Diabetes mellitus in older persons with neurocognitive disorder: overtreatment prevalence and associated structural brain MRI findings.

BACKGROUND: Tight diabetes control is often applied in older persons with neurocognitive disorder resulting in increased hypoglycemic episodes but little is known about the pattern of brain injury in these overtreated patients. This study aims to: (a) quantify the prevalence of diabetes overtreatment in cognitively impaired older adults in a clinical population followed in an academic memory clinic (b) identify risk factors contributing to overtreatment; and (c) explore the association between diabetes overtreatment and specific brain region volume changes. METHODS: Retrospective study of older patients with type 2 diabetes and cognitive impairment who were diagnosed in a memory clinic from 2013 to 2020. Patients were classified into vulnerable and dependent according to their health profile. Overtreatment was defined when glycated hemoglobin was under 7% for vulnerable and 7.6% for dependent patients. Characteristics associated to overtreatment were examined in multivariable analysis. Grey matter volume in defined brain regions was measured from MRI using voxel-based morphometry and compared in patients over- vs. adequately treated. RESULTS: Among 161 patients included (median age 76.8 years, range 60.8-93.3 years, 32.9% women), 29.8% were considered as adequately treated, 54.0% as overtreated, and 16.2% as undertreated. In multivariable analyses, no association was observed between diabetes overtreatment and age or the severity of cognitive impairment. Among patients with neuroimaging data (N = 71), associations between overtreatment and grey matter loss were observed in several brain regions. Specifically, significant reductions in grey matter were found in the caudate (adj ß coeff: -0.217, 95%CI: [-0.416 to -0.018], p = .033), the precentral gyri (adj ßcoeff:-0.277, 95%CI: [-0.482 to -0.073], p = .009), the superior frontal gyri (adj ßcoeff: -0.244, 95%CI: [-0.458 to -0.030], p = .026), the calcarine cortex (adj ßcoeff:-0.193, 95%CI: [-0.386 to -0.001], p = .049), the superior occipital gyri (adj ßcoeff: -0.291, 95%CI: [-0.521 to -0.061], p = .014) and the inferior occipital gyri (adj ßcoeff: -0.236, 95%CI: [-0.456 to - 0.015], p = .036). CONCLUSION: A significant proportion of older patients with diabetes and neurocognitive disorder were subjected to excessively intensive treatment. The association identified with volume loss in several specific brain regions highlights the need to further investigate the potential cerebral damages associated with overtreatment and related hypoglycemia in larger sample.

Qualitative Evaluation of a Pilot Physician Training Program in Long-Term Care Facilities in Switzerland.

Increasing demand for long-term care facilities (LTCFs) and increasingly complex medical needs of LTCF residents necessitate recruiting new physician graduates and developing programs which provide them with experience and specific skills in geriatric and palliative medicine. We developed an educational program for physicians in training, which combines 1 year of immersion at 20% full-time equivalent with (1) theoretical teaching, (2) clinical exposure under the supervision of a senior LTCF physician, and (3) structured case presentations and debriefing with experienced geriatricians. This article presents a preliminary qualitative evaluation of this program from the perspectives of the trainees, supervising physicians, and public health stakeholders. The program was well accepted by all parties and showed positive effects on trainees' interest in long-term care medicine. Suggestions for improving future programs and their implementation are provided.

A contribution to the French validation of the clinical anxiety scale amongst health care workers in Switzerland.

