Publications by authors named "Régis Gonthier"

45 Publications

Impact of Geriatric Hotlines on Health Care Pathways and Health Status in Patients Aged 75 Years and Older: Protocol for a French Multicenter Observational Study.

JMIR Res Protoc 2020 Feb 13;9(2):e15423. Epub 2020 Feb 13.

Department of Clinical Gerontology, University Hospital of Saint-Etienne, Saint Etienne, France.

Background: In France, emergency departments (EDs) are the fastest and most common means for general practitioners (GPs) to cope with the complex issues presented by elderly patients with multiple conditions. EDs are overburdened, and studies show that being treated in EDs can have a damaging effect on the health of elderly patients. Outpatient care or planned hospitalizations are possible solutions if appropriate geriatric medical advice is provided. In 2013, France's regional health authorities proposed creating direct telephone helplines, "geriatric hotlines," staffed by geriatric specialists to encourage interactions between GP clinics and hospitals. These hotlines are designed to improve health care pathways and the health status of the elderly.

Objective: This study aims to describe the health care pathways and health status of patients aged 75 years and older hospitalized in short-stay geriatric wards following referral from a geriatric hotline.

Methods: The study will be conducted over 24 months in seven French university hospital centers. It will include all patients aged 75 and older, living in their own homes or nursing homes, who are admitted to short-stay geriatric wards following hotline consultation. Two questionnaires will be filled out by medical staff at specific time points: (1) after conducting the telephone consultation and (2) on admitting the patient to a short-stay geriatric medical care. The primary endpoint will be mean hospitalization duration. The secondary endpoints will be intrahospital mortality rate, the characteristics of patients admitted via the hotline, and the types of questions asked and responses given via the hotline.

Results: The study was funded by the National School for Social Security Loire department (École Nationale Supérieure de Sécurité Sociale) and the Conference for funders of prevention of autonomy loss for the elderly of the Loire department in November 2017. Institutional review board approval was obtained in April 2018. Data collection started in May 2018; the planned end date for data collection is May 2020. Data analysis will take place in the summer of 2020, and the first results are expected to be published in late 2020.

Conclusions: The results will reveal whether geriatric hotlines provide the most effective management of elderly patients, as indicated by shorter mean hospitalization durations. Shorter hospital durations could lead to a reduced risk of complications-geriatric syndromes-and the domino chain of geriatric conditions that follow. We will also describe different geriatric hotlines from different cities and compare how they function to improve the health care of the elderly and pave the way toward new advances, especially in the organization of the care path.

Trial Registration: ClinicalTrials.gov NCT03959475; https://clinicaltrials.gov/ct2/show/NCT03959475.

International Registered Report Identifier (irrid): DERR1-10.2196/15423.
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http://dx.doi.org/10.2196/15423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055780PMC
February 2020

[Socio-economic vulnerability, support and hospitalisation plan in people aged over 75].

Soins Gerontol 2019 Jul - Aug;24(138):32-38

Département de gérontologie clinique, université Jean-Monnet, faculté de médecine Jacques-Lisfranc, CHU de Saint-Étienne, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France. Electronic address:

The return home after a period in hospital is a high-risk situation for an elderly person. Services exist to facilitate the hospital-home transition but are sometimes not used. Few studies suggest that socio-economic vulnerability is an important factor in a successful return home. One study shows that this relationship is vague and disputed. In fact, compliance with a support plan, recommended when a patient returns home, is multifactorial and does not seem to depend on the existence or otherwise of socio-economic vulnerability.
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http://dx.doi.org/10.1016/j.sger.2019.04.012DOI Listing
July 2019

[Interest of follow-up of recommendations over a period of 6 months for elderly subjects who have been screened for frailty].

Geriatr Psychol Neuropsychiatr Vieil 2019 06;17(2):145-152

Département de gérontologie clinique, Hôpital de la Charité, Saint-Étienne, France, Gérontopôle Auvergne Rhône-Alpes, Saint-Etienne, France.

Frailty is a partially reversible geriatric syndrome. Its prevention requires a structured screening, and is a major public health issue given the increasing life expectancy of the population. The observance of the recommendations made after a screening of the frailty patients is not well known. The objective of our research was to describe the characteristics of patients evaluated in a frailty-day-hospital and followed up recommendation adherence at 3 and 6 months.

Methods: patients aged over 65 years old with an ADL score of at least 5 out of 6, were evaluated according to the Fried score to classify patients into pre-frailty or frailty patients. According to the standardized geriatric assessment, recommendations were prescribed for each medico-social situation according to HAS recommendations. A follow-up assessment of these measures was carried out at home basis at 3 and 6 months.

Results: 82 patients were included, with mean age of 83.7±5.7 years. 99% were pre-frail or frail and received an average of 3.7±1.7 recommendations. At 3 months, there is an inverse correlation between number and follow-up compliance (r=-0.340, p=0.008), as well as at 6 months (r=-0.352, p=0.006). Between 3 and 6 months, there is a significant increase recommendation number followed (r=0.707, p=0.000).

Conclusion: at 6 months, 74.3% recommendations were realized, with a significant increase of recommendation number between the 3rd and 6th month. This result is encouraging by showing the benefit of home support in recommendations follow-up.
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http://dx.doi.org/10.1684/pnv.2018.0773DOI Listing
June 2019

Comparison of two hospitalization modes in geriatrics either directly via a hotline or after an emergency unit admission.

Geriatr Psychol Neuropsychiatr Vieil 2018 Sep;16(3):255-262

Département de gérontologie clinique, Service de gérontologie clinique, Hôpital la charité, CHU Saint-Etienne, France.

