Service de medecine geriatrique

Paris, France

Service de medecine geriatrique

Paris, France

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PubMed | University Claude Bernard Lyon 1, Service de medecine geriatrique and Nantes University Hospital Center
Type: Journal Article | Journal: Geriatrie et psychologie neuropsychiatrie du vieillissement | Year: 2016

The loss autonomy in the aging population is a major public health issue. Mobility impairment, which precedes loss of autonomy, could yet be accessible to multi-modal and personalised programs to enhance balance and physical performances, and avoid loss of autonomy. Moreover, such preventive programs are likely to be more effective when the patients are taken in charge before presenting with difficulties in daily living. The aging demographics and the consequences of the loss of autonomy clearly indicate a need for better addressing these patients with lowering mobility, even though they will mostly have subtle symptoms and no spontaneous complaints. This could be achieved by improving the screening of mobility impairment and the development of specific personalised preventive programs in primary care. In this brief narrative review, we aimed to summarise the current body of knowledge on mobility impairment prevention in the elderly, and open the field for future research in primary care.


Cudennec T.,Service de Medecine Geriatrique | Gendry T.,Service de Pneumologie | Labrune S.,Service de Pneumologie | Giraud V.,Service de Pneumologie | And 3 more authors.
Lung Cancer | Year: 2010

Management of elderly patients with bronchial cancer should take into account specific factors linked to the patient's age, and the presence of co-morbidities. A geriatric evaluation enables us to use relevant information in the therapeutic decision-making process. However, the Comprehensive Geriatric Assessment described in the literature is tedious and time-consuming. We describe the use of a simplified geriatric evaluation (SGE), in 57 patients aged ≥75 years (mean age: 80.8 years) with thoracic cancer, before discussing therapeutic options with colleagues from various departments. This evaluation enabled us to classify the patients into four groups: group 1 consisted of patients in a good general state; group 2+ comprised patients with no more than two stabilized co-morbidities or one poorly or non-stabilized co-morbidity; group 2- comprised patients with more than two stabilized co-morbidities, or at least two poorly or non-stabilized co-morbidities; group 3 consisted of frail patients. The three patients in group 1 did not have any negative factors that could complicate their management and therefore received anti-tumor therapy. The 15 patients in group 3 were considered to have co-morbidities or functional alterations that were too advanced for them to benefit from anti-tumor therapy, and received symptomatic treatment only. Among the 39 patients in the intermediary groups 2+ and 2-, 24 underwent surgery, chemotherapy or radiotherapy (21 (87.5%) patients in group 2+ and 3 (20.0%) patients in group 2-). These data suggest that the SGE is an important aid to decision-making in the management of elderly patients with bronchial cancer. © 2009 Elsevier Ireland Ltd. All rights reserved.


Ricanet-Delannoy A.,Service de Soins de Suite et Readaptation Geriatrique | Kim B.-A.,Service de Medecine Geriatrique | Comte B.,Service de Geriatrie
Revue de Geriatrie | Year: 2013

Myasthenia Gravis (MG) is an uncommon autoimmune disease, usually described in young adults. However it may occur in older patients. We report the case of a 74 years-old female who developed myasthenia during rehabilitation after orthopedic surgery. Clinical symptoms can be nonspecific as reported in this case. In the geriatric population, MG diagnosis can be difficult and the symptoms related either to other comorbidities or other diagnosis. Clinicians may keep this diagnosis in mind because MG may have severe consequences on functional status and lead to severe dependence in geriatric patients. Efficient treatments can reduce symptoms and allow functional rehabilitation.


