Bleeding complications with oral anticoagulants in the elderly: an observational study.

Over recent years, new oral anticoagulant agents (NOAC) have been commercialized as a new treatment in order to prevent or treat thromboembolic events. Although the use of NOACs is easier than for vitamin K antagonists (VKA), their risk-benefit balance still raises concerns, especially in the elderly. To evaluate bleeding complications with anticoagulants agents (NOAC and VKA) among a geriatric population. A retrospective study performed in the four units of the acute geriatric department of CHU Charleroi (116 beds). All the patients who received at least one dose of oral anticoagulant (NOAC or VKA) during their hospitalization between January 1st 2013 and May 31th 2014 were enrolled. Medical files of 242 patients were analyzed, and the type and severity of bleeding were recorded. Mean age was 84 ± 5.4 years old. Seventy-three percent were prescribed VKA. Rivaroxaban was the most prescribed NOAC among this population. Atrial fibrillation was the primary indication of oral anticoagulation in 73% with VKA and 94% with NOAC. Fourty-six patients presented a bleeding (38 patients (22% of patients with VKA) with VKA and 8 patients with NOAC (12% of patients with NOAC)). We found 13 major bleedings with VKA and only one with NOAC. The results of this study are encouraging concerning the utilization of NOACs in the geriatric population. However, larger studies are needed to confirm this.

Comprehensive geriatric assessment and comorbidities predict survival in geriatric oncology.

OBJECTIVES: The comprehensive geriatric assessment (CGA) can detect geriatric problems and potentially improve survival, physical, and cognitive state of patients, as well as increase an older person's chances of staying at home longer. In older people, the number and severity of comorbidity increase with age and are an important determinant of survival. The aim of the study was to assess to which extent CGA and comorbidities could be seen as determinants of survival. MATERIALS AND METHODS: This study analyzed data from two hospitals that included geriatric assessments of patients aged 70 years and more with cancer linked to mortality. Logistic regression was used to model survival predictors. RESULTS: Two hundred and five various cancer patients (47% females) with a median age of 79 were included. They presented with a lot of undiagnosed geriatric problems. Screening scales (G8, SEGA), cognitive, and psychological disorders, and low albumin levels appeared to be independent survival factors. A frailty profile classification was associated with higher mortality. The average comorbidity was graded 2 according to the Charlson scale. By the geriatric cumulative illness rating scale (CIRS-G), the arithmetic average number of affected organ systems was 5 (range 0-10) in all patients. Cardiovascular disorders were the most common comorbidity. Renal insufficiency and anaemia were negatively associated with survival. CONCLUSION: Old cancer patients present a lot of comorbidities and newly diagnosed geriatric problems. Several tools provide determinants of survival in old cancer patients. Prospective trials evaluating the utility of a CGA to guide interventions to improve quality of cancer care in older adults are justified.

Use of the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) for an objective assessment of disability determination according to the Modified Katz Scale: a prospective longitudinal study.

BACKGROUND: The aim of this study was to demonstrate that the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) tool can be applied for a factual score determining urinary incontinence in the Katz-6 Scale, and it is effective to identify score 2 from score 3. METHODS: Functional capacity of 63 patients (14 M, 49 F aged from 70 to 99 years old) was evaluated with a Mini Mental State Examination (MMSE), Katz Index for Activities of Daily Living, and ICIQ-UI-SF questionnaire. Mean comparative analysis was performed. ICIQ-UI-SF scores were then entered as variables. These data observed in Katz continence item scored 2 and Katz continence item scored 3 were compared in a combined box-and-whisker and dot plot. Sensitivity and specificity of each variable were tested and results were evaluated using a receiver operating characteristic (ROC) curve. The best variable (ICIQ-UI-SF Score) was retained as a breach permitting to distinguish patients to be scored 2 or 3 over continence Katz item. RESULTS: Statistical analysis demonstrated significant difference between the sample of Katz continence item scored 2 and the sample of Katz continence item scored 3 over the ICIQ-UI-SF Score and the Katz global Score, but the difference was not significant concerning the MMSE Score. Using ROC analysis, we compared the discriminant power of the ICIQ-UI-SF Score for continence Katz item Score. Criterion values and coordinates of the ROC curve were studied and the ICIQ-UI-SF score of 13 was considered the best one. CONCLUSIONS: We demonstrated that the best variable (ICIQ-UI-SF Score) to retain as a breach permitting to distinguish patients to be scored 2 or 3 over continence Katz item is 13.