Hospitalizations via the emergency services of the elderly represent on average 41% of the stays. The family physician is aware of the deleterious effects of using emergency rooms and know that intensive use contributes to the disorganization of these services. The provision of a telephone line, enabling doctors to have direct access to a geriatrician doctor, is a new service allowing, if necessary, direct hospitalization in geriatrics but its interest is still poorly evaluated.

Methods: From June 1st, 2015, to June 1st, 2016, we compared the route of care for inpatients directly in short stays of geriatrics thanks to the hotline (group hotline) versus the route of those passed by emergencies (group EU, emergency unit).

Results: 520 patients were included in the study. The duration of stay was shorter during hospitalization via the hotline, 11.6 [95% CI, 10.8-12.3] days in a direct hospitalization versus 14.1 [95% CI, 13.5-14.7] days of a passage through emergencies (p <0.05). Patients who were admitted to the emergency room were more likely to be hospitalized again. Among the 170 patients re-hospitalized, an average duration before re-hospitalization of 29.5 [CI 95%, 23.6-35.4] days was observed in patients hospitalised via the hotline, while those entered by emergencies were hospitalized in 24.1 [95% CI, 20.4-27.8] days (p <0.05).

Conclusion: This analysis suggests that the intra-hospital course of geriatric patients directly addressed in short stays of geriatrics by direct admission was shorter and more efficient than the course of an intermediate stage in the emergencies. It seems important to discuss the generalization of the hotline device for the functioning of the geriatric pathway.
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http://dx.doi.org/10.1684/pnv.2018.0743DOI Listing
September 2018

Predictive performance of four frailty screening tools in community-dwelling elderly.

BMC Geriatr 2017 11 10;17(1):262. Epub 2017 Nov 10.

Département de Gérontologie Clinique, CHU de Saint Etienne, Hôpital de la Charité, 44 rue Pointe Cadet, 42000, Saint-Etienne, France.

Background: This study compares the performance of four frailty screening tools in predicting relevant adverse outcome (disability, institutionalization and mortality) in community-dwelling elderly.

Methods: Our study involved a secondary analysis of data from the FréLE cohort study. We focused on the following four frailty screening tools: the abbreviated Comprehensive Geriatric Assessment (aCGA), the Groningen Frailty Indicator (GFI), the Vulnerable Elders Survey-13 (VES-13) and the Fried scale. We used the Barberger-Gateau scale to assess disability. For comparison, we determined the capacity of these tools to predict the occurrence of disability, institutionalization or death using the receiver operating characteristic (ROC) curve. We also determined the threshold at which an optimal balance between sensitivity and specificity was reached. Odds ratios (ORs) were calculated to compare the risk of adverse outcome in the frail versus non-frail groups.

Results: In total, 1643 participants were included in the mortality analyses; 1224 participants were included in the analyses of the other outcomes (74.5% of the original sample). The mean age was 77.7 years, and 48.1% of the participants were women. The prevalence of frailty in this sample ranged from 15.0% (Fried) to 52.2% (VES-13). According to the Barberger-Gateau scale, 643 (52.5%) participants were fully independent; 392 (32.0%) were mildly disabled; 118 (9.6%) were moderately disabled; and 71 (5.8%) were severely disabled. The tool with the greatest sensitivity for predicting the occurrence of disability, mortality and institutionalization was VES-13, which showed sensitivities of 91.0%, 89.7% and 92.3%, respectively. The values for the area under the curve (AUC) of the four screening tools at the proposed cut-off points ranged from 0.63 to 0.75. The odds (univariate and multivariate analysis) of developing a disability were significantly greater among the elderly identified as being frail by all four tools.

Conclusion: The multivariate analyses showed that the VES-13 may predict the occurrence of disability, mortality and institutionalization. However, the AUC analysis showed that even this tool did not have good discriminatory ability. These findings suggest that despite the high number of frailty screening tools described in the literature, there is still a need for a screening tool with high predictive performance.
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http://dx.doi.org/10.1186/s12877-017-0633-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681791PMC
November 2017

Decision-making for gastrostomy after 70 years old: a prospective study about 26 patients.

Geriatr Psychol Neuropsychiatr Vieil 2017 Sep;15(3):247-263

Service de gérontologie clinique, CHU de Saint-Étienne, Faculté de médecine Jacques Lisfranc, COMU Lyon, France.

Management of undernutrition is based on young adults analysis. However, enteral nutrition is mainly discussed in the elderly. The aim of this study was to analyse factors related to laying gastrostomy, in geriatrics. A prospective, descriptive study, was conducted in the Loire department, from 2014 to 2016, in geriatric and palliative units. All patients over 70 years who had a theorical indication of gastrostomy were included. Decision-making process was analyzed from data affecting the reflection. Patients were followed for three months. Twenty-six patients were included with an average of 81 years old. They were frailty with a low mean serum albumin (29.2 g/L), an undernutrition (85%), an extended bedridden (73%), a medical history of aspiration pneumonia (46%) and with pressure ulcers (27%). The main diagnoses were strokes (38%) and dementia (23%). After a singular decision-making, only 15% received a gastrostomy. At three months, 69.2% of patients had died. Patients over 70 years old, with a vital prognosis at short term, are not good candidates for gastrostomy. In geriatrics, decision-making for gastrostomy laying is complex because managed by contradictory recommendations. It requires a global assessment to identify risk situations. The early detection of undernutrition is the key to successful management, for patients requiring gastrostomy.
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http://dx.doi.org/10.1684/pnv.2017.0687DOI Listing
September 2017

Interest of a medical surgical geriatric unit in a district hospital: a retrospective study.

Geriatr Psychol Neuropsychiatr Vieil 2017 Sep;15(3):231-241

Département de gérontologie clinique, CHU Hôpital Charité, Saint-Étienne, France.

