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BACKGROUND This survey assessed how much of a taboo surrounds urge or mixed urinary incontinence (UI), through questions to affected patients and healthcare professionals using online questionnaires, with the objective to contrast the patients' perceptions with that of the doctors. METHODS This quantitative study was preceded by a qualitative phase carried out with general practitioners, specialists, and UI patients. Following these phases, questionnaires were made available on the internet. They covered questions pertaining to perceptions of UI, degree of embarrassment and its consequences, patient-doctor relationship, and treatments. RESULTS Overall, 310 UI patients of male or female gender participated in the study, as did 101 general practitioners, 50 urologists, and 30 gynecologists. The analysis revealed that 60% of patients felt embarrassment about UI, the condition representing for them a taboo topic similar to cancer. This taboo was shown to be seen further enhanced by doctors. UI was associated with a loss of self-esteem (51%) and restriction to daily life (44%). The patients' answers revealed that UI was only brought up by doctors in 6% of cases, whereas the patient was the first to bring it up in 55%, primarily with their general practitioner (80%). Thus, in 4 out of 10 cases, the issue was not addressed; 49% of patients stated they did not discuss their condition with their partner and 33% did not discuss it with anybody. CONCLUSION UI is still a major taboo and we have a long way to go to change attitudes. LEVEL OF EVIDENCE 3.

Ageing implicates a remodeling of our immune system, which is a consequence of the physiological senescence of our cells and tissues coupled with environmental factors and chronic antigen exposure. An immune system that senesces includes more differentiated cells with accumulation of highly differentiated CD4 and CD8 T cells. The pool of naive T cells decreases with the exponential thymic involution induced by age. Differentiated T cells have similar, if not higher, functional capacities but scarce studies are looking at the impact of senescence among specific T cells. After a stimulation, other immune cells (monocytes, dendritic cells and NK) are functionally altered during ageing. It is as if the immune system was more efficient at the basal level, but less efficient after a stimulation in the old compared to young people, likely due to less reserve. Concerning the clinical impact, older people are more prone to certain pathogens and their clinical manifestations differ from the younger people. Severe flu and VZV reactivation are more frequent with an altered cellular response to vaccination. Vaccination failure can have detrimental consequences in people presenting frailty criteria. Old people frailty is majored by their comorbidities and diseases like cancer. Thus, chemotherapies are employed with circumspection in older patients. The use of anti-PD-1/PD-L1 immunotherapies is therefore attractive, because of less side effects with a better response compared to chemotherapy. Old persons inclusion is lacking in current studies and clinical trials. Some subgroups or pooled analyses confirm the gain in response without increased toxicities in older patients but their inclusion criteria differ from the real-life practice. Specific studies focusing on this population are needed because of the increasing cancer incidence with age and the overall ageing of the population.

This survey assessed how much of a taboo surrounds urge or mixed urinary incontinence (UI), through questions to affected patients and healthcare professionals using online questionnaires, with the objective to contrast the patients' perceptions with that of the doctors.This quantitative study was preceded by a qualitative phase carried out with general practitioners, specialists, and UI patients. Following these phases, questionnaires were made available on the internet. They covered questions pertaining to perceptions of UI, degree of embarrassment and its consequences, patient-doctor relationship, and treatments.Overall, 310 UI patients of male or female gender participated in the study, as did 101 general practitioners, 50 urologists, and 30 gynecologists. The analysis revealed that 60% of patients felt embarrassment about UI, the condition representing for them a taboo topic similar to cancer. This taboo was shown to be seen further enhanced by doctors. UI was associated with a loss of self-esteem (51%) and restriction to daily life (44%). The patients' answers revealed that UI was only brought up by doctors in 6% of cases, whereas the patient was the first to bring it up in 55%, primarily with their general practitioner (80%). Thus, in 4 out of 10 cases, the issue was not addressed; 49% of patients stated they did not discuss their condition with their partner and 33% did not discuss it with anybody.UI is still a major taboo and we have a long way to go to change attitudes.3.