BACKGROUND: Anxiety disorders are frequent but remain often underdiagnosed and undertreated. Hence, valid screening instruments are needed to enhance the diagnostic process. The Clinical Anxiety Scale (CAS) is a 25-item anxiety screening tool derived from the Hamilton Anxiety Scale (HAM-A). However, this scale is not available in French. The General anxiety disorder - 7 (GAD-7) scale, which has been validated in French, is a 7-item instrument with good psychometric properties. This study contributes to the validation of an adapted French version of the CAS, using the GAD-7 as the reference. METHODS: A forward-backward English-French-English translation of the CAS was performed according to standard practice. The French versions of the CAS and GAD-7 were completed by 127 French speaking healthcare professionals. CAS internal consistency was assessed using Crohnbach's alpha, and test-retest reliability was tested after 15 days in a subsample of 30 subjects. Convergent validity with GAD-7 was assessed using Pearson's correlation coefficient. Test-retest reliability was explored using one-way random effects model to calculate the intra-class correlation coefficient (ICC). RESULTS: French CAS showed excellent internal consistency (Cronbach's alpha 0.97), high convergent validity with GAD-7 (Pearson's R 0.81, p < 0.001), and very good test-retest reliability (ICC = 0.97, 95% CI 0.93-0.98). CONCLUSION: The proposed French version of the CAS showed high reliability and validity that need to be further investigated in different populations.

"If I Become a Vegetable, Then no": A Thematic Analysis of How Patients and Physicians Refer to Prognosis When Discussing Cardiopulmonary Resuscitation.

Background: Documenting decisions about the relevance cardiopulmonary resuscitation (CPR) is a standard practice at hospital admission yet a complex task. Objective: Our aim was to explore how physicians approach and discuss CPR prognosis with older patients recently admitted to a post-acute care unit. Method: We recorded 43 conversations between physicians and patients about the relevancy of CPR that took place at admission at the geriatric rehabilitation service of a Swiss university hospital. Thematic analysis determined (i) who initiated the talk about CPR prognosis, (ii) at what point in the conversation, and (iii) how prognosis was referred to. Results: Prognosis was mentioned in 65% of the conversations. We categorized the content of references to CPR prognosis in five themes: factors determining the prognosis (general health, age, duration of maneuvers); life (association of CPR with life, survival); proximal adverse outcomes (broken ribs, intensive care); long-term adverse outcomes (loss of autonomy, suffering a stroke, pain, generic, uncertainty); and being a burden. Discussion and conclusion: Discussing CPR is important to all patients, including those for whom it is not recommended. Information about CPR prognosis is essential to empower and support patients in expressing their expectations from life-prolonging interventions and attain shared decision-making.

Older patients referred for geriatric consultation in the emergency department: characteristics and healthcare utilization.

BACKGROUND: Comprehensive geriatric assessment (CGA) is difficult to perform in the emergency department (ED) environment and performance of screening tools in identifying vulnerable older ED patients who are best candidates for a geriatric consultation remain questionable. AIM: To determine the characteristics of older patients referred for a geriatric consultation by ED staff and to investigate these patients' subsequent healthcare utilization. METHODS: Secondary analysis of data previously collected for a prospective observational study of patients aged 75 + years visiting the ED of an academic hospital in Switzerland over four months (Michalski-Monnerat et al., J Am Geriatr Soc 68(12):2914-20, 2020). Socio-demographic, health, functional (basic activities of daily living; BADL), cognitive, and affective status data were collected at admission by a research nurse using a standardized brief geriatric assessment. Information on geriatric consultations, hospitalization, discharge destination, and 30-day readmission were retrieved from hospital database. Bivariable and multivariable analyses were performed using this data set collected previously. RESULTS: Thirty-two (15.8%) of the 202 enrolled patients were referred for a geriatric consultation. Compared to the others, they were older (84.9 ± 5.4 vs 82.9 ± 5.4 years, p = .03), more impaired in BADL (4.8 ± 1.6 vs 5.5 ± 1.0, p = .01), with more comorbid conditions (5.3 ± 1.5 vs 4.5 ± 1.9, p = .03), more frequently admitted after a fall (43.7% vs 19.4%, p = .01), and hospitalized over the previous 6-month period (53.1% vs 30.6%, p = .02). Multivariable analyses that adjusted for variables significantly associated with outcomes in bivariable analysis found that being admitted after a fall (AdjOR 4.0, 95%CI 1.7-9.4, p < .01) and previously hospitalized (AdjOR 2.7, 95% CI 1.2-6.2, p = .02) remained associated with increased odds of consultation, whereas the inverse association with BADL performance remained (AdjOR 0.7, 95%CI 0.5-0.9, p = .01). Patients referred for geriatric consultation had higher odds of hospitalization (84.4% vs 49.4%; AdjOR 5.9, 95%CI 2.1-16.8, p < .01), but similar odds of home discharge when admitted, and of 30-day readmission. CONCLUSION: About one in six older ED patients were referred for a geriatric consultation who appeared to be those most vulnerable, as suggested by their increased hospitalization rate. Alternative strategies are needed to enhance access to geriatric consultation in the ED.