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 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.
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http://dx.doi.org/10.1684/pnv.2017.0681DOI Listing
September 2017

[Study of patients benefiting from a geriatric oncology assessment].

Soins Gerontol 2017 Jul - Aug;22(126):33-39

Pôle gériatrie et médecine interne, CHU de Saint-Étienne, hôpital de La Charité, 44 rue Pointe Cadet, 42055 Saint-Étienne, France.

A retrospective study carried out in 2014 focused on the 124 geriatric oncology consultations carried out at Saint-Étienne university hospital. The opinion of the geriatric oncologist was evidently incorporated into the treatment plan, with requests for early assessments. The geriatric oncologist often recommended a specific curative treatment and the majority of assessments were followed up by the oncologist. The benefit of the liaison between the oncologist and gerontologist with regard to the patient's care was clearly demonstrated.
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http://dx.doi.org/10.1016/j.sger.2017.05.007DOI Listing
September 2017

Evaluation of the quality of medical certificates in the context of the opening of a measure of legal protection for adults over 60 years of age.

Geriatr Psychol Neuropsychiatr Vieil 2017 Jun;15(2):145-152

Service de gériatrie, Hôpital de la Charité, CHU de Saint-Étienne, France.

In France between 700,000 and 800,000 people will be covered by legal protection. The opening of any measure is conditioned by a detailed medical certificate. It is drawn up by a doctor registered on the list drawn up by the public prosecutor. No specific training is required. A single piece of legislation frames the content of the certificates. We therefore investigated whether the medical certificates currently produced were in compliance with the code of civil procedure. 111 medical certificates collected and anonymized by the tribunal d'instance of Saint-Étienne, from 4 January to 3 April 2016. The certificates concerned applications for the opening of legal protection for adults over 60 years of age. 57% of detailed medical certificates satisfied the requirements of article 1219 of the code of civil procedure, with no difference between requests for curatorship and guardianship. 76% of adults had cognitive impairment, 14% had a psychiatric disability, and 10% had a functional disability. 72% medical certificates proposed a guardianship measure, 21% a reinforced curatorship and 7% a simple curatorship. The circumstances justifying the opening of a measure of protection and the way of life of the adult were respectively found in 32% and 83% of the certificates. In 49% of the cases, the doctors dispensed the majority of hearing with the judge and the right to vote was retained in 10% of the adults subject to a guardianship application. The study showed a deficiency in the application of article 1219 of the code of civil procedure but also in the information that was requested. The drafting of the detailed medical certificate requires specific medical and legal knowledge. This raises the question of the training of doctors on the list of public prosecutors. Like the medical assessment carried out in the context of the assessment of bodily injury, the detailed medical certificate must become a real expertise carried out by doctors trained in this exercise.
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http://dx.doi.org/10.1684/pnv.2017.0664DOI Listing
June 2017

[Identifying frailty and the importance of personalised support].

Soins Gerontol 2017 Mar - Apr;22(124):23-29

Service de gérontologie clinique, CHU de Saint-Étienne, hôpital la Charité, 44 rue Pointe Cadet, 42055 Saint-Étienne, France. Electronic address:

Over recent years, many hospitals have been looking to promote optimum ageing by developing a strategy for identifying frailty in elderly people. This raises the question of prevention in the field of ageing and the capacities to change behaviour which is harmful to health at any age. Early and long-term support is essential.
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http://dx.doi.org/10.1016/j.sger.2017.02.005DOI Listing
August 2017

[Impact of occupational therapy on the experience of carers].

Soins 2016 Mar(803):42-4

Faculté de médecine J. Lisfranc, 10, rue de la Marandière BP80019, 42270 Saint-Priest-en-Jarez, France.

A study was carried out in 2014 and 2015 analysing the effects of occupational therapy on the carers of patients with Alzheimer's disease or related conditions. The level of "burden" felt by carers was measured before and after this therapy. The results show a real improvement in the quality of their daily life.
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http://dx.doi.org/10.1016/j.soin.2016.01.006DOI Listing
March 2016

Protective Effect of Long-Term CPAP Therapy on Cognitive Performance in Elderly Patients with Severe OSA: The PROOF Study.

J Clin Sleep Med 2015 Apr 15;11(5):519-24. Epub 2015 Apr 15.

Laboratoire de Physiologie de l'exercice, Equipe SNA Epis EA 4607, Université Jean Monnet, Faculté de médecine J. Lisfranc, Hôpital universitaire, Saint-Etienne, France.

Objective: Obstructive sleep apnea syndrome (OSA) leads to a deterioration in cognitive functions, with regard to memory and executive functions. However, few studies have investigated the impact of treatment on these cognitive functions in elderly subjects.

Methods: The study was conducted in a large cohort of subjects aged 65 years or older (the PROOF cohort). Subjects were not diagnosed or treated for OSA. Subjects underwent a polygraphic recording. Cognitive performance was assessed in all OSA subjects at baseline and 10 years later, whether or not they were receiving continuous positive airway pressure (CPAP) therapy.

Results: A group of 126 patients were analyzed. Only 26% of them were treated, with therapy initiated at the discretion of the primary care physician. Among treated subjects, self-reported compliance with therapy was good (> 6 h/night on average), and 66% of them reported an improvement in their quality of life. Patients receiving CPAP treatment had a higher apneahypopnea index (p = 0.006), a higher oxygen desaturation index (p < 0.001), and experienced more pronounced daytime repercussions (p = 0.004). These patients showed a statistically significant improvement in mental agility (similarities test; p < 0.0001) and memory performance (Grober and Buschke delayed free recall; p = 0.02).

Conclusion: CPAP treatment is associated with the maintenance of memory performance over time.
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http://dx.doi.org/10.5664/jcsm.4694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410925PMC
April 2015

General management of nonagenarian patients: a review of the literature.

