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Lunar Dust is representing both an engineering challenge for future exploration missions due to systems potential contamination (due to regolith mobilization during e.g. traverse phases, landings, scooping, astronauts EVAs..) and a scientific target for e.g. mineralogical and compositional analysis of the Lunar surface. Therefore predicting not only interactions with systems but also payloads landed at the lunar surface is an important part of future missions design. Strong partnerships and synergies between agencies and space industries are now allowing the preparation of new missions with challenging timescales, for a return to the Moon in the next couple of years. In this context, the analysis of re-analysis of some of the Apollo era data and other landed assets is of high interest to perform the calibration of predictive algorithms and simulations tools of regolith transport and interactions with systems. The present work is organized in two parts: in the first part, we present a modelling study of two experiments included in the Apollo Lunar Surface Experiment Package (ALSEP): the Lunar Ejecta and Meteoroids Experiment (LEAM), which experienced failures linked to thermal control and the Dust Detector Experiment (DDE) which could measure solar cells performance variations due to dust coverage. In the second part, we present simulation results for the contamination of the Imaging System accommodated on the PROSPECT experiment that will be embarked on the Luna 27 lander, due to land on the Moon in the next couple of years. We will discuss the quality of our predictions, the uncertainties inherent to the measurements, and the way forward in terms of better representation of lunar dust transport and interactions processes through models.

Background and purpose Older adults at risk for falls live independently in the community in their own home and have rehabilitation needs. However, little is known about whether home coaching of older adults can decrease falls at home. We sought to determine whether a novel program for preventing falls and a loss of exercise capacity, the T4H program, in which home helpers act as exercise coaches by using an information technology (IT) device, was acceptable and feasible. Methods Between February 2015 and October 2015, we performed a cluster randomized controlled trial in which home helpers either assisted older adults 75 years and over, to participate in the T4H program, or provided standard home help over 3 months. We assessed levels of acceptability and satisfaction among the older adults and home helpers with regard to the exercise program and the technologies used. To measure efficacy, the main outcome measures for the older adults were the absence of falls requiring medical or paramedical care, unplanned hospitalizations, walking ability in a Timed Up and Go test (TUG), and self-care ability by the Barthel Index at the 3-month follow-up visit. Results and discussion Overall, 35 older adults were included, aged 89 years and with 68.6% women. Eighty-five percent of the respondents were pleased or very pleased to have participated in the T4H exercise program, 70% were satisfied with the IT devices, and 92% were satisfied with their home helper's level of involvement. Two of the 4 home helper respondents were satisfied or very satisfied with the exercise program, and 2 were moderately satisfied. The proportions of older adult participants with no falls or no unplanned hospitalizations were higher in the T4H group (92.3% and 85.7%, respectively) than in the control group (81.8% and 71.4%, respectively), although these intergroup differences were not statistically significant. The T4H and control groups did not differ significantly with regard to the TUG time (median [IQR]: 27.6 seconds [17.9-58.6] vs 30.7 seconds [19.7-57.2], respectively) or the Barthel Index (median [IQR]: 90 [75-95] and 90 [75-95], respectively). Conclusions The novel T4H home help model was feasible and was associated with a high level of participant satisfaction. We observed a trend toward fewer falls and hospitalizations and better quality of life in the older adults.

Non-use of the walker may be secondary to an initial inappropriate prescribing, a lack of adequate training, a lack of monitoring and side effects of using. Improving both stability and mobility in users is due to several biomechanical mechanisms. The benefits of walker are: general physiological effects, more confidence, better social life and decrease in the burden of care. The disadvantages of walker are: technical or practical aspects criticized by users, musculoskeletal disorders, delayed reaction time, fall risk and stigma. Few scientific data evaluating the interest of the walker concerning mobility exist, thus recommendations are low grade and are often taken from professional clinical experiences. The choice of technical walking assistance depends on the pathology and biomechanical mechanism. The walker robots are few distributed.

Background To our knowledge, there are few indices that can assess oral health in the elderly. Those that are currently used are subjective and test the impact of oral health on quality of life. It appears to be relevant to create an easy and reproducible index, based on an oral health clinical exam that can be correlated with infectious disease risk in the elderly. Objectives This article aims to explain the methodology used to create an oral health index to assess infectious disease risk in elderly patients more than 65 years old. Design Cluster randomized trial. Setting Long-term care and rehabilitation facilities. Participants All patients who were included were 65 years old or older and were present in participant wards at the beginning of the study or were admitted during the study period. Measurements The assessment index was developed with the assistance of two dentists, after conducting a literature review. This was an index composed of eight criteria, which included most oral health problems associated with infections in the elderly. A score of 1 was given if a single criterion was observed. The final score ranged from 0 to 8 (0 for a healthy oral health index and 8 for a bad index). Results The oral health index was used in 2513 patients. This index grew significantly with age (P = 0.002) and malnutrition (P = 0.004). The pneumonia incidence rate was significantly correlated with the oral health index (P = 0.002). Conclusion This index is easy to use, with few items, and it takes into account most infectious disease risk factors. It would be interesting to integrate this score into a routine admission check-up process in the elderly for the purpose of preventing infectious diseases.

Summary Background Prevention strategies are urgently needed to tackle the growing burden of Alzheimer's disease. We aimed to assess efficacy of long-term use of standardised ginkgo biloba extract for the reduction of incidence of Alzheimer's disease in elderly adults with memory complaints. Methods In the randomised, parallel-group, double-blind, placebo-controlled GuidAge clinical trial, we enrolled adults aged 70 years or older who spontaneously reported memory complaints to their primary-care physician in France. We randomly allocated participants in a 1:1 ratio according to a computer-generated sequence to a twice per day dose of 120 mg standardised ginkgo biloba extract (EGb761) or matched placebo. Participants and study investigators and personnel were masked to study group assignment. Participants were followed-up for 5 years by primary-care physicians and in expert memory centres. The primary outcome was conversion to probable Alzheimer's disease in participants who received at least one dose of study drug or placebo, compared by use of the log-rank test. This study is registered with ClinicalTrials.gov, number NCT00276510. Findings Between March, 2002, and November, 2004, we enrolled and randomly allocated 2854 participants, of whom 1406 received at least one dose of ginkgo biloba extract and 1414 received at least one dose of placebo. By 5 years, 61 participants in the ginkgo group had been diagnosed with probable Alzheimer's disease (1·2 cases per 100 person-years) compared with 73 participants in the placebo group (1·4 cases per 100 person-years; hazard ratio [HR] 0·84, 95% CI 0·60–1·18; p=0·306), but the risk was not proportional over time. Incidence of adverse events was much the same between groups. 76 participants in the ginkgo group died compared with 82 participants in the placebo group (0·94, 0·69–1·28; p=0·68). 65 participants in the ginkgo group had a stroke compared with 60 participants in the placebo group (risk ratio 1·12, 95% CI 0·77–1·63; p=0·57). Incidence of other haemorrhagic or cardiovascular events also did not differ between groups. Interpretation Long-term use of standardised ginkgo biloba extract in this trial did not reduce the risk of progression to Alzheimer's disease compared with placebo. Funding Ipsen.

