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Baudouin E, Zitoun S, Corruble E, Vidal JS, Becquemont L, Duron E. Association between car driving and successful ageing. A cross sectional study on the "S.AGES" cohort. PLoS One 2023; 18:e0285313. [PMID: 37141341 PMCID: PMC10159353 DOI: 10.1371/journal.pone.0285313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Assessing successful ageing (SA) is essential to identify modifiable factors in order to enforce health promotion and prevention actions. SA comprises 3 dimensions: an active engagement with life, a low probability of disease and disease-related disability, and a high cognitive and physical functional capacity. Driving seems to be linked to SA as it is a mean to preserve social interactions and requires preserved functional and cognitive status. This study aims to investigate whether driving status can be considered a proxy of SA, by describing determinants associated with driving status in the 65+. METHODS This cross-sectional study is ancillary to the S.AGES (Sujets AGÉS-Aged Subjects) study, an observational prospective cohort study which included patients suffering from chronic pain, type-2 diabetes mellitus or atrial fibrillation from 2009 to 2014. SA was defined by the success of three dimensions: physiological comprised of comorbidity and autonomy scores, psychological comprised of cognitive status and emotional state, and a social dimension. RESULTS 2,098 patients were included of whom 1,226 (58.4%) reported being drivers. 351/2,092 (16.7%) were classified as successful agers: 292/1,266 (23.8%) in the driver group vs. 59/872 (6.8%) in the non-driver group; p < .001. In the final logistic model, after adjustment for relevant variables, SA was associated with driver status OR 1.94 [1.36-2.77]. CONCLUSION Driving may be considered as a proxy to SA: it reflects elders' independence, cognitive ability and a means to maintain social interactions. To preserve their mobility and enable them to achieve SA, regular screening of driving skills, specific rehabilitation programs are needed. Moreover development and communication on special transports services, communal rides or even driverless car to avoid apprehension around older adults driving could be solutions.
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Affiliation(s)
- Edouard Baudouin
- Université Paris-Saclay, UVSQ, CESP, Team MOODS, Le Kremlin-Bicêtre, France
- Département de Gériatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - Sarah Zitoun
- Université Paris-Saclay, UVSQ, CESP, Team MOODS, Le Kremlin-Bicêtre, France
- Département de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Emmanuelle Corruble
- Université Paris-Saclay, UVSQ, CESP, Team MOODS, Le Kremlin-Bicêtre, France
- Département de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-Sébastien Vidal
- Département de Gériatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Paris, France
- Université Paris Descartes, INSERM, Paris, France
| | - Laurent Becquemont
- Université Paris-Saclay, UVSQ, CESP, Team MOODS, Le Kremlin-Bicêtre, France
- Clinical Research Center, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Emmanuelle Duron
- Université Paris-Saclay, UVSQ, CESP, Team MOODS, Le Kremlin-Bicêtre, France
- Département de Gériatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
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Effects of chronic tramadol administration on cognitive flexibility in mice. Psychopharmacology (Berl) 2021; 238:2883-2893. [PMID: 34173033 DOI: 10.1007/s00213-021-05903-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE Tramadol is widely used for pain relief especially in seniors. However, long-term use of tramadol has serious adverse effects, including cognitive impairment. Besides its memory effects, already demonstrated in animals, a recent clinical report suggests that tramadol could also affect executive function in seniors. Several studies have hypothesized that the anti-muscarinic properties of tramadol could be responsible for the deleterious effects of tramadol on cognition. OBJECTIVES We aimed at investigating the effects of chronic administration of tramadol on cognitive flexibility in adult male mice, as assessed by a visual discrimination reversal task using a touchscreen device. The effects of tramadol were further compared to those of scopolamine, a reference muscarinic antagonist. RESULTS We found that, during the early phase of the reversal task, when cognitive flexibility is most in demand, both tramadol-treated mice (20 mg/kg, s.c., twice a day) and scopolamine-treated mice (0.5 mg/kg, s.c., twice a day) needed more correction trials and showed a higher perseveration index than saline-treated mice. Therefore, tramadol affects cognitive flexibility, and its anticholinergic properties could be at least partly involved in these deficits. CONCLUSIONS In view of these deleterious cognitive effects of tramadol, physicians should be cautious when prescribing this analgesic, especially in seniors who are more vulnerable to adverse drug events and in which alternative prescription should be preferred whenever possible.
