Publications by authors named "Thomas Celarier"

16 Publications

  • Page 1 of 1

COVID-19 and Quarantine, a Catalyst for Ageism.

Front Public Health 2021 12;9:589244. Epub 2021 Apr 12.

Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France.

In February 2021, France had more than 76,000 deaths due to COVID-19 and older adults were heavily affected. Most measures taken to reduce the impact of COVID-19 (quarantine, visit ban in nursing home, etc.) significantly influenced the lives of older adults. Yet they were rarely consulted about their implementation. Exclusion of and discrimination against older adults has been accentuated during the COVID-19 pandemic. While many articles discussing COVID-19 also mention ageism, few actually incorporate the perspectives and opinions of older adults. Our research aims to assess the ageism experienced by older adults during the COVID-19 pandemic. We conducted interviews with older adults (63-92 years, mean age = 76 years) in an urban area of France. Participants reported experiencing more ageism during the COVID-19 pandemic, including hostile and benevolent ageism from older adults' families. Despite reports of experiencing ageist attitudes and behaviors from others, however, older adults also identified positive signs of intergenerational solidarity during this COVID-19 crisis.
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http://dx.doi.org/10.3389/fpubh.2021.589244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072107PMC
April 2021

Domestic Activities Associated With a Decreased Risk of Cognitive Disorders: Results of the "Fréle" Cohort.

Front Public Health 2020 9;8:602238. Epub 2020 Dec 9.

Centre technique d'appui et de formation (CETAF), Saint-Etienne, France.

Previous cohorts studied the association of various types of physical activities with the incidence of cognitive disorders. The objective of this work was to analyze the association of leisure, domestic and professional physical activities with mild and moderate cognitive disorders in older people living in the community. We used retrospective data from the "FRéLE" (FRagilité: étude Longitudinale de ses Expressions) a longitudinal and observational study. Data collected included socio-demographic variables, lifestyle and health status. Cognitive disorders were assessed using the Montreal Cognitive Assessment (MoCA). Two cut-offs of MoCA were used to analyze mild and moderate cognitive disorders. Physical activity was assessed by the Physical Activity Scale for the Elderly (PASE) structured in three sections: leisure, household, and professional activities. Spline and logistic regression models were used to estimate the risk of cognitive disorders. At baseline, 428 participants (for study of mild disorders) and 1,271 participants (for study of moderate disorders) without cognitive disorders were included in the analysis. The mean ages were 74 and 78 years, respectively. After a 2-year follow-up, we found mild cognitive disorders in 154 participants (36%) and 71 cases of moderate cognitive disorders (5.6%). In multi-adjusted logistic models, domestic activities were associated with cognitive disorders, but not leisure and professional activities. We found an inverse relation between domestic sub-score and cognitive disorders defined by MoCA < 18. With a specific questionnaire and quantitative information on the type of activities, this study contributed to the debate on the beneficial effects of physical activity on cognition.
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http://dx.doi.org/10.3389/fpubh.2020.602238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793943PMC
December 2020

Vitamin D and survival in COVID-19 patients: A quasi-experimental study.

J Steroid Biochem Mol Biol 2020 11 13;204:105771. Epub 2020 Oct 13.

Department of Clinical Gerontology, University Hospital of Saint-Etienne, Saint-Etienne, France; Chaire Santé des Ainés, University of Jean Monnet, Saint-Etienne, France; Gérontopôle Auvergne-Rhône-Alpes, Saint-Etienne, France.

Vitamin D may be a central biological determinant of COVID-19 outcomes. The objective of this quasi-experimental study was to determine whether bolus vitamin D3 supplementation taken during or just before COVID-19 was effective in improving survival among frail elderly nursing-home residents with COVID-19. Sixty-six residents with COVID-19 from a French nursing-home were included in this quasi-experimental study. The "Intervention group" was defined as those having received bolus vitamin D3 supplementation during COVID-19 or in the preceding month, and the "Comparator group" corresponded to all other participants. The primary and secondary outcomes were COVID-19 mortality and Ordinal Scale for Clinical Improvement (OSCI) score in acute phase, respectively. Age, gender, number of drugs daily taken, functional abilities, albuminemia, use of corticosteroids and/or hydroxychloroquine and/or antibiotics (i.e., azithromycin or rovamycin), and hospitalization for COVID-19 were used as potential confounders. The Intervention (n = 57; mean ± SD, 87.7 ± 9.3years; 79 %women) and Comparator (n = 9; mean, 87.4 ± 7.2years; 67 %women) groups were comparable at baseline, as were the COVID-19 severity and the use of dedicated COVID-19 drugs. The mean follow-up time was 36 ± 17 days. 82.5 % of participants in the Intervention group survived COVID-19, compared to only 44.4 % in the Comparator group (P = 0.023). The full-adjusted hazard ratio for mortality according to vitamin D3 supplementation was HR = 0.11 [95 %CI:0.03;0.48], P = 0.003. Kaplan-Meier distributions showed that Intervention group had longer survival time than Comparator group (log-rank P = 0.002). Finally, vitamin D3 supplementation was inversely associated with OSCI score for COVID-19 (β=-3.84 [95 %CI:-6.07;-1.62], P = 0.001). In conclusion, bolus vitamin D3 supplementation during or just before COVID-19 was associated in frail elderly with less severe COVID-19 and better survival rate.
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http://dx.doi.org/10.1016/j.jsbmb.2020.105771DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553119PMC
November 2020

