[Alzheimer's disease: what's new in 2023]. / Maladie d'Alzheimer: ce qui a changé en 2023.

The increasing prevalence of Alzheimer's disease in the general population presents a number of medical, economic and social challenges for the years to come. After 20 years of research with no new treatment option, a new class of drugs is set to be introduced in Europe. Anti-amyloid drugs, which are already available in the United-States, slow the disease progression by targeting the biological processes causing the disease, unlike the symptomatic treatments that are currently available. However, their precise indications and the monitoring of their adverse events are still to be defined. Several other drugs are in advanced stages of development, such as those targeting the tau protein or neuroinflammation, suggesting that the management of the disease will be quite different in the years to come.

L'augmentation du nombre de personnes atteintes de la maladie d'Alzheimer présente des enjeux médicaux, économiques et sociaux pour les années à venir. Après 20 années de recherche sans nouveauté médicamenteuse, une nouvelle classe de molécules est sur le point d'arriver sur le marché en Europe. Les traitements antiamyloïde, déjà commercialisés aux États-Unis, ralentissent le déclin cognitif en ciblant le processus biologique qui en est à l'origine, contrairement aux traitements symptomatiques disponibles actuellement. Cependant, leurs indications précises et la gestion de leurs effets indésirables restent encore à définir. D'autres traitements sont dans des phases avancées d'élaboration, comme ceux ciblant la protéine tau ou l'inflammation, laissant envisager que la prise en charge de la maladie sera bien différente dans les années à venir.

Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study.

BACKGROUND: Frailty assessment by paramedics in the prehospital setting is understudied. The goals of this study were to assess the inter-rater reliability and accuracy of frailty assessment by paramedics using the Clinical Frailty Scale (CFS). METHODS: This was a cross-sectional study with paramedics exposed to 30 clinical vignettes created from real-life situations. There was no teaching intervention prior to the study and paramedics were only provided with the French version of the CFS (definitions and pictograms). The primary outcome was the inter-rater reliability of the assessment. The secondary outcome was the accuracy, compared with the expert-based assessment. Reliability was determined by calculating an intraclass correlation coefficient (ICC). Accuracy was assessed through a mixed effects logistic regression model. A sensitivity analysis was carried out by considering that an assessment was still accurate if the score differed from no more than 1 level. RESULTS: A total of 56 paramedics completed the assessment. The overall assessment was found to have good inter-rater reliability (ICC = 0.87 [95%CI 0.81-0.93]). The overall accuracy was moderate at 60.6% (95%CI 54.9-66.1) when considering the full scale. It was however much higher (94.8% [95%CI 92.0-96.7] when close assessments were considered as accurate. The only factor associated with accurate assessment was field experience. CONCLUSION: The assessment of frailty by paramedics was reliable in this vignette-based study. However, the accuracy deserved to be improved. Future research should focus on the clinical impact of these results and on the association of prehospital frailty assessment with patient outcomes. REGISTRATION: This study was registered on the Open Science Framework registries ( https://doi.org/10.17605/OSF.IO/VDUZY ).

Masticatory performance in oral function assessment: Alternative methods.

BACKGROUND: Masticatory function declines with age or disease, implicating a poor chewing efficiency and an often-unconscious change for a less healthy, yet easy to chew diet. Timely screening of masticatory function may foster an early-onset diagnosis and potential treatment. The aim of this study was to compare alternative diagnostic tools for masticatory function to a Jelly-scan test. MATERIALS AND METHODS: Patients aged 70 years and older who were hospitalised for rehabilitation were recruited for this study. A total of four different tests for masticatory function were administered. The Japanese Society of Gerodontology glucose extraction test (Jelly-scan) was used as reference to compare a colour-changing gum test (Gum1-colour) as well as a mixing ability test with a visual (Gum2-visual) and opto-electronical (Gum2-digital) analyses. Receiver operating characteristic (ROC) curves were used to establish the discriminative value, kappa-values were used to estimate individual agreements and correlations were verified using Spearman's tests. RESULTS: Sixty-one patients (Men n = 23, Women n = 38) aged 82.4 ± 6.8 years participated in the experiments. The average number of natural teeth was 16.5 ± 10.5, 34.4% of the participants wore removable dentures. For all tests, the sum of sensitivity and specificity was >150%. All test correlated with Jelly-scan (absolute Rho >0.5). With Jelly-scan 51 participants (83.6%) were diagnosed with "masticatory hypofunction". After reducing the cut-off value of the test from 100 mg/dL to 65 mg/dL, only 33 participants (54%) fulfilled the diagnosis. This post-hoc analysis increased the sensitivity of the Gum2-tests and the agreement to kappa >0.5 for all three tests. CONCLUSION: All three tests can be considered useful screening alternatives. In its original version, Jelly-scan may tend to over-diagnose masticatory hypofunction, hence a novel cut-off with better agreement between tests is suggested.

