Search

To evaluate the effect of clinical pharmacy interventions on the unplanned rehospitalizations rates of elderly people admitted for fall to the elderly emergency medicine (EEM) unit in a teaching hospital. DESIGN AND MEASURES This was a longitudinal, comparative pilot study. Patients aged at least 75 who were admitted to the EEM unit for a fall and who had at least two chronic diseases and who were being treated with two or more medications were included from February 1, 2018 to June 30, 2018 and followed by 90 days. The main outcomes were the unplanned rehospitalizations rate at Limoges Teaching Hospital within the 90 days (primary outcome), 30 days and 72 hrs. The estimated cost-saving was also assessed. RESULTS We included 252 patients. The mean age was 88.4 ± 5.8 years and the average baseline number of medications was 8.3 ± 3.4. In total, 158 pharmaceutical interventions were performed, reflecting an acceptance rate of 94.9%. We found a significant reduction of the rate of unplanned rehospitalizations at 90-day (OR = 0.45 (0.26-0.79) p = 0.005). These results were still consistent at 30-day (p = 0.035) and 72 hours (p = 0.041). We found a cost-saving of 37,770 euros related to 21 avoided rehospitalizations. CONCLUSIONS Our results highly emphasize the positive effects of clinical pharmacy services on the prevention of unplanned rehospitalizations of old adults admitted for fall.

Background Independence is related to the aging process. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Independence is related to physical, psychological, biological, and socioeconomic factors. An enhanced understanding of older people’s independence trajectories and associated risk factors would enable the develop early intervention strategies. Methods Independence trajectory analysis was performed on patients identified in the Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV) database. UPSAV cohort is a prospective observational study. Participants were 221 community-dwelling persons aged ≥75 years followed for 24 months between July 2011–November 2013 and benefits from a prevention strategy. Data were collected prospectively using a questionnaire. Independence was assessed using the “Functional Autonomy Measurement System (Système de Mesure de l’Autonomie Fonctionnelle (SMAF))”. Group-based trajectory modeling (GBTM) was performed to identify independence trajectories, and the results were compared with those of k-means and hierarchical ascending classifications. A multinomial logistic regression was performed to identify predictive factors of the independence trajectory. Results Three distinct trajectories of independence were identified including a “Stable functional autonomy (SFA) trajectory” (53% of patients), a “Stable then decline functional autonomy decline (SDFA) trajectory” (33% of patients) and a “Constantly functional autonomy decline (CFAD) trajectory” (14% of patients). Not being a member of an association, and previous fall were significantly associated of a SDFA trajectory (P P Conclusions Community-living older persons exhibit distinct independence trajectories and the predictive factors. The evidence from this study suggests that the prevention and screening for the loss of independence of the older adults should be anticipated to maintaining autonomy.

Introduction: Very little is known about the impact of vision impairment (VI) on physical health in late-life in sub-Saharan Africa populations, whereas many older people experience it. We investigated the association between self-reported VI and frailty in Central African older people with low cognitive performance. Methods: It was cross-sectional analysis of data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) population-based study. After screening for cognitive impairment, older people with low cognitive performance were selected. Frailty was assessed using the Study of Osteoporotic Fracture index. Participants who met one of the 3 parameters assessed (unintentional weight loss, inability to do 5 chair stands, and low energy level) were considered as pre-frail, and those who met 2 or more parameters were considered as frail. VI was self-reported. Associations were investigated using multinomial logistic regression models. Results: Out of 2,002 older people enrolled in EPIDEMCA, 775 (38.7%) had low cognitive performance on the screening test. Of them, 514 participants (sex ratio: 0.25) had available data on VI and frailty and were included in the analyses. In total, 360 (70%) self-reported VI. Prevalence of frailty was estimated at 64.9% [95% confidence interval: 60.9%–69.1%] and 23.7% [95% CI: 20.1%–27.4%] for pre-frailty. After full adjustment, self-reported VI was associated with frailty (adjusted odds ratio = 2.2; 95% CI: 1.1–4.3) but not with pre-frailty (adjusted odds ratio = 1.8; 95% CI: 0.9–3.7). Conclusion: In Central African older people with low cognitive performance, those who self-reported VI were more likely to experience frailty. Our findings suggest that greater attention should be devoted to VI among this vulnerable population in order to identify early frailty onset and provide adequate care management.

A systematic review of the literature was carried out to assess the risk factors for readmission to the emergency room in people aged 75 and over. This review shows that some socio-demographic factors (high age, male gender, not being single), some underlying conditions (cardio-respiratory diseases, diabetes, cognitive impairment, cancer, depression), a recent history of falling and an impaired autonomy before admission are risk factors for readmission to the emergency room more than the cause of admission itself or its severity in people aged 75 and over. It remains to determine the best predictive readmission score in the elderly and whether a systematic identification of risk factors associated with specific management in the at-risk oldest reduce their readmission after a first visit to the emergency room.

Background Colorectal cancer is a major public concern, being the second deadliest cancer in the world. Whereas survival is high for localized forms, metastatic colorectal cancer has showed poor prognosis, with a 5-year survival barely surpassing 11%. Conventional chemotherapies against this disease proved their efficiency and remain essential in first-line treatment. However, the large number of authorized protocols complexifies treatment decision. In common practice, such decision is made on an empirical basis, by assessing benefits and risks for the patient. In other words, there is currently no efficient means of predicting the efficacy of any chemotherapy protocol for metastatic colorectal cancer. Methods/design The use of a chemosensitivity assay, the Oncogramme®, should help clinicians administer the best chemotherapy regimen to their patients. We hypothesize it would ultimately improve their survival. In this multicentred, prospective trial (ONCOGRAM), eligible patients with metastatic colorectal cancer are randomized to determine whether they will receive an Oncogramme®. For clinicians whose patients benefited from the assay (arm A), results are used as a decision support tool. Patients not undergoing the Oncogramme® procedure are treated according to current practice, without the assistance of the assay (arm B). Primary outcome is 1-year progression-free survival. Secondary outcomes include response rates, as well as 6-month and 1-year survival rates. Discussion This study aims at investigating the clinical utility of the Oncogramme® as a decision support tool for the treatment of patients with metastatic colorectal cancer. If the Oncogramme® positively influenced patient overall survival and/or progression-free survival, it would be of great value for clinicians to implement this assay within the current landscape of personalized medicine tools, which include genomics and biomarker assays. Trial registration ClinicalTrials.gov identifier NCT03133273. Registered on April 28, 2017.

Management of oropharyngeal dysphagia (OD) is mainly based on modifying liquid viscosity and solid consistency in order to preserve oral feeding while avoiding unsafe swallowing. Adding thickening powders (TP) to water is the most common practice in patients suffering from OD to liquids, but ready-to-use gelled waters (RGW) can also be proposed. The main objective of this study was to assess the efficacy of a RGW and a TP on swallowing in hospitalized patients with different OD etiologies. This open, crossover, multicenter trial recruited thirty hospitalized patients with OD to liquids, confirmed by positive 3-ounce water test or positive Practical Aspiration Screening Scheme test. The patient’s ability to swallow 120 g of a RGW (IDDSI level 4) and a drink prepared with TP (nectar viscosity; NTP, 291 cP, IDDSI level 2; or if necessary, honey; HTP, 769 cP, IDDSI level 3) was evaluated in a random order at 1- to 3-day intervals. The main criterion was the efficacy of each product, defined as the proportion of patients who successfully swallowed without immediate reflexive cough. The RGW and TP were successfully swallowed in respectively 93.3% (95% CI: 77.9–99.2) and 82.8% (95% CI: 64.2–94.2) of patients with different dysphagia etiologies (stroke, neurodegenerative diseases, or aging) and unable to swallow thin water. Taste and texture of both study products were well appreciated by patients, with a preference for the RGW over TP. Therefore, the use of these thickened products could be part of the therapeutic strategy for patients with OD to liquids.

