[Knowledge and application of the HAS recommendations concerning the diagnosis of undernutrition in people aged 70 and above: an international online survey among members of the "Société Française de Gériatrie et de Gérontologie"]. / Connaissances et application des recommandations HAS concernant le diagnostic de la dénutrition chez la personne de 70 ans et plus : une enquête menée en ligne auprès des membres de la Société française de gériatrie et de gérontologie.

OBJECTIVES: To assess the knowledge and the use in clinical practice of the "French National Authority for Health" (HAS) 2021 recommendations on the diagnosis of malnutrition in older adults aged 70 years and above. METHODS: An online survey was developed by the working Group on Geriatrics and Nutrition (GEGN) of the "Société Française de Gériatrie et de Gérontologie (SFGG)" and conducted among members of the SFGG. A self-administered questionnaire composed of 21 closed questions was used. RESULTS: A total of 132 (10.2 %) members of the SFGG responded to the survey. The respondents were aged 43.4 ± 9.94 years old and 97 (73.5 %) were women. Almost half of them were medical doctors (n = 53 ; 40.2 %). Of the respondents, 81 % had already heard of the HAS 2021 recommendations. This percentage is higher for doctors (96 %) than for other professions (74 %). French respondents were more likely to have heard of these -recommendations (84 %) than respondents from other countries (42.9 %). However, only 41.6 % of the respondents believe they know these recommendations in detail. On a visual analogue scale from 0 (never) to 100 (always), respondents use these recommendations in their professional practice at 76.8 ± 20.2 %. However, on a scale from 0 (never difficult) to 100 (always difficult), some barriers to their use in clinical practice were highlighted. These mainly concerned the measurement of muscle mass (84.4 ± 17.2 %) and muscle strength (79.5 ± 19.9 %) in patients. CONCLUSION: Although the majority of respondents use the HAS 2021 recommendations in their professional practice, they often have difficulties in measuring muscle strength and muscle mass of their patients. The assessment of sarcopenia still needs to be implemented in clinical routine. Until then, better communication about simple alternatives that do not require special equipment is needed.

Decreasing hospitalizations through geriatric hotlines: a prospective French multicenter study of people aged 75 and above.

BACKGROUND: The Emergency unit of the hospital (Department) (ED) is the fastest and most common way for most French general practitioners (GPs) to respond to the complexity of managing older adults patients with multiple chronic diseases. In 2013, French regional health authorities proposed to set up telephone hotlines to promote interactions between GP clinics and hospitals. The main objective of our study was to analyze whether the hotlines and solutions proposed by the responding geriatrician reduced the number of hospital admissions, and more specifically the number of emergency room admissions. METHODS: We conducted a multicenter observational study from April 2018 to April 2020 at seven French investigative sites. A questionnaire was completed by all hotline physicians after each call. RESULTS: The study population consisted of 4,137 individuals who met the inclusion and exclusion criteria. Of the 4,137 phone calls received by the participants, 64.2% (n = 2 657) were requests for advice, and 35.8% (n = 1,480) were requests for emergency hospitalization. Of the 1,480 phone calls for emergency hospitalization, 285 calls resulted in hospital admission in the emergency room (19.3%), and 658 calls in the geriatric short stay (44.5%). Of the 2,657 calls for advice/consultation/delayed hospitalization, 9.7% were also duplicated by emergency hospital admission. CONCLUSION: This study revealed the value of hotlines in guiding the care of older adults. The results showed the potential effectiveness of hotlines in preventing unnecessary hospital admissions or in identifying cases requiring hospital admission in the emergency room. Hotlines can help improve the care pathway for older adults and pave the way for future progress. TRIAL REGISTRATION: Registered under Clinical Trial Number NCT03959475. This study was approved and peer-reviewed by the Ethics Committee for the Protection of Persons of Sud Est V of Grenoble University Hospital Center (registered under 18-CETA-01 No.ID RCB 2018-A00609-46).

Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review.

Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.

Associations between Vitality/Nutrition and the Other Domains of Intrinsic Capacity Based on Data from the INSPIRE ICOPE-Care Program.