Mortality in COVID-19 older patients hospitalized in a geriatric ward: Is obesity protective?

BACKGROUNDS: To investigate the relationship between obesity and 30-day mortality in a cohort of older hospitalized COVID-19 inpatients. METHODS: Included patients were aged 70 years or more; hospitalized in acute geriatric wards between March and December 2020; with a positive PCR for COVID-19; not candidate to intensive care unit admission. Clinical data were collected from patients electronic medical records. Data on 30-day mortality were retrieved from the hospital administrative database. RESULTS: Patients included (N = 294) were on average 83.4 ± 6.7 years old, 50.7% were women, and 21.7% were obese (BMI > 30 kg/m2). At 30-day, 85 (28.9%) patients were deceased. Compared to survivors in bivariable analysis, deceased patients were older (84.6 ± 7.6 vs 83.0 ± 6.3 years), more frequently with very complex health status (63.5% vs 39.7%, P < .001), but less frequently obese (13.4% vs 24.9%, P = .033) at admission. Over their stay, deceased patients more frequently (all P < .001) developed radiologic signs of COVID-19 (84.7% vs 58.9%), anorexia (84.7% vs 59.8%), hypernatremia (40.0% vs 10.5%), delirium (74.1% vs 30.1%), and need for oxygen (87.1% vs 46.4%) compared to survivors. In multivariable analysis that controlled for all markers of poor prognosis identified in bivariable analysis, obese patients remain with 64% (adjOR 0.36, 95%CI 0.14-0.95, P = .038) lower odds to be deceased at 30-day than non-obese patients. CONCLUSIONS: In this population of older COVID-19 inpatients, an inverse association between obesity and 30-day mortality was observed even after adjusting for all already-known markers of poor prognosis. This result challenges previous observations in younger cohorts and would need to be replicated.

Executive function and prospective falls: a 6-year longitudinal study in community-dwelling older adults.

BACKGROUND: Older people with impaired executive function (EF) might have an increased fall risk, but prospective studies with prolonged follow-up are scarce. This study aimed to investigate the association between a) EF at baseline; b) 6-year decline in EF performance; and fall status 6 years later. METHODS: Participants were 906 community-dwelling adults aged 65-69 years, enrolled in the Lausanne 65 + cohort. EF was measured at baseline and at 6 years using clock drawing test (CDT), verbal fluency (VF), Trail Making Test (TMT) A and B, and TMT ratio (TMT-B - TMT-A/TMT-A). EF decline was defined as clinically meaningful poorer performance at 6 years. Falls data were collected at 6 years using monthly calendars over 12 months. RESULTS: Over 12-month follow-up, 13.0% of participants reported a single benign fall, and 20.2% serious (i.e., multiple and/or injurious) falls. In multivariable analysis, participants with worse TMT-B performance (adjusted Relative Risk Ratio, adjRRRTMT-B worst quintile = 0.38, 95%CI:0.19-0.75, p = .006) and worse TMT ratio (adjRRRTMT ratio worst quintile = 0.31, 95%CI:0.15-0.64, p = .001) were less likely to report a benign fall, whereas no significant association was observed with serious falls. In a subgroup analysis among fallers, participants with worse TMT-B (OR:1.86, 95%CI = 0.98-3.53, p = .059) and worse TMT ratio (OR:1.84,95%CI = 0.98-3.43,p = .057) tended to have higher odds of serious falls. EF decline was not associated to higher odds of falls. CONCLUSIONS: Participants with worse EF were less likely to report a single benign fall at follow-up, while fallers with worse EF tended to report multiple and/or injurious falls more frequently. Future studies should investigate the role of slight EF impairment in provoking serious falls in active young-old adults.

