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1. Better functional recovery after acute stroke in older patients managed in a new dedicated post-stroke geriatric unit compared to usual management

Author

Bruno Oquendo, Charlotte Nouhaud, Witold Jarzebowski, Anne Leger, Christel Oasi, Massamba Ba, Carmelo Lafuente-Lafuente, and Joel Belmin

Subjects
Stroke, Older adults, Rehabilitation, Post-stroke unit, Mortality, Disability, Internal medicine, RC31-1245
Abstract

Objectives: A Stroke care Pathway dedicated to the ELders (SPEL) for patients with acute stroke was created in 2013 at the hospitals Pitié-Salpêtrière-Charles Foix (Paris, France). It is characterized by a stroke unit dedicated to emergency stroke care, and a post stroke geriatric unit (PSGU) including rehabilitation and management of geriatric syndromes. The aim of the study was to compare the functional recovery of patients transferred to PSGU versus other rehabilitation care in patients over 70 years of age after stroke. Design: A cohort observational study over a 4-year period. Setting: Hospitals Pitié-Salpêtrière and Charles Foix (Paris, France). Participants: We studied patients over 70 years admitted to the participating stroke unit for acute stroke consecutively hospitalized from January 1, 2013, to January 1, 2017. Intervention: Patients transferred in the PSGU were compared to those admitted in other rehabilitation units. Measurements: The primary outcome was 3-month functional recovery after stroke. The secondary outcomes were the hospital length of stay and the returning home rate. A multivariable logistic regression was applied to adjust for confounding variables (age, sex, NIHSS score and Charlson’s comorbidity score). Results: Among the 262 patients included in the study, those in the PGSU were significantly older, had a higher Charlson’s comorbidity score and a higher initial NIHSS severity score. As compared to the other patients, functional recovery at 3 months was better in the PSGU (Rankin's score decreased by 0.80 points versus 0.41 points, p = 0.01). The average total length of stay was reduced by 16 days in the patients referred to the PSGU (p = 0.002). There was no significant difference in the returning home rate between the two groups (p = 0.88). Conclusion: The SPEL which includes a post-stroke geriatric unit (PSGU) has been associated with improved recovery and had a positive impact in the management of older post-stroke patients.