BACKGROUND: The vitality domain of intrinsic capacity (IC) represents the synthesis of biological interactions and metabolism. As part of the Integrated Care for Older People (ICOPE) program developed by the World Health Organization (WHO), vitality focuses on the nutritional status of older adults. The objective of this work was to describe the vitality domain of IC in community-dwelling older people and to examine the associations of the vitality components (appetite loss and weight loss) with the other IC domains assessed within the framework of ICOPE. METHODS: Cross-sectional data were obtained between January 2020 and February 2022 through the INSPIRE-ICOPE-Care program, a real-life ICOPE implementation initiative developed in the Occitania region of France. Participants were men and women aged 60 and older, looking for primary care services within the French healthcare system. RESULTS: Appetite loss was reported by 14.0% (2013) of the participants, and weight loss by 12.4% (1788). A total of 863 participants (6.01%) declaring weight loss also suffered from appetite loss. In total, 2910 participants (20.27%) screened positive for the domain of vitality. Appetite loss was significantly associated with positive screenings for the domains of cognition (OR = 2.14 [1.84;2.48]), vision (OR = 1.51 [1.28;1.79]), hearing (OR = 1.18 [1.01;1.37]), psychology (OR = 3.95 [3.46;4.52]), and locomotion 'OR = 2.19 [1.91;2.51]). We found significant associations of weight loss with the IC domains of cognition (OR = 1.65 [1.42;1.93]), psychology (OR = 1.80 [1.56;2.07]), locomotion (OR = 1.64 [1.41;1.91]), vision (OR = 1.24 [1.04;1.47]), and hearing (OR = 1.32 [1.12;1.55]). People reporting simultaneous appetite and weight loss showed higher odds of screening positive for psychological (OR = 5.33 [4.53;6.27]) and locomotion impairments (OR = 3.38 [2.88;3.98]). CONCLUSIONS: Appetite and weight loss are common among older people and are related to other potential IC impairments, especially psychological and locomotion. Further studies are needed to explore the longitudinal associations of vitality with the incidence of clinically meaningful declines in the other IC domains.

[Conducting a multimodal exercise program in primary and secondary prevention of mobility disabilty in older adults at risk: guidelines and practical applications]. / Conduite d'un programme d'exercice multimodal en prévention primaire et secondaire de la perte de mobilité chez le senior à risque : recommandations et applications pratiques.

The implementation of strategies to prevent mobility disability in seniors at-risk with a strong focus on exercise is a public health imperative. These strategies must follow a pragmatic, structured and personalized approach. In order to obtain short, medium and long-term benefits, it is essential to consider the coordination of adapted physical exercise programs and to harmonize good practices. In support of national policies for the prevention of loss of autonomy, it is important to define clear guidelines to conduct effective programs. These programs should have a strong emphasis on evidence-based literature and should be validated by a consensus of multi-professional experts. The aim of this consensus is to outline the steps implementing these programs, to present their constituent elements and their practical application. Conception and elaboration of these programs should include frequency, intensity, duration, type of work, volume and individual progressiveness. Programs should also be focused on a personalised approach to develop participant health education, self-efficacy and empowerment for physical activity to ensure long-term health related behaviours. Moreover, trained professionals must supervise these programs in order to assure participants safety and program effectiveness. These guidelines will support policies for the prevention of loss of autonomy and mobility, throughout their development over the national territory.

Minerals and Antioxidant Micronutrients Levels and Clinical Outcome in Older Patients Hospitalized for COVID-19 during the First Wave of the Pandemic.

Excessive inflammatory response has been implicated in severe respiratory forms of coronavirus disease 2019 (COVID-19). Trace elements such as zinc, selenium, and copper are known to modulate inflammation and immunity. This study aimed to assess the relationships between antioxidant vitamins and mineral trace elements levels as well as COVID-19 severity in older adults hospitalized. In this observational retrospective cohort study, the levels of zinc, selenium, copper, vitamin A, ß-carotene, and vitamin E were measured in 94 patients within the first 15 days of hospitalization. The outcomes were in-hospital mortality secondary to COVID-19 or severe COVID-19. A logistic regression analysis was conducted to test whether the levels of vitamins and minerals were independently associated with severity. In this cohort (average age of 78 years), severe forms (46%) were associated with lower zinc (p = 0.012) and ß-carotene (p < 0.001) concentrations, and in-hospital mortality (15%) was associated with lower zinc (p = 0.009), selenium (p = 0.014), vitamin A (p = 0.001), and ß-carotene (p = 0.002) concentrations. In regression analysis, severe forms remained independently associated with lower zinc (aOR 2.13, p = 0.018) concentrations, and death was associated with lower vitamin A (aOR = 0.165, p = 0.021) concentrations. Low plasma concentrations of zinc and vitamin A were associated with poor prognosis in older people hospitalized with COVID-19.