Swiss Med Wkly 2014 23;144:w14059. Epub 2014 Dec 23.

Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint Priest-En-Jarez, France.

The number of nonagenarian people in the world is steadily growing. This phenomenon will increase in future years: in 2050, world population prospects estimate 71.16 million people aged 90 years or older. The two main causes of death among people aged 85 years or more in Europe in 2003 were cardiovascular and cerebrovascular diseases and cancers. However, the elderly are often excluded from clinical trials; they are underrepresented in clinical registries and especially nonagenarians. Care (medical, surgical, oncology) of these very elderly is currently insufficiently based on scientific recommendations. For the physician, the choice to treat or not to treat very elderly patients (for fear of side effects) is difficult. Oncology is particularly affected by this problem. Here we review these different fields of internal medicine management of nonagenarian patients with a special focus on oncology and on comprehensive geriatric assessment as a base for all care decision taking.
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http://dx.doi.org/10.4414/smw.2014.14059DOI Listing
May 2015

[Epidemiology, morbidity, mortality, cost to society and the individual, and main causes for falls].

Authors:
Régis Gonthier

Bull Acad Natl Med 2014 Jun;198(6):1025-39

Falls are the leading cause of accidental death among the elderly, accounting for about 12 000 deaths per year. The risk of falls increases with age: one-third of subjects over 65 years old living in the community and half of those over 85 fall at least once a year. Despite their frequency, falls should not be trivialized, as they are associated with significant morbidity and care expenditure: 10% of falls have severe traumatic consequences, and30 % of hospital admissions for traumatic injury among elderly individuals are due to falls. Even when they have no physical repercussions, falls can have psychological effects (anxiety while walking, fear of falling), and can be complicated by a psychomotor disadaptation syndrome with voluntary restriction of activities of daily living in 30% of cases. Risk factors for falls are numerous, and falls are rarely due a single, precise reason. Recurrent falls are associated with balance and gait impairment and decreased muscle strength, sometimes due to a latent pathological condition. Factors that may favor falls in the home must be taken into account through targeted prevention actions. Among institutionalized populations, the risk of falls increases with the severity of dementia, the use of certain drugs (particularly psycho tropics) and the existence of wasting, which leads to a decline in quadriceps strength. About 1.5% of all health expenditure is related to falls. The majority of these costs are due to hospitalization, fractures of the proximal femur being the most costly complication. In recent years, thanks to the prevention of both osteoporosis and falls, the annual number of hip fractures has been stable at about 79,500 cases per year, standardized hospitalization rates have declined, and the average length of stay has decreased. With the increasing number of elderly people, one priority to reduce healthcare costs is to identify and correct factors of frailty in midlife, using a preventive approach.
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June 2014

Use of calcium supplements, vitamin D supplements and specific osteoporosis drugs among French women aged 75-85 years: patterns of use and associated factors.

Drugs Aging 2013 Dec;30(12):1029-38

Département de Gérontologie Clinique, CHU Saint-Etienne, Hôpital Charité, 42055, Saint-Etienne Cedex 2, France,

Background: Despite the availability of effective preventive and curative medications for osteoporosis, and guidelines for its diagnosis and management, few individuals are treated for osteoporosis, even among those who have already had a fracture.

Objectives: Our objective was to describe the patterns of use of medication for osteoporosis, i.e., calcium supplements, vitamin D supplements, and specific anti-osteoporotic drugs, such as bisphosphonates, in a large sample of French older women living at home, and to identify individual factors associated with use of these medications overall and in two specific clinical situations.

Methods: Cross-sectional analysis of data from 4,221 women aged 75-85 years who participated in a balance and mobility examination as part of the screening procedure for the Ossébo study, a randomized controlled trial testing the effectiveness of exercise for the prevention of fall-related injuries. Electoral rolls were used to invite women in 16 towns to participate (participation rate 10.3 %). Information collected through questionnaires included current medication use and, in particular, use of osteoporosis medications (specific osteoporosis drugs, calcium and vitamin D supplementation) in the past 6 months, and history of fracture since the age of 50, including fracture locations. Fractures were categorized in three groups: no fracture, major osteoporotic fracture (hip, humerus, wrist, pelvis, and vertebra), and other fracture.

Results: Nearly 48 % of the participants reported they did not take calcium or vitamin D supplements or any specific osteoporosis drugs. Of the 2,133 women who reported using osteoporosis medication, 85 % used vitamin D supplements (25 % as the sole medication against this disease), 59 % calcium supplements, and 42 % a specific anti-osteoporotic drug (75 % of them combining it with vitamin D supplementation). The use of any osteoporosis medication was significantly associated (p < 0.001) with a history of a major osteoporotic fracture, lower weight, dual-energy X-ray absorptiometry (DXA) bone-density measurement in the past 5 years, a cancer-screening examination in the past 5 years, and a positive attitude toward medication use in general. Living alone was associated with a lower likelihood of using a specific anti-osteoporotic drug, and a higher education level was associated with a higher likelihood of vitamin D supplementation. Of the 1,553 women who had already had a major osteoporotic fracture, one-third (34.8 %) were not taking any osteoporosis medication. In this subgroup, use of this medication was associated with the same factors as in the overall study population. In particular, neither older age nor a history of falls in the previous 12 months was associated with a higher likelihood of using osteoporosis medication. Among the 909 women who reported using a specific osteoporosis drug, vitamin D use was associated with a higher educational level and a more frequent preventive attitude.

Conclusion: In France, as in other western countries, women aged 75 years and over are not managed according to guidelines. Further studies should address the barriers encountered in improving quality of care in osteoporosis management.
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http://dx.doi.org/10.1007/s40266-013-0121-9DOI Listing
December 2013

[The announcement of the diagnosis of cancer: point of view of the general practitioner].

