between some intervention guidelines. The current evidence on the impact of nutritional deficiencies (i.e. calcium, protein and vitamin D) is presented, as are strategies to prevent falls. One possible reason for the under-prescription of pharmacological treatments for osteoporosis in the oldest old is the perception that anti-fracture efficacy requires long-term treatment. However, a review of the data shows convincing anti-fracture efficacy already by 12months. Results: The safety profiles of these pharmacological agents are generally satisfactory in this patient segment provided a few precautions are followed. Conclusion: These patients should be considered for particular consultation/follow-up procedures in the effort to convince on the benefits of treatment and to allay fears of adverse drug reactions, since poor adherence is a major problem for the success of a strategy for osteoporosis and limits cost-effectiveness.

Background Sarcopenia is defined as a progressive and generalized loss of muscle mass with either a loss of muscle strength or a loss of physical performance but there is no recommendation regarding the diagnostic tools that have to be used. In this study, we compared the prevalence of sarcopenia assessed using different diagnostic tools. Methods To measure muscle mass, muscle strength and physical performance, we used for each outcome two different diagnostic tools. For muscle mass, we used Dual Energy X-Ray Absorptiometry (DXA) and bio-electrical impedance analysis (BIA); for muscle strength, we used a hydraulic dynamometer and a pneumatic dynamometer; for physical performance we used the Short Physical Performance Battery test (SPPB test) and the walk speed. Eight diagnostic groups were hereby established. Results A total of 250 consecutive subjects were recruited in an outpatient clinic in Liege, Belgium. Estimated prevalence of sarcopenia varied from 8.4% to 27.6% depending on the method of diagnosis used. Regarding muscle mass, BIA systematically overestimated muscle mass compared to DXA (mean estimated prevalence with BIA = 12.8%; mean prevalence with DXA = 21%). For muscle strength, the pneumatic dynamometer diagnosed twice more sarcopenic subjects than the hydraulic dynamometer (mean estimated prevalence with PD = 22.4%; mean estimated prevalence with HD = 11.4%). Finally, no difference in prevalence was observed when the walking speed or the SPPB test was used. A weak overall kappa coefficient was observed (0.53), suggesting that the 8 methods of diagnosis are moderately concordant. Conclusion Within the same definition of sarcopenia, prevalence of sarcopenia is highly dependent on the diagnostic tools used.

P-197 Development and validation of a self-administrated quality of life questionnaire specific to sarcopenia: the SarQoL C. Beaudart, J.-Y. Reginster, R. Rizzoli, E. Biver, Y. Rolland, I. Bautmans, J. Petermans, S. Gillain, F. Buckinx, J. Van Beveren, M. Jacquemain, P. Italiano, N. Dardenne, O. Bruyere University of Liege, Liege, Belgium; University of Liege, Liege, Belgium; Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Gerontologie clinique et medecine interne, Toulouse; Belgium; Chu Liege, Chenee, Belgium

Background Currently, there is growing evidence that vitamin D plays a role on several tissues including skeletal muscle. Previous studies suggested that vitamin D deficiency is associated with low muscular strength. The objective of this meta-analysis is to summarize the effects of vitamin D supplementation on muscle strength. Methods A systematic research of randomized controlled trials (RCTs) assessing the effect of …

The reduced muscle mass and impaired muscle performance that define sarcopenia in older individuals are associated with increased risk of physical limitation and a variety of chronic diseases. They may also contribute to clinical frailty. A gradual erosion of quality of life (QoL) has been evidenced in these individuals, although much of this research has been done using generic QoL instruments, particularly the SF-36, which may not be ideal in older populations with significant comorbidities. This review and report of an expert meeting presents the current definitions of these geriatric syndromes (sarcopenia and frailty). It then briefly summarizes QoL concepts and specificities in older populations and examines the relevant domains of QoL and what is known concerning QoL decline with these conditions. It calls for a clearer definition of the construct of disability, argues that a disease-specific QoL instrument for sarcopenia/frailty would be an asset for future research, and discusses whether there are available and validated components that could be used to this end and whether the psychometric properties of these instruments are sufficiently tested. It calls also for an approach using utility weighting to provide some cost estimates and suggests that a time trade-off study could be appropriate. © 2013 Springer Science+Business Media New York.