[Delirium superimposed on dementia. Clinical practice and perspectives]. / État confusionnel aigu chez les personnes atteintes de démence. Pratique clinique et perspectives.

Delirium is a commonly encountered syndrome in clinical practice. Older people with cognitive disorders are most at risk of developing delirium during the hospital stay. However, the risk of underdiagnosis is significant, particularly because of the overlap of behavioral symptoms and cognitive impairment between delirium and dementia. With an aging population and an ever-increasing prevalence of cognitive disorders, this article exposes the bilateral relationship maintained between dementia and delirium and bring certain diagnostic tools and clinical management clues to support the clinician. Finally, the perspectives of ongoing clinical research that could respond to current challenges are discussed.

L'état confusionnel aigu (ECA) est un syndrome fréquemment rencontré dans la pratique clinique. Les personnes âgées atteintes de troubles cognitifs sont les plus à risque de développer un ECA durant le séjour hospitalier. Le risque de sous-diagnostic est important, les symptômes comportementaux et de l'atteinte cognitive en lien avec la démence étant notamment parfois difficiles à distinguer de ceux de l'état confusionnel. Devant une population vieillissante et une prévalence de troubles cognitifs toujours grandissante, cet article aborde la relation bilatérale entretenue entre la démence et l'ECA, et propose certains outils diagnostiques et aides à la prise en charge pour le clinicien. Enfin, les perspectives de la recherche clinique en cours qui pourraient répondre aux défis actuels sont évoquées.

[Healthy aging in Geneva : the innovative approach of the VieSA project]. / Vieillir en santé à Genève : l'approche novatrice du projet VieSA.

With Switzerland's population ageing, promoting healthy ageing remains a public health issue. This represents a challenge for the healthcare system, which is still mainly focused on curative or palliative care. It has been clearly established that it is possible to maintain the functional capacity of older people by taking early action on health-related behaviors. The VieSA (Vieillissement en Santé) project in the canton of Geneva, inspired by the WHO's ICOPE programme, offers innovative ways of promoting healthy ageing for and by seniors, by focusing on maintaining seniors' resources rather than targeting any deficits.

Face au vieillissement de la population en Suisse, la promotion du vieillissement en santé reste un enjeu de santé publique. Cela représente un défi pour le système de soins encore principalement orienté vers les soins curatifs ou palliatifs. Il est clairement établi qu'il est possible de maintenir les capacités fonctionnelles des seniors en agissant précocement sur les comportements liés à la santé. Le projet VieSA (Vieillissement en santé), mené dans le canton de Genève, s'inspire du programme ICOPE de l'OMS et offre des perspectives novatrices pour promouvoir le vieillissement en santé pour et par les seniors, en s'appuyant sur le maintien des ressources des seniors plutôt qu'en ciblant les déficits éventuels.

One-year persistent symptoms and functional impairment in SARS-CoV-2 positive and negative individuals.

BACKGROUND: Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors. OBJECTIVE: The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative. METHODS: From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date. RESULTS: At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history. CONCLUSION: SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

Fighting social isolation in times of pandemic COVID-19: the role of video calls for older hospitalized patients.

BACKGROUND: Loneliness and social isolation are associated with anxiety and psychological discomfort, especially amongst the oldest and fragile persons. AIMS: SILVER evaluates the acceptance of video calls by old hospitalized patients and their relatives during the ban on visits due to the COVID-19. Moreover, SILVER evaluates if the use of different communication technology is associated with different outcomes in terms of anxiety, fear of self and of others' death and mood. METHODS: SILVER is an observational multicentre study. Patients hospitalized in two geriatric units in Switzerland and in one orthogeriatric unit in Italy and their relatives were enrolled. Participants can freely choose to use phone or video calls and were evaluated over a week. We measured anxiety, fear of death and mood at baseline and at the end of the study with standard scales. The use of video or phone calls was associated to a change in these parameters by two-way ANOVA for repeated measures. RESULTS: Sixty-four patients and relatives were enrolled, 26.5% used phone calls and 73.5% video calls. The use of video calls was associated with a reduction in anxiety and fear of death in patients and relatives as compared to participants using phone calls. DISCUSSION: Old patients and their relatives accepted and appreciated the use of video calls during hospitalization; moreover, participant using video calls appears to be less anxious and less afraid of death. CONCLUSIONS: Video calls may be a useful communication tool for hospitalized older patients to keep social relationships with relatives and reduce their anxiety and fear of death. TRIAL REGISTRATION: Retrospectively registered on 1st September 2021 in ClinicalTrials.gov (NCT05000099).