Older people's experience of the partial lockdown during the COVID-19 pandemic in Switzerland: a cross-sectional study.

OBJECTIVES: This study aimed to evaluate older people's experience of a COVID-19 partial lockdown (16 March-11 May 2020) in Lausanne, Switzerland. SETTING AND PARTICIPANTS: Community-dwelling participants of the Lausanne cohort (Lc65+) in 2020, aged 71-86 years (n=2642). DESIGN AND OUTCOME: This cross-sectional study was nested within the Lc65+ longitudinal study. A specific COVID-19 questionnaire was sent on 17 April 2020 to evaluate participants' experience of the lockdown (outcome). Multinomial logistic regression models were used to determine the sociodemographic, living environment, health and social factors associated. RESULTS: Out of 2642 participants, 67.8% described the lockdown as 'somewhat' difficult (reference group), 21.5% as 'not at all' difficult (positive) and 10.7% as 'very or extremely' difficult (negative). The relative risk of a positive experience was higher in participants living alone (relative risk ratio, RRR=1.93, 95% CI 1.52 to 2.46) or in a house (RRR=1.49, 1.03 to 2.16); lower in those who reported fear of falling (RRR=0.68, 0.54 to 0.86), functional difficulties (RRR=0.78, 0.61 to 0.99), feeling of loneliness (RRR=0.67, 0.49 to 0.91), unfamiliarity with communication technologies (RRR=0.69, 0.52 to 0.91), usual social support (RRR=0.71, 0.50 to 0.93), previous participation in group activities (RRR=0.74, 0.59 to 0.92) and among women (RRR=0.75, 0.59 to 0.95). The relative risk of a negative experience was higher in participants with fear of falling (RRR=1.52, 1.07 to 2.15), and lower in those who had a terrace/garden (RRR=0.66, 0.44 to 0.99) and owned a dog (RRR=0.32, 0.11 to 0.90). CONCLUSIONS: Only one in 10 participants experienced the lockdown as very or extremely difficult. Specific interventions targeting vulnerability factors, such as fear of falling, could lessen the impact of any future similar situation.

Trends in the disability-free life expectancy in Switzerland over a 10-year period: an analysis of survey-based data.

INTRODUCTION: Increasing life expectancy raises concerns whether the years gained will be spent free of disability. Lately, trends across countries have been heterogeneous. This work examined recent trends in disability-free life expectancy and life expectancy with mild  or severe disability in Switzerland. METHODS: Life expectancy was estimated using national life tables, by sex and 5-year age groups. Based on Sullivan's method, disability-free life expectancy and life expectancy with disability were computed using information from the Swiss Health Survey on age- and sex-specific prevalence of mild and severe disability. Life expectancy, disability-free life expectancy and life expectancy with disability were estimated in 2007, 2012, and 2017, at 65 and 80 years of age, for both sexes. RESULTS: Between 2007 and 2017, disability-free life expectancy at 65 and 80 years of age increased by 2.1 and 1.4 years, respectively, in men and by 1.5 and 1.1 years, respectively, in women. Meanwhile, life expectancy with mild disability decreased by 6 months in both sexes at age 65 and in men at age 80, but only 1 month in women at age 80. Life expectancy with severe disability also decreased at both ages, by approximately 6 months in women but only 2 to 3 months in men. The proportion of disability-free life expectancy increased significantly in both sexes and ages. For example, disability-free life expectancy / life expectancy at age 65 increased from 67% (95% confidence interval [CI] 66‒69) to 73% (95% CI 71‒74) in women and from 77% (95% CI 75‒79) to 82% (95% CI 81‒84) in men. CONCLUSION: From 2007 to 2017, disability-free life expectancy at age 65 and 80 increased in Swiss women and men. These gains outweighed those in life expectancy, reflecting some compression of morbidity.

