Clinical Outcomes of Bipolar Hemiarthroplasty with a Conjoined Tendon-Preserving Posterior Approach for Femoral Neck Fractures.

Background and Objectives: The conventional posterior approach in the lateral decubitus position is widely used for femoral neck fractures in femoral hemiarthroplasty. Postoperative dislocation is the major problem with this approach. The conjoined tendon-preserving posterior (CPP) approach is a less invasive surgical approach than the conventional posterior approach to the hip, maintains posterior stability, and preserves short external rotators and joint capsules. However, the mention was required to avoid muscle damage and whether muscle damage affects postoperative dislocation or not. The current study aimed to evaluate the clinical results of the CPP approach in hemiarthroplasty for femoral neck fractures and identify muscle damage risk factors. Materials and Methods: This study was a retrospective cohort study and included 170 hips in 168 patients. The mean age at the operation was 81.2 years. The preservation rate of the internal obturator muscle and gemellus inferior muscle and factors related to intraoperative short rotator muscle injury were investigated retrospectively. The postoperative complications and the relation between muscle damage and postoperative dislocation were investigated. Results: In the four hips (2.3%) with the obturator internus muscle damage, thirty-eight hips (22.4%) with gemellus inferior muscle damage were detected; in the muscle-damaged cases, the high body mass index (BMI) was significantly higher. The complication occurred in four hips (2.3%), including postoperative posterior dislocation in one hip without muscle damage (0.6%). Postoperative infection occurred in one hip (0.6%), and peroneal or sciatic nerve paralysis was suspected in two hips (1.1%). Conclusions: Compared to the conventional posterior approach in previous reports, the CPP approach reduces postoperative dislocation. A higher BMI is a risk factor for muscle damage, and the gemellus inferior muscle damage has no effect on postoperative dislocation. The CPP approach for BHA appeared to be an effective treatment method.

[Psychological characteristics of working and non-working elderly people.]

A comparative analysis of the psychological characteristics of the working and non-working population in the context of personal employment, demand and quality life. The study was conducted with the participation of 51 women and 58 men, age 65,35±5,25 years. Randomization into two groups: the 1st group - 59 people of those continuing to work in the field of higher and vocational education; the 2nd group (50 people) consisted of non-working pensioners whose labor activity was related to teaching, taking care of their families, children and grandchildren, the circle of their social contacts is limited by the connections necessary to ensure life. An assessment was made of the orientation of the personality, the level of prevailing needs, the formation and strength of motives, the degree of adequacy of one's own attitude to various life situations, and the psycho-emotional state. It is shown that working pensioners have a higher indicator of the personality's orientation to the task and a low indicator of the personality's orientation to oneself. In the 1st group a stable psycho-emotional state was revealed for a number of functional indicators of a physical, role, social nature, significantly higher indicators of vitality and the physical component of health, they strive to maintain professionalism, financial freedom, and independence. In the 2nd group the desire to overcome social isolation, the desire to develop creativity in oneself prevails. In the 1st and 2nd groups, there were no differences in the levels of the motivational-need sphere. To expand the possibilities of the life potential of an elderly person, it is necessary to study the psychological characteristics older working and non-working population.

Development of Hepatocellular Carcinoma in Patients Aged 75-84 Years With Chronic Hepatitis C Treated With Direct-Acting Antivirals.

