[Study of the links between type 2 diabetes and geriatric criteria]. / Étude des liens entre diabète de type 2 et critères gériatriques.

Type 2 diabetes in the elderly remains a major concern for all healthcare professionals and is itself considered a "global pandemic". Its prevalence is high and will continue to increase in years to come, becoming more and more prevalent in the elderly and very elderly. We offer a general summary of the work focusing on the links between type 2 diabetes and geriatric criteria.

[Prescribing inappropriate medication in the elderly: review of the main therapeutic scales]. / Prescription médicamenteuse inappropriée chez le sujet âgé : revue des principales échelles thérapeutiques.

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[Geriatrics and e-technology in an institution]. / Gériatrie et e-technologie en Ehpad.

The objective of the GER-e-TEC™ project is to provide a personalised medical follow-up of residents in nursing homes with the aid of a telemedicine intelligent platform. It will assist the nursing staff by automatically processing information obtained from sensors and questionnaires in order to give an early warning about high-risk situations. This telemedicine tool will enable health professionals to optimise residents' care.

[Frailty scales to be used in emergency unit for elderly patients]. / Des échelles pour repérer la fragilité du sujet âgé aux urgences.

It is essential to carry it out in the emergency unit in order to improve the care of the elderly subject in a hospital setting. In this context, the role of nurse host organiser seems essential in order to optimize this care, reduce the duration of the hospital stay and anticipate possible risks of decompensation of geriatric syndromes.

[The use and consequences of physical restraint in geriatric care]. / Contention physique en gériatrie, usages et répercussions.

The use of physical restraint with the elderly remains a much-debated topic. Its use remains criticised and is also something of a paradox given its practice in this kind of facilities. All health professionals may use it in their daily practice, in a wide variety of situations.

[Benzodiazepine withdrawal syndrome in the elderly patient]. / Le syndrome de sevrage aux benzodiazépines chez le sujet âgé.

Withdrawal syndrome is a well known diagnostic entity. As the symptomatology related to this syndrome is extremely unspecific, care must be taken not to ignore withdrawal syndrome, the consequences of which, while rare, can lead to often long and complicated hospitalisations.

[Horton disease in the elderly patient]. / La maladie de Horton du sujet âgé.

Horton disease is difficult to diagnose in the elderly, due to the non-specificity of clinical signs. When evoked in the case of recent headaches, laboratory tests must be carried out to look for signs of inflammation.

[What to do before a hypervitaminia B12 in the elderly]. / Conduite à tenir devant une hypervitaminémie B12 chez le sujet âgé.

Hypervitanimia B12 is an early marker of serious pathologies. These include solid neoplasms, malignant blood diseases and acute/chronic hepatopathies. Hypervitaminemia B12 in geriatrics is thereby an indicator in the diagnosis and prognosis of these conditions.

Assessment of the Zulfiqar Frailty Scale (ZFS) in Primary Healthcare.

INTRODUCTION: The primary aim of the study was to validate the Zulfiqar Frailty Scale (ZFS) and examine its concordance with the modified Short Emergency Geriatric Assessment (mSEGA) scale, Part A. METHODS: A prospective observational study was conducted in Guadeloupe (France) over a two-month duration (from 20 February to 20 April 2024), involving elderly individuals aged 65 and older, deemed self-sufficient with an ADL (Activities of Daily Living) score exceeding four out of six. RESULTS: Within this community cohort of 98 individuals, averaging 75 years in age, frailty according to the modified SEGA criteria was prevalent in 29%. Frailty according to the "ZFS" score was prevalent in 40%. Key predictors of frailty identified in our study included age, comorbidity (Charlson score), polypharmacy (total number of medications and therapeutic classes), and functional ability (ADL scores). Notably, experiences of falls and hospitalizations within the past six months significantly influenced the classification of frailty according to both ZFS and SEGA scales. Significant associations with the presence of home care aides (p < 0.0001), monopodal support test results (p < 0.0001), memory impairments (p < 0.0001), and recent hospitalizations (p = 0.0054) underscored the multidimensional impact of frailty. The Pearson correlation coefficient and its 95% confidence interval between the SEGA and Zulfiqar Frailty Scales stood at 0.73 [0.61: 0.81]. The discernment threshold for frailty was set at three out of six criteria, showcasing a sensitivity of 64% and a negative predictive value of 80%. The area under the curve (AUC) for the Zulfiqar Frailty Scale was reported as 0.8. CONCLUSION: The "ZFS" tool allows for the detection of frailty with a highly satisfactory sensitivity and negative predictive value.