Bull Cancer 2013 Oct;100(10):955-62

Faculté de médecine Jacques-Lisfranc, 15, rue Ambroise-Paré, 42023 Saint-Étienne, France.

The announcement of the diagnosis of cancer is difficult for doctors and patients alike. The main objective is the study of announcement's techniques used by physicians to send their patients in cancer centers. The second objective is to analyze encountered difficulties and experience of the announcement of the diagnosis. The final objective would be to provide practical ideas for GPs for a better communication with their patients in this announcement. We have conducted a qualitative study by interviewing fifteen GPs. The fifteen semi-structured interviews have been recorded and transcribed verbatim. A first analysis has been done manually to achieve a set of nodes and then in a second time using N Vivo Software 9. Most of the GPs break the news of cancer with or without pathology. They know the basics of patient-physician communication to promote the patient's expression. Some doctors have a positive experience and claim their role in this announcement. Their negative experience is linked to representations made about the disease and generated feeling. The results of this study show a need of training for physicians in order to acquire know-how and attitude at the time of cancer announcement.
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http://dx.doi.org/10.1684/bdc.2013.1825DOI Listing
October 2013

[Refusal of application to care in Alzheimer's disease and related diseases: establishment of a mobile unit hospital extra].

Geriatr Psychol Neuropsychiatr Vieil 2013 Mar;11(1):49-55

CM2R, CHU de Saint-Étienne, France.

Unlabelled: Refusal of care and support in these patients with Alzheimer's disease and related illnesses at home is a cause of accelerated loss of autonomy and increases the risk of a crisis with early institutionalization. Factors contributing to the denial of care are poorly understood and very few epidemiological data exist.

Materials And Methods: we compared age, diagnosis, level of severity of the disease, the type of behavioral, family status of 101 patients living in denial of care and support as seen by a mobile home (group UPEPc) to 136 control patients seen at the memory clinic (group CM). Patients living in denial of care appear to significantly low age [82/80.5, p<0.0001], with more advanced disease [average MMSE 18/22, p<0.0001], the presence family conflicts and behavioral disorders [delirious--hallucination, agitation--aggression, depression, apathy, p<0.05].

Conclusion: the profile of patients refusing home care is specific and it is important to educate GPs conditions that favor an obstacle to medicalization. The advantage of a mobile extramural to analyze risk factors for refusal of care and propose alternatives should be further investigated.
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http://dx.doi.org/10.1684/pnv.2013.0390DOI Listing
March 2013

[Successful aging: how to improve its occurrence in the elderly?].

Geriatr Psychol Neuropsychiatr Vieil 2012 Jun;10(2):207-14

Département de gérontologie clinique.

Objectives: To assess the seniors' expectations for acceding to successful aging and the impact of preventive actions.

Method: Descriptive study of a representative sample of healthy pensioners using a 20-item questionnaire exploring the difficulties in daily life, the options chosen to achieve successful aging and the impact of preventive actions. Self-rated health feelings and well-being were assessed by visual analogical scales.

Results: The questionnaire was sent to 998 subjects and 651 responses were completed. Mean age of the subjects was 72.9±1.2 years, and 60% were women. Main reported complaints concerned memory loss (20.4%) and mood swings (18.9%). Sleep (82.3%) and physical activity (81.4) were considered as priorities to accede to successful aging. Social activities were significantly more important for subjects with higher educational level than for subjects with lower educational level (p<0.0001). Women and people living alone were more interested in preventive action concerning physical and psychological well-being than men and people living in family (p<0.05).

Conclusion: A better analysis of the complaints and needs of aging subjects should be useful to ensure successful ageing.
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http://dx.doi.org/10.1684/pnv.2012.0318DOI Listing
June 2012

[Botulinum toxin in the elderly to the care of limbs spastic hypertonia and toes or fingers dystonias].

Geriatr Psychol Neuropsychiatr Vieil 2012 Mar;10(1):17-26

Unité de médecine physique et de réadaptation, Hôpital La Charité, CHU de Saint-Étienne.

Objective: To show the botulinum toxin interest and limits in the elderly presenting a limbs spastic hypertonia and/or a dystonia, through a clinical study and a literature review.

Method: We report a 6 years and 8 months retrospective single center study, concerning 49 patients, all of them was more than 70 years old and had received one or several botulinum toxin injections for a limbs spastic hypertonia and/or a dystonia.

Results: The population average was 76,9 years old (70 to 92 years old). It was possible to realize several sessions for the same patient if respecting a three months interval between two sessions. No major side effects was noticed. More than half of the patients felt a significant improvement of their life quality, their functional status and/or on pain. A multidisciplinary care was systematically associated with the botulinum toxin.

Conclusion: The botulinum toxin is an additional asset for the spasticity care of the geriatric patient in rehabilitation, if indications and contraindications are advisedly targeted. The age cannot be considered as a limitating factor.
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http://dx.doi.org/10.1684/pnv.2012.0314DOI Listing
March 2012

[Frailty in older population: a brief position paper from the French society of geriatrics and gerontology].

Geriatr Psychol Neuropsychiatr Vieil 2011 Dec;9(4):387-90

Service de gérontologie clinique et médecine interne, Pôle Gériatrie, CHU de Toulouse.

Frailty in the older population is a clinical syndrome which evaluate a risk level. The Frailty syndrome defines a reduction of the adaptation capacity to a stress. It can be modulated by physical, psychological and social factors. The screening of the frailty syndrome is relevant for older people without disability for basic activities of daily living. The clinical criteria of frailty must be predictive of the risk of functional decline and adverse outcomes, consensual at the international level, and easy to perform in primary care as well as in the clinical researches.
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http://dx.doi.org/10.1684/pnv.2011.0311DOI Listing
December 2011

[Frailty: learnings from the SAFEs cohort study and future perspectives for the research].

