Factors associated with caregivers' underestimation of quality of life in patients with Alzheimer's disease.

OBJECTIVE: The aim of this study was to identify the factors associated with differences between how Alzheimer's disease (AD) patients and their caregivers rate the patient's health-related quality of life (QoL). METHODS: Cross-sectional, multicentre study. Patients were 65 years or more, suffering from mild to moderate AD, native French speakers, with a main caregiver. Interrater agreement of the QoL-AD was assessed using the intraclass coefficient. A generalised linear model was used to identify factors related to the difference in health-related QoL scores between patients and their caregivers. RESULTS: The 122 patients of the study were 82 ± 6 years old and mainly women (69%). Independent factors related to the difference between patients and caregivers were: Mini Mental State Exam score (ß = 0.32; 95% CI = 0.05-0.59); instrumental activities of daily living score (ß = -0.61; 95% CI = -1.14 to -0.07); total Neuropsychiatric Inventory score (ß = 0.10; 95% CI = 0.05-0.59), and Zarit's burden score (ß = 0.09; 95% CI = 0.01-0.17). CONCLUSION: Practitioners must take into account the trend towards underestimation when health-related QoL is rated by caregivers or proxies.

A case of meningitis due to Achromobacter xylosoxidans denitrificans 60 years after a cranial trauma.

BACKGROUND: Achromobacter xylosoxidans (AX) is a non-fermentative aerobic gram-negative bacillus. It is an opportunistic pathogen and the causative agent of various infections. We report an original case of late posttraumatic meningitis due to AX denitrificans. CASE REPORT: An 83-year-old man was hospitalized for acute headache, nausea and vomiting. The emergency brain computer tomography (CT) scan did not reveal any anomaly. In his medical history, there was an auditory injury due to a cranial trauma incurred in a skiing accident 60 years earlier. Cytobiochemical analysis of the cerebrospinal fluid (CSF) revealed increased levels of neutrophils and proteins. The CSF bacterial culture was positive: the Gram stain showed a gram-negative bacillus, oxidase + and catalase +, and the biochemical pattern using the API 20 NE strip revealed AX dentrificans. Late posttraumatic meningitis on a possible osteomeningeal breach was diagnosed even though the breach was not confirmed because the patient declined a second brain CT scan. The patient was successfully treated with meropenem. CONCLUSIONS: This report demonstrates the importance of searching for unusual or atypical organisms when the clinician encounters meningitis in a particular context, as well as the importance of adequate follow-up of craniofacial traumas.

Churg-Strauss syndrome: retrospective study in Burgundian population in France in past 10 years.

Churg-Strauss Syndrome (SCS) is a systemic vasculitis associated with asthma and eosinophilia. The aim of our work is to describe this pathology in the Burgundian population in France. We counted from the hospitalisation data-processing summaries, the whole of the SCS hospitalised in Burgundy between 1998 and 2008. During the follow-up, the clinical and paraclinical characteristics of every patient were collected. The average prevalence is of 11.3 per million inhabitants and the incidence is of 1.2 new cases per million inhabitants per annum. There exists however, a great prevalence disparity and incidence amongst the various departments of the area. The patient's average follow-up is of 7.7 years. In 23% of the cases one finds a starting factor for vasculitis. The delay between the first signs and the diagnostic is an average of 61 months. The ANCA are positive in 26% of cases and of anti-myeloperoxidase specificity in 83% of cases (P < 0.001). The most profitable biopsies are essentially cutaneous and neuromuscular. At the diagnostic, two-third of the patients have had a treatment adapted according to the current recommendations based on the Five Factor Score. The remission rate within a 1-year period is of 77%. The remission is strongly correlated to the therapeutic protocol associating corticoids and cyclophosphamide (P < 0.05). In conclusion, the prevalence of SCS in our area is similar to that observed in other European regions. However, this vasculitis remains a difficult and often a tardive diagnostic pathology.

"Card sorting": a tool for research in ethics on treatment decision-making at the end of life in Alzheimer patients with a life threatening complication.