Introduction et but de l’etude L’impact de la sarcopenie sur la qualite de vie est actuellement etudie au moyen de questionnaires de qualite de vie generiques. Toutefois, ces questionnaires ne sont pas toujours appropries a des pathologies specifiques telles que la sarcopenie. L’objectif de notre etude consiste donc a developper et valider un questionnaire de qualite de vie specifique a la sarcopenie pour Sarcopenia Q – reduction des items ; – developpement des questions ; – pre-test du questionnaire. La validation du questionnaire SarQoL® a ete realisee par la verification des proprietes psychometriques suivantes : puissance discriminative (regression logistique), coherence interne (α de Cronbach), validite de construit (correlation de Spearman), fiabilite test-retest (ICC) et effets de plancher et de plafond. Resultats et analyse statistique Le questionnaire SarQoL® est compose de 55 items, repartis en sept domaines de qualite de vie, retranscrits sous forme de 22 questions. Le pre test du questionnaire indique que le SarQoL® se complete facilement, en 10 min environ, de maniere independante. Au total, 296 sujets d’un âge moyen de 74,2 ± 6,1 ans ont ete inclus dans la phase de validation du questionnaire. Parmi ces sujets, 43 etaient atteints de sarcopenie. Apres ajustement sur des variables potentiellement discriminantes, le score total (sur 100) du questionnaire SarQoL® pour les sujets atteints de sarcopenie est significativement inferieur au score des sujets non sarcopeniques (55,9 ± 13,4 pour les sujets atteints de sarcopenie contre 68,1 ± 14,9 pour les non sarcopeniques, p Conclusion Le premier questionnaire de qualite de vie specifique a la sarcopenie developpe est comprehensible par la population cible. Ce questionnaire SarQoL®, developpee en francais, est valide, coherente et fiable et peut de ce fait etre recommandee dans un cadre de recherche ou dans un cadre clinique. La sensibilite au changement du questionnaire SarQoL® doit encore ete evaluee.

Introduction et but de l’etude Comparer la teneur en energie et en proteines des repas servis et reellement consommes dans deux maisons de repos belges. Materiel et methodes La teneur en nutriments des repas servis et reellement consommes par les sujets residant en maison de repos est calculee durant 5 jours consecutifs par la methode des pesees alimentaires. La difference entre les apports alimentaires servis et reellement consommes est evaluee au moyen du test de Chi 2 . Resultats et analyse statistique Un total de 56 sujets âges de 86,6 ± 7,01 ans en moyenne et majoritairement de sexe feminin (71,4 %), provenant de deux maisons de repos situees a Liege en Belgique, a ete inclus dans l’etude. Ces sujets avaient, en moyenne, un indice de masse corporelle de 24,8 ± 4,85 kg/m 2 ; un score au test de Tinetti de 21,6 ± 6,05 points et un Mini Mental State Examination de 22,3 ± 6,61 points. Parmi ces 56 sujets, 36 (64,3 %) avaient un statut nutritionnel, mesure au moyen du Mini Nutritional Assessement , considere comme normal, 18 sujets (32,2 %) etaient a risque malnutrition, tandis que deux sujets (3,57 %) etaient malnutris. Les repas servis en maison de repos apportaient en moyenne 1748,2 ± 126,6 kcal par jour. Cependant, les residents ne mangent pas la totalite des repas servis. En effet, leur consommation energetique moyenne etait de 1570,4 ± 314,9 kcal. La difference entre l’energie servie et l’energie consommee etait statistiquement significative ( p p = 0,63). Les sujets presentant un statut nutritionnel normal, selon le MNA, ont consomme significativement plus de calories (1631,3 ± 261,8 kcal) que les sujets malnutris ou a risque de malnutrition (1454,9 ± 377,5 kcal) ( p = 0,05). Etonnamment, aucune difference significative entre ces groupes n’a pas ete observee pour la consommation de proteines ( p = 0,07), mais nous admettons que notre echantillon est assez petit. D’une maniere interessante, l’energie apportee par les repas et l’energie consommee par les residents etaient significativement differentes entre les deux maisons de repos etudiees ( p p = 0,02 respectivement). Au contraire, nous n’avons pas observe de difference entre les deux maisons de repos en ce qui concerne l’apport et la consommation de proteines. Conclusion Les repas servis en maison de repos ne sont pas entierement consommes par les residents. Effectivement, la quantite de calories consommee est significativement inferieure a la quantite de calories reellement consommees. Cependant, les residents consomment la totalite des proteines servies. Les besoins nutritionnels des personnes residant en maison de repos necessitent des investigations complementaires.

