Intrinsic values of procalcitonin in bacterial bloodstream infections in people aged 75 years and over: a retrospective study.

OBJECTIVE: To evaluate PCT measurement in the diagnosis of bloodstream infection (BSI) in hospitalized patients aged 75+. METHOD: Descriptive, retrospective, monocentric study conducted in France, in patients with at least one blood culture and PCT and CRP measurements within the 24 hours before or after blood culture. RESULTS: The mean PCT and CRP values for the 118 (15.2%) positive blood cultures were 18.90 ng/ml [95%CI: 0.007-334.7] and 153.93 mg/l [1-557], respectively. With a threshold of 0.3 ng/ml, PCT measurement had a sensitivity of 84%, a specificity of 53%, a PPV of 24%, and an NPV of 95%, making it possible to rule out BSI in 350 (45.1%) patients (α-risk=5%). CONCLUSION: PCT measurement may eliminate BSI diagnosis more quickly than does blood culture reducing the inadequate and detrimental use of antibiotic therapy. A prospective study is required to validate its usefulness and confirm the cut-off value in geriatric populations.

Zoledronic Acid Contraindications Prevalence among Hip-Fractured Patients Aged 75 Years or Over Hospitalized in an Orthogeriatric Unit.

OBJECTIVE: Zoledronic acid (ZA) is an antiosteoporotic drug that has been proven to reduce mortality after a hip fracture (HF). ZA is however underused with older HF patients. One possible cause may be the high prevalence of severe renal failure and hypocalcemia which contraindicate ZA administration. The aim of this study was to assess the prevalence of these 2 contraindications in patients aged 75 years or older admitted into an orthogeriatric (OG) unit after a low-energy HF. The secondary objective was to assess the prevalence of situations in which ZA must be used with caution. METHODS: Our retrospective descriptive monocentric study was performed in an OG unit on a cohort of elderly patients hospitalized for HF from August 2015 to August 2017. Prevalence of hypocalcemia lower than 2 mmol/L and Cockcroft creatinine clearance lower than 35 mL/min was recorded. RESULTS: Among the 194 patients admitted for HF, 136 patients (mean age 86 ± 5.6 years; 101 women) were included. The mean length of hospital stay was 15 ± 9 days. 111 (81.5%) had no contraindications to ZA administration. More than 80% presented situations in which ZA had to be used with caution, including 25(OH)D deficiency (20%). CONCLUSION: The majority of subjects aged 75 years or older admitted to hospital after an HF seem to have no contraindication for ZA administration during their immediate postoperative hospital stay. The hospitalization period after HF repair gives the opportunity to give most of them this treatment to improve their prognosis, taking into account situations in which ZA must be used with caution.

Management of preoperative pain in elderly patients with moderate to severe cognitive deficits and hip fracture: a retrospective, monocentric study in an orthogeriatric unit.

BACKGROUND: Patients with cognitive deficits are 3 times more likely to suffer a hip fracture than geriatric patients of the same age group without cognitive deficits. The persistence of perioperative pain following hip fracture is a risk factor for the occurrence of delirium, poor functional prognosis, and the development of secondary chronic pain. Patients with cognitive deficits receive 20 to 60% less analgesics than those without cognitive deficits. Our retrospective descriptive monocentric study was performed in an orthogeriatric unit on a cohort of elderly patients hospitalized for hip fracture. The aim of the study was to compare the quantity of strong opioids delivered in a morphine sulfate equivalent daily during the preoperative period after a hip fracture between cognitively intact patients and those with cognitive deficits. RESULTS: Our total population of 69 patients had a median age of 90 years old, and 46% of these patients had moderate or severe cognitive deficits. During the preoperative period, the same quantity of strong opioids was administered to both groups of patients (13.1 mg/d versus 10.8 mg/d (p = 0.38)). Patients with moderate to severe cognitive deficits more often experienced delirium during their hospitalization (p < 0.01) and received more psychotropic drugs in the first 3 postoperative days (p = 0.025). CONCLUSIONS: We reported that with standardized pain management in an orthogeriatric unit, patients aged 75 years and older received the same daily average quantity of strong opioids during the preoperative period regardless of the presence of cognitive deficits.

Cognitive Screening Tool for Geriatrics: A Retrospective Observational Study on the Correlation of the Scores in 30-Point Clock Face Test and MMSE.

BACKGROUND: Over the past 30 years, the clock drawing test (CDT) has generated considerable interest due to its usefulness in the early detection of cognitive impairments, particularly those seen in neurodegenerative dementias (including Alzheimer's disease), vascular dementia, and mixed dementia. The present study aimed to determine whether the results of the "30-Point Clock Face Test" (CFT-30), a standardized version of the CDT that uses a 30-point scale, correlate with those of the Mini-Mental State Examination (MMSE). METHODS: This is a retrospective, observational study. All patients hospitalized in a Hospital-University Clinic Geriatrics Unit (Grenoble Alpes University Hospital, Grenoble, France), from January 1, 2017, to December 31, 2018, were included. Patient data and scores were retrieved from hospital archives, and the results of the two tests of interest, MMSE and the CFT-30, were analyzed. RESULTS: We included 214 patients aged ≥75 years. The mean ± SD age was 86.4 ± 5.6 years, and 68.7% were female. A strongly positive, significant correlation was seen between the CFT-30 and MMSE (r = 0.73, P < 0.001) scores. The total scores obtained by these two tests were identical (t = 1.22, P = 0.22). CONCLUSION: CFT-30 is a good complement to the tools usually used in the investigation of cognitive impairments in older people. In addition to its metrological qualities, the standardized and normalized CFT-30 is extremely simple and very fast to use.

