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OBJECTIVES: To describe the evolution of prevalence of depressive symptoms and antidepressant use between 1988 and 1999 in a large representative sample of older community-dwelling French people. DESIGN: Prospective cohort designed in 1988/89 to study cerebral and functional aging. SETTING: Urban and rural communities in southwestern France. PARTICIPANTS: Three thousand six hundred thirty-seven adults aged 65 and older living in noninstitutional settings at baseline. MEASUREMENTS: Participants were interviewed 3, 5, 8, and 10 years after the initial data collection. Depressive symptomatology was evaluated using a French version of the Center for Epidemiological Studies Depression Scale. Longitudinal analysis of the prevalence of depressive symptomatology was performed using a logistic mixed model adjusted for antidepressant use, sex, age, education level, living conditions, psychiatric antecedents, drug consumption, and diagnosis of dementia. RESULTS: Over the 10 years of follow-up, the prevalence of depressive symptomatology decreased from 13.8% to 8.3%. This decrease was statistically significant even after adjustment (odds ratio = 0.88 per increased year, 95% confidence interval = 0.85-0.90) and was more pronounced in subjects having reported previous depression at baseline. During the same period, antidepressant use rose from 5.2% to 11.9%, mainly due to increased use of selective serotonin reuptake inhibitors. Furthermore, the proportion of subjects who had depressive symptoms and did not use antidepressants decreased from 11.8% to 6.2%. CONCLUSION: This study suggests better management of late-life depression in the last decade and illustrates the heterogeneity of depression disorder in late life. [ABSTRACT FROM AUTHOR]

Background: The prognostic assessment of older cancer patients is complicated by their heterogeneity. We aimed to assess the prognostic value of routine inflammatory biomarkers., Methods: A pooled analysis of prospective multicenter cohorts of cancer patients aged ≥70 was performed. We measured CRP and albumin, and calculated Glasgow Prognostic Score (GPS) and CRP/albumin ratio. The GPS has three levels (0 = CRP ≤ 10 mg/L, albumin ≥ 35 g/L, i.e., normal values; 1 = one abnormal value; 2 = two abnormal values). One-year mortality was assessed using Cox models. Discriminative power was assessed using Harrell's C index (C) and net reclassification improvement (NRI)., Results: Overall, 1800 patients were analyzed (mean age: 79 ± 6; males: 62%; metastases: 38%). The GPS and CRP/albumin ratio were independently associated with mortality in patients not at risk of frailty (hazard ratio [95% confidence interval] = 4.48 [2.03-9.89] for GPS1, 11.64 [4.54-29.81] for GPS2, and 7.15 [3.22-15.90] for CRP/albumin ratio > 0.215) and in patients at risk of frailty (2.45 [1.79-3.34] for GPS1, 3.97 [2.93-5.37] for GPS2, and 2.81 [2.17-3.65] for CRP/albumin ratio > 0.215). The discriminative power of the baseline clinical model (C = 0.82 [0.80-0.83]) was increased by adding GPS (C = 0.84 [0.82-0.85]; NRI events (NRI+) = 10% [2-16]) and CRP/albumin ratio (C = 0.83 [0.82-0.85]; NRI+ = 14% [2-17])., Conclusions: Routine inflammatory biomarkers add prognostic value to clinical factors in older cancer patients.

