Search

Background: Long-term exposure to anticholinergic and sedative drugs could be a modifiable risk factor for cognitive decline. The objective of this study was to measure the association between previous cumulative anticholinergic and sedative drug exposure (Drug Burden Index) and cognitive decline. Methods: A cohort study (MEMORA cohort) was conducted in a French memory clinic for patients attending a consultation between November 2014 and December 2020, with at least 2 Mini-Mental State Examination (MMSE) measurements (≥ 6 months apart) and available medication data from the local Primary Health Insurance Fund database (n = 1,970). Drug Burden Index was linearly cumulated until each MMSE measurement and was used to categorise patients according to their level of exposure (no exposure, moderate, or high). The longitudinal association between Drug Burden Index and MMSE was assessed using a multivariate linear mixed model, adjusted for age, education level, anxiety disorders, depressive disorders, functional autonomy, and behavioural disorders. Results: Overall, 1,970 patients were included with a mean follow-up duration of 2.78 years (± 1.54) and 2.99 visits per patients (5,900 MMSE + Drug Burden Index measurements collected). At baseline, 68.0% of patients had moderate cumulative anticholinergic and sedative drug exposure and a mean MMSE of 21.1. MMSE decrease was steeper in patients with moderate and high Drug Burden Index (-1.74 and -1.70/year, respectively) than in patients with no exposure (-1.26/year) after adjusting for age, education, anxiety and depressive disorders, functional autonomy, and behavioural disorders (p < 0.01). Conclusions: Long-term exposure to anticholinergic and sedative drugs is associated with steeper cognitive decline. Medication review focusing on de-prescribing these drugs could be implemented early to reduce cognitive impairment. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "Impact of cumulative exposure to anticholinergic and sedative drugs on cognition in older adults: a memory clinic cohort study." The correction states that several paragraphs were unintentionally omitted from the original article during the typesetting process. The omitted paragraphs provide additional information about the cognitive decline observed in older adults with different levels of exposure to anticholinergic and sedative drugs. The correction emphasizes the negative impact of these drugs on cognition and highlights the need to consider cumulative exposure over time. The document also mentions that previous studies have shown conflicting results regarding the association between anticholinergic or sedative exposure and cognition, and discusses the limitations of the study's methodology. Overall, the correction provides important additional information to the original article and highlights the complexity of studying the impact of medication on cognition in older adults. [Extracted from the article]

Purpose: Enterobacteriaceae (EB) bloodstream infections (BSI) are frequent and serious in older patients. Physicians are faced with the dilemma of prescribing early appropriate empirical antibiotics to limit the risk of death, and sparing broad-spectrum antibiotic prescription. The aim of the study was to assess the rate of appropriate empirical antibiotics prescription to treat EB BSI in older patients and its impact on survival. Methods: This study conducted in 49 centres enrolled retrospectively up to the 10 last consecutive patients aged 75 years and over and treated for EB BSI. Factors related to in-hospital death were investigated using logistic regression. Results: Among the 487 enrolled patients (mean age 86 ± 5.9 years), 70% had at least one risk factor of being infected by third-generation cephalosporins (3GC)-resistant strain; however, only 13.8% of EB strains were resistant to 3GC. An empirical antimicrobial treatment was initiated for 418 patients (85.8%), and for 86% (n = 360/418) of them, it was considered appropriate. In-hospital mortality was 12.7% (n = 62) and was related to the severity of infection (OR 3.17, CI 95% 1.75–5.75), while a urinary portal of entry was protective (OR 0.34, CI 95% 0.19–0.60). Neither the absence of nor inappropriate empirical antibiotics prescription was associated with increased mortality. Conclusion: While patients enrolled in this study were at risk of being infected by multidrug-resistant bacteria, yet mainly treated with 3GC, empirical antibiotics prescription was appropriate in most cases and did not influence mortality. [ABSTRACT FROM AUTHOR]

Background: We aimed to propose a correction of the Lawton instrumental activity of daily living (IADL) score to take into account the possibility to have never done some activities, and measured its agreement and reliability with the usual IADL score.Methods: A cross-sectional study was conducted in outpatients attending French memory clinics between 2014 and 2017. Lawton IADL, cognitive performance, diagnosis, neuropsychiatric symptoms, and sociodemographics characteristics were collected. A corrected IADL was calculated and its agreement with the usual IADL was assessed.Results: The study included of 2391 patients (79.9 years old, 61.7% female). Based on the usual IADL, 36.9% of patients had never carried out at least one of the activities. This proportion reached 68.8% for men and 17.7% for women. Women had a mean IADL higher than men: 4.72 vs 3.49, this difference decreased when considering the corrected IADL: 4.82 vs 4.26 respectively. Based on Bland-Altman method, 93.5% of observations lied within the limits agreement. The ICC between the 2 scores was 0.98. The relationships between patients' characteristics and the IADL scores were similar, regardless the usual or corrected version.Conclusions: This corrected IADL score had an excellent degree of agreement with the usual version based the ICC. This simple correction could benefit both for the clinical practice by providing a more accurate description of the real clinical state of the patients allowing to manage them more precisely, and for research involving the evaluation of the functional abilities of patients. [ABSTRACT FROM AUTHOR]

Geriatric assessment is a method aimed to describe elderly individual's health status. Effectiveness has been demonstrated in different domains. The ultimate outcome of Comprehensive Geriatric Assessment is the development of a coordinated care plan in which geriatric interventions focus on the particular problems of each patient. In the oncology setting, the method may help to estimate 1) the real place of cancer among the whole set of patient's health problems, 2) patient's tolerance to cancer treatments, and 3) treatment benefit/risk balance. Primary care providers play a pivotal role along the process, in strong collaboration with geriatricians and oncologists. This new pattern of interdisciplinary collaboration is currently being evaluated in Pilot Units of Coordination in Geriatric Oncology.

Unlabelled: The management of elderly patients with cancer is not established. The use of antineoplastic agents (particularly of chemotherapy) raises a lot of questions. Efficiency and toxicity. Data come from subgroups of clinical trials and from selected populations. Chronological age itself does not contra-indicate chemotherapy. Pharmacokinetics. Physiologic and functional changes occur with aging but there is great inter-patient variability. Oral chemotherapy. Oral treatments underline the problem of compliance. Under-treatment. Elderly patients are under-represented in clinical trials. Relevant issues have to be defined individually and cancer's real place in patient's general situation has to be specified. Geriatric assessment. This tool has proved its usefulness in many domains for global management of elderly patients. A multidisciplinary team is necessary, under geriatrician coordination. The aim is to elaborate an individualized medico-social intervention program. Geriatric assessment in oncology. Its interest for cancer patients is shown by emerging reports but its routine use by oncologists is impossible. Treatment strategies. They are not validated., Future: New clinical and pharmacokinetic studies are necessary in order to specify the place of the various tools and to enhance the handling of such molecules.

Geriatric oncology represents a novel specialty which can be defined as specific older cancer patients management. It includes a validated geriatric procedure, the comprehensive geriatric assessment, which is the best way of approaching the complex interacting medical problems of frail older patients. Geriatric assessment of elderly cancer patients is actually a subject for discussion among geriatric oncology community. Geriatric assessment may provide either guidelines for anti-cancer treatment in the elderly, or guidelines for the management of older patients with cancer. Two clinical research ways are now developed : firstly the definition of the most relevant geriatric variables allowing clinical trials in such a heterogeneous population; secondly, the determination and the validation of a specific tool to screen frail and vulnerable older patients, and the study of the geriatric assessment impact on the quality of life of older cancer people.