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Background: Orthogeriatric units have shown through several studies their effectiveness on reducing the morbidity and mortality after hip fracture. What about other emergency surgeries at the elderly? We evaluated the results of a small medical surgical geriatric unit (UMCG) for all the not sheduled surgeries., Methods: A retrospective sudy has been done, analyzing management of patients over 75 years after an emergency surgery, between 1 st January 2013 and 15 February 2014 for the surgical unit, and between 15 February 2014 and 15 April 2014 for the UMCG. 3-month mortality, 6-month mortality and the main early complications were compared between the two groups, by a multivariated analysis fitting on the data on patient characteristics., Results: 3-month mortality was significantly lower in the UMCG group (odds ratio 0.07 [95%IC: 0.004-0.48]; p=0.02), while the patients in this unit were more likely with dementia, with fall antecedent and with more comorbidity. 6-month mortality as well was lower in the UMCG group (0.10 [0.02-0.36]; p=0.001)., Conclusion: Management of not sheduled surgeries at the elderly in specific surgical geriatric unit is associated in a statistically significant reduction of 3-month mortality and 6-month mortality.

Background: The effect of age on declining immunity is well established, but its influence on humoral responses to influenza vaccines is still debated., Objective: To compare prospectively the immunogenicity of an influenza vaccine in elderly and healthy control subjects and to search for correlations between this specific humoral protection and clinical and virological parameters., Methods: A prospective study of the humoral response to influenza vaccine was conducted over 9 consecutive years in the long-term care units of the Saint-Etienne University Hospital, France. Antibodies directed against the vaccinal strains in an inactivated trivalent vaccine were tested by radial haemolysis before and 1 month after 477 and 242 cumulative annual vaccinations in elderly people and in healthy controls, respectively. During the last 6 years of the study, clinical samples from patients with fever > or =38 degrees C were tested systematically for the diagnosis of an influenza infection., Results: A significant rise in anti-A/H3N2 antibody titres was observed in 49.3% of the elderly subjects and in 48.3% of the controls (not significant). The rises for the A/H1N1 and B strains were 31.4 and 39.2% (p < 0.001) and 30.6 and 40.5 (p < 0.001), respectively. When control subjects under 31 years old were excluded, no significant difference was recorded for any strain. Only 3.9% of the vaccinated elderly experienced any clinical influenza infection as defined by fever >/=38 degrees C and virological proof., Conclusions: The humoral response to influenza immunization is not impaired in the elderly compared with middle-aged controls, and the incidence of febrile episodes due to influenza is low in this vaccinated elderly population. These findings provide further evidence supporting the recommendation for annual influenza vaccination in the elderly., (Copyright 2003 S. Karger AG, Basel)

Objectives: Report of epidemiological, clinical and virological data collected from the prospective surveillance of febrile episodes observed in aged residents of a long-stay care unit of 33 beds, at the University Hospital of Saint-Etienne, during the 1997-1998 winter season., Methods: Systematic collection of clinical and biological data from febrile patients (> or = 38 degrees C) on a form, including virological findings obtained from a nasal swab and paired serum specimens., Results: From 38 patients (37 of them having been vaccinated against influenza in October 1997), 18 febrile episodes were recorded in 16 subjects, including 3 respiratory syncytial virus infections and a late-occurring outbreak (March 1998) of influenza due to a A/H3N2 strain (15 cases, 14 of them virologically confirmed). No death was noted after the influenza outbreak. In 8 of the 9 tested patients with influenza, "protective" titres of antibodies directed towards the hemagglutinin of the vaccinal strain were present by radial hemolysis test three months before the beginning of the outbreak. During the influenza outbreak, the attack rate of symptomatic infection was 45.5% in elderly and 47.5% in healthcare workers (mainly unvaccinated). The occurrence of the first cases in the latter suggests their possible role in the transmission of the virus to the aged., Conclusion: This study underlines the epidemic circulation of multiple respiratory viruses during the same winter season in long-stay care facilities, the occurrence of clinical influenza infections in vaccinated patients exhibiting protective antibody titres and the role of unvaccinated healthcare workers in the propagation of influenza in institutionalised aged.