FGF19 and muscle architecture in older patients.

BACKGROUND: Sarcopenia has a significant medical and economic impact. Serum fibroblast growth factor 19 (FGF19) has recently been described as promoting muscle mass and strength, and could be an interesting marker for early diagnosis of sarcopenia and prevention of its consequences. Ultrasound is a robust non-invasive technique used to measure muscle parameters, which cannot be evaluated by usual body composition measures, but are known to be associated with muscle function. In this cross-sectional cohort study, we aimed to determine whether FGF19 levels were correlated with functional muscle tests and muscle ultrasound parameters. METHODS: Patients over 70 years old with a mobility disability risk were recruited from the cohort of the "well on your feet" mobility loss prevention program. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older Patients 2 (EWGSOP2) criteria. We have performed functional battery tests, muscle ultrasound measures and bioimpedance spectroscopy. FGF19 levels were measured by the ELISA method. RESULTS: Out of 52 patients involved (34 women, mean age 81.3 years), 30 patients were sarcopenic (15 patients with probable sarcopenia and 15 with certain sarcopenia). Sarcopenic patients were older (mean 82.8 versus 79.6 years, P = 0.033), with higher frailty Fried score (P = 0.006), lower IADL score (P = 0.008), had lower daily protein intakes (P = 0.023) and were less performant to muscle functional tests than non-sarcopenic patients. Serum FGF19 levels were negatively correlated with the SPPB score (rs = 0.28; P = 0.045). FGF19 levels were correlated positively with the pennation angle (rs = 0.31; P = 0.024), but negatively with muscle fiber length (rs = -0.44; P = 0.001). We found no association between FGF19 and muscle thickness (P = 0.243). CONCLUSION: We highlighted in older patients significant correlations between FGF19 levels, pennation angle and muscle fiber length, suggesting that FGF19 could provide an enabling environment for the development of large muscle fibers, as previously suggested in histological studies in mice. However, high FGF-19 levels were unexpectedly associated with a low SPPB score. Further studies are needed to validate and further elucidate these exploratory findings.

Screening for hypertension-mediated organ damage and aetiology: still of value after 65 years of age?

BACKGROUND: Secondary forms and hypertension-mediated organ damage (HMOD) may differ between younger and older hypertensive patients. The aim of the present study was to explore the specificity of HMOD and secondary forms in patients ≥ 65 years in comparison to younger ones in a contemporary cohort. METHODS: We analysed 938 patients recruited between 2004 and 2014 (Cardiology department, Croix-Rousse Hospital, Lyon) who had at baseline HMOD and secondary forms screening among them 190 were ≥ 65 years. RESULTS: The mean (2.1 ± 0.8 vs. 1.2 ± 0.9, P < 0.001) and frequency of HMOD (96.3% vs. 72.9%, P < 0.001) was higher in patients ≥ 65 years than younger ones. Carotid femoral pulse wave velocity > 10 m/s was the most frequent HMOD in patients ≥ 65 years (90.1%), while echocardiographic left ventricular hypertrophy was the most common in the younger patients (45.0%). Among ECG left ventricular indexes, only R wave in aVL lead was significantly more frequently observed in patients ≥ 65 years (32.6%) than in younger ones (19.0%, P < 0.001). The frequency of secondary hypertension was not significantly different between younger and older patients (respectively; 30.5% vs. 27.8%, P = 0.487). The most frequent aetiology was primary aldosteronism regardless of age, followed by renovascular hypertension (6.3% vs. 3.3%, P = 0.038). Among older patients, 3.2% were treated with adrenalectomy and 6.3% with percutaneous transluminal renal angioplasty. CONCLUSION: Extensive screening of HMOD in older patients may be questionable as nearly all patients had one; aetiology must however be explored as a third of older patients had a secondary form.

Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia: a randomised study.

