[Prise en charge de l'iléostomie à haut débit chez les personnes âgées : une revue systématique de cas et de séries de cas]. / High-output ileostomy management in older adults: A systematic review of case reports and case series.

The aim was to perform a systematic review of cases published in the literature to describe the management of high-output ileostomy (HOI) in older adults. A literature search was performed in PubMed©, and Scopus© for all publications up to March 1st, 2023. Case reports and/or case series reporting data from older adults on HOI management were included. Publication year, country, sex, age, aetiology of the stomy, time from ileostomy to HOI, daily volume threshold, Treatment regimen, and effectiveness were extracted. In total, 428 studies were identified, of which 9 (describing 10 cases) were included in this review. The mean age was 69.9 ± 4.7 years. The most frequent aetiology of ileostomy was occlusion. The daily volume considered to be excessive ranged from 1 to 2 litres per 24-hour period. The main side effects of HOI were dehydration, acute renal failure, and weight loss. Loperamide was the most frequently used drug. Most studies reported that non-pharmacological therapies were also used. No death was reported in any of the studies. In all, ileostomy exposes older individuals to complications. Medical therapy with loperamide coupled with rehydration seems to be efficacious in the medium term. Multidisciplinary management is advisable, in order to increase the chances of achieving ostomy reversal as early as possible, when indicated.

Tools for assessing social isolation and feelings of loneliness in older adults: a systematic review.

Older adults who are socially isolated or who feel lonely have a higher risk of morbidity and mortality. It is important to be able to assess them with efficient tools. The objective was to describe tools for assessing feelings of loneliness (FoL) and social isolation (SI) in older adults, and to estimate their prevalence. A systematic review was conducted including 18 studies. For FoL, the most frequently used tool was the UCLA Loneliness Scale. For SI, the most frequently used tool was the Lubben Social Network Scale. The median prevalences of FoL and SI were 24.1% and 42.5%, respectively. Both of these constructs will become more prominent in the coming decades; therefore, there is a need to identify the best tools.

Predictors of Nursing Home Entry within 36 Months after Hospitalization via the Emergency Department among Persons Aged 75 Years or Older.

OBJECTIVE: We aimed to identify risk factors for nursing home (NH) entry 36 months after hospitalization via the emergency department (ED) in a population of patients aged 75 years or older. METHODS: This was a prospective multicentre cohort. Patients were recruited from the emergency departments (EDs) of nine hospitals. Subjects had been hospitalised in a medical ward in the same hospital as the ED to which they were initially admitted. Subjects who experienced NH entry prior to ED admission were excluded. NH entry has been defined as the incident admission either into an NH or other long-term care facility within the follow-up period. Variables from a comprehensive geriatric assessment of patients were entered into a Cox model with competing risks to predict NH entry during 3 years of follow-up. RESULTS: Among 1306 patients included in the SAFES cohort, 218 (16.7%) who were already in an NH were excluded. The remaining 1088 patients included in the analysis were aged 84 ± 6 years on average. During 3 years of follow-up, 340 (31.3%) entered an NH. The independent risk factors for NH entry were that they: living alone (Hazard ratio (HR) 2.00, had a 95% confidence interval (CI) 1.59-2.54, p < 0.0001), could not independently perform activities of daily living (HR 1.81, 95% CI 1.24-2.64, p = 0.002), and had balance disorders (HR 1.37, 95% CI 1.09-1.73, p = 0.007), dementia syndrome (HR 1.80, 95% CI 1.42-2.29, p < 0.0001) and a risk of pressure ulcers (HR 1.42, 95% CI 1.10-1.82, p = 0.006). CONCLUSION: The majority of the risk factors for NH entry within 3 years after emergency hospitalization are amenable to intervention strategies. It is therefore reasonable to imagine that targeting these features of frailty could delay or prevent NH entry and improve the quality of life of these individuals before and after NH entry.

The Obesity Paradox and Mortality in Older Adults: A Systematic Review.