The G8 screening tool has been developed to identify older cancer patients requiring a geriatric assessment for tailoring therapy. Little is known about its prognostic value, particularly by tumour site. An optimised version has been recently developed, but no prognostic information is available. We compared the prognostic value of both instruments overall and by tumour site.Data were from a prospective cohort of cancer patients ≥70 years old referred to 1 of 6 French geriatric oncology clinics between 2007 and 2014 (n = 1333). Endpoints were overall 1- and 3-year survival. Cox proportional-hazards models were built to assess the predictive value of abnormal G8 and modified-G8 scores, based on published cut-offs or by classes of increasing risk. Sensitivity analyses involved adjusting for age, gender, treatment, metastasis, and tumour site (digestive, breast, urinary tract, prostate, other solid cancers, and haematological malignancies) and stratifying by tumour site and metastatic status.Abnormal scores were independently associated with overall 1-year survival: adjusted hazard ratio [aHR] = 4.3[G8]/4.9[modified-G8] and 3-year survival: aHR = 2.9/2.6; all p 0.0001. Associations persisted after stratifying by metastatic status and in most cancer sites (exceptions: colorectal (G8) and upper digestive cancer (both tools) [1-year analysis]; digestive cancers (both tools) [3-year analysis]). For both tools, classes of increasing risk showed a graded relationship with mortality (p 0.0001).Our results identified both abnormal G8 and modified-G8 scores as strong and consistent predictors of overall survival, regardless of metastatic status or tumour site. These findings strengthen the clinical utility of these instruments in the geriatric oncology setting.

Background/Introduction Age is one of the strongest predictors/risk factors for ischemic stroke in subjects with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) have been shown to be effective in the prevention of this condition; however, clinical evidence on bleeding risk with this therapeutic strategy in very old and frail geriatric patients is poor. Purpose To assess bleeding risk in French geriatric patients aged ≥80 years and diagnosed with AF newly treated with rivaroxaban. Methods Subjects, presenting to one of 33 geriatric centers, with non-valvular AF and recent initiation of a treatment with rivaroxaban were enrolled in the study and followed-up every 3 months for 12 months. Clinical and routine laboratory data and evaluation scores, such as HAS-BLED, HEMORR2HAGES, ATRIA, and CHA2DS2-VASc, as well as comprehensive geriatric evaluation were reported. Major bleeding, as defined in ROCKET AF study, was reported at each visit, and this primary outcome was adjudicated by an independent committee. Results of this cohort were compared with findings from a similar cohort treated with vitamin K antagonists (VKAs) from the same centers (n=924). Results A total of 1045 subjects were enrolled in the study of whom 995 (95%) had a one-year follow-up (analyzed population). The mean (standard deviation (SD)) age was 86.0 (4.3) years, with the majority of patients being female (61%), 23% aged 90 years or older, and 48% having an estimated glomerular filtration rate (eGFR) Conclusions This is the first large-scale prospective study in geriatric population in AF subjects treated with DOAC (rivaroxaban) Major bleeding risk appeared higher in very old than younger population, however major bleeding and ICH rates were significantly lower with rivaroxaban than with VKAs when used in the same geriatric population. This study indicates that Rivaroxaban can be used in very old and frail patients for the treatment of non-valvular AF. Acknowledgement/Funding Unrestricted grant from Bayer

To describe the epidemiology of prostate cancer (PCa) and its natural history in the elderly patient. To propose adaptations of geriatric evaluation specific to PCa. Recall therapeutic options and the treatment options specific to elderly patients.Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific societies of geriatrics, from the National Cancer Institute using the following keywords: elderly, geriatrics, prostate cancer, diagnosis, treatment.The median age at diagnosis for PCa is 69 years old, making PCa the very type of cancer of the elderly. The specific mortality of the disease increases with age. This translates two of its characteristics. First, a diagnosis at higher grade and stage is more common in older patients than in younger patients. Secondly, use of curative therapeutic options is less common in elderly patients than in younger patients. SIOG recommends a specific geriatric assessment for patients with PCa, which may be useful, but the need for an initial detection of cognitive disorders is open to criticism. There is no therapeutic trial, if only prospective, dedicated to elderly patients with PCa. However, decision-making in the elderly patient with PCa must pursue two goals: first, the respect of the expectations specific to each patient and secondly, the search for the global clinical benefit; goals that should not be restricted to elderly patients.PCa in the elderly patient follow the current guidelines for diagnostic and for treatment. Compliance with these guidelines should eliminate both the late diagnosis and the under-treatment actually observed.

