Proton pump inhibitors and risk of severe COVID-19 in older people.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 is a viral respiratory infection that can cause systemic disorders and lead to death, particularly in older people. Proton pump inhibitors (PPIs) increase the risk of enteric and lung infections. Considering the broad use of PPIs in older people, the potential role of PPIs in COVID-19 could be of dramatic significance. The objective of our study was to evaluate the link between PPIs and severe COVID-19 in older people. METHOD: We performed a retrospective cohort study, including all patients aged ≥65, hospitalised for a diagnosis of COVID-19. Epidemiological, clinical and biological data were extracted and we performed an Inverse Probability of Treatment Weighing method based on a propensity score. RESULTS: From March 2020 to February 2021, a total of 834 patients were included, with a median age of 83 and 52.8% were male. A total of 410 patients had a PPIs prescription, 358 (87.3%) were long-term PPIs-users and 52 (12.7%) were recent PPIs-users. Among PPIs-users, 163 (39.8%) patients developed severe COVID-19 versus 113 (26.7%) in PPIs-non users (odds ratio (OR) = 1.59 [1.18-2.14]; P < 0.05). Moreover, the double dose PPI-users had a higher risk of developing severe COVID-19 (OR = 3.36 [1.17-9.66]; P < 0.05) than the full dose PPI-users (OR = 2.15 [1.22-3.76]; P < 0.05) and the half dose PPI-users (OR = 1.64 [1.13-2.37]; P < 0.05). CONCLUSION: Our study reports evidence that the use of PPIs was associated with an increased risk of severe COVID-19 in older people.

Decreasing hospitalizations through geriatric hotlines: a prospective French multicenter study of people aged 75 and above.

BACKGROUND: The Emergency unit of the hospital (Department) (ED) is the fastest and most common way for most French general practitioners (GPs) to respond to the complexity of managing older adults patients with multiple chronic diseases. In 2013, French regional health authorities proposed to set up telephone hotlines to promote interactions between GP clinics and hospitals. The main objective of our study was to analyze whether the hotlines and solutions proposed by the responding geriatrician reduced the number of hospital admissions, and more specifically the number of emergency room admissions. METHODS: We conducted a multicenter observational study from April 2018 to April 2020 at seven French investigative sites. A questionnaire was completed by all hotline physicians after each call. RESULTS: The study population consisted of 4,137 individuals who met the inclusion and exclusion criteria. Of the 4,137 phone calls received by the participants, 64.2% (n = 2 657) were requests for advice, and 35.8% (n = 1,480) were requests for emergency hospitalization. Of the 1,480 phone calls for emergency hospitalization, 285 calls resulted in hospital admission in the emergency room (19.3%), and 658 calls in the geriatric short stay (44.5%). Of the 2,657 calls for advice/consultation/delayed hospitalization, 9.7% were also duplicated by emergency hospital admission. CONCLUSION: This study revealed the value of hotlines in guiding the care of older adults. The results showed the potential effectiveness of hotlines in preventing unnecessary hospital admissions or in identifying cases requiring hospital admission in the emergency room. Hotlines can help improve the care pathway for older adults and pave the way for future progress. TRIAL REGISTRATION: Registered under Clinical Trial Number NCT03959475. This study was approved and peer-reviewed by the Ethics Committee for the Protection of Persons of Sud Est V of Grenoble University Hospital Center (registered under 18-CETA-01 No.ID RCB 2018-A00609-46).

High-dose versus standard-dose vitamin D supplementation in older adults with COVID-19 (COVIT-TRIAL): A multicenter, open-label, randomized controlled superiority trial.

