Réhospitalisation à 30 jours d une sortie d unité de court séjour gériatrique (étude monocentrique sur 123 retours au domicile consécutifs)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Analyse de caractéristiques médicales et sociales chez des patients âgés dont le diagnostic de démence est méconnu avant hospitalisation

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Perte d'autonomie pour les activités de la vie quotidienne dans la maladie d'Alzheimer (description, facteurs déterminants et évolution argumentés par les données de la cohorte REAL.FR)

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

La Maladie d'Alzheimer (étude de la place du médecin généraliste dans la prise en charge du patient Alzheimer en ville)

L'augmentation du nombre de patients atteints de la maladie d'Alzheimer pose de plus en plus de difficultés en terme de prise en charge médico-sociale du patient et de sa famille. Le médecin généraliste est souvent seul au centre d'une prise en charge qui se doit d'être de plus en plus multidisciplinaire. A partir d'une enquête auprès de médecins traitants de patients Alzheimer nous avons cherché à illustrer un exemple de prise en charge en ville avec ses limites et ses attentes. Cette prise en charge était basée sur un suivi gériatrique hospitalier semestriel intégré dans un programme national de recherche. Il apparaît que les principales difficultés de cette prise en charge viennent de leur disponibilité limitée, de la difficulté à organiser un maintien à domicile avec les paramédicaux, de leur manque de temps pour soutenir l'aidant principal et une formation médicale parfois insuffisante. Une implication de plus en plus importante des médecins généralistes dans les réseaux de soins gériatriques paraît inéluctable dans le futur, visant ainsi une prise en charge optimale de ces patients.ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Real-life impact of respiratory panel PCR assay on antibiotic prescription in geriatric acute care in the pre-COVID-19 era

International audienceObjectives: In this era of bacterial resistance, avoiding inappropriate use of antibiotic treatments is of major importance. Respiratory tract infections are frequent among older patients, and differentiating viral from bacterial infections is a challenge. The aim of our study was to evaluate the impact of recently available respiratory PCR testing on antimicrobial prescription in geriatric acute care. Methods: We performed a retrospective study, including all hospitalized geriatric patients who had had multiplex respiratory PCR testing prescribed from 1st October 2018 to 30th September 2019. The PCR test comprised a respiratory viral panel (RVP) and a respiratory bacterial panel (RBP). PCR testing could be prescribed at any time during hospitalization by geriatricians. Our primary endpoint was antibiotic prescription after viral multiplex PCR testing results. Results: All in all, 193 patients were included, 88 (45.6%) of whom had positive RVP, while none had positive RBP. Patients with positive RVP had significantly fewer antibiotic prescriptions following test results than patients with negative RVP (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.22–0.77; p = 0.004). Among positive-RVP patients, factors associated with antibiotic continuation were presence of radiological infiltrate (OR 12.02, 95%CI 3.07–30.29), and detected Respiratory Syncytial Virus (OR 7.54, 95%CI 1.74–32.65). That said, discontinuation of antibiotic treatment seems safe. Conclusion: In this population, the impact of viral detection by respiratory multiplex PCR on antibiotic therapy was low. It could be optimized by means of clearly formulated local guidelines, qualified staff and specific training by infectious disease specialists. Cost-effectiveness studies are necessary

Potentially inappropriate prescription of antidepressants in old people: characteristics, associated factors, and impact on mortality