Background Pain is a major public health concern in the aging population. However, medication brings about negative effects that compel healthcare professionals to seek alternative management techniques to alleviate pain. Hypnosis has been recognized as an effective technique to manage pain, but its long-term efficacy has yet to be examined in older adults. Aims The aim was to assess the effectiveness, over a 12-month period, of home-care hypnosis in elderly participants suffering from chronic pain. Design Real-life retrospective one-arm study with a 12-month follow-up. Settings Elderly Persons Suffering From Chronic Pain enrolled in a clinical health care program that offered home medical follow-up. Participants/Subjects Fourteen elderly women (mean age 81 years) with chronic pain participated in the home-care hypnosis program. All participants presented chronic pain (≥6 months) with average pain score >4/10. Methods Participants took part in seven 15-minute hypnosis sessions within 12 months. The Brief Pain Inventory questionnaire was used to evaluate pain perception and pain interference at baseline and at 3-, 6-, and 12-month follow-up period. Results Hypnosis home-care program significantly decreased pain perception and pain interference compared to baseline after 3 months (–29% and –40%, p Conclusions Seven sessions of 15 minutes allocated throughout a 12-month period produced clinically significant decreases in pain perception and pain interference. Hypnosis could be considered as an optimal additional way for health practitioners to manage chronic pain in an elderly population with long-term efficacy. This study offers a new long-term option to improve chronic pain management at home in elderly populations through a low-cost nonpharmacological intervention.

Hip fracture is a frequent and serious condition in the elderly. We conducted a retrospective cohort study to answer the following questions: (1) Could treatment in an orthogeriatric unit help to reduce the average length of stay for patients aged over 75 years admitted to hospital for the treatment of a hip fracture?; and (2) Could such treatment influence the post-operative outcomes of patients with hip fracture? Our study included 534 patients admitted to hospital between January 2017 and December 2018 for surgical treatment of a hip fracture. We compared 246 patients who received traditional orthopaedic care with 288 patients treated in an orthogeriatric unit. Our cohort included 410 women (77%). The average age was 87.5 ± six years, and 366 patients (68%) were living at home prior to the fracture. A statistically significant difference in median length of stay (from 10 to 9 days) was observed between patients who did and did not receive orthogeriatric unit treatment (groups 1 and 2; 95% CI: 0.64; 2.59; p = 0.001). There was no difference in pre-operative delay, intra-hospital mortality rate, place of recovery, rate of institutionalisation after six months, or the number of new fractures at 6 months between the groups. The mortality rate after six months was 23.6% and 21.3% in groups 1 and 2, respectively; the difference was not significant. Orthogeriatric unit treatment reduced the median length of stay by one day, in line with most previous studies. According to Pablos-Hernandez et al., multifaceted orthogeriatric treatment is most effective. In our study, only 38% of the patients received surgical treatment within 48 hours, where early surgery is key for reducing the length of hospital stay. The intrahospital mortality rate was 2.6%, which is comparable to literature data. The discharge rate did not differ by orthogeriatric treatment status, which is also consistent with previous findings (e.g. Gregersen et al.). Lastly, the mortality rate after six months was slightly reduced by orthogeriatric care. In line with this, Boddaert et al. reported a difference in mortality rate after six months between groups who did and did not receive orthogeriatric treatment (15% vs. 24%).

Introduction: The prevalence of neurocognitive disorders (NCDs) increases with age and is associated with cognitive impairment. Older patients with NCD admitted to the emergency department (ED) are readmitted after discharge to home more often than those without NCD. Comprehensive geriatric assessment (CGA) is effective for improving clinical outcomes in older patients; however, the usefulness of CGA for older patients with NCD admitted to the ED has not been investigated. The main objective of our study is to assess the effectiveness of a geriatric emergency medicine unit (GEMU) for elderly patients with NCD admitted to the ED. Methods: This historical cohort study included patients aged 75 years and older with NCD admitted to the ED of Limoges University Hospital in France over a 4-year period. We compared patients treated in our hospital’s GEMU, the MUPA unit (exposed group), and patients who received standard care by emergency physicians (control group). The primary end point was the incidence of 30-day readmissions. Results: The study included 801 patients admitted to the ED between January 1, 2015, and December 31, 2018 (400 in the exposed group). Of those, 72.5% were female, and the mean age was 87 ± 5 years. After adjusting for confounding factors, the 30-day readmission rate was significantly associated with the MUPA unit intervention. Conclusion: CGA in a GEMU improved health outcomes in elderly patients with NCD in the ED. We recommend that all EDs include a geriatric team, such as the MUPA unit, to treat all patients with NCD admitted to the ED.

Resume Introduction Les fractures de l’extremite superieure du femur sont frequentes et graves chez le sujet âge, en raison d’un important taux de mortalite a court terme. Si le delai de prise en charge chirurgicale est un facteur essentiel, une prise en charge medicale orthogeriatrique pourrait permettre de diminuer cette mortalite a 6 mois, mais cette donnee n’a pas ete confirmee a large echelle en France. Aussi, nous avons mene une etude retrospective ayant pour but de repondre aux questions suivantes : 1) une prise en charge chirurgicale retardee influence-t-elle le taux de mortalite a 6 mois ? ; 2) existe-t-il des facteurs medicaux corrigeables pouvant influencer la mortalite a 6 mois ? Hypothese Une prise en charge chirurgicale retardee n’etait pas un facteur isole d’augmentation de la mortalite a 6 mois apres fracture de l’extremite superieur du femur. Methode Nous avons inclus les patients âges de 75 ans et plus victimes d’une fracture de l’extremite superieure du femur necessitant une prise en charge chirurgicale. Nous avons ainsi analyse retrospectivement les dossiers de 476 patients en relavant les differentes pathologies medicales associees, les caracteristiques pre-, per- et postoperatoires. Une analyse univariee puis multivariee ont ete realisees pour identifier les facteurs de risque de mortalite a 6 mois. Resultats Notre analyse univariee montrait qu’un delai preoperatoire superieur a 48 h engendrait un risque 1,5 (Odds Ratio (OR) = 1,57/IC 95 % : 1–2,48/p = 0,04) fois plus important de mortalite a 6 mois. Ce facteur de risque ne persistait pas en analyse multivariee prouvant qu’il ne s’agit pas d’un facteur de risque independant. En analyse multivariee, les anticoagulants (OR = 2/IC 95 % : 1,13–3,50/p = 0,02), la demence (OR = 2,2/IC 95 % : 1,32–3,59/p = 0,002), l’arteriopathie obliterante des membres inferieurs (OR = 2,9/IC 95 % : 1,10–7,70/p = 0,03), la perte de 2 points d’hemoglobine entre le bilan preoperatoire et postoperatoire (OR = 1,9/IC 95 % : 1,05–3,12/p = 0,04), le sexe masculin (OR = 1,82/IC 95 % : 1,05–3,12/p = 0,04), un âge superieur a 85 ans (OR = 5,26/IC 95 % : 1,49–5,26/p = 0,002) et un score de Charlson ≥ 7 (OR = 2,13/IC 95 % : 1,29–3,52/p = 0,003) etaient les variables explicatives associees au deces a 6 mois de maniere statistiquement significative. Discussion – Conclusion Notre etude demontre que les patients a risque sont les patients de sexe masculin, âges de plus de 85 ans ayant des pathologies medicales associees (score de Charlson ≥ 7). Un traitement preexistant par anticoagulant augmente dans notre etude le delai preoperatoire et augmente le risque de mortalite a 6 mois de ces patients. La prise en charge de ces patients a risque doit avoir pour objectif de ne pas aggraver les pathologies medicales sous-jacentes en offrant la possibilite d’une prise en charge dans les 48 heures. Les patients sous anticoagulants doivent beneficier d’une attention particuliere permettant de ne pas retarder la prise en charge chirurgicale. Niveau de preuve IV, etude retrospective sans groupe controle.

