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Guillaume Deschasse,1,2 Elodie Drumez,2,3 Fabien Visade,2,4 Anne Charpentier,5 Céline Delecluse,4 Gilles Loggia,6,7 Pascale Lescure,7 Jadwiga Attier-Żmudka,8,9 Jennifer Bloch,5 Cédric Gaxatte,5 Frédéric Bloch,1 François Puisieux,5 Jean-Baptiste Beuscart2,5 1Department of Geriatrics, CHU Amiens-Picardie, Amiens, France; 2ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, University Lille, CHU Lille, Lille, France; 3Department of Biostatistics, CHU Lille, Lille, France; 4Geriatrics Department, Lille Catholic Hospitals, Lille, France; 5Department of Geriatrics, CHU Lille, Lille, France; 6COMETE, INSERM, Normandie Univ, UNICAEN, Caen, France; 7Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France; 8Geriatric Department, General Hospital of Saint-Quentin, Saint-Quentin, France; 9CHIMERE EA 7516 Team Research, Jules Verne University, Amiens, FranceCorrespondence: Guillaume Deschasse, Department of Geriatrics, CHU Amiens-Picardie, Amiens, France, Tel +33-322-088-000, Fax + 33-322-455-748, Email deschasse.guillaume@chu-amiens.frBackground: Acute geriatric units (AGUs) require efficient discharge planning tools. Risk factors for discharge from an AGU to post-acute care (PAC) have not previously been investigated in detail.Methods: The objective is to identify risk factors for PAC transfer. The DAMAGE (prospective multicenter cohort) consecutively included more than 3500 subjects aged 75 or older and admitted to an AGU. The patients underwent a comprehensive geriatric assessment (CGA) during their stay in the AGU. Only community-dwelling patients admitted to the AGU from the emergency department were included in the analysis. We recorded the characteristics of the care pathway and identified risk factors for discharge to home or to a PAC facility.Results: 1928 patients were included. Loss of functional independence (a decrease in the Katz activities of daily living (ADL) score between 1 month prior to admission and AGU admission), living alone, social isolation, a high Katz ADL score at home, a low Katz ADL on admission, and delirium on admission were risk factors for transfer to PAC. Obesity, an elevated serum albumin level, and community-acquired infection were associated with discharge to home. Neither sex nor age was a risk factor for home discharge or transfer to PAC.Conclusion: The present results might help clinicians and discharge planning teams to identify patients at risk of transfer to PAC more reliably and promptly in AGUs.Keywords: care transitions, health services, rehabilitation, risk factors, acute geriatric unit

OBJECTIVES: The objectives were to compare clinical pharmacist interventions between two care groups: COVID-19-positive and COVID-19-negative patients, and to identify drugs that require particular attention, especially those involved in COVID-19 management. METHODS: A prospective cohort study was conducted on patients with positive and negative COVID-19 statuses admitted to Lille University Hospital over 1 month. Pharmaceutical analysis instigated interventions to rectify drug-related errors. For each pharmaceutical intervention (PI), the anatomical therapeutic chemical classification of the drug and the outcome of such an intervention were specified. RESULTS: The study included 438 patients. Prescription analysis led to 188 PIs performed on 118 patients (64 COVID-19-positive patients and 54 COVID-19-negative patients). Most drug-related problems were incorrect dosage representing 36.7% (69/188) of all interventions: 27.9% (29/104) for the COVID-19-positive group and 47.6% (40/84) for the COVID-19-negative group. The most frequent PI in 34% (64/188) of cases was terminating a drug: 27.9% (29/104) for the COVID-19-positive group and 47.6% (40/84) for the COVID-19-negative group. The main drug classes involved were antithrombotic agents (20.7%, 39/188), antibacterials for systemic use (13.8%, 26/188) and drugs for gastric acid-related disorders (6.4%, 12/188). Study population was limited to a single centre over 1 month. CONCLUSION: No difference in PI was noted between the two groups. The presence of pharmacists led to a reduction in drug-related prescription problems, especially for antithrombotic and antibacterial drugs for both groups. Clinical pharmacy commitment in such a pandemic is therefore important.

Background consideration of the first hospital re-admission only and failure to take account of previous hospital stays, which are the two significant limitations when studying risk factors for hospital re-admission. The objective of the study was to use appropriate statistical models to analyse the impact of previous hospital stays on the risk of hospital re-admission among older patients. Methods an exhaustive analysis of hospital discharge and health insurance data for a cohort of patients participating in the PAERPA (‘Care Pathways for Elderly People at Risk of Loss of Personal Independence’) project in the Hauts de France region of France. All patients aged 75 or over were included. All data on hospital re-admissions via the emergency department were extracted. The risk of unplanned hospital re-admission was estimated by applying a semiparametric frailty model, the risk of death by applying a time-dependent semiparametric Cox regression model. Results a total of 24,500 patients (median [interquartile range] age: 81 [77–85]) were included between 1 January 2015 and 31 December 2017. In a multivariate analysis, the relative risk (95% confidence interval [CI]) of hospital re-admission rose progressively from 1.8 (1.7–1.9) after one previous hospital stay to 3.0 (2.6–3.5) after five previous hospital stays. The relative risk [95%CI] of death rose slowly from 1.1 (1.07–1.11) after one previous hospital stay to 1.3 (1.1–1.5) after five previous hospital stays. Conclusion analyses of the risk of hospital re-admission in older adults must take account of the number of previous hospital stays. The risk of death should also be analysed.

Many older adults take benzodiazepines and sedative-hypnotics for the treatment of sleep disorders. With a view to considering the possible discontinuation of hypnotics, the objectives of the present study were to describe bedtime habits and sleep patterns in older adults and to identify the sleep medications taken. An expert group developed a structured interview guide for assessing the patients’ bedtime habits, sleep patterns, and medications. During an internship in a community pharmacy, 103 sixth-year pharmacy students conducted around 10 interviews each with older adults (aged 65 or over) complaining of sleep disorders and taking at least one of the following medications: benzodiazepines, benzodiazepine derivatives (“Z-drugs”), antihistamines, and melatonin. A prospective, observational study was carried out from 4 January to 30 June 2016. The pharmacy students performed 960 interviews (with 330 men and 630 women; mean ± standard deviation age: 75.1 ± 8.8). The most commonly taken hypnotics were the Z-drugs zolpidem (n = 465, 48%) and zopiclone (n = 259, 27%). The vast majority of patients (n = 768, 80%) had only ever taken a single hypnotic medication. The median [interquartile range] prescription duration was 120 (48–180) months. About 75% (n = 696) of the patients had at least 1 poor sleep habit, and over 41% (n = 374) had 2 or more poor sleep habits. A total of 742 of the patients (77%) reported getting up at night—mainly due to nycturia (n = 481, 51%). Further, 330 of the patients (35%) stated that they were keen to discontinue their medication, of which 96 (29%) authorized the pharmacist to contact their family physician and discuss discontinuation. In France, pharmacy students and supervising community pharmacists can identify problems related to sleep disorders by asking simple questions about the patient’s sleep patterns. Together with family physicians, community pharmacists can encourage patients to discuss their hypnotic medications.