BACKGROUND: Treating pneumonia in old patients remains challenging for clinicians. Moreover, bacterial antimicrobial resistance is a major public health threat. OBJECTIVE: The PROPAGE study evaluated the interest of a strategy using serial measurements of procalcitonin (PCT) to reduce the duration of antibiotic therapy in old patients with pneumonia. METHODS: PROPAGE took place from Dec.-2013 to Jun.-2016 in eight French geriatric units. It was a prospective, comparative, randomised, open-label study involving old patients (≥ 80 years) who had initiated antibiotic treatment for pneumonia in the previous 48 h. PCT was monitored in all patients and two decision-making PCT-based algorithms guided antibiotic therapy in patients from the PCT group. RESULTS: 107 patients were randomised (PCT, n = 50; Control, n = 57). Antibiotic therapy exposure was reduced in the PCT group as compared to the Control group (median duration of antibiotic therapy, 8 vs. 10 days [rank-test, p = 0.001]; antibiotic persistence rates on Days 6 and 8, 54% and 44% vs. 91% and 72%) and no significant difference was found in recovery rate (84% vs. 89.5%; Pearson Chi² test, p = 0.402). CONCLUSION: Although, the superiority of the strategy was not tested using a composite criterion combining antibiotic therapy duration and recovery rate was not tested due to the small sample size, the present study showed that monitoring associated with PCT-guided algorithm could help shorten antibiotic treatment duration in the very old patients without detrimental effects. Measuring PCT levels between Day 4 and Day 6 could be helpful when making the decision regarding antibiotic discontinuation. TRIAL REGISTRATION: NCT02173613. This study was first registered on 25/06/2014.

Adherence to recommendations after comprehensive geriatric assessment by mobile geriatric team during 500 home visits / Suivi des recommandations de l'Unité mobile extrahospitalière de Lyon-Sud sur 500 visites à domicile

Mobile geriatric team making home visit (MGT) were created to reinforce the link between home and hospital. Frail elderly patients can benefit from a comprehensive geriatric assessment (CGA) by a geriatric mobile team during a home visit. MGT at the hospital center of Lyon Sud presents recommendations after a CGA to better adjust healthcare to patients' needs. There are few studies that have analysed the MGT who treat patients at home. Objectives: The goal of the study was to determine adherence rate at 2 months and examines the socio-demographic profile of patients assessed by the MGT. We conducted a descriptive and retrospective study in single center, with 500 patients during 2 years (2016-2017). Results: The mean adherence rate was 65,1%. The highest rate concerned recommendations on the future orientation. The lower rate concerned recommendations on lifestyle and environment. Mean age of the 500 patients was 83.5 years, 61% were women. The patients included in this study take an average of seven prescription medications (whitout psychotropic medications). The majority of the patients was GIR 3 and achieved an average score of 3 on ADL scale and 2 of IADL scale. Ninety-six per cent of the patients had a caregiver. It has been proven statistically that, adherence rate of recommendations (more than 65%), reduce unplanned hospitalizations. Conclusion: This study with a large sample of patients allows to better describe patients seen at home. It is a vulnerable population presenting a polypathology, dependence, associated with an unstable socio-family context. This work shows that the recommendations must be applied to limit hospitalizations and that the involvement of the team makes it possible to improve the follow-up of the recommendations.

L'unité mobile extrahospitalière de gériatrie de Lyon-Sud propose une expertise gériatrique pluridisciplinaire au domicile des patients. Elle émet des recommandations pour rationaliser le parcours du sujet âgé en fonction de ses problématiques. L'objectif principal était de déterminer le taux de suivi à 2 mois des recommandations, et l'objectif secondaire de décrire le profil des patients suivis. Cette étude a inclus 500 patients sur 2 ans et a analysé 1 677 recommandations. Le taux de suivi global était de 65,1 %. Les patients avaient un âge médian de 83,5 ans, 61 % étaient des femmes et 88 % avaient un GIR ≤ 4. L'application des recommandations permet une diminution des hospitalisations non programmées. L'implication de l'équipe à l'issue de la visite optimise la mi%se en œuvre de ces recommandations. Le grand effectif de cette étude permet de mieux décrire les patients vus à domicile : une population vulnérable présentant une polypathologie, dépendance, associés à un contexte socio-familial instable. Ce travail montre que les recommandations doivent être appliquées pour limiter les hospitalisations et que l'implication de l'équipe permet d'améliorer le suivi des préconisations.