Objectifs : L’objectif de l’etude est de verifier l’interet de la Vibrosphere™ dans la reeducation des patients geriatriques chuteurs. Materiels et methodes : 24 sujets d’âge moyen 85,5 ans, hospitalises en service de geriatrie pour une chute durant les 6 derniers mois, ont ete divises en deux populations. Une reeducation classique est proposee a la premiere, la deuxieme beneficiant d’une reeducation sur Vibrosphere™. La reeducation a dure 9 jours. L’evaluation est realisee aux jours 0 et 10, par un test de marche (Locometrix ®), une evaluation du maintien postural, un Timed-up and go, et le Falls efficacy scale. Un groupe controle de 20 sujets, d’âge moyen 79,9 ans, non-chuteurs a ete constitue. Resultats : Au sein de la deuxieme population, une amelioration ( p < 0,05) de la vitesse de marche est observee, ainsi qu’une tendance a l’amelioration de la frequence, de la longueur, de la symetrie et de la regularite des pas. Le maintien postural est ameliore a l’issue des 9 jours de reeducation sur Vibrosphere™. Les 2 types de reeducations ont permis d’obtenir des benefices similaires au niveau de la marche et de l’equilibre. Conclusion : Cette etude confirme l’efficacite de la reeducation pour une duree de traitement relativement breve. Les ameliorations constatees montrent que la Vibrosphere™ est un outil adapte a la reeducation de patients geriatriques chuteurs. En permettant l’amelioration des qualites d’equilibre, la Vibrosphere™ entrainerait des benefices sur la marche. Cette technique complementaire a la reeducation peut etre integree dans la revalidation d’une personne âgee hospitalisee.

It is important to focus on how we deliver the most acute stages of hospital care when acute medical admissions are likely to comprise older patients with multimorbidity, frailty, and polypharmacy.1 A recent Cochrane review showed that the acute geriatric medicine model was extremely efficient, with substantial reductions in death, disability, and institutionalisation compared with …

A systematic review of the international literature concerning the organisation of the Geriatric Day Hospital (GDH) was performed. From 1987 till now, few papers were found describing the activity and the effectiveness of the GDH. All the studies comparing specific geriatric approaches to regular medicine demonstrate the efficiency of geriatric care, particularly the geriatric assessment. So, with a degree of evidence 1a, a better outcome is found for patients undergoing a geriatric assessment and intervention, compared to patients having no geriatric assessment at all. However, there is no evidence of benefit for the geriatric day hospital compared to patients treated in a geriatric ward or other location of geriatric care. Moreover, there is no clear consensus on the settings and activities of a geriatric day hospital. Terms as day unit, day hospital, day care, are used interchangeably and are not always covering the same activity. The same remark can be made on the exact composition of the geriatric multidisciplinary team and its role. However nurses and paramedical workers are always mentioned as all performing geriatric assessment. The diagnostic activities on the GDH are seldom described and studied. More information is available on rehabilitation activity, often developed in specific patient populations such as stroke patients, dementia patients, cardiac patients or patients with other chronic diseases. In this selected patient populations positive effects on outcome are shown in the GDH (level of evidence 1a). Another problem is the heterogeneity of the population. For scientific reason the GDH should focus on organising care for specific medical problems. Diseases as dementia, stroke, cardiac insufficiency, could be good models to investigate the efficiency of geriatric assessment and interventions within the setting of a GDH.