The successful design of musical interventions for dementia patients requires knowledge of how rhythmic abilities change with disease severity. In this study, we tested the impact of the severity of the neurocognitive disorders (NCD) on the socioemotional and motor responses to music in three groups of patients with Major NCD, Mild NCD, or No NCD. Patients were asked to tap to a metronomic or musical rhythm while facing a live musician or through a video. We recorded their emotional facial reactions and their sensorimotor synchronization (SMS) abilities. Patients with No NCD or Mild NCD expressed positive socioemotional reactions to music, but patients with Major NCD did not, indicating a decrease in the positive emotional impact of music at this stage of the disease. SMS to a metronome was less regular and less precise in patients with a Major NCD than in patients with No NCD or Mild NCD, which was not the case when tapping with music, particularly in the presence of a live musician, suggesting the relevance of live performance for patients with Major NCD. These findings suggest that the socioemotional and motor reactions to music are negatively affected by the progression of the NCD.

Background: In older people, dementia is a well-established risk factor for falls. However, the association and the causal relationship between falls and the earlier stages of cognitive impairment remains unclear. The purpose of the study was to review the literature data on the association between falls and cognitive impairment, no dementia, including Mild Cognitive Impairment. Methods: According to PRISMA guidelines, we searched five electronic databases (EMBASE, Web of Science, Medline, CINAHL, and PsychINFO) for articles published between January 2011 and August 2022 on observational studies of older people with a cognitive assessment and/or cognitive impairment diagnosis and a recording of falls. Their quality was reviewed according to the STROBE checklist. Results: We selected 42 of the 4934 initially retrieved publications. In 24 retrospective studies, a statistically significant association between falls and cognitive status was found in only 15 of the 32 comparisons (47%). Of the 27 cross-sectional analyses in prospective studies, only eight (30%) were positive and significant. We counted four longitudinal analyses, half of which suggested a causal relationship between falls and cognitive impairment. The investigational methods varied markedly from one study to another. Conclusion: It is still not clear whether falls are associated with cognitive impairment, no dementia. Data in favor of a causal relationship are scarce. Further studies are needed to clarify their relationship.

Long-term care facility (LTCF) older residents display physiological alterations of cellular and humoral immunity that affect vaccine responses. Preliminary reports suggested a low early postvaccination antibody response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this study was to focus on the specific T-cell response. We quantified S1-specific IgG, neutralizing antibody titers, total specific IFNγ-secreting T cells by ELISpot, and functionality of CD4+- and CD8+-specific T cells by flow cytometry, after two doses of the BNT162b2 vaccine in younger and older people, with and without previous COVID-19 infection (hereafter referred to as COVID-19-recovered and COVID-19-naive subjects, respectively). Frailty, nutritional, and immunosenescence parameters were collected at baseline in COVID-19-naive older people. We analyzed the immune response in 129 young adults (median age 44.0 years) and 105 older residents living in a LCTF (median age 86.5 years), 3 months after the first injection. Humoral and cellular memory responses were dramatically impaired in the COVID-19-naive older (n = 54) compared with the COVID-19-naive younger adults (n = 121). Notably, older participants’ neutralizing antibodies were 10 times lower than the younger’s antibody titers (p + and IFNγ+IL-2+TNFα+ cells among specific CD4+ T cells, and the frequency of specific CD8+ T cells were lower in COVID-19-naive older participants than in COVID-19-naive young adults (p p = 0.0018, respectively). However, COVID-19-recovered older participants (n = 51) had greater antibody and T-cell responses, including IFNγ+ and IFNγ+IL-2+TNFα+-specific CD4+ T cells (p +-specific CD8+ T cells (p + and CD8+ T cells, in addition to impaired antibody response, and that specific studies are warranted to assess the efficiency of SARS-CoV-2 mRNA-based vaccines, as in other immunocompromised subjects. Our study also shows that, despite their physiological alterations of immunity, vaccination is highly efficient in boosting the prior natural memory response in COVID-19-recovered older people.

We quantified S1-specific IgG, neutralizing antibody titers, specific IFNγ secreting T cells and functionality of specific CD4+ and CD8+ T cells in 130 young adults (median age 44.0 years) and 106 older residents living in a long-term care facility (86.5 years) after 2 doses of BNT162b2. Three months after the first injection, humoral and cellular memory responses were dramatically impaired in the 54 COVID-19-naive older compared to the 121 COVID-19-naive younger adults. Notably, older participants’ neutralizing antibodies, detected in 76.5% (versus 100% in young adults,P< 0.0001), were ten times lower than the younger’s antibody titers (P< 0.0001). Antibody and T cell responses were greater among the 52 COVID-19-recovered than among the 54 COVID-19-naive older adults (P< 0.0001). Our study shows that 2 doses of BNT162b2 does not guarantee long-term protection against SARS-CoV-2 in the older. An additional dose should be considered to boost their specific memory response.

International audience; The aim of this study is to maintain up-to-date information about the current state of elderly people that are medically followed for risks of fall. Our proposal consists of an individual information database management system that can provide information on-demand on various variables. Such a system has to deal with several sources of uncertainty: lack of information, evolving information and reliability of the information sources. We consider that the features of the person may evolve with time causing uncertainty due to obsolete information. Our context includes new information received bit by bit, with no possibility to collect all required information at once. This paper establishes a first proposal to manage a set of uncertain observations, in order to reduce erroneous and obsolete information while keeping the benefit of previously collected information. We propose an architecture of the system based on a probabilistic knowledge model about the characteristics of interest, a set of decay functions that help to evaluate the confidence degree in previous observations, and a reasoning module to manage new observations, maintain the compatibility and the quality of the observation set. We detail the algorithms of the reasoning module, and the algorithm to update the confidence degree of the observations.

International audience; Background Music-based interventions appear to be efficient non-pharmacological approaches to improve emotional, social, and cognitive functioning of patients with neurodegenerative diseases such as Alzheimer's Disease (AD). Objectives Because the benefits seem to increase with patients motor involvement, we studied the ability to move in synchrony with musical rhythms and more specifically the impact of live performance compared to video recording of a musician on sensorimotor abilities in patients with cognitive impairments (AD, vascular and mixed dementia) and in patients with no evidence of cognitive impairments. Methods Sensorimotor synchronization (SMS) to a metronomic or a musical stimulus was assessed in patients when they were viewing a live musician or his pre-recorded video. Results Participants were better at synchronizing to a metronome than to music but this effect was modulated by the social context. While SMS to a metronome was better when facing a video than a live performance, there was no impact of the social context on SMS to music. Lastly, we found no group differences on SMS. Conclusion The decrease in synchronization ability to metronome in the live performance may be due to the social pressure associated with the presence of the musician. Such a pressure might be removed in pleasant and ecological social activities, like moving with music, explaining the lack of the social context effect on SMS to music. Remarkably, the group with cognitive impairments performed no worse than the group without cognitive impairments, which suggests relatively spared SMS abilities in these patients. By showing that it is possible to encourage a patient to synchronize with others, even in front of a video, the results of our study indicate that SMS can be used as a relevant predictor in clinical trials and open up promising therapeutic options for patients living in remote areas.