BACKGROUND: Vitamin D supplementation has been proposed as a treatment for Coronavirus Disease 2019 (COVID-19) based on experimental data and data from small and uncontrolled observational studies. The COvid19 and VITamin d TRIAL (COVIT-TRIAL) study was conducted to test whether a single oral high dose of cholecalciferol (vitamin D3) administered within 72 hours after the diagnosis of COVID-19 improves, compared to standard-dose cholecalciferol, the 14-day overall survival among at-risk older adults infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). METHODS AND FINDINGS: This multicenter, randomized, controlled, open-label, superiority trial involved collaboration of 9 medical centers in France. Patients admitted to the hospital units or living in nursing homes adjacent to the investigator centers were eligible if they were ≥65 years, had SARS-CoV-2 infection of less than 3 days, and at least 1 COVID-19 worsening risk factor (among age ≥75 years, SpO2 ≤94%, or PaO2/FiO2 ≤300 mm Hg). Main noninclusion criteria were organ failure requiring ICU, SpO2 ≤92% despite 5 L/min oxygen, life expectancy <3 months, vitamin D supplementation >800 IU/day during the preceding month, and contraindications to vitamin D supplements. Eligible and consenting patients were randomly allocated to either a single oral high-dose (400,000 IU) or standard-dose (50,000 IU) cholecalciferol administered under medical supervision within 72 hours after the diagnosis of COVID-19. Participants and local study staff were not masked to the allocated treatment, but the Steering Committee and the Data and Safety Monitoring Board were masked to the randomization group and outcome data during the trial. The primary outcome was 14-day overall mortality. Between April 15 and December 17, 2020, of 1,207 patients who were assessed for eligibility in the COVIT-TRIAL study, 254 met eligibility criteria and formed the intention-to-treat population. The median age was 88 (IQR, 82 to 92) years, and 148 patients (58%) were women. Overall, 8 (6%) of 127 patients allocated to high-dose cholecalciferol, and 14 (11%) of 127 patients allocated to standard-dose cholecalciferol died within 14 days (adjusted hazard ratio = 0.39 [95% confidence interval [CI], 0.16 to 0.99], P = 0.049, after controlling for randomization strata [i.e., age, oxygen requirement, hospitalization, use of antibiotics, anti-infective drugs, and/or corticosteroids] and baseline imbalances in important prognostic factors [i.e., sex, ongoing cancers, profuse diarrhea, and delirium at baseline]). The number needed to treat for one person to benefit (NNTB) was 21 [NNTB 9 to ∞ to number needed to treat for one person to harm (NNTH) 46]. Apparent benefits were also found on 14-day mortality due to COVID-19 (7 (6%) deaths in high-dose group and 14 (11%) deaths in standard-dose group; adjusted hazard ratio = 0.33 [95% CI, 0.12 to 0.86], P = 0.02). The protective effect of the single oral high-dose administration was not sustained at 28 days (19 (15%) deaths in high-dose group and 21 (17%) deaths in standard-dose group; adjusted hazard ratio = 0.70 [95% CI, 0.36 to 1.36], P = 0.29). High-dose cholecalciferol did not result in more frequent adverse effects compared to the standard dose. The open-label design and limited study power are the main limitations of the study. CONCLUSIONS: In this randomized controlled trial (RCT), we observed that the early administration of high-dose versus standard-dose vitamin D3 to at-risk older patients with COVID-19 improved overall mortality at day 14. The effect was no longer observed after 28 days. TRIAL REGISTRATION: ClinicalTrials.gov NCT04344041.

Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia: a randomised study.

