Search

On January 1st, 2018, we established an orthogeriatrics (OG) unit for patients aged ≥ 70 years old with hip fracture, based on a purely geriatric management 24-hours post-operation. In this article we discuss the results of the implemented measures (geriatric follow-up with standardized protocols) on mortality after 6 weeks, operative delay, and complications. Among the 607 treated patients, the mortality rate was 6.75 %, which was unaffected by the average operative delay of 35 hours. Age, male gender, dependency status, cognitive disorder and malnutrition all significantly increased the mortality rate. Presenting at least one complication multiplied the mortality rate by 4.79, a cardiac complication by 3.92, and severe malnutrition by 4.95., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

How to apply treatment recommendations from various knowledgeable specialist societies concerning the very complex patient? Within a population weakened by the cumulative effect of comorbidities, loss of autonomy aggravated by geriatric syndromes and biological changes linked to aging which interact with the pharmacokinetics and pharmacodynamics of drugs, there is fertile soil for the advent of adverse conditions linked to simultaneously prescribing multiple treatments. Our aim is to analyze various clinical reasoning tools permitting an appropriate drug prescription while considering the state of health, life expectancy and time to benefit with the aim of reducing iatrogenesis., Competing Interests: L’auteur n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Improving glycaemia level is helpful to the clinician in diabetes management. Elderly diabetics make up a group that is non-homogeneous and with a very varied health status, whose treatment must be adjusted to take into account comorbidities, degree of frailty and both functional and mental disability, in addition to their life expectancy and personal preferences. Thus, the target of treatment should be defined along three categories of patients: robust, vulnerable and dependent. This article reviews information from the literature high-lighting current recommendations for treatment, the clear inclination towards overtreatment of the elderly diabetic and the resulting noxious effects of occurring hypoglycemia, that are often not recognized by the patient and his doctor., Competing Interests: L’auteur n’a déclaré aucun conflit d’intérêts en relation avec cet article.