Context: The role of comprehensive geriatric assessment for older patients with advanced chronic kidney disease still needs to be defined. In this population, data is lacking on the care proposals made by geriatricians during comprehensive geriatric assessment and on the follow-up of these proposals., Objectives: To describe a population of older outpatients with advanced renal disease seen at a geriatric consultation, and geriatric syndromes identified. To study care suggestions made by the geriatrician, and the follow-up of these suggestions., Methods: Retrospective monocentric study, including all outpatients treated with hemodialysis and seen at the geriatric consultation implemented in a dialysis facilities network in Aquitaine region, France, from 2014 to 2017. Six domains were analysed: functional independence, cognition, gait/balance, mood, nutrition and drug prescription., Results: Among 49 patients, mean age 79 years, 50% had a loss of independence, 32% cognitive impairment, 24% mood disturbance, 55% gait or balance disturbance, and 65% potentially inappropriate medications. The most frequent care suggestions of the geriatrician were drugs optimisation, intervention of a psychologist, a dietetician or a speech and language therapist, home support service implementation, and the exploration of cognitive impairment. Suggestions of intervention of other healthcare professionals, drug optimisation and biological/imaging tests were followed in respectively 46, 33 and 18% of cases., Conclusion: A geriatric outpatient consultation in a nephrology facility allows identification of frequent and multiples geriatric syndromes, requiring coordinated interventions. Collaboration between healthcare professionals, including a geriatrician, should be reinforced to improve design and follow-up of the individualised care plan for older patients with advanced chronic kidney disease., (Copyright © 2020 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: Clinical experience suggests that functional decline (FD) during treatment may have a major adverse impact on outcome. Geriatric assessment of older patients before cancer treatment is usually based on use of a screening tool (such as G8) followed by comprehensive geriatric assessment (CGA). However, many oncology teams cannot implement geriatric oncology management due to non-availability of geriatricians. Consequently, we decided to evaluate whether a procedure using G8 and routinely available factors could help oncologists foresee the outcome in patients ≥70: we firstly evaluated whether functional decline is a determinant of early death, then searched for predictors of early functional decline (measured before initiation of the second cycle of chemotherapy), including G8 but voluntarilly excluding CGA., Methods: We tested the value of clinical, biological factors and early FD to predict early death on a cohort of 292 patients (≥70 years) treated with first-line chemotherapy. We then used a logistic regression model to search for pretreatment predictors of FD, including the same factors and G8 but excluding CGA., Results: FD occurred in 48 patients. In multivariate analyses, early FD (OR = 4.13, 95% CI [1.89; 9.04], p < .01), disease extension (OR = 4.55, 95% CI [1.96; 10.57]; p < .01), and being male (OR = 2.59, 95% CI [1.12; 5.97], p = .02) were significant prognostic factors for early death; G8 was the only significant factor associated with FD (OR = 4.38, 95% CI [1.28; 14.92], p = .018)., Conclusions: FD has an important prognostic significance in patients ≥70 treated with chemotherapy, and G8 predicts for its occurrence. These data reinforce the routine use of G8 in the management of these patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The absence of fever in bacteremia in patients who are older is known to delay diagnosis. Our objective was to determine whether atypical presentation was associated to mortality as a result of bacteremia in this patient cohort as well as possible factors associated with this atypical presentation., Methods: We conducted an observational prospective study in 2 French university hospitals in 2016-2017 including patients ages ≥75 years with bacteremia. Atypical presentation was defined as the absence of a temperature ≥38.3°C or <36°C, chills, or hypotension. Mortality and dependence for activities of daily living (ADL) were recorded at 1 week (D7) and 3 months (D90)., Results: Among the 151 patients (mean age 85.4±5.8 years) enrolled, atypical presentation prevalence was 21.2%. D7 and D90 mortality rates were 7.9% and 40.0%, respectively. Atypical presentation was independently associated with D7 (odds ratio (OR) 4.46, 95% confidence interval (CI) 1.04-19.24) and D90 mortality (OR 3.76, 95% CI 1.30-10.92) after controlling for other prognostic factors. Patients with diabetes and those infected with Staphylococcus aureus were more likely to have atypical signs of infection. ADL score decreased from 3.6±2.0 before bacteremia to 2.8±2.1 at D90 (P <0.001)., Conclusion: Patients who are older with bacteremia have poor vital and functional prognoses in the short and long terms. The absence of typical signs of infection is associated with mortality. Blood culture should be considered for patients who are older, especially with diabetes with acute unexplained clinical manifestations., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Previous studies have reported on the higher risk of functional decline among older patients with cancer. However, few have focused on factors of functional decline in older