First, to present the epidemiological data of aging and of cancers and to describe the respectives expected evolutions. Second, to present biological and genetic data on aging and on the relationships between aging and oncogenesis.Bibliographic search from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as from the web sites of geriatric scientific societies, the United Nations, the World Bank, the World Health Organization, the Institut National du Cancer and the Ligue Contre le Cancer from the following keywords: aging, elderly, cancer, epidemiology, biology, genetics.The entire world population is aging very significantly and very rapidly. In France, new cases of cancer are diagnosed in 62.4% of cases in patients over 65 and in 11.5% of cases in patients over 80 years. Cancer mortality occurs in 75.3% of cases in patients over 65 years of age and in 24.8% of cases in patients over 80 years of age. Cancer-specific mortality is consistently higher in patients older than 75 years compared to younger patients; this reflects, among other things, an age discrimination which is called agism. It has been established that cellular aging is marked by 9 major families of biological and genomic abnormalities. Biological aging and oncogenesis are intertwined with increasingly well established relationships. They are both the product of natural selection and they are found in all species with both renewal tissues and a distinction between germinal tissue and somatic tissue.Epidemiological data predict that oncology, including urological oncology, is becoming very predominantly geriatric oncology; it is critical and urgent that society be prepared for it and that every care-giver be prepared, that is, be specifically trained. Biological and genetic data argue for a great entanglement between aging and oncogenesis; research in each of these areas should be reconciled for mutual benefit.

To describe the epidemiology of renal cell carcinoma (RCC) and its natural history in the elderly patient. To propose adaptations of geriatric evaluation specific to RCC. Recall therapeutic options and the treatment options specific to elderly patients.Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific societies of geriatrics, from the National Cancer Institute using the following keywords: elderly, geriatrics, renal cell carcinoma, small renal mass, diagnosis, treatment.The incidence of RCC increases in France and peaks between 70 and 80 years. This increase in incidence is mainly due to the diagnosis of small renal masses (SMR). The specific mortality of RCC increases with age (at least between 75 and 95 years). Tumor biopsy, especially of SMR, should be considered in the elderly patient. The geriatric assessment of patients with CaR has no specificity apart from specific evaluation of renal function and operative risk. There is no prospective therapeutic trials dedicated to elderly patients with localized RCC. Surgical treatment requires the use of fast track protocol (the modalities of which are being elaborated) in which geriatricians play a key role throughout the process. The role of percutaneous ablative treatment should be better defined in elderly patients. However, given their low specific mortality, surveillance of SRM (at least initially) is probably an interesting option, certainly under-used, although its impact on quality of life remains to be clarified. The overarching goal of geriatric oncology must guide the decisions of care in the older patient with CaR: first, the respect of patient-specific expectations and secondly the search for an overall clinical benefit; objectives that have no reason to be restricted to elderly patients.RCC is becoming a predominantly elderly cancer. It responds to the current general diagnostic and therapeutic guidelines. It is desirable that clinical research help to better define the respective roles of percutaneous biopsy and treatment of localized RCC.

To explain the notion of frailty, then to explain how crucial is the detection of frailty detection in the elderly patient, and, in cases of suspected frailty, how crucial is the need for geriatric assessment. To describe (i) how this assessment of the elderly cancer patient is performed, (ii) how the results of this geriatric assessment must drive the decision making, and (iii) the role of the geriatrician in the care pathway.Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific geriatric societies, from the National Cancer Institute using the following keywords: elderly, geriatrics, cancer, frailty, assessment, decision making.The goal of frailty detection is to optimize care, to maintain the independence and the survival of the patient. The prevalence of frailty increases with the age and the diagnosis of cancer. Detection of frailty in the elderly patient with cancer is performed using the G8 questionnaire recommended by the INCa. In case of anomaly or clinical justification, the patient receives a geriatric assessment, which is a multidimensional and multidisciplinary procedure. The clinician can call on the UCOG of the region in which he practices. The relevance of medical decisions will be based on the results of this geriatric assessment. The geriatrician plays a crucial role and will be involved throughout the care.The detection of frailty in the elderly patient with cancer is obligatory. Consecutive geriatric assessment can be performed by the UCOG of the region. The results of the geriatric assessment must serve as a basis for any therapeutic decision making and the preservation of the independence of the patient must remain the priority.

