Spatio-Temporal Gait Parameters of Hospitalized Older Patients: Comparison of Fallers and Non-Fallers.

Gait disorders are predisposing factors for falls. They are accessible to rehabilitation and can be analyzed using tools that collect spatio-temporal parameters of walking, such as the GAITRite® mat. The objective of this retrospective study was to find differences between the spatio-temporal parameters in patients who had fallen compared to patients who did not fall in a population of older patients hospitalized in acute geriatrics department. Patients over 75 years were included. For each patient, spatio-temporal parameters were collected using the GAITRite® mat. The patients were divided into two groups according to whether they had a history of fall. The spatio-temporal parameters were compared between the two groups and in relation to the general population. Sixty-seven patients, with an average age of 85.9 ± 6 years, were included. The patients had comorbidities, cognitive impairment and were polymedicated. The mean walking speed was 51.4 cm/s in non-fallers group and 47.3 cm/s in fallers group (p = 0.539), indicating pathological walking in comparison with the general population of the same age (average 100 cm/s). No association was found between the spatio-temporal parameters and fall, probably linked to many confounding factors such as the pathogenicity of walking of our patients and their comorbidities.

Diagnosis of vascular parkinsonism: A new tool for gait hypokinesia occurring in older persons.

INTRODUCTION: Reliable diagnosis of vascular parkinsonism (VaP) in the presence of a gait hypokinesia is an issue that is encountered in geriatrics. The EVAMAR-AGEX study was focusing on the phenomenon of recurrent falls in older persons (OP) with this parkinsonian gait. The present study is focusing on the diagnosis of VaP-related parkinsonian gait by developing a diagnostic guidance model adapted to OP. METHODS: Data from baseline and the 2-year follow-up visit were used to carry out univariate analysis and calculation of odds ratios, allowing to identify relevant variables to include in the diagnostic guidance model. To evaluate the model, confusion matrices were created, evaluating true positive, false negative, false positive and true negative incidences, sensitivity and specificity, and negative and positive predictive values. RESULTS: 79 patients included 58% male; average age 81.24 years. VaP diagnosis according to Zijlmans criteria occurred in 28%; neurodegenerative parkinsonian syndromes in 72%. A 4-criteria model was established to facilitate diagnostic: lack of prior hallucinations, lack of movement disorders tremor excluded, no cognitive fluctuations, and ≥75 years of age at diagnosis. In combination of 4/4 criteria, all of them were required to disclose a specificity of 91% in the diagnosis of VaP. In combination of 3/4, in case of negative test, a negative predictive value for VaP diagnosis of 0.97 was obtained. CONCLUSION: The challenge of our tool is both to be able to rule out what is probably not a VaP and to argue what makes a VaP diagnosis probable in OP.

Humoral immune response after COVID-19 infection or BNT162b2 vaccine among older adults: evolution over time and protective thresholds.

The objectives of this study were to assess the dynamics of the SARS-CoV-2 anti-RBD-IgG response over time among older people after COVID-19 infection or vaccination and its comparison with indicative levels of protection. Geriatric patients with SARS-CoV-2 serological test results were included and divided into three groups. A vaccine group (n = 34), a group of natural COVID-19 infection (n = 32), and a group who contracted COVID-19 less than 15 days after the first injection (n = 17). Eighty-three patients were included; the median age with IQR was 87 (81-91) years. In the vaccine group at 1 month since the first vaccination, the median titer of anti-RBD-IgG was 620 (217-1874) BAU/ml with 87% of patients above the theoretical protective threshold of 141 BAU/ml according to Dimeglio et al. (J Infec. 84(2):248-88, [7]). Seven months after the first vaccination, this titer decreased to 30 (19-58) BAU/ml with 9.5% of patients > 141 BAU/ml. In the natural COVID-19 infection group, at 1 month since the date of first symptom onset, the median titer was 798 (325-1320) BAU/ml with 86.7% of patients > 141 BAU/ml and fell to 88 (37-385) with 42.9% of patients > 141 BAU/ml at 2 months. The natural infection group was vaccinated 3 months after the infection. Five months after the vaccination cycle, the median titer was 2048 (471-4386) BAU/ml with 83.3% of patients > 141 BAU/ml. This supports the clinical results describing the decrease in vaccine protection over time and suggests that vaccination after infection can maintain significantly higher antibody titer levels for a prolonged period of time.