BACKGROUND: Treating pneumonia in old patients remains challenging for clinicians. Moreover, bacterial antimicrobial resistance is a major public health threat. OBJECTIVE: The PROPAGE study evaluated the interest of a strategy using serial measurements of procalcitonin (PCT) to reduce the duration of antibiotic therapy in old patients with pneumonia. METHODS: PROPAGE took place from Dec.-2013 to Jun.-2016 in eight French geriatric units. It was a prospective, comparative, randomised, open-label study involving old patients (≥ 80 years) who had initiated antibiotic treatment for pneumonia in the previous 48 h. PCT was monitored in all patients and two decision-making PCT-based algorithms guided antibiotic therapy in patients from the PCT group. RESULTS: 107 patients were randomised (PCT, n = 50; Control, n = 57). Antibiotic therapy exposure was reduced in the PCT group as compared to the Control group (median duration of antibiotic therapy, 8 vs. 10 days [rank-test, p = 0.001]; antibiotic persistence rates on Days 6 and 8, 54% and 44% vs. 91% and 72%) and no significant difference was found in recovery rate (84% vs. 89.5%; Pearson Chi² test, p = 0.402). CONCLUSION: Although, the superiority of the strategy was not tested using a composite criterion combining antibiotic therapy duration and recovery rate was not tested due to the small sample size, the present study showed that monitoring associated with PCT-guided algorithm could help shorten antibiotic treatment duration in the very old patients without detrimental effects. Measuring PCT levels between Day 4 and Day 6 could be helpful when making the decision regarding antibiotic discontinuation. TRIAL REGISTRATION: NCT02173613. This study was first registered on 25/06/2014.

[The geriatric hotline improves practice, survey of general practitioners in the Saint-Etienne area]. / La hot line gériatrique, enquête auprès des médecins généralistes du bassin stéphanois.

Faced with an aging French population, the demand for unscheduled care is growing. In order to avoid referring elderly patients to emergency departments, which are unsuitable for them, the Regional Health Agencies have created telephone hot lines dedicated to geriatrics. They are exclusively accessible to general practitioners in order to obtain advice or a place in a geriatric hospital. General practitioners are rarely asked about the value of this tool in their practice.

[Compliance with recommendations during a stay in follow-up and rehabilitation care in the elderly, comparison of three intervention strategies]. / SSR, observance des recommandations : trois stratégies d'intervention.

The objective of this study was to compare three hierarchical intervention strategies of an educational program for the prevention of falls in elderly people in a follow-up and rehabilitation care facility, and to evaluate the compliance with the recommendations related to extrinsic risk factors for falls, behavioral and environmental.

[Socio-economic vulnerability, support and hospitalisation plan in people aged over 75]. / Vulnérabilité socio-économique, plan d'aide et hospitalisation chez les plus de 75 ans.

The return home after a period in hospital is a high-risk situation for an elderly person. Services exist to facilitate the hospital-home transition but are sometimes not used. Few studies suggest that socio-economic vulnerability is an important factor in a successful return home. One study shows that this relationship is vague and disputed. In fact, compliance with a support plan, recommended when a patient returns home, is multifactorial and does not seem to depend on the existence or otherwise of socio-economic vulnerability.

Impact of Medical Specialties on Diagnostic and Therapeutic Management of Elderly Cancer Patients.

The management (diagnostic and therapeutic) of cancer in the geriatric population involves a number of complex difficulties. The aim of this study was to assess the impact of a medical specialty on the diagnostic and therapeutic management of elderly cancer patients. Four clinical scenarios of cancer in the geriatric population, with a dedicated survey to gather information regarding each clinical case's diagnostic and therapeutic approaches, as well as the different criteria influencing physicians' therapeutic decisions, were exposed to geriatricians, oncologists, and radiotherapists in Saint-Etienne. The surveys were filled out by 13 geriatricians, 11 oncologists, and 7 radiotherapists. There was a homogeneity of responses regarding the confirmation of cancer diagnostics in the elderly. There were strong disparities (inter- and intra-specialties) for several clinical situations regarding the therapeutic management of cancer. There were significant disparities in terms of surgical management, the implementation of a chemotherapy protocol, and the adaptation of the chemotherapy dosage. Contrary to oncologists, who primarily consider the G8 and the Karnofsky score, geriatric autonomy scores and frailty with cognitive assessment were the key factors determining diagnostic/therapeutic therapy for geriatricians. These results raise important ethical questions, requiring specific studies in geriatric populations to provide the homogenous management of elderly patients with cancer.