To define the necessary arrangements of medical treatment with anti-angiogenics, mTOR inhibitor or systemic immunotherapies in the management of metastatic renal cell carcinoma in elderly patients.Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: metastatic renal cell carcinoma, elderly, treatment.The selection criteria for the medical treatment of metastatic renal cell carcinoma in elderly patients are the IMDC score, necessarily complemented by performance status, the tolerability profile of treatments, more frequent drug interactions, treatment adherence, management capacity of side effects, and patient preference. Each of these criteria is detailed in critical ways.The efficacy and tolerability of medical treatments for metastatic renal cancer have not been reported as different depending on age. No dosage adjustment is recommended in principle. However, prevention and early treatment of side effects of treatment should be strengthened in elderly patients.

To define and present potential improvements for the management of bladder cancer in older patients.Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: bladder cancer, treatment, BCG, chemotherapy, cystectomy, and elderly.The oncological principles of medico-surgical management of bladder cancer do not differ according to age. On the other hand, the patient comorbidities have been likely to alter the tolerance of these treatments. At the NMIBC stages, no adaptation of the standard treatment has demonstrated any interest. At the MIBC stages, the prognosis was improved by geriatric multidisciplinary perioperative management.The indications and principles of surgical treatments must be identical regardless of the patient age. At the NMIBC stages, adjuvant therapy, including BCG therapy, should not be questioned because of the age of the patient. On the other hand, at the localized MIBC stages, neoadjuvant and adjuvant chemotherapy should not be considered as a standard and their indications assessed individually after geriatric assessment.

To define and present explanations for the epidemiological, pathological and prognostic differences in bladder cancer in elderly patients.Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: bladder cancer, carcinogenesis, elderly, epidemiology, prognosis.Bladder cancer is a growing concern for the elderly first and foremost and with an impact, mainly those who are consumers or former users of tobacco, whose therefore frequently have comorbidities associated with this consumption. The initiated carcinogenesis extends with the life length of patients, increasing the prevalence of bladder cancer. Aging promotes carcinogenesis by both potentiating its genetic abnormalities and reducing the immune system performance of the aged host to destroy cancer cells. The delay in the diagnosis of bladder cancer in elderly patients is explained and make up for the time could improve the prognosis.Regardless of variations in therapeutic effect and morbidity and mortality of treatments, aging promotes the occurrence and aggressiveness of bladder cancer. The incentive to stop exposure to carcinogens and the search for bladder cancer in patients with hematuria should not reduce with advanced age but instead be promoted in order to improve the prognosis.

Background To define a core set of geriatric data to be methodically collected in clinical cancer trials of older adults, enabling comparison across trials. Patients and methods Following a consensus approach, a panel of 14 geriatricians from oncology clinics identified seven domains of importance in geriatric assessment. Based on the international recommendations, geriatricians selected the mostly commonly used tools/items for geriatric assessment by domain (January–October 2015). The Geriatric Core Dataset (G-CODE) was progressively developed according to RAND appropriateness ratings and feedback during three successive Delphi rounds (July–September 2016). The face validity of the G-CODE was assessed with two large panels of health professionals (55 national and 42 international experts) involved both in clinical practice and cancer trials (March–September 2017). Results and discussion After the last Delphi round, the tools/items proposed for the G-CODE were the following: (1) social assessment: living alone or support requested to stay at home; (2) functional autonomy: Activities of Daily Living (ADL) questionnaire and short instrumental ADL questionnaire; (3) mobility: Timed Up and Go test; (4) nutrition: weight loss during the past 6 months and body mass index; (5) cognition: Mini-Cog test; (6) mood: mini-Geriatric Depression Scale and (7) comorbidity: updated Charlson Comorbidity Index. More than 70% of national experts (42 from 20 cities) and international experts (31 from 13 countries) participated. National and international surveys showed good acceptability of the G-CODE. Specific points discussed included age-year cut-off, threshold of each tool/item and information about social support, but no additional item was proposed. Conclusion We achieved formal consensus on a set of geriatric data to be collected in cancer trials of older patients. The dissemination and prospective use of the G-CODE is needed to assess its utility.