Older adults should not be omitted from inclusion in clinical trials of SARS-CoV-2 vaccines.

Maturitas 2021 04 6;146:63-64. Epub 2020 Oct 6.

Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France; UPRES EA 4638, Université d'Angers, Angers, France; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, ON, Canada.

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http://dx.doi.org/10.1016/j.maturitas.2020.10.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537629PMC
April 2021

Recurrence or Relapse of COVID-19 in Older Patients: A Description of Three Cases.

J Am Geriatr Soc 2020 10 13;68(10):2179-2183. Epub 2020 Aug 13.

Groupe Immunité des Muqueuses et Agents Pathogènes-EA3064, University Hospital of Saint-Etienne, Saint-Etienne, France.

Background: COVID-19 has infected millions of people worldwide, particularly in older adults. The first cases of possible reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported in April 2020 among older adults.

Design/setting: In this brief report, we present three geriatric cases with two episodes of SARS-CoV-2 infection separated by a symptom-free interval.

Participants: The participants of this brief report are three cases of hospitalized geriatric women.

Measurements/results: We note clinical and biological worsening during the second episode of COVID-19 for all three patients. Also, there is a radiological aggravation. The second episode of COVID-19 was fatal in all three cases.

Conclusion: This series of three geriatric cases with COVID-19 diagnosed two times apart for several weeks questions the possibility of reinfection with SARS-CoV-2. It raises questions in clinical practice about the value of testing for SARS-CoV-2 infection again in the event of symptomatic reoccurrence. J Am Geriatr Soc 68:2179-2183, 2020.
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http://dx.doi.org/10.1111/jgs.16728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361461PMC
October 2020

Impact of Home Quarantine on Physical Activity Among Older Adults Living at Home During the COVID-19 Pandemic: Qualitative Interview Study.

JMIR Aging 2020 May 7;3(1):e19007. Epub 2020 May 7.

Autonomic Nervous System Research Laboratory, University of Jean Monnet, Saint-Etienne, France.

Background: Older adults and those with pre-existing medical conditions are at risk of death from severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). In this period of quarantine, one of the reasons for going out is physical activity. This issue is important, as the impact of a sedentary lifestyle might be lower for children and young adults, but is far more severe for older adults. Although older adults need to stay at home because they have a higher risk of coronavirus disease (COVID-19), they need to avoid a sedentary lifestyle. Physical activity is important for older adults, especially to maintain their level of independence, mental health, and well-being. Maintaining mobility in old age is necessary, as it may predict loss of independence in older adults.

Objective: Our first objective was to evaluate the impact of this quarantine period on physical activity programs and on the physical and mental health of older adults. Our second objective was to discuss alternatives to physical activity programs that could be suggested for this population to avoid a sedentary lifestyle.

Methods: We conducted a qualitative survey using semistructured interviews with professionals (managers in charge of physical activity programs for older adults and sports trainers who run these physical activity programs) from the French Federation of Physical Education and Voluntary Gymnastics (FFPEVG) and older adults participating in a physical activity program of the FFPEVG. We followed a common interview guide. For analysis, we carried out a thematic analysis of the interviews.

Results: This study suggests that the COVID-19 epidemic has affected, before quarantine measures, the number of seniors attending group physical activity programs in the two study territories. In addition, despite the decline in their participation in group physical activities before the quarantine, older adults expressed the need to perform physical activity at home. There is a need to help older adults integrate simple and safe ways to stay physically active in a limited space. A national policy to support older adults for physical activity at home appears essential in this context.