[Subacute cerebellar ataxia, an uncommon SARS-CoV-2 complication infection in older adults]. / Ataxie cérébelleuse subaiguë : une atteinte atypique par le SARS-CoV-2 chez la personne âgée.

Cerebellar ataxia can be caused by neoplasia, toxics (drugs, heavy metals, alcohol), infection, vascular lesions or auto-immune and paraneoplastic pathologies. Neuroimaging must be performed urgently in case of sudden onset and serologies as well as a lumbar puncture should be performed. Several case reports of ataxia associated with COVID-19 have been published, however the underlying pathogenic mechanisms remain unclear. This is a diagnosis of exclusion when other causes are ruled out and when the ataxia appears simultaneously to COVID-19 infection. We lack data on best management, but the prognosis appears mostly favorable with good functional recovery without any specific treatment. This paper describes the case of a patient who developed a cerebellar ataxia as the only neurological manifestation of a SARS-CoV-2 infection.

Une ataxie cérébelleuse peut être causée par un processus (para)néoplasique, auto-imun, une exposition toxique, une infection ou une lésion vasculaire. Une imagerie doit être réalisée en urgence devant toute atteinte aiguë et le bilan devrait être complété par des sérologies larges et une ponction lombaire. Plusieurs cas d'ataxie liée au Covid-19 ont été décrits, dont le mécanisme étiopathogénique reste incomplètement élucidé, le diagnostic se faisant plutôt par exclusion lorsque les symptômes apparaissent de manière concomitante à l'infection. Des données manquent sur la prise en charge mais le pronostic semble favorable, avec une bonne récupération fonctionnelle. Cet article décrit le cas d'une patiente ayant présenté une ataxie cérébelleuse comme symptôme neurologique isolé contemporain d'une infection à SARS-CoV-2.

[Treatment of congestive heart failure in older persons and SGLT2 inhibitors - Having your patient's best interests at heart]. / Traitement de l'insuffisance cardiaque chez la personne âgée et inhibiteurs du SGLT2 - En avoir le cœur net.

The treatment and management of heart failure (HF) are constantly evolving. The latest guidelines recommend the use of SGLT2 inhibitors (SGLT2i) as an integral part to treating HF with reduced ejection fraction (< 40%). However, given that the patients included in these trials do not reflect the heterogeneity of the health of many elderly patients, we recommend basing the therapeutic decision on the patient's state of frailty. If a SGLT2i treatment at a standard dose (10 mg 1x/day) is recommended for robust patients, we suggest initiating treatment at 5 mg 1x/day for vulnerable patients, and then after 1 month increasing the dose to 10 mg 1x/day. Finally, for dependent patients, we recommend therapeutic abstention in the absence of sufficient scientific evidence.

La prise en charge de l'insuffisance cardiaque (IC) est en constante évolution. Les dernières recommandations préconisent l'utilisation des inhibiteurs du SGLT2 (iSGLT2) pour le traitement de l'IC à fraction d'éjection réduite (< 40%). Cependant, les populations des études ne reflètent pas l'hétérogénéité de la population âgée en termes de santé et nous proposons de baser la décision thérapeutique selon la Clinical Frailty Scale : si, pour les patients robustes, un traitement par iSGLT2 à dose standard (10 mg 1 x/jour) est préconisé, nous proposons, pour les patients vulnérables, d'initier le traitement à 5 mg 1 x/jour, puis d'augmenter à 10 mg 1 x/jour après 1 mois. Finalement, pour les patients dépendants, nous recommandons une abstention thérapeutique en l'absence d'évidences scientifiques suffisantes.