Summary A nationwide survey was performed using a two-round web-based Delphi procedure to develop a set of consensus guidelines for preventing infections among residents in nursing homes (NHs). The research group was led by an investigative group of six specialists. Research analysts conducted a literature search and review of practice guidelines, systematic reviews and articles or abstracts published in English and French on the topic of infection prevention. The literature search was examined by 23 specialists (who compiled a preliminary list of 301 recommendations). Using a Delphi survey online instrument, 81 experts from all relevant medical specialties in the fields of infection prevention and control and geriatrics rated their agreement with each of the recommendations using a nine-point scale (1 = strongly disagree, 9 = strongly agree). During the second round, 79 participants received anonymous feedback from the first round and assessed a narrowed list of 130 recommendations. Recommendations were retained and classified according to the overall median score and ratings percentages by stakeholders. A total of 79 raters rated ≥10% of items, and 264 recommendations were retained and rated as follows: 240 items reached consensus, 24 items reached near consensus, 37 items were discarded and one recommendation was deleted. Many infections, though not all, can be prevented in the frail elderly. Thus, these guidelines should be adopted by each healthcare professional and facility to implement routine infection control procedures.

International audience; PURPOSE: Idiopathic generalized epilepsies (IGE) are age-related epileptic syndromes mainly described in children and adolescence. Our aim is to describe their electroclinical features in the elderly. METHODS: Patients aged 70 years or more were prospectively selected in a geriatric EEG laboratory on the basis of rhythmic generalized spikes and waves discharges. Their clinical data were then examined to ascertain the syndromic diagnosis. RESULTS: Among 1181 geriatric patients referred for EEG over a 30-month period, IGE were identified in 10 cases. Eight patients began seizures in childhood or adulthood (3 childhood absence epilepsies, 2 juvenile/adult myoclonic epilepsies and 3 epilepsies with-generalized-tonic-clonic-seizures alone (EGTCS)) and 2 very late in life with EGTCS. The early-onset IGE cases had usually experienced a quiescent long period in adulthood before relapsing late in life. This relapse, mostly severe, consisted of absence status, myoclonic status or repeated generalized tonic clonic seizures and was often not-situation related. Absence status and myoclonic status were stopped by Clonazepam. The two late-onset IGE cases had familial history of epilepsy. Inappropriate antiepileptic drugs (AED) previously given in four patients with two worsenings were corrected. CONCLUSIONS: In this study, the non-negligible number of elderly cases observed over a short period of time suggests that IGE are frequent in the elderly but underestimated until recently. IGE may be lifelong with late severe exacerbations. A few very late-onset IGE cases exist. EEG remains useful in contributing to diagnose IGE and AED adjustment continues to be beneficial at extreme age.

Because of a lack of efficacy of influenza vaccination in elderly population, there are still numerous outbreaks in geriatric health care settings. The health care workers (HCW) flu vaccination is known to get herd immunity and decrease the impact of influenza in elderly population living in geriatric health care settings. However, the rates of vaccinated HCWs are still low in France. The French Geriatric Infection Risk Institute (ORIG) performed the VESTA study, a three-phase multicentre to identify factors limiting vaccination in HCWs, and to develop and implement active programs promoting HCWs influenza vaccination. To implement multicenter programs to enhance HCW influenza vaccination. It was a cluster randomised interventional studies. 43 geriatric health care settings (GHCSs), long term care and rehabilitation care settings in France. 1814 Health care workers from 20 GHCSs in the interventional group and 2,435 health care workers in 23 GHCSs in the control group. After the failure of a first educational program giving scientific information and. tested during the 2005–06 flu season in 43 HCSs, a second program was designed with the help of marketing experts, one year after Program 1. The objectives were to involve HCWs in the creation of “safety zones”, and to give personal satisfaction. Program 2 was tested during the 2006–07 season. 20 of the 24 HCSs from the Program 1 cluster were included in the Program 2 cluster (1,814 HCWs), and 16 of the 19 HCSs from the Control 1 cluster, plus 7 new HCSs with interest in participating, were included in the Control 2 cluster (23 HCSs; 2,435 HCWs). The efficacy of each program was assessed by calculating and comparing the percentage of vaccinated HCWs, from all HCSs taken together, in the program and control clusters. Program 1 failed to increase the HCW vaccination coverage rate (VCR) (Program 1: 34%; Control 1: 32%; p>0.05),). Program 2 increased the VCR in HCWs (Program 2: 44%; Control 2: 27%; Chi2 test, p

This paper presents HADES® Gate Driver, a new solution that efficiently drives Silicon-Carbide (SiC) devices in multi-kW converters. It discusses how it allows taking full advantage of SiC technology by placing the gate driver circuits very close to the power transistors: The resulting lower parasitic inductances enable faster switching times and subsequently higher efficiency. Higher operating temperature for both the gate driver and the power transistors also translate into considerable reduction of complexity, size and weight of the system, in particular of the cooling systems. Finally, the paper describes how HADES® reference design is built from a new chipset especially developed for this purpose and designed to operate up to 225°C: THEMIS, ATLAS and RHEA.