[One-year mortality after a hip fracture: prospective study of a cohort of patients aged over 75 years old]. / Mortalité des 75 ans et plus après une fracture de l'extrémité supérieure du fémur : suivi d'une cohorte prospective.

Hip fracture (HF) is a serious complication of the elderly who have suffered a fall. Studies focused on patients over 75 years old without excluding the most vulnerable are not frequent. Before we can think about the creation of an orthogeriatric unit, we evaluated the mortality rate one year after a HF only of patients over 75 years old and we identified associated factors with mortality, functional status and living. METHODS: Prospective observational study of 75 years and older hospitalized for a HF in a conventional orthopaedic unit. Surgical and geriatric data collected was: instrumental activities of daily life ADL (IADL), comorbidity (cumulative illness rating scale-geriatric (CIRS-G)), mini nutritional assessment (MNA), severity, preoperative delay. A phone assessment one year after HF was about: vital and functional status, living place. RESULTS: The mean age of 113 patients included was 87 years (76-100). The mortality rate was 35%. It was associated with low IADL day -15 (p< 0.01), elevated CIRS-G (p< 0.01), severity (p=0.05) and malnutrition (p=0.05). Preoperative delay average was 70.7 h (+/- 59) and 48.6% had surgery within 48 hours. Among survivors and from the data available, 45% had a functional decline one year after the HF and 11% were admitted in a nursing home. CONCLUSION: Without any exclusion of frailty patients, the one-year mortality rate of HF of people aged 75 years and older was 35%. HF is a public health challenge due to its high prevalence, poor prognosis with considerable expense. The associated factors help to explain why geriatricians are required and support the project of creating an orthogeriatric unit. Nevertheless, geriatric care will not likely change prognosis of the most vulnerable patients but could improve the level of care.

Usefulness of oximetry for sleep apnea screening in frail hospitalized elderly.

BACKGROUND: Sleep Apnea Syndrome (SAS) prevalence increases with age. In the elderly, symptoms are less specific (falls, cognitive or functional decline, polymedication). Polysomnography, the gold standard technique to diagnose SAS, is challenged by sleep laboratories' waiting lists and high associated costs. Nocturnal oximetry is an easy-to-use tool widely available outside the sleep medicine field identifying intermittent hypoxia, the landmark of SAS. It might be an interesting and easy way to screen for SAS in the functionally and cognitively impaired elderly living in long-term care settings. OBJECTIVES: The primary goal of this study was to assess the accuracy of the variability index of nocturnal pulse oximetry to detect moderate to severe SAS in patients older than 75 hospitalized in stable condition. The secondary goals were to assess the accuracy of the other indices of pulse oximetry (oxygen desaturation index [ODI]), and to determine the prevalence of moderate to severe SAS in our population. METHODS: In-hospital sleep studies with simultaneous respiratory polygraphy and nocturnal pulse oximetry were performed. Comorbidities were assessed by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) in association with a comprehensive geriatric assessment. RESULTS: Eighty patients (mean age 85.3 ± 5.3 years) were included. Seventy-two percent of the patients exhibited moderate to severe SAS (95% CI 58.9-82.9), including 59.5% of severe SAS (apnea + hypopnea index >30/hour). SaO2 variability index using a threshold of 0.51, the sensitivity and negative predictive value (NPV) were 100%. With a value above 0.88, positive predictive value and specificity were high (respectively 96.6% and 93.8%). ODI of 3% or higher and 4% or higher were highly specific but less sensitive. CONCLUSION: Prevalence of moderate to severe SAS in multimorbid hospitalized elderly patients is high. Automatic analysis of the variability of nocturnal SaO2 is a reliable tool for geriatricians to screen and rule out moderate to severe SAS. Our study suggests an important role of pulse oximetry as the first step in the diagnostic strategy for moderate to severe SAS in this population.

[Predictors of functional decline of older persons after an hospitalisation in an acute care for elder unit: importance of recent functional evolution]. / Facteurs prédictifs du déclin fonctionnel de la personne âgée après une hospitalisation en court séjour gériatrique: importance de l'évolution fonctionnelle récente.

OBJECTIVES: To identify the predictors of functional decline of older persons after hospitalization in an Acute Care for Elder unit (ACE). METHODS: Retrospective observational study based on a population hospitalised in ACE unit in Grenoble University Hospital. Dead patients within hospitalisation and patient fully disable or already hospitalized 15 days before hospitalisation were excluded. The primary outcome was the functional decline defined by a loss in activity daily life (ADL) between discharge and 15 days before hospitalisation. The predictive factors included socio-demographic data, geriatric assessment and the admission pathway. RESULTS: 184 patients were included (mean 86.4±6.2 years, 64.1% women). The admission by emergency department was predominant (77.2%). The mean length of stay was 16.0±9.5 days. A functional decline as present for 31.0% des patients; for 95% of these patients, the functional decline occurred before admission to ACE. Factors associated with functional decline at discharge were: recent functional decline, ADL level at admission, pressure sore, denutrition and admission via the emergency room (ER) (p<0.05). In the multivariate analysis, recent functional decline was strongly associated with functional decline at discharge (OR=58.8, p<0.01). Outside this factor, ADL level at admission (OR=3.2, p<0.01), hypoalbuminemaia (OR=2.6, p=0.01) and an admission via the ER (OR=2.6, p=0.05) were independently associated with functional decline at discharge. CONCLUSION: Better management of hospitalised older persons, according to the ACE model, has diminished the negative functional effects of hospitalization. Identification of recent functional decline rather than other usually identified predictors would be useful for detection of older patients who might benefit from a geriatric program. Detecting and correcting early malnutrition and developing direct admissions mechanisms may improve functional prognosis of hospitalised older patients.