Purpose/introduction A Fracture Liaison Service (FLS) was set up at Lille University Hospital in 2016. The purpose of this study was to assess persistence with osteoporosis treatment in patients from the FLS over a period of 1 year, and to determine predictors of discontinuation. Methods The study population comprised adults of both genders, aged 50 or over, admitted to Lille University Hospital between January 2016 and January 2019 for a low-trauma fracture and managed in our FLS. Outcomes included (1) persistence rate at 1 year after treatment initiation, (2) persistence rate at 2 years after treatment initiation, (3) persistence rate at 1 and 2 years after treatment initiation according to type of treatment, (4) predictors of non-persistence, and (5) reasons for discontinuing treatment over 1 year after initiation. Persistence was determined using the Kaplan–Meier method. Results In all, 1224 patients (≥50 years old) with a recent history of low-trauma fracture (≤12 months) were identified. Of these, 380 patients – 79.2% female; mean (SD) age 76 (11) years – were seen at the FLS. In those 380 patients, 410 fractures were found and 360 of them (87.8%) were major fractures, breaking down as follows: vertebra (44%), hip (19%), proximal humerus (10%), and pelvis (8%). Osteoporosis treatment was prescribed for 367 (96.6%) patients and 275 of them began the prescribed treatment. The following anti-osteoporosis drugs were prescribed: zoledronic acid (n=150, 54.5%), teriparatide (n=63, 22.9%), and denosumab (n=39, 14.2%). Oral bisphosphonates were prescribed for a few patients (n=23, 8.4%). Persistence with osteoporosis medication (any class) was estimated at 84.1% (95% CI: 79.1% to 88.1%) at 12-month follow-up, and dropped to 70.3% (95% CI: 63.7% to 75.9%) at 24 months. When drug-specific analyses were performed using the Kaplan–Meier method, persistence rates at 12 and 24 months were found to be higher with denosumab than with any other treatment. Independent predictors of non-persistence at 12 months were ‘follow-up performed by a general practitioner (GP)’ – Odds Ratio (OR) for GP vs. FLS = 3.68; 95% CI, 1.52 to 8.90, p=0.004 – and ‘treatment with zoledronic acid’ – OR for zoledronic acid vs. denosumab = 3.39; 95% CI, 1.21 to 9.50, p=0.019; OR for zoledronic acid vs. teriparatide = 8.86; 95% CI, 1.15 to 68.10, p=0.035. Conclusions This study provides evidence of the success of our FLS in terms of long-term persistence with osteoporosis treatments. However, osteoporosis treatment initiation still needs to be improved.

Despite known adverse effects of anticholinergic (AC) medication, little work has been devoted to the impact of high anticholinergic burden on the rate of hospital readmission. The purpose of this study was to analyze prospectively the link between high AC burden and the rate of all-cause thirty-day hospital readmission in older people. This was a prospective non-interventional study conducted from January to August 2019 in one acute-care geriatric ward. All hospital stays of patients aged at least 75 years who were discharged to their home were included in the analysis. AC burden was determined from discharge prescriptions using the Anticholinergic Drug Scale (ADS) and the Anticholinergic Risk Scale (ARS), and defined as high if ≥3. The analysis concerned 350 hospital stays. Median patient age was 88 years (interquartile interval 84–91). In a multivariate analysis, the risk of hospital readmission within 30 days was not increased for patients with high AC burden (ADS≥3): odds ratio 1.16 [95% confidence interval 0.56–2.37], compared to a patient whose anticholinergic burden was not high. Unlike retrospective studies on this issue, the findings of our prospective analysis do not support a higher risk of hospital admission within 30 days for older people with high AC burden as assessed from their discharge prescriptions.

Résumé : Nous avons étudié l'association entre l'incidence des fractures de la hanche et les caractéristiques du lieu de vie en France. La répartition spatiale de l'incidence des fractures de la hanche était hétérogène et il existait une relation significative entre la privation sociale, l'urbanisation, l'accès à la santé et le risque de fracture de la hanche. Objectif : Plusieurs études ont montré de grandes disparités dans la répartition spatiale des fractures de hanche (FH). L'objectif de l'étude était d'analyser l'association entre l'incidence des FH et les caractéristiques du lieu de vie. Méthodes : Tous les patients âgés de 50 ans ou plus, résidant en France, qui ont été hospitalisés pour une HF entre 2012 et 2014 ont été inclus, en utilisant la base de données nationale française des sorties d'hôpital. Les ratios d'incidence standardisés (SIR) ont été calculés pour chaque unité spatiale et ajustés sur l'âge et le sexe. Une régression écologique a été réalisée pour analyser l'association entre l'incidence standardisée de l'HF et les variables écologiques. Nous avons ajusté le modèle pour la structure spatiale du quartier. Nous avons utilisé trois variables pour caractériser les zones de vie : un indice de privation (French-EDI) ; l'accès aux soins (indice standardisé français) ; l'utilisation du sol (pourcentage de surfaces artificialisées). Résultats : 236 328 HF ont été enregistrées dans la base de données nationale des hôpitaux français, conduisant à une incidence annuelle d'HF de 333/100 000. L'analyse spatiale a révélé des variations géographiques de l'incidence de l'HF avec un SIR variant de 0,67 [0,52 ; 0,85] à 1,45 [1,23 ; 1,70]. Il y avait une association significative entre les taux d'incidence de l'HF et : (1) l'indice French-EDI (tendance p=0,0023) ; (2) l'accessibilité des médecins généralistes et des infirmières (tendance p=0,0232 et p=0,0129, respectivement) ; (3) le pourcentage de surfaces artificialisées (p

Introduction La pandemie a COVID-19 est responsable de pres de 3 millions de deces. En l’absence de traitement curatif a ce jour, la prevention est la seule strategie efficace pour la controler. La vaccination est un des piliers de cette prevention. Elle a commence par les sujets les plus fragiles, les residents d’etablissement d’hebergement pour personnes âgees dependantes (EHPAD). Ils ont beneficie des premiers vaccins disponibles a ARN messager depuis le 28 decembre 2020. Ils presentent une immunosenescence physiologique a l’origine habituellement d’une immunite innee moins efficiente et ou d’une immunite adaptative moins durable. Les donnees concernant cette population âgee particuliere sont absentes que ce soit sur la reponse immunitaire naturelle versus l’immunite vaccinale et les facteurs (âge, comorbidites, statut nutritionnel) pouvant modifier les reponses du systeme immunitaire. L’objectif de ce travail est de comparer la qualite de la reponse vaccinale anti-SARS-CoV-2 versus l’immunite naturelle. Materiels et methodes Etude observationnelle prospective monocentrique d’une cohorte de residents d’EHPAD et d’unites de soins de longue duree de plus de 65 ans d’un centre hospitalo-universitaire francais. Les residents beneficient de la vaccination par COMINARTY (BNT162b2), 2 doses a 21 jours d’intervalle. Les objectifs sont de comparer la reponse immunitaire specifique 3 mois apres COVID-19 et 3 mois apres la vaccination. Elle evalue le nombre de lymphocytes T totaux specifiques anti-S et d’anticorps neutralisants (Virus neutralization test) 3 mois apres une infection COVID-19 prouvee avant toute vaccination et 3 mois apres la vaccination chez les sujets « naifs ». La qualite de reponse immunitaire postvaccinale est evaluee en comparant l’amplitude, le nombre de lymphocytes T, d’anticorps totaux anti-S en fonction de la presence d’anticorps prevaccinaux (infection anterieure). La qualite de la reponse immunitaire est comparee en fonction de l’etat nutritionnel des sujets âges et des indicateurs d’immunosenescence sur l’immunite adaptative (nombre de lymphocytes T, taux d’anticorps totaux anti-S et d’anticorps neutralisants en fonction des taux basals de cytokines proinflammatoires, du pourcentage et du nombre absolu de lymphocytes CD4+ naifs, lymphocytes CD8+ de differenciation terminale). Resultats Seules les donnees pour les reponses a 3 mois seront disponibles pour cette communication. Description de la population : EHPAD de 104 lits et USDL de 96 lits avec 162 residents presents avec une moyenne d’âge de 83 ans et des comorbidites lourdes avec un GIR moyen pondere de 761 en EHPAD et de 865 en USLD. Quatre-vingt-sept residents ont presente une infection a COVID-19 documentee entre mars et decembre 2020. Quatre-vingt-quinze pour cent des residents ont beneficie d’une vaccination anti-SARS-CoV-2 et 90 % ont accepte la participation a l’etude. Les premieres donnees a 3 mois en Elispot apres immunisation naturelle anti-S : – sujets > 65 ans : mediane 33 spots (n = 34) ; – sujets > 75 ans : mediane 22 spots (n = 13). Conclusion A suivre.