"Obesity paradox" describes the counterintuitive finding that aged overweight and obese people with a particular disease may have better outcomes than their normal weight or underweight counterparts. This systematic review was performed to summarize the publications related to the obesity paradox in older adults, to gain an in-depth understanding of this phenomenon. PubMed©, Embase©, and Scopus© were used to perform literature search for all publications up to 20 March 2022. Studies were included if they reported data from older adults on the relation between BMI and mortality. The following article types were excluded from the study: reviews, editorials, correspondence, and case reports and case series. Publication year, study setting, medical condition, study design, sample size, age, and outcome(s) were extracted. This review has been registered with PROSPERO (no. CRD42021289015). Overall, 2226 studies were identified, of which 58 were included in this systematic review. In all, 20 of the 58 studies included in this review did not find any evidence of an obesity paradox. Of these 20 studies, 16 involved patients with no specific medical condition, 1 involved patients with chronic diseases, and 2 involved patients with type 2 diabetes mellitus. Seven out of the nine studies that looked at short-term mortality found evidence of the obesity paradox. Of the 28 studies that examined longer-term mortality, 15 found evidence of the obesity paradox. In the studies that were conducted in people with a particular medical condition (n = 24), the obesity paradox appeared in 18 cases. Our work supports the existence of an obesity paradox, especially when comorbidities or acute medical problems are present. These findings should help guide strategies for nutritional counselling in older populations.

Self-Rated Health as a Predictor of Mortality in Older Adults: A Systematic Review.

The aim of this study was to investigate the link between self-reported health (SRH) and mortality in older adults. In total, 505 studies were found in PubMed and Scopus, of which 26 were included in this review. In total, 6 of the 26 studies included did not find any evidence of an association between SRH and mortality. Of the 21 studies that included community dwellers, 16 found a significant relationship between SRH and mortality. In total, 17 studies involved patients with no specific medical conditions; among these, 12 found a significant link between SRH and mortality. Among the studies in adults with specific medical conditions, eight showed a significant association between SRH and mortality. Among the 20 studies that definitely included people younger than 80 years, 14 found a significant association between SRH and mortality. Of the twenty-six studies, four examined short-term mortality; seven, medium-term mortality; and eighteen, long-term mortality. Among these, a significant association between SRH and mortality was found in 3, 7, and 12 studies, respectively. This study supports the existence of a significant relation between SRH and mortality. A better understanding of the components of SRH might help guide preventive health policies aimed at delaying mortality in the long term.

Derivation and validation of a 90-day unplanned hospital readmission score in older patients discharged form a geriatric ward.

PURPOSE: To derive and validate a 90-day unplanned hospital readmission (UHR) score based on information available to non-hospital based care providers. METHODS: Retrospective longitudinal study with cross-validation method. Participants were older adults (≥ 65 years) admitted to a geriatric short-stay department in a general hospital in France. Patients were split into a derivation cohort and a validation cohort. We recorded demographic information, medical history, and concurrent clinical characteristics. The main outcome was 90-day UHR. Data obtained from hospital discharge letters were used in a logistic regression model to construct a predictive score, and to identify risk groups for 90-day UHR. RESULTS: In total, 750 and 250 aged adults were included in both the derivation and the validation cohorts. Mean age was 87.2 ± 5.2 years, most were women (68.1%). Independent risk factors for 90-day UHR were: use of mobility aids (p = .02), presence of dementia syndrome (p = .02), history of recent hospitalisation (p = .03), and discharge to domiciliary home (p = .005). From these four risk factors, three groups were determined: low-risk group (score < 4), medium-risk group (score between 4 and 6), and high-risk group (score ≥ 6). In the derivation cohort the 90-day UHR rates increased significantly across risk groups (14%, 22%, and 30%, respectively). The 90-day UHR score had the same discriminant power in the derivation cohort (c-statistic = 0.63) as in the validation cohort (c-statistic = 0.63). CONCLUSIONS: This score makes it possible to identify aged adults at risk of 90-day UHR and to target multidisciplinary interventions to limit UHR for patients discharged from a Geriatric Short-Stay Unit.