Geriatr Psychol Neuropsychiatr Vieil 2011 Jun;9(2):135-49

Département de médecine interne, réhabilitation et gériatrie, Hôpitaux Universitaires et faculté de médecine de Genève, Suisse.

Even though the efforts in research have detailed further the physiopathology and the dynamics of the frailty process an operational definition of frailty is still far from being unequivocal. Studies carried out from the SAFEs cohort study allowed a pragmatic approach in the identification of the at-risk groups for the lost of independency during the hospital stay and factors influencing their future at short-, mid- and long-term. Based upon these results, we propose to discuss the relevance of the current operational indicators of frailty in order to show that clinical markers or indicators are insufficient to differentiate the frailty process from normal ageing. Finally we give rise to the imperative necessity to detect frailty at a preclinical stage with the help of biological and more particularly inflammatory markers.
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http://dx.doi.org/10.1684/pnv.2011.0279DOI Listing
June 2011

Nursing home admission in elderly subjects with dementia: predictive factors and future challenges.

J Am Med Dir Assoc 2012 Jan 13;13(1):83.e17-20. Epub 2011 Apr 13.

Faculty of Medicine, University of Reims Champagne-Ardenne, EA 3797, Reims, France.

Objectives: The aim of this study was to identify factors predictive of nursing home admission (NHA) over a period of 1 year among elderly subjects with dementia.

Methods: The study population was drawn from the SAFES cohort that was formed within a national research program into the recruitment of emergency departments in 9 teaching hospitals. Subjects were to have been hospitalized in a medical ward in the same hospital as the emergency department to which they were initially admitted. Subjects who experienced NHA before emergency department admission were excluded. Those with a confirmed diagnosis of dementia were considered in the present analysis. NHA has been defined as the incident admission into either a nursing home or other long term care facility within the follow-up period. Data obtained from a Comprehensive Geriatric Assessment were used in a Cox model to predict 1-year NHA.

Results: The 425 subjects of the study were 86 ± 6 years old, and were mainly women (63%). NHA rate was 40% (n = 172). Four factors were identified to increase NHA risk: age 85 or older (hazard ratio [HR] = 1.5; 95% confidence interval [CI] = 1.1-2.1), inability to use the toilet (HR = 2.5; 95% CI = 1.5-4.2), balance disorders (HR = 1.5; 95% CI = 1.1-2.1), and living alone (HR = 1.5; 95% CI = 1.1-2.1). Three factors decreased this risk significantly: inability to transfer (HR = 0.5; 95% CI = 0.3-0.8), increased number of children (HR = 0.88; 95% CI = 0.96-0.99), and increased initial Mini-Mental State Examination score (HR = 0.97; 95% CI = 0.8-0.9).

Conclusion: NHA determinants in dementia are strongly linked to the patient's own characteristics but also to his or her physical or social environment. Interventions should target both members of the dyad "patient-caregiver" because both are affected by the disease.
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http://dx.doi.org/10.1016/j.jamda.2011.03.002DOI Listing
January 2012

Level of physical activity at the age of 65 predicts successful aging seven years later: the PROOF study.

Rejuvenation Res 2011 Apr 31;14(2):215-21. Epub 2011 Mar 31.

Equipe d'Accueil Système Nerveux Autonome, Epidémiologie, Physiologie, Exercice, Santé (SNA-EPIS), PRES Lyon, Université Jean Monnet, Hôpital Universitaire, Saint-Étienne, France.

Background: Physical activity has a pleiotropic effect and is a significant factor in successful aging. This study aims to quantify the relationship between the physical activity of a 65-year-old cohort and the level of life satisfaction and self-rated health 7 years later.

Methods: A total of 988 questionnaires were sent by mail to a representative sample of healthy pensioners. Life satisfaction and health status were estimated on two visual analogical scales in answer to the following questions: (1) How would you estimate your state of health? and (2) Are you generally satisfied with your life? The level of physical activity was estimated using a questionnaire which enabled us to calculate: (1) Daily energy expenditure (DEE), (2) physical activity energy expenditure (PAEE), (3) daily energy expenditure higher than 5 metabolic equivalents (METs) (DEQisa), (4) Activity index (PAEE/DEE), (5) VO(2) peak.

Results: In all, 686 responses were validated. The average age was 72.9 ± 1.2 years old with 59.5% of women (n = 408). Amongst the sample, 98.8% (n = 676) lived in their own homes and 25.2% (n = 172) lived alone. Mean DEE was 10.365 ± 1.964  kJ/24  h, mean PAEE was 4.479 ± 1.170  kJ/24  h, mean activity index was 0.42 ± 0.05, and mean estimated oxygen uptake (VO(2)) peak was 22.5 ± 1.6  mL/min per kg. Activity index and VO(2) peak were the variables most significantly correlated with self-rated health (p = 0.0032 and p = 0.0011, respectively) and life satisfaction (p = 0.0117 and p = 0.0053).

Conclusions: Energy spent in activity and VO(2) peak estimated from DEE, measured at the age of 65, appear to be strong predictors of well-being 7 years later.
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http://dx.doi.org/10.1089/rej.2010.1101DOI Listing
April 2011

Can maintaining cognitive function at 65 years old predict successful ageing 6 years later? The PROOF study.

Age Ageing 2011 Mar 20;40(2):259-65. Epub 2011 Jan 20.

Department of Geriatrics, University Hospital of Saint-Etienne, 42055 Saint Etienne Cedex 2, France.

Background: preservation of cognitive abilities is required to have a good quality of life. The predictive value of cognitive functioning at 65 years old on successful ageing 6 years later is not established.

