Improved oral hygiene and Candida species colonization level in geriatric patients.

OBJECTIVES: This work consists in improving oral hygiene (OH) for elderly dependent people in long-term hospital care, in order to decrease the degree of colonization and the associated risk of developing oral candidiasis. As this population frequently suffers from such colonization and because it is difficult to install and practice OH care, a study protocol was designed at the request of geriatricians. The objective of the present study was to set up a programme of OH, applied by the care staff, and to monitor oral colonization of by Candida spp. BASIC RESEARCH DESIGN: We compared the levels of hygiene and Candida spp. colonization for a group of 110 long-term patients in geriatric departments at T1, when clinical data were collected and oral mycological samples taken before the OH protocol was applied, and at T2, during the postprotocol phase after 3 months of application, when the clinical data and sample collection were repeated. RESULTS: During these 3 months 11 patients died. These patients were excluded from the results, which are presented for matched series of the 99 patients still present at T2. Statistical analysis comparing the clinical and biological parameters at T1 and T2 established that there had been an improvement in OH: the 'adequate' level was reached for 72.4% of patients at T2 compared with 41.8% at T1 (P < 0.001) and the 'very inadequate' level was observed for 9.2% at T2 compared with 27.9% at T1 (P < 0.01). A reduction was observed in the number of patients showing the highest degree of C. albicans and C. glabrata colonization (> 50 colony forming units) from 41.9% at T1 to 24.9% at T2 (P < 0.05) and from 56.4% at T1 to 13.0% at T2 (P < 0.05) respectively. The number of patients with candidiasis fell significantly from 43.2% at T1 to 10.2% at T2. CONCLUSIONS: The OH protocol led to an overall decrease in Candida spp. colonization, a significant reduction in the number of candidiasis and an improvement in the level of oral and denture hygiene but vigilance is still necessary concerning OH care and the initial training of staff in specific care of the mouth.

Evaluation of some platelet parameters in a group of elderly people.

Platelet production time (PPT), plasmatic beta-thromboglobulin (beta-TG), platelet density distribution, and mepacrine labelled granular content of the platelets were simultaneously determined in a group of elderly subjects. Vascular deterioration, assessed by the history and clinical examination, was variable in extension and severity. PPT was slightly but not significantly shortened, whereas the raised beta-TG level and diminished platelet density and granular content suggested an in vivo release reaction process. The results are not correlated with the apparent severity of vascular deterioration, and the release reaction may not be solely related to enhanced platelet-vessel wall interactions.

Cutaneous cholesterol and plasma lipoproteins in elderly active and bedridden patients compared with young adults.

This report concerns two groups of elderly patients, one active and the other inactive with cardiovascular histories. Cutaneous and plasma cholesterol (Ch) and the lipoprotein fractions were analyzed in each group and compared with those of a young group. The cutaneous histological ageing type was studied in the three groups. No histological difference was seen to exist between the elderly populations (skin type II), the young group had normal type O skin. A significant difference was seen to exist between the levels of cutaneous Ch of the two elderly groups and that of the young group. Changes in the cutaneous Ch with respect to the ratio (total Ch/HDL Ch) were found to differ in the two elderly groups: the active elderly patients presented a positive correlation as did the young subjects but the inactive patients showed a negative correlation.

[Treatment of severe urinary infection in the elderly. Clinical and bacteriological study of 130 cases (author's transl)]. / Le traitement de l'infection urinaire sévère du sujet âgé. A propos d'une étude clinique et bactériologique portant sur 130 cas.

Strict criteria were applied in the choice of the 130 patients with severe urinary infections included in the study: men or women over 65 years of age presenting with clinical signs and symptoms, a bacterial count greater than or equal to 10(6)/mm3, one type of germ found on urine culture. The results of an antibiogram showed the frequency with which each germ was involved and their sensitivity to antibiotics, more particularly gentamicin, minocyclin, sulphamethoxazole-trimethoprime, oxolinic acid. Based on sensitivity and tolerance criteria, the choice of antibiotic was : oxolinic acid orally ; gentamicin parenterally, after evaluation of renal function. These results can assist the physician, when confronted with cases of severe urinary infection, and before the results of the antibiogram are available, in choosing effective therapy adapted to each case.