Introduction Proximal femur fractures are common and dangerous in older adults, given the high short-term mortality rate. While surgical treatment is vital, medical orthogeriatric care may reduce the 6-month mortality rate; however, this has not been determined on a broad scale in France. This led us to conduct a retrospective study to answer the following questions: (1) Does delayed surgical treatment impact the 6-month mortality rate? (2) Are there correctable medical factors that impact the 6-month mortality? Hypothesis Delayed surgical treatment is not an isolated risk factor for higher 6-month mortality after proximal femur fracture. Methods We included all patients 75 years or older who had suffered a proximal femur fracture requiring surgical treatment. This allowed us to analyze the medical records of 476 patients retrospectively. We documented their comorbidities and pre-, intra- and postoperative characteristics. A univariate then multivariate analysis was done to identify risk factors for mortality at 6 months. Results In the univariate analysis, time to surgery of more than 48 hours increased the risk of dying at 6 months by 1.5 fold (Odds ratio (OR) = 1.57/95% CI: 1–2.48/p = 0.04). However, this risk factor was not significant in the multivariate analysis since it is not an independent risk factor. In the multivariate analysis, anticoagulants (OR = 2/95% CI: 1.13–3.50/p = 0.02), dementia (OR = 2.2/95% CI: 1.32–3.59/p = 0.002), peripheral artery disease (OR = 2.9/95% CI: 1.10–7.70/p = 0.03), 2-point drop in hemoglobin count from preoperative to postoperative (OR = 1.9/95% CI: 1.05–3.12/p = 0.04), male sex (OR = 1.82/95% CI: 1.05–3.12/p = 0.04), age above 85 years (OR = 5.26/95% CI: 1.49–5.26/p = 0.002) and Charlson comorbidity index ≥ 7 (OR = 2.13/95% CI: 1.29–3.52/p = 0.003) were statistically associated with mortality at 6 months. Discussion/Conclusion Our study found that the patients most at risk for dying within 6 months of a hip fracture were males, older than 85 and have associated medical conditions (Charlson index ≥ 7). Prior anticoagulant treatment increases the time to surgery in our study and therefore increases the risk of these patients dying within 6 months. Treatment of these at-risk patients should ensure that their underlying medical conditions are not made worse, while providing treatment within 48 hours. Patients taking anticoagulants must be monitored carefully to ensure surgical treatment is not delayed. Level of evidence IV, retrospective study without control group.

Highlights • We conducted a large multicenter trial focusing on the perception of telemedicine over a two-year period in the real world. • Health professionals confirmed their positive perception of telemedicine after two years of use. • We pointed out the importance of involving staff members in a participatory approach to ensure generalized adherence to telemedicine as a service. • The results establish lines of action for a large-scale deployment of such solution., The management of neuropsychiatric symptoms is a challenge in long-term care facilities. Our objective was to assess the perception of telemedicine, as a useful tool to connect staff to specialized units. In this multicenter prospective study, 90 patients from ten facilities benefited from 180 sessions over two years. The primary outcome was the perception of telemedicine evaluated through semi-structured interviews at baseline and two years later. Our results revealed positive perceptions of telemedicine, confirmed after two years of real-life experience with its use. Not only do staff members believe that telemedicine is not a downgraded version of medicine, but they also believe that it could improve the quality of care. They expressed a very positive sense of recognition of their professional qualifications and indicated their need to be involved in change processes to ensure successful implementation and better adherence to telemedicine as a service.

Resume Introduction Notre objectif etait de mettre en place une validation pharmaceutique des prescriptions dans un service d’urgences adultes pour ameliorer la securisation de la prise en charge medicamenteuse des patients dans un service a haut risque iatrogene. Materiel et methodes Validation des ordonnances des patients avec un traitement chronique par un interne en pharmacie (sous la responsabilite d’un pharmacien senior) suivant la methodologie de la Societe francaise de pharmacie clinique (SFPC). Cela entre 8 h 30 et 12 h 30, apres participation au staff du service. A chaque probleme identifie, des interventions pharmaceutiques (IP) etaient proposees au medecin en charge du patient. Resultats Quatre cent quatre-vingt-un prescriptions ont ete validees entre le 02/11/2015 et le 15/04/2016 dont 15,2 % avec des problemes et ayant fait l’objet d’IP. Les contre-indications, les surdosages et les administrations non appropriees representaient 78 % des problemes. On retrouvait 82,2 % d’IP acceptees ayant entraine une modification de prescription. Discussion/conclusion Le taux d’IP etait eleve et justifiait le maintien d’une presence pharmaceutique dans ce service pour ameliorer la qualite de la prise en charge medicamenteuse et lutter contre l’iatrogenie medicamenteuse.

Summary Background The aim of this study was to develop a prescription validation procedure in an emergency department (ED) in order to improve drug safety for patients in a setting with a high prevalence of iatrogenic risk. Material and methods A pharmacy resident performed pharmaceutical analyses of prescriptions written in the ED in the morning (8:30–12:30). Working under the responsibility of a senior pharmacist, the resident had access to patient charts and attended ED staff meetings. Pharmaceutical interventions were proposed to the attending physician if the prescription deviated from good practices according to the prescription validation methodology of the French society of clinical pharmacy (SFPC). Results Four hundred and eighty-one prescriptions were analyzed from November 11, 2015 through April 15, 2016. Pharmaceutical interventions were proposed for 73 prescriptions (15.2%) because of drug errors. Contraindications, overdosing, and inappropriate administration routes accounted for 78% of these errors. Discussion/Conclusion The rate of pharmaceutical intervention was high, providing evidence of the need for prescription validation in this kind of medical ward in order to improve the quality of drug management and avoid iatrogenic risks.

Background Hyponatremia is the most common electrolyte disorder in older adults and it can increase morbidity and mortality. Approximately one in three older adults fall each year; mild chronic hyponatremia can predispose this group to injurious falls and fractures and serum levels of sodium can also influence bone health. Little is known regarding the association between mild chronic hyponatremia and injurious fall prevalence in elderly patients admitted to the Emergency Department (ED). Therefore, the present study investigated the link between mild hyponatremia and the risk of injurious falls in elderly patients admitted to the Emergency Geriatric Medicine Unit (The MUPA Unit). Methods This cross-sectional study was conducted over 4 months and included patients ≥75 years of age who were admitted to the MUPA Unit of University Hospital Center of Limoges (France). Sociodemographic factors, fall events, comorbidities, medications, and sodium levels were assessed (hyponatremia was considered as sodium level < 136 mEq/L). Additionally, the short Comprehensive Geriatric Assessment (short-CGA), the Frailty score on the Short Emergency Geriatric Assessment (SEGA), and the Katz Activity of Daily Living (ADL) scale were administered. Results Of the 696 cases included in the final analysis, the mean age was 86.1 ± 5.6 years and 63.1% were female. The prevalence of falls was 27.9% (95% confidence interval [CI]: 24.6–31.2%) and that of mild hyponatremia was 15.9% (95% CI: 13.2–18.6%). The prevalence rate of mild hyponatremia was 13.2% (95% CI: 10.1–16.3%) in patients without falls and 26.1% (95% CI: 19.8–32.4%) in patients admitted for falls. Mild hyponatremia was significantly associated with falls (P < 0.001) and the adjusted odds ratio (OR) was 3.02 (95% CI: 1.84–4.96). Conclusions Because mild hyponatremia might be a risk factor for injurious falls and ED admission, determination of sodium levels during basic biomarker assessment on ED admission could be an important component of fall prevention strategies for the elderly.