Chronic obstructive pulmonary disease (COPD) is a chronic disease characterized by incompletely reversible airflow limitation, measured by a decrease of FEV(1)/FVC ratio. International consensus does not agree on a single threshold for this ratio, which can define airflow obstruction. Although the prevalence of COPD in the elderly population varies according to the definition used, it definitely increases with age and could reach 15% in those over 65 years of age. Therefore, ageing of the population should result in increased prevalence and socioeconomical costs of COPD during coming years. In France, diagnosis of COPD in the elderly is difficult, late and insufficient. Management, which has the same goals as in younger populations, has to be global and coordinated. Some points should be considered with particular attention considering the cumulative risks related on the one hand to COPD and on the other to ageing: pharmacological side-effects, decreased physical and social autonomy, nutritional impairment, comorbidities. Given the lack of specific data in elderly populations, pharmacological indications are generally considered to be the same as in younger populations, but some additional precautionary measures are necessary. Pulmonary rehabilitation seems to be beneficial at any age. Palliative care comes up against important difficulties: an indefinite beginning of the palliative stage in COPD; insufficient palliative care resources; insufficient communication; insufficient utilization of palliative care resources. Global COPD management in elderly requires coordination, best reached in health care network organizations involving medical and/or social professionals.

Background and aims: The French institute for study of geriatric infection risk (ORIG) has run a multiphase multicenter study (VESTA) to develop and implement active programs promoting healthcare worker (HCW) influenza vaccination. The present article reports results after implementation of the first active program. Method: A cluster-randomized controlled trial was conducted from December 1 to December 15, 2005, and a total of 43 geriatric wards (3646 HCWs) were randomly assigned to two clusters. The program cluster (24 wards; 1918 HCWs) received the active program whereas no action was taken in the control cluster (19 wards; 1728 HCWs). The program was educational; its objective was to convince HCWs to be vaccinated by giving them topdown scientific information and developing a sense of altruism. Data from 1201 HCWs (63%) from the program cluster and 1144 HCWs (66%) from the control cluster were collected. Results: The program failed to increase the HCW influenza vaccination rate (program: 34%; control: 32%; p>0.05), but won the faithfulness of vaccinated HCWs (5% vs 8% HCWs quitted vaccination; p

In Europe, 60% of all cancers and 75% of all deaths from cancer occur in patients older than 65 years. The incidence of many cancers (prostate, colorectal, and hematological) either increases with age or remains high (breast and lungs). The two principal characteristics of cancer in the elderly are late diagnosis and comorbidity that requires specific geriatric assessment and cooperation between the oncologist and the geriatrician. Academic and pharmaceutical industry research must focus on the specificities of cancers in the elderly and of response to treatment according to functional abilities and comorbidity. Equal access to high quality medical care and procedures must be ensured, regardless of age; this is not currently the case everywhere.

Although the role of inflammation has been studied in specific diseases or in community living elderly, data in hospitalized acute care elderly patients are scarce. The present study was designed to determine the predictive value of sociodemographic, clinical and biological factors for mortality in acute care geriatric wards. Retrospective study was conducted in two acute care wards in a university-based geriatric hospital with elderly patients (n=224) consecutively admitted to acute care wards with available medical files. Sociodemographic variables, primary medical diagnosis and number of associated conditions, dementia, depression, pressure sores, functional status (measure by the activities of daily living=ADL scale), weight, and plasma levels of albumin, transthyretin, C-reactive protein (CRP) and orosomucoid were recorded at admission. Patients who died in the acute care wards were compared to those who survived. The mean length of stay was 16+/-13 days; mortality was 12%. Univariate analysis revealed that disability, no anti-depressant drug, pressure ulcers, a higher number of associated conditions, living with another person, and biological markers of malnutrition (albumin35g/l, transthyretin200mg/l) and inflammation (CRPor =30mg/l, orosomucoidor =1.25g/l) were significantly associated with an increase in the risk of death. The logistic regression model retained CRPor =30mg/l (odds ratio (OR)=3.72, 95% confidence interval (CI)=1.34-10.31; p=0.009) and disability for at least one ADL item (OR=2.16, 95% CI=1.55-2.99; p0.001) as independent risk factors for death. We conclude that CRP and disability are strong independent risk factors for death in this population, and special attention should be paid to these patients in an integrated therapeutic approach to geriatric care.

Resume Introduction En France, l’âge moyen du diagnostic du cancer bronchique est de 64 ans. Il est de 76 ans dans la population des plus de 70 ans, son incidence etant liee a l’augmentation avec l’âge du risque intrinseque de developper un cancer et au vieillissement de la population. Les methodes de diagnostic ne different pas chez le sujet âge et chez le sujet plus jeune, et la fibroscopie bronchique reste notamment la pierre angulaire du diagnostic, avec des taux de complications comparables. Etat des connaissances Le bilan d’extension a ete profondement modifie ces dernieres annees avec l’avenement du TEP-Scan, qui semble de plus en plus devenir l’examen de reference et permet de limiter les interventions chirurgicales inutiles, a fortiori chez les sujets âges. L’exploration encephalique par scanner ou mieux par IRM est egalement imperative avant de proposer un acte chirurgical. Avant la decision therapeutique l’evaluation de l’etat de sante du sujet âge est une etape fondamentale. Elle repose sur le concept de l’evaluation geriatrique : l’evaluation geriatrique standardisee de depistage (Geriatric Multidimentionnal Assessment) , et l’evaluation geriatrique approfondie (Comprehensive Geriatric Assessment) qui releve de la competence geriatrique. Perspectives C’est une approche globale du malade qui permet notamment de preciser et de hierarchiser les differents problemes du malade et leur impact fonctionnel sur les activites de la vie quotidienne, l’environnement social du malade… Certaines variables geriatriques (IADL, BADL, MMSE, IMC, etc.) peuvent etre predictives du taux de survie apres chimiotherapie ou du taux de complications postoperatoires apres une chirurgie thoracique. Les grands principes therapeutiques du cancer bronchique sont applicables chez le sujet âge ; la survie a long terme sans recidive apres resection chirurgicale est independante de l’âge. Que la strategie oncologique soit curative ou palliative, le malade âge atteint d’un cancer bronchique doit beneficier de soins de support. Ils s’integreront dans une demarche palliative si tel est le cas. En fait, l’âge seul n’est pas le facteur permettant de recuser une prise en charge oncologique optimale. Conclusions L’elaboration du programme personnalise de soins d’un malade âge atteint d’un cancer bronchique devrait etre basee sur le couplage : evaluation oncologique – evaluation geriatrique approfondie.