Vitamin D and COVID-19 Severity in Hospitalized Older Patients: Potential Benefit of Prehospital Vitamin D Supplementation.

Studies involving the associations between vitamin D supplementation taken before the onset of COVID-19 infection and the clinical outcomes are still scarce and this issue remains controversial. This study aimed to assess the relationships between vitamin D (VitD) status and supplementation and coronavirus disease 2019 (COVID-19) severity in older adults (average age of 78 years) hospitalized for COVID-19. We conducted an observational retrospective cohort study with 228 older hospitalized patients during the first wave of the COVID-19 pandemic. The outcomes were in-hospital mortality secondary to COVID-19 or critically severe COVID-19. A logistic regression analysis was conducted to test whether pre-hospital VitD supplementation was independently associated with severity. In this study, 46% of patients developed a severe form and the overall in-hospital mortality was 15%. Sixty-six (29%) patients received a VitD supplement during the 3 months preceding the infection onset. Additionally, a VitD supplement was associated with fewer severe COVID-19 forms (OR = 0.426, p = 0.0135) and intensive care unit (ICU) admissions (OR = 0.341, p = 0.0076). As expected, age > 70 years, male gender and BMI ≥ 35 kg/m2 were independent risk factors for severe forms of COVID-19. No relationship between serum 25(OH)D levels and the severity of the COVID-19 was identified. VitD supplementation taken during the 3 months preceding the infection onset may have a protective effect on the development of severe COVID-19 forms in older adults. Randomized controlled trials and large-scale cohort studies are necessary to strengthen this observation.

Quality of life and sarcopenic patients.

Sarcopenia is defined as a progressive and generalised loss of muscle strength, muscle mass and physical performance with advancing age. Among the multiple consequences of sarcopenia, the reduction in the quality of life associated with it can undeniably be considered as a major consequence. Quality of life is measured via generic or specific questionnaires. Current research, mainly using so-called "generic" questionnaires, has identified a reduced quality of life in patients with primary age-related sarcopenia, mainly in areas related to functional status and physical performance. A specific quality of life questionnaire could, in combination with a generic questionnaire, provide more precise data on the impact that sarcopenia has on patient's quality of life. The first quality of life questionnaire specific to sarcopenia, the SarQoL®, was developed in 2015. Psychometric validation of the SarQoL® has been carried out in several international patient populations indicating excellent internal consistency, reliability and convergent validity and sensitivity to change, as well as an absence of floor and ceiling effects. In combination with a generic questionnaire, this specific questionnaire is therefore suitable for measuring the quality of life of populations suffering from sarcopenia, both in research and in clinical practice and in the context of both observational or interventional evaluations.

Study of a tool supporting the link between community and hospital care: a six-month study of a geriatric hotline.

The growing elderly population and their overlapping conditions require more specialised care. The difficulties accessing scheduled hospital admissions often lead to visits to accident and emergency departments (A&E), which can have a harmful effect on these patients. The French Regional Health Agency (ARS) has developed geriatric hotlines in certain geriatric departments. An analysis of the populations concerned will allow adjustments to be made to this system in order to improve care pathways for the elderly and to better meet the needs of general practitioners. This is a descriptive, retrospective, monocentric epidemiological study conducted between February and July 2017. The caller, the reason for the call, the general practitioner's request, the demographic and geriatric characteristics of the patients and the response provided were described. Calls were mainly made by general practitioners, in 72.8% of the cases, for acute conditions. Access to hospital admission accounted for 69.6% of the requests, while a home assessment accounted for 16% of requests. Fifty-five per cent of the patients were admitted to hospital and 75% of them were admitted directly to the geriatric department. Twenty-one per cent of requests for hospital admission received other treatment. The average age of the patients was 86, with a majority of patients being poly-medicated, having multiple pathologies and also more neurocognitive disorders than the general population. Guidance is provided in 30% of the calls, improving the care pathway of these elderly patients. The time to response and to hospital admission is short, thus favouring direct access to hospital departments. The main independent risk factor for hospital admission was the presence of acute illness. This link between community and hospital care seems to respond to the principal requests of general practitioners, i.e. hospitalisation for acute conditions. It is beneficial for the management of these patients who are at risk of decompensation. Coordination and communication between the different players involved in community and hospital care must continue to develop to improve the care pathway of these complex geriatric patients.