[Vaccination against influenza, pneumococcus and herpes zoster in the elderly Survey of prescribing physicians: assessment of knowledge and identification of obstacles to the prescription of vaccination]. / Vaccination contre la grippe, le pneumocoque et le zona chez les sujets âgés Enquête menée autour des médecins prescripteurs : état des lieux des connaissances et identification des freins à la prescription de la vaccination.

Vaccination coverage is insufficient for influenza, pneumococcus, and herpes zoster in people over the age of 65 in France, even though these are common infectious diseases. Using a computerised questionnaire, the aim of our study was to assess the knowledge of general practitioners, geriatricians, infectious diseases specialists and interns in the Loire region about the vaccination against these three diseases in elderly subjects, to identify the obstacles to vaccination, and to evaluate whether the provision of knowledge modifies the prescriptions and vaccination recommendations made to patients. Of the 125 responses from doctors and interns, 90.2 % are correct for influenza, 69.2 % for pneumococcus, and 32.8 % for herpes zoster, with no significant difference between specialities. By providing information, practitioners are more willing to vaccinate their patients against influenza (99 %), pneumococcus (93 %), and herpes zoster (39 %). The main obstacles to vaccination are the patient's refusal (85 %), the doctor's lack of knowledge and time (70 % and 41 % respectively), doubts about the vaccine's effectiveness (28 %), and fear of side effects (21 %).

Impact of influenza, herpes zoster, and pneumococcal vaccinations on the incidence of cardiovascular events in subjects aged over 65 years: a systematic review.

This systematic review aims to summarize the impact of vaccination against influenza, shingles, and pneumococcus on the incidence on the risk of cardiovascular events in the elderly. This protocol was developed in accordance with PRISMA guidelines. We conducted a literature search and identified all relevant articles published regarding the matter up to September 2022. We retrieved 38 studies (influenza vaccine = 33, pneumococcal vaccine = 5, and zoster vaccine = 2). A total of 28 and 2 studies have shown that influenza and pneumococcal vaccines significantly lower the risk of cardiovascular disease in the elderly. Also, repeated influenza vaccination shows a consistent and dose-dependent protective effect against acute coronary syndromes and stroke. Moreover, dual influenza and pneumococcal vaccination was associated with lower risks of some cardiovascular events (stroke, congestive heart failure, ischemic heart disease, and myocardial infarction). However, the impact of PCV13 on cardiovascular events has not been studied, nor has the currently recommended vaccination schedule (PCV13 + PPV23). As for herpes zoster vaccination, only the protective effect against stroke has been studied with the live attenuated herpes zoster vaccine, but no studies have been conducted with the recombinant subunit herpes zoster vaccine. This review outlines the benefits of the vaccines mentioned above beyond their preventive action on infectious diseases. It is intended for health professionals who wish to inform and advise their elderly patients.

Therapeutic Fasting: Are Patients Aged 65 and Over Ready?

While being the main potential beneficiaries of therapeutic fasting's health benefits, the elderly are frequently thought of as being too fragile to fast. The main objective of our survey was to review the knowledge, practices, and acceptability of therapeutic fasting in subjects aged 65 years and over. From September 2020 to March 2021, an online questionnaire was sent to subjects aged 65 and over, using the mailing list of local organizations working in the field of aging. The mean age of the 290 respondents was 73.8 ± 6.5 years, 75.2% were women and 54.1% had higher education. Among the respondents, 51.7% had already fasted and 80.7% deemed therapeutic fasting interesting, 83.1% would be willing to fast if it was proven beneficial for their health, and 77.2% if it was proven to decrease the burden of chronic diseases. Subjects aged 65 to 74 years considered themselves as having the greatest physical and motivational abilities to perform therapeutic fasting. People aged 65 years, or more, are interested in therapeutic fasting and a large majority would be ready to fast if such practice was proven beneficial. These results pave the way for future clinical trials evaluating therapeutic fasting in elderly subjects.

The impact of advanced age on anticoagulant therapy for acute venous thromboembolism.