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Chagnas MO, Poiraudeau S, Lefèvre-Colau MM, Rannou F, Nguyen C. Diagnosis and management of lumbar spinal stenosis in primary care in France: a survey of general practitioners. BMC Musculoskelet Disord 2019; 20:431. [PMID: 31521138 PMCID: PMC6745066 DOI: 10.1186/s12891-019-2782-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 08/26/2019] [Indexed: 11/12/2022] Open
Abstract
Background Lumbar spinal stenosis (LSS) is a common spinal condition and the most frequent indication for spinal surgery in elderly people. General practitioners (GPs) are on the 1st line for its diagnosis and treatment. We aimed to assess how GPs diagnose and treat people with LSS in France. Methods We conducted a cross-sectional survey in a primary care setting. French GPs were selected by a random draw from the French Medical Board. The questionnaire was designed by 3 physicians specialized in physical and rehabilitation medicine and a resident in general practice. A provisional questionnaire was tested in a pilot survey of 11 French GPs. Participants’ feedbacks served to build the final questionnaire. This latter was submitted by e-mail or mail to 330 GPs. GPs were surveyed about the 3 main domains relevant to the management of people with LSS in primary care: 1/ diagnosis, 2/ pharmacological treatments and 3/ non-pharmacological treatments, using self-administered open- and closed-ended questions and visual analog scales. Results Overall, 90/330 (27.3%) GPs completed the survey. 51/89 (57.3%) GPs were confident with managing people with LSS. Low back pain 51/87 (58.6%), neurogenic claudication 38/87 (43.7%) and paresthesia in the lower limbs 31/87 (35.6%) were the 3 most frequently cited clinical signs leading to the diagnosis of LSS. Improvement with lumbar flexion was mentioned by 9/87 (10.3%) GPs. 85/86 (98.8%) would consider prescribing lumbar imaging, 60/84 (71.4%) corticoid spinal injections and 42/79 (53.2%) would never prescribe lumbar flexion-based endurance training. All GPs would refer people with LSS to another specialist. Conclusions French GPs lack confidence with diagnosing LSS and prescribing pharmacological and non-pharmacological treatments for people with LSS. Electronic supplementary material The online version of this article (10.1186/s12891-019-2782-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie-Ombeline Chagnas
- Assistance Publique-Hôpitaux de Paris, Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Serge Poiraudeau
- Assistance Publique-Hôpitaux de Paris, Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Université de Paris, Faculté de Santé, UFR Médecine, Sorbonne Paris Cité, 75006, Paris, France.,INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne 75004 Cité, ECaMO Team, Paris, France.,Institut Fédératif de Recherche sur le Handicap, 75013, Paris, France
| | - Marie-Martine Lefèvre-Colau
- Assistance Publique-Hôpitaux de Paris, Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Université de Paris, Faculté de Santé, UFR Médecine, Sorbonne Paris Cité, 75006, Paris, France.,INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique Paris Sorbonne 75004 Cité, ECaMO Team, Paris, France.,Institut Fédératif de Recherche sur le Handicap, 75013, Paris, France
| | - François Rannou
- Assistance Publique-Hôpitaux de Paris, Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Université de Paris, Faculté de Santé, UFR Médecine, Sorbonne Paris Cité, 75006, Paris, France.,INSERM UMR 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire (T3S), Faculté des Sciences Fondamentales et Biomédicales, 75006, Paris, France
| | - Christelle Nguyen
- Assistance Publique-Hôpitaux de Paris, Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Université de Paris, Faculté de Santé, UFR Médecine, Sorbonne Paris Cité, 75006, Paris, France. .,INSERM UMR 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire (T3S), Faculté des Sciences Fondamentales et Biomédicales, 75006, Paris, France.
