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Bonin-Guillaume S.,Service de Medecine Interne Geriatrie | Bonin-Guillaume S.,Aix - Marseille University | Durand A.-C.,Aix - Marseille University | Yahi F.,Aix - Marseille University | And 6 more authors.
Aging Clinical and Experimental Research | Year: 2015

Background and aims: For older adults, an Emergency Department (ED) visit represents a period of vulnerability that extends beyond the visit itself. This study aimed to determine the impact of the role of caregiver, and geriatric conditions of patients on early unplanned rehospitalization (EUR) within 3 months after an ED visit. Methods: This prospective longitudinal experimental study included consecutively 173 patients aged 75 and older admitted in an ED over a 2-week period (18.7 % of the total visits). Only older patients having a caregiver were analyzed (78.0 %, n = 135). Medical conditions and a comprehensive geriatric assessment were recorded for each patient. All caregivers were interviewed about their tasks and emotional impact using the short Zarit Burden Inventory. Three months after, patients or their caregivers were called about the vital status, and EUR of patients. Results: Among the patients included, 64.2 % had an EUR and 28.9 % of their caregivers reported a high level of burden. EUR was strongly associated with a high caregiver burden (OR 8.7, 95 % CI 1.5–49.8). No association was found for patient’s medical or geriatric status. Caregivers reported a significantly high burden when patients were malnourished, or were at risk of adverse health outcomes based on the ISAR scale, and when they had greater disabilities in IADLs and ADLs, or cognitive impairments. Conclusions: Many hospital readmissions after an ED visit may be preventable by identifying caregiver’s high burden. Reasons that lead to this high burden should be checked at the first visit. © 2015, Springer International Publishing Switzerland.

Pham C.-T.,Laboratoire Of Neuropathologie Raymond Escourolle | de Silva R.,University College London | Haik S.,Laboratoire Of Neuropathologie Raymond Escourolle | Verny M.,University Pierre and Marie Curie | And 6 more authors.
Neurobiology of Aging | Year: 2011

The influence of age on the prevalence of argyrophilic grain disease has been analyzed in the hippocampus from 29 centenarians. Argyrophilic grains were detected in 12 cases with Gallyas silver method, in 24 cases with anti-exon 10 (RD4) immunohistochemistry, in all the cases with a phospho-independent anti-tau (piTau) antibody and with a monoclonal antibody against Ser202 of the tau protein (AT8), suggesting a maturation of the grains. Ballooned neurons were found in the hippocampus of 12 cases in which grains were, on average, more abundant. Coiled bodies were found in 26, 15 and 13 cases respectively with piTau antibody, RD4 and Gallyas method. Cases with coiled bodies had a higher density of grains. The mean density of grains did not differ in the patients with or without dementia. The prevalence of tau-positive grains has been underestimated in the very old population. As neurofibrillary tangles, they appear to be a constant accompaniment of age but, contrarily to neurofibrillary tangles, do not seem to be strongly associated with dementia. © 2009 Elsevier Inc.

Matheron E.,University of Burgundy | Dubost V.,Service de Medecine Interne Geriatrie | Mourey F.,University of Burgundy | Pfitzenmeyer P.,University of Burgundy | Manckoundia P.,University of Burgundy
Archives of Gerontology and Geriatrics | Year: 2010

PDS is a geriatric affliction, described in 1999, characterized by postural impairments, including backward disequilibrium, freezing, a deterioration in the ability to anticipate postural adjustments, anxiety and fear of falling, inducing loss of autonomy. This study compared 10 subjects suffering from PDS, aged 87.3±4.9 years, with 10 control subjects, aged 85.4±7.9 years concerning postural control (body sway amplitude). In all participants, postural control was assessed using the SwayStar™ system in natural (spontaneous) and standardized stances, eyes open and eyes closed over a period of 40s. It was found that: (1) with eyes open, subjects with PDS showed greater body sway amplitude than did controls whatever the position (natural or standardized) and the plane (sagittal or frontal) considered (F1,16=6.05; p=0.026), (2) with eyes closed, subjects with PDS showed greater body sway amplitude than did controls in the natural stance whatever the plane (F1,18=7.65; p=0.013). In conclusion, PDS has a negative effect on postural control. This data must be taken into account during the rehabilitation of patients with this syndrome. © 2009 Elsevier Ireland Ltd.