Older Persons Displaying Parkinsonian Gait: Prediction and Explanation of the Recurrent Falling Phenomenon and Its Related Poor Prognosis.

INTRODUCTION: Parkinsonian gait in older persons is a major risk factor for recurrent falling. This prospective, longitudinal study (named EVAMAR-AGEX) aimed to validate the threshold value of two or more falls per year for distinguishing non-recurrent (NRF) from recurrent fallers (RF), to explore predictive factors for recurrent falling, and to identify factors which underlie the transition of patients from NRF to RF. The study took place over 2 years, with an intermediate analysis at 1 year of follow-up. Herein, we report results after 2 years of follow-up. METHODS: Participants over the age of 65, diagnosed with parkinsonian gait, were followed over the course of 2 years. Induced parkinsonian syndrome and uncontrolled orthostatic hypotension were excluded. Assessments of motor, visual, and cognitive functions were carried out during visits at baseline. Between visits at 12 and 24 months of follow-up, data were collected by phone call every 2 months (falls, traumatic falls, hospitalizations, cognitive fluctuations, delirium, and mortality). Odds ratios (ORs) for a panel of predictive factors for recurrent falling were established using a Bayesian model. RESULTS: Sixty-six of the 79 initially enrolled participants progressed to the second year of the study, with a mean age of 80.57 (SD 6.3), 56% male, presenting parkinsonian gait (53% Parkinson's disease, 15% atypical neurodegenerative parkinsonism, 21% vascular parkinsonism, and 11% diffuse Lewy body disease). At 2 years of follow-up, 67% were RF. Univariate analysis revealed a previous history of falls to be the most significant predictive factor of recurrent falls (OR 13.16, credibility interval [CrI] [95%] 4.04-53.73), and this was reinforced at 2 years of follow-up compared to the intermediate 1-year analysis (OR 11.73, CrI [95%] 4.33-35.28). Multivariate analysis confirmed a previous history of falls (OR 13.20, CrI [95%] 3.29-72.08) and abnormal posture (OR 3.59, CrI [95%] 1.37-11.26) to be predictive factors for recurrent falling. Cognitive decline and fluctuating cognition were associated with the transition from NRF to RF (-3.5 MMSE points for participants transitioning from NRF to RF). CONCLUSION: Within this population of older persons presenting parkinsonian gait, a previous history of falls and abnormal posture may be used to easily identify individuals at risk of recurrent falls. Cognitive decline and fluctuations may underlie the transition of NRF to RF.

Animal-assisted intervention and agitation in patients with dementia: evaluation in a special care unit by the Cohen-Mansfield Agitation Inventory.

BACKGROUND: Animal-assisted interventions (AAI) show promising results, but they suffer from a lack of studies and contradictory results. OBJECTIVE: Our study deals with dog intervention and agitation in older patients with dementia. METHODS: An epidemiological quasi-experimental study was carried out in patients living in a special care unit (SCU) in an Ehpad in the French Haut-Rhin region. Agitation was assessed using the Cohen-Mansfield Agitation Inventory at three consecutive periods one month after the introduction, discontinuation and resumption of a dog mediation. RESULTS: 26 patients were included in the study (76.92% female); mean age was 85.35 years and the mean score on MMSE was 6.85. Stopping AAI leads to an 11.9% relative increase in agitation (P = 0.03) whereas reintroduction of AAI leads to a 29.9% relative decrease in agitation (P < 0.0001). CONCLUSION: AAI presents an interesting and efficient therapy for agitation in older patients with dementia. However, further studies are needed to standardise their implementation (rhythm, duration and type of interaction) in order to ensure an optimal care.

[Animal-assisted intervention and agitation in patients with dementia: evaluation in a special care unit by the Cohen-Mansfield Agitation Inventory]. / Intérêt de la médiation animale sur l'agitation dans la maladie d'Alzheimer et les maladies apparentées : évaluation en unité de vie protégée à l'aide de l'échelle de Cohen-Mansfield.