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Consensus multidisciplinaire d’experts en douleur et gériatrie : utilisation des antalgiques dans la prise en charge de la douleur de la personne âgée (hors anesthésie). ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.douler.2017.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Vannacci A, Lombardi N, Simonetti M, Fornasari D, Fanelli A, Cricelli I, Cricelli C, Lora Aprile P, Lapi F. Regular use of acetaminophen or acetaminophen-codeine combinations and prescription of rescue therapy with non-steroidal anti-inflammatory drugs: a population-based study in primary care. Curr Med Res Opin 2017; 33:1141-1148. [PMID: 28318320 DOI: 10.1080/03007995.2017.1308920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There are contrasting positions concerning the benefit-risk ratio of acetaminophen use for osteoarthritis (OA)-related pain. To clarify the effectiveness of acetaminophen or acetaminophen-codeine combinations according to their regimen of use, we evaluated whether being a regular user (adherent) of these medications decreased the occurrence of rescue therapy with non-steroidal anti-inflammatory drugs (NSAIDs). METHODS Using the Health Search IMS Health Longitudinal Patient Database, we formed a cohort of patients aged ≥18 years and newly treated with acetaminophen or acetaminophen-codeine combinations for OA between 1 January 2001 and 31 December 2013. These patients were followed up for one year in which they were categorized as regular or irregular users of these medications according to a variable medication possession ratio (VMPR) ≥ 50% or lower. We operationally defined the rescue therapy as the use of any NSAIDs prescribed for OA-related pain. RESULTS Overall, 40,029 patients (69.5% females; mean age: 68 ± 13.57) treated with acetaminophen or acetaminophen-codeine combinations formed the cohort. After the first year of treatment, regular users showed a statistically significantly lower risk of being prescribed with rescue therapy with NSAIDs (OR = 0.89; 95% CI 0.84-0.96). CONCLUSION These findings show that regular use of acetaminophen or acetaminophen-codeine combinations may reduce the need for NSAIDs to treat OA-related pain.
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Affiliation(s)
- Alfredo Vannacci
- a Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology , University of Florence , Florence , Italy
| | - Niccolò Lombardi
- a Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology , University of Florence , Florence , Italy
| | - Monica Simonetti
- b Health Search , Italian College of General Practitioners and Primary Care , Florence , Italy
| | - Diego Fornasari
- c Department of Medical Biotechnology and Translational Medicine , University of Milan , Milan , Italy
| | - Andrea Fanelli
- d Unit of Anaesthesiology and Pain Therapy , General Hospital S. Orso Malpighi, University Hospital of Bologna , Bologna , Italy
| | - Iacopo Cricelli
- b Health Search , Italian College of General Practitioners and Primary Care , Florence , Italy
| | - Claudio Cricelli
- e Italian College of General Practitioners and Primary Care , Florence , Italy
| | | | - Francesco Lapi
- b Health Search , Italian College of General Practitioners and Primary Care , Florence , Italy
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Oude Engberink A, Lognos B, Badin M, Carbonnel F, Lalau M, Blain H, Bourrel G. [Primary care pain management in the elderly population: The opening to non-pharmacological interventions. Qualitative study focused on GP experiences]. Presse Med 2016; 45:e377-e387. [PMID: 27597302 DOI: 10.1016/j.lpm.2016.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/19/2015] [Accepted: 01/04/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES First of all, understand the management of pain in the elderly population through GP experiences and, secondly, explore their implication to the benefit of well aging. METHOD Qualitative study with data collection combining 2 focus groups and 5 in depth interviews centered on the lived experience of 16 GPs in the Languedoc-Roussillon region in southern France. A semiopragmatic phenomenological analysis of the fully transcribed verbatim interviews was used to establish the significant categories in relation with our objectives. RESULTS The GPs feel that the pain management still needs improvement even though it has become one of their priorities. GPs often notice iatrogenic effects in the care taking process of multiple pathologies which make them choose for the use of non-pharmacological interventions. The complex nature of pain, which has multiple significations for the elderly population, needs an overall approach by the GPs. They feel that it's their job to manage this because of the proximity and knowledge of the patient and his weaknesses. For them, aging well is a patient experience, they are only a support in this process. DISCUSSION GPs think that they are expert in the complex process of pain management. This process has to be seen in a multidimensional approach of an older person with multiple pathologies. Therefore, they make use of non-pharmacological interventions. CONCLUSION These interventions need to be developed to improve the quality of life in the elderly population.