Background Direct oral anticoagulants (DOACs) are effective to prevent strokes; however, bleeding risk of DOACs in very old and frail geriatric patients is poorly known. Purpose : To assess bleeding risk in geriatric patients aged ≥ 80 years with AF newly treated with rivaroxaban. Methods Subjects from 33 centers, with non-valvular AF newly treated with rivaroxaban were enrolled and followed-up every 3 months for 12 months. Clinical and biological data were recorded. Major bleedings were recorded at each visit. The cohort was compared with a cohort treated with vitamin K antagonists (VKA) from the same centers (n = 924). Results In total, 995 subjects had a 1-year follow-up. The mean (standard deviation (SD)) age was 86.0 (4.3) years, 23% were aged 90 years and older. 61% were women and 48% had an estimated glomerular filtration rate (eGFR) Conclusions In this first large-scale prospective study in geriatric population with AF, major bleeding rates were significantly lower with rivaroxaban than with VKAs.

Background The emergence of ICIs has modified the treatment of many types of cancers. However, efficacy and safety data of such agents (anti PD-1/anti PD-L1) are cruelly missing in elderly patients ⩾ 80 year-old. Methods A retrospective monocentric study was conducted between April 2015 and April 2019 in all ⩾ 80 year-old ICIs-treated patients, as a part of a clinical trial or standard of care. Patients/disease characteristics were collected using electronic medical records. Clinical response was assessed according to iRECIST criteria; survival was estimated according to Kaplan-Meier method and toxicity was assessed according to CTCAE v 4.0. Results Of the 415 patients who received an ICI, 42 (10.1%) were aged ⩾ 80 years (median: 84; range: 80-93). The most represented tumour types were NSCLC (45.2%), renal cell carcinoma (30.9%) and bladder carcinoma (16.7%). 92.9% were stage IV. ICIs were given as first-line therapy in 7 patients (16.7%) and as second-line or beyond in 35 patients (83.3%). 29 patients had nivolumab, 10 patients had pembrolizumab and 3 had atezolizumab. ICIs were given mostly as monotherapy (97.6%). A median of 7.5 doses were administered (range: 1-37). Of the 42 patients, 40.5% were PS ⩾ 2 and 88.1% had impaired G8 score. Mean Charlson Index was 3 (range: 0-6), polypharmacy was present in 26 cases and 35.7% had an albumin level Conclusions ICIs appear to be an acceptable treatment option for octogenarian patients, with manageable toxicity. Legal entity responsible for the study Mebarki Soraya. Funding Has not received any funding. Disclosure E. Fabre: Honoraria (self): Roche; Honoraria (self): AstraZeneca; Honoraria (self): BMS; Honoraria (self): Merck. S. Oudard: Research grant / Funding (self): Boehringer; Honoraria (self): Ipsen; Honoraria (self): Bayer; Honoraria (self), Travel / Accommodation / Expenses: Pfize; Honoraria (self), Travel / Accommodation / Expenses: MSD; Honoraria (self), Travel / Accommodation / Expenses: Astellas; Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: Janssen; Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: BMS; Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: Sanofi. E. Paillaud: Honoraria (self), Advisory / Consultancy: BMS; Honoraria (self): Servier; Honoraria (self), Travel / Accommodation / Expenses: Roche. All other authors have declared no conflicts of interest.

Scientific societies recommend the implementation of a comprehensive geriatric assessment (CGA) in cancer patients aged 70 and older. The EGA is an interdisciplinary multidimensional diagnostic process seeking to assess the frail older person in order to develop a coordinated plan of treatment and long-term follow-up. Identification of comorbidities and age-induced physiological changes that may increase the risk of anticancer treatment toxicities is essential to better assess the risk-benefit ratio in elderly cancer patients. The systematic implementation of a CGA for each patient is difficult to perform in daily practice. Therefore, it is recommended to screen vulnerable patients who will benefit from a complete CGA. Our work presents the vulnerability screening tools validated by at least two independent studies in a cancer elderly population setting. Among seven screening tools, the G8 and the VES13 are the most effective, and have been validated specifically in older population with cancer. The G8 is recommended by scientific societies and the French National Cancer Institute (INCa) because of its easy implementation in daily clinical practice, its high sensitivity and fair specificity. Although studies are underway to improve its performance, the G8 is currently the simplest tool to routinely identify older cancer patients who should have a complete assessment in geriatric oncology.