[SEGA frailty scale in emergency: back to basics]. / Échelle de fragilité SEGA aux urgences : retour aux sources.

Can the SEGA scale, implemented in the emergency department, effectively predict morbidity and mortality? A prospective study was conducted from January 30, 2018, to July 16, 2018, at the Emergency Department of Chaumont Hospital. Patients aged over 65 were included, while those under 65, in palliative care, or in a life-threatening emergency were excluded. The SEGAm score was calculated for each included patient, and their outcomes were assessed at the end of the emergency department visit and one year later. A total of 278 subjects were included. Vital status at one year was known for all subjects, with no loss to follow-up or censoring. At one year, 56 patients out of 278 (20.1%, 95% CI 15.6% to 25.3%) had died, with less than half of these deaths (n = 25) occurring after readmission to the emergency department or during the emergency visit. The average age was 82 ± 8.2 years, with 158 women and 120 men. Regarding living arrangements, 130 (46.8%) lived at home without caregivers, 100 (36%) lived at home with caregivers, and 48 (17.3%) lived in nursing homes. The average Charlson Comorbidity Index was 5.49 ± 1.99, with an average number of medications of 7.52. The primary methods of referral were as follows: C15 for 144 patients (51.8%), general practitioner for 59 patients (21.2%), spontaneous consultation for 58 patients (20.9%), and family referral for 8 patients (2.9%). The main reasons for admission were falls for 55 patients (19.8%), dyspnea for 33 patients (11.9%), and other reasons for 60 patients (21.6%). Post-emergency department disposition included hospitalization for 167 patients (60.1%) and discharge for 111 patients (39.9%), with no deaths occurring during this period. The SEGAm frailty score (grid A) had an average completion time of 8.18 min ± 3.64. A score of ≤ 8 was found for 85 patients (30.6%), a score between 9 and 11 for 51 patients (18.3%), and a score ≥ 12 for 142 patients (51.1%). In this geriatric population, the risk of death at 12 months was estimated at 31% (95% CI 23.5% to 39.3%) for subjects with a SEGA score exceeding 12, compared to approximately 10% for those with lower SEGA scores. The risk of death or readmission was 52.8% (95% CI 44.3% to 61.2%) for subjects with a SEGA score exceeding 12, compared to 20% to 30% for those with lower SEGA scores. The SEGA score provides valuable prognostic information that is not fully captured by the Charlson score or reason for hospitalization.

[Use of the Stopp/Start version 2 tool in an acute geriatric unit]. / Usage de l'outil Stopp/Start version 2 en unité gériatrique aiguë.

INTRODUCTION: Inappropriate drug prescriptions (IP) lead to a high risk of adverse effects, especially for the elderly. Their detection is essential - which can be done using therapeutic lists, including the Stopp/Start scale version 2. METHODS: Observational study - from August 1, 2016, to November 30, 2016, in an advanced geriatric unit at Rouen University Hospital - using the Stopp/Start version 2 list. RESULTS: Eighty-five patients were included, with a ratio of 1.36 women per every man. Sixty-one patients (71.8%) had prescriptions for more than five drugs. The average Charlson comorbidity score was 6.05. One hundred ninety-one IPs were found. Classes E and G (kidney function and respiratory system prescriptions, respectively) were not uncovered. Fifty-four Stopp criteria - 66% of Stopp criteria - never emerged during our study. Using the 34 Start criteria, 187 omissions of prescriptions were found. Classes F and G (endocrine system and urogenital system drugs, respectively) were not observed at any time. Ten criteria were never seen (B3/C1/C4/C5/E6/E7/F1/G1/G2/G3). Nineteen criteria were mentioned less than three times - i.e., in approximately 10% of omissions. CONCLUSION: Our study is part of an approach to protecting the elderly. A significant number of IP and prescription drug omissions were uncovered using this Stopp/Start version 2 tool.

Evaluation of Nutritional Status in an Acute Geriatric Unit: Retrospective Study and Analysis of Frailty Syndrome.