persons with cancer and are mainly hospital-based and focus on consequences of cancer treatment. The aim of the study was to identify determinants of functional decline in older subjects with cancer in a population-based study., Methods: Using cancer registries, we identified older subjects (age ≥ 65 years) with cancer in three prospective cohort studies from Gironde, a French department. Functional status was measured using the Instrumental Activities of Daily Living (IADL) and the basic Activities of Daily Living (ADL) scales, and functional decline was measured between cancer pre- and post-diagnosis visits. Studied variables were demographic and socioeconomic (age at diagnosis, sex, living alone, education), cancer-related (stage at diagnosis, treatment received), smoking status, health-related (polypharmacy, depressive symptomatology), and geriatric-specific (cognitive impairment or dementia). Analyses were performed using logistic regression models., Results: Age (≥85 years), cognitive impairment or dementia, and advanced stage at diagnosis were associated with a higher risk of ADL limitations, whether considering death or not. Age (≥85 years), education and polypharmacy were associated with a higher risk of ADL and/or IADL limitations., Conclusions: We identified factors that could impact on ADL and/or IADL limitations in older patients with cancer. The information on these determinants is useful in clinical settings to identify patients with cancer at high risk of functional decline., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Recent research suggests that sleep disorders or changes in sleep stages or EEG waveform precede over time the onset of the clinical signs of pathological cognitive impairment (e.g., Alzheimer's disease). The aim of this study was to identify biomarkers based on EEG power values and spindle characteristics during sleep that occur in the early stages of mild cognitive impairment (MCI) in older adults. Methods: This study was a case-control cross-sectional study with 1-year follow-up of cases. Patients with isolated subjective cognitive complaints (SCC) or MCI were recruited in the Bordeaux Memory Clinic (MEMENTO cohort). Cognitively normal controls were recruited. All participants were recorded with two successive polysomnography 1 year apart. Delta, theta, and sigma absolute spectral power and spindle characteristics (frequency, density, and amplitude) were analyzed from purified EEG during NREM and REM sleep periods during the entire second night. Results: Twenty-nine patients (8 males, age = 71 ± 7 years) and 29 controls were recruited at T0. Logistic regression analyses demonstrated that age-related cognitive impairment were associated with a reduced delta power (odds ratio (OR) 0.072, P < 0.05), theta power (OR 0.018, P < 0.01), sigma power (OR 0.033, P < 0.05), and spindle maximal amplitude (OR 0.002, P < 0.05) during NREM sleep. Variables were adjusted on age, gender, body mass index, educational level, and medication use. Seventeen patients were evaluated at 1-year follow-up. Correlations showed that changes in self-reported sleep complaints, sleep consolidation, and spindle characteristics (spectral power, maximal amplitude, duration, and frequency) were associated with cognitive impairment ( P < 0.05). Conclusion: A reduction in slow-wave, theta and sigma activities, and a modification in spindle characteristics during NREM sleep are associated very early with a greater risk of the occurrence of cognitive impairment. Poor sleep consolidation, lower amplitude, and faster frequency of spindles may be early sleep biomarkers of worsening cognitive decline in older adults.

Background: In older patients, the agreement is low between creatinine clearance estimated with the Cockcroft-Gault equation (eCrCl) and glomerular filtration rate estimated with the Chronic Kidney Disease Epidemiology Collaboration equation (eGFR CKD-EPI ). The implications of these discrepancies for drug prescription have so far been assessed only for a few selected molecules., Objective: The aim of this study was to investigate the proportion of geriatric patients receiving drugs with a different recommended dose or indication (i.e. an adjustment discrepancy) depending on eCrCl versus eGFR CKD-EPI estimates of kidney function., Methods: Patients admitted to acute geriatric care units in our university hospital were eligible for inclusion. All drug classes were studied. We retrospectively determined recommended prescriptions according to eCrCl and eGFR CKD-EPI ., Results: Sixty percent of patients received at least one drug requiring dose adjustment and/or received a drug with a relative contraindication based on their estimated kidney function. Thirty-one percent of patients received at least one drug with an adjustment discrepancy: 20% received at least one drug for which the recommended dose differed depending on eCrCl versus eGFR CKD-EPI estimates of kidney function, 4% received a drug with a relative contraindication according to eCrCl but not eGFR CKD-EPI , and 7% received both. Factors independently associated with an adjustment discrepancy were older age and lower weight. Main drug classes involved were benzodiazepines, anticoagulants, and anti-microbial drugs., Conclusion: In acute geriatric care units, recommended drug dose adjustments are frequently discordant according to the equations used to estimate kidney function, notably for benzodiazepines, anticoagulants, and anti-microbial drugs. The consequences for treatment efficacy and safety should be investigated.