BACKGROUND: End stage dementia is a particularly difficult aspect of care for patients with Alzheimer's disease and related dementias. In care institutions, caregivers and family are concerned by treatment decision-making for an acute life threatening complication occurring in Alzheimer patients at the end of life. How should the best treatment pathway be decided: to treat or not to treat? Which arguments are used for decision-making? These are mainly ethical questions which are currently difficult to express and investigate. METHODS/DESIGN: Cross sectional multicentre study of clinical cases involving 67 health centres (university hospitals, general hospitals, local hospitals and homes for the elderly) in the east of France. The method was based on the "card sorting" technique, with a set of 36 cards, each labelled with a different item relating to arguments for treatment decision-making. For each clinical case, medical staff and carers expressed in a meeting the pieces of information which they believed had been taken into account in the decision. Each participant received a card game, selected fewer than ten and ranked them according to the importance they attached to each one. All selected cards were then put on the table anonymously for participants, respecting the order of importance of the cards in each pile. Lastly, all games were photographed together in order to analyse occurrence and order frequencies. The cards were then classified on the table by frequency to open the discussion. Discussion time, which was conducted by the head carer of the department, concerned the clinical situation of the patient based on the shared responses. DISCUSSION: During team meetings, the "card sorting" method was quickly adopted by professionals as a tool to assist with discussion beyond the context of the study. The participants were not compelled to mention their feelings in relation to a case, and it is significant that the anonymity which we tried to maintain so that each person felt "listened to" without value judgement was very often discarded by the individuals themselves.

Stroke in the very old: incidence, risk factors, clinical features, outcomes and access to resources--a 22-year population-based study.

BACKGROUND: For several years, the burden of stroke in very old patients has been increasing in western countries. Nevertheless, we have little information about this new challenge in individuals >or=80. METHODS: We ascertained all first-ever strokes in the population of Dijon, France (150,000 inhabitants), from 1985 to 2006. The incidence of stroke, risk factors, clinical presentation, resource mobilization and 1-month outcome were evaluated in individuals >or=80 and compared to the data obtained in younger patients. RESULTS: We collected 1,410 first-ever strokes in people >or=80 years (39%) versus 2,130 in those <80 years. The incidence was 997/100,000, and 68/100,000, respectively. Over the 22 years, the incidence of stroke in individuals >or=80 years rose significantly. A lower prevalence of diabetes, hypercholesterolemia and alcohol intake, as well as a higher prevalence of hypertension, atrial fibrillation, previous myocardial infarction and use of prestroke antiplatelet agents were noted in patients >or=80 years. The clinical presentation was severer and the 1-month outcome in terms of case fatality and handicap was worse, despite improvements observed over time. Finally, in patients >or=80 years, the use of CT scan, MRI, cervical Doppler, angiography and carotid surgery were significantly lower than for younger patients. Length of stay >30 days was more frequent, and discharge to prestroke residence was less common. However, all these improved between the first and the last study periods. CONCLUSIONS: Our findings have important implications not only for clinical management but also for initiating preventive strategies and health policy.

Prognostic factors in stage D heart failure in the very elderly.

BACKGROUND: The clinical characteristics of frail older patients with advanced heart failure have scarcely been studied. OBJECTIVE: To describe this population and to identify some prognostic factors of mortality. METHODS: 104 patients aged 75 years and older hospitalized with refractory heart failure were enrolled in a prospective multicentric study. RESULTS: Mean age was 87.2 +/- 5.3 years. Dyspnea (79.8%), crepitant rales (76.9%) and peripheral edema (73.1%) were particularly frequent. Signs of low cardiac output such as renal insufficiency (46.9%), cutaneous low flow (40.4%), and systolic hypotension (< or =100 mm Hg) (24.3%) were observed less often. Signs of cognitive impairment including anxiety (55.4%), sleep disorders (43.7%) and delirium (35.5%) were frequent. Asthenia and chronic pain were noted in 92.3 and 37.5% of cases, respectively. Mortality rates were 32.7, 59.6 and 71.2% during hospitalization, at 6 months and at 12 months, respectively. According to the multivariate Cox model, six significant factors suggesting a poor prognosis were observed: chronic renal insufficiency, past neuropsychological pathology, long-term treatment with nitrates, presence of edema, low cutaneous flow, and pain. The ability to sit on a chair was the only significant factor associated with a good prognosis. CONCLUSION: Our study identified some clinical and prognostic factors which had been observed in very old patients with refractory heart failure. Pain management has to be a priority in these patients in order to improve their quality of life.

Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis.

BACKGROUND: There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP). METHODS: The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments - Urology (U), Infectious Diseases (ID), Internal Medicine (IM), Geriatrics (G) - of two French university hospitals. RESULTS: The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen.Overall, a 3:1 ratio of community-acquired AP (CA-AP) to nosocomial AP (N-AP) was observed. Urine culture isolated mainly E. coli (58% of AP, 68% of CA-AP), with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen). For N-AP, these treatments were more likely to be inadequate (42% vs. 8%, p < 0.001) and had a higher rate of bacteriological failure (48% vs. 19%, p < 0.001). Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p < 0.001). Patients older than 49 had more underlying urinary tract disorders and a higher rate of clinical failure (30% versus 10%, p < 0.0001). CONCLUSION: This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.

Clinical determinants of failure in balance tests in elderly subjects.

We assessed the role of clinical and biological parameters on performance in four balance tests in elderly subjects. An observational study was conducted in the Center for Preventive Medicine of Nancy (France) in 2368 community-living elderly subjects aged 60 and older. Body mass index (BMI), Mini-Mental State Examination (MMSE), clock test, "Health score" and use of psychotropic drugs (UPD) were assessed. Participants performed four balance tests: "one-leg-stand" (OLS), "timed-up-and-go" (TUG), "rise-from-the-floor" (RFF) and "sit-to-stand" (STS). The statistical analysis showed that women were almost twice as likely to fail balance tests as men. In both women and men, the following determinant factors of the performance in balance tests were found: for OLS: age, BMI and health score; for TUG: age, BMI, clock test and health score; for RFF: BMI and health score. In addition, in women other determinant factors were: MMSE for OLS, UPD for TUG, age and clock test for RFF. In men, the clock test and the UPD were also significant determinant factors for OLS. Similar results were found for STS. In conclusion, female sex, overweight, low cognitive status, low self-perception of health and UPD were associated with a higher risk of failure in balance tests.

Is backward disequilibrium in the elderly caused by an abnormal perception of verticality? A pilot study.

OBJECTIVE: We hypothesised that backward disequilibrium (BD), defined by a posterior position of the centre of mass with respect to the base of support, could be caused by a backward tilt in the perception of verticality. METHODS: The relationship between BD, the perception of verticality, and the history of falls in 25 subjects aged 84.5+/-7.4 years was analysed. An original ordinal scale, the BD scale (BDS), was used to quantify BD. Postural (PV) and haptic verticals (HV) were measured in sagittal plane. RESULTS: BDS scores closely correlated with the number of falls (r = 0.81, p =10(-5)). The more the PV was tilted backward, the greater the BDS scores (r = -0.95, p<10(-6)), with a huge backward tilt of about 15 degrees in 4 subjects with severe BD. In these subjects, the tilt in perception of verticality was transmodal since a severe backward HV tilt was also found. CONCLUSIONS: This transmodality suggested high-order cognitive disruption in the construction of the subjective vertical used in postural control by subjects showing BD, which confirmed our hypothesis. SIGNIFICANCE: This study clearly shows that perception and action with respect to gravity are closely related and brings a new insight about fall mechanisms in the elderly.

Multidisciplinary management in geriatric day-hospital is beneficial for elderly fallers: a prospective study of 28 cases.

We determined whether management including medical, psychological, and physiotherapeutic approaches, over a period of 6 weeks, has a beneficial effect on motor abilities, psychological status, and independence of elderly fallers with psychomotor disadaptation syndrome (PDS). We included 28 subjects (mean age 81.4 years). They were assessed from a medical, motor, and psychological point of view at both the inclusion and the end of the multidisciplinary intervention. A follow-up was conducted with multidisciplinary assessment at 6 and 9 months after the beginning of the study in order to evaluate duration of benefits of the management. The statistical analysis concerned only subjects who took part in the total multidisciplinary program, i.e., 14 subjects. The multidisciplinary intervention had an overall positive impact on motor abilities as shown by the increase in the mini-motor test scores, the rate of success in rising from the floor and decrease of time for the dual task. This study also showed a reduction in the fear of falling and a decrease in the rate of fallers. This positive effect on motor abilities, fear of falling and rate of fallers was sustained until 9 months after the beginning of the multidisciplinary management. This study shows the importance of a multidisciplinary management of elderly fallers with PDS.