[Fast-evolving cognitive impairment: a home-based diagnosis]. / Troubles neurocognitifs d'évolution rapide.

Syphilis is a sexually transmitted disease which incidence increased over the last 10 years in Switzerland. The clinical and neurocognitive manifestations observed in case of symptomatic neurosyphilis can be very heterogeneous and can mimic neurocognitive disorders of other origins. This article discusses the diagnostic and management pitfalls in an older patient whose diagnosis of neurosyphilis was initially suspected during a home visit.

La syphilis est une maladie à transmission sexuelle dont l'incidence est en constante augmentation ces 10 dernières années en Suisse. Les manifestations cliniques et neurocognitives observées en cas de neurosyphilis symptomatique sont très hétérogènes et peu spécifiques, pouvant mimer des troubles neurocognitifs d'autre origine. Cet article discute des écueils diagnostiques et de prise en charge d'un patient âgé chez lequel un diagnostic de neurosyphilis a été évoqué lors d'une visite à domicile.

Wish to Die Among Residents of Swiss Long-Term Care Facilities: A Multisite Cross-Sectional Study.

OBJECTIVES: The wish to die (WTD) in persons near the end of life is a clinically important, ethically and practically complex phenomenon as demonstrated by the intense debates on assisted dying legislation around the world. Despite global aging and increasing institutionalization in old age, WTD among residents of long-term care facilities (LTCF) is underexplored. We aimed to assess the prevalence of WTD and identify its predictors in older LTCF residents. DESIGN: Multisite cross-sectional observational study. SETTING AND PARTICIPANTS: 31 LTCF in the 3 major linguistic regions of Switzerland, including residents 75 years or older, admitted to the LTCF 4 to 10 months before the study, without severe cognitive impairment. METHODS: Between February 2013 and June 2017, trained research staff interviewed residents to assess WTD using 2 validated instruments and collected information on potential predictors, including depressive symptoms, anxiety, demoralization, feeling to be a burden, spiritual distress, symptom burden, multimorbidity, and drug use. Demographic data were obtained by chart review. Descriptive statistics as well as univariate and multivariate regression analyses were performed. RESULTS: From 427 eligible residents, 101 were excluded, 46 refused, and 280 were included in the study (acceptance rate 85.9%). In general, residents readily and openly addressed the topic of WTD. The prevalence of WTD was 16.0% and 16.2% according to the 2 instruments, with all but 1 of the residents expressing a passive WTD. The strongest independent predictors for a WTD were depressive symptoms (OR 7.45 and 5.77 for the 2 WTD assessment instruments) and demoralization (OR 2.62 and 3.66). CONCLUSIONS AND IMPLICATIONS: The WTD is a relevant concern affecting approximately 1 in 6 LTCF residents. Further research is needed to investigate which interventions could best address the potentially modifiable factors that were associated with the WTD in this specific setting and population.

Conceptualization and content validation of the MEDication literacy assessment of geriatric patients and informal caregivers (MED-fLAG).