International audience; Time-to-event analysis is frequently used in medical research to investigate potential disease-modifying treatments in neurodegenerative diseases. Potential treatment effects are generally evaluated using the logrank test, which has optimal power and sensitivity when the treatment effect (hazard ratio) is constant over time. However, there is generally no prior information as to how the hazard ratio for the event of interest actually evolves. In these cases, the logrank test is not necessarily the most appropriate to use. When the hazard ratio is expected to decrease or increase over time, alternative statistical tests such as the Fleming-Harrington test, provide a better sensitivity. An example of this comes from a large, five-year randomised, placebo-controlled prevention trial (GuidAge) in 2854 community-based subjects making spontaneous memory complaints to their family physicians, which evaluated whether treatment with EGb761 can modify the risk of developing AD. The primary outcome measure was the time to conversion from memory complaint to Alzheimer's type dementia. Although there was no significant difference in the hazard function of conversion between the two treatment groups according to the preplanned logrank test, a significant treatment-by-time interaction for the incidence of AD was observed in a protocol-specified subgroup analysis, suggesting that the hazard ratio is not constant over time. For this reason, additional post hoc analyses were performed using the Fleming-Harrington test to evaluate whether there was a signal of a late effect of EGb761. Applying the Fleming-Harrington test, the hazard function for conversion to dementia in the placebo group was significantly different from that in the EGb761 treatment group (p = 0.0054), suggesting a late effect of EGb761. Since this was a post hoc analysis, no definitive conclusions can be drawn as to the effectiveness of the treatment. This post hoc analysis illustrates the interest of performing another randomised clinical trial of EGb761 explicitly testing the hypothesis of a late treatment effect, as well as of using of better adapted statistical approaches for long term preventive trials when it is expected that prevention cannot have an immediate effect but rather a delayed effect that increases over time.

International audience; Background: Age and short leukocyte telomeres have been associated with a higher risk of Alzheimer's disease (AD). Inflammation is involved in AD and it is suggested that anti-inflammatory interleukin-10 (IL-10) may partly antagonize these processes. Objective: The aim is to correlate telomere length (TL) in peripheral blood mononuclear cells (PBMC) from patients with AD to disease progression rate. Moreover, we evaluated whether TL was associated with IL-10 production by unstimulated or amyloid-beta (A beta)-stimulated PBMC. Methods: We enrolled 31 late-onset AD and 20 age-matched healthy elderly (HE). After a two-year follow-up period, patients were retrospectively evaluated as slow-progressing (ADS) (Mini Mental State Examination (MMSE) decline over the two years of follow-up = 5 points). TL was measured by flow cytometry and in vitro IL-10 production by enzyme-linked immunosorbent assay. Results: TL (mean +/- SD) for HE, ADS, and ADFwas 2.3 +/- 0.1, 2.0 +/- 0.1, and 2.5 +/- 0.1 Kb, respectively. ADS showed a shorter TL compared to HE (p = 0.034) and to ADF (p = 0.005). MMSE decline correlated with TL in AD (R-2 = 0.284; p = 0.008). We found a significant difference in IL-10 production between unstimulated and A beta-stimulated PBMC from ADS (40.7 +/- 13.7 versus 59.0 +/- 27.0; p = 0.004) but not from ADF (39.7 +/- 14.4 versus 42.2 +/- 22.4). HE showed a trend toward significance (47.1 +/- 25.4 versus 55.3 +/- 27.9; p = 0.10). Conclusion: PBMC from ADF may be characterized by an impaired response induced by A beta and by a reduced proliferative response responsible for the longer telomeres. TL might be a contributing factor in predicting the rate of AD progression.

International audience; It is well known that both falls and epileptic seizures are very frequent and harmful in the elderly. Moreover, although seizures may cause falls, their relationship is poorly documented in this population. We report four women (mean age: 84.5 years) who presented falls with: late-onset focal seizures of possible parietal (Case 1) or frontal localisation (Case 2), early onset with late aggravation of juvenile myoclonic epilepsy (Case 3), and generalised situation-related myoclonic seizures (Case 4). Falls were presumably associated with tonic posturing of left (Case 1) or right (Case 2) hemibody, to bilateral and massive myoclonic jerks (Cases 3 and 4) with a loss of consciousness (Case 3). The diagnosis of seizures was difficult and routine EEG was unremarkable in Cases 1 and 2, requiring video-EEG monitoring to capture the clinical events. Adequate treatment offered recovery from seizures and falls in all patients. Other mechanisms of seizure-induced falls in older patients and their management are discussed. In conclusion, falls may be caused by different seizure types and appear to be underestimated due to difficulties in seizure diagnosis in the elderly. Recognizing falls related to seizures is important in geriatric practice, as it facilitates adequate management.

There is no single universally accepted biochemical marker of nutritional status in the elderly. Many markers are affected by non-nutritional factors.The purpose of this study was to determine the biological parameters best related to anthropometric markers of malnutrition in an elderly polypathological population, and determine cutoff values for these potential parameters to diagnose malnutrition.This prospective study enrolled 116 elderly hospitalized patients and 76 elderly outpatients. Nutritional status (albumin, transthyretin, body mass index (BMI), skinfold thickness) and biological parameters (leptin, insulin-like growth factor-1 (IGF-1), IGF binding protein-1 (IGFBP-1), IGFBP-3, C-reactive protein (CRP), orosomucoid) were assessed. We defined malnutrition according to the lowest quartile of BMI and skinfold thickness measured in a large healthy elderly French sample population.In this sample of elderly patients (age: 85+/-7 years old), leptin concentration was the only biological parameter significantly related to nutrition status. Independent correlations were found between leptin concentration and BMI, skinfold thickness and sex. The relationship between nutritional status and leptin concentration is significantly different in each sex: the more the patients are undernourished, the lower the leptin concentration in both sexes. The optimal leptin cutoff value for the diagnosis of malnutrition in this population was 4 microg/l in men (sensitivity 0.89, specificity 0.82) and 6.48 microg/l in women (sensitivity 0.90, specificity 0.83).Leptin concentration is highly correlated with anthropometric data whereas albumin or transthyretin are known to be also influenced by morbidity and inflammatory conditions. Serum leptin concentration could be used for nutritional assessment in elderly patients with acute diseases.