Methods: nine hundred and seventy-six questionnaires were sent by mail to a sample of healthy and voluntary French pensioners. Successful ageing was defined through health status and well-being. Cognitive abilities had been assessed 6 years earlier according to an objective method (Free and Cued Selective Recall Reminding Test (FCSRT), the Benton visual retention test and the similarities subtest of the Wechsler Adult Intelligence Scale-Revised) and a subjective one (Goldberg's anxiety scale, Mac Nair's scale and a Visual Analogue Scale to evaluate memory abilities change in the last 5 years).

Results: six hundred and eighty-six questionnaires could be analysed. The mean age was 72.9 ± 1.2 years old with 59% of women and 99% lived at home. Well-being was negatively correlated with the FCSRT (r = -0.08, P = 0.0318) but positively related with the Benton (r = 0.09, P = 0.0125) and the similarities tests (r = 0.09, P = 0.0118). There is a negative correlation between anxious and cognitive complaints measured at baseline, and successful ageing indicators 6 years later.

Conclusion: preservation of cognitive abilities at the age of retirement can predict a successful ageing 6 years later. ClinicalTrials.gov Identifier: NCT00759304.
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http://dx.doi.org/10.1093/ageing/afq174DOI Listing
March 2011

[Prophylactic treatment of venous thromboembolic disease in palliative care. A survey about four different clinical cases].

Presse Med 2009 Sep 16;38(9):1235-9. Epub 2009 Apr 16.

Service de Soins Palliatifs, CHU Saint-Etienne, Saint-Etienne, France.

Unlabelled: There are no specific studies evaluating the benefit/risk of antithrombotic prophylactic treatment in patients hospitalised in a palliative care unit. So, the aim of this study was to evaluate the clinicians attitudes about antithrombotic prophylaxis for patients in palliative care units and the elements which determined their decisions.

Methods: The clinical data of 4 terminally ill patients were extracted from database of a Palliative Care Unit in France. These 4 patients were selected as they represented several different situations according to the presence or not of major thrombotic risk factors, bleeding risk factors, and request of compassionate care. Through an open questionnaire, fourteen clinicians usually in charge of palliative care patients were individually interviewed about antithrombotic prophylactic therapy for each case of patients.

Results: except in the case of a patient with major thrombotic risk factors, no bleeding risk factor and wishing to receive active care, both the attitudes of clinicians to initiate or continue a prophylactic therapy and the elements which lead to their decisions were heterogeneous at least.

Conclusion: the absence of recommendations based on validated clinical trials evaluating the efficacy and safety of thromboembolism prophylactic treatment in palliative care patients lead to uncertain decisions for clinicians. Added to an objective evaluation of thrombotic and hemorrhagic risks factors, the wish of patient to receive or not active care is probably the most important element to consider.
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http://dx.doi.org/10.1016/j.lpm.2008.11.021DOI Listing
September 2009

Behavioral and psychological symptoms of dementia and bipolar spectrum disorders: review of the evidence of a relationship and treatment implications.

CNS Spectr 2008 Sep;13(9):796-803

Department of Geriatrics, Saint-Etienne University Hospitals, 42055 Saint-Etienne Cedex 2, France.

Dementia is a neuropsychiatric disorder characterized by cognitive impairment and behavioral disturbances. The behavioral and psychological symptoms of dementia (BPSD) are common, contributing to caregiver burden and premature institutionalization. Management of BPSD is complex and often needs recourse to psychotropic drugs. Though widely prescribed, there is a lack of consensus concerning their use, and serious side effects are frequent. This is particularly the case with antidepressant treatment based on the assumption that BPSD is depressive in nature. A better understanding of BPSD etiology could lead to better management strategies. We submit that some BPSD could be the consequence of both dementia and an undiagnosed comorbid bipolar spectrum disorder, or a pre-existing bipolar diathesis pathoplastically altering the clinical expression of dementia. The existence of such a relationship is based on clinical observation, as far as the high frequency of bipolar spectrum disorders in the general population, with a prevalence estimated to be between 5.4% and 8.3%, and the psychopathological similarities between BPSD and mood disorder episodes in bipolar illness. We will review the concept of the bipolar spectrum and explain BPSD before proposing clinical pointers of a possible bipolar spectrum contaminating the phenomenology of dementia, which could lead to the targeted prescription of mood-stabilizing agents in lieu of antidepressant monotherapy. These considerations are of heuristic interest in reconceptualizing the origin of the behavioral manifestations of dementia, with important implications for geriatric practice.
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http://dx.doi.org/10.1017/s1092852900013924DOI Listing
September 2008

[Quality of life in old age].

Authors:
Régis Gonthier

Bull Acad Natl Med 2007 Feb;191(2):237-44; discussion 244

Gérontologie clinique, Hôpital de la Charité, CHU 42055 Saint-Etienne.

Quality of life is a concept describing the aptitude of an individual to function in a given environment and to draw satisfaction from it. It is associated with the notions of good health and well-being. Quality of life is first and foremost a subjective concept. When confronted with the problems of a chronic disease, the elderly subject him/herself must evaluate its repercussions and the effectiveness of medical interventions. Preventive measures and specific geriatric care have increased the longevity and quality of life of old people. It is important to stress that specific geriatric care does not weigh heavily on health-care expenditure and is profitable in the long term. However, this extra longevity is accompanied in a significant minority of people by multiple sensory and/or cognitive disabilities, loneliness and dependency, with a negative impact on people's view of this period of life.
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February 2007

[Does the care for the fear of falling bring a profit to community living elderly people who had experienced falls?].

Psychol Neuropsychiatr Vieil 2007 Sep;5(3):225-34

CHU de Saint-Etienne, Hôpital Charité, Gérontologie Clinique, 42055, Saint-Etienne Cedex 2, France.

