[General practitioners' satisfaction after a geriatric assessment into primary care: data from FAP study]. / Ressentis des médecins généralistes ayant participé à un projet d'évaluation gériatrique en soins premiers : données issues de l'étude FAP.

In response to demographic challenges, primary care need to get familiar with the concept of frailty and the early detection of cognitive impairment. The « Frailty and Alzheimer's disease prevention into primary care ¼ (FAP) project introduced a geriatric evaluation with a nurse in primary care in order to assess older patients. Our work aimed to evaluate the general practitioner's (GPs) opinion involved in FAP project. METHODS: This is an observational descriptive study performed in Occitanie region. 26 GPs have involved in this project. The gathering of information was performed through an online survey. RESULTS: GPs estimated that most of the patients benefiting from a primary care geriatric evaluation would have declined hospital evaluation. 92% of the surveyed GPs gave a strongly positive or positive opinion regarding the detection of previously unidentified health issues and the improvement of patient care following this evaluation. 42% of the GPs found that the personalized plan of cares is difficult or very difficult to do. 73% of the GPs considered that they have a better knowledge of frailty syndrome and cognitive impairment after the evaluation. CONCLUSION: GPs feedback was very positive and promising for the future. It could be interesting to develop this geriatric evaluation in primary care into new regions.

Patients' satisfaction after a geriatric assessment into primary care: data from FAP study.

Given the current demographic situation, the primary care must consider the frailty concept. The « Frailty and Alzheimer's disease prevention into Primary care ¼ project (FAP) enabled geriatric assessment by a nurse in general practitioner's office to assess older persons. The aim of our study was to evaluate patients' satisfaction after geriatric assessment into primary care. METHODS: This is an observational descriptive study performed in the Occitanie area on a population of 268 older patients. Gathering of information was performed through a phone survey. RESULTS: A total of 133 questionnaires were filled in. Average age was 80 (±6) years old and 60% were women. 75.2% (n=100) were frail or pre-frail; 72% (n=89) of participants have been completely satisfied by this assessment; 71% (n=24) have been completely satisfied about their personalized plan of care; 79% (n=89) of them thought the general practitioners' office as the best place for geriatric assessment; 42% (n=52) would have refused the evaluation in the hospital. DISCUSSION: Patient's feedback is very encouraging. They were favorable to the development of the geriatric assessment into primary care and the generalization of the FAP project in other areas. Further studies must be carried out in order to evaluate the medico-economic effect of this care model.

[Proton pump inhibitors: Real indication or trivialized prescription?] / Les inhibiteurs de pompe à protons : vraie indication ou prescription banalisée ?

PURPOSE: Protons Pump Inhibitors (PPIs) are widely used in France. The aim of our study was to determine the rate of exposure to PPIs in old patients and to assess the appropriateness of their prescription according to French guidelines. METHODS: We performed a descriptive study from 1st June to 30th August 2016, including all patients admitted in the department of geriatric post emergency of the university hospital of Toulouse with a prescription of PPI. Data concerning age, name of PPI, dose, indication, duration of prescription and the modification of PPI prescription were collected. RESULTS: Among 375 patients admitted during this period, 134 (35.7) were exposed to PPIs with a mean age of 85.9±6.6years. About one third of them were exposed to PPI more than one year (N=49). Prescription was inappropriate for the criteria "dose and indication" and "duration" for respectively 59 (44.0%) and 15 (11.2%) cases. In 50 cases (37.3%), the PPI was renewed, stopped in 69 cases (51.5%) and the dose was reduced for 15 patients (11.2%). CONCLUSION: According to our data, the prescription of PPI was no appropriate in about 40% of included patients. A reassessment of their prescription with awareness of patients should be necessary to improve the good utilization of these "popular" drugs and to prevent some serious adverse reactions after long exposure.

Nutrition, Frailty, Cognitive Frailty and Prevention of Disabilities with Aging.

Older adults can be categorized into three subgroups to better design and develop personalized interventions: the disabled (those needing assistance in the accomplishment of basic activities of daily living), the 'frail' (those presenting limitations and impairments in the absence of disability) and the 'robust' (those without frailty or disability). However, despite evidence linking frailty with a poor outcome, frailty is not implemented clinically in most countries. Since many people are not identified as frail, their treatment is frequently inappropriate in health care settings. Assessing the frail and prefrail older adults can no longer be delayed, we should rather act preventively before the irreversible disabling cascade is in place. Clinical characteristics of frailty such as weakness, low energy, slow walking speed, low physical activity and weight loss underline the links between nutrition and frailty. Physical frailty is also associated with cognitive frailty. We need to better understand cognitive frailty, a syndrome which must be differentiated from Alzheimer's disease. At the Gérontopôle frailty clinics, we have found that almost 40% of the patients referred to our center by their primary care physicians to evaluate frailty had significant weight loss in the past 3 months, 83.9% of patients presented slow gait speed, 53.8% a sedentary lifestyle and 57.7% poor muscle strength. Moreover, 43% had a Mini-Nutritional Assessment less than 23.5 and 9% less than 17, which reflects protein-energy undernutrition. More than 60% had some cognitive impairment associated with physical frailty.

Nutrition and neurodegeneration: epidemiological evidence and challenges for future research.