A new formula for correction of total calcium level into ionized serum calcium values in very elderly hospitalized patients.

Ionized calcium (Ca(2+)) seems to be the best measure of active serum calcium but, in France, numerous laboratories do not have Ca(2+) analyzers so that numerous clinicians use Payne's formula to obtain adjusted calcium (Ca(Ad)) values. In frail very elderly patients with protein/energetic malnutrition and very low concentrations of albumin, "correction" with Payne's formula usually gives false hypercalcemic results, so that hypocalcemia may be seriously underdiagnosed. Two hundred and ninety-four patients of 80 years and older with serum albumin level < 35 g/l were included in four French hospitals for elderly people. Biological measurements were standardized in order to determine Ca(2+) and total calcium (Ca(T)) in accordance with approved guidelines. Ca(Ad) was calculated with Payne's formula whereas the dependence of Ca(2+) with serum protein, albumin and Ca(Ad) was investigated by linear regression, the goodness-of-fit of each equation with the measure of Ca(2+) being studied. Taking into account serum protein and albumin levels, multiple linear regression gave the equation: Ca(2+) (mmol/l)=0.188-0.00469 protein (g/l)+0.0110 albumin (g/l)+0.401 Ca(Ad) with r(2)=0.442. The relative difference between the measure and the value given by the equation did not depend upon the center, and the correlation between measured and computed values of Ca(2+) was better, for any group, with our formula than with Payne's formula. When Ca(2+) was expressed with Ca(T) instead of Ca(Ad), albumin term was no longer significant and the new equation was: Ca(2+) (mmol/l)=0.592-0.00449 protein (g/l)+0.410 total calcium (mmol/l) with r(2)=0.438. We propose an alternative to direct measurement of Ca(2+) with a simple formula usable in geriatric units, which are often deprived of high-performance equipment.

Energy cost and cardiorespiratory adaptation in the "Get-Up-and-Go" test in frail elderly women with postural abnormalities and in controls.

BACKGROUND: This study investigated the hypothesis that postural abnormalities might increase energy expenditure during a clinical functional test in frail elderly persons. METHODS: Two groups of hospitalized women (aged 73 to 100 years) were recruited. Women who showed postural and gait abnormalities as described in the psychomotor disadaptation syndrome (PDS) were compared with control participants. The authors measured energy expenditure during the timed "up and go" test. For each participant, oxygen uptake, carbon dioxide output, expiratory minute ventilation, breathing frequency, heart rate, and alveolar ventilation were recorded 10 minutes before, during, and 10 minutes after exercise. The arterial pressure of carbon dioxide was estimated from expired gases. RESULTS: The mean oxygen uptake values were significantly higher in women with PDS than in the control group during exercise and recovery periods (4.89 +/- 1.68 vs 3.75 +/- 1.25 ml . kg(-1) . min(-1) and 4.69 +/- 1.45 vs 3.76 +/- 0.97 ml . kg(-1) . min(-1), respectively [p <.05]). Expiratory minute ventilation was always higher in women with PDS than in controls regardless of the period of the test (p <.05), and alveolar ventilation was higher in women with PDS only during the exercise period (p <.05). The estimated arterial pressure of carbon dioxide did not change significantly between the different phases of the test but was always lower (p <.05) in women with PDS compared with the control group. CONCLUSIONS: The significant increase in oxygen uptake during the exercise and recovery periods in women with PDS compared with controls suggests that postural abnormalities that characterize PDS may be associated with an increase in energy expenditure. In clinical practice, the low capacity to tolerate even moderate exercise must be considered when specific rehabilitation programs are offered to women with PDS.

Mini motor test: a clinical test for rehabilitation of patients showing psychomotor disadaptation syndrome (PDS).

