Axial Multicentric Osteosarcoma in an English Cocker Spaniel

No abstract available

Early Hospital Discharge of Older Adults Admitted to the Emergency Department: Effect of Different Types of Recommendations Made by a Mobile Geriatric Team

International audienc

Mobile Geriatric Team Advice: Effect on Length of Hospital Stay in Older Adults

International audienc

Hypovitaminosis D in geriatric inpatients: a marker of severity of chronic diseases

Background and aims: Hypovitaminosis D is associated with adverse health outcomes including several bone and non-bone chronic diseases. It remains unclear whether hypovitaminosis D leads to more numerous or more severe chronic diseases. Our aim was to determine whether there was an association between serum 25-hydroxyvitamin D deficiency (i.e., 25OHD <= 25 nmol/L) and, respectively, the number and severity of chronic diseases assessed with the Kaplan-Feinstein index (KFI) among geriatric inpatients. Methods: Two hundred and forty older Caucasian adults admitted between December 2008 and September 2009 to the geriatric acute care unit of Angers University Hospital, France (mean 84.6 +/- 0.4 years; 68.8% women) were included in this cross-sectional study. Serum 25OHD, KFI score and number of chronic diseases (i.e., diseases lasting at least 3 months or running a course with minimal change, whatever their nature or site) were assessed. Subjects were divided into 2 groups according to 25OHD concentration (either deficient for 25OHD <= 25 nmol/L, or non-deficient for 25OHD >25 nmol/L). Age, gender, use of vitamin D supplements, number of chronic diseases, serum parathyroid hormone and season tested were used as potential confounders. Results: Mean serum 25OHD concentration was 35.2 +/- 1.7 nmol/L. The 102 (42.5%) subjects with 25OHD deficiency had higher KFI compared with their counterparts (p=0.008). Vitamin D deficiency was not significantly associated with the number of chronic diseases (adjusted beta=-0.37 with p=0.216), but with KFI (unadjusted beta=1.33 with p=0.008; adjusted beta=1.37 with p=0.010). Conclusions: Irrespective of the number of chronic diseases, 25OHD deficiency was associated with the severity of chronic diseases. (C) 2012, Editrice Kurti

Mobile Geriatric Team and Length of Hospital Stay Among Older Inpatients: A Case-Control Pilot Study

International audienc

Who is at risk of long hospital stay among patients admitted to geriatric acute care unit? Results from a prospective cohort study

1) To confirm that vitamin D deficiency, defined as serum 25-hydroxyvitamin D (25OHD) concentration < 25nmol/L, was associated with long length-of-stay (LOS) among older inpatients admitted to geriatric acute care unit; and 2) to examine which combination of risk factors of longer LOS including vitamin D deficiency best predicted longer LOS.Based on a prospective cohort study with a 25-day follow-up on average, 531 consecutive older inpatients (mean age 85.0 +/- 7.2 years, 59.1% women) admitted to the geriatric acute care unit of Angers University Hospital, France, were included. Linear regression models showed that male gender (P < 0.025), delirium (P < 0.015) and vitamin D deficiency (P < 0.001) were independently associated with a longer LOS. The highest risk of a longer LOS was shown while combining vitamin D deficiency with male gender (Odds ratio (OR)=3.70 with P < 0.001). The risk increased significantly while delirium was associated with these two baseline characteristics (OR=4.76 with P=0.001). Kaplan-Meier distributions of discharge differed significantly between participants who had or not the combination of the 3 criteria (P < 0.007). Vitamin D deficiency, delirium and male gender were significant risk factors for a longer LOS in the studied sample of older inpatients

Association of Depressive Symptoms with Recurrent Falls: A Cross-Sectional Elderly Population Based Study and a Systematic Review

Background: Screening of depressive symptoms is recommended in recurrent fallers. Compared to the 30-item and 15-item Geriatric Depression Scales (GDS), the 4-item GDS is easier to administer and quicker to perform. The association between abnormal 4-item GDS score and recurrent falls has not yet been examined. In addition, while depressive symptoms-related gait instability is well known, the association with recurrent falls has been few studied. Objective: 1) To examine the association between abnormal 4-item GDS score and recurrent falls in community-dwelling older adults using original data from health examination centers (HEC) of French health insurance of Lyon, and 2) to perform a systematic review of studies that examined the association of depressive symptoms with recurrent falls among older adults. Methods: Firstly, based on a cross-sectional design, 2,594 community-dwellers (mean age 72.1 +/- 5.4years; 49.8% women) were recruited in HEC of Lyon, France. The 4-item GDS score (abnormal if score >= 1) and recurrent falls (i.e., 2 or more falls in the past year) were used as main outcomes. Secondly, a systematic English and French Medline literature search was conducted on May 28, 2012 with no limit of date using the following Medical Subject Heading (MeSH) terms "Aged OR aged, 80 and over", "Accidental falls", "Depressive disorder" and "Reccurence". The search also included the reference lists of the retrieved articles. Results: A total of 19.0% (n=494) participants were recurrent fillers in the cross-sectional study. Abnormal 4-item GDS score was more prevalent among recurrent fallers compared to non-recurrent fallers (44.7% versus 25.0%, with P<0.001), and was significantly associated with recurrent falls (Odd ratio (OR)=1.82 with P<0.001 for full model; OR=1.86 with P<0.001 for stepwise backward model). In addition to the current study, the systematic review found only four other studies on this topic, three of them examining the association of depressive symptoms with recurrent falls using 30-item or 15-item GDS. All studies showed a significant association of depressive symptoms with recurrent falls. Conclusions: The current cross-sectional study shows an association between abnormal 4-item GDS score and recurrent falls. This association of depressive symptoms with recurrent falls was confirmed by the systematic review. Based on these results, we suggest that recurrent falls risk assessment should involve a systematic screening of depressive symptoms using the 4-item GDS