External validation of the Hospital Frailty Risk Score in France.

BACKGROUND: The Hospital Frailty Risk Score (HFRS) has made it possible internationally to identify subgroups of patients with characteristics of frailty from routinely collected hospital data. OBJECTIVE: To externally validate the HFRS in France. DESIGN: A retrospective analysis of the French medical information database. SETTING: 743 hospitals in Metropolitan France. SUBJECTS: All patients aged 75 years or older hospitalised as an emergency in 2017 (n = 1,042,234). METHODS: The HFRS was calculated for each patient based on the index stay and hospitalisations over the preceding 2 years. Main outcome measures were 30-day in-patient mortality, length of stay (LOS) >10 days and 30-day readmissions. Mixed logistic regression models were used to investigate the association between outcomes and HFRS score. RESULTS: Patients with high HFRS risk were associated with increased risk of mortality and prolonged LOS (adjusted odds ratio [aOR] = 1.38 [1.35-1.42] and 3.27 [3.22-3.32], c-statistics = 0.676 and 0.684, respectively), while it appeared less predictive of readmissions (aOR = 1.00 [0.98-1.02], c-statistic = 0.600). Model calibration was excellent. Restricting the score to data prior to index admission reduced discrimination of HFRS substantially. CONCLUSIONS: HFRS can be used in France to determine risks of 30-day in-patient mortality and prolonged LOS, but not 30-day readmissions. Trial registration: Reference ID on clinicaltrials.gov: ID: NCT03905629.

[Health issues of patients aged 65 years or over managed in general practice: which associations are remarkable?] / Résultats de consultation des patients âgés de 65 ans et plus pris en charge en médecine générale : quelles sont les associations remarquables ?

INTRODUCTION: We aimed at identifying the associations of health issues managed in general practice encounters with patients aged 65 years or over, according to their sex. METHODS: Ancillary study of the ECOGEN study on the consultation practice of French general practitioners. We have studied the 15 most frequent health issues managed in patients aged 65 years or over and identified the pairs most frequently and strongly associated. RESULTS: The sample included 5,782 encounters corresponding to 17,182 health issues managed. Each encounter involved an average of 3.0 [2.9-3.0] health issues. The strongest associations mainly included cardio-metabolic conditions. The most frequent and strong pair (OR: 3.8 [3.3-4.4]) associated non-complicated arterial hypertension with lipid disorder. Some associations were specific to patient sex. CONCLUSION: The remarkable associations identified may enable to improve the management of elderly patients with multimorbidity by favouring synergic treatments.

Integrating a Prevention Care Path into the Daily Life of Older Adults with Mobility Disability Risk: Introducing a Predictive Response Model to Exercise.

INTRODUCTION: Exercise and nutrition are the best targets to tackle mobility issues in community-dwelling older adults. As exercise response relies on multiple factors, improving the understanding of their interactions is a necessity to tailor effective preventive strategies. Based on a prevention care path designed for community-dwelling older adults with mobility disability risk, our main goal was to determine the predictive factors of the response to a multimodal intervention, combining structured exercise training and nutritional counselling. Thus, this study aimed to tailor prevention programs for non-responder participants. METHODS: We analyzed the response of participants to a prevention program and built a multivariate predictive model to highlight the profile of the best responders. The model was based on the likelihood of at least 1 point of short physical performance battery (SPPB) score gain. Inclusion criteria were being aged ≥70 years and having completed a multicomponent group-based supervised training consisting of 20 sessions (10 weeks). RESULTS: A total of 103 participants were included, their mean ± SD age was 81.9 ± 5.7 years. The model demonstrated interactions between baseline SPPB score (OR=0.42; p < 0.001), body mass index (BMI; OR=0.82; p=0.003), and grip strength value (OR=1.15; p=0.008). The highest probability of response was found for participants with low SPPB, normal BMI (21 kg/m2), and high grip strength (27 kg). CONCLUSION: This study demonstrated that the response to a multimodal intervention in community-dwelling older adults with mobility disability risk was influenced by the baseline SPPB score, BMI, and grip strength value. To increase the proportion of responders, strategies that could be more effective include constituting more homogenous group, and implementing a specific approach for obese sarcopenic older adults and those with low grip strength by increasing the dose of physical activity and monitoring endurance and mobility activities between sessions. Our results provide important consideration for the development of targeted-interventions.

