Therapeutic advice issued by a geriatric mobile team and 3-year mortality in older inpatients.

Our objective was to determine whether the provision of therapeutic advice (i.e., any recommendation for an increase or decrease in drug dosage, or for the addition, withdrawal or replacement of at least one drug) by hospital geriatric mobile teams (GMTs) was associated with long-term mortality among older inpatients. Data on therapeutic advice provided by the GMT of Angers University Hospital, France, were collected from 694 consecutive inpatients examined in 2012 (mean age 84.4 ± 6.3 years; 65.6% female), who were followed up after 3 years. We found no between-group differences regarding the 3-year mortality (P = 0.30) and no cumulative survival difference (log-rank P = 0.43). The provision of therapeutic advice by a GMT was not associated with better 3-year survival (HR = 1.18, P = 0.40) in these frail inpatients.

Comparison of hospital course of geriatric inpatients with or without active cancer: a bicentric case-control study.

BACKGROUND: The hospital course of older patients with cancer hospitalized in geriatrics units remain poorly known. The aim of our study was to compare the clinical characteristics and hospital courses of geriatric inpatients with or without active cancer. METHODS: A case-control study was conducted in 2013 in the geriatric acute care units of Angers University Hospital and Le Mans Hospital, France, to compare 204 consecutive cases with cancer (mean age, 85.4±5.5 years; 42.6% male) and 1,020 controls without active cancer (mean age, 85.5±5.8 years; 42.6% male) matched for age, gender, recruitment period and center. Hospital courses were evaluated by the length of hospital stay and the in-hospital mortality. The place of life, body mass index, cumulative illness rating scale-geriatrics (CIRS-G) score, history of falls, and reason for admission were used as covariates. RESULTS: Cases with active cancer exhibited a higher (i.e., worse) CIRS-G score (p<0.001) and were hospitalized more often for an organic failure (p<0.001) than controls. The hospital stay of cases was longer (16.3±13.0 days versus 12.6±9.4 days, p<0.001), and their in-hospital mortality rate was higher than controls (23.5% versus 5.6%, p<0.001). After adjustment, having an active cancer was associated with increased length of hospital stay (ß=3.3, p<0.001) and greater in-hospital mortality (OR=4.4, p<0.001). CONCLUSION: The length of hospital stay and in-hospital mortality rate were greater in geriatric patients with active cancer compared to controls, which reflects more complicated hospital courses in this population.

Circulating vitamin D concentration and age-related macular degeneration: Systematic review and meta-analysis.

Vitamin D may be involved in ocular function in older adults, but there is no current consensus on a possible association between circulating concentrations of 25-hydroxyvitamin D (25OHD) and the occurrence of age-related macular degeneration (AMD). Our objective was to systematically review and quantitatively assess the association of circulating 25OHD concentration with AMD. A Medline search was conducted in November 2015, with no date limit, using the MeSH terms "Vitamin D" OR "Vitamin D deficiency" OR "Ergocalciferols" OR 'Cholecalciferol' combined with "Age-related macular degeneration" OR "Macular degeneration" OR "Retinal degeneration" OR "Macula lutea" OR "Retina". Fixed and random-effects meta-analyses were performed to compute (i) standard mean difference in 25OHD concentration between AMD and non-AMD patients; (ii) AMD risk according to circulating 25OHD concentration. Of the 243 retrieved studies, 11 observational studies-10 cross-sectional studies and 1 cohort study-met the selection criteria. The number of participants ranged from 65 to 17,045 (52-100% women), and the number with AMD ranged from 31 to 1440. Circulating 25OHD concentration was 15% lower in AMD compared with non-AMD on average. AMD was inversely associated with the highest 25OHD quintile compared with the lowest (summary odds ratio (OR)=0.83 [95%CI:0.71-0.97]), notably late AMD (summary OR=0.47 [95%CI:0.28-0.79]). Circulating 25OHD<50nmol/L was also associated with late-stage AMD (summary OR=2.18 [95%CI:1.34-3.56]), an association that did not persist when all categories of AMD were considered (summary OR=1.26 [95%CI:0.90-1.76]). In conclusion, this meta-analysis provides evidence that high 25OHD concentrations may be protective against AMD, and that 25OHD concentrations below 50nmol/L are associated with late AMD.