BACKGROUND: The assessment of patients' medication literacy skills (i.e., abilities to access, comprehend and interact with medication-related information) is an important step in assisting clinicians to plan for appropriate care. Despite several attempts by researchers to develop measures of medication literacy, an instrument tailored to the specific needs of older adults remains a significant shortfall. Therefore, an interprofessional team that included a citizen co-researcher conceptualized a new standardised measure of medication literacy-the MEDedication Literacy Assessment of Geriatric patients and informal caregivers (MED-fLAG). MED-fLAG was designed as a three-dimensional self-reported measure of functional, interactive and critical skills. This study describes the conceptualization process and provides the results of an evaluation of MED-fLAG's content validity, acceptability, and feasibility during a hospital stay. METHODS: MED-fLAG was developed in accordance with the guidance on scale development and standards for good content validity, by using the following steps: (I) conceptualization of a provisional version of MED-fLAG; (II) iterative qualitative evaluation of its content validity by older adults, informal caregivers and healthcare professionals. RESULTS: The qualitative assessment of the initial 54-item MED-fLAG was conducted in 36 participants, namely 13 home-dwelling older adults and/or informal caregivers and 23 healthcare professionals. Six rounds of revisions were performed to achieve content validity and to propose a 56-item revised MED-fLAG. Participants reported benefits of using a standardized assessment of medication literacy during a hospital stay but warned about certain limitations and prerequisites. The extent to which MED-fLAG could be integrated into discharge planning needs to be further investigated. CONCLUSIONS: MED-fLAG is the first medication literacy measure tailored to the specific needs of older patients and informal caregivers. A unique feature of this measure is that it includes prescribed and non-prescribed medications, irrespective of the galenic form. Additional studies are required to evaluate the other measurement properties of MED-fLAG, and to reduce the number of items before considering its clinical application.

On the basis of what has been written about medication literacy and the experiences of experts, we developed a new questionnaire to measure medication literacy (MED-fLAG) in older adults and/or informal caregivers. MED-fLAG was then submitted to older adults, informal caregivers and healthcare professionals to retrieve their feedback concerning the relevance, comprehensibility and exhaustiveness of the proposed items. In future, MED-fLAG will allow health professionals to evaluate medication literacy skills in older patients during hospitalization and/or in their informal caregivers when they are responsible for preparing or administering the medications, and then propose individualised support.

Effectiveness of Information Sessions About COVID-19 Vaccines in Healthcare Professionals Working in Geriatrics.

Objectives: To determine change in (a) perceived knowledge about COVID-19 vaccines; (b) level of confidence in transmitting information about vaccines; and (c) intention to get vaccinated; among healthcare professionals (HCP) working in a Swiss academic geriatric department who attended a 30-minute information session about COVID-19 vaccines. Measurements: At the session's end, a self-administered questionnaire collected information about socio-demographics, personnel, and/or relatives' experience with COVID-19. In addition, participants were asked to rate their: (a) perceived knowledge about COVID-19 vaccines; (b) level of confidence in transmitting information about COVID-19 vaccines to patients and relatives; and (c) intention to get vaccinated; before and after the session. Results: Overall, 97 (42.2% of all HCPs) participated to 14 sessions and completed the questionnaire. Improvements were observed in knowledge, confidence in providing information, and intention to be vaccinated after the session (all p < .001). Similar improvements were observed in subgroup analyses by gender, age groups, profession (involved in direct care or not), and previous experience with COVID-19 (all p < .010). However, HCP aged 20 to 29 years were less likely to feel completely confident in providing information than those aged 30 to 49 and 50+ years (17.1% vs. 43.2% vs. 44.0%, respectively, p = .031) and to report being very likely to be vaccinated (31.4% vs. 56.8% vs. 56.0%, respectively, p = .060). Conclusions: These information sessions positively influenced HCP knowledge, confidence in providing information, and, to a lesser extent, intention to be vaccinated. Younger HCP reported similar improvements but remained less likely to consider vaccination. Additional efforts are needed to convince these undecided HCP and enhance COVID-19 vaccines uptake.

Fighting social isolation in times of pandemic COVID-19: the role of video calls for older hospitalized patients.