INTRODUCTION: Management of venous thromboembolic events (VTE) has been completely changed after the introduction of direct oral anticoagulants (DOAC). VTE is common in the geriatric population, but the management of DOACs remains complex because of the lack of specific data in this polymedicated fragile population.An exhaustive search of anticoagulants in the indication of VTE was performed on PubMed, including data from clinical trials, observational studies, real-world data, drug-drug interaction studies, as well as various guidelines from scientific societies. AREAS COVERED: The present review aims to summarize our current knowledge on the era of DOACs in the management of VTE in the elderly. This involves learning the pharmacokinetics/pharmacodynamics of drugs specific to geriatrics, the problem of drug-drug interactions, and the main randomized clinical trials validating the use of DOACs. EXPERT OPINION: DOACs have become an essential part of the management of VTE in the elderly, both for their efficacy and safety. However, we are faced with a list of unmet needs, such as the relevance of DOACs in the very elderly, cancer patients, and those with renal impairment. Clinicians and pharmacists must remain cautious about comedications, as well as about the patient's comorbidities.

Time course response after single injection of botulinum toxin to treat spasticity after stroke: Systematic review with pharmacodynamic model-based meta-analysis.

BACKGROUND: The time-course response after a single injection of botulinum toxin (BoNT) for post-stroke spasticity is debated. We addressed this issue by conducting a systematic review and a pharmacodynamic model-based meta-analysis. METHODS: We searched Medline, PeDro and Google Scholar databases up to March 2020, selecting randomized controlled trials of post-stroke and traumatic brain injury patients with arm or leg muscle hypertonia, comparing BoNT to placebo, or different BoNT preparations. The main outcome was change in Modified Ashworth Scale (MAS) score. A non-linear mixed effect model was used to estimate maximal toxin and placebo effects (Emax and EPlacebo), the effect disappearance half-life (T1/2off) of BoNT and the doses achieving 50 and 80% of Emax (D50 and D80). The equivalence ratios between different BoNT preparations were calculated from D50 values. Adverse events were recorded. RESULTS: Altogether, 2,236 unique records were screened by 2 independent reviewers: 35 eligible trials including 3011 patients (95% post-stroke) were identified. For all BoNT preparations, the BoNT Emax of -1.11 (95% credible interval -1.31; -0.29) was reached at 5 weeks; the maximal placebo effect was -0.30 (-0.37; -0.22). Both D50 and D80 differed significantly by muscle volume. At D50, the equivalence ratio was significantly higher for abobotulinumtoxinA (3.35) than onabotulinumtoxinA and lower for letibotulinumtoxinA (0.41). T1/2off was longer for abobotulinumtoxinA than for onabotulinumtoxinA and the other preparations (13.1 weeks [95% credible interval 7.7; 19.3] vs 8.6 weeks [7.1; 10.1]). Adverse events were minor, with a weak, but significant, dose-response relation for muscle weakness. CONCLUSIONS: This first pharmacodynamic model-based meta-analysis of individuals with stroke revealed that for all BoNT-A preparations, BoNT-A injections to treat spasticity have maximal effect at 5 weeks. The T1/2off was longer for abobotulinumtoxinA than other preparations. Differences between certain BoNT unit scales were also confirmed.

What obstacles to nursing home for Dependent older adults' entry? Analysis of 186 situations resulting from an Inter-Establishment Resident Orientation Commission / Quels freins à l'entrée en Établissement d'hébergement pour personnes âgées dépendantes ? Analyse de 186 situations issues d'une Commission d'orientation des résidents inter-établissement

The decision to admit an older adult with loss of autonomy to an institution is complex. There are many obstacles to the decision to be referred to an institution and it partly explain long hospital stays and inadequate health care spending. Several of these obstacles have been identified in the literature (medical complexity, psycho-behavioural disorders, social vulnerability, etc.). This work is based on an experiment that aimed at coordinating the players during an "inter-hospital consultation meeting" dedicated to the decision to admit older patients who cannot find a solution immediately. This work aim to identify the obstacles to the referral of patients to HITH services. This is a single-centre descriptive study. It analyses prospective data collected between January 2017 and the end of June 2019. The average length of hospitalisation before leaving the institution is relatively homogeneous according to the different complexity criteria defined, except for heavy dependence and obesity, where in these situations there are longer average lengths of hospitalisation. The absence of complexity criteria is not necessarily associated with a shorter hospital stay. The commission makes it possible to create synergies between players in the same gerontological basin and facilitates the admission of complex cases to hospital.