Introduction La pandémie à COVID-19 est responsable de près de 3 millions de décès. En l’absence de traitement curatif à ce jour, la prévention est la seule stratégie efficace pour la contrôler. La vaccination est un des piliers de cette prévention. Elle a commencé par les sujets les plus fragiles, les résidents d’établissement d’hébergement pour personnes âgées dépendantes (EHPAD). Ils ont bénéficié des premiers vaccins disponibles à ARN messager depuis le 28 décembre 2020. Ils présentent une immunosénescence physiologique à l’origine habituellement d’une immunité innée moins efficiente et ou d’une immunité adaptative moins durable. Les données concernant cette population âgée particulière sont absentes sur la réponse immunitaire vaccinale et les facteurs (âge, comorbidités, statut nutritionnel) pouvant modifier les réponses du système immunitaire. L’objectif de ce travail est de comparer la qualité de la réponse vaccinale anti-SARS-CoV-2 par rapport à des sujets immunocompétents de 18 à 65 ans. Matériels et méthodes Étude observationnelle prospective monocentrique d’une cohorte de résidents d’EHPAD et d’unités de soins de longue durée de plus de 65 ans d’un centre hospitalo-universitaire français par rapport à des professionnels de santé et du médicosocial de 18 à 65 ans. Les 2 groupes bénéficient de la vaccination par COMINARTY(BNT162b2), 2 doses à 21 jours d’intervalle. Les objectifs sont : – évaluer l’amplitude de la réponse lymphocytaire T totale anti-S à 3 mois : nombre de cellules sécrétrices d’interféron gamma ; – évaluer l’amplitude de la réponse lymphocytaire T CD4+ et T CD8+ spécifique anti-S à 3 et 9 mois (nombre de lymphocytes T spécifiques anti-S détectés à 3 et 9 mois, après enrichissement en T CD4+ et en T CD8+) ; – évaluer l’amplitude de la réponse humorale spécifique anti-S à 3 et 9 mois (taux d’anticorps totaux anti-S et d’anticorps neutralisants). Seules les données pour les réponses à 3 mois seront disponibles pour cette communication. Résultats Description de la population: EHPAD de 104 lits et USDL de 96 lits avec 162 résidents présents avec une moyenne d’âge de 83 ans et des comorbidités lourdes avec un GIR moyen pondéré de 761 en EHPAD et de 865 en USLD. Quatre-vingt-sept résidents ont présenté une infection à COVID-19 documentée entre mars et décembre 2020. Quatre-vingt-quinze pour cent des résidents ont bénéficié d’une vaccination anti-SARS-CoV-2 et 90 % ont accepté la participation à l’étude. Pour le groupe contrôle 125 professionnels du CHU ont été inclus à l’étude en collaboration avec l’équipe de la médecine du travail et le centre de vaccination. Les premières données à 3 mois en Elispot après immunisation naturelle anti-S : – sujets 65 ans : médiane 33 spots (n = 34) ; – sujets > 75 ans : médiane 22 spots (n = 13). Conclusion À suivre.

Background Aging of the French population confronts our society with enormous challenges, including an adaptation of the health system. The elderly population consumes a disproportionate amount of available healthcare, especially when provided by hospitals. This reflects the higher prevalence of most chronic diseases and disabilities among older persons. These facts illustrate the lack of appropriate organization necessary for the healthcare system to deal with the comorbid conditions and disabilities presented by old patients. In 2007, the ministerial circular for the development of geriatric care described organizational procedures designed to help hospitals optimize care for the elderly and stimulate coordination among healthcare providers. We report the development of geriatric departments in the hospitals of the Nord-Pas-de-Calais region as they were implanted over the last decade, and discuss the successes, the benefits and the limitations of this organization. Methods We monitored the development of geriatric departments in the region and propose a reflection on the benefits and shortcomings of their organization, taking into consideration changing needs in terms of quantity of care. An annual declarative regional survey was conducted for 8 years. More qualitative information was obtained from onsite visits of the regional health agency. These elements helped explain some of the quantitative findings. Results Although geriatric departments were successfully developed in recent years using the hospital sector organizational scheme, the fact remains that the offer of care for old patients remains insufficient. This insufficiency stems from growing needs due to changes in the demographic make-up of the population that also has an important impact outside the realm of healthcare. Conclusion We demonstrate the need for regulatory changes and reflection on ways to favor a healthcare referral scheme that would take into full consideration the possibilities of care outside the hospital setting and the potential for multidisciplinary coordination among all adult specialties, including general medicine.

Alzheimer’s disease (AD) is a frequent pathology, with a poor prognosis, for which no curative treatment is available in 2018. AD prevention is an important issue, and is an important research topic. In this manuscript, we have synthesized the literature reviews and meta-analyses relating to modifiable risk factors associated with AD. Smoking, diabetes, high blood pressure, obesity, hypercholesterolemia, physical inactivity, depression, head trauma, heart failure, bleeding and ischemic strokes, sleep apnea syndrome appeared to be associated with an increased risk of AD. In addition to these well-known associations, we highlight here the existence of associated factors less described: hyperhomocysteinemia, hearing loss, essential tremor, occupational exposure to magnetic fields. On the contrary, some oral antidiabetic drugs, education and intellectual activity, a Mediterranean-type diet or using Healthy Diet Indicator, consumption of unsaturated fatty acids seemed to have a protective effect. Better knowledge of risk factors for AD allows for better identification of patients at risk. This may contribute to the emergence of prevention policies to delay or prevent the onset of AD.