Oral function and nutritional status in non-acute hospitalised elders.

INTRODUCTION: Malnutrition and risk of malnutrition continues to be a common finding in elders, yet its association with oral function in hospitalised patients remains unclear. MATERIAL AND METHODS: Patients aged 70 years or over who had been hospitalised for non-acute rehabilitation were recruited. Nutritional risk was screened using the Mini-Nutritional Assessment Short Form (MNA-SF) and Nutritional Risk Screening (NRS) scores. Malnutrition was assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. All participants underwent the oral hypofunction test battery, evaluating oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory and swallowing function. Statistical analyses comprised Mann-Whitney or Kruskal-Wallis tests. Bivariate associations between categorical variables were tested using the Pearson chi-square test; for continuous variables, the Spearman correlation was calculated. A P-value < .05 was considered statistically significant. RESULTS: Sixty patients aged a mean 82.5 ± 7.0 years participated. Some 88.3% were diagnosed with oral hypofunction, and this was more common in older patients (P = .020). Analysing the 7 oral hypofunction tests as an interval variable (NiOF) revealed additional correlations with number of teeth (ρ = 0.477) as well as the nutritional risk, evaluated by the MNA-SF (ρ = -0.284) and NRS (ρ = 0.317) scores. NiOF scores were higher among denture wearers (P = .003). GLIM did not confirm the correlation with NiOF. Biomarkers such as serum albumin and CRP were not associated with the NiOF score. CONCLUSION: In this sample, the association between oral function and nutritional state is more obvious in nutritional risk scores than in the malnutrition diagnosis by GLIM.

[Ortho-geriatric rehabilitation: challenges and impact]. / Réadaptation ortho-gériatrique : enjeux et impact.

The risk of developing functional dependence rises with age. Following an acute event, a rehabilitation stay is often needed to restore functional capacities and consider home discharge. The geriatric rehabilitation process usually involves standardized multidisciplinary management, setting and frequent reviewing of the goals, and a discharge plan. In a retrospective observational study conducted in orthogeriatric rehabilitation conducted in Geneva, comorbidities, functional status at admission, and length of stay appear to have a significant impact on recovery potential and destination at discharge, whereas the intensity of the rehabilitation program (number of therapies per week) does not influence patient outcome.

Le risque de développer une dépendance fonctionnelle augmente avec l'âge. À la suite d'un événement aigu, un séjour en réadaptation est souvent nécessaire pour restaurer les capacités fonctionnelles et permettre un retour à domicile. Le processus de réadaptation gériatrique comporte une prise en charge standardisée pluridisciplinaire, la fixation et la révision régulière d'objectifs et la planification de la sortie. Dans une étude observationnelle rétrospective en réadaptation ortho-gériatrique menée à Genève, les comorbidités, l'état fonctionnel à l'admission et la durée de séjour prédisent les chances de récupération fonctionnelle et le retour à domicile, tandis que l'intensité du programme (nombre de thérapies par semaine) n'influence pas le devenir du patient.

[An infectious diseases ward dedicated to elderly patients: why and how?] / Unité d'infectiologie gériatrique : pourquoi et comment ?

The management of infections in the elderly requires medical and nursing expertise with a standardized global geriatric evaluation. We present here an original and pioneering unit in Switzerland, dedicated to polymorbid and complex elderly patients hospitalized for an acute infection and who will benefit from joint management by an interdisciplinary team including a geriatrician, an infectious diseases specialist and a pharmacogeriatrician. The Hôpital des Trois-Chêne, which has geriatric emergencies, intermediate care beds, SOMADEM (somatic dementia) and UGIMP (medico-psychiatric) programs adapted to this population, seems to be the ideal place to host this unit. The teams will benefit from theoretical and practical training associated with field coaching.