La décision d'entrée en établissement d'un sujet âgé en perte d'autonomie est complexe. Les freins à la décision d'orientation en établissement expliquent en partie des durées d'hospitalisation longues et à l'origine de dépense de santé inadéquates. Plusieurs de ces freins ont été identifiés dans la littérature (complexité médicale, troubles psycho-comportementaux, vulnérabilité sociale…). À partir d'une expérimentation qui vise la coordination des acteurs lors d'une « réunion de concertation inter-établissement ¼ dédiée à la décision d'entrée de patients âgés ne trouvant pas de solution dans l'immédiat, l'objectif de ce travail est d'identifier les freins à l'orientation des patients en Ehpad. Il s'agit d'une étude descriptive mono-centrique analysant des données prospectives recueillies entre janvier 2017 et fin juin 2019. Les durées moyennes d'hospitalisation avant le départ en institution sont relativement homogènes en fonction des différents critères de complexité définis sauf pour la dépendance lourde et l'obésité où dans ces situations il existe des durées moyennes d'hospitalisation plus longues. L'absence de critère de complexité n'est pas obligatoirement associée à un raccourcissement du séjour hospitalier. La CORIE permet de créer des synergies entre les acteurs d'un même bassin gérontologique et facilite l'entrée en établissement des cas complexes.

Prospective multicentered study describing the health pathway of a short-stay geriatric population hospitalised through geriatric telephonic hotline / Étude prospective multicentrique décrivant le parcours de soins d'une population gériatrique hospitalisée en court séjour via une hotline gériatrique

Rationale: The ARS finance geriatric hotlines in order to improve the articulation between town medicine and the hospital. The objective of our study is to describe the health status and the care pathway of subjects aged over 75 years hospitalised in a geriatric short stay hospital via a geriatric hotline. Materials and methods: This prospective multicentre study included 1,451 subjects over 24 months. The primary endpoint was the average length of stay. The secondary endpoints were medico-socio-demographic data. Results: The population hospitalised via a hotline is comparable to that usually found in geriatric short stay services. The length of stay is correlated with the lifestyle and the mode of discharge (p < 0.001). There was a significant excess risk of non-return to the previous place of residence according to age, average length of stay, comorbidities and degree of dependence. Conclusion: The care pathway for elderly people over 75 years old hospitalised through the hotline is optimised, with an average length of stay of 14 days, demonstrating a good link between town medicine and hospital. This approach allows for the early management of elderly subjects in the geriatric care system.

Rationnel: Les Agences régionales de santé (ARS) financent des hotlines gériatriques en vue d'améliorer l'articulation entre la médecine de ville et l'hôpital. L'objectif de notre étude est de décrire l'état de santé et le parcours de soin des sujets âgés de plus de 75 ans hospitalisés en court séjour gériatrique via une hotline gériatrique. Matériel et méthode: Cette étude multicentrique prospective a inclus 1 451 sujets sur 24 mois. Le critère de jugement principal est la durée moyenne de séjour (DMS). Les critères de jugements secondaires sont les données médico-socio-démographiques. Résultats: La population hospitalisée via une hotline est comparable à celle habituellement retrouvée dans les services de court séjour gériatrique. La DMS est corrélée au mode de vie et au mode de sortie (p < 0,001). Il existe un surrisque significatif de non-retour au lieu de vie antérieur selon l'âge, la durée moyenne de séjour, les comorbidités et le degré de dépendance. Conclusion: Le parcours de soins du sujet âgé de plus de 75 ans passant par la hotline est optimisé avec une durée moyenne de séjour à 14 jours, témoignant d'une bonne articulation entre médecine de ville et hôpital. Cette démarche permet de prendre en charge précocement les sujets âgés dans la filière gériatrique.