International audience

As the prevalence of pain increases with age, taking too much medication can lead to negative side effects in elderly patients. While evidence in the literature has shown that clinical hypnosis is effective in an adult population, there are few studies in an aging population and efficacy has never been established in a home care setting. The goal of this study was to determine the effects of a hypnosis program delivered during home care interventions in elderly women during a 12-week period.This pilot trial took place from April 2016 to October 2017 at Limoges, France. Fifteen elderly women with chronic pain participated (81 (65-87) years old). All participants presented chronic pain for more than 6 months (inclusion criteria: average pain score4/10). Participants took part in three 15-min hypnosis sessions separated by four to six weeks. Each hypnosis session was personalized and carried out with induction, pain perception alteration, and post-hypnotic suggestions. Pain perception and pain interference were evaluated with the Brief Pain Inventory questionnaire, and compared between before and after the 12-week hypnosis program.Hypnosis home care program significantly improved scores on worst (8.9 to 6.7, P0.001), average (6.8 to 5.1, P0.001), and current pain perception (6.5 to 3.9, P0.001), pain interference with physical activity (P0.001) and with socio-affective factors (P0.01).Taken together, these findings show that a hypnosis intervention is feasible and effective to manage pain in an elderly population.

International audience; The use of complementary and alternative therapies is growing year after year, and Reiki therapy takes a place of choice. Reiki therapy, classed as a biofield energy therapy, raises the question of validity when applied to patients, especially in palliative care. The purpose of this review is to highlight the effects of Reiki therapy on pain, anxiety/depression and quality of life of patients, specifically in palliative care. The current article indicates that Reiki therapy is useful for relieving pain, decreasing anxiety/depression and improving quality of life in several conditions. Due to the small number of studies in palliative care, we were unable to clearly identify the benefits of Reiki therapy, but preliminary results tend to show some positive effects of Reiki therapy for the end-of-life population. These results should encourage teams working in palliative care to conduct more studies to determine the benefits of Reiki therapy on pain, anxiety/depression and quality of life in palliative care.

Background Stroke causes functional decline, psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Although physical activity (PA) is beneficial in stroke recovery, PA recommendations are rarely met after hospital discharge. There is presently no standard strategy for monitoring and inciting PA at home during the subacute phase of stroke recovery. The main aim of this study is to evaluate the effects of a home-based physical activity incentive and education program (Ticaa’dom) on functional capacity in subacute stroke patients. Methods This study is a comparative prospective, observer-blinded, monocentric, parallel, randomized controlled clinical trial. This study will include 84 patients: 42 patients in the home-based physical activity incentive group (HB-PAI) and 42 in the control group (CG). The intervention group will follow the HB-PAI program over 6 months: their PA will be monitored with an accelerometer during the day at home while they record their subjective perception of PA on a chart; they will observe a weekly telephone call and a home visit every three weeks. The CG will receive traditional medical care over 12 months. The main study outcome will be the distance on a 6-minute walk test. Secondary outcomes will include measurements of lower limb strength, independence level, body composition, cardiac analysis, fatigue and depression state. Discussion The results of this trial will demonstrate the value of implementing the Ticaa’dom program during the subacute phase of stroke recovery. Trial registration ClinicalTrials.gov, NCT01822938. Registered on 25 March 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2410-9) contains supplementary material, which is available to authorized users.

International audience; We investigated the association between elevated plasma concentrations of circulating soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) and injurious falls and mortality over a 5-year period. We studied the prospective relationship between levels of circulating adhesion molecules and falls in 680 community-dwelling participants in the MOBILIZE Boston Study. The mean sVCAM-1 (±SD) concentration was 1192 ± 428 ng/mL. Over 5-years of follow-up, 10.2% of participants died. The baseline sVCAM-1 (±SD) concentration was 1434 ± 511 ng/mL in those who died vs. 1162 ± 402 ng/mL in those who survived (P

Resume Introduction L’objectif de ce travail est d’evaluer les resultats a long terme de la chirurgie de resection pulmonaire pour cancer chez l’octogenaire. Methodes Etude retrospective bi-centrique incluant les patients de plus de 80 ans, operes d’un cancer du poumon a visee curative (chirurgies diagnostiques exclues) au CHU de Lyon entre 2000 et 2010. Resultats Soixante-trois patients (42 hommes et 21 femmes) ont ete inclus. L’âge moyen etait de 82 ans. Les interventions realisees etaient des lobectomies (50), bilobectomies (5) ou pneumonectomies (8). Il n’y a pas eu de chirurgie video-assistee. Les resections atypiques ont ete exclues. La mortalite perioperatoire etait de 4,7 % (lobectomie : 4 %, bilobectomie : 0 %, pneumonectomie : 12,5 %). Le taux de complications perioperatoires graves etait de 14 %. Le suivi median a ete de 22,8 mois (1–91). La survie globale a cinq ans etait de 34 % pour la cohorte totale et la mediane de survie globale s’etablissait a 23,5 mois. La survie a cinq ans en fonction de l’atteinte ganglionnaire etait de : N0 : 36 %, N1 : 29 % et N2 : 20 %, p Conclusions Meme chez l’octogenaire, la chirurgie est une technique efficace du traitement du cancer pulmonaire. La survie est influencee par le type histologique et l’atteinte ganglionnaire. La mise en place d’une evaluation geriatrique individualisee standardisee devrait aider a selectionner les patients en vue de la chirurgie.

OBJECTIVES: To determine the concordance between falls recorded using an investigational fall detection device and falls reported by nursing staff in a nursing home. DESIGN: Six-month prospective study. SETTING: Hebrew SeniorLife nursing home units in Boston, Massachusetts. PARTICIPANTS: Nursing home residents with a documented history of at least one fall within 12 months before consent (N = 62, mean age 86.2 ± 8.1, 66% female). INTERVENTION: Subjects continuously wore an automated falls detection device on a pendant around their neck. The device contained triaxial accelerometers set to detect a rapid change in position that was interpreted as a fall. MEASUREMENTS: Healthcare staff reported daily falls, defined as unexpected events in which residents were found on the floor, and the number of these falls was compared with the number of falls recorded according to the device. RESULTS: Seven of 37 residents whom nursing staff found on the floor had a fall recorded according to the device (19%). The device did not identify any of the clinical fall events in 23 of the 37 fallers (62%). The device detected 17 of 89 total falls that nursing staff recorded (sensitivity 19%) within an 8-hour time window. Of 128 fall events that the device recorded, 17 were concordant with nursing reports (13%) within an 8-hour time window, and 111 (87%) were false positives. CONCLUSION: There is poor concordance between falls recorded using the investigational fall detection device and falls to the floor that nursing home staff report. Language: en

Background: Exercise programs are presumed to rehabilitate gait disorders and to reduce the risk of falling in dementia patients. This study aimed to analyze the specific effects of multicomponent exercise on gait disorders and to determine the association between gait impairments and the risk of falling in dementia patients before and after intervention. Methods: We conducted an 8-week multicomponent exercise program in 16 dementia patients (age 86.7 ± 5.4 years). All participants were assessed several times for gait analysis (Locométrix®), Tinetti score and physical activity (Body Media SenseWear® Pro armband). Results: After 8 weeks of the exercise program, the mean gait speed was 0.12 m/s faster than before the intervention (0.55 ± 0.17 vs. 0.67 ± 0.14 m/s). The multicomponent exercise program improved gait performance and Tinetti score (p < 0.05). Gait performance (gait speed, stride length) was correlated with the Tinetti score (p < 0.05). Conclusion: Analysis of spatiotemporal gait parameters using an accelerometer method provided a quick and easy tool to estimate the benefits of an exercise program and the risk of falling.