Published
2024
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3. Auteurs

Author

Laetitia, Amalou, Cédric, Annweiler, Élise, Artaud-Macari, Alexis, Arvin-Bérod, Patrick, Assayag, Maria, Bailleul, Emma, Bajeux, Grégory, Baptista, Martine, Barateau, Bernard, Bauduceau, Laetitia, Beernaert, Joël, Belmin, Athanase, Bénétos, Michel, Benoit, Hubert, Blain, Sylva, Blazkova, Wanda, Blervaque, Sylvie, Bonin-Guillaume, Mylène, Bonnaire, Marc, Bonnefoy, Mathilde, Bordage, Lyse, Bordier, Chokri, Boubakri, Didier, Bouccara, Anne-Sophie, Boureau, Bruneau, Marie-Andrée, Pierre-Emmanuel, Cailleaux, Priscille, Carvalho, Philippe, Chassagne, Aline, Corvol, Matthieu, Coulongeat, Antoine, Cuvelier, Sandra, De Breucker, Laure, De Decker, Tristan, De Nattes, Amandine, Dessertennes, Audrey, De Vos, Benoît, de Wazières, Frédéric, Di Fiore, Aurélien, Dinh, Cristiano, Donadio, Jean-Michel, Dorey, Jean, Doucet, Olivier, Drunat, Feriel, Fennira, Claire, Falandry, Juliette, Fontaine, Thibaut, Fraisse, Patrick, Friocourt, Tamàs, Fülöp, Julien, Gaudric, Jean-Bernard, Gauvain, Gaëtan, Gavazzi, Xavier, Gbaguidi, Charles-Emmanuel, Geffroy, Christian, Geny, Édouard, Georgeton, Baptiste, Gérard, Angélique, Giacomini, Mathilde, Gisselbrecht, Alice, Gochard-Rodrigues, Bernard, Goichot, Régis, Gonthier, Odile, Goria, Adrien, Grancher, Béatrice, Guérin, Dominique, Guerrot, Olivier, Hanon, Charlotte, Havreng-Théry, Réjean, Hébert, Mathieu, Herrmann, Patrick, Hidoux, Jérémie, Huet, Witold, Jarzebowski, Olivier, Jeanjean, Georges, Kaltenbach, Alain, Koskas, Pierre, Krolak-Salmon, Carmelo, Lafuente-Lafuente, Pierre-Olivier, Lang, Martine, Le Noc Soudani, Amandine, Lecarpentier, Laurent, Lechowski, Pierre-Olivier, Lefebvre, Anne, Léger, Caroline, Lemaitre, Thierry, Lequerré, Anaïs, Lesourd, Pierre, Lutzler, Arach, Madjlessi, Éric, Maeker, Emmanuel, Maheu, Patrick, Manckoundia, Nathalie, Maubourguet, Sylvie, Meaume, Anne, Michel, Boubacar, Mohamed, Hélène, Montialoux, Sophie, Moulias, France, Mourey, Stéphane, Nacache, Sylvain, N'Guyen, Charlotte, Nouhaud, Jean-Luc, Novella, Christel, Oasi, Marine, Olivieri, Bruno, Oquendo, Mourad, Ould Slimane, Marc, Paccalin, Elena, Paillaud, Frédéric, Pamoukdjian, Sylvie, Pariel, Erika, Parmentier-Decrucq, Christine, Perret-Guillaume, Mélissa-Asli, Petit, François, Pinoche, Julien, Poissy, Valérie, Pouysségur, Isabelle, Prêcheur, Alain, Putot, Yasmine, Rassam-Hasso, Agathe, Raynaud-Simon, Clothilde, Riquier, Frédéric, Roca, Jean, Roche, Pierre-Alexandre, Roger, Nathalie, Salles, Patricia, Senet, Dominique, Somme, Carmen, Suna-Enache, Alain, Tavildari, Achille, Tchalla, Laurent, Teillet, Lise, Teisseire, Cathy, Théry, Éric, Vérin, Maurice, Viala, Marguerite, Vignon, Olivier, Vittecoq, Eugenia, Volpentesta, Lise, Willems, Alberto, Zalar, Sabrina, Aït, Gilles, Albrand, Jean-Pierre, Aquino, André, Aurengo, Odile, Baugé-Faraldi, Nadine, Bazin, Jean-Louis, Beaudeux, Xavier, Belenfant, Lotfi, Ben Slama, Athanase, Benetos, Jean-Marc, Bereder, Gilles, Berrut, François, Blanchard, Jacques, Boddaert, Christophe, Bouché, Rabia, Boulahssass, Isabelle, Bourdel-Marchasson, Anne, Bruhat, Marie-Andrée, Bruneau, Agnès, Camus, Corinne, Capet, Emmanuelle, Champion, Dominique, Chavanne, Patrick, Chérin, Florence, Chopin, Thierry, Constans, Pascal, Couturier, Véronique, Cressot, Laure, de Decker, Anne-Sophie, De Saint-Léger, Benoit, De Wazières, Philippe, Denormandie, Violaine, Derambure, Laurent, Druesne, Bernard, Durand-Gasselin, Richard, Durant, Marc, Faraldi, Anne-Laure, Fauchais, Audrey, Fel, Éric, François, Florent, François, Éric, Frau, Jacques, Gaillat, Danièle, Ganem-Chabenet, David, Gaucher, Pierre, Gauthier, Gaël, Gendron, Armelle, Gentric, Laura, Goodrich, Isabelle, Got, Etty, Grynberg, Jean-Michel, Guérin, Olivier, Guerin, Karine, Guignery-Kadri, Bernard, Guillot, Victor, Haddad, Pierre, Haond, Cyril, Hazif-Thomas, Jacqueline, Henry, François, Héron, Géraldine, Heurteux, Caroline<ce:sup loc='post">†</ce:sup>, Hommet, Marc, Humbert, Cécile, Hvostoff, Jean-Marc, Jacquot, Claude, Jeandel, Nadir, Kadri, Norelyakin, Kara, Aïda, Kerkeni, Aïni, Khris, Kiyoka, Kinugawa, Rémy, Klein, Emmanuel, Krupka, Marc, Labétoulle, Gilles, Lascault, Julien, Le Guen, Cédric, Le Guillou, Véronique, Lefebvre des Noëttes, Daniel, Letonturier, Caroline, Levasseur, Jean-Pierre, Louvel, Emmanuelle, Magny, Nicolas-Dominique, Manchon, Dominique, Manière, Jean, Mariani, Sophie, Marilier, Thierry, Marquet, Charlotte, Mathon, Emmanuel, Mazen, Anthony, Mézière, Pierre, Michel Jean, Christelle, Mischis-Troussard, Anne-Sophie, Moiziard, A., Morais José, Robert, Moulias, Andy, Musat, Angela, Musat, Cathy, Nabet, Henry, Noguès, Fati, Nourhashémi, Fannie, Onen, Hakki, Onen S., Yves, Otmezguine, Béatrice, Pallot-Prades, Marie-Pierre, Pancrazi, Maxime, Patout, Éric, Pautas, Jérôme, Pellerin, Renaud, Péquignot, Benoît, Pernot, Anne, Petit, Pierre<ce:sup loc='post">†</ce:sup>, Pfitzenmeyer, Benoît, Plaud, Emilie, Puget, François, Puisieux, Lucie, Quibel, Muriel, Rainfray, Cyrielle, Rambaud, Vincent, Rialle, Yves, Rolland, Jean-Nicolas, Royal, Guillaume, Savard, Jean-Pierre, Schuster, Denise, Strubel, Catherine, Terrat, Catherine, Terret, Jean-Étienne, Terrier, Daniel, Tessier, Sarah, Thomas, Thierry, Thomas, Christophe, Trivalle, Lucie, Valembois, Bruno, Vellas, Éric, Verin, Marc, Verny, Marie, Vetel Jean, Pierre, Veyssier, Thomas, Vogel, and Fabienne, Wirotius