COVID-19 Health Crisis Workloads and Screening for Psychological Impact in Nursing Home Staff: A Qualitative and Quantitative Survey.

Background: Nursing homes were particularly affected by the COVID-19 pandemic. The purpose of this study was to evaluate qualitatively and quantitatively with the use of a self-reported questionnaire as a tool for screening for mental disorders in nursing home staff. Methods: A multicenter epidemiological study was conducted in 12 nursing homes in France with 1117 nursing home staff eligible. Socio-demographic, occupational, and medical data were collected by anonymous self-reported questionnaire using validated scales to assess anxiety/depressive symptoms (HAD scale) and post-traumatic stress disorder (PCL-5). A total of 12 semi-structured interviews were conducted to assess acceptance and expectations for the use of the questionnaire. Results: The participation rate was 34.5%. Data from 373 questionnaires were included in the analysis. The questionnaire was well accepted by the participants and met their wishes for prevention action. The sample was 82% female. More than half reported a feeling of powerlessness and lack of time or staffing. The prevalence of anxiety symptoms was 22%, depressive symptoms 10%, and post-traumatic stress 7%. Conclusions: This study underlines the interest in screening for mental disorders by self-reported questionnaire and deploying preventive actions in the workplace to reduce stress and facilitate the reconciliation of family and working life in this context of the pandemic.

Anxiety, depression and coping evolution during the Covid-19 pandemic in older people with psychiatric diseases / Anxiété, dépression et évolution du coping durant la pandémie de Covid-19 dans une population de patients âgés avec troubles psychiatriques

Introduction: Lockdown over the Covid-19 pandemic might have had a major impact on people's mental health. The present longitudinal study was aimed to explore the impact of the two first lockdowns on anxious and depressive symptoms of older subjects suffering from psychiatric disorders and to highlight their strategies to cope with the stress induced by these lockdowns. Methods: Twenty-one outpatients from psychogeriatric units benefited from a follow-up visit phone. They filled out questionnaires assessing their anxious (GAD-7) and depressive (Mini-GDS) symptomatology and a questionnaire about their coping strategies (Brief COPE). Results: The depressive symptomatology significantly decreased between the 1st lockdown and the second assessment 9 months later with a GDS score significantly decreasing from 1.7 ± 1.2 to 0.9 ± 1.0. Conversely, anxiety remained stable with a mean GAD-7 score from 6.2 ± 5.1 to 6.3 ± 4.4. Furthermore, coping strategies were correlated with both depressive symptomatology and anxiety. At the same time, coping strategies focused on emotional support, acceptance, selfdistraction, and expression of feeling during the first lockdown had shifted 9 months later towards positive reframing and problem-solving strategies (active coping and planification) with a significant increase of active coping. Conclusion: The study showed that during the Covid-19 pandemic and its lockdown, older subjects with psychiatric disorders were able to engage coping strategies and to mitigate their depressive symptomatology and these coping strategies were flexible according to the context.

