L'hyponatrémie du sujet âgé :Implication dans la fragilité

Hyponatremia is the most common electrolyte disorder in elderly patients. The incidence is about 7 % in elderly healthy people but can exceed 40 % in hospitalized patients. Considering all its aetiologies hyponatremia is associated with increased mortality and appears as a factor of poor prognosis. Alteration in the regulation of water homeostasis in the elderly result from multiple consequence of aging: change in body composition, alteration in renal function and hormonal changes. The high frequency of nutritional problems, particularly protein malnutrition predisposes the elderly to the development of hyponatremia. Although diuretics especially thiazides are implicated as a frequent cause of hyponatremia on geriatric medicine, normovolemic hyponatremia and more particularly the syndrome of inappropriate antidiuresis is the most common cause. The aetiology of this syndrome can be determined in only approximately half of the cases. Cancers and medications, principally psychotropic agents commonly prescribed in geriatrics are the most frequent aetiologies. Hyponatremia could be a factor of frailty in geriatrics. Mild to moderate hyponatremia is generally considered asymptomatic but recent studies reported that asymptomatic hyponatremia contributes to neurological troubles like cognitive disorders, posture and gait impairments. Hyponatremia could be an independent risk factor of falls and could be associated with the development of osteoporosis. This review of the literature emphasizes the importance of screening and a systematic management of hyponatremia in the elderly people, even in the minor forms and those considered as asymptomatic.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Incontinence du sujet âgé: Particularités et prise en charge

Urinary incontinence is very common among the elderly and results in a series of personal and economic complications. This population is often very heterogeneous with the aetiologies or dependences which are not very obvious. It is thus important to carry out among these patients a total assessment which will make it possible to detect the affections or the dependence from which it suffers. The BGMST (Belgian Geriatric Minimum Screening Test) includes a series of non aggressive tests which will answer this need. The performance of urodynamic tests is not easily achieved in case of not very autonomous or intellectually little collaborating patients. The prescription of surgical treatments is not necessarily to reject (urge incontinence). With regard to drugs, a good knowledge of their metabolism, of their interferences with other treatments in progress, is important especially in the absence of literature taking into account this heterogeneous old population. The prescriptions must be regularly re-examined in order to avoid weakening of these patients. In addition, in the elderly, aetiologies of incontinence are often multiple and consequently its daily management becomes particularly difficult.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Une rhabdomyolyse d’origine peu commune : la pneumonie à Mycoplasme pneumoniae

no abstract availabl

Kératite périphérique ulcérative et forme limitée de la granulomatose de Wegener.

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

L'Hôpital de jour gériatrique : une interface ambulatoire au service des personnes âgées

L'hôpital de jour gériatrique est une structure ambulatoire qui propose une prise en charge diagnostique et thérapeutique aux personnes âgées en tant qu'alternative aux hospitalisations classiques. Cet article a pour but de mieux faire connaître la structure aux cliniciens de terrain. Il en décrit l'historique dans le monde et en Belgique, y commente les résultats d'une méta-analyse et d'enquêtes nationales réalisées depuis 2007, date de parution du Programme de Soins pour le Patient Gériatrique. Comparés aux données publiées,les hôpitaux de jours gériatriques belges proposent une approche plutôt à orientation diagnostique alors que certains développent la revalidation. Ils offrent, à l'aide d'une équipe multidisciplinaire, une évaluation gériatrique globale des syndromes gériatriques (déclin fonctionnel,fragilité,chutes, troubles de la mémoire, malnutrition,...) en étroite collaboration avec la première ligne et le réseau de soins. L'évaluation gériatrique standardisée a prouvé des bénéfices significatifs lors d'une hospitalisation conventionnelle qui malheureusement comporte toutefois des risques (déclin fonctionnel, chutes, confusion aiguë, iatrogénie et infections nosocomiales). L'hôpital de jour gériatrique propose donc un accès à un plateau spécifique (examens techniques et avis spécialisés) associé à une évaluation gériatrique standardisée en vue d'élaborer un plan de soin en soutien au travail de première ligne tout en évitant une hospitalisation classique

Prevalence and Impact of Atrial Fibrillation on Intra-Hospital Mortality in Patients Aged ≥75 Years

It is unclear whether the association between atrial fibrillation (AF) and intra-hospital mortality in patients aged 75 years and older is causal or not. This study aims (1) to describe the prevalence and clinical characteristics of AF in ≥75-year-old inpatients and (2) to study the association between AF and length of stay (LOS) and intra-hospital mortality. This retrospective cohort study includes consecutive patients aged ≥75 years admitted between January 2017 and December 2019 to a Belgian secondary hospital. Survival analysis was conducted on the whole dataset and a propensity score-matched dataset separately. Propensity score matching (PSM) was performed to account for the individual probability of having AF given a set of covariates. In 9,105 patients, 3,137 (34%) had a diagnosis of AF upon hospital admission. AF prevalence increased with age strata (from 29% to 38%), and Charlson Co-morbidity Index (from 28% to 57%). Intra-hospital mortality (20%) was higher in the AF group than in the AF-free group (25% vs 17%, p 10 days (odds ratio 1.08, confidence interval: 0.98 to 1.20, p = 0.13). The risk of intra-hospital death for patients with AF remained higher compared with those without AF (log-rank p = 0.0015 and hazard ratio 1.17; confidence interval: 1.04 to 1.32, p = 0.008). In conclusion, the prevalence of AF was high (34%) in inpatients aged ≥75 years and increased with age and co-morbidity burden. After PSM, patients with AF had a 17% higher risk of intra-hospital mortality than patients without AF