BACKGROUND: Direct-acting antiviral (DAA) treatment has revolutionized hepatitis C virus (HCV) care. We aimed to evaluate the risk for the development of hepatocellular carcinoma (HCC) in patients aged 75-84 years with chronic hepatitis C after HCV elimination. METHODS: This multicenter cohort study included 2405 consecutive patients with chronic hepatitis C without a history of HCC who achieved HCV elimination by DAAs. Patients in whom HCC developed within 1 year of DAA initiation were excluded. Propensity score matching analysis was used to evaluate differences in HCC risk between patients aged 75-84 versus 60-74 years. RESULTS: The median observational period was 3.5 years. Among patients aged 75-84 years with a high Fibrosis-4 (FIB-4) index (≥3.25 at baseline), there was no significant difference in the annual incidence of HCCs between groups with an FIB-4 index ≥3.25 (2.75 per 100 person-years [PY]) versus <3.25 (2.16 per 100 PY) at 12 weeks after the end of treatment, unlike the results in those aged 60-74 years (3.61 and 1.51 per 100 PY, respectively) (adjusted hazard ratio, 2.20; P = .04). In 495 pairs matched by propensity score matching, in patients without cirrhosis, the cumulative HCC incidence was significantly higher in the 75-84-year than in the 60-74-year age group (P = .04). CONCLUSIONS: Older patients aged 75-84 years remained at high risk for the development of HCC, even after HCV elimination and the improvement of the FIB-4 index to <3.25.

[Technology at the heart of vulnerability]. / La "techné" au cœur de la vulnérabilité.

The ubiquitous presence of the elderly in care services raises questions about the evolution and limits of new techniques and technologies in the care relationship. We carried out a cross-sectional study in a geriatric ward, using parallel patient and carer questionnaires to assess how each felt about innovations, analyze their opportunities and evaluate their dangers in care provision.

["Assure" program, to improve the management of emergency situations in Ehpad]. / Programme Assure, pour améliorer la prise en charge des situations d'urgence en Ehpad.

The Assure approach (improvement of emergency care) is a project designed to improve emergency care for the 63,000 residents of homes for the dependent elderly (Ehpad) in the Ile-de-France region. By reinforcing the skills of caregivers in emergency situations and facilitating collaboration between care providers, the Assure approach is mobilizing, alongside all the Ehpad in the Ile-de-France region over a period of two years, the emergency medical assistance services, emergency physicians, mobile geriatric teams and nursing and care assistant training institutes.

[The ethical charter for the elderly in the daily life of GHSIF care providers]. / La charte éthique du grand âge dans le quotidien des acteurs de soin du GHSIF.

The elaboration of a charter of ethics and support for the elderly, drawn up by Fabrice Gzil, places different notions of care at the center of the care of the elderly for those working in the field at the Groupe hospitalier sud Île-de-France (GHSIF). The 10 points presented are implemented on a daily basis. By highlighting these actions, the charter can be appropriated and brought to life in order to provide support adapted to the collective and individual needs of the elderly patients and residents.

[Inappropriate admissions of Ehpad residents to emergency departments]. / Admissions inappropriées des résidents d'Ehpad aux urgences.

After a review of inappropriate admissions of residents of residential care facilities for the dependent elderly (Ehpad) to the emergency room, we propose ways to reduce them. They include giving the coordinating physician a clinical role, organizing continuity and permanence of care in all Ehpad, signing agreements between Ehpad and hospital for direct hospitalization and collaboration with mobile teams and geriatric hotlines, generalizing the level of medical intervention in Ehpad, and deepening the training of Ehpad caregivers in geriatrics.

[Geriatric restraints as a last resort]. / Contentions en gériatrie, dernier recours.

Relying on the remaining abilities of elderly people at home, in hospital or in residential care facilities for the dependent elderly, allows them to maintain their autonomy and avoid restraints. If geriatric caregivers observe an elderly person who is agitated, at risk of falling, or putting themselves in danger, they suggest strategies to calm the person. As a last resort, physicians may prescribe an appropriate restraint. This is a deprivation of liberty. The multidisciplinary evaluation every twenty-four hours of this care is based on the principle of beneficence by re-evaluating the prescribed device.

[Screening for frailty in the elderly subject]. / Dépister la fragilité chez le sujet âgé.

The identification of frailty can be done by any health professional. This assessment allows corrective measures to be taken in order to act early on reversible elements.

Clinical features of nursing and healthcare-associated pneumonia due to COVID-19.