BACKGROUND: Animal-assisted interventions (AAI) show promising results but they suffer from a lack studies and contradictory results. OBJECTIVE: Our study deals with dog intervention and agitation in older patients with dementia. METHODS: An epidemiological quasi-experimental study was carried out in patients living in a Special Care Unit (SCU) of an Ehpad in the French Region of Haut-Rhin. Agitation was assessed by the Cohen-Mansfield Agitation Inventory at three consecutive periods of one month after the instauration, discontinuation and resumption of a dog mediation. RESULTS: 26 patients were included in the study (76,92% female); mean age was 85,35 years and the mean score on MMSE was 6,85. Stopping AAI leads to a 11,9% relative increase in agitation (p = 0,03) whereas reintroduction of AAI leads to a 29,9% relative decrease in agitation (p < 0.0001). CONCLUSION: Animal-assisted interventions present an interesting and efficient therapy for agitation in older patients with dementia. However, further studies need to standardize their practices (rhythm, duration and type of interaction) to ensure an optimal care.

Therapeutic prevention of COVID-19 in elderly: a case-control study.

COVID-19 is a particularly aggressive disease for the elderly as 86% of deaths related to COVID-19 occur in people over 65 years of age. Despite the urgent need for a preventive treatment, there are currently no serious leads, other than the vaccination. The aim of this retrospective case-control study is to find a pharmacological preventive treatment of COVID-19 in elderly patients. One-hundred-seventy-nine patients had been in contact with other COVID-19 patients at home or in hospital, of whom 89 had tested RT-PCR-positive (COVID-pos) for the virus and 90 had tested RT-PCR-negative (COVID-neg). Treatments within 15 days prior to RT-PCR (including antihypertensive drugs, antipsychotics, antibiotics, nonsteroidal anti-inflammatory drugs, proton pump inhibitors (PPIs), oral antidiabetics (OADs), corticosteroids, immunosuppressants), comorbidities, symptoms, laboratory values, and clinical outcome were all collected. COVID-pos patients more frequently had a history of diabetes (P = .016) and alcoholism (P = .023), a lower leukocyte count (P = .014) and a higher mortality rate - 29.2% versus 14.4% - (P = .014) when compared to COVID-neg patients. Patients on PPIs were 2.3 times less likely (odds ratio [OR] = 0.4381, 95% confidence interval [CI] [0.2331, 0.8175], P = .0053) to develop COVID-19 infection, compared to those not on PPIs. No other treatment decreased or increased this risk. COVID-pos patients on antipsychotics (P = .0013) and OADs (P = .0153), particularly metformin (P = .0237), were less likely to die. Thus, patients on treatment with PPI were less likely to develop COVID-19 infection, and those on antipsychotics or metformin had a lower risk of mortality. However, prospective studies, including clinical trials, are needed to confirm or not these findings.

Presence of active myocarditis at the 6 month follow-up appointment for a severe form of COVID-19: a case report.

Here, we present the case of an 81-year-old male patient, who was hospitalized for a severe form of COVID-19. Transthoracic echocardiogram (TTE) performed 1 month after symptom onset was normal. Respiratory evolution was favourable, and the patient was discharged at Day 78. At 6 months, despite a good functional recovery, he presented pulmonary sequelae, and the TTE revealed a clear reduction of left ventricular ejection fraction (LVEF) and mild LV dilatation without cardiac symptoms. The cardiac magnetic resonance (CMR) using Lake Louise Criteria (LLC), T1 and T2 mapping showed focal infero-basal LV wall oedema, elevated T1 and T2 myocardial relaxation times especially in basal inferior and infero-lateral LV walls, and sub-epicardial late gadolinium enhancement in those LV walls. The diagnosis of active myocarditis was raised especially based on TTE abnormalities and CMR LLC, T1 and T2 mapping. Currently, we are not aware of published reports of a 6 month post-COVID-19 active myocarditis.

Gait Disorder among Elderly People, Psychomotor Disadaptation Syndrome: Post-Fall Syndrome, Risk Factors and Follow-Up - A Cohort Study of 70 Patients.