What are the criteria for admitting an elderly polymorbid patient to intensive care ? The multidimensional geriatric evaluation is a tool to screen for geriatric syndromes, with the division of elderly patients into 3 categories: robust, vulnerable and dependent. Targeting certain co-morbidities such as cognitive disorders, delirium, frailty, polymedication and malnutrition, allows clinicians to estimate the risks of mortality and functional and cognitive handicaps during a stay in intensive care. Based on a review of the literature, this article offers some guidelines for triage of older patients for admission to intensive care, using an ethical, multidisciplinary approach that takes into account the patient's fears and preferences., Competing Interests: L’auteur n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Atrial fibrillation is a common cardiac disease of aging. The risk of stroke and bad prognosis increase with age and atrial fibrillation. Compared with younger people, elderly people have higher risks for both thrombosis and bleeding. Stroke prevention with oral anticoagulants is the cornerstone of the management of atrial fibrillation but is often questioned because of the risk of bleeding, furthermore comorbidities, comedications, fall risks, poor compliance. These factors frequently found in frail elderly patients complicate the management of antithrombotic therapy. This article reviews the evidence for the risks and benefits of anticoagulation in the elderly with atrial fibrillation, by comparing the new oral anticoagulants to vitamin K antagonists., Competing Interests: L’auteur n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Proximal femur fractures in the elderly are still a major event in the functional trajectory of patients. In order to optimize their care, a pilot orthogeriatric unit was created in 2018 at the Valais Hospital. This innovative unit, managed by the internist-geriatrician within the orthopedic department, allows the early and standardized management of geriatric syndromes and postoperative complications. This article describes the practical operation of the unit, presents the preliminary results, and develops suggestions for improvement., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Does inappropriate treatment contribute to the risk of falls and fractures in older diabetic patients ? Among 2205 diabetics hospitalized in a geriatric ward, this retrospective study analyses the follow-up of the group with a fracture (12 %) according to the glycated hemoglobin (HbA1c) and the recommended targets. In our collective where only 4 % are healthy (50 % are vulnerable, 46 % are frail), the average value of HbA1c is 6.9 %. When we compare HbA1c, we find that more than 79.3 % of patients have HbA1c at least 0.5 % below the recommended target for their category. This suggests overtreatment that may have contributed to falls., Competing Interests: les auteur n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The extended life expectancy questions the quality of life of these additional years: with or without disability ? A review of the literature gives us some tips on preventive measures to maintain good health at an advanced age. Engaging in regular and moderate physical activity (such as walking) offers a range of health benefits, including reduced risk of all-cause mortality, lower risk for various diseases (ischemic stroke, ischemic heart disease, diabetes, breast and colon cancer), prevention of falls and functional decline in seniors living at home. Maintaining a healthy lifestyle (non-smoking, low alcohol consumption, adequate nutrition) as well as up-to-date immunization status and vitamin D supplementation in the deficient or vulnerable population, are factors that contribute to a better health in the last years of life., Competing Interests: L’auteur n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Capgras delusion is classified with the misidentification syndromes. In dementia it associates cognitive deficiency of memory and facial recognition (prosopoagnosia) with delirious idea of substitution by a double. The first reported case in the paper describes the important affective and comportmental reactions due to the identification of a double perceived as an imposter, affecting both the suffering person and his family. Rarely, as reported in the second case, misrecognition concerns the person itself (autoprosopagnosia) who can have the illusion to be in front of a twin brother (« auto-Capgras »). We discuss data from the literature concerning prevalence, results of cerebral imaging and functional prognosis associated with this curious syndrome., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Will my patient actually benefit from the medication that I've prescribed? Faced with an elderly, frail patient, the family doctor is often confronted by this dilemma. This article reviews the evidence that can assist clinicians in determining the best approach to treating diabetes, hypertension and hyperlipidemia in elderly patients, by defining treatment goals specific to each patients' functional and cognitive capacities. Avoiding hypoglycemia and hypotension, with all of their consequences, must remain the highest priority driving objectives for optimal management of diabetes and hypertension in the geriatric population., Competing Interests: L’auteur n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Engaging in regular and appropriate physical activity confers health benefits at any age. For seniors, swapping the role of « sedentary » for « someone who's on the move » offers much more substantial benefits than any medication, and notably even starting at a dose of 10-15 minutes per day ! Any physician who cares for elderly patients must pursue the objective of encouraging physical activity that is integrated into daily life (e.g. walking, gardening, shopping). This article consists of a literature review concerning the evidence for the benefits of physical activity in seniors in terms of quality of life, longevity, maintenance of functional independence, and prevention of cognitive decline., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The thiamine deficiency and its clinical consequences, especially the Wernicke encephalopathy, are still often not diagnosed. The etiologies are numerous, but the most frequent is the alcohol dependence. The diagnostic is mainly clinical and the treatment must be started as soon as possible by substituting the thiamine with intravenous injection., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Diabetic glycemic targets in older patients must reflect their preferences, clinical status and life expectancy. The presence of multiple comorbidities as well as functional or cognitive impairment are better predictors than age alone of both limited life expectancy and reduced benefit of intensive treatment. For most of these patients, the harms of intensive diabetes therapy outweigh the benefits. Our retrospective study analyzing 257 diabetic patients hospitalized in a geriatric ward shows a very high incidence of over-treatment and suggests the need to review our practices and to adopt individualized treatment goals.

Hip fracture in the elderly can be associated with dramatic issues like death in the year or severe handicap requiring admission in a nursing home. Implementation of a close cooperation between orthopaedic surgeon and geriatrician materialize in the creation of unit, known as orthogeriatric unit where the roles of each member are precisely defined from admission to discharge, with coordinated care protocols and standardized orders. Benefits of the orthogeriatric ward are clarified in this paper, referring to literature, with description of an improvement of functional score after 3 months, reduction of in-hospital mortality and post-operative complications.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, incurable, mostly declared near the age of sixty-seventy, but more rarely for the older individuals. Because presenting symptoms are non specific (muscle weakness, functional decline, loss of ambulation, dyspnea, dysphagia), diagnosis in early stages may be difficult and delayed, particularly on polymorbid older patients. Symptomatic management is the mainstay of treatment for ALS; care in multidisciplinary team, with maximal psychologic support, is associated with enhanced quality of life. In this article we remind markings aspects of ALS of the older subject, in the light of the follow-up of five patients in our geriatric service.

Diabetes mellitus, a common condition in older persons, is caused by a complex interaction of genetic and environmental factors. Treatment objectives in older diabetic patient will be based on an individualized approach, the target goals varying with life-limiting comorbid illness, cognitive or functional impairments. Appropriate therapeutic goals are to avoid symptomatic hyperglycemic episodes and acute metabolic decompensation, as well as severe hypoglycemia in frail patients, while nutritional restriction should be minimized to prevent these patients' quality of life.