Gleize F.,Service de Medecine Geriatrique | Zmudka J.,Service de Medecine Geriatrique | Lefresne Y.,Service de Medecine Geriatrique | Delforge C.,Medecin Generaliste | And 3 more authors.
Revue de Geriatrie | Year: 2014

Introduction: Frailty is a geriatric syndrome, characterizes by a dynamic process of increasing vulnerability favoured by age. Frailty is associated with high risk for falls, disability, hospitalization, and mortality. Purpose: To compare the objective assessment of the frailty to Fried's criteria with subjective assessment perceived by the physician and the patient to identify a screening tool easier. Methods: A descriptive prospective study in patients over 75 years coming consult three general practitioners, during 1 year. Frailty was defined by the presence of three criteria including weight loss, weakness (grip strength), self-reported exhaustion, low physical activity and slow walking speed. Present one or two criteria defined pre-frail patients. The physician and the patient were asked to estimate the frailty by numerical scale from 0 to 10. Patients were considered as pre-frail, subjectively, for a score of 5 or 6, and frailty for a score ≥ 7. Results: 64 patients were included (38 women and 26 men) aged 81.2 ± 5.0 years. To Fried's criteria, 10 (15.6%) were frail and 34 (53.1%) were pre-frail. Subjectively, 20 were considered frail and 25 as pre-frail to the patient against 22 and 24 for the physician. Only 2 patients were considered frail to the patient, to the physician and to Fried's criteria. Subjective fatigue of the patient was the most correlated criterion (p=0.0313). Conclusion: Fried tool is difficult to implement in primary care. Subjective fatigue of the patient seems to constitute an interesting approach for simple screening tool in general practice to allow early treatment and delay progression to dependence. © La Revue de Gériatrie, Tome 39, N°3 MARS 2014.


Onen F.,Service de medecine geriatrique | Onen S.-H.,Unite geriatrique devaluation et de traitement des troubles du sommeil
NPG Neurologie - Psychiatrie - Geriatrie | Year: 2010

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent condition in older adults. Despite its high prevalence, OSAS is significantly under diagnosed and under treated in this population. Several factors underlie the lack of recognition of OSAS in older adults. One important factor may be the atypical clinical presentation of the disorder. Age-related physiological changes, multiple comorbidities with possible disease - disease interactions, and the effects of multiple medication may be responsible for atypical manifestations of OSAS. Older individuals with sleep apnea are often unaware of the nighttime symptoms of this condition and rarely complain of daytime sleepiness. However, falls, cognitive impairment, stroke, glaucoma, and impaired quality of life are unspecific but frequently associated conditions in the elderly with OSAS. Definitive diagnosis depends on polysomnography (PSG), usually requiring costly overnight laboratory testing. In addition, PSG is inconvenient for some elderly patients with multiple comorbid conditions. A simple bedside test, the Observation-based Nocturnal Sleep Inventory (ONSI), is useful to screen sleep apnea in the elderly. The ONSI may be practical in situations in which PSG is initially impractical or in populations with comorbidities to help define further diagnostic and treatment options. Tolerance to continuous positive air pressure in elderly symptomatic OSAS patients is similar to that of younger patients. Elderly patients with untreated OSAS have high healthcare utilization because of cardiovascular disease morbidity and use of cardiovascular and psychotropic medication. © 2010.


Onen S.H.,Unite geriatrique devaluation et de traitement des troubles du sommeil | Onen F.,Service de medecine geriatrique
NPG Neurologie - Psychiatrie - Geriatrie | Year: 2010

Frequently, patients with Alzheimer's disease spend their nights in a state of restlessness and their days in a state of sleepiness. Sometimes these patients present delayed sleep phase pattern characterized by an inability to fall asleep at a desired conventional time together with an inability to awaken at a desired and socially acceptable time (they tend to fall asleep some hours after midnight and have difficulty waking up in the morning). These sleep-wake disturbances became increasingly more marked with the progression of the disease. The sleep-wake disturbances in elderly people and particularly in patients with Alzheimer's disease may result from changes at different levels: a reduction of environmental synchronizers or their perception, a lack of mental and physical activity, an age or disease related anatomical change with loss of functionality of the biological clock. In Alzheimer's disease patients, controlling sleep-wake disturbances with sedative drugs often increases both sleep disturbance and cognitive dysfunction. A chronobiological approach with bright-light therapy, melatonin administration, and sleep hygiene may be an interesting therapeutic alternative in the management of sleep-wake disorders in Alzheimer patients. The aim of these therapeutics is to improve sleep and diurnal activity, and consequently to increase the quality of life in patients with Alzheimer's disease and their caregivers. © 2009 Elsevier Masson SAS. All rights reserved.