Resume Cet article est le fruit des travaux d’un groupe de pneumologues et de geriatres, reunis pour un atelier. On reconnait le vieillissement physiologique ou la fonction respiratoire reste tres longtemps conservee, le vieillissement dit usuel et le vieillissement avec comorbidites. Ces deux derniers ont pour consequence la diminution de la capacite fonctionnelle et donc des capacites d’adaptation des sujets. Dans la premiere partie sont envisages les facteurs qui participent au vieillissement pulmonaire. Ils sont multiples. On ne saurait negliger les pathologies respiratoires obstructives chroniques. Ainsi la prevalence de l’asthme est estimee entre 6 et 10 % chez les sujets de plus de 60 ans. De meme la mortalite liee a la BPCO est en augmentation en particulier en ce qui concerne les sujets âges. Un autre element a prendre en compte est la frequence du developpement avec l’âge de pathologies chroniques a retentissement respiratoire. Un exemple interessant est le syndrome parkinsonien qui agit a la fois sur la commande ventilatoire et la mecanique ventilatoire. On observe egalement chez les sujets âges une denutrition proteinoenergetique avec des consequences comme la sarcopenie. L’effet des medicaments a visee therapeutique pulmonaire comme les bronchodilatateurs, les corticoides et la theophylline est mal connu faute d’etudes de phase 2 dose - reponse chez ces sujets. Enfin de nombreux medicaments donnes pour des pathologies dont l’incidence augmente avec l’âge comme l’HTA, les troubles du rythme ont une action potentiellement deletere sur la fonction pulmonaire. Dans une deuxieme partie sont envisagees les possibilites d’exploration de la fonction respiratoire chez le sujet âge au repos comme a l’effort. Un des points majeurs est la difficulte de proposer des valeurs de reference valables pour cette population. Si les indications de realisation d’une exploration fonctionnelle respiratoire sont identiques a celles de la population generale, la realisation des examens peut etre plus difficile chez les sujets âges soit pour des raisons de comprehension, soit pour des raisons de capacite de realisation, soit par perte de la motilite. On choisira donc en fonction du contexte de proposer des methodes necessitant une cooperation importante encore appelees volitionnelles ou des methodes non volitionnelles. Une strategie d’exploration initiale de ces sujets est proposee en fonction de la presence ou non d’une dyspnee, de la perte de la mobilite. L’amelioration de l’accessibilite pour les sujets âges aux methodes d’exploration doit s’accompagner du developpement de recherche clinique sur les tests non volitionnels.

Points essentiels Il existe plusieurs systemes mnesiques sur lesquels les medicaments peuvent avoir une action specifique. Le systeme nerveux central du sujet âge est particulierement sensible aux medicaments, il faut evoquer une origine iatrogene devant toute alteration recente et/ou brutale des fonctions mnesiques. Devant une alteration mnesique recente , tous les medicaments non indispensables et en particulier les psychotropes doivent etre arretes ou diminues. Le sujet âge et en particulier le sujet dement est a risque par la frequence et par l’importance des consequences sur la memoire: il faut reevaluer regulierement la balance benefice/risque pour privilegier les traitements indispensables.

Resume Contexte Les sujets tres âges (80 ans et plus) et les sujets âges polypathologiques sont victimes d’une iatrogenie frequente et grave, alors qu’ils restent quasiment exclus de la recherche clinique. Methodes Nous avons recueilli par questionnaire l’opinion des geriatres sur la necessite et la faisabilite d’essais therapeutiques controles randomises (ETCR) dans cette population. Resultats Parmi les geriatres interroges, 48,3 % avaient deja participe a un ETCR mais 96,8 % les jugent scientifiquement indispensables. Parmi les geriatres n’ayant jamais participe a un ETCR, 36 % etaient dans ce cas, faute de proposition. Les principales difficultes ressenties par les geriatres pour developper les ETCR sont methodologiques (heterogeneite des patients incompatible avec des criteres d’inclusion trop stricts) et liees au consentement du patient. Pour 38,2 % des geriatres, l’absence d’obligation reglementaire pour l’industrie pharmaceutique est un frein important au developpement de ces ETCR. Conclusions Le developpement des ETCR chez les sujets tres âges depend donc avant tout d’un choix politique avec adoption d’une reglementation adaptee.

Resume Malgre son importance le risque infectieux reste peu etudie en geriatrie. Un nombre important de personnes âgees reside en etablissement hebergeant des personnes âgees dependantes (EHPAD) pour lesquelles aucune surveillance epidemiologique active n’est formalisee. L’Observatoire du Risque Infectieux en Geriatrie (ORIG) a donc ete cree pour federer les professionnels de la geriatrie et promouvoir la recherche dans le domaine du risque infectieux. Des etudes ont ete menees a terme par l’ORIG concernant le risque des pneumopathies nosocomiales en geriatrie. Dans l’enquete nationale de prevalence 2001, l’ORIG etait charge d’effectuer l’analyse des patients de plus de 65 ans. Une enquete sur la vaccination des personnels en geriatrie a ete effectuee en 2003 et un travail prospectif portant sur 100 institutions analysant les raisons de la non-vaccination des soignants en geriatrie doit debuter en 2005. A la demande du Secretariat d’Etat aux personnes âgees, l’ORIG effectuera une enquete de prevalence des infections nosocomiales dans le Val-de-Marne en 2005. L’ORIG a depose un programme hospitalier de recherche clinique sur les soins bucco-dentaires qui a ete accepte et est actuellement en cours. L’ORIG est reconnu par la plupart des acteurs de sante publique, il est societe filiale de la Societe Francaise de Geriatrie et Gerontologie et partenaire de la Societe Francaise d’Hygiene Hospitaliere.