INTRODUCTION: The aim of our study is to evaluate the nutritional status of patients in an acute geriatric unit. METHODS: Patients included in the study were hospitalized in an acute geriatric unit over a period of 6 months. The nutritional status of each patient was evaluated with anthropometric measurements (the BMI and MNA scales), and biological measurements (albumin). Frailty was evaluated using three scales: the Fried scale, the CFS and the modified SEGA scale. RESULTS: A total of 359 patients were included, comprising 251 women (70%) with an average age of 85.28 years. The study showed that 102 elderly subjects were considered undernourished according to the BMI scale, 52 subjects were undernourished according to the MNA scale, and 50 subjects were undernourished according to their albumin levels. The relationships between undernutrition and frailty syndrome studied in our work show that elderly subjects who are undernourished according to the BMI and MNA scales are significantly frail according to Fried and Rockwood, whereas those who are undernourished according to their albumin levels are significantly frail according to Fried and the modified SEGA scale. CONCLUSION: The relationship between undernutrition and the frailty syndrome is close, and their joint screening is necessary, whether on an outpatient or in-hospital basis, in order to prevent negative events related to comorbidities and geriatric syndromes.

Assessing the Efficacy of the Modified SEGA Frailty (mSEGA) Screening Tool in Predicting 12-Month Morbidity and Mortality among Elderly Emergency Department Visitors.

INTRODUCTION: Rapid identification of frail elderly individuals upon admission to the emergency department is pivotal for enhancing their care and alleviating emergency room congestion. OBJECTIVE: This pilot study aims to explore the relationship between morbidity, mortality, and frailty, as assessed by the mSEGA scale, among individuals aged 65 years or older in the emergency department. METHODS: A retrospective cohort study was conducted at a single center. The pilot study included patients aged 65 and above who were admitted to Chaumont Hospital's emergency unit (Haute-Marne department) for medical and/or surgical reasons between 1 July 2017 and 31 January 2018. Data encompassed socio-demographic characteristics, medical profiles, and emergency department visit details. Outcomes for patients one year post-admission were obtained through consultation with their respective general practitioners. RESULTS: A total of 255 subjects participated, with a mean age of 82.1 ± 8.2 years. Primary admission reasons were falls (n = 51, 20.0%), digestive issues (excluding hemorrhage) (n = 30, 11.8%), and "other" causes (n = 61, 23.9%). Among participants, 78 (30.6%) scored ≤8 on the mSEGA frailty scale, 49 (19.2%) scored 9 to 11, and 125 (50.2%) scored ≥12. Concerning post-emergency department outcomes, 152 patients (59.6%) were hospitalized, while 103 (40.4%) were discharged. No deaths were reported during the study period, and vital status was known for all subjects at the one-year mark. At that point, 63 out of 255 patients had passed away, with 30 of them being readmitted to the emergency department either before or at the time of their one-year death. The 12-month survival rate analysis based on frailty status revealed a significant difference. Low-frailty patients exhibited a survival rate of 87.2% (95% CI; [77.5-92.9]), whereas frail/very frail patients had a survival rate of 70.0% (95% CI; [62.7-76.2]). Similarly, the 12-month readmission-free survival rate demonstrated statistically significant disparities. Low-frailty patients had a rate of 76.9% (95% CI; [65.9-84.8]), compared to 51.4% (95% CI; [43.8-58.5]) for very frail patients. CONCLUSION: Utilizing the mSEGA frailty scale in the Emergency Department could provide crucial prognostic insights, highlighting significant differences in 12-month survival and readmission-free survival rates based on frailty status.

Early Hospital Discharge Using Remote Monitoring for Patients Hospitalized for COVID-19, Regardless of Need for Home Oxygen Therapy: A Descriptive Study.

AIM: Since beds are unavailable, we prospectively investigated whether early hospital discharge will be safe and useful in patients hospitalized for COVID-19, regardless of their need for home oxygen therapy. POPULATION AND METHODS: Extending the initial inclusion criteria, 62 patients were included and 51 benefited from home telemonitoring, mainly assessing clinical parameters (blood pressure, heart rate, respiratory rate, dyspnea, temperature) and peripheral saturation (SpO2) at follow-up. RESULTS: 47% of the patients were older than 65 years; 63% needed home oxygen therapy and/or presented with more than one comorbidity. At home, the mean time to dyspnea and tachypnea resolutions ranged from 21 to 24 days. The mean oxygen-weaning duration was 13.3 ± 10.4 days, and the mean SpO2 was 95.7 ± 1.6%. The nurses and/or doctors managed 1238 alerts. Two re-hospitalizations were required, related to transient chest pain or pulmonary embolism, but no death occurred. Patient satisfaction was good, and 743 potential days of hospitalization were saved for other patients. CONCLUSION: The remote monitoring of vital parameters and symptoms is safe, allowing for early hospital discharge in patients hospitalized for COVID-19, whether or not home oxygen therapy was required. Oxygen tapering outside the hospital allowed for a greater reduction in hospital stay. Randomized controlled trials are necessary to confirm this beneficial effect.