Background and objective: Defective transmission of drug information during the transition from hospital to home care are causes of adverse drug reactions in older patients. We aimed to reach a consensus concerning information about changes in treatment to be transmitted to primary caregivers when an older patient is discharged from hospital. Methods: A qualitative focus group study was conducted with general practitioners, geriatricians, community pharmacists, and hospital pharmacists providing care for older patients. Four steps were used to reach a focus group consensus: 1) presentation of the purpose of the focus group; 2) generation and enumeration of ideas; 3) sharing opinions about these ideas; 4) voting to create a list of ranked items. The process involved three focus groups. Results: A consensus was reached on ten items: indication for continued, discontinued, newly introduced or changed treatments and their duration; reasons for discontinuing drugs or introducing new drugs; information about re-evaluating treatments; reasons for hospital stay, significant elements and diagnosis at discharge; administrative information concerning the patient; the name of the primary care physician, and the discharging hospital unit and the physician(s) in charge; known allergies, information about liver and kidney failure; main adverse effects to monitor; date of latest blood tests; hospital admission/discharge dates. Conclusion: The consensus on the list of information items concerning changes in the treatment should be used by hospital physicians and pharmacists to ensure safe patient discharge.

Objective: Anosognosia heterogeneously affects cognitive functioning and indeed, at the very onset of dementia symptoms. This raises the question of accountable predictors of each cognitive impairment. The objective of this study was to identify the cognitive and non-cognitive predictors of so-called cognitive anosognosia. Method: A paradigm based on the discrepancies between performance predictions and actual performance in the light of the Dementia Rating Scale (DRS) helped distinguish cognitive anosognosia in relation to four major functions: Attention Initiation-perseveration, Conceptualisation and Memory. Patients achieved a complete set of neuropsychological tests and assessments of the level of anxiety, apathy and functional independence. Results: Significant correlations existed between all cognitive anosognosia scores (AS) and neuropsychological performance scores of the participants. Similarly, significant correlations were found between the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores and the Initiation and Conceptualisation AS and between anxiety score and Conceptualisation and Memory AS. However, the regression models were exclusively cognitive for Attention Initiation-perseveration and Memory AS. Only the Conceptualisation AS was predicted by a non-strictly cognitive regression model including the ADL score. Conclusions: If the different specific cognitive anosognosias are predicted by separate sets of variables, our results emphasise that dysexecutive impairment plays a major role regardless of the deficiencies considered.

Microsporidia are protists close to the kingdom of fungi that may cause eye infections. Most cases are reported in Asia and affect both immunocompromised and immunocompetent patients. Here, we report a rare case of microsporidial keratoconjunctivitis in an immunocompetent French patient 3 weeks after returning from India. In our patient, Weber trichrome staining of conjunctival scrapings revealed rounded elements approximately 1-3 μm in size. Conventional polymerase chain reaction analysis by ribosomal RNA subunit sequencing showed 100% identity with Vittaforma corneae. Treatment by corneal debridement combined with fluoroquinolone eye drops allowed complete resolution of the lesions. Although rare, ocular microsporidiosis should be investigated in a patient who is native to Asia or has returned from an endemic area and presents with keratoconjunctivitis of undetermined etiology.

Health is a multi-dimensional concept, capturing how people feel and function. The broad concept of Active and Healthy Ageing was proposed by the World Health Organisation (WHO) as the process of optimizing opportunities for health to enhance quality of life as people age. It applies to both individuals and population groups. A universal Active and Healthy Ageing definition is not available and it may differ depending on the purpose of the definition and/or the questions raised. While the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has had a major impact, a definition of Active and Healthy Ageing is urgently needed. A meeting was organised in Montpellier, France, October 20-21, 2014 as the annual conference of the EIP on AHA Reference Site MACVIA-LR (Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon) to propose an operational definition of Active and Healthy Ageing including tools that may be used for this. The current paper describes the rationale and the process by which the aims of the meeting will be reached. Health is a multi-dimensional concept, capturing how people feel and function. The broad concept of Active and Healthy Ageing was proposed by the World Health Organisation (WHO) as the process of optimizing opportunities for health to enhance quality of life as people age. It applies to both individuals and population groups. A universal Active and Healthy Ageing definition is not available and it may differ depending on the purpose of the definition and/or the questions raised. While the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has had a major impact, a definition of Active and Healthy Ageing is urgently needed. A meeting was organised in Montpellier, France, October 20-21, 2014 as the annual conference of the EIP on AHA Reference Site MACVIA-LR (Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon) to propose an operational definition of Active and Healthy Ageing including tools that may be used for this. The current paper describes the rationale and the process by which the aims of the meeting will be reached.

Rationale, aims and objectives To assess the impact of an automated drug distribution system on medication errors (MEs). Methods Before-after observational study in a 40-bed short stay geriatric unit within a 1800 bed general hospital in Valenciennes, France. Researchers attended nurse medication administration rounds and compared administered to prescribed drugs, before and after the drug distribution system changed from a ward stock system (WSS) to a unit dose dispensing system (UDDS), integrating a unit dose dispensing robot and automated medication dispensing cabinet (AMDC). Results A total of 615 opportunities of errors (OEs) were observed among 148 patients treated during the WSS period, and 783 OEs were observed among 166 patients treated during the UDDS period. ME [medication administration error (MAE)] rates were calculated and compared between the two periods. Secondary measures included type of errors, seriousness of errors and risk reduction for the patients. The implementation of an automated drug dispensing system resulted in a 53% reduction in MAEs. All error types were reduced in the UDDS period compared with the WSS period (P

The original version of this article, published on 5 June 2019, an author's name was misspelled.

Objective Post-fall syndrome (PFS) is a severe complication of falls in older adults. PFS is considered to be a medical emergency in geriatric patients, given the risk of a decompensatory “domino effect” and mortality. Unfortunately, there is currently no consensus on how to detect patients at risk of PFS. The primary objective of the present study was to profile patients suffering from PFS. The secondary objective was to study the prognosis of patients with PFS after their discharge from an aftercare and rehabilitation department (ARD). Material/Patients and methods We prospectively surveyed patients hospitalized in the geriatric ARD at Lille University Hospital (Lille, France) after a fall. Cases (i.e. patients meeting the criteria for PFS: the simultaneous presence of a postural disorder, a gait disorder and a psychobehavioural disorder) were compared with controls (i.e. patients free of PFS). Results Seventy-two patients were included (females: 74%). The median [interquartile range] age was 85.5 [81; 90]. Thirty-four patients (47%) had PFS. The symptoms most frequent significantly associated with PFS were retropulsion in stance, and anxiety about movement. Cases and controls did not differ significantly with regard to other signs (little step walking, axial akinesia, oppositional hypertonia, etc.). Patients with PFS were more likely to present with vascular dementia (P = 0.0166) and osteoporosis (P = 0.0458), and were less likely to be taking drugs associated with falls (P = 0.0003). Initial functional assessments (according to both the Mini Motor Test and the Timed Up-and-Go test) showed that functional abilities were more severely impaired in the patients suffering from PFS. Nevertheless, the same functional assessment on discharge did not reveal a significant difference between the two groups. Likewise, there were no intergroup differences in mortality or institutionalization on discharge from the ARD. Discussion/Conclusion The imperative development of a precise, consensual definition of PFS is now justified by the gravity of this syndrome and the potential for functional recovery. Continuation of this ongoing study may highlight prognostic factors associated with the status of patients with PFS 6 months after discharge from the ARD.