Published
2023
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4. Utilisation des anticoagulants chez les patients âgés atteints de fibrillation atriale dans un service de cardiogériatrie

Author

Carmelo Lafuente-Lafuente, Witold Jarzebowski, H. Yang, Charlotte Nouhaud, Joël Belmin, Département Hospitalo-Universitaire Fight Ageing and STress (DHU FAST ), Université Pierre et Marie Curie - Paris 6 (UPMC), Service de gériatrie à orientation cardiologique [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC)

Subjects
Gynecology, medicine.medical_specialty, business.industry, Risque hémorragique, Anticoagulants, 030204 cardiovascular system & hematology, Atrial fibrillation, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Older patients, Fibrillation atriale, Medicine, 030212 general & internal medicine, Hemorrhagic risk, Cardiology and Cardiovascular Medicine, business, Patient âgé
Abstract

International audience; ObjectiveOlder people with atrial fibrillation (AF) have an increased embolic risk but they are less frequently treated with anticoagulants. We wanted to assess our current practice in a specialized service.Patients and methodsProspective observational study including all patients older than 75 years admitted during 3 months in a cardio-geriatric unit. Patients’ embolic risk (CHADS2 score), hemorrhagic risk (HAS-BLED score), anti-thrombotic treatment at arrival and any modification afterwards, were analyzed.ResultsThirty-four patients were included (mean age: 85 years). AF was known in 28 patients, of whom 20 were under anticoagulant therapy at their admission (10 fluindione, 9 warfarine, 1 dabigatran), 4 received aspirin and 4 no anti-thrombotic treatment. Only the treatment of one of these patients was modified, replacing aspirin by warfarin. AF was newly diagnosed in 6 patients, of whom anticoagulation were initiated in 4 patients (3 warfarine, 1 fluindione). Finally, 9 patients (26%) left the hospital without anticoagulant treatment. Reasons given by their attending doctors were: advanced dementia (4 patients), estimated excessive hemorrhagic risk (4), and estimated low embolic risk (1). There was a clear trend to initiate anticoagulation more frequently in patients with a newly diagnosed AF (P = 0.09)ConclusionsA substantial proportion of older patients with AF do not receive anticoagulant therapy, even after having been admitted to a specialized service. Advanced dementia and hemorrhagic risk are the reasons most frequently given for that.; But de l’étudeLes patients âgés atteints de fibrillation atriale (FA) ont un risque embolique élevé mais ils sont moins souvent anticoagulés. Nous voulions évaluer nos pratiques dans un service de gériatrie spécialisé.Patients et méthodeÉtude observationnelle descriptive incluant tous les patients de plus de 75 ans avec une FA hospitalisés pendant une période de 3 mois dans un service de cardiogériatrie. Leur risque embolique (score CHADS2), risque hémorragique (score HAS-BLED), traitement antithrombotique à l’arrivée et toute modification postérieure, ont été recueillis.RésultatTrente-quatre patients ont été inclus (âge moyen : 85 ans). La FA était déjà connue chez 28 patients, dont 20 suivaient à l’arrivée une anticoagulation efficace (10 fluindione, 9 warfarine, 1 dabigatran), 4 un traitement par aspirine et 4 aucun traitement antithrombotique. Seul le traitement d’un de ces patients a été modifié, en remplaçant l’aspirine par warfarine. La FA a été une découverte à l’occasion de leur hospitalisation chez 6 patients, dont 4 ont été mis sous anticoagulation (3 warfarine, 1 fluindione). Au total, 9 patients (26 %) sont sortis de l’hôpital sans une anticoagulation. Les raisons invoquées étaient : démence évoluée (4 patients), risque hémorragique jugé excessif (4), risque embolique jugé faible (1). Il y a eu une nette tendance à davantage d’initiation de l’anticoagulation chez les patients avec une FA nouvellement découverte (p = 0,09).ConclusionsUn nombre non négligeable de patients âgés avec FA restent sans traitement anticoagulant même après passage dans un service spécialisé. La démence évoluée et le risque hémorragique sont les raisons les plus fréquemment invoquées.