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Affiliation(s)
- Agnes Oude Engberink
- Département de médecine générale, faculté de médecine de Montpellier, Nîmes, France; CEPS Platform, university of Montpellier, France.
| | - Beatrice Lognos
- Département de médecine générale, faculté de médecine de Montpellier, Nîmes, France; CEPS Platform, university of Montpellier, France
| | - Melanie Badin
- Département de médecine générale, faculté de médecine de Montpellier, Nîmes, France
| | - François Carbonnel
- Département de médecine générale, faculté de médecine de Montpellier, Nîmes, France; CEPS Platform, university of Montpellier, France
| | - Marion Lalau
- Département de médecine générale, faculté de médecine de Montpellier, Nîmes, France
| | - Hubert Blain
- Département de gérontologie, CHRU de Montpellier, France
| | - Gérard Bourrel
- Département de médecine générale, faculté de médecine de Montpellier, Nîmes, France; CEPS Platform, university of Montpellier, France
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Aubrun F, Chrétien E, Letrilliart L, Ginoux M, Belhassen M, Lanteri-Minet M, Van Ganse E, Beloeil H. What are the therapeutic alternatives to dextropropoxyphene in France? A prescribers' survey. Anaesth Crit Care Pain Med 2016; 36:15-19. [PMID: 27320052 DOI: 10.1016/j.accpm.2016.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/01/2016] [Indexed: 11/17/2022]
Abstract
About a year after dextropropoxyphene (DXP) withdrawal from the French market, we conducted a survey among members of the French Society of Anesthesia & Intensive Care Medicine (Sfar) and of the French Society of the Study and Treatment of Pain (SFETD) to identify the indications for which this WHO level II analgesic had been prescribed, the prescriber's feedback following withdrawal, and the substitutive analgesics prescribed. DXP had been prescribed by more than 75% of the 430 anaesthesiologists and 230 pain specialists interviewed, mainly for acute and chronic non-cancer pain of moderate intensity. While two thirds of pain specialists were not satisfied with DXP withdrawal, this decision did not affect the majority of anaesthesiologists. In both groups, the main substitutive analgesic was tramadol combined with acetaminophen, while only 24% of prescribers considered acetaminophen alone as a substitute.
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Affiliation(s)
- F Aubrun
- Department of Anesthesiology and Critical Care, Université Claude-Bernard-Lyon 1, hospices civils de Lyon, CHU de Lyon, groupe hospitalier Nord-hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
| | - E Chrétien
- Department of Anesthesiology and Critical Care, Université Claude-Bernard-Lyon 1, hospices civils de Lyon, CHU de Lyon, groupe hospitalier Nord-hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - L Letrilliart
- Université Claude-Bernard-Lyon 1, collège universitaire de médecine générale, 8, avenue Rockefeller, 69373 Lyon cedex 08, France
| | - M Ginoux
- Université Claude-Bernard-Lyon 1, UMR CNRS 5558, faculté d'odontologie, 11, rue Guillaume-Paradin, 69372 Lyon cedex 08, France
| | - M Belhassen
- Université Claude-Bernard-Lyon 1, UMR CNRS 5558, faculté d'odontologie, 11, rue Guillaume-Paradin, 69372 Lyon cedex 08, France
| | - M Lanteri-Minet
- Department of Pain Management, université Nice-Sophia-Antipolis, Inserm/UdA, U1107, Neuro-Dol, université d'Auvergne, pôle neurosciences cliniques, CHU de Nice, hôpital de Cimiez, 4, avenue Reine-Victoria, 06000 Nice, France
| | - E Van Ganse
- Université Claude-Bernard-Lyon 1, UMR CNRS 5558, faculté d'odontologie, 11, rue Guillaume-Paradin, 69372 Lyon cedex 08, France; Hospices civils de Lyon, CHU de Lyon, groupe hospitalier Nord-hôpital de la Croix-Rousse, service de pneumologie, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - H Beloeil