Fear of falling may be as debilitating as the fall itself, leading to a restriction in activities and even a loss of autonomy.ObjectivesThe main objective was to evaluate the prevalence of the fear of falling among elderly fallers. The secondary objectives were to determine the factors associated with the fear of falling and evaluate the impact of this fear on the activity “getting out of the house”.Patients and methodProspective study conducted between 1995 and 2006 in which fallers and patients at high risk for falling were seen at baseline by the multidisciplinary falls consultation team (including a geriatrician, a neurologist and a physical medicine and rehabilitation physician) and then, again 6 month later, by the same geriatrician. The fear of falling was evaluated with a yes/no question: “are you afraid of falling?”.ResultsOut of 635 patients with a mean age of 80.6 years, 502 patients (78%) expressed a fear of falling. Patients with fear of falling were not older than those who did not report this fear, but the former were mostly women (P

In elderly individuals balance disorders and muscle weakness can lead to prescribing a walker. There are several different models. According to the very poor effort tolerance in this population, the energy cost necessary to operate walking technical aids should be taken into account when making a choice.ObjectiveCompare two types of walker in regards to energy cost produced during gait in weakened elderly individuals.MethodThirty subjects over the age of 65 (six men and 24 women, mean age 81.9 years) were admitted in geriatrics care. They all required a walker and performed the same 10-m course with a fixed walker, then with a model bearing front wheels. The walking speed (S) was computed, heart rate at rest (HRrest) and maximum heart rate (HRmax) were recorded during the test. The physiological cost index (PCI=HRmax−HRrest/S) was calculated. Finally a timed get-up-and-go (TGUG) test was performed with each of these technical aids.ResultsWith a rollator walker, HRmax was lower (P

Summary Background Elderly patients with an acute coronary syndrome (ACS) are less likely to be enrolled into randomized, controlled trials or receive guideline-recommended therapies, because of a higher burden of comorbidity, including functional decline. Aim To assess the prognostic value of functional decline in a prospective, observational cohort of elderly ACS patients. Methods ACS patients aged ≥ 70 years were enrolled. The ACS definition included ST- and non-ST-segment elevation myocardial infarction, and unstable angina pectoris. Clinical admission and laboratory data and echocardiographic variables were recorded. Functional decline was defined as needing assisted care in daily life. The study endpoint was all-cause mortality. Results Overall, 151 patients were enrolled (mean age 78 ± 5 years; 52% men). Twenty-eight (19%) patients had functional decline. No significant difference in therapeutic management was observed between patients with functional decline and those living independently. Twenty-seven (18%) patients died during follow-up (median 447 days). Functional decline correlated with poor outcome ( p = 0.008; hazard ratio [HR] 2.87 [1.31–6.25]). Other prognostic markers were diabetes, Killip class ≥ II, elevated E/Ea ratio, C-reactive protein, B-type natriuretic peptide, haemoglobin, glycaemia and no coronary angiography. By multivariable analysis, C-reactive protein > 13 mg/L correlated with poor outcome ( p = 0.007; HR 4.77 [1.52–14.96]). There was a trend towards correlation between functional decline and poor outcome ( p = 0.051; HR = 2.77 [0.99–7.72]). Conclusion Functional decline seems to portend poor prognosis in elderly ACS patients. Larger, community-based studies are needed to confirm these findings in a multivariable model.

A core operational definition of active and healthy aging (AHA) is needed to conduct comparisons. A conceptual AHA framework proposed by the European Innovation Partnership on Active and Healthy Ageing Reference Site Network includes several items such as functioning (individual capability and underlying body systems), well-being, activities and participation, and diseases (including non-communicable diseases, frailty, mental and oral health disorders). The instruments proposed to assess the conceptual framework of AHA have common applicability and availability attributes. The approach includes core and optional domains/instruments depending on the needs and the questions. A major common domain is function, as measured by the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). WHODAS 2.0 can be used across all diseases and healthy individuals. It covers many of the AHA dimensions proposed by the Reference Site network. However, WHODAS 2.0 does not include all dimensions proposed for AHA assessment. The second common domain is health-related quality of life (HRQoL). A report of the AHA questionnaire in the form of a spider net has been proposed to facilitate usual comparisons across individuals and groups of interest. (C) 2015 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.

International audience; Acrylamide (AAM) has been recently discovered in food as a Maillard reaction product. AAM and glycidamide (GA), its metabolite, have been described as probably carcinogenic to humans. It is widely established that senescence and carcinogenicity are closely related. In vitro, endothelial aging is characterized by replicative senescence in which primary cells in culture lose their ability to divide. Our objective was to assess the effects of AAM and GA on human endothelial cell senescence. Human umbilical vein endothelial cells (HUVECs) cultured in vitro were used as model. HUVECs were cultured over 3 months with AAM or GA (1, 10 or 100 μM) until growth arrest. To analyze senescence, β-galactosidase activity and telomere length of HUVECs were measured by cytometry and semi-quantitative PCR, respectively. At all tested concentrations, AAM or GA reduced cell population doubling compared to the control condition (p < 0.001). β-galactosidase activity in endothelial cells was increased when exposed to AAM (≥10 μM) or GA (≥1 μM) (p < 0.05). AAM (≥10 μM) or GA (100 μM) accelerated telomere shortening in HUVECs (p < 0.05). In conclusion, in vitro chronic exposure to AAM or GA at low concentrations induces accelerated senescence. This result suggests that an exposure to AAM might contribute to endothelial aging.At all tested concentrations, AAM or GA reduced cell population doubling compared to the control condition (p < 0.001). β-galactosidase activity in endothelial cells was increased when exposed to AAM (≥10 μM) or GA (≥1 μM) (p < 0.05). AAM (≥10 μM) or GA (100 μM) accelerated telomere shortening in HUVECs (p < 0.05).In conclusion, in vitro chronic exposure to AAM or GA at low concentrations induces accelerated senescence. This result suggests that an exposure to AAM might contribute to endothelial aging.

Opinion/feedback Private practice-hospital patient pathways for elderly people with falls or at risk of falls: a study in Lille (northern France). About a third of the over-65 population will fall at least once a year. In France, falls are responsible for more than 9000 deaths among the over-65s and constitute a frequent reason for admission to long-stay care establishments [1] . Many different factors are involved in falls, which prompts the need for multidisciplinary assessments. For the last 15 years, Lille University Medical Centre (Lille, northern France) has been running multidisciplinary assessments at its day hospital for elderly people who have fallen or are at risk of falling. The patients’ medical, rehabilitational and retraining needs are identified during their admission to the day hospital. In 2013, the day hospital and the Lille urban area's existing private-practice care networks (e.g. physiotherapy) were completed by a number of innovative care systems: a care network for fall prevention and home-based rehabilitation (“ESPRAD Chute”), patient education workshops on falls, and a day hospital for follow-up care and geriatric retraining (“HDJ SSR Geriatrique”). The ESPRAD Chute network is based on nurse-led homecare and provides the patient with 15 home-based therapy sessions that complement surgery-based care. Patient education is based on 12 weekly sessions for elderly fallers. The HDJ SSR Geriatrie day hospital provides multidisciplinary rehabilitation for fallers or people at risk of falls and who require intensive rehabilitation and retraining. The interface between the day hospital and existing care structures enabled us to create private practice-hospital pathways for the multidisciplinary management of elderly people at risk of falls. We present our experience of these patient pathways and the associated care systems.