International audienceBACKGROUND:The increasing use of antidepressants (ADs) has raised concerns about their inappropriate use in old people.OBJECTIVE:To examine the prevalence of potentially inappropriate prescribing (PIP) of ADs, their associated factors, and their impact on mortality in a sample of old people in France.METHODS:The analysis used data from the SIPAF study, a cross-sectional study consisting of 2,350 people aged ≥ 70 years. Trained nurses interviewed participants at home between 2008 and 2010. Information was collected concerning socio-demographic and health characteristics, including medication use. The study population consisted of the 318 AD users from the SIPAF study (13.5%). PIP of ADs was defined according to national and international criteria. Factors associated with PIP of ADs were assessed using a multivariate logistic regression model. The influence of PIP of ADs on mortality was assessed using a Cox model (median follow-up 2.8 years).RESULTS:Among the SIPAF study, 71% of AD users were female and the mean age was 84 ± 7 years. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (19.8%). We found PIP of ADs in 36.8% of the study population, mainly the co-prescription of diuretics with SSRIs (17.6%) and the prescription of tricyclics (12.9%). PIP of ADs was associated with polypharmacy (aOR5-9 drugs 2. 61, 95% CI 1.11-6.16 and aOR≥10 drugs 2.69, 95% CI 1.06-6.87) and comorbidity (aOR3-4 chronic diseases 2.59, 95%CI 1.04-6.44 and aOR≥5 chronic diseases 2.33, 95%CI 0.94-5.79), and increased the risk of mortality during follow-up (aHR 2.30, 95%CI 1.28-4.12).CONCLUSIONS:This study shows that more than one third of AD prescriptions may be inappropriate in old people. PIP of ADs was related to polypharmacy and comorbidity and increased mortality among AD users

Persistent eosinopenia is associated with in-hospital mortality among older patients: unexpected prognostic value of a revisited biomarker

International audienceIntroduction: Infection is one of the major causes of mortality and morbidity in older adults. Available biomarkers are not associated with prognosis in older patients. This study aimed to analyze the value of eosinopenia (eosinophil count< 100/mm 3) as a prognosis marker among older patients with suspected or confirmed bacterial infection. Methods: A retrospective study was performed from 1 January to 31 December 2018 among patients in a geriatrics ward suffering from a bacterial infection treated with antibiotics. Biomarker data including the eosinophil count, neutrophil count and C-reactive protein (CRP) were collected within 4 days after patient diagnosis. Persistent eosinopenia was defined as a consistent eosinophil count< 100/mm 3 between Day 2 and Day 4. The association of biomarkers with 30-day hospital mortality in a multivariate analysis was assessed and their predictive ability using the area under the ROC curve (AUC) was compared. Results: Our study included 197 patients with a mean age of 90 ± 6 years. A total of 36 patients (18%) died during their stay in hospital. The patients who died were more likely to have persistent eosinopenia in comparison to survivors (78% versus 34%, p < 0.001). In the multivariate analysis, persistent eosinopenia was associated with inhospital mortality with an adjusted HR of 8.90 (95%CI 3.46-22.9). The AUC for eosinophil count, CRP and neutrophil count between Day 2 and Day 4 were 0.7650, 0.7130, and 0.698, respectively. Conclusion: Persistent eosinopenia within 4 days of diagnosis of bacterial infection appeared to be a predictor of in-hospital mortality in older patients

A Decision Support Tool Facilitating Medicine Design for Optimal Acceptability in The Older Population

International audiencePurposeMedicine acceptability, which is of the utmost importance for vulnerable patients’ adherence, is driven by both user and product characteristics. Herein, a novel multivariate approach integrating the many aspects of acceptability is used to discriminate positively and negatively accepted medicines in the older population.MethodsAn observational study was carried out in eight hospitals and eight nursing homes to collect a large set of real-life data on medicines uses in older patients (≥65 years). Mapping and clustering explored these multiple observational measures and summarised the main information into an intelligible reference framework. Resampling statistics were used to validate the model’s reliability.ResultsA three-dimensional map and two clusters defining acceptability profiles, as positive or negative, emerged from the 1079 evaluations. Factors of interest (medicines, user features…) were positioned on the map at the barycentre of their evaluations and assigned to an acceptability profile. Focusing on patients’ ability to swallow, we have highlighted the tool’s efficacy in demonstrating the impact of user features on medicine acceptability.ConclusionsThis multivariate approach provides a relevant judgement criterion for this multi-dimensional concept. Facilitating the choice of the most appropriate dosage form to achieve optimal acceptability in a targeted population, this tool is of real potential to improve clinical decisions