Introduction Neuropsychiatric symptoms (NPSs) in elderly patients with dementia are frequent in long-term care facilities (LTCFs) and are associated with adverse events. Telemedicine is an emerging way to provide consultation and care to dependent LTCF residents who may not have easy access to specialty services. Several studies have evaluated telemedicine for dementia care but to date, no study has evaluated its impact in the management of NPS in patients with dementia living in LTCF. Methods and analysis The Dementia in long-term care facilities: Telemedicine for the management of neuropsychiatric symptoms (DETECT) study is a 24-month multicentre prospective cluster randomised controlled study with two arms: a control arm (usual care) and an intervention arm (telemedicine consultation) for NPSs management. DETECT enrolled 20 LTCFs. The primary outcome is based on the acceptability of the telemedicine among the LTCF staff which will be assessed in the intervention group by quantitative and qualitative indicators. The rate of unscheduled hospitalisations and/or consultations due to disruptive NPSs, psychotropic drug use and health costs will be described in both groups. Approximately, 200 patients are expected to be recruited. Ethics and dissemination The study protocol was approved and sponsored by the French Ministry of Health. The study received ethical approval from the Toulouse University Hospital Institutional Review Board. We will communicate the final results to the public via conferences and results will also be submitted for publication in international peer-reviewed scientific journals. Trial registration number NCT02472015.

The economic aspects are crucial in the implementation of strategies and especially in accessibility to new therapies in order to achieve a significant reduction in the incidence and severity of neurological pathologies. This accessibility faces economic considerations. Economic considerations have assumed an increasingly prominent role in the planning, management and evaluation of health systems, ranging from the design of ways to pay providers or to improve access to care for households, to the definition of essential packages for insurance, to decisions about whether or not to include new medicines on hospital, state or national formularies. Epilepsy and dementia now represent a major public health problem. They pose a problem in view of their medical, cultural, and economic consequences. However, epilepsy and dementia remain as conditions that may not always be recognized and whose costs are largely unknown. Economic analyses in developing countries are rare.

International audience; The objective was to analyse and discuss data from three studies of newly-diagnosed epileptic seizures (provoked and unprovoked) conducted in Geneva, Martinique, and the Reunion Island, in which the same methodology was used. We extracted data from three studies in which the incidence of seizures was estimated and aetiologies identified. Data was extracted and analysed using STATA. Group comparison was performed firstly for each study as a single group, and secondly by considering Martinique and the Reunion Island as an overseas group, in comparison with Geneva, considered as a mainland group. Uncorrected χ(2)was used and statistical significance (two-sided, p=0.05) was determined for each aetiology per cohort. The incidence of newly-diagnosed epileptic seizures per 100,000 was 71.0, 80.6, and 100.4 in Geneva, Martinique, and the Reunion Island, respectively. A bimodal distribution and predominance of generalised seizures was noted. The male to female ratio was higher in Martinique (∼2.0) than other populations (∼1.5). Status epilepticus was noted in Geneva and more so in the Reunion Island. The incidence of provoked seizures per 100,000 was 25.2, 16.4, and 17.7, and for unprovoked seizures was 45.6, 64.1, and 81.2 in Geneva, Martinique, and the Reunion Island, respectively. There was a greater risk of provoked seizures in Geneva relative to the overseas group, which was due to tumours, use of toxic substances, and drug abuse. The risk of unprovoked seizures in Geneva was due to trauma and infections. In Martinique, alcoholism and HIV were foremost factors for provoked and unprovoked seizures, and stroke was an important aetiology in both Martinique (provoked seizures) and the Reunion Island (unprovoked seizures). The risk of provoked seizures was greatest in Geneva and risk of unprovoked seizures was greatest in the Reunion Island. Toxic substances, alcohol, infection, and trauma constituted major factors for epileptic seizures in Geneva, while alcoholism, HIV, and stroke were major factors in the overseas group. Relative eradication of tropical infections has paved a way for the emergence of non-communicable aetiologies (stroke, alcoholism). Males from Martinique demonstrated the greatest risk of epileptic seizures, signifying the importance of alcoholism, HIV, etc. Three steps should follow: follow-up studies (mortality), strong mechanisms for prevention (or control) of risk factors, guidelines on whether to treat or not.

Dental neglect and high levels of unmet dental needs are becoming increasingly prevalent among elderly residents of long-term care facilities, although frail, elderly, and dependent populations are the most in need of professional dental care. Little is known about the validity of teledentistry for diagnosing dental pathology in nursing home residents., To evaluate the accuracy of teledentistry for diagnosing dental pathology, assessing the rehabilitation status of dental prostheses, and evaluating the chewing ability of older adults living in nursing homes (using direct examination as a gold standard)., Multicenter diagnostic accuracy study performed in France and Germany., Eight nursing homes in France and Germany., Nursing home residents with oral or dental complaints, self-reported or reported by caregivers, willing to receive oral or dental preventive care. In total, 235 patients were examined. The mean age was 84.4 ± 8.3 years, and 59.1% of the subjects were female., The patients were examined twice. Each patient was his or her own control. First, the dental surgeon established a diagnosis by reviewing a video recorded in the nursing home and accessed remotely. Second, within a maximum of 7 days, patients were examined conventionally (face-to-face) by the same surgeon who established the initial diagnosis., All residents received a comprehensive clinical examination in their home by a trained geriatrician and underwent a dental hygiene evaluation that used the Silness-Loe and Greene-Vermillion dental hygiene assessment indices. The diagnoses established via the video recording and in the face-to-face setting were compared. The main outcome measure was number of dental pathologies., In total, 128 (55.4%) patients had a dental pathology. The sensitivity of teledentistry for diagnosing dental pathology was 93.8% (95% confidence interval [CI] 90.7-96.9), and the specificity was 94.2% (95% CI 91.2-97.2). Among the 128 cases of dental pathology identified by teledentistry, 6 (4.8%) were false positives. The teledentistry assessments were quicker than the face-to-to-face examinations (12 and 20 minutes, respectively)., Teledentistry showed excellent accuracy for diagnosing dental pathology in older adults living in nursing homes; its use may allow more regular checkups to be carried out by dental professionals.