- Université Rennes 1, CHU de Rennes, pôle d'anesthésie-Samu-urgences-réanimations, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
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Becquemont L, Bauduceau B, Benattar-Zibi L, Al-Salameh A, Berrut G, Bertin P, Bucher S, Corruble E, Danchin N, Derumeaux G, Doucet J, Falissard B, Forette F, Hanon O, Pasquier F, Pinget M, Ourabah R, Piedvache C. Cardiovascular Drugs and Metformin Drug Dosage According to Renal Function in Non-Institutionalized Elderly Patients. Basic Clin Pharmacol Toxicol 2015; 118:468-73. [DOI: 10.1111/bcpt.12526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Laurent Becquemont
- Pharmacology Department; Faculty of Medicine Paris-Sud; University Paris-Sud; UMR 1184; CEA, DSV/iMETI; Division of Immuno-Virology; IDMIT, INSERM Center for Immunology of Viral Infections and Autoimmune Diseases; Assistance Publique-Hôpitaux de Paris, Hopital Bicêtre; Le Kremlin Bicêtre France
| | | | | | - Abdallah Al-Salameh
- Pharmacology Department; Faculty of Medicine Paris-Sud; University Paris-Sud; UMR 1184; CEA, DSV/iMETI; Division of Immuno-Virology; IDMIT, INSERM Center for Immunology of Viral Infections and Autoimmune Diseases; Assistance Publique-Hôpitaux de Paris, Hopital Bicêtre; Le Kremlin Bicêtre France
| | | | - Philippe Bertin
- Rheumatology Department; Limoges University Hospital; Limoges France
| | - Sophie Bucher
- General Practice Department; Faculty of Medicine Paris-Sud; University Paris-Sud; Le Kremlin-Bicêtre France
| | - Emmanuelle Corruble
- Department of Psychiatry; Faculty of Medicine Paris-Sud; INSERM U 669; University Paris-Sud; Bicêtre University Hospital; Assistance Publique-Hôpitaux de Paris; Le Kremlin Bicêtre France
| | | | - Geneviève Derumeaux
- Cardiovascular Functional Exploration; Louis Pradel Hospital, Hospices Civils de Lyon; Bron France
| | - Jean Doucet
- Internal Medicine, Geriatrics and Therapeutics; Saint Julien University Hospital; Rouen University; Rouen France
| | - Bruno Falissard
- Biostatistics Department; Faculty of Medicine Paris-Sud; INSERM U 669; University Paris-Sud; Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse; Le Kremlin-Bicêtre France
| | - Francoise Forette
- National Foundation of Gerontology; University Paris Descartes; Paris France
| | - Olivier Hanon
- Geriatrics Department; University Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Broca; Paris France
| | | | - Michel Pinget
- Endocrinology, Diabetes and Diseases of Nutrition (Pôle NUDE); University Hospital of Strasbourg and the European Centre for the Study of Diabetes (CeeD); University of Strasbourg; Strasbourg France
| | - Rissane Ourabah
- General Practice Department; Faculty of Medicine Paris-Sud; University Paris-Sud; Le Kremlin-Bicêtre France
| | - Celine Piedvache
- Pharmacology Department; Faculty of Medicine Paris-Sud; University Paris-Sud; UMR 1184; CEA, DSV/iMETI; Division of Immuno-Virology; IDMIT, INSERM Center for Immunology of Viral Infections and Autoimmune Diseases; Assistance Publique-Hôpitaux de Paris, Hopital Bicêtre; Le Kremlin Bicêtre France
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Lazkani A, Delespierre T, Bauduceau B, Benattar-Zibi L, Bertin P, Berrut G, Corruble E, Danchin N, Derumeaux G, Doucet J, Falissard B, Forette F, Hanon O, Pasquier F, Pinget M, Ourabah R, Piedvache C, Becquemont L. Predicting falls in elderly patients with chronic pain and other chronic conditions. Aging Clin Exp Res 2015; 27:653-61. [PMID: 25637513 DOI: 10.1007/s40520-015-0319-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim was to identify fall predictors in elderly suffering from chronic pain (CP) and to test their applicability among patients with other chronic conditions. METHODS 1,379 non-institutionalized patients aged 65 years and older who were suffering from CP (S.AGE CP sub-cohort) were monitored every 6 months for 1 year. Socio-demographic, clinical and pain