Resume Le handicap a la marche survenant chez la personne âgee est la somme du vieillissement physiologique et des effets de la pathologie. Il est moteur, sensoriel et cognitif. Les techniques derivees de la robotique peuvent compenser certaines deficiences complexes en apportant une aide adaptee modulee par l’environnement. Les deambulateurs intelligents sont des aides techniques a la marche, integrant des fonctions robotiques, permettant d’eviter au patient de dependre d’une aide humaine pour se deplacer. Il peut s’agir de systemes passifs, pousses par l’utilisateur, qui vont etre capables de detecter et eviter un obstacle (MARC Robotic Walker), d’autres, en mode passif ou actif (le patient suit le robot), vont aussi pouvoir diriger le patient vers un lieu de son choix dans sa maison de retraite (Nursebot, Care-O-Bot). Un de ces systemes a pu beneficier d’une evaluation prolongee en conditions d’usage reel avec un bon retour (Guido), mais il reste tres couteux. Monimad est un projet de deambulateur incluant une aide aux transferts assis debout. La loi de commande a ete definie apres avoir etudie la cinematique et la cinetique du lever avec une aide humaine. Le fonctionnement d’un prototype de Monimad a ete verifie sur des volontaires jeunes avant les tests chez des personnes âgees.

International audience; We investigated IL-10 and IL-6 production in amyloid-beta (A beta) stimulated peripheral blood mononuclear cells (PBMCs) in twenty Alzheimer's disease (AD) patients with slow progression, eleven with fast progression, and twenty age-matched controls. Promoter polymorphisms in IL-10 (position -592, -819, -1082), IL-6 (-174), transforming growth factor-beta 1 (TGF-beta 1) (-10, -25), interferon-beta (IFN-gamma) (-874), and tumor necrosis factor-alpha (TNF-alpha) (-308) genes were analyzed. IL-10 production after A beta stimulation was high in PBMCs from slow decliners and almost completely abrogated in fast decliners. Association between AA IFN-gamma low-producing genotype and fast progression was demonstrated. Investigations in a larger sample will clarify these findings.

Les geriatres sont de plus en plus mal a l’aise vis-a-vis de l’industrie pharmaceutique et des autorites de sante qui, au-dela des discours de facade, continuent respectivement a commercialiser et a laisser commercialiser des medicaments qui n’ont pas ete etudies chez les patients âges. Les recommandations de la FDA (Food and Drug Administration) et de l’ICH (International Conference for Harmonisation), remontant a 10 ans et plus, stipulent de ne pas mettre de limite superieure d’âge dans les essais therapeutiques, d’y inclure des patients heterogenes et de realiser des etudes avec pharmacocinetique et pharmacodynamie de population. Les auteurs s’interrogent sur l’evolution de ce phenomene de decalage entre les patients des essais et les patients auxquels le nouveau medicament est prescrit et sur sa mise en relation avec la forte incidence des effets secondaires des medicaments chez les sujets âges dans un contexte de judiciarisation de la medecine. Ils plaident pour une prise de conscience commune des industriels et des autorites de sante afin que ces etudes se realisent et puissent beneficier aux industriels et non leur nuire. A defaut, des attitudes individuelles plus ou moins critiquables des prescripteurs concernant les nouveaux medicaments ne manqueront pas d’apparaitre telles que le refus de prescrire, la demande de signature de decharge aupres des patients ou les demandes d’essais randomises individuels.

Non-use of the walker may be secondary to an initial inappropriate prescribing, a lack of adequate training, a lack of monitoring and side effects of using. Improving both stability and mobility in users is due to several biomechanical mechanisms. The benefits of walker are: general physiological effects, more confidence, better social life and decrease in the burden of care. The disadvantages of walker are: technical or practical aspects criticized by users, musculoskeletal disorders, delayed reaction time, fall risk and stigma. Few scientific data evaluating the interest of the walker concerning mobility exist, thus recommendations are low grade and are often taken from professional clinical experiences. The choice of technical walking assistance depends on the pathology and biomechanical mechanism. The walker robots are few distributed.

For more than ten years, the French State and administrative regions have pursued economic development policies that stimulate all forms of innovation and encourage strategic market alliances of the economic stakeholders of a region. These ‘cluster’ policies aim to create ecosystems that are conducive to innovation and promote the emergence of collaborative organisations. Among these innovation clusters, we are concerned with those in the healthcare field pertaining to ageing and autonomy. Business models and action plans for these collaborative organisations are neither easy to define nor easy to stabilise and reinforce, because of the diversity of stakeholders with multiple expectations involved. This paper presents an application of the FAcT-Mirror method in the Sol’iage (http://www.soliage.com/english-version/) innovation cluster during its development stage. We demonstrate that the FAcT-Mirror method is particularly efficient and effective during the process of transformation from the emerging stage (stage of intention) to the development stage (stage of action) for a healthcare cluster to collectively produce common tools (definitions, strategy, working groups, and action plans).

Clinicians must be aware that aging can lead to changes in the pharmacokinetics and pharmacodynamics of many drugs. Drug distribution may be modified with aging secondarily to the decrease of serum albumin and to modifications of body composition (increase in the proportion of fat mass and decrease of lean mass). Hepatic metabolism of several drugs is reduced with age, especially drugs which depend of hepatic blood flow or P450 cytochroms. The incidence of renal failure increase largely with age. Glomerular filtration rate should be systematically estimated in older patients and, when needed, the doses of those drugs having significant renal elimination should be adjusted. In older patients, changes in the response to drugs can also develop, concerning specially the central nervous system (increased sensibility to any neurological effect of drugs), the cardiovascular system and the renal management of water and electrolytes. In many cases, the pharmacological changes associated to age are mild and requires no dose adjustment. However, many drugs should be adapted depending on the individual situation of each patient, particularly his renal function and nutritional state. Finally, some drugs should be avoided in older patients because of a bad effectiveness/tolerance ratio compared to alternatives.