Drug-induced adverse effects are one of the main avoidable causes of hospitalization in older people. Numerous lists of potentially inappropriate medications for older people have been published, as national and international guidelines for appropriate prescribing in numerous diseases and for different age categories. The present review describes the general rules for an appropriate prescribing in older people and summarizes, for the main conditions encountered in older people, medications that are too often under-prescribed, the precautions of use of the main drugs that induce adverse effects, and drugs for which the benefit to risk ratio is unfavourable in older people. All these data are assembled in educational tables designed to be printed in a practical pocket format and used in daily practice by prescribers, whether physicians, surgeons or pharmacists., Les effets indésirables médicamenteux représentent l'une des principales causes évitables d'hospitalisation chez les sujets âgés. Un certain nombre de listes de médicaments potentielle-ment inappropriés chez les sujets âgés a été publié et il existe de nombreuses recommandations internationales pour le bon usage des médicaments par pathologie, et par tranche d'âge. La présente mise au point précise les règles générales de prescription des médicaments chez les sujets âgés et résume, pour les situations cliniques les plus fréquemment rencontrées, les médicaments sous-utilisés à tort et à recommander, les précautions d'emploi à observer pour réduire les effets secondaires des principaux médicaments pourvoyeurs d'effets indésirables et les médicaments dont le rapport bénéfice/risque est défavorable chez les sujets âgés. Ces recommandations sont synthétisées dans des tableaux didactiques conç us pour être imprimés dans un format de poche et être utilisés au quotidien par les prescripteurs quel que soit leur domaine d'activité, médicale, chirurgicale, ou pharmaceutique.

National audience; La présente revue de la littérature a pour objectif d'argumenter les nouvelles recommandations françaises publiées en 2012 retenant le risque de chute, évalué par l'antécédent de chute dans la dernière année, comme indication de la mesure de la densité minérale osseuse (DMO) par l'absorptiométrie biphotonique par rayons X (DXA). Cette recommandation repose sur le fait que premièrement, l'ostéoporose et le risque de chute représentent les deux premiers facteurs de risque de fracture non vertébrale après la ménopause. Deuxièmement, la mesure de la DMO par DXA apporte une information significative sur le risque de fracture, indépendamment du risque de chute. Ainsi, un sujet chuteur aura d'autant plus de risque de se fracturer qu'il aura une DMO basse. Troisièmement, les traitements anti-ostéoporotiques n'ont montré une efficacité anti-fracturaire qu'en cas d'ostéoporose ostéodensitométrique. Quatrièmement, la prévalence de l'ostéoporose est élevée chez les sujets chuteurs d'autant que ceux-ci sont fragiles [chutes répétées, sarcopénie (faible masse et force musculaire), réduction de mobilité, perte de poids, en particulier], ces facteurs étant des facteurs de risque communs d'ostéoporose et de chute. Cependant, l'indication de la DXA doit être nuancée chez les sujets chuteurs dont l'espérance de vie est limitée, les traitements n'ayant montré une efficacité anti-fracturaire qu'après 12 mois d'administration et en cas de faible accessibilité à la DXA (éloignement, patients dépendants, ayant une altération cognitive sévère par exemple). Des travaux sont souhaitables pour mieux définir comment intégrer le risque de chute et la fragilité dans l'évaluation du risque de fracture par la DMO et le score FRAX®

Functional alterations of barium-sensitive potassium inward rectifier (Kir) current, which is involved in the vasodilation of middle cerebral arteries (MCA) in rat brain, have been described during brain ischemiaireperfusion (I/R). The authors investigate the effects of I/R on Kir current recorded in isolated myocytes from MCA of control rats and from contralateral and ipsilateral MCA of ischemic rats by the whole-cell patch-clamp technique, and the relationship between its alteration and The severity of brain injury. The vascular smooth muscle cells exhibited similar morphologic features in all conditions, and the Kir was present in the three groups of myocytes, exhibiting a characteristic inward rectification and a normal external potassium dependence. The Kir density was significantly reduced in cell of MCA ipsilateral to occlusion with a maximum at −135 mV, whereas there was no difference between control and contralateral cells. This alteration in Kir density in occluded MCA was significantly correlated with severity of brain injury and brain edema. These results suggest that the alteration of Kir density in MCA myocytes after I/R and the consecutive impaired dilation of MCA may contribute to aggravation of the brain injury.

Cisapride, a gastrointestinal prokinetic agent, has been associated with cases of Torsades de Pointes but its effects on the cardiac action potential have not been described. We investigated its electrophysiological effects on rabbit isolated Purkinje fibres. The results demonstrated that cisapride (0.01-10 microM) lengthened concentration-dependently the action potential duration without modifying other parameters and induced early after depolarizations and subsequent triggered activity. This typical class III antiarrhythmic effect, that showed "reverse" rate-dependence and was reduced by increasing external K concentration, can account for clinical arrhythmogenesis.

BACKGROUND Postprandial hypotension (PPH) is increasingly recognized as a common cause of falls and syncope in elderly persons. Noninvasive ambulatory blood pressure monitoring (ABPM) has been recommended for detecting PPH. This study investigates postprandial blood pressure (BP) changes by means of ABPM in elderly patients experiencing falls or syncopes. METHODS Twenty-four-hour ABPM was performed in 156 inpatients (111 women, mean age 80.4 +/- 8.1 years). Among them, 45 had been admitted for falls and 75 for syncope; 36 with no history of falls or syncope served as controls. Postprandial change in systolic blood pressure (deltaSBP) was calculated by subtracting the mean SBP within the 2 hours following the meal from the mean SBP within the 2 hours preceding the meal. PPH was defined by a deltaSBP > or = 20 mm Hg. RESULTS For the entire group, mean SBP decreased after the three meals. On average, the decline in SBP was greater after breakfast than after lunch or dinner, and the number of patients experiencing PPH was greater after breakfast. Average maximal deltaSBP was significantly larger in the syncope group than in the other groups ( p < .05). Moreover, the number of patients experiencing PPH was significantly higher in the syncope/fall group than in the control group (23% vs 9%; p = .03). Compared with patients without PPH, patients with PPH were more likely to have a history of diabetes mellitus (p < .01) or to use more than three different drugs daily ( p = .04), and they showed greater daytime SBP variability (p < .0001). Furthermore, there was a strong positive correlation between preprandial SBP and deltaSBP after breakfast. CONCLUSIONS About one out of four elderly patients with falls or syncope experiences PPH, usually after breakfast. Postprandial decline in BP contributes to BP variability. deltaSBP and preprandial SBP are positively correlated.