Direct observation of postural and motor abilities appears as very important in assessment of patients showing psychomotor disadaptation syndrome (PDS). We examine feasibility and reliability of mini motor test (MMT) which has been developed in order to establish rehabilitation goals in this population. MMT is a 20-item score which assesses abilities in bed, quality of sitting position, abilities in the standing position, and quality of gait. MMT has been conducted by two different independent investigators, a physiotherapist and a physician, in four different geriatric centers. One hundred and one subjects (mean age: 84.9 +/- 6.0 years) were included in the study. The agreement between the two investigators was highly satisfying for both MMT total score and each item of MMT. Redundancy between items appeared very limited. The difference between investigators for MMT total score did not vary significantly with score of the mini-mental-state examination (MMSE). The correlation between MMT and the Katz index was found significantly negative. MMT is an easy direct-observation test which may be particularly useful in patients who present with severe postural and gait impairment. This test can be used in clinical practice by different professional actors in order to allow an interdisciplinary approach for a common rehabilitation goal in the PDS patients.

[Specificity of stroke in the elderly: clinical characteristics and impact on care]. / Particularités de l'accident vasculaire cérébral du sujet âgé et impact sur la prise en charge.

Stroke in the elderly differs from stroke in younger adults in several points. It represents the most frequent consequence of atherothrombotic disease associated with hypertension, diabetes and hypercholesterolemia. It is also the main complication of cardiac arrhythmia. From a clinical point of view, epileptic seizure is frequently observed at the onset, and prognosis is darkened by a high risk of dementia occurrence (20%). Management of stroke in acute phase requires intensive care, which has been shown to decrease mortality and handicap by 20% in Stroke Units. Fibrinolysis with rt-PA can be carried out till 80 years. Primary and secondary prevention are still very efficacious in old patients and decrease not only the risk of stroke, but also the risk of dementia. Moreover, influenzae vaccination has been shown to decrease the risk of stroke in the following year in subjects over 65 years.

Psychomotor disadaptation syndrome. A new clinical entity in geriatric patients.

Psychomotor Disadaptation Syndrome (PDS) is characterized by backward disequilibrium in a sitting and standing position, reactional hypertonia, an alteration of postural reactions, gait modifications, and fear of falling. PDS may be the result of a loss of postural reserves, reaching a frailty threshold that does not allow subjects to maintain an adequate functional level. This clinical picture may be associated with frontal-subcortical dysfunction in which microangiopathy could play a key role. PDS may be triggered by numerous factors, such as cardiovascular and metabolic diseases, falls, and bed rest. In addition to medical and neurological evaluations, a specific rehabilitation program is one of the most important aspects of the management of patients showing PDS.

[Admission to intensive care of very old patients]. / L'admission en réanimation des personnes très âgées.

UNLABELLED: THE EXTENT OF THE PROBLEM: Because of the costs of intensive care, there is a possibility that access to this sector may be limited for those above a certain age. It would therefore appear necessary to develop an ethical clinical strategy in order to assess as precisely as possible and on individual level, the benefits and risks of these techniques, since age itself is simply a criterion among so many others. Among the elements that are important for the decision is the respect of the patient's wish, when it can be obtained since this is a fundamental point. In studies conducted in the United States, 50 to 90% of the elderly persons interviewed did not wish to be resuscitated in the case of cardiac arrest. CRITERIA FOR ADMISSION: The decision to admit an elderly patient in an intensive care unit must take into account the functional state of the patient, appreciated on daily activity and mobility scores and the neuro-psychological assessment, before hospitalization. In parallel, the severity of the underlying disease and the impact on visceral failures, assessed by the severity scores on admission appear to be more reliable prognostic elements than the patients' age itself. FOLLOWING RESUSCITATION: The quality of life of elderly patients within the months following resuscitation is difficult to assess, but is considered as acceptable in the majority of surviving patients. IN PRACTICE: The choice of admission in intensive care of an elderly patient requires a multidisciplinary approach that takes into account the patient's and/or family's wishes, the benefit/risk ratio of the technical act but which also, in certain cases, bears in mind the principle of end of life and the patient's dignity.

[Ogilvie syndrome in the elderly: retrospective study of 40 cases]. / Syndrome d'Ogilvie chez la personne âgée: étude rétrospective de 40 cas.