INTRODUCTION: Falls among older people are a major health issue and the first cause of accidental death after 75 years of age. Post-fall syndrome (PFS) is commonly known and yet poorly studied. OBJECTIVE: Identify risk factors for PFS and do a follow-up 1 year later. METHODS: We included all patients over 70 years of age hospitalized after suffering a fall in a case-control study, and then followed them in a cohort study. PFS was retained in case of functional mobility decline (transferring, walking) occurring following a fall in the absence of an acute neurological, orthopedic or rheumatic pathology directly responsible for the decline. The data initially collected were: clinical (anamnestic, emergency and departmental/ward evolution, medical history, lifestyle, treatments, clinical examination items); and imaging if the patient had been subjected to brain imaging in the last 3 years prior to inclusion. Regarding the follow-up at 1 year, we collected from the general physician the occurrence and the characteristics of new falls, functional mobility assessment, hospitalization and death. RESULTS: Inclusion took place from March 29, 2016 to June 7, 2016 and follow-up until June 30, 2017. We included 70 patients. A total of 29 patients exhibited a PFS (41.4 %). Risk factors for PFS included age, walking disorder prior to the fall, the use of a walking aid prior to the fall, no unaccompanied outdoor walk in the week before the fall, visual impairment making close reading impossible, stiffness in ankle dorsiflexion, grip strength and the fear of falling. Among patients with PFS, 52.9% could still perform a transfer at 1 year and 64.7% could still walk against 80.7% and 85.2%, respectively, for patients without PFS. CONCLUSION: The study showed the existence of body functions/structure impairments and activity limitations prior to the fall among patients exhibiting a PFS. This suggests the existence of a pre-fall syndrome, i.e., a psychomotor disadaptation syndrome existing prior to the fall. Among the 8 risk factors, fear of falling, vision impairment and muscle strength could be targeted for improvement. The diagnosis of PFS could be a marker of loss of functional mobility at 1 year.

Effects of a short-term interval aerobic training program with recovery bouts on vascular function in sedentary aged 70 or over: A randomized controlled trial.

BACKGROUND: Interval aerobic training programs with active recovery bouts (IATP-R) are reported as being more adapted to seniors while improving cardiorespiratory and endurance parameters. Report of benefits on vascular function is still limited. PURPOSE: To measure the impact of IATP-R on vascular function among seniors. METHODS: Sedentary volunteers (≥70 years of age) were randomly assigned to either IATP-R (n = 30) or control group (n = 30). The IATP-R consisted of 2 weekly sessions of 30-min (6 × 4-min at first ventilatory threshold (VT1) intensity + 1-min at 40% of VT1) cycling exercise over 9.5-week. Controls remained their sedentary life over the same period. In all participants, the endothelial function was measured by flow-mediated dilation (FMD) in brachial artery and arterial stiffness through the carotid/radial and carotid/femoral pulse wave velocity (PWV). Systolic (SBP) and diastolic blood pressure (DBP) were measured at baseline and 9.5 weeks later. RESULTS: Resulting from a planned interim analysis, IATP-R improved SBP (IATP-R: from 133.7 ± 9.8 to 122.6 ± 9.4 mmHg vs. Controls: from 128.9 ± 12.5 to 132.6 ± 14.7 mmHg), DBP (IATP-R: from 80.2 ± 7.0 to 74.1 ± 6.7 mmHg vs. Controls: from 77.1 ± 6.8 to 80.3 ± 7.5 mmHg), and FMD (IATP-R: from 6.7 ± 2.0 to 7.5 ± 2.7% vs. Controls: from 7.9 ± 2.7 to 7.5 ± 2.5%). No significant impact on PWV was measured. CONCLUSION: Although these findings resulted from an interim analysis, IATP-R might be effective in regulating BP and improving endothelial function among sedentary seniors.

Effects of a short-term Interval Aerobic Training Programme with active Recovery bouts (IATP-R) on cognitive and mental health, functional performance and quality of life: A randomised controlled trial in sedentary seniors.