To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU.Systematic review and meta-analysis based on literature search of multiple databases and the references lists of all identified articles and by contacting authors.GEMUs.Elderly people admitted to a GEMU.Quality of the studies was assessed on 10 criteria. The outcome parameters were mortality, institutionalization, functional decline, readmission, and length of stay at different follow-up points. A random-effects meta-analysis was performed using Hedges' gu and variance of relative risk (RR).GEMUs are organized in a heterogeneous way and the included studies gave no thorough description of comprehensive geriatric assessment (CGA). Involvement of a multidisciplinary team was a key element in all GEMUs. The individual trials showed that admission to a GEMU has one or more favorable effects on the outcomes of interest, with two significant effects in the meta-analysis: less functional decline at discharge from the GEMU (RR=0.87, 95% confidence interval (CI)=0.77-0.99; P=.04) and a lower rate of institutionalization 1 year after discharge (RR=0.78, CI=0.66-0.92; P=.003). For the other outcomes in the meta-analysis, a GEMU did not induce significantly different outcomes than usual care.This meta-analysis shows a significant effect in favor of the GEMU group on functional decline at discharge and on institutionalization after 1 year. There is heterogeneity between the studies, poor quality of some randomized controlled trials, and shortage of information about CGA. Multidisciplinary CGA offered in a GEMU may add value to the care for frail older persons admitted to the hospital, but the limitations confirm the need for well-designed studies using explicit CGA and more-structured and -coherent assessment instruments such as the Minimum Data Set Resident Assessment Instrument.

In the elderly, gait disorders and cognitive frailty may influence each other and increase the risk of falling. The aim of the present study was to determine gait parameters in elderly people with different cognitive profiles (controls, individuals with mild cognitive impairment [MCI] and Alzheimer's disease [AD] patients) with the Locometrix® three-axis accelerometer and establish whether or not this tool is more useful than conventional clinical tests (the timed “get up and go” test, the pull test and the single-leg balance test). Study subjects were all over 65, living at home and free of known gait impairments. A neuropsychological battery was applied to 14 control subjects, 14 MCI subjects and six AD patients. A motor evaluation (in single- and dual-task paradigms) was performed with three conventional clinical tests and the Locometrix® (standardized gait). Our results showed that in a single-task paradigm, the Locometrix® was more accurate than validated, conventional tests and generated a characteristic gait profile for each of the three cognitive profiles. In a dual-task paradigm, the gait of MCI subjects more closely resembled that of AD patients than that of control subjects. We conclude that the Locometrix® is a high-performance tool for defining gait profiles, which correspond to given cognitive profiles. The use of a dual-task paradigm is a good way to screen for gait abnormalities in MCI.

P108 What are the clinical characteristics of patients improving their gait and body balance with whole body vibration? Results of a 3-month randomized controlled trial C. Beaudarta, F. Buckinxa, D. Maquetb, J.-M. Crielaardb, J.-Y. Reginstera, O. Bruyerea,b a Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium b Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium

Originally, sarcopenia refers to the age-related decline in lean body mass. In fact, most human physiologic systems decrease with ageing, independently of substantial disease effects, at an average linear loss rate of 0.3-1.3% per year between the age of 30 and 70 years. Conceptually, sarcopenia can therefore be considered as the effect of ageing on muscle mass; a phenomenon occurring in all ageing humans and animals. At the level of the muscle itself, sarcopenia is characterized by loss of muscle fibers and atrophy of the remaining muscle cells. This phenomenon is strongly related to increased levels of inflammatory markers in the blood circulation, especially interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha, which are known to have cytotoxic and proteolytic properties. In fact, during normal aging circulating levels of inflammatory cytokines such as IL-6 and TNF-alpha become slightly elevated, a phenomenon corresponding to a chronic low-grade inflammatory profile. Several clinical situations and contextual factors which are accompanied by acute elevations of inflammation can provoke a dramatic acceleration of the process, thus leading to loss of physical dependency in the elderly patient. A supplementary element in this context is the fact that the muscle weakness due to sarcopenia is more important than can be explained by atrophy alone. Moreover, the required muscle components mandatory for physical independency show high inter-individual variability and depend on both intrinsic factors (body weight, co-morbidity, etc.) and external factors (physical environment of the patient, etc.). In geriatric practice, the assessment of muscle performance might therefore be more instructive for clinical decision making, rather than muscle mass. Since daily activities in the elderly often require sustained intense muscle contractions (e.g. when bearing shopping bags), these may be more challenging given the reduced muscle strength, and could explain the common sensation of fatigue. This tiredness duringdaily activities is not a trivial symptom but a predictor of disability and mortality in older individuals. In a general population, the sensation of fatigue is very common and predominantly present in residents of long-term care facilities. In our recent studies, we have shown that muscle endurance, self-perceived fatigue, mobility and inflammation are significantly interrelated in elderly persons. In the clinical context, muscle endurance can be evaluated using a simple test based on grip strength. This lecture will provide a brief overview of the underlying mechanisms of sarcopenia and focus on the role of inflammation, muscle weakness and fatigue on the functional mobility in elderly patients.