Impact of a Geriatric Intervention to Improve Screening and Management of Undernutrition in Older Patients Undergoing Surgery for Colorectal Cancer: Results of the ANC Stepped-Wedge Trial.

Almost two in three patients who are aged 75 years and older and scheduled for surgery for colorectal cancer (CRC) are undernourished. Despite evidence that perioperative nutritional management can improve patients outcomes, international guidelines are still insufficiently applied in current practice. In this stepped-wedge cluster-randomized study of five surgical hospitals, we included 147 patients aged 70 years or older with scheduled abdominal surgery for CRC between October 2013 and December 2016. In the intervention condition, an outreach team comprising a geriatrician and a dietician visited patients and staff in surgical wards to assist with the correct application of guidelines. Evaluation, diagnosis, and prescription (according to nutritional status) were considered appropriate and strictly consistent with guidelines in 39.2% of patients in the intervention group compared to only 1.4% in the control group (p = 0.0002). Prescription of oral nutritional supplements during the perioperative period was significantly improved (41.9% vs. 4.1%; p < 0.0001). However, there were no benefits of the intervention on surgical complications or adverse events. A possible benefit of hospital stay reduction will need to be confirmed in further studies. This study highlights the importance of the implementation of quality improvement interventions into current practice for the perioperative nutritional management of older patients with CRC.

[Which quality of life for the sarcopenic patient?] / Quelle qualité de vie pour le patient sarcopénique ?

Sarcopenia is defined as a progressive and generalized loss of muscle strength, muscle mass and physical performance with advancing age. Among the multiple consequences of sarcopenia, the reduction in the quality of life associated with it can undeniably be considered as a major consequence. Quality of life is measured via generic or specific questionnaires. Current research, mainly using so-called "generic" questionnaires, identifies a reduced quality of life in patients with primary age-related sarcopenia, mainly in areas related to functional status and physical performance. A specific quality of life questionnaire could, in combination with a generic questionnaire, provide more precise data on the impact that sarcopenia has on the quality of life of patients. It was in 2015 that the first quality of life questionnaire specific to sarcopenia, the SarQoL®, was developed. Psychometric validation of the SarQoL® has been carried out in several international patient populations indicating excellent internal consistency, reliability and convergent validity and sensitivity to change as well as an absence of floor and ceiling effects. In combination with a generic questionnaire, this specific questionnaire is therefore suitable for measuring the quality of life of populations suffering from sarcopenia, both in research and in clinical practice, both in the context of observational or interventional evaluations.

[Study of a tool supporting the community-hospital link, the Central Hospital Group's geriatric hotline, over a period of 6 months]. / Étude d'un outil favorisant le lien ville-hôpital : la hotline gériatrique du Groupement Hospitalier Centre, sur une durée de 6 mois.

The increasing elderly population and their overlapping conditions require more specialised care. The difficulties accessing scheduled hospital admission lead to visits to Accident and Emergency Department (A&E), which have a harmful effect on these patients. The Regional Health Agency (ARS) has developed geriatric hotlines in all geriatric sectors. An analysis of the population concerned will allow changes to be made to this system in order to improve the care pathway for the elderly and to better meet the needs of the general practitioners. This was a descriptive, retrospective, monocentric epidemiological study conducted from February to July 2017. The applicant, reason for the call, the general practioner's request, the demographic and geriatric characteristics of the patients, the response provided were described. The calls were mainly made by the general practitioners, in 72.8% of the cases, for acute conditions. Access to hospital admission accounted for 69.6% of the requests, a home assessment, 16 %. Fifty-five per cent of the patients were admitted to hospital, 75 % of them directly in geriatrics. Twenty-one per cent of the requests for hospital admission received other treatment. The average age was 86 years, with a majority of patients being poly-medicated, having multiple pathologies and also more neurocognitive disorders than the general population. Guidance is provided in 30 % of the calls, improving the care pathway of these elderly patients. The time to response and to hospital admission is short, thus favouring direct access to hospital departments. The main independent risk factor for hospital admission was the presence of acute illness. This community-hospital link seems to answer the principal request of GPs, i.e. hospitalization in acute condition. It is beneficial for the management of these patient at risk of decompensation. Coordination and communication between the different community-hospital players must continue to develop to improve the care pathway of these complex geriatric patients.