BACKGROUND: Interval aerobic training programme with active recovery bouts (IATP-R) has shown to improve tolerance to IATP among seniors. However, data concerning its benefits for seniors' health are still limited. PURPOSE: The purpose of this study was to examine the effects of IATP-R on seniors' health status. METHODS: Sedentary volunteers (n = 60, aged ≥70 years) were randomly assigned to either IATP-R or maintained sedentary lifestyle for 9.5 weeks. IATP-R consisted of 30-minute cycling (6 × 4 minutes at first ventilatory threshold (VT1 ) intensity + 1 minute at 40% of VT1 ) twice a week. Cognitive and functional performances were assessed with the Trail Making Test (TMT-A; TMT-B); Paced Auditory Serial Addition Test (PASAT); Timed Up and Go (TUG) test; 6-Minute Walk Test (6-MWT); one-leg balance test; and the Short Physical Performance Battery (SPPB) tests, respectively. QoL and anxiety/depression status were measured by the Short Form-12 and the Goldberg's Scale, respectively. All participants were assessed at baseline and 9.5 weeks later. RESULTS: Compared to controls, IATP-R improved cognitive functions (TMT-A: +1.5% vs -21.5%; TMT-B: +0.9% vs -13.3%; PASAT: +1.4% vs -14.6%; semantic fluency: -1.1% vs +11.7%), functional performance (TUG: +5.4% vs -16.5%; 6-MWT: -3.2% vs +11.5%; SPPB: -3.2% vs +14.6%; One-leg balance: -16.3% vs +25.0%); QoL (physical health: -13.3% vs +23.1%; mental health: -7.1% vs +8.2%); and depressive symptoms (+26.3% vs -42.8%). Significant impacts were measured neither on letter modality of fluency tasks nor on anxiety score. CONCLUSION: These data showed that IATP-R is an effective training programme to improve functional and cognitive performances, mental health and well-being in sedentary seniors. Trial registration ClinicalTrials.gov NCT02263573. Registered October 1, 2014.

Systematic Review and Pragmatic Clinical Approach to Oral and Nasal Vitamin B12 (Cobalamin) Treatment in Patients with Vitamin B12 Deficiency Related to Gastrointestinal Disorders.

The objective of this review is to provide an update on the effectiveness of oral and nasal vitamin B12 (cobalamin) treatment in gastrointestinal (GI) disorders. Relevant articles were identified by PubMed and Google Scholar systematic search, from January 2010 and June 2018, and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the Cochrane Library and the ISI Web of Knowledge. Data gleaned from reference textbooks and international meetings were also used, as was information gleaned from commercial sites on the web and data from CARE B12 research group. For oral vitamin B12 treatment, 4 randomized controlled trials (vs. intramuscular), 4 narrative and 4 systematic reviews, and 13 prospective studies fulfilled our inclusion criteria. These studies concerned patients with vitamin B12 deficiency related to: food-cobalamin malabsorption (n = 6), Biermer's disease (n = 3), veganism or vegetarianism (n = 1), total gastrectomy after Roux-en-Y gastric bypass (n = 2) and Crohn's disease (n = 1). Four prospective studies include patients with vitamin B12 deficiency related to the aforementioned etiologies, except veganism or vegetarianism. The systematic present review documents that oral vitamin B12 replacement, at a daily dose of 1000 µg (1 mg), was adequate to normalize serum vitamin B12 levels and cure main clinical manifestations related to vitamin B12 deficiency, in GI disorders, and thus, with safety profile. For nasal vitamin B12 treatment, only one preliminary study was available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 (except in patients presenting with severe neurological manifestations). Oral vitamin B12 treatment avoids the discomfort, contraindication (in patients with anticoagulation), and cost of monthly injections.

Effects of Interval Aerobic Training Program with Recovery bouts on cardiorespiratory and endurance fitness in seniors.