La prise en charge des infections de la personne âgée nécessite une expertise médico-soignante avec une évaluation gériatrique globale standardisée. Nous présentons ici une unité originale et pionnière en Suisse, dédiée aux patients âgés polymorbides et complexes hospitalisés pour infection aiguë. Ils bénéficieront d'une prise en charge conjointe par une équipe interdisciplinaire comprenant entre autres le gériatre, l'infectiologue et le pharmacogériatre. L'hôpital des Trois-Chêne, qui possède des urgences gériatriques, des lits de soins intermédiaires, les programmes SOMADEM (somatique démence) et UGIMP (médico-psychiatrique) adaptés à cette population, semble le lieu idéal pour accueillir cette unité. Les équipes bénéficieront d'une formation théorique et pratique associée à du coaching de terrain.

Incidence, characteristics and clinical relevance of acute stroke in old patients hospitalized with COVID-19.

BACKGROUND: Stroke in the course of coronavirus disease (COVID-19) has been shown to be associated with more severe respiratory symptoms and higher mortality, but little knowledge in this regard exists on older populations. We aimed to investigate the incidence, characteristics, and prognosis of acute stroke in geriatric patients hospitalized with COVID-19. METHODS: A monocentric cross-sectional retrospective study of 265 older patients hospitalized with COVID-19 on acute geriatric wards. 11/265 presented a stroke episode during hospitalization. Mortality rates and two-group comparisons (stroke vs non-stroke patients) were calculated and significant variables added in logistic regression models to investigate stroke risk factors. RESULTS: Combined ischemic and hemorrhagic stroke incidence was 4.15%. 72.7% of events occurred during acute care. Strokes presented with altered state of consciousness and/or delirium in 81.8%, followed by a focal neurological deficit in 45.5%. Ischemic stroke was more frequently unilateral (88.8%) and localized in the middle cerebral artery territory (55.5%). Smoking and a history of previous stroke increased by more than seven (OR 7.44; 95% CI 1.75-31.64; p = 0.007) and five times (OR 5.19; 95% CI 1.50-17.92; p = 0.009), respectively, the risk of stroke. Each additional point in body mass index (BMI) reduced the risk of stroke by 14% (OR 0.86; 95% CI 0.74-0.98; p = 0.03). In-hospital mortality (32.1% vs. 27.3%; p > 0.999) and institutionalization at discharge (36.4% vs. 21.1%; p = 0.258) were similar between patients with and without stroke. CONCLUSION: Incident stroke complicating COVID-19 in old patients was associated with active smoking, previous history of stroke, and low BMI. Acute stroke did not influence early mortality or institutionalization rate at discharge.

Validation of a novel diagnostic tool for decreased tongue pressure.

INTRODUCTION: Reduced tongue pressure may render eating and swallowing difficult. The purpose of this study was to investigate whether the tongue training device can also be used as a diagnostic device and whether its sensitivity and specificity are equal to the numerical tongue pressure measuring device. MATERIAL AND METHODS: The target group is patients aged 70 years and over who are hospitalised for rehabilitation. Tongue pressure was measured by both, a tongue pressure measuring instrument and a tongue training tool. The diagnosis of the reduced tongue pressure was made with the tongue pressure measuring instrument and set the verified with the novel tongue training tool. RESULTS: Sixty-two participants were included in the study. Forty-five were classified by the tongue pressure measuring device and 53 by the tongue training device as 'low tongue pressure'. Spearman correlation confirmed a positive correlation between the tongue pressure measuring device and the tongue training device rs  = 0.800, p = 0.01 level (2-tailed). The tongue training device test identified sensitivity was 100%, and its specificity was 52.9%. The AUC of the ROC curve is 0.901. CONCLUSION: The tongue training device seems a simple, safe and readily available alternative to the tongue pressure measuring device for the diagnosis of low tongue pressure, with an excellent sensitivity and very good specificity.

[Feedback on post COVID-19 rehabilitation]. / Réadaptation post-COVID-19†: retour d'expérience.

The outbreak of Coronavirus Disease 19 (COVID-19) following the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) viral infection has placed particular pressure on occidental health systems, especially in terms of acute care resources and critical care skills. A number of affected patients subsequently required a rehabilitation process, due to multiple functional limitations, either as a result of an extended stay in intensive care or the consequences of the infection itself. The aim of this article is to report on the Geneva experience in post COVID19 rehabilitation, through 2 clinical vignettes, illustrating the heterogeneity of symptoms and deficits that may be encountered following this disease.