INTRODUCTION: The objective of this study was to clarify the clinical differences between nursing and healthcare-associated pneumonia (NHCAP) and community-acquired pneumonia (CAP) due to COVID-19. We also investigated the clinical characteristics to determine whether there is a difference between the variant and non-variant strain in patients with NHCAP due to COVID-19. In addition, we analyzed the clinical outcomes in NHCAP patients with mental disorders who were hospitalized in a medical institution for treatment of mental illness. METHODS: This study was conducted at five institutions and assessed a total of 836 patients with COVID-19 pneumonia (154 cases were classified as NHCAP and 335 had lineage B.1.1.7.). RESULTS: No differences in patient background, clinical findings, disease severity, or outcomes were observed in patients with NHCAP between the non-B.1.1.7 group and B.1.1.7 group. The median age, frequency of comorbid illness, rates of intensive care unit stay, and mortality rate were significantly higher in patients with NHCAP than in those with CAP. Among the patients with NHCAP, the mortality rate was highest at 37.5% in patients with recent cancer treatment, followed by elderly or disabled patients receiving nursing care (24.3%), residents of care facilities (23.0%), patients receiving dialysis (13.6%), and patients in mental hospitals (9.4%). CONCLUSIONS: Our results demonstrated that there were many differences in the clinical characteristics between NHCAP patients and CAP patients due to COVID-19. It is necessary to consider the prevention and treatment content depending on the presence or absence of applicable criteria for NHCAP.

Treatment of Chronic Periodontitis with Smoking Cessation Care and Periodontal Surgery in an Elderly Patient: A Case Report Including a 4-year Follow-up.

This report describes a case of chronic periodontitis requiring treatment including smoking cessation care and periodontal surgery in an elderly patient with a long-term smoking habit. The patient, a 79-year-old man, presented with the chief complaint of halitosis. He had a 56-year history of smoking cigarettes. An initial examination revealed that 34.5% of sites had a probing depth (PD) of ≥4 mm, with 24.1% of sites showing bleeding on probing (BOP). Open bite and loss of appropriate anterior and lateral guidance were also found. Radiographic examination revealed extensive horizontal bone resorption in the maxillary and mandibular molars. Based on a clinical diagnosis of severe generalized chronic periodontitis, initial periodontal therapy consisting of plaque control, smoking cessation care, scaling and root planing, and caries treatment of #47 was performed. Prosthetic treatment with a removable partial denture was planned for #26, which was missing. The patient quit smoking at the end of initial periodontal therapy. Subsequently, surgical periodontal therapy including open flap debridement was performed on #16, #17, #18, and #27. Following reevaluation, a full metal crown (#47) and removal partial denture (#26) were placed. The patient was then placed on supportive periodontal therapy (SPT). Periodontal treatment including surgical therapy resulted in an improvement in PD and a reduction in the number of sites with BOP. The patient has not started smoking again since initial treatment. Improvement has been adequately maintained over a 4-year period. The present results suggest that even when a patient has been exposed to a risk factor for a long time, periodontal treatment and control of that risk factor can contribute to stabilization of periodontal conditions. Some problems with occlusion have persisted, however. Additional care is necessary to retain stable periodontal conditions during SPT.

[Select and combine tools to assess the risk of an elderly person falling]. / Choisir et savoir combiner les outils d'évaluation du risque de chute d'une personne âgée.

Falls are a major problem in the elderly population. It is important to be able to effectively estimate the risk in order to implement appropriate actions. The large number of existing tools and the sometimes divergent or contradictory data make clinical assessment of this risk difficult. A review of the literature helps to determine the most relevant methods.

[ALLeGRO, a constructive partnership around gerontechnologies]. / Allegro, un partenariat constructif autour des gérontechnologies.

The ageing of the French population is a challenge for the years to come. Gerontechnology represents an asset in the face of this challenge. Surprisingly, the hospital environment is not very well equipped. This is why the university hospital center of Angers has created the ALLEGRO living lab in order to promote the development of gerontechnology in the health sector with the active participation of users.