Introduction: Several studies have reported disparities in the care management and survival of older cancer patients. The aim of our study was to identify determinants of treatment administration in this population of cancer patients aged over 65 years taking into account competing risks of death., Methods: The INCAPAC study is a population-based study. Four cancer registries and three prospective cohort studies on older subjects (age ≥65 years) from Gironde, a French department, were merged to identify older cancer patients. We used a non-parametric multi-state model including three states (cancer, treatment and all-cause death). This model allowed studying determinants of treatment administration (all treatments including curative, symptomatic and palliative treatments) and mortality considering that patients can move from cancer state to death state, either directly or through the treatment phase. Studied variables were demographic and socioeconomic-, cancer-, health-, and geriatric-related., Results: A total of 450 patients were included in the analyses. They were mainly aged 85 and over, men and educated. Among included patients, 372 (83%) received cancer treatment. In the final multivariate model, dementia was associated with a lower likelihood of receiving cancer treatment (HR = 0.68, 95% CI = 0.47-0.99). In treated patients, age, sex, comorbidities, dependency and stage at diagnosis were associated to all-cause mortality, and in untreated patients, diagnosis of dementia and stage at diagnosis were associated to mortality., Conclusion: Further studies are necessary to understand the impact of geriatric impairments on treatment administration and to develop clinical practice guidelines., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Studies on cancer survival have revealed disparities not only between the elderly and their younger counterparts, but also among the elderly themselves. The aim of this work was to identify sociodemographic, socioeconomic, clinical, and care-related determinants of survival or mortality in older patients with cancer by a systematic synthesis of the literature. Understanding these factors is of great value for guiding health policies and programs aimed at reducing cancer survival disparities. We conducted a search of MEDLINE and SCOPUS databases under PRISMA guidelines. Results were limited to articles published in English and French from 2005 to 2015, and focused on elderly patients with cancer. The article selection was performed in a stepwise fashion: title, abstract, and full-text selection. Studied determinants and results of each article were synthesized. Forty-five articles were eligible and included in the study. We observed different ways of measuring socioeconomic status, comorbidities, and treatment among studies. Cancer-specific and overall survival were the main studied outcomes. Advanced age, low income, low socioeconomic status, presence of comorbidities, advanced stage, and poor tumor grade were found to be associated with lower survival or higher mortality. On the other hand, female gender and being married were predictive of increased survival or lower mortality. The next logical step is to carry out studies on elderly patients from different countries and to incorporate pertinent factors in a unique model. Moreover, specific geriatric health impairments should be taken into account in further research because of their association with survival., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Geriatric syndromes (GSs) are often the result of cumulative insults to multiple organ systems and are considered common in older adults. However, their frequency and co-occurrence are not well known in the elderly population. This study aimed to determine the prevalence of several GSs and to analyze the co-occurrence of these syndromes in a general population of elderly individuals., Methods: A cross-sectional analysis of 630 adults aged 75 years or older participating in the 10-year follow-up of the Bordeaux sample of the French Three-City Study was conducted. The following 10 GSs were assessed: physical frailty, dementia and cognitive impairment, depressive symptoms, polymedication, social isolation, thinness, falls, dependence, sensory deficit, and incontinence. The prevalence of the 10 GSs was estimated, and multiple correspondence analysis (MCA) models were used to explore the mutual associations between these GSs., Results: The mean age of the participants was 83.3 years; 69% were women, and 80.5% [95% confidence interval (CI) = 76.3-82.7] had at least one GS. The most frequent GSs were polymedication (50.6% 95%CI = 46.7-54.5) and falls (43.1% 95%CI = 38.4-46.1). The MCA models identified two major dimensions of the 10 GSs: "Dementia-Dependence-Incontinence" and "Frailty-Depression-Isolation.", Conclusions: GSs were very common in this French elderly population and were grouped into two major dimensions: the "Dementia-Dependence-Incontinence" and "Frailty-Depression-Isolation.", (© The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)