L'épidémie de la maladie Coronavirus Disease 19 (COVID-19), consécutive à l'infection virale du Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) a particulièrement mis sous pression les systèmes de santé occidentaux, notamment en termes de ressources de soins aigus et de compétences en soins intensifs. Un certain nombre de patients atteints ont nécessité par la suite une phase de réadaptation, en raison de limitations fonctionnelles multiples, consécutives, soit à un séjour prolongé aux soins intensifs, soit aux conséquences de l'infection elle-même. Le but de cet article est de rapporter l'expérience genevoise en réadaptation post-COVID-19, à travers 2 vignettes cliniques, illustrant l'hétérogénéité des symptômes et déficits qui peuvent se rencontrer suite à cette maladie.

[Issues and challenges related to COVID-19 in acute geriatric care: lessons learned from the Geneva experience]. / Enjeux et défis du Covid-19 en gériatrie aiguë: leçons tirées de l'expérience genevoise.

The older patients have been the most affected by the SARS-CoV-2 pandemic. In addition, this infection has been responsible for high mortality rate in this population. In this article we wanted to describe the clinical findings we encountered in older people with COVID-19 and share some of the issues and challenges we faced during the COVID-19 pandemic.

Les personnes âgées ont été les plus touchées par la pandémie de SARS-CoV-2. De plus, cette infection a été responsable d'une mortalité élevée au sein de cette population. Dans cet article, nous avons souhaité décrire les particularités cliniques du Covid-19 que nous avons constatées chez les patients âgés et faire part de plusieurs enjeux et défis auxquels nous avons été confrontés au cours de la pandémie de Covid-19.

Individual healthy aging indices, measurements and scores.

The positive gerontological approach to aging has resulted in successive terminologies to describe the process of aging, including successful aging, active aging, healthy aging, or healthy and active aging, amongst others. Each definition proposed by geriatricians, psychologists, sociologists or public health specialists has been based on specific aspects of aging that are most important to the authors' discipline, explaining the current difficulty in determining which is the best set of criteria to determine "good aging". Two successive analyses of the measurements used in longitudinal studies from 1989 to 2018 testify to this heterogeneity in the types of questions proposed to evaluate the quality of the individual aging process. To confront this complexity, new and integrated indices have successively been proposed to quantify and qualify the survival period of aging individuals. The present paper aims to describe and compare the value of the "healthy aging index", the "modified healthy aging index", the "healthy aging score" and the "selfie aging test". Attempts to date to identify the best individual measurement of "aging well" have been interesting, and certainly show promise, but their limitations to specific populations call for more concerted effort from the scientific community to obtain worldwide validation. Another option would be to identify the best self-assessment questionnaire and include it in a mobile device, enabling longer term personal follow-up of aging functions. There is a clear lack of data of this type at present, and an urgent need to obtain such information, to enable early and targeted interventions.

[Nutritional management of older people in neuro-rehabilitation]. / Prise en charge nutritionnelle du sujet âgé en neuro-réadaptation.

Stroke is the most common acute neurological disease in the world. Approximately 16 000 strokes occur each year in Switzerland. In the older population, the stroke outcomes are related to high risk of malnutrition due to neurological deficits impacting oral feeding. Therefore, systematic screening of malnutrition is required upon admission to hospital. Then, assessment of the nutritional status by a specialist should be initiated before deciding on individualised nutritional strategy. Rehabilitation is complex and must be done in multidisciplinary team to provide optimal care to the patients.

L'accident vasculaire cérébral (AVC) est la maladie neurologique aiguë la plus répandue dans le monde. En Suisse, on dénombre 16 000 nouveaux cas d'AVC chaque année. Le patient âgé souffrant d'AVC est à haut risque de dénutrition du fait de la prévalence particulièrement élevée dans cette population, à laquelle s'ajoutent la pathologie neurologique et ses déficits impactant l'alimentation. Par conséquent, un dépistage systématique de la dénutrition est nécessaire dès l'admission en milieu hospitalier. Par la suite, une évaluation nutritionnelle par un spécialiste doit être mise en place afin de permettre au patient de bénéficier d'un traitement précoce et individualisé. L'importance d'une collaboration et d'une prise en charge multidisciplinaire fait désormais partie des objectifs de référence pour ces patients.