[Integrated geriatric assessment - resolved and unresolved issues (review).]

The review presents an analysis of the literature on the controversial issues of the use of Comprehensive Geriatric Assessment. For all its obvious significance and expediency, the questions remain WHO, WHERE and WHEN conducts it? Should it initially be one-step or step-by-step? What are the intermediate and end points of the study? Which tool for its screening is the least time-consuming and long-lasting? It is concluded that many issues have not yet been resolved and further research is needed on this issue.

[Some aspects of improving the medical and social rehabilitation of the elderly who permanently live in general-type boarding schools.]

The article reflects the age and gender structure of the contingent of elderly people living in a General boarding house. The most common diseases in this category of persons, the presence of a disability group and individual programs for rehabilitation (habilitation) of the disabled person were established. The need for medical care, including medicines, was studied. There is a need to improve measures for medical and social rehabilitation, including in improving the employment of this contingent of people and the development of their leisure time. Examples of positive experience in this area among other regions of the Russian Federation are given.

[A case of elderly myxedema coma patient with end-stage renal failure].

CASE: 84-year-old woman had been diagnosed hypothyroidism before, but she did not take tablets of thyroid hormone prescribed. Anorexia and decreased consciousness level were discovered by workers of the facility. Her family doctor found thyroid function abnormality as a cause, and she was introduced to our hospital to treat because the whole body condition was bad. Her physical examination was observed that JCS was 3-10. Laboratory examination showed that TSH 562.81 µIU/mL, fT4 0.40 ng/mL, pH 7.33, and Na 124 mEq/L. It was not a contradictory finding with the diagnostic criteria of mucus edema coma. Blood and peritoneal dialysis is denied, although her data indicated eGFR 8-10 ml/min/1.73 m2. Her hospitalization was long-term, but exhibited finally good clinical course. After three months of hospitalization, she was discharged from the hospital. The problems were as follows. The clear guideline of myxedema coma with end-stage renal failure state and many complications was not found. She and her family did not hope dialysis under this condition.We treated a case of myxedema coma in a case of an elderly person with terminal renal failure who did not hope dialysis. In addition to myxedema coma as a rare disease, there are many basic diseases in the elderly. Although it was a difficult case, it is important to repeatedly confirm the explanation and the intention of the person and the family with regard to the selection of the treatment policy.

[Compliance with recommendations during a stay in follow-up and rehabilitation care in the elderly, comparison of three intervention strategies]. / SSR, observance des recommandations : trois stratégies d'intervention.

The objective of this study was to compare three hierarchical intervention strategies of an educational program for the prevention of falls in elderly people in a follow-up and rehabilitation care facility, and to evaluate the compliance with the recommendations related to extrinsic risk factors for falls, behavioral and environmental.

[The power of words]. / Le pouvoir des mots.

Storytelling is a medium with extraordinary powers. It is an art of speech that addresses the imagination, opens the door to memories and emotions, and brings about a "well-being" and a sense of calm. A storyteller from the association Âge d'or de France talk about her experience in residential institutions for dependent elderly people, in the open or protected sector.

[Memory(ies) at risk ]. / Mémoire(s) en péril.

When an elderly person suffers from severe memory problems, it is useful to look at the behaviour of those around him or her. Serious "absences" can be observed, revealing an intergenerational memory at risk.

[Video calls to disoriented elderly persons during the COVID-19 health crisis]. / Appels vidéo auprès de personnes âgées désorientées pendant la crise sanitaire.

Maintaining an exchange between the disoriented elderly patient and his family circle is essential to help reduce patient anxiety. When visits are not possible, the implementation of video calls with highly disoriented individuals shows a benefit of these virtual exchanges. The introduction of new technologies, if accompanied, does not disturb the patient and does not alter the quality of the relationship.