OBJECTIVE: To assess, in a population of elderly patients, the circumstances clinical and progressive characteristics and form of management of an acute colonic pseudo-obstruction (ACPO). METHOD: Retrospective study of the files of 40 patients aged 70 and more having presented an acute colonic pseudo-obstruction and hospitalised in the university hospital in Dijon from January 1995 to June 2000. RESULTS: The population was composed of 24 men (60%) and 16 women (40%) with a mean age of 80.8 years. The reasons for hospitalisation were varied: only 15 patients had been referred for an occlusive syndrome. 39 patients presented with abdominal distension, 30 suffered from abdominal pain. In this population, 17 patients exhibited reduced or clearly limited mobility, 20 patients had altered cognitive capacity with an MMS < 20. Thirty-eight patients suffered from a progressive heart disease and 8 patients presented with advanced dementia. The usual treatment of these patients to help the intestinal transit included diuretics in 25 cases and agents slowing the transit in 19 cases. Biologically speaking, hypokalaemia was observed in 21 cases and increased thyroid stimulating hormone (TSH) in 3 cases. An image was obtained of the abdomen without preparation in all patients: the mean caecum diameter was of 9.8 cm. A colon aspiration was performed in 20 patients and molecules to improve peristaltism were administered in 21 cases, with neostigmine prescribed for 9 patients. Surgery was required for 7 patients and 3 of them subsequently died. In terms of progression, 20 patients were cured after treatment, 13 relapsed and 7 patients worsened. Unfortunately, 10 patients died in our series. DISCUSSION: In our study, the clinical profiles of acute colonic pseudo-obstruction were similar to those described in the literature: they occurred in varying circumstances, in medical or surgical settings ina predominantly male population of elderly, heavily dependent,patients. Treatment of this affection is not clearly codified for fragile patients with multiple diseases and the mortality rate observed should stimulate further studies, notably on pharmacological level.

[An overview on palliative care and the end of life. Results of a survey conducted in a sample of the French population]. / Regards sur les soins palliatifs et la fin de vie. Résultats d'une enquête réalisée sur un échantillon de la poulation française.

OBJECTIVE: To have an overview of the French population concerning palliative care. METHOD: French opinion poll, based on a questionnaire submitted to 302 persons recruited at random in the street, in several regions of France. It included questions concerning the representation of pain, the sick body, death, the end of life and palliative care. RESULTS: Regarding the management of pain, the majority of persons surveyed (59.6%) felt that the general practitioner was the appropriate referent to treat pain. The population's experience with regard to the death of a close relative revealed that death had occurred in hospital in 58.3% of cases. Nevertheless, the majority (57%) of the population wished to die in their own home. The concept of palliative care centres is increasing in the public's mind, but remains vague in its practical aspects for 60.9% of the population surveyed. For 29.5% of the population surveyed, information and training of health professionals in palliative care was considered as a priority. CONCLUSION: The end of life and death is a source of fear for most of the population. This motivates a transfer towards the medical corps for the professional and technical management of this period of life, and the health professionals must be prepared to respond appropriately to this specific demand.

Assessment of the use of hypolipidemic agents (HAs), mainly statins, in elderly subjects aged 80 years and more in Burgundy: analysis of 13,211 patients.

Only few studies have investigated the use of HA in elderly subjects and there are no data in very elderly subjects. We assessed the prescription of HA and analyzed the relationship between such prescriptions and frailty markers among persons aged 80 and more in an observational study. We recorded the prescriptions for 13,211 patients aged 80-109 years and affiliated to the "Mutualité-Sociale-Agricole (MSA)" of Burgundy over a 1-month period. The prescription of a HA among all included patients, and the existence of serious long-term disease(s) (LTD), polypharmacy or a prescription of cardiovascular drugs among patients receiving a HA were recorder. Among the 13,211 patients, 3412 aged 80-98 years were treated with an HA. The main HA were statins (70.4%), and fibrates were used in 27.3% of cases. Of these 3412 patients, 2250 had one or several LTD mainly coronaropathy, hypertension, diabetes mellitus or peripheral artery disease. The mean number of drugs per prescription was 6.37. Among subjects treated with HA, 40% also received antiplatelets, 35.6% ß-blockers and 30% inhibitors of the renin-angiotensin system. For 99% of the patients, the prescription of HA was a renewal. Prescribers were mainly general practitioners (96.8%). Statins are the most widely prescribed HA even among very elderly subjects. However, after 80 years the prescription of HA, mainly statins, decreases with aging. This could be explained by polypathology, polypharmacy and the deterioration in metabolic functions which are markers of frailty. This study should encourage research into the use of statins in very elderly subjects.