Introduction: fall is common in old people and has multiple consequences, physical but also psychological, with a fear of falling which results in reduction in the activities of everyday life, loss of autonomy and entry in dependence. The aim of the study was to evluate the benefit of taking into account the fear of falling in the care of old people who had experienced falls.

Methodology: old people who experienced falls and with a good cognitive status were followed in a day hospital during one year. Evaluation including a specific assessment of the responsibility of the psychological factor, the photolangage, was performed before and after multi-field rehabilitation. We used the rating scales ADL, IADL, SF-36, SAFE, and verbal and analogical scales of the fear of falling.

Results: fifteen patients were included (mean age 85 years +/- 5,7). The majority were women living alone, with a good nutritional status, a moderated renal insufficiency, and a comorbidity involving polymedication. Scores on the ADL and IADL scales showed a consolidation of the patients' autonomy, with a slight but significant improvement of the IADL scores (p < 0,05). All scales assessing the fear of falling (visual analogical, verbal scales, SAFE) showed a statistically significant improvement (p<0,001). SF-36 scale, exploring the quality of life perceived by the patients, showed a great deterioration immediately after falling, and a statistically significant improvement on seven of the eight subscales after rehabilitation. The global physical score (GCV) was improved in a nonsignificant way, whereas the global psychic score (MCS) progressed in a statistically significant way (p < 0,001).

Conclusion: this pilot study shows that multi-field rehabilitation and adapted assumption of responsibility of fear of falling brings a benefit in term of quality of life and preservation of autonomy in old people living in the community who had experienced falls.
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September 2007

Loss of independence in Katz's ADL ability in connection with an acute hospitalization: early clinical markers in French older people.

Eur J Epidemiol 2007 25;22(9):621-30. Epub 2007 Jul 25.

Department of Rehabilitation and Geriatrics, Hospital of Trois-Chêne, University Hospitals of Geneva, Chemin du Pont-Bochet 3, Thônex-Genève, 1226 Geneva, Switzerland.

Background: The preservation of autonomy and the ability of elderly to carry out the basic activities of daily living, beyond the therapeutic care of any pathologies, appears as one of the main objectives of care during hospitalization.

Objectives: To identify early clinical markers associated with the loss of independence in elderly people in short stay hospitals.

Methods: Among the 1,306 subjects making up the prospective and multicenter SAFEs cohort study (Sujet Agé Fragile: Evolution et suivi-Frail elderly subjects, evaluation and follow-up), 619 medical inpatients, not disabled at baseline and hospitalized through an emergency department were considered. Data used in a multinomial logistic regression were obtained through a comprehensive geriatric assessment (CGA) conducted in the first week of hospitalization. Dependency levels were assessed at baseline, at inclusion and at 30 days using Katz's ADL index. Baseline was defined as the dependence level before occurrence of the event motivating hospitalization. To limit the influence of rehabilitation on the level of dependence, only stays shorter than 30 days were considered.

Results: About 514 patients were eligible, 15 died and 90 were still hospitalized at end point (n = 619). Two-thirds of subjects were women, with a mean age of 83. At day 30 162 patients (31%) were not disabled; 61 (12%) were moderately disabled and 291 severely disabled (57%). No socio-demographic variables seemed to influence the day 30 dependence level. Lack of autonomy (odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.2-3.6), walking difficulties (OR = 2.7, 95% CI = 1.3-5.6), fall risk (OR = 2.1, 95% CI = 1.3-6.8) and malnutrition risk (OR = 2.2, 95% CI = 1.5-7.6) were found in multifactorial analysis to be clinical markers for loss of independence.

Conclusions: Beyond considerations on the designing of preventive policies targeting the populations at risk that have been identified here, the identification of functional factors (lack of autonomy, walking difficulties, risk of falling) suggests above all that consideration needs to be given to the organization per se of the French geriatric hospital care system, and in particular to the relevance of maintaining sector-type segregation between wards for care of acute care and those involved in rehabilitation.
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http://dx.doi.org/10.1007/s10654-007-9150-1DOI Listing
January 2008

'Faster counting while walking' as a predictor of falls in older adults.

Age Ageing 2007 Jul 9;36(4):418-23. Epub 2007 Mar 9.

Department of Geriatrics, Saint-Etienne University Hospitals, Saint-Etienne, France.

Objective: To establish whether changes in a spoken verbal task performance while walking compared with being at rest could predict falls among older adults.

Design: Prospective cohort study of 12 months' duration.

Setting: Twenty-seven senior housing facilities.

Participants: Sample of 187 subjects aged 75-100 (mean age 84.8 +/- 5.2). During enrollment, participants were asked to count aloud backward from 50, both at rest and while walking and were divided into two groups according to their counting performance. Information on incident falls during the follow-up year was monthly collected.

Measurements: The number of enumerated figures while sitting on a chair and while walking, and the first fall that occurred during the follow up year.

Results: The number of enumerated figures under dual-task as compared to single task increased among 31.5% of the tested subjects (n = 59) and was associated with lower scores in MMSE (P = 0.034), and higher scores in Geriatric Depression Scale (P = 0.007) and Timed Up & Go (P = 0.005). During the 12 months follow-up, 54 subjects (28.9%) fell. After adjusting for these variables, the increase in counting performance was significantly associated with falls (adjusted OR = 53.3, P < 0.0001). Kaplan-Meier distributions of falls differed significantly between subjects who either increased or decreased their counting performance (P < 0.0001).

Conclusions: Faster counting while walking was strongly associated with falls, suggesting that better performance in an additional verbal counting task while walking might represent a new way to predict falls among older adults.
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http://dx.doi.org/10.1093/ageing/afm011DOI Listing
July 2007