Conclusions: Given the results of our study, it seems necessary to globally communicate how important it is for older adults to maintain physical activity at home. We are concerned about the level of independence and mental health state of older adults after the end of quarantine if there is no appropriate campaign to promote physical activity among them at home.
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http://dx.doi.org/10.2196/19007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7207013PMC
May 2020

[Therapeutic education in elderly over 75 years old living at home A pilot study of 48 patients].

Geriatr Psychol Neuropsychiatr Vieil 2020 03;18(1):43-52

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

Therapeutic patient education (TPE) allows elderly as well as young adults to evaluate patient's self-care and adaptation skills to their own clinical condition. Falling is a symptom present in various chronic diseases, which leads to loss of autonomy, fear of recidivism and frequent admissions into institutions. Study objective was to evaluate at 3 and 6 months the impact of TPE on fall recurrence, perceived quality of life and fear of falling, in elderly over 75 living at home.

Methods: We performed a prospective study comparing two groups: a group participating in day hospital (group "TPE") and a control group (group "Hospitalized") of elderly patient not receiving TPE recruited in short geriatric stays following a fall at home.

Results: 28 patients in the "TPE" group and 20 patients in the "Hospitalized" group were included. The "TPE" group reported significantly better perceived quality of life at 3 months and 6 months. At 6 months, fear of falling was twice as high in the "Hospitalized" group than in the "TPE" group.

Conclusions: The group of subjects who was able to benefit from therapeutic education at home had an improved quality of life at 3 and 6 months and a decrease in the fear of falling at 6 months.
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http://dx.doi.org/10.1684/pnv.2019.0841DOI Listing
March 2020

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

Graduated compression stockings in prevention of venous thromboembolism among acutely ill medical patients aged over 75 years: a French national survey.

Clin Interv Aging 2019 25;14:1153-1157. Epub 2019 Jun 25.

Centre d'Investigation Clinique, Inserm CIC-EC 1408, Saint Etienne, France.

The thromboprophylactic efficacy of graduated compression stockings (GCS) has not yet been demonstrated in acutely ill medical patients, and guidelines vary considerably. Older acutely ill medical patients appear to constitute a distinctive population presenting high risks of both thrombosis and bleeding. To evaluate the practices and beliefs of a panel of French geriatricians regarding GCS management in acutely ill medical patients aged over 75 years. A survey was designed to study French geriatric practice concerning GCS use for thromboprophylaxis. A total of 111 geriatricians answered the questionnaire. Among the responders, 46% declared frequent or very frequent prescription of GCS for preventing venous thromboembolism (VTE) in acutely ill, hospitalized medical patients, 54% declaring that they frequently re-evaluated GCS prescription during the patient's hospitalization. The main reason reported for discontinuing GCS use was patient request. Regarding complications of GCS, 87% of responders declared having already noted adverse effects with the use of GCS, although 80% estimated the risk of complications to be low or very low. In the context considered, the efficacy of wearing GCS was believed to be high or very high for 73% of responders. GCS prescription was judged to be in accordance with evidence-based medicine for 69%. There is a gap between the frequent use of GCS to prevent VTE in older patients presenting an acute medical illness and the availability of data concerning their efficacy, safety, and management by nurses. Prospective trials including clinical and cost effectiveness are needed.
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http://dx.doi.org/10.2147/CIA.S197603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601338PMC
December 2019

[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

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

[Pulmonary hypertension in the elderly].

Geriatr Psychol Neuropsychiatr Vieil 2015 Mar;13(1):8-14

Gérontologie clinique, La Charité, CHU Saint-Étienne, Saint-Étienne, France, SNA-EPIS (EA 4607), Université Saint-Étienne, Jean Monet, Saint-Étienne, France.

In the past decade, a significant improvement has been done in the management of pulmonary arterial hypertension, a devastating disease. Beside the aging population, one of the next challenges is to develop a specific management of a pulmonary hypertension's suspicion, in the aged patients. In fact, recent data have shown that if pulmonary hypertension were mostly related to chronic heart or lung failure, or pulmonary embolism, some elderly may in fact develop a real pulmonary arterial hypertension. Because of the potential therapies which may be proposed, the evaluation of a pulmonary hypertension's suspicion in the elderly needs a stringent evaluation by trained physicians, in collaboration with geriatricians.
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http://dx.doi.org/10.1684/pnv.2015.0526DOI Listing
March 2015

[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

[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