BACKGROUND: Loneliness and social isolation are associated with anxiety and psychological discomfort, especially amongst the oldest and fragile persons. AIMS: SILVER evaluates the acceptance of video calls by old hospitalized patients and their relatives during the ban on visits due to the COVID-19. Moreover, SILVER evaluates if the use of different communication technology is associated with different outcomes in terms of anxiety, fear of self and of others' death and mood. METHODS: SILVER is an observational multicentre study. Patients hospitalized in two geriatric units in Switzerland and in one orthogeriatric unit in Italy and their relatives were enrolled. Participants can freely choose to use phone or video calls and were evaluated over a week. We measured anxiety, fear of death and mood at baseline and at the end of the study with standard scales. The use of video or phone calls was associated to a change in these parameters by two-way ANOVA for repeated measures. RESULTS: Sixty-four patients and relatives were enrolled, 26.5% used phone calls and 73.5% video calls. The use of video calls was associated with a reduction in anxiety and fear of death in patients and relatives as compared to participants using phone calls. DISCUSSION: Old patients and their relatives accepted and appreciated the use of video calls during hospitalization; moreover, participant using video calls appears to be less anxious and less afraid of death. CONCLUSIONS: Video calls may be a useful communication tool for hospitalized older patients to keep social relationships with relatives and reduce their anxiety and fear of death. TRIAL REGISTRATION: Retrospectively registered on 1st September 2021 in ClinicalTrials.gov (NCT05000099).

Fear of falling and all-cause mortality among young-old community-dwelling adults: a 6-year prospective study.

This study investigated whether fear of falling (FOF) measured by two different instruments, the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR), is associated with mortality at 6-year follow-up. Participants (n = 1359, 58.6% women) were community-dwelling persons enrolled in the Lausanne cohort 65 + , aged 66 to 71 years at baseline. Covariables assessed at baseline included demographic, cognitive, affective, functional and health status, while date of death was obtained from the office in charge for population registration. Unadjusted Kaplan Meyer curves were performed to show the survival probability for all-cause mortality according to the degree of FOF reported with FES-I and SQ-FAR, respectively. Bivariable and multivariable Cox regression analyses were performed to assess hazard ratios, using time-in-study as the time scale variable and adjusting for variables significantly associated in bivariable analyses. During the 6-year follow-up, 102 (7.5%) participants died. Reporting the highest level of fear at FES-I (crude HR 3.86, 95% CI 2.37-6.29, P < .001) or "FOF with activity restriction" with SQ-FAR (crude HR 2.42, 95% CI 1.44-4.09, P = .001) were both associated with increased hazard of death but these associations did not remain significant once adjusting for gender, cognitive, affective and functional status. As a conclusion, although high FOF and related activity restriction, assessed with FES-I and SQ-FAR, identifies young-old community-dwelling people at increased risk of 6-year mortality, this association disappears when adjusting for potential confounders. As a marker of negative health outcomes, FOF should be screened for in order to provide personalized care and reduce subsequent risks.

[Geriatrics]. / Gériatrie.

Sleeping enough is associated with a reduced risk of mortality and dementia. New evidence support regular physical exercise, including at home, as a corner stone intervention to prevent falls and fractures. In contrast, supplementation with high doses of vitamin D is ineffective and even deleterious in this indication and a routine screening in asymptomatic adults is not recommended. Several studies illustrate our difficulties in prescribing and deprescribing in frail older patients and a study suggests that statins in cardiovascular primary prevention should considered only when a patient's life expectancy exceeds 2.5 years. Finally, several studies have fueled the debate about screening for hearing impairment.

Dormir ni trop ni trop peu est associé à une réduction du risque de mortalité et de déclin cognitif. De nouvelles études confirment que l'exercice physique régulier, y compris à domicile, constitue la clé de voûte de la prévention des chutes et des fractures. Par contre, la supplémentation par de hautes doses de vitamine D n'est pas efficace, voire délétère, dans cette indication et le dépistage systématique d'un déficit n'est pas recommandé chez les patients adultes asymptomatiques. Plusieurs études illustrent nos difficultés à prescrire et déprescrire, chez les patients âgés fragiles, et une étude suggère qu'un traitement de statines en prévention cardiovasculaire primaire ne se justifie que si l'espérance de vie du patient dépasse 2,5 ans. Finalement, plusieurs études sont venues nourrir le débat sur le dépistage de la presbyacousie.