Among six synthetic retinoids tested, the retinoid 6-[3-(1-adamantyl)-4-hydroxyphenyl]-2-naphthalene carboxylic acid (CD437) was highly efficient in inducing growth inhibition of 8MG-BA and GL-15 human glioblastoma cell lines, with growth arrest at the S phase of the cell cycle. CD 437 also induced apoptosis in these cells, with 8MG-BA being the most sensitive. In these cells, induction of apoptosis by CD437 has been related to the downregulation of Bcl-2 expression and to CPP32 activation, but not to p53 expression. The remaining non-apoptotic cells presented a morphological pattern of astroglial differentiation with overexpression of glial fibrillary acidic protein (GFAP) and glutamine synthetase (GS). The mechanism of action of CD437, originally developed as a RARgamma agonist, is not yet elucidated. However, our results suggest that it acts through an increase of the expression of retinoid-inducible genes, such as RARbeta2 and/or RARalpha2.

To study pneumococcal immunization coverage in older patients in hospital, and the impact of two actions aiming at improving this coverage.We reported a prospective and descriptive study conducted from November 2009 to August 2010, including all new patients ≥75 years old received in a geriatric short-stay department and residing in Val-de-Marne, France. This study was performed in three successive three-month periods, to assess the vaccination coverage in the months following hospital release. Period I was the reference; Period II included an awareness campaign of general practitioners relying on the hospitalization discharge report, containing an indication for the vaccination; Period III consisted in a systematic proposal of vaccination by the geriatric hospital department.Indication for pneumococcal vaccination has been given to 139 patients (61.2%) in 227 processed questionnaires. The main indication was heart failure for 105 patients (75.5%). Twenty-four patients were already vaccinated (17.2%). No vaccination was reported in the three months following period I in 33 included patients. The awareness campaign targeting regular doctors resulted in only one vaccination out of 37 patients. Immunization coverage in the department had reached 84.5% of inoculation (38 of 45 patients).Pneumococcal vaccination is often prescribed in elderly patients but generally not executed. The awareness campaign did not result in a big enough immunization coverage improvement, compared to a codified proposal of vaccination during hospital stay.

We report on a case of Clostridium septicum aortic mycotic aneurysm in an 83-year-old patient. This is a rare infectious disease. To our knowledge, only 31 cases have been reported in the literature. The clinical presentation is dominated by abdominal pain with fever. Although only the bacteriological samples can definitely identify the germ, the presence of gas bubbles around an aneurysm on abdominal computed tomography scan suggests C. septicum aortic infection. This infectious disease is frequently associated with neoplasia, mainly colonic. Treatment is primarily surgical resection with bypass or graft, associated with prolonged antibiotic therapy. The prognosis is poor due to vascular complications and pathogenesis of C. septicum. Patients cumulate the death risk from mycotic aneurysm and C. septicum sepsis.

Background Nosocomial infections are extremely common in the elderly and may be related to ageing of the immune system. The Immune Risk Phenotype (IRP), which predicts shorter survival in elderly patients, has not been evaluated as a possible risk factor for nosocomial infection. Our aim was to assess the prevalence of nosocomial infections in elderly in-patients and to investigate potential relationships between nosocomial infections and the immunophenotype, including IRP parameters. Results We included 252 consecutive in-patients aged 70 years or over (mean age, 85 ± 6.2 years), between 2006 and 2008. Among them, 97 experienced nosocomial infections, yielding a prevalence rate of 38.5% (95% confidence interval, 32.5-44.5). The main infection sites were the respiratory tract (21%) and urinary tract (17.1%) When we compared immunological parameters including cell counts determined by flow cytometry in the groups with and without nosocomial infections, we found that the group with nosocomial infections had significantly lower values for the CD4/CD8 ratio and naive CD8 and CD4 T-cell counts and higher counts of memory CD8 T-cells with a significant increase in CD28-negative CD8-T cells. Neither cytomegalovirus status (positive in 193/246 patients) nor presence of the IRP was associated with nosocomial infections. However, nosocomial pneumonia was significantly more common among IRP-positive patients than IRP-negative patients (17/60 versus 28/180; p = 0.036). Conclusion Immunological parameters that are easy to determine in everyday practice and known to be associated with immune system ageing and shorter survival in the elderly are also associated with an elevated risk of nosocomial pneumonia in the relatively short term.