This paper aims to present the MIRAS project : a multimodal interactive robot developed to provide assistance in strolling for people suffering from locomotion troubles. The first part of this paper summarizes goals and expected impacts of the project. Each work package is then detailed: description of use-cases and associated multimodal functions, conception and realization of the robot, security analysis and clinical validation. First results of user tests are analyzed to focus on users and developers feedback. Before concluding the paper, a short discussion about interests and problematic of the study is exposed., L’objet de cet article est de présenter le projet MIRAS : Robot avec interaction multimodale pour l’assistance à la déambulation. Les objectifs de ce projet sont exposés dans un premier temps ; puis chaque axe de travail est détaillé : description des scenarii et fonctions multimodales associées, présentation du travail de conception et de réalisation du robot, synthèse de l’étude de sécurité et, enfin, présentation des travaux menés pour la validation clinique. Les résultats des premiers essais pilotes sont également analysés pour souligner les points d’amélioration. Enfin, une discussion sur l’intérêt de l’étude et ses problématiques est menée avant de conclure l’article.

In the preparatory phase of a randomised controlled trial data were collected to assess the magnitude of changes on cognitive functions in 1628 volunteers (age range 45-75 years) that were recruited from general practitioners' patient population. Subjects were administered a short neuropsychological battery of tests including three paper-and-pencil tests, which assessed immediate recall, delayed memory, and attention. Being on antihypertensive medication was associated with low results for all three tests in every age group, and in all strata according to blood pressure levels. Psychotropic drug use was correlated with low results for all three tests. Differences between psychotropic drug users and nonusers increased with age. Antihypertensive treatment and psychotropic drug use seem to be important to consider in longitudinal studies of cognitive decline in aging.

Pneumonias in elderly are frequent and severe. They require an accurate assessment following clinical, biological and radiological steps. Each of them can contribute to give answers to the following questions: does this patient need emergency hospitalisation? Is the infection really bacterial and pulmonary? Should antibiotics be started? Which others treatments should be associated for the infection itself and for comorbid conditions? Concerning prevention, every effort must be done to decrease the incidence of these infections, especially vaccination. Pulmonary infections in nursing home need specific attention: cumulation of bad prognosis factors, risk of epidemic propagation, and vaccination of all people caring patients when required.

Objectives To assess the impact of a hygiene-encouragement program on reducing infection rates (primary end point) by 5%. Design A cluster randomized study was carried out over a 5-month period. Settings and participants Fifty nursing homes (NHs) with 4345 beds in France were randomly assigned by stratified-block randomization to either a multicomponent intervention (25 NHs) or an assessment only (25 NHs). Intervention The multicomponent intervention was targeted to caregivers and consisted of implementing a bundle of infection prevention consensual measures. Interactive educational meetings using a slideshow were organized at the intervention NHs. The NHs were also provided with color posters emphasizing hand hygiene and a kit that included hygienic products such as alcoholic-based hand sanitizers. Knowledge surveys were performed periodically and served as reminders. Measurements The primary end point was the total infection rate (urinary, respiratory, and gastrointestinal infections) in those infection cases classified either as definite or probable. Analyses corresponded to the underlying design and were performed according to the intention-to-treat principle. This study was registered (#NCT01069497). Results Forty-seven NHs (4515 residents) were included and followed. The incidence rate of the first episode of infection was 2.11 per 1000 resident-days in the interventional group and 2.15 per 1000 resident-days in the control group; however, the difference between the groups did not reach statistical significance in either the unadjusted (Hazard Ratio [HR] = 1.00 [95% confidence interval (CI) 0.89–1.13]; P = .93]) or the adjusted (HR = 0.99 [95% CI 0.87–1.12]; P = .86]) analysis. Conclusion Disentangling the impact of this type of intervention involving behavioral change in routine practice in caregivers from the prevailing environmental and contextual determinants is often complicated and confusing to interpret the results.

In France, although there are 445,000 beds in nursing homes (NHs) for elderly people, no studies on the burden of infections in NHs have been published. We sought to estimate the prevalence of infection among the residents and to assess the extent to which infections were associated with the residents' risk factors. We performed a nationwide, multicentre, cross-sectional, clustered period prevalence survey over five one-month periods. Cases of infection were classified as definite or, in the absence of laboratory confirmation, as probable. A total of 44,869 residents in 578 volunteer facilities were enrolled in the survey. The overall prevalence rate of infections was 11.23% [95% confidence interval (CI): 10.50-11.97] and differed significantly (P0.001) across survey periods (the time of the year the survey was carried out). The rate of definite cases was 4.60% (95% CI: 4.04-5.54) and the rate of probable cases was 6.63% (95% CI: 5.77-7.98). Respiratory tract infections were the most frequent and accounted for 41% of all infections. Infections were significantly associated with age, length of stay, full disability, urinary device, bedsores and the survey period. Only prevention programmes may reduce the impact of infections on this frail population.

International audience; IntroductionNeuroinflammation is thought to be important in Alzheimer's disease pathogenesis. Mast cells are a key component of the inflammatory network and participate in the regulation of the blood-brain barrier's permeability. Masitinib, a selective oral tyrosine kinase inhibitor, effectively inhibits the survival, migration and activity of mast cells. As the brain is rich in mast cells, the therapeutic potential of masitinib as an adjunct therapy to standard care was investigated.MethodsA randomised, placebo-controlled, phase 2 study was performed in patients with mild-to-moderate Alzheimer's disease, receiving masitinib as an adjunct to cholinesterase inhibitor and/or memantine. Patients were randomly assigned to receive masitinib (n = 26) (starting dose of 3 or 6 mg/kg/day) or placebo (n = 8), administered twice daily for 24 weeks. The primary endpoint was change from baseline in the Alzheimer's Disease Assessment Scale - cognitive subscale (ADAS-Cog) to assess cognitive function and the related patient response rate.ResultsThe rate of clinically relevant cognitive decline according to the ADAS-Cog response (increase >4 points) after 12 and 24 weeks was significantly lower with masitinib adjunctive treatment compared with placebo (6% vs. 50% for both time points; P = 0.040 and P = 0.046, respectively). Moreover, whilst the placebo treatment arm showed worsening mean ADAS-Cog, Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory, and Mini-Mental State Examination scores, the masitinib treatment arm reported improvements, with statistical significance between treatment arms at week 12 and/or week 24 (respectively, P = 0.016 and 0.030; P = 0.035 and 0.128; and P = 0.047 and 0.031). The mean treatment effect according to change in ADAS-Cog score relative to baseline at weeks 12 and 24 was 6.8 and 7.6, respectively. Adverse events occurred more frequently with masitinib treatment (65% vs. 38% of patients); however, the majority of events were of mild or moderate intensity and transitory. Severe adverse events occurred at a similar frequency in the masitinib and placebo arms (15% vs. 13% of patients, respectively). Masitinib-associated events included gastrointestinal disorders, oedema, and rash.ConclusionsMasitinib administered as add-on therapy to standard care during 24 weeks was associated with slower cognitive decline in Alzheimer's disease, with an acceptable tolerance profile. Masitinib may therefore represent an innovative avenue of treatment in Alzheimer's disease. This trial provides evidence that may support a larger placebo-controlled investigation.Trial registrationClinicaltrials.gov NCT00976118