Medication modification in a population of community-dwelling individuals aged 65 years or older.

BACKGROUND: medication safety is a major public health challenge, particularly among older populations. Changing the medication's form may be inappropriate and may incur a risk of adverse effects. OBJECTIVES: the objectives were to estimate the prevalence of medication modification and to identify factors associated with the practice of medication modification in community-dwelling older individuals. DESIGN: observational, cross-sectional, single-centre and epidemiological study. SETTINGS: community. SUBJECTS: outpatients and/or their accompanying persons, aged 65 years or over. METHODS: sociodemographic and clinical variables were recorded. It was also noted how the medication was taken, who administered the medications, the number of oral medications ingested per day, and whether or not the form of the medication was modified to facilitate administration. Descriptive analyses and logistic regression were performed. RESULTS: a total of 252 individuals were included in the study, with a mean age of 83 ± 7 years. Of these, 44 (17.5%) reported modifying their medication, either routinely (n = 36) or occasionally (n = 8). The factors independently associated with medication modification were the existence of psycho-behavioural disorders [odds ratio (OR) = 3.78; 95% confidence interval (CI) = 1.84-7.76; P < 0.0001], mobility difficulties (OR = 2.16; 95% CI = 1.01-4.62; P = 0.04), and the presence of dysphagia (OR = 3.23; 95% CI = 1.49-6.99; P < 0.0001). CONCLUSIONS: this study indicates that main caregivers are more likely to engage in medication modification than nurses or the patients themselves. Factors associated with medication modification include swallowing difficulties and psycho-behavioural disorders. These findings provide new avenues that could help to mitigate this practice.

COVID-19 versus Seasonal Influenza: Comparison of Profiles of Older Adults Hospitalized in a Short-Term Geriatric Ward in France.

The objective was to compare the profile and outcomes of older adults admitted to a geriatric short-stay unit for COVID-19, to those of older adults admitted to the same unit for seasonal influenza infection. This was an observational study performed in a General Hospital in France. Patients ≥ 70 years admitted to a geriatric short-stay unit for COVID-19 between March 18 and November 15, 2020 were included. They were compared with patients of the same age group, admitted to the same geriatric short-stay unit for seasonal influenza infection over the periods January to March 2019 and January to March 2020. Data collection included demographic information, medical history, clinical signs and symptoms, outcomes, and hospital discharge patterns. Descriptive and intergroup comparison analyses were performed. In total, 153 patients were included in the study, 82 in the seasonal influenza group, and 71 in the COVID-19 group. The average age was 87.6 ± 4.8 and 87.6 ± 6.5 years in the COVID-19 and seasonal influenza groups, respectively. There was no difference between groups regarding the Charlson comorbidity index (3.4 ± 3.0 versus 3.4 ± 2.8). The seasonal influenza group more often had fever, cough, sputum, and renal failure, whereas the COVID-19 group more often experienced diarrhea, and death. The COVID-19 group was frequently living in collective housing. The profile at admission of older adults hospitalized for COVID-19 or seasonal influenza infection was similar. Although fever and respiratory signs were less common in the COVID-19 group, these patients experienced more complications (such as renal failure or oxygen therapy requirement) and higher mortality.

Contribution of Research in the West Indies and Northeast Amazonia to Knowledge of the 2014-2015 Chikungunya Epidemic in the Americas.