The prevention of dementias, such as Alzheimer's disease (AD), is a growing public health concern, due to a lack of effective curative treatment options and a rising global prevalence. Various potential risk or preventive factors have been suggested by epidemiological research, including modifiable lifestyle factors such as diet. Current epidemiological data are in favour of a protective role of certain micronutrients (B vitamins related to homocysteine metabolism, the anti-oxidant vitamins C and E, flavonoids, polyunsatured omega-3 fatty acids, vitamin D) and macronutrients (fish) in the prevention of cognitive decline and dementia/AD. Some factors have been targeted by interventions tested in randomized controlled trials (RCTs), but many of the results are conflicting with observational evidence. Epidemiological analysis of the relations between nutrient consumption and cognitive decline is complex and it is highly unlikely that a single component plays a major role. In addition, since multiple factors across the life course influence brain function in late life, multidomain interventions might be more promising in the prevention of cognitive decline and dementia/AD. Designing such trials remains very challenging for researchers. The main objective of this paper is to review the epidemiologic data linking potential protective factors to cognitive decline or dementia/AD, focusing particularly on the roles of adiposity, caloric restriction, micro (group B vitamins related to homocysteine metabolism, the anti-oxidant vitamins C and E, flavonoids, polyunsatured omega-3 fatty acids, vitamin D) and macronutrients (fish). Limitations of the current data, divergence with results of interventional prevention studies and challenges for future research are discussed.

Weight changes in Alzheimer's disease patients with increased aberrant motor behavior.

OBJECTIVE: Weight loss and behavioral disturbances are frequent over the course of Alzheimer's disease (AD) and are risk factors for poor outcome. We investigated the impact of aberrant motor behavior (AMB) on weight changes in older adults with AD. The hypothesis that patients with AMB are more likely to lose weight than patients without AMB was assessed. METHODS: A prospective study of 686 patients with moderate AD from the REAL.FR cohort was assessed. The AMB at baseline was defined by the item 10 from the Neuropsychiatric Inventory scale (NPI-10). Patients were classified as "no or light AMB" (NPI-10 < 4), and "significant AMB" (NPI-10 ≥ 4). Weight changes were determined over the 4-year follow-up. RESULTS: The mean weight change over the 4 years was +2.2 ± 0.9 kg in patients with "significant AMB," whereas weight remained stable in patients with "no or light AMB" (p = 0.02). CONCLUSION: Older adults with moderate AD and "significant AMB" do gain weight.

Improving care of older adults with dementia: description of 6299 hospitalizations over 11 years in a special acute care unit.

OBJECTIVE: To describe hospitalizations in a Special Acute Care inpatient Unit for older adults with Alzheimer's disease (AD) and other related disorders. DESIGN: An 11-year observational study of consecutive hospitalizations from 1996 to 2006. SETTING: The Alzheimer Special Acute Care inpatient Unit in the Geriatrics Department of the Toulouse University Hospital, France. PARTICIPANTS: A total of 4708 patients with dementia accounting for 6299 consecutive hospitalizations. MEASUREMENTS: Data regarding admission causes, cognition, physical disability, nutritional assessment, behavioral and psychological symptoms of dementia, and sociodemographics were recorded. RESULTS: Data from 6299 hospitalizations are presented: 4708 (74.7%) hospitalizations accounted for first-time admissions and 1591 (25.3%) were rehospitalizations. Among the first-time admissions, complications of dementia and cognitive diagnosis experienced a significant switch in frequency. Whereas until 2001, the main cause of admission was for a diagnosis (51%), complications became the primary cause from 2003 onward with a significant increasing trend (56%) (P < .001). The most frequent cause of complications was behavioral and psychological symptoms of dementia, with a significant trend for an increased frequency (P < .001). Agitation-aggressiveness represented 60% of behavioral and psychological symptoms of dementia. Between 1996 and 2006, the age of patients at first-time admission gradually increased over time, as did the severity of cognitive impairment and the prevalence of unsatisfactory nutritional status (P for trend < .001 for each variable). CONCLUSIONS: The evolving patient characteristics and the causes of first-time admissions changed over the course of 11 years. Behavioral and psychological symptoms of dementia, especially agitation-aggressiveness, have progressively become the key drivers of Special Acute Care inpatient Unit hospitalizations. These findings suggest that the role, mission, and functioning of the Special Acute Care inpatient Unit within the Alzheimer care system has been modified over time.

Weight loss and rapid cognitive decline in community-dwelling patients with Alzheimer's disease.

Weight loss is a frequent complication of Alzheimer's disease (AD) and a strong predictor of adverse outcomes in patients suffering from this disease. The aim of this study was to determine whether weight loss was a predictor of rapid cognitive decline (RCD) in AD. Four hundred fourteen community-dwelling ambulatory patients with a diagnosis of probable AD and a Mini-Mental State Examination (MMSE) score between 10 and 26 from the REAL.FR (REseau sur la maladie d'ALzheimer FRançais) cohort were studied and followed up during 4 years. Patients were classified in 2 groups according to weight loss defined by a loss of 4% or more during the first year of follow-up. RCD was defined as the loss of 3 points or more in MMSE over 6 months. The incidence of RCD was determined among both groups over the last 3 years of follow-up. MMSE, Katz's Activity of Daily Living scale, Mini-Nutritional Assessment scale, co-morbidities, behavioral and psychological symptoms of dementia, medication, level of education, living arrangement, and caregiver's burden were assessed every 6 months. Eighty-seven patients (21.0%) lost 4% or more of their initial weight during the first year. The incidence of RCD for all patients was 57.6 (95% confidence interval (CI) = 51.6-64.8) per 100 person-year (median follow-up of 15.1 months). In Cox proportional hazards models, after controlling for potential confounders, weight loss was a significant predictor factor of RCD (adjusted hazard ratio (HR) = 1.50, 95% CI = 1.04-2.17). In conclusion, weight loss predicted RCD in this cohort. Whether the prevention of weight loss (by improving nutritional status) impacts cognitive decline remains an open question.