We compared the densities of lesions immunolabeled with ubiquitin, tau and beta A4 antibodies and stained by various silver impregnations, with the intellectual status. The densities of senile plaques and neurofibrillary tangles labelled by anti-ubiquitin antibody were correlated with the Blessed test score. Ubiquitin-positive neurofibrillary tangles were less numerous than those labelled by Gallyas, anti-tau, Bodian's and Bielschowsky's methods. There were five times more beta A4 deposits than ubiquitin positive plaques. beta A4 deposits could be numerous in cases in which ubiquitin immunolabelling was entirely negative. Bielschowsky's method, silver methenamine and thioflavin S revealed more senile plaques than anti-ubiquitin, whereas anti-tau, Gallyas', Bodian's and Cross' techniques revealed similar numbers. Anti-ubiquitin positive lesions were correlated with the severity of dementia. Compared with other staining methods, sensitivity of anti-ubiquitin was weaker for neurofibrillary tangles than for senile plaques. These findings suggest that ubiquitin epitopes are linked to the neurofibrillary changes (in the perikaryon or within the senile plaques), and are absent from beta A4 deposits, either diffuse or compact.

Cholinergic neurons were studied by immunohistochemistry, with an antiserum against choline acetyltransferase (ChAT), in the basal forebrain (Ch1 to Ch4) of four patients with Alzheimer's disease (AD) and four control subjects. ChAT-positive cell bodies were mapped and counted in Ch1 (medial septal nucleus), Ch2 (vertical nucleus of the diagonal band), Ch3 (horizontal nucleus of the diagonal band) and Ch4 (nucleus basalis of Meynert). Compared to controls, the number of cholinergic neurons in AD patients was reduced by 50% on average. The interindividual variations in cholinergic cell loss were high, neuronal loss ranging from moderate (27%) to severe (63%). Despite the small number of brains studied, a significant correlation was found between the cholinergic cell loss and the degree of intellectual impairment. To determine the selectivity of cholinergic neuronal loss in the basal forebrain of AD patients, NPY-immunoreactive neurons were also investigated. The number of NPY-positive cell bodies was the same in controls and AD patients. The results (1) confirm cholinergic neuron degeneration in the basal forebrain in AD and the relative sparing of these neurons in some patients, (2) indicate that degeneration of cholinergic neurons in the basal forebrain contributes to intellectual decline, and (3) show that, in AD, such cholinergic cell loss is selective, since NPY-positive neurons are preserved in the basal forebrain.

La Presse Medicale - In Press.Proof corrected by the author Available online since mardi 20 mai 2014

The observational diagnosis phase of the VESTA study was aimed to determine the composite profiles of vaccinated/non-vaccinated HCWs by analyzing reasons to accept/decline influenza vaccination. Between June and September 2005, 2485 HCWs (female: 82.9%; nursing auxiliaries: 42.1%; vaccination coverage: 23.4%) from 53 French geriatric HCSs were included in the study. Cluster analysis determined 3 composite profiles: HCWs for whom information programs on vaccination can be useful (59%), HCWs staunchly opposed to vaccination (36%), and skeptical HCWs (5%). Qualitative analysis provided some aspects of influenza vaccine reluctance. Effective programs would be multidimensional and target the most susceptible group.

Elderly patients represent a heterogeneous population in which decisions on cancer treatment are often difficult. The present study aims to report a 2-year period of the activity of geriatric assessment consultations and the impact on treatment decisions. Since January 2007, we have systematically carried out geriatric consultations, using well-known international scales, for elderly patients in whom treatment decisions appear complex to oncologists. From January 2007 to November 2008, 161 patients (57 men, 104 women; median age 82.4 years, range 73-97) were seen at geriatric consultations. Most of the patients (134/161) were undergoing first-line treatment and cancer was metastatic in 86 patients (53%). Geriatric assessment found severe comorbidities (grade 3 or 4 in CIRS-G scale) in 75 patients, dependence for at least one activity of daily living (ADL) in 52 patients, cognitive impairment in 42 patients, malnutrition in 104 patients (65%) and depression in 39 patients. According to the oncologists' prior decisions, there were no changes in treatment decisions in only 29 patients. Cancer treatment was changed in 79 patients (49%), including delayed therapy in 5 patients, less intensive therapy in 29 patients and more intensive therapy in 45 patients. Patients for whom the final decision was delayed or who underwent less intensive therapy had significantly more frequent severe comorbidities (23/34, p

To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents.Pair-matched cluster-randomized trial.Forty nursing homes matched for size, staff vaccination coverage during the previous season, and resident disability index.All persons aged 60 and older residing in the nursing homes.Influenza vaccine was administered to volunteer staff after a face-to-face interview. No intervention took place in control nursing homes.The primary endpoint was total mortality rate in residents from 2 weeks before to 2 weeks after the influenza epidemic in the community. Secondary endpoints were rates of hospitalization and influenza-like illness (ILI) in residents and sick leave from work in staff.Staff influenza vaccination rates were 69.9% in the vaccination arm versus 31.8% in the control arm. Primary unadjusted analysis did not show significantly lower mortality in residents in the vaccination arm (odds ratio=0.86, P=.08), although multivariate-adjusted analysis showed 20% lower mortality (P=.02), and a strong correlation was observed between staff vaccination coverage and all-cause mortality in residents (correlation coefficient=-0.42, P=.007). In the vaccination arm, significantly lower resident hospitalization rates were not observed, but ILI in residents was 31% lower (P=.007), and sick leave from work in staff was 42% lower (P=.03).These results support influenza vaccination of staff caring for institutionalized elderly people.