PubMed | Service de medecine geriatrique
Type: | Journal: Soins. Gerontologie | Year: 2015

As hospitals visiting times are extended, patients families and friends are granted an ever more important place. The nursing team of an acute geriatrics unit open 24/7 examined the place and the role of patients families and friends and their involvement in care.


De Malherbe A.,Service de Medecine Geriatrique | Moulias S.,Service de Medecine Geriatrique | Cudennec T.,Service de Medecine Geriatrique | Teillet L.,Service de Medecine Geriatrique
Soins Gerontologie | Year: 2015

As hospitals' visiting times are extended, patients' families and friends are granted an ever more important place. The nursing team of an acute geriatrics unit open 24/7 examined the place and the role of patients' families and friends and their involvement in care. © 2015 Elsevier Masson SAS. All rights reserved.


PubMed | Service de medecine geriatrique
Type: Journal Article | Journal: Geriatrie et psychologie neuropsychiatrie du vieillissement | Year: 2013

In France, only a third of demented patients have an established diagnostic of dementia. Hospitalization is often an opportunity to perform a diagnostic of dementia. Real benefits for patients of such a diagnostic process are unknown. The objective of the study was to observe prognosis of elderly patients hospitalized in geriatric courses in terms of mortality, hospitalization rate and entry into an institution. This was a monocentric prospective study with a one-year follow-up of 90 patients hospitalized in an acute geriatric ward with either dementia known by general practitioner, either diagnosed during the hospitalization according to DSM IV criteria. A one year follow-up by phone has been conducted. From a consecutive set of 159 inpatients for 18 weeks, we included in this study 49 patients with a known dementia (group 1, mean age 85.74.6 years, mean Mini-mental state examination (MMSE) score 12.46.2) and 41 patients with dementia diagnosed during hospitalization (group 2, mean age 88.46.4 years, mean MMSE score 16.16.5). Differences between the two groups were significant for age (p<0.03) and MMSE score (p<0.02). One-year mortality rate was near 30% in the 2 groups. Rate of institutionalization was 33% in group 1 and 49% in group 2 (not statistically significant). There was a significant difference in number of days spent at home between group 1 and group 2, respectively 190.9159.9 days vs 111.1148.1 days (p<0.03). Demented patients previously diagnosed lived longer at home at one year than patients newly diagnosed. These results tend to support the diagnosis of dementia in very elderly patients with multiple comorbidities. Conditions of living at home, in particular the quality of life, should be the object of further studies.


PubMed | Center hospitalier Saint Quentin, Service de medecine geriatrique and Center hospitalier Beauvais
Type: Journal Article | Journal: Geriatrie et psychologie neuropsychiatrie du vieillissement | Year: 2015

Frailty is a geriatric syndrome associated with high risk for falls, disability, hospitalization, and mortality. The aim of this study is to assess the prevalence of frailty to the Frieds criteria in primary care and its evolution and the outcome of the patients at 1 year. Descriptive prospective study of patients over 75 years coming consult three general practitioners, evaluated initially and at 1 year. Frailty was defined by the presence of three criteria including weight loss, weakness (grip strength), self-reported exhaustion, low physical activity and slow walking speed. Of the 55 patients re-evaluated, 10.9% of patients were frail, 56.4% pre-frail and 32.7% were robust. Robust who become frail during the initial assessment, had a lower IADL score (p = 0.004) and a lower grip strength (p = 0.0311) than those who remained robust. Fried tool is difficult to implement in primary care. Grip strength and IADL are interesting for a simple screening tool in general practice to allow early treatment and delay progression to addiction.

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