PURPOSE OF REVIEW: Although the chikungunya virus was discovered more than 60 years ago, it has only really been studied since the outbreak in La Reunion in 2005-2006. Ten years later, between 2014 and 2015, the chikungunya virus spread throughout the Americas, affecting millions of people. The objective of this review is to describe the contributions of research on chikungunya virus infection gained from epidemic in the West Indies and the Guiana Shield. RECENT FINDINGS: Prevalence data were similar to those found in the Indian Ocean or Asia during epidemics. Clinically, there is now a better understanding of the typical, atypical, and severe forms. Several studies have insisted on the presence of neurological forms of chikungunya infection, such as encephalitis or Guillain-Barré syndrome. Cases of septic shock due to chikungunya virus as well as thrombotic thrombocytopenic purpura were described for the first time. Given the magnitude of the epidemic and the large number of people affected, this has led to a better description and new classifications of chikungunya virus infections in specific populations such as pregnant women, the elderly, and children. Several studies also described the behavior of populations faced with an emerging disease. SUMMARY: Current epidemiological data from tropical regions highlights the risk of spreading emerging diseases at higher latitudes, especially concerning arboviruses, since the vector Aedes albopictus is already established in many parts of northern countries. A better understanding of the disease and its epidemic dynamics will foster better management, the crucial importance of which was demonstrated during the COVID-19 epidemic.

Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review.

BACKGROUND: Vitamin D has diverse and extensive effects on the immune system, including activating innate immunity and reducing the overactive adaptive immune response. A systematic review was performed to identify and synthesize the best available evidence on the association between vitamin D level and risk of COVID-19, adverse outcomes and possible benefits of supplementation in aged 60 years or over. METHODS: A literature search was performed in PubMed© and Scopus© for all publications from inception published before 15 March 2021. Studies reporting data from aged patients on vitamin D use and COVID-19 were included. Basic science articles, editorials and correspondence were excluded. Publication year, study design and setting, characteristics of the study population were extracted. This study is registered with PROSPERO, under the number CRD42020223993. RESULTS: In total, 707 studies were identified, of which 11 observational studies were included in the final review. Four studies compared vitamin D-supplemented COVID-19 patients to non-supplemented patients, and seven compared patients with vitamin D deficiency to patients without deficiency. In all four studies, patients with vitamin D supplementation had better rates of primary clinical outcomes (death, the severity of the disease, oxygen therapy requirement…). In studies comparing patients with vitamin D deficiency and patients without vitamin D deficiency, those without vitamin D deficiency had better primary clinical outcomes (death rate, the severity of the disease, oxygen therapy requirement, invasive mechanical ventilation need…). CONCLUSION: This systematic review seems to support an association between vitamin D deficiency and the risk of COVID-19 in aged people. In addition, vitamin D deficiency appears to expose these subjects to a greater risk of adverse outcomes. Because of its simplicity of administration, and the rarity of side effects, including vitamin D in preventive strategies for certain viral diseases, it appears to be an attractive option.

Adaptation of WHO Definitions of Clinical Forms of Chikungunya Virus Infection for the Elderly.

The WHO defined three clinical forms for chikungunya virus infection (CHIKV, namely, acute, atypical, and severe cases) and a chronic form. These definitions seemed inappropriate for the elderly. So, we propose an adapted definition for elderly people. A cross-sectional analysis was performed including patients aged ≥ 65 years, who attended the emergency department with a positive biological diagnosis of CHIKV in 2014. A total of 267 elderly patients (80 ± 8 years) were included. When using the 2015 WHO definitions, 114 patients could not be classified (42.7%) in any of the category, of whom 43 (37.7%) reported absence of fever, 85 (74.6%) reported absence of joint pain, and 14 (12.3%) reported absence of both fever and joint pain. After adaptation of the WHO definitions, the 114 unclassifiable patients were reclassified as follows: eight as typical cases, 50 as atypical cases, 42 as severe cases, and 14 remained unclassifiable. The atypical clinical form was the most common form. The 2015 WHO definitions of the clinical forms at the acute phase of CHIKV are ill suited to the elderly. The adapted definition we propose here appears to be more appropriate and could help improved management of older patients with CHIKV.

Is Chikungunya Virus Infection an Independent Risk Factor for 2-Year Mortality in Older Afro-Caribbean Subjects?