Background Elevated plasma soluble vascular cell adhesion molecule-1 (sVCAM-1) is a presumed marker of endothelial dysfunction, both in the brain and systemic circulation. Impairments in memory and cognition have been associated with cardiovascular diseases, but little is known about their relationships to abnormal cerebral endothelial function. Methods We studied the cross-sectional association between sVCAM-1 and markers of cerebrovascular hemodynamics and cognitive function in 680 community-dwelling participants in the MOBILIZE Boston Study, aged 65 years and older. Cognitive function was assessed using the Hopkins Verbal Learning Memory Test and Trail Making Tests (TMTs) A and B. Global cognitive impairment was defined as Mini-Mental State Examination (MMSE) score less than 24. sVCAM-1 was measured by ELISA assay. Beat-to-beat blood flow velocity (BFV) and cerebrovascular resistance (CVR = mean arterial pressure / BFV) in the middle cerebral artery were assessed at rest by transcranial Doppler ultrasound. Results sVCAM-1 concentrations were higher among participants with an MMSE score

Introduction L’echec therapeutique au cours du traitement antituberculeux est une situation frequente et preoccupante du fait de ses diverses implications. Cette etude avait pour objectif de determiner les facteurs associes a l’echec therapeutique au cours du traitement antituberculeux au Togo. Methodes Nous avons conduit une etude retrospective comparative sur les cas de tuberculose pulmonaire sous traitement au Togo de 2015 et 2016. Les cas d’echec au traitement etaient compares au cas gueris. Une regression logistique a permis ressortir les facteurs associes a l’echec. Resultats Quatre-vingt-un cas d’echec et 168 gueris etaient inclus. L’âge moyen des echecs (38,64 ans) et des gueris (38,90 ans) etait similaire (p = 0,14). Le sex-ratio etait de 0,54 chez les echecs contre 0,81 chez les gueris (p = 0,082). La proportion des co-infectes TB/VIH etait similaire (p = 0,83) dans les deux groupes. En analyse multivariee, les facteurs associes a l’echec therapeutique etaient : antecedents de traitement antituberculeux (OR = 13,06 [1,44–118,17]), bacilloscopie du 2e mois de traitement positive (OR = 38,75 [10,52–142,76]), manque d’argent pour se deplacer au CDT (OR = 5,80 [1,51–22,21]), survenue des effets secondaires (OR = 3, 61 [1,06–12,22]), interruption du traitement d’au moins 14 jours (OR = 8,15 [2,35–28,28]), absence de visite de suivi du prestataire (OR = 3,27 [1,03–10,40]), absence de DOT familiale (OR = 23,76 [5,66–99,64]). Conclusion Cette etude a permis d’identifier les facteurs associes a l’echec therapeutique et dont la prise en compte dans les plans d’action contribuerait a reduire le nombre d’echec therapeutique.

Summary Purpose: To describe seizure types and risk factors among elderly people with newly diagnosed epileptic seizures living on La Reunion, a French Island in the Southern Indian Ocean. Methods: We describe an elderly population with newly diagnosed epileptic seizures using data from the EPIREUN study conducted between July 1, 2004 and June 30, 2005. The methodology is described in detail in the EPIREUN study report (Mignard et al., 2009). Key Findings: There were 153 single unprovoked seizures (84.1%); their incidence was 278.1 [95% confidence interval (CI) 237.4–325.9] per 100,000. The incidence of newly diagnosed epilepsy was 125.4 (95% CI, 99.1–158.8) per 100,000. Twenty-eight acute symptomatic seizures occurred (15.4%); the incidence was 50.9 (95% CI 35.1–73.7) per 100,000. The annual incidence of newly diagnosed epileptic seizure in the elderly was 330.8 (95% CI 286.1–382.6) per 100,000: 403.0 (95% CI 328.5–494.3) per 100,000 in men and 279.6 (95% CI, 227.4–343.8) per 100,000 in women. Sex had a significant (p = 0.014) effect on incidence: elderly men had a risk ratio of 1.44 compared to women of developing a newly diagnosed epileptic seizure. The etiology of single unprovoked seizure was as follows: stroke, 77 cases (50.3%); cryptogenic, 36 (23.5%); alcoholism, 10 (6.6%); a combination of several causes such as polypathology, 9 (5.9%); degenerative disease, 6 (4.0%); HIV infection, 2 (2.0%), and undetermined causes (2.7%). Most patients (170; 93.4%) were hospitalized, and 110 (60.8%) were treated. Among patients treated, 49 (44.5%) were given sodium valproate, 25 (22.7%) benzodiazepines, 12 (10.9%) phenytoin, 9 (8.2%) lamotrigine, 8 (7.3%) Trileptal, and 7 (6.4%) gabapentin. Significance: Our findings show that the incidences of newly diagnosed epileptic seizures and newly diagnosed epilepsy were high in the elderly population of La Reunion. These incidences were significantly higher in men than in women. These results may be attributable to the high incidence of cerebrovascular diseases and comorbidities in this population.

Background According to the CDC, falls rank among the leading causes of accidental death in the United States, resulting in significant health care costs annually. In this paper we present information about everyday lifestyle decisions of the older adult that may help reduce the risk of falling. We pursued two lines of inquiry: first, we identify and then test known mutable fall risk factors and ask how the resolution of such problems correlates with changes in fall rates. Second, we identify a series of everyday lifestyle options that persons may follow and then ask, does such engagement (e.g., engagement in exercise programs) lessen the older adult’s risk of falling and if it does, will the relationship hold as the count of risk factors increases? Methods Using a secondary analysis of lifestyle choices and risk changes that may explain fall rates over one year, we drew on a data set of 13,623 community residing elders in independent housing sites from 24 US states. All older adults were assessed at baseline, and a subset assessed one year later (n = 4,563) using two interRAI tools: the interRAI Community Health Assessment and interRAI Wellness Assessment. Results For the vast majority of risk measures, problem resolution is followed by lower rate of falls. This is true for physical measures such as doing housework, meal preparation, unsteady gait, transferring, and dressing the lower body. Similarly, this pattern is observed for clinical measures such as depression, memory, vision, dizziness, and fatigue. Among the older adults who had a falls risk at the baseline assessment, about 20 % improve, that is, they had a decreased falls rate when the problem risk improved. This outcome suggests that improvement of physical or clinical states potentially may result in a decreased falls rate. Additionally, physical exercise and cognitive activities are associated with a lower rate of falls. Conclusions The resolution of risk problems and physical and cognitive lifestyle choices are related to lower fall rates in elders in the community. The results presented here point to specific areas, that when targeted, may reduce the risk of falls. In addition, when there is problem resolution for specific clinical conditions, a decreased risk for falls also may occur.

Introduction: The elderly population is at high risk of functional decline, which will induce significant costs due to long-term care. Dependency could be delayed by preventing one of its major determinants: falls. Light paths coupled with personal emergency response systems could prevent the functional decline through fall prevention. Methods: This study aimed to evaluate the effectiveness of light paths coupled with personal emergency response systems on the functional decline in an elderly population living at home. It is a secondary analysis on data from a previous cohort. In all, 190 older adults (aged 65 years or more) living at home participated. Participants in the exposed group were equipped with home-based technologies: light paths coupled with personal emergency response systems. The participants’ functional status was assessed using the Functional Autonomy Measurement System scale at baseline (T0) and at the end of the study (T12-month). Baseline characteristics were evaluated by a comprehensive geriatric assessment. Results: After 1 year, 43% of the unexposed group had functional decline versus 16% of the exposed group. Light paths coupled with personal emergency response systems were significantly associated with a decrease in the functional decline (Δ Functional Autonomy Measurement System ⩾ 5) at home (odds ratio = 0.24, 95% confidence interval (0.11–0.54), p = 0.002). Discussion: This study suggests that light paths coupled with personal emergency response systems prevent the functional decline over 12 months. This result may encourage the prescription and use of home-based technologies to postpone dependency and institutionalization, but they need a larger cost-effectiveness study to demonstrate the efficiency of these technologies.