Published
2016
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5. Insuffisance cardiaque chez les sujets âgés de plus de 80 ans

Author

L. Hittinger, Carmelo Lafuente-Lafuente, Emmanuelle Berthelot, Charlotte Nouhaud, Patrick Assayag, Service de Gériatrie à orientation cardiologique et neurologique, CHU Charles Foix [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Mondor de Recherche Biomédicale (IMRB), and Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)

Subjects
Pediatrics, medicine.medical_specialty, medicine.drug_class, business.industry, Incidence (epidemiology), [SDV]Life Sciences [q-bio], MEDLINE, General Medicine, 030204 cardiovascular system & hematology, Therapeutic education, medicine.disease, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Heart failure, Edema, Natriuretic peptide, medicine, 030212 general & internal medicine, medicine.symptom, business, Weight gain, Clinical syndrome
Abstract

Heart failure (HF) is a clinical syndrome that associates clinical signs in people over 80 years of age, an increase in natriuretic peptides and abnormal cardiac structures that result from cardiac aging in many cases. The most common symptoms are grouped according to the acronym "EPOF" (shortness of breath, weight gain, edema, fatigue). Over the age of 80, comorbidities must be taken into account. The incidence and prevalence of HF significantly increases with age and makes HF the most common reason for hospitalization for people over 80, and an important health expense. The management of HF, necessarily multidisciplinary with a geriatric evaluation, has improved over time due to effective targeted treatment, but mortality, hospitalization and readmission rates remain high. Therapeutic education and patient follow-up for treatment optimization are needed.

Published
2019
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6. [Heart failure in patients over 80 years old]

Author

Emmanuelle, Berthelot, Charlotte, Nouhaud, Carmelo, Lafuente-Lafuente, Patrick, Assayag, and Luc, Hittinger

Subjects
Aged, 80 and over, Heart Failure, Hospitalization, Aging, Clinical Trials as Topic, Patient Education as Topic, Natriuretic Peptide, Brain, Humans, Cardiovascular Agents, Heart, Prognosis, Biomarkers, Peptide Fragments
Abstract

Heart failure (HF) is a clinical syndrome that associates clinical signs in people over 80 years of age, an increase in natriuretic peptides and abnormal cardiac structures that result from cardiac aging in many cases. The most common symptoms are grouped according to the acronym "EPOF" (shortness of breath, weight gain, edema, fatigue). Over the age of 80, comorbidities must be taken into account. The incidence and prevalence of HF significantly increases with age and makes HF the most common reason for hospitalization for people over 80, and an important health expense. The management of HF, necessarily multidisciplinary with a geriatric evaluation, has improved over time due to effective targeted treatment, but mortality, hospitalization and readmission rates remain high. Therapeutic education and patient follow-up for treatment optimization are needed.