Finding a biomarker of long length-of-stay (LOS) would provide a simple solution to target frail older inpatients at such risk. The aim of this study was to determine whether serum 25-hydroxyvitamin D (25OHD) deficiency, defined as serum concentration 14 days; n=120) versus the other two tertiles combined (

Background In order to address the challenges of an ageing population the Belgian government decided to allocate resources to the creation of geriatric day hospitals (GDHs). Although GDHs are meant to be a strategy to support general practitioners (GPs) caring for the frail elderly, few Belgian GPs seem to refer to a GDH. This study aims to explore the barriers and facilitating factors of GPs' referral to GDHs. Methods A qualitative study using focus group discussions (FGDs) was conducted. Fifteen FGDs were organized in the different Belgian regions (Flanders, Wallonia, Brussels). Results Contextual factors such as the unsatisfactory cooperation between hospital and GPs and organizational barriers such as the lack of communication on referral procedures between hospital and primary health care (PHC) were identified. Lack of basic knowledge about the concept or the local organization of GDH seemed to be a problem. Unclear task descriptions, responsibilities and activities of a GDH formed prominent points of discussion in all FGDs. Nevertheless a lot of possible advantages and disadvantages of GDHs for the patient and for the GP were mentioned. Conclusions In the case of poor referral to GDHs, focusing on improving overall collaboration between primary and secondary health care is essential. This can be achieved by actively delivering adequate information, permanent communication and more involvement of PHC in the organization and functioning of GDHs. The absence of a transparent health care system with delineated role definitions, seems to hinder the integration of new initiatives like GDHs in the care process. Strategies to enhance referral to GDHs should use a comprehensive approach.

The authors studied muscular blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) in 5 patients suffering from severe intermit tent claudication (stage II). They applied the bolus technique of H2150 and 1502 with a detection by positron emission tomography (PET). Tomograms were recorded at the greatest diameter of the calfs, at rest and ten minutes after a treadmill walk test leading to the development of ischemic pain in the affected extremity. F and E data were compared with the values obtained by more usual methods, namely occlusive venous strain gauge plethysmography and femoral venous blood sampling. During the study, these patients received naftidrofuryl, a vasodilatator drug, in an intravenous dose of 600 mg diluted in 250 mL saline infused over a six- hour period in a placebo-controlled, double-blind, crossover protocol (two con secutive experiments, a week apart). The results showed that all blood flow values measured at rest and after ex ercise by PET were in close correlation (r = 0.71) with the plethysmographic findings. The agreement between the two methods of measuring blood flow was less obvious with an Altman's presentation of the data: there was a tendency to measure higher values with PET scan. Concerning E, the correlation was poor at rest. After exercise, the values were more elevated with PET and no correlation was found with blood samples. The authors found no significant effect of naftidrofuryl either on flow or metabolic data.

Contains fulltext : 87746.pdf (Publisher’s version ) (Closed access) This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert's opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP's intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver's confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a "case finding" strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies 'typical' cases. In typical cases, among older subjects, the diagnosis of "probable AD" can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and "emergency" hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients' right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force. 01 februari 2010