Context: optimising care pathways for the elderly is a major challenge in view of the ageing population. The acute geriatric unit (AGU) is a "pivotal" hospital care unit in the care pathway of the elderly.Objectives: to identify the risk factors for transfer to follow-up care and rehabilitation upon admission to the AGU, to describe the association between end-of-life trajectories and transition to exclusive comfort care for patients who die in the AGU, to develop and validate a prognostic score for individual and collective risk of mortality in the medium and long term (3 and 12 months respectively) after discharge from the AGU.Method: we conducted a series of analyses on data from the DAMAGE cohort. The DAMAGE cohort is a prospective multicentre study that consecutively included 3509 subjects aged 75 years or more hospitalised in the AGU. These patients underwent a broad comprehensive geriatric assessment during their stay and a description of their care pathway was collected.Results: 1928 patients were included for the search of risk factors for transfer to post-acute hospital care facility. Significant loss of functional independence, high ADL score at home, low ADL score at admission, living alone, social isolation and delirium were risk factors for transfer to post-acute hospital care facility. Obesity, high serum albumin and community infection were associated with return home.123 (69.5%) decedents received comfort care only. The frailty-related end-of-life trajectory (with or without dementia) accounted for almost 70% of deaths. Frailty in the absence of established dementia was not associated with a more frequent transition to comfort care only (odds ratio [95% CI]: 1.44 [0.44- 4.76]).3112 frail or dependent elderly patients with a high proportion of deaths at 3 months (n=455, 14.8%) and 12 months (n=1014, 33%) were included for the mortality score. The score predicted an individual risk of mortality of between 1% and 80% at 3 months and between 5% and 93% at 12 months, with a C-statistic in the validation cohort of 0.728 at 3 months and 0.733 at 12 months.Conclusion: This series of analyses allows us to better describe and identify certain risk factors useful for optimising and planning the care pathway of elderly patients in the UGA and beyond their stay in the UGA., Contexte : l'optimisation des parcours de soins des personnes âgées est un défi majeur au vu du vieillissement de la population. L'unité de gériatrie aiguë (UGA) est une unité de soins hospitaliers « pivot » dans le parcours de soins des personnes âgées.Objectifs : identifier les facteurs de risque (FDR) de transfert en soins de suite et réadaptation (SSR) dès l'admission en UGA, décrire l'association entre trajectoires de fin de vie et transition en soins de confort exclusifs pour les patients décédés en UGA, développer et valider un score pronostique du risque individuel et du risque collectif de mortalité à moyen et long terme (respectivement 3 et 12 mois) après la sortie de l'UGA.Méthode: nous avons conduit une série d'analyses sur les données de la cohorte DAMAGE. La cohorte DAMAGE est une étude prospective multicentrique qui a inclus consécutivement 3509 sujets âgés de 75 ans ou plus hospitalisés en UGA. Ces patients ont bénéficié d'une large évaluation gériatrique standardisée au cours de leur séjour et la description de leur parcours de soins a été recueillie.Résultats : 1928 patients ont été inclus pour la recherche de FDR de transfert en SSR. Une perte d'indépendance fonctionnelle importante, un score ADL élevée à domicile, un score ADL bas à l'admission, vivre seul, d'être isolé socialement et le syndrome confusionnel étaient des FDR de transfert vers le SSR. L'obésité, un taux sérique d'albumine élevé et une infection communautaire étaient associés au retour au domicile. 123 (69,5%) décédés ont bénéficié de soins de confort exclusifs. La trajectoire de fin de vie liée à la fragilité (avec ou sans troubles neurocognitifs majeurs (TNCM)) représentait près de 70% des décès. La fragilité en l'absence de TNCM établis n'était pas associée à une transition plus fréquente vers les soins de confort exclusifs (odds ratio [IC 95%] : 1,44 [0,44- 4,76]). 3112 patients âgés et fragiles ou dépendants, avec une forte proportion de décès à 3 mois (n=455, 14,8%) et à 12 mois (n=1014, 33%) ont été inclus pour la réalisation du score de mortalité. Le score prédit un risque individuel de mortalité compris entre 1% et 80% à 3 mois et entre 5% et 93% à 12 mois, avec une statistique C dans la cohorte de validation de 0,728 à 3 mois et 0,733 à 12 mois.Conclusion : cette série d'analyses permet de mieux décrire et identifier certains FDR utiles pour l'optimisation et la planification du parcours de soins des patients âgés en UGA et au-delà de leur séjour en UGA.

Age-associated or diabetes arterial changes such as endothelial dysfunction are involved in the significantly increased risk of cardiovascular complications. The presence of endothelial dysfunction in the coronary or peripheral circulation has been shown to constitute a risk factor for cardiovascular events independent of the development of atherosclerosis or other vascular risk factors. Therapeutic approaches capable of preventing or reversing age-related endothelial dysfunction may thus help to reduce cardiovascular risk. The aim of the study was to determine the effects of two treatments, one on age-related endothelial dysfunction, the other on diabetes endothelial dysfunction. For primary and secondary prevention, aspirin can reduce the incidence of cardiovascular events. The first part of the present work evaluated the effect of low-dose aspirin on age-related endothelial dysfunction in C57B/J6 aging mice. Age-related endothelial dysfunction was assessed by the response to acetylcholine (ACh) of phenylephrine (Phe)-induced precontracted aortic segments isolated from 12-, 36-, 60- and 84-week-old mice. The effect of low-dose aspirin was examined in mice presenting a decrease in endothelial-dependent relaxation. The effects of age and aspirin treatment on structural changes were determined in mouse aortic sections. The effect of aspirin on the oxidative stress markers malondialdehyde (MDA) and 8-hydroxy-2'-deoxyguanosine (8-OhdG) was in addition quantified. Compared to that of 12-week-old mice, the EDR was significantly reduced in 60- and 84-week-old mice (p, Les modifications artérielles liés au vieillissement ou au diabète telles que la dysfonction endothéliale contribuent à augmenter le risque de survenue d'événements cardiovasculaires. La dysfonction endothéliale, coronaire ou périphérique, est reconnue comme un facteur indépendant de survenue d'évènements cardiovasculaires indépendamment de la présence d'athérosclérose ou de facteur de risque d'athérosclérose. Des approches thérapeutiques capables de prévenir ou de restaurer la dysfonction endothéliale pourrait aider à réduire le risque de survenue d'accidents cardiovasculaires. Ce travail a pour but d'évaluer les effets de deux molécules, l'une sur la dysfonction endothéliale liée à l'âge, l'autre sur la dysfonction liée au diabète. En prévention primaire et secondaire, l'aspirine à faible dose réduit l'incidence des évènements cardiovasculaires. La première partie de ce travail étudie les effets de l'aspirine à faible dose sur la dysfonction endothéliale chez des souris C57B/J6. La dysfonction endothéliale liée à l'âge est établie par la réponse à l'acétylcholine (ACh) de segments aortiques précontractés par phenylephrine (Phe) et isolés de souris âgées de 12-, 36-, 60- et 84 semaines. Les effets de l'aspirine à faible dose sont étudiés chez des souris présentant une altération de la relaxation endothélium-dépendante. Les effets de l'âge et du traitement par aspirine sur la structure de la paroi ont été déterminés sur des coupes aortiques de souris. Les effets de l'aspirine sur des marqueurs du stress oxydants, le malondialdehyde (MDA) et l'8-hydroxy-2'-deoxyguanosine (8-OhdG) ont été étudiés. Comparée à celle des souris âgées de 12 semaines, la relaxation endothelium-dépendante était significativement réduite chez les souris âgées de 60- et 84-semaines (p