The management of cancer in the elderly patients is becoming a major problem of public health. The population is becoming older, the risk of cancer is increasing with age and therapeutic tools are improving. The numerous pharmacological changes of age might influence the pharmacokinetic and pharmacodynamic variables of many drugs, in particular the agents of chemotherapy. The development of news drugs, with less toxicity, administrated weekly or orally, and of supportive care (hematological growth factors, nutritional support) allows proposing specific treatment to elderly patients with cancer. However, evidence-based medicine data are lacking to define optimal schedules in this population due to low inclusion rates in clinical trials. This paper explores the specificities of chemotherapy in elderly patients with cancer.

Tumors of the pituitary stalk are rare and their diagnosis is sometimes difficult.We report a case of a primary lymphoma of the pituitary stalk in a 78-year-old patient. To our knowledge, only seven similar cases have been previously published: prominent symptoms were headache, fatigue and diplopia; biologically, anterior pituitary low secretion or hyperprolactinemia were found in the majority of cases; regarding the imaging, only three patients presented an initial and isolated lesion of the stalk; histological evidence was obtained by a trans-sphenoidal biopsy in case of hypothalamic or pituitary associated lesion or by a trans-cranial biopsy in the event of an isolated lesion. As an alternative, a lumbar puncture could be performed; although less invasive, its diagnostic performance is lower.Current treatment relies on chemotherapy with intravenous methotrexate associated with intrathecal methotrexate infusion if cerebrospinal showed abnormal cells. Unfortunately, the results remain poor with a median survival of 9 months.

La chute chez la personne âgee est un evenement important, souvent lourd de consequences en termes physiques (fractures, plaies, hematomes…) et psychologiques (syndrome post-chute, phobie de la marche, anxiete, limitation de la mobilite…) Une des consequences les plus severes de la chute de la personne âgee est la fracture de l’extremite superieure du femur (FESF), et c’est surtout dans le cadre de la FESF qu’ont ete etudiees les relations entre nutrition, chutes et fractures. La denutrition est l’un des parametres contribuant a la survenue de la chute et de la FESF mais egalement un facteur pronostic important en termes de morbidite et de mortalite associees.

Status epilepticus is quite frequent in the elderly but rarely studied despite the poor functional prognosis and significant mortality.We retrospectively evaluated the clinical manifestations and electroencephalogram findings observed over a two-year period in 63 consecutive inpatients aged over 70 years presenting status epilepticus. The variables studied included age, sex, the number of concomitant chronic active diseases, previous neurological disorders, brain lesions on CT or MRI, the use and withdrawal of medications and outcome.The incidence of status epilepticus was 1%; two-thirds in women and one-third in men. The mean age was 83 years. Complex partial status epilepticus was noted in 91% with predominant features of confusion (89%), impairment of consciousness (75%) or psychiatric symptoms (46%). Etiologies were often multifactorial and acute symptomatic. Etiology was metabolic in 60%, drug-induced in 51%, demential in 44%, cerebrovascular in 37%, infectious in 30% and other neurological disorders in 28% of the cases. Antiepileptic drugs used to treat status epilepticus were benzodiazepine (60%), often in association with lamotrigine (51%), valproate (46%) or phenytoin (25%). Maintenance of an antiepileptic drug was found in 70% of cases. Complications were loss of autonomy (86%), malnutrition (67%), infections (51%), dementia (30%), pressure sores (14%), and recurrent epilepsy (13%). Mortality was 32% of cases and it was higher in men.These findings have shown some special features of status epilepticus among the elderly but other prospective studies are needed to confirm these results and to identify optimal management to decrease mortality, and improve the poor functional prognosis.

The official French demographic previsions are a growing number of the older than 75 years elderly people. The Emergency services face this demographic evolution. We describe the establishment of the geriatric intervention group at the emergency of the Henri-Mondor university hospital at Creteil (France) and analyse the results of the geriatric assessment at the short unit care during the first four months.We analysed the results of the geriatric assessment of 206 patients during the first four months, by considering the final unit care. The geriatric assessment evaluates functional abilities, cognitive status and thymic function with elderly people validated tests and subjective assessment of nutrition status and the sensorial functions.The statistical analysis of the geriatric assessment results was significant among the different hospitalized groups of patients, for the cognitive status, the nutritional risk and the walk and standing evaluation.The results of the geriatric assessment at emergency showed cognitive impairment and gait abnormality in elderly patients were at risk of hospitalization.