[Older patients and injectable anticancer drug: Feasibility study of the implementation of pharmaceutical interviews in oncogeriatrics in a hospital center]. / Patients âgés et anticancéreux injectables : étude de faisabilité de la mise en place d'entretiens pharmaceutiques d'oncogériatrie dans un centre hospitalier.

INTRODUCTION: In our establishment, pharmaceutical interviews in oncogeriatrics have been developed to reduce drug iatrogenesis. The target patients were older patients (≥65years) with polypharmacy and/or identified at risk of frailty (G8≤14), starting an injectable cancer protocol. METHODS: The aim of this study is to evaluate the feasibility of implementing pharmaceutical interviews in oncogeriatrics over a period of six months. RESULTS: In total, 30 patients benefited from a pharmaceutical interview in oncogeriatrics (median age 76 years; 21 patients with G8≤14). Two-thirds of the patients met other interveners during patient care, 4 of whom after referral by the pharmacist. As for medication reviews: 93% of patients required pharmaceutical intervention (average of 3.5 per patient). The majority proposed therapeutic follow-ups and discontinuations of treatment. According to their evaluation by a pharmacist/oncologist pair, 97% of pharmaceutical interventions would have a positive clinical impact, of which 13 % a major clinical impact. The main drug classes concerned by the pharmaceutical interventions were analgesics, drugs used in diabetes and psycholeptics. Among the four pharmaceutical interventions with major clinical impact, nine proposed the optimization of analgesic treatment. DISCUSSION: The implementation of these interviews allowed us to initiate the creation of a care pathway dedicated to older patients identified as fragile. The pharmaceutical care offered appear to provide added value in the care of these patients. Organizational changes are necessary to promote multidisciplinarity and improve our practices in oncogeriatrics.

Frailty Status and Gait Parameters of Older Women With Type 2 Diabetes.

OBJECTIVES: Gait decline in individuals with frailty status is associated with comorbidities, falls and reduced mobility, reflecting changes in gait. The prevalence of frailty in individuals with type 2 diabetes is higher compared to individuals without diabetes. However, the consequences of frailty status on gait in older women with diabetes are unclear. The objective of the study was to investigate gait changes in older women with diabetes who are classified as vulnerable, having 1 or more frailty conditions, or robust, having none of the conditions, according to the Fried phenotype. METHODS: Participants included 203 older women: 112 without diabetes and 91 with diabetes. The nondiabetes robust group included 59 older women: nondiabetes, vulnerable, 53; diabetes, robust, 26; and diabetes, vulnerable, 65. Gait parameters were obtained by using the GAITRite system and included velocity, cadence, step length, stance time and double-support time. Multivariate analysis was conducted followed by post hoc analysis. RESULTS: Older women with diabetes and vulnerable status used more drugs and had higher body mass indexes than the groups without diabetes who were vulnerable and robust; there was no difference between the diabetes, robust and diabetes, vulnerable groups. Falls history and fear of falling were similar in all groups. Vulnerable older women with diabetes walked with decreased velocity, cadence and step length and increased stance time compared to all groups and with increased double-support time compared to the nondiabetes robust and nondiabetes vulnerable groups. CONCLUSIONS: Gait decline in vulnerable older women with diabetes is worsened by their frailty status. Our study reinforces the importance of screening older women with diabetes for frailty status.

Longevidade Avançada - A reinvenção do tempo / Advanced Longevity ­ The reinvention of time / Longevidad Avanzada ­ La reinvención del tiempo / Longévité Avancée - La réinvention du temps

Este ensaio apresenta algumas reflexões a partir de estudos internacionais e nacionais sobre a longevidade avançada. Dialoga com as bases teóricas, e destaca a escuta dos sentimentos, expressos em primeira pessoa, dos indivíduos que atingem esse patamar etário. A escuta da palavra dos que vivem as fragilidades e restrições próprias à longevidade são importantes na compreensão dos processos de constatação, aceitação, recusa, ou reconstrução possível, a partir das limitações que se acentuam. Essas palavras devem servir de guias a ações no âmbito familiar e social e referência na elaboração de políticas públicas de cuidado e apoio. Ressalta a noção da dignidade humana como princípio-guia das pesquisas e ações cotidianas, e nos cuidados na longevidade avançada. Ao escutar as palavras dos velhos cidadãos, a visão que se tem da velhice e, em especial, dos mais longevos, nunca mais será a mesma.

This essay contains reflections from both national and international studies on the subject of what comes after the Advanced Longevity. It takes into account theoretical basis, and highlights the feelings expressed by the individuals who reach this age level. Listening to the individuals that live the fragilities and limitations of this age level is important in order to understand the process of recognition, acceptance, rejection or possible reconstruction from the limitations that are accentuated. What these individuals have to say should serve as guides to action both in the family and social context as well as a reference in the elaboration of public policies for care and support. This essay emphasizes the notion of human dignity as a guiding principle of research, everyday actions and care in advanced longevity. After hearing the words of senior citizens the idea that one has of this age level will never be the same.

Este ensayo presenta el resultado de estudios internacionales y nacionales sobre la longevidad avanzada. Destaca junto con las reflexiones teóricas, la escucha de los sentimientos expresados en primera persona, de los individuos que llegan a esa faja etaria. Escuchar la palabra de los que viven las fragilidades y limitaciones propias de la longevidad es importante para entender los procesos de constatación, aceptación, rechazo o posible reconstrucción, partiendo de las limitaciones que se acentúan. Esas palabras deben servir como guías para acciones en el contexto familiar y social y referencia en la elaboración de políticas públicas para el cuidado y apoyo. Resalta la noción de dignidad humana como principio vector de la investigación y acciones cotidianas y en los cuidados de la longevidad avanzada. Al oír las palabras de los viejos ciudadanos la visión que se tiene de la vejez, en particular, de la longevidad avanzada, nunca será la misma.

Cet article présente les résultats des études nationales et internationales sur la longévité Avancée et met en évidence aux côtés des réflexions théoriques, l´écoute des sentiments exprimés dans la première personne des individus qui atteignent cette âge. L'écoute des personnes qui vivent leurs propres faiblesses et les limites sont importantes pour comprendre le processus de vérification, de l'acceptation, le rejet, ou possible reconstruction des limitations qui sont accentuées. Ces mots devraient servir de guides à l'action dans le contexte familial et social et référence dans l'élaboration des politiques publiques en matière de soins et de soutien. Souligne la notion de dignité humaine, comme principe directeur de la recherche et les actions de tous les jours, et les soins de la longévité de pointe. En entendant les mots des personnes âgées la vision que l'on a de la vieillesse et, en particulier, les personnes âgées, ne sera jamais le même.

How's Your Health at Home: Frail Homebound Patients Reported Health Experience and Outcomes.

We used a web-based mixed methods survey (HowsYourHealth - Frail) to explore the health of frail older (78% age 80 or older) adults enrolled in a home-based primary care program in Vancouver, Canada. Sixty per cent of eligible respondents participated, representing over one quarter (92/350, 26.2%) of all individuals receiving the service. Despite high levels of co-morbidity and functional dependence, 50 per cent rated their health as good, very good, or excellent. Adjusted odds ratios for positive self-rated health were 7.50, 95 per cent CI [1.09, 51.81] and 4.85, 95 per cent CI [1.02, 22.95] for absence of bothersome symptoms and being able to talk to family or friends respectively. Narrative responses to questions about end of life and living with illness are also described. Results suggest that greater focus on symptom management, and supporting social contact, may improve frail seniors' health.