Published
2019

7. [Drug treatment of agitation in emergency departments: The case of elderly persons. Letter to the article: 'Drug management of agitation in emergency departments: Theoretical recommendations and studies of practices']

Author

Witold, Jarzebowski, Cristiano, Donatio, Charlotte, Nouhaud, Emmanuelle, Magny, Carmelo, Lafuente-Lafuente, and Joël, Belmin

Subjects
Emergency Services, Psychiatric, Critical Care, Practice Guidelines as Topic, Humans, Practice Patterns, Physicians', Psychomotor Agitation
Published
2015

8. Ont collaboré à cet ouvrage

Author

Joël, Belmin, Philippe, Chassagne, Patrick, Friocourt, Régis, Gonthier, Claude, Jeandel, Fati, Nourhashémi, Gilles, Albrand, Laetitia, Amalou, Cédric, Annweiler, Alexis, Arvin-Bérod, Grégory, Baptista, Martine, Barateau, Lotfi, Ben Slama, Athanase, Benetos, Michel, Benoit, Jean-Marc, Bereder, Gilles, Berrut, Hubert, Blain, François, Blanchard, Sylva, Blazkova, Sylvie, Bonin-Guillaume, Marc, Bonnefoy, Mathilde, Bordage, Chokri, Boubakri, Didier, Bouccara, Christophe, Bouché, Rabia, Boulahssass, Anne-Sophie, Boureau, Marie-Andrée, Bruneau, Corinne, Capet, Emmanuelle, Champion, Thierry, Constans, Aline, Corvol, Pascal, Couturier, Antoine, Cuvelier, Laure, de Decker, Philippe, Denormandie, Benoît, de Wazières, Aurélien, Dinh, Jean-Michel, Dorey, Olivier, Drunat, Claire, Falandry, Audrey, Fel, Feriel, Fennira, Juliette, Fontaine, Thibaut, Fraisse, Éric, François, Florent, François, Patrick, Frémont, Tamàs, Fülöp, Jacques, Gaillat, Julien, Gaudric, Jean-Bernard, Gauvain, Gaëtan, Gavazzi, Xavier, Gbaguidi, Charles-Emmanuel, Geffroy, Christian, Geny, Armelle, Gentric, Alice, Gochard-Rodrigues, Laura, Goodrich, Odile, Goria, Béatrice, Guérin, Olivier, Guerin, Karine, Guignery-Kadri, Bernard, Guillot, Olivier, Hanon, Cyril, Hazif-Thomas, Caroline, Hommet, Marc, Humbert, Cécile, Hvostoff, Witold, Jarzebowski, Georges, Kaltenbach, Norelyakin, Kara, Kiyoka, Kinugawa, Rémy, Klein, Pierre, Krolak-Salmon, Emmanuel, Krupka, Carmelo, Lafuente-Lafuente, Pierre-Olivier, Lang, Laurent, Lechowski, Véronique, Lefebvre des Noëttes, Julien, Le Guen, Cédric, Le Guillou, Caroline, Lemaitre, Martine, Le Noc Soudani, Daniel, Letonturier, Pierre, Lutzler, Arach, Madjlessi, Emmanuelle, Magny, Nicolas-Dominique, Manchon, Patrick, Manckoundia, Charlotte, Mathon, Nathalie, Maubourguet, Sylvie, Meaume, Anthony, Mézière, Anne, Michel, Robert, Moulias, France, Mourey, Sylvain, Nguyen, Henry, Noguès, Charlotte, Nouhaud, Jean-Luc, Novella, Christel, Oasi, Fannie, Onen, Marc, Paccalin, Marie-Pierre, Pancrazi, Sylvie, Pariel, Maxime, Patout, Benoit, Pernot, Christine, Perret-Guillaume, Benoît, Plaud, Muriel, Rainfray, Cyrielle, Rambaud, Agathe, Raynaud-Simon, Vincent, Rialle, Frédéric, Roca, Yves, Rolland, Jean-Nicolas, Royal, Nathalie, Salles, Jean-Pierre, Schuster, Dominique, Somme, Alain, Tavildari, Achille, Tchalla, Catherine, Terret, Jean-Étienne, Terrier, Cathy, Théry, Sarah, Thomas, Lucie, Valembois, Bruno, Vellas, Éric, Verin, Marc, Verny, Maurice, Viala, and Thomas, Vogel

Published
2019
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9. Le traitement médicamenteux de l’agitation aux urgences : le cas des personnes âgées. Correspondance à propos de l’article : « Prise en charge médicamenteuse des agitations aux urgences : recommandations théoriques et études des pratiques »

Author

Carmelo Lafuente-Lafuente, Joël Belmin, Witold Jarzebowski, Charlotte Nouhaud, Emmanuelle Magny, and Cristiano Donatio

Subjects
business.industry, Medicine, General Medicine, business, Humanities
Abstract

La Presse Medicale - In Press.Proof corrected by the author Available online since mardi 6 octobre 2015

Published
2015
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