data and medication use were assessed at baseline for the association with falls in the following year. Falls were assessed retrospectively at each study visit. Logistic regression analyses were performed to identify fall predictors. The derived model was applied to two additional S.AGE sub-cohorts: atrial fibrillation (AF) (n = 1,072) and type-2 diabetes mellitus (T2DM) (n = 983). RESULTS Four factors predicted falls in the CP sub-cohort: fall history (OR: 4.03, 95 % CI 2.79-5.82), dependency in daily activities (OR: 1.81, 95 % CI 1.27-2.59), age ≥75 (OR: 1.53, 95 % CI 1.04-2.25) and living alone (OR: 1.73, 95 % CI 1.24-2.41) (Area Under the Curve: AUC = 0.71, 95 % CI 0.67-0.75). These factors were relevant in AF (AUC = 0.71, 95 % CI 0.66-0.75) and T2DM (AUC = 0.67, 95 % CI 0.59-0.73) sub-cohorts. Fall predicted probability in CP, AF and T2DM sub-cohorts increased from 7, 7 and 6 % in patients with no risk factors to 59, 66 and 45 % respectively, in those with the four predictors. Fall history was the strongest predictor in the three sub-cohorts. CONCLUSION Fall history, dependency in daily activities, age ≥75 and living alone are independent fall predictors in CP, AF and T2DM patients.
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Affiliation(s)
- Aida Lazkani
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France.
| | - Tiba Delespierre
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France
| | | | | | - Philippe Bertin
- Rheumatology Department, Limoges University Hospital, Limoges, France
| | - Gilles Berrut
- Clinical Gerontology, Nantes University Hospital, Nantes, France
| | - Emmanuelle Corruble
- Paris-Sud Faculty of Medicine, Psychiatry Department, Bicêtre University Hospital, AP-HP, INSERM U 669, Paris-Sud University, Le Kremlin-Bicêtre, France
| | | | - Geneviève Derumeaux
- Cardiovascular Functional Exploration, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Jean Doucet
- Internal Medicine, Geriatrics and Therapeutics, Saint Julien University Hospital, Rouen University, Rouen, France
| | - Bruno Falissard
- Paris-Sud Faculty of Medicine, Biostatistics Department, AP-HP, Paul Brousse Hospital, INSERM U 669, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Francoise Forette
- National Gerontology Foundation, Paris Descartes University, Paris, France
| | - Olivier Hanon
- AP-HP, Broca Hospital, Geriatrics Department, Paris Descartes University, EA 4468, Paris, France
| | - Florence Pasquier
- Lille University Hospital, Lille Nord de France University, UDSL, EA 1046, Lille, France
| | - Michel Pinget
- Endocrinology, Diabetes and Nutrition-Related Diseases (NUDE Unit), Strasbourg University Hospital, and the European Centre for the Study of Diabetes (CeeD), Strasbourg University, Strasbourg, France
| | - Rissane Ourabah
- General Practice Department, Paris-Sud Faculty of Medicine, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Celine Piedvache
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France
| | - Laurent Becquemont
- Pharmacology Department, Paris-Sud Faculty of Medicine, AP-HP, Bicêtre Hospital, Paris-Sud University, 63, rue Gabriel Péri, 94276, Le Kremlin-Bicêtre, France
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Bucher S, Bauduceau B, Benattar-Zibi L, Bertin P, Berrut G, Corruble E, Danchin N, Delespierre T, Derumeaux G, Doucet J, Falissard B, Forette F, Hanon O, Ourabah R, Pasquier F, Piedvache C, Pinget M, Ringa V, Becquemont L. Primary care management of non-institutionalized elderly diabetic patients: The S.AGES cohort - Baseline data. Prim Care Diabetes 2015; 9:267-274. [PMID: 25086913 DOI: 10.1016/j.pcd.2014.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/04/2014] [Accepted: 07/10/2014] [Indexed: 11/17/2022]
Abstract
AIM S.AGES is a multicenter prospective cohort study of non-institutionalized patients aged 65 and over with atrial fibrillation, type