Contexte: Le confinement durant la pandémie de Covid-19 a eu un impact majeur sur la santé mentale. Cette étude longitudinale réalisée durant la pandémie avait pour objectif d'évaluer l'impact des deux premiers confinements sur les symptômes anxieux et dépressifs de sujets âgés avec troubles psychiatriques, et de mettre en évidence leurs stratégies d'adaptation pour faire face au stress. Méthodes: Vingt et un patients de psychogériatrie ont bénéficié d'un suivi en téléconsultation. Ils ont renseigné des questionnaires mesurant leur symptomatologie anxieuse (GAD 7) et dépressive (Mini-GDS), et leurs stratégies de coping. Résultats: La symptomatologie dépressive a significativement diminué entre le premier confinement et l'évaluation réalisée neuf mois plus tard (avec respectivement : scores à la Mini-GDS à 1,7 = 1,2 et 0,9 ± 1,0, p = 0,01). En revanche, le niveau d'anxiété ne s'est pas modifié (avec respectivement score GAD7 à 6,2 ± 5,1 et 6,3 ± 6,4, p = 0,4). Par ailleurs, des corrélations significatives entre certaines stratégies de coping, la dépression et l'anxiété ont été observées. Les stratégies de coping centrées sur le soutien émotionnel lors du premier confinement ont évolué vers des stratégies orientées sur la résolution de problème neuf mois plus tard. Ainsi, l'étude a montré que durant cette période de confinement et de pandémie de Covid-19, des sujets âgés ont pu mobiliser des stratégies de coping et atténuer leur symptomatologie dépressive et que ces stratégies ont été modulables selon le contexte.

Prediction of hospital readmission of multimorbid patients using machine learning models.

OBJECTIVE: The objective of this study is twofold. First, we seek to understand the characteristics of the multimorbid population that needs hospital care by using all diagnoses information (ICD-10 codes) and two aggregated multimorbidity and frailty scores. Second, we use machine learning prediction models on these multimorbid patients characteristics to predict rehospitalization within 30 and 365 days and their length of stay. METHODS: This study was conducted on 8 882 anonymized patients hospitalized at the University Hospital of Saint-Étienne. A descriptive statistical analysis was performed to better understand the characteristics of the patient population. Multimorbidity was measured using raw diagnoses information and two specific scores based on clusters of diagnoses: the Hospital Frailty Risk Score and the Calderon-Larrañaga index. Based on these variables different machine learning models (Decision Tree, Random forest and k-nearest Neighbors) were used to predict near future rehospitalization and length of stay (LoS). RESULTS: The use of random forest algorithms yielded better performance to predict both 365 and 30 days rehospitalization and using the diagnoses ICD-10 codes directly was significantly more efficient. However, using the Calderon-Larrañaga's clusters of diagnoses can be used as an efficient substitute for diagnoses information for predicting readmission. The predictive power of the algorithms is quite low on length of stay indicator. CONCLUSION: Using machine learning techniques using patients' diagnoses information and Calderon-Larrañaga's score yielded efficient results to predict hospital readmission of multimorbid patients. These methods could help improve the management of care of multimorbid patients in hospitals.

Vitamin D supplementation prior to or during COVID-19 associated with better 3-month survival in geriatric patients: Extension phase of the GERIA-COVID study.

BACKGROUND: The objective of this extension phase of the quasi-experimental GERIA-COVID study was to determine whether vitamin D3 supplementation taken prior to or during COVID-19 was associated with better 3-month survival in geriatric patients hospitalized for COVID-19. METHODS: Intervention group was defined as all participants supplemented with vitamin D3 prior to or during COVID-19 (n = 67). Supplements were either bolus vitamin D3 (ie, 50,000 IU per month, or 80,000 IU or 100,000 IU or 200,000 IU every 2-3 months), or daily supplementation with 800 IU. Comparator group involved those without vitamin D supplements (n = 28). Outcome was 3-month mortality. Covariables were age, sex, functional abilities, history of malignancies, cardiomyopathy, undernutrition, number of acute health issues, antibiotics use, systemic corticosteroids use, and 25(OH)D concentration. RESULTS: 76.1 % (n = 51) of participants survived at 3 months in Intervention group, compared to only 53.6 % (n = 15) in Comparator group (P = 0.03). The fully-adjusted hazard ratio for 3-month mortality was HR = 0.23 [95 %CI: 0.09;0.58](P = 0.002) in Intervention group compared to Comparator group. Intervention group had also longer survival time (log-rank P = 0.008). CONCLUSIONS: Vitamin D3 supplementation was associated with better 3-month survival in older COVID-19 patients.