Manckoundia P.,Service de Medecine Interne Geriatrie | Manckoundia P.,University of Burgundy | Lorenzini M.,Service de Medecine Interne Geriatrie | Disson-Dautriche A.,Center Regional Of Pharmacovigilance | And 6 more authors.
Archives of Gerontology and Geriatrics | Year: 2012

Only few studies have investigated the use of HA in elderly subjects and there are no data in very elderly subjects. We assessed the prescription of HA and analyzed the relationship between such prescriptions and frailty markers among persons aged 80 and more in an observational study. We recorded the prescriptions for 13,211 patients aged 80-109 years and affiliated to the " Mutualité-Sociale-Agricole (MSA)" of Burgundy over a 1-month period. The prescription of a HA among all included patients, and the existence of serious long-term disease(s) (LTD), polypharmacy or a prescription of cardiovascular drugs among patients receiving a HA were recorder. Among the 13,211 patients, 3412 aged 80-98 years were treated with an HA. The main HA were statins (70.4%), and fibrates were used in 27.3% of cases. Of these 3412 patients, 2250 had one or several LTD mainly coronaropathy, hypertension, diabetes mellitus or peripheral artery disease. The mean number of drugs per prescription was 6.37. Among subjects treated with HA, 40% also received antiplatelets, 35.6% β-blockers and 30% inhibitors of the renin-angiotensin system. For 99% of the patients, the prescription of HA was a renewal. Prescribers were mainly general practitioners (96.8%). Statins are the most widely prescribed HA even among very elderly subjects. However, after 80 years the prescription of HA, mainly statins, decreases with aging. This could be explained by polypathology, polypharmacy and the deterioration in metabolic functions which are markers of frailty. This study should encourage research into the use of statins in very elderly subjects. © 2011 Elsevier Ireland Ltd.

Gauthier J.,Service de Medecine Interne Geriatrie | Kisterman J.P.,Center hospitalier les Chanaux | Chapalain F.,Center hospitalier les Chanaux | Texier A.,Center hospitalier les Chanaux | And 2 more authors.
Revue de Medecine Interne | Year: 2015

Introduction: Given the implications of rehospitalization at the individual and societal level, it seems important to identify elderly persons (EP) at risk. We analyzed the predictive factors of early rehospitalization in EP aged 75 years or more hospitalized in a medicine department. Methods: A single-center retrospective study that included EP aged 75 years or more hospitalized in a polyvalent medical department following an emergency admission. Patients who died during the hospitalization, who had been transferred or hospitalized during the previous month, were excluded. The impact of sociodemographic, administrative and biomedical data on rehospitalization at one month was analyzed. Results: A total of 319 hospitalizations were collected (mean age of patients: 84.7. ±. 5.7 years). Most lived at home (80.2%) and among these 8.4% had no home help. The rehospitalization rate was 16.3%, among which 2/3 were related to the reason for the initial hospitalization. Among the predictive factors found in the univariate analysis (male sex, multiple diseases, polypharmacy, multiple hospitalizations, cognitive disorders and calls to emergency services), only the presence of at least two previous hospitalizations in the year (odds ratio [OR] = 2.10; 95% confidence interval [95%CI] [1.01-4.39]; P = 0.048) and the presence of confusion without dementia (OR = 3.78; IC 95% [1.09-13.06]; P = 0.04) were significant. Discharge to a rehabilitation unit and increased support at home did not affect the likelihood of rehospitalization. Conclusion: The rehospitalization of EP is frequent and difficult to anticipate because there are few predictors and their impact is weak. The most important factors were medical: multiple hospitalizations and confusion without dementia. © 2015 Société nationale française de médecine interne (SNFMI).

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