PURPOSE: The aim of this study was to investigate whether Chikungunya virus infection (CVI) was an independent risk factor for 2-year mortality in Afro-Caribbean subjects aged 65 years or older. PATIENTS AND METHODS: A retrospective cohort study was performed from January 2014 to December 2016 in the University Hospital of Martinique. Subjects aged ≥65 years admitted to the hospital were included. Baseline characteristics and concurrent manifestations at admission were collected. Subjects were followed up by phone for 2 years. RESULTS: A total of 687 old Afro-Caribbean subjects (80.4±8.0 years) were included: 467 positive for CVI (Chik+) and 220 negative for CVI (Chik-). During the follow-up, 180 (26.2%) died. The proportion of deaths was higher among Chik- (40.9%) than among Chik+ subjects (21.6%) (p<0.0001). By multivariable analysis, when adjusted for age polyarthralgia, neurological troubles, cardiovascular disorders, absence of neutrophilia, thrombocytopenia, hypernatremia, and hospital stay, Chik+ subjects had significantly higher survival rates (HR: 0.58; 95% CI: 0.40-0.85) than Chik- ones. CONCLUSION: Within the two years following hospital admission of subjects aged ≥65 years or older, Chik+ subjects had significantly higher survival rates than Chik- ones.

Predictive capacity of the modified SEGA frailty scale upon discharge from geriatric hospitalisation: a six-month prospective study.

The aim of this study was to describe the predictive role of the modified SEGA frailty scale on nursing home admission, readmission to hospital, falls and mortality. MATERIAL AND METHODS: We performed a prospective, single-centre cohort study in patients discharged from a geriatric hospital ward between July 2016 and February 2017, with follow-up of six months. Patients aged 65 and over who were returning home from hospital were included. The primary outcome measure was admission to a nursing home at six months. We used a Cox model to explore the predictive nature of the variables. RESULTS: Thirty-three patients (18.4%) with a mean age of 80.9 years (± 6.5) were classified as not very frail and 146 (81.6%) with a mean age of 86 years (± 6.5) as frail/very frail. After six months, 13.5% of the frail/very frail patients and 1.2% of the not very frail patients had entered a nursing home (p = 0.169). Frailty status was significantly associated with readmission to hospital at three months (p = 0.026) and single or multiple falls at six months (p = 0.003). CONCLUSION: The modified SEGA scale may predict the occurrence of adverse events and improve the transition to home.

[Predictive capacities at the end of hospitalisation in geriatrics of the modified SEGA frailty score: a 6-month prospective study]. / Capacités prédictives du score de fragilité de la grille SEGA modifiée en sortie d'hospitalisation de gériatrie : étude prospective à 6 mois.

The aim of this study was to describe the predictive role of the modified SEGA fragility score on nursing home admission, rehospitalization, falls and mortality. MATERIAL AND METHODS: We performed a prospective, single-center cohort study in patients leaving geriatric hospitalization between July 2016 and February 2017, with follow-up at 6 months. Patients 65 years of age and over, returning home, were included. The primary outcome measure was admission to an institution at 6 months. We realized a Cox model to explore the predictive character of the variables. RESULTS: Thirty-three patients (18.4%), mean age 80.9 years (± 6.5), were not very fragile. At 6 months, 13.5% of the fragile or very fragile patients and 1.2% of the patients who were not very fragile had entered the institution (p = 0.169). Fragility status was statistically significantly associated with rehospitalization at 3 months (p = 0.026) and single or multiple drop at 6 months) month (p = 0.003). CONCLUSION: The SEGAm grid would predict the occurrence of derogatory events and improve return home.

[The opinion of private duty nurses in Martinique on the vaccination of elderly subjects]. / L'opinion des infirmiers libéraux en Martinique sur la vaccination des sujets âgés.

Improving immunisation coverage for older adults is a public health issue. Since 2008, nurses have been authorised to vaccinate this population against influenza without a medical prescription. One study examined the opinions of a sample of 78 private duty nurses in Martinique on influenza and anti-tetanus vaccination of elderly populations. The majority of nurses said they were not in favour of vaccination.