Interval aerobic training programs (IATP) improve cardiorespiratory and endurance parameters. They are, however, unsuitable to seniors as frequently associated with occurrence of exhaustion and muscle pain. The purpose of this study was to measure the benefits of an IATP designed with recovery bouts (IATP-R) in terms of cardiorespiratory and endurance parameters and its acceptability among seniors (≥70 years). Sedentary healthy volunteers were randomly assigned either to IATP-R or sedentary lifestyle. All participants performed an incremental cycle exercise and 6-minute walk test (6-MWT) at baseline and 9.5 weeks later. The first ventilatory threshold (VT1 ); maximal tolerated power (MTP); peak of oxygen uptake (VO2peak ); maximal heart rate (HRmax ); and distance walked at 6-MWT were thus measured. IATP-R consisted of 19 sessions of 30-minute (6 × 4-min at VT1  + 1-minute at 40% of VT1 ) cycling exercise over 9.5 weeks. With an adherence rate of 94.7% without any significant adverse events, 9.5 weeks of IATP-R, compared to controls, enhanced endurance (VT1 : +18.3 vs -4.6%; HR at baseline VT1 : -5.9 vs +0.2%) and cardiorespiratory parameters (VO2peak : +14.1 vs -2.7%; HRmax : +1.6 vs -1.7%; MTP: +19.2 vs -2.3%). The walk distance at the 6-MWT was also significantly lengthened (+11.6 vs. -3.1%). While these findings resulted from an interim analysis planned when 30 volunteers were enrolled in both groups, IATP-R appeared as effective, safe, and applicable among sedentary healthy seniors. These characteristics are decisive for exercise training prescription and adherence.

Critically ill elderly patients (≥ 90 years): Clinical characteristics, outcome and financial implications.

BACKGROUND: Patients aged over 90 are being admitted to intensive care units (ICUs) with increasing frequency. The appropriateness of such decisions still remains controversial due to questionable outcome, limited resources and costs. Our objective was to determine the clinical characteristics and outcome in elderly patients (≥ 90 years) admitted in a medical ICU, with an additional focus on medico-economic implications. METHODS: We reviewed the charts of all patients (≥ 90 years) admitted to our ICU. We compared them with all other ICU patients (< 90 years), sought to identify ICU mortality predictors and also performed a long-term survival follow-up. RESULTS: In the study group of 317 stays: median age was 92 years (IQR: 91-94 years); most patients were female (71.3%.). Acute respiratory failure (52.4%) was the main admission diagnosis; mean SAPS II was 55.6±21.3; half the stays (49.2%) required mechanical ventilation (duration: 7.2±8.8 days); withholding and withdrawing decisions were made for 33.4% of all stays. ICU and hospital mortality rates were 35.7% and 42.6% respectively. Mechanical ventilation (OR = 4.83, CI95%: 1.59-15.82) was an independent predictor of ICU mortality whereas age was not (OR = 0.88, CI95%: 0.72-1.08). Social security reimbursement was significantly lower in the study group compared with all other ICU stays, both per stay (13,160 vs 22,092 Euros, p< 0.01) and per day of stay (p = 0.03). CONCLUSION: Among critically ill elderly patients (≥ 90 years), chronological age was not an independent factor of ICU mortality. ICU care-related costs in this population should not be considered as a limiting factor for ICU admission.

Effect of Aerobic Training on Peak Oxygen Uptake Among Seniors Aged 70 or Older: A Meta-Analysis of Randomized Controlled Trials.

Older adults undergo a progressive decline in cardiorespiratory fitness and functional capacity. This lower peak oxygen uptake (VO2peak) level is associated with increased risk of frailty, dependency, loss of autonomy, and mortality from all causes. Regular physical activity and particularly aerobic training (AT) have been shown to contribute to better and healthy aging. We conducted a meta-analysis to measure the exact benefit of AT on VO2peak in seniors aged 70 years or older. A comprehensive, systematic database search for articles was performed in Embase, Medline, PubMed Central, Science Direct, Scopus, and Web of Science using key words. Two reviewers independently assessed interventional studies for potential inclusion. Ten randomized controlled trials (RCTs) were included totaling 348 seniors aged 70 years or older. Across the trials, no high risk of bias was measured and all considered open-label arms for controls. With significant heterogeneity between the RCTs (all p < 0.001), pooled analyses were computed for VO2peak. Not only was VO2peak found significantly higher in the training group compared to controls (mean difference [MD] = 1.56; 95% confidence interval [CI]: 0.90-2.23) in pooled analysis of the 10 RCTs but also when the analysis was adjusted on the participants' health statuses. MD among healthy and unhealthy seniors were, respectively, 1.72 (95% CI: 0.34-3.10) and 1.47 (95% CI: 0.60-2.34). This meta-analysis confirms the AT-associated benefits on VO2peak in healthy and unhealthy seniors.