Objective Nursing homes for older adults are increasingly confronted with older persons with long-term care needs and increased dependence while care staff number is increasingly restricted [1] . The e-monitor’age project aims at improving organization of care, well-being and security of residents. It is based on the development of a system of intelligent supervision which aims at improving the global efficiency of these establishments in order to allow an increased availability of the care staff. The development of this technology is based on a participative approach: the end-users needs are the starting point. Method Three focus groups were organized in each nursing home which participates to the project in order to collect the needs of the future users: medical and direction staff. The collected data were then analyzed and allowed to write the functional specifications of the project. Results Focus groups highlighted that help to supervision of the residents in difficult situations is essential and that the feeling of insecurity and need of support are major at night. Three objectives were retained for the development of the system: security of residents, discomfort and prevention on the long-term. Discussion The major originality of this work is the multidisciplinary approach: the project involves academic researchers, industrialists and medical staff. This participative conception is based on a close collaboration between all the actors. One of the most important factors for a successful development of such technology is the analysis of end-users needs [2] . Unfortunately such a work which actively involves medical staff is very rare [3] , that's why our project is particularly original.

Soluble vascular cell adhesion molecule-1 (sVCAM-1) is associated with hypertension, vascular inflammation, and systemic endothelial dysfunction. We evaluated whether elevated plasma sVCAM-1 is associated with impaired cerebrovascular function and mobility impairments in elderly people. We studied the cross-sectional relationships between plasma sVCAM-1 level, gait speed, and cerebrovascular hemodynamics, and its longitudinal relationship with falls in 680 community-dwelling participants aged ≥65 years in the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study. Falls were recorded prospectively for 1 year on daily calendars. sVCAM-1 was measured by ELISA assay and beat-to-beat blood flow velocity in the middle cerebral artery during rest and in response to changes in end-tidal CO 2 was measured by transcranial Doppler ultrasound. sVCAM-1 concentration was 1094±340 ng/mL in normotensives, 1195±438 ng/mL in controlled hypertensives, and 1250±445 ng/mL in uncontrolled hypertensives ( P =0.008). The mean resting blood flow velocity and cerebral vasomotor range were, respectively, 41.0±10.3 cm/s and 1.3±0.4 cm/s per millimeter of mercury. Elevated sVCAM-1 levels indicative of endothelial dysfunction were associated with reduced resting blood flow velocity ( P =0.017) and cerebral vasomotor range ( P =0.0048). Elevated sVCAM-1 levels were associated with slower gait speed (P =0.0011) and an increased odds of injurious falls (odds ratio, 2.4; 95% confidence interval, 1.4–4.2; P =0.0028). An elevated sVCAM-1 level may be a marker of cerebral blood flow dysregulation because of endothelial damage from hypertension. It may also signal the presence of cerebral microvascular disease and its clinical consequences, including slow gait speed and falls.

International audience; Conflicting data on the relationship between antihypertensive medications and falls in elderly people may lead to inappropriate undertreatment of hypertension in an effort to prevent falls. We aimed to clarify the relationships between the chronic use of different classes of antihypertensive medications and different types of falls, to determine the effect of medication dose, and to assess whether the risk of falls is associated with differences in cerebral blood flow. We assessed demographics, clinical characteristics, and chronic antihypertensive medication use in 598 community-dwelling people with hypertension, aged 70 to 97 years, then followed them prospectively for self-reported falls using monthly calendar postcards and telephone interviews. Antihypertensive medication use was not associated with an increased risk of falls. Participants reporting use of angiotensin-converting enzyme inhibitors had a significantly decreased 1-year risk of injurious falls (odds ratio, 0.62; 95% confidence interval, 0.39-0.96), whereas those using calcium channel blockers had a decreased risk of all falls (odds ratio, 0.62; 95% confidence interval, 0.42-0.91) and indoor falls (odds ratio, 0.57; 95% confidence interval, 0.36-0.91), compared with participants not taking these drugs. Larger doses of these classes were associated with a lower fall risk. Participants taking calcium channel blockers had higher cerebral blood flow than those not taking these medications. In relatively healthy community-dwelling elderly people, high doses of antihypertensive agents are not associated with an increased risk of falls.

International audience; Background: Circulating vascular adhesion molecule-1 (sVCAM-1) is a presumed marker of endothelial activation and dysfunction, but little is known about its association with mood. We hypothesized that elevated plasma concentrations of sVCAM-1 may be a marker of depressive symptoms due to cerebral vascular disease.Methods: We studied 680 community-dwelling participants in the MOBILIZE Boston Study, aged 65 years and older. sICAM-1 and sVCAM-1 were measured by ELISA assay and depressive symptoms were assessed during home interviews using the Revised Center for Epidemiological Studies Depression Scale (CESD-R). Cerebral White Matter Hyperintensities (WMHs) were quantified by MRI in a subgroup of 25 participants.Results: One hundred seventy nine (27 %) subjects had a CESD-R Score ≥ 16, indicative of depressive symptoms. The mean sVCAM-1 concentration (±SD) was 1176 ± 417 ng/mL in a group with CESD-R Scores

International audience; Introduction: This study contributes to assess the impact of an additional task on the gait parameters in elderly people with dementia. Summary of facts: Each patient completed a locomotor test in situation of single and dual-task. The gait quality was assessed using the Locometrix to collect the following parameters: speed, stride length, cadence, regularity, power. Conclusion: The gait quality of patients is significantly impaired in dual-task situation. Consideration must be conducted to provide a specific program activity for these patients to maintain their autonomy.

International audience; : Is epilepsy truly an "African ailment"? We aimed to determine this, since international health agencies often refer to epilepsy as an African disease and the scientific literature has spoken the same tone. Various published materials, mainly reports, articles, were used to gather Asian and African evidence on various aspects of epilepsy and many of its risk and associated factors. Our results suggest that in no way can epilepsy be considered as an African ailment and such characterization is most likely based on popular beliefs rather than scientific evidence. In comparison to Africa, Asia has a 5.0% greater burden from all diseases, and is 17.0% more affected from neuropsychiatric disorders (that include epilepsy). Given that more countries in Asia are transitioning, there may be large demographic and lifestyle changes in the near future. However these changes are nowhere close to those expected in Africa. Moreover, 23 million Asians have epilepsy in comparison to 3.3 million Africans and 1.2 million sub-Saharan Africans. In comparison to Africa, Asia has more untreated patients, 55.0% more additional epilepsy cases every year, because of its larger population, with greater treatment cost and possibly higher premature mortality. Of several associated factors discussed herein, many have more importance for Asia than Africa. The current state of epilepsy in Asia is far less than ideal and there is an urgent need to recognize and accept the importance of epilepsy in Asia. In no way can epilepsy be considered as an African ailment. This is most likely based on popular beliefs rather than scientific evidence. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.

International audience; PURPOSE: We aimed to determine the incidence and case-fatality of first-ever status epilepticus (SE) among the general population living in La Reunion Island, a French overseas territory in the Indian Ocean near Madagascar. METHODS: We recruited cases (1st July 2004-30th June 2005) in a population-based manner using neurology, neurosurgery, electroencephalogram, emergency, paediatric and neuroradiology services; emergency medical aid service; emergency and admission service of private and public clinics; neurologists (public and private); private paediatricians and practitioners of various rural hospitals. All cases had an electroencephalogram (EEG) and were assessed by an epileptologist. Standard definition and classification schemes were used. Those with known epilepsy were not part of this analysis. RESULTS: Sixty-five cases (males: n=41, 63.1%) had epileptologist-confirmed SE, with 38.5% (n=25) being >60 years of age. Global incidence rate was 8.52/100 000 (95% confidence interval 6.5-10.5). A bimodal age distribution with high frequency and incidence among young (60 years) (frequency: 40.0%; incidence 35.0/100,000) was observed. We found that 60%, 32.3%, 6.7% had convulsive, partial and non-convulsive SE respectively (1% remained unclassified). Of the cases identified, 44.6%, 38.5%, 16.9% had unprovoked, provoked or cryptogenic seizures respectively. The most important aetiological factors identified included: stroke (27.7%), alcoholism/toxicity (18.5%), cryptogenic (16.9%), infections (10.8%). Mortality was 18.5%. CONCLUSION: The incidence of SE incidence in La Reunion Island was lower than that described elsewhere. The status type was found to be dependent on aetiology and age. The study confirms that SE is more frequent in men and in older adults and is associated with significant short-term case mortality.

Background:The worldwide population is ageing and the proportion of elderly aged 60 and over is expected to dramatically rise in Low and Middle Income Countries (LMIC). The epidemic of dementia will not spare those countries, where the largest increases in numbers of people affected are estimated. Besides, dementia is still understudied in sub-Saharan Africa (SSA) compared to other regions. This paper describes the protocol for the 'Epidemiology of Dementia in Central Africa' population-based study, which aims at estimating the prevalence of dementia in two countries of Central Africa and investigating possible risk factors.Methods/Design:A multicenter population-based study was carried out in Central African Republic and Republic of Congo between 2011 and 2012 including both urban and rural sites in each country. Around 2000 participants aged ≥65 years old were interviewed in total using the Community Screening Interview for Dementia (CSI-D), the GMS-AGECAT and the CERAD's 10-word list. Elderly with low performance to the cognitive part of the CSI-D (COGSCORE ≤ 24.5) were then clinically assessed by neurologists and underwent further psychometrical tests. DSM-IV and NINCDS-ADRDA criteria were required for dementia and Alzheimer's disease (AD) diagnoses respectively. The algorithmic 10/66 dementia diagnosis was also determined. Petersen's criteria were required for the diagnosis of Mild Cognitive Impairment. Sociodemographic, and environmental factors including vascular, nutritional, biological, psychosocial and lifestyle factors were collected in each setting in order to investigate factors associated with dementia. Blood sampling was realized to investigate genetic variations that could modify the risk of dementia.Discussion:For now, no large epidemiological study has been undertaken to compare the prevalence of dementia in both rural and urban areas within SSA countries. This programme will provide further evidence regarding the prevalence of dementia in SSA, and also the possible rural/urban disparities existing with associated factors. Furthermore, the genetics of AD in those populations will be addressed.

Introduction: Since 2002, with the creation of Centers of Memory Resources and Research (CMRR), considerable progress has been made in France regarding the administrative and institutional framework within which Alzheimer's disease (AD) is managed. In this study, we explore three approaches that can help optimize the inclusion of patients in clinical trials related to AD. They are as follows: to assess communication concerning clinical trials on AD in French CMRR, to analyze the internal organization of these centers concerning the dynamics of inclusion, and to evaluate screening tools used. Methods: A national, descriptive, cross-sectional survey was conducted in all CMRR in France between May 1 and July 31, 2011, using a self-administered questionnaire. All investigators, subinvestigators and the relevant CMRR personnel were involved. Results: A total of 75% of the CMRR participated, and about 30% of the physicians contacted responded positively to the survey. Only 50% reported having communicated with health care professionals at least once in the previous 3 months, and less than 50% had communicated occasionally with the general public. A total of 75% of those surveyed had a research group but only half of the groups were active, 50% of the physicians did not have a consultation time dedicated to study recruitment, and 75% of the respondents had a screening tool in their CMRR but over half of them were not satisfied with it. Conclusion: This investigation provides a basis for improving the screening of patients by both internal organizational development and adaptation of tools already available. Improvement requires promoting regular communication that is appropriate and targeted to health care professionals, smaller memory centers, associations and the public, and therefore, familiarizing the whole population with clinical research on AD.

Introduction La prescription de groupes sanguins (PGS), souvent effectuee de facon systematique en medecine d’urgence, entraine un surcout, evitable par une demarche plus raisonnee. Nous avons etudie l’impact de la mise en place d’un protocole de PGS. Methodes Nous avons mene une etude observationnelle, descriptive, de type avant–apres, multicentrique, du 1 er fevrier au 31 mars 2015 versus 2016 dans notre CHU et un hopital peripherique (HP). Nous avons inclus tous les patients admis aux urgences (hors dechocage) ayant beneficie d’une PGS. Nous avons mis en place entre ces deux periodes un protocole definissant les indications de PGS, valide par les equipes d’anesthesie du CHU et de l’HP. Nous avons compare les pratiques professionnelles avant et apres ce protocole sur les deux sites. Le critere principal de jugement etait le taux de PGS non conformes au protocole. Nous avons egalement recueilli le taux de doublons au CHU. Resultats Nous avons inclus un total de 989 patients, 540 en 2015 et 449 en 2016. L’âge moyen en 2015 et 2016 etait de 65,8 ± 23,7 ans et 67,9 ± 22,3 ans avec un sex-ratio (homme/femme) de 0,9 et 0,9. Le taux de PGS non conformes etait de 55,4 % (IC95 % [51,2–59,6]) en 2015 et de 46,8 % (IC95 % [42,2–51,4]) en 2016 soit une amelioration de 8,6 % ( p = 0,009). L’amelioration etait plus importante a l’HP (47 % contre 24,5 % soit une amelioration de 22,5 %, [ p = 0,0009]). Le taux de doublons au CHU etait de 43,1 % (IC95 % [38,4–47,8]) contre 37,3 % (IC95 % [32,2–42,4]) soit une amelioration de 5,8 %. Le surcout du aux PGS non conformes etait de 6378 € en 2015 et de 4479 € en 2016 (par extrapolation sur un an : 38 266 € contre 26 875 €). Celui du aux doublons de 3903 € contre 2730 € (soit 23 420 € contre 16 381 € sur un an). Conclusion Notre etude a confirme la sur-prescription de GS, avec un impact medico-economique defavorable. Des economies sont possibles par la mise en place de protocoles de PGS et par l’informatisation du dossier transfusionnel des patients.

L’objectif de ce travail est d’explorer de nouvelles pistes technologiques pour la prevention de la perte d’autonomie des personnes âgees vivant a domicile. Cette experimentation vise a evaluer en milieu ecologique, l’impact reel des nouvelles technologies sur les principaux determinants de la perte d’autonomie, la chute a domicile en priorite. Cette evaluation se concoit dans un cadre global d’evaluation pluridisciplinaire avec a terme une evaluation medico-economique indispensable pour une appreciation de l’efficience de ces outils. Dans ce travail, l’efficacite sur la prevention des chutes a domicile et la bonne acceptabilite de ces outils semble se verifier mais ces resultats necessitent une confirmation par une etude randomisee.

International audience

Introduction Cette etude a pour objectif principal d’analyser les effets d’un programme multi-composant (equilibre, marche, double-tâche) sur les troubles de la marche et le risque de chute de patients atteints de demence. L’objectif secondaire est de determiner s’il existe une relation entre les capacites de marche et le risque de chute chez les patients dements avant et apres un programme d’entrainement. Materiel et methodes Nous avons propose a 16 patients dements (86,7 ± 5,4 ans) un programme d’exercices multi-composants d’une duree de 8 semaines. La marche, le risque de chute et le niveau d’activite physique sont respectivement evalues par le Locometrix ® , le test de Tinetti et le Body Media SenseWear ® Pro armband avant et apres le programme d’entrainement. Resultats Le programme d’exercices multi-composants ameliore les performances de marche et le score au test de Tinetti ( p p Discussion–conclusion L’analyse des parametres spatio-temporels de la marche par un accelerometre (Locometrix ® ) est une methode simple et rapide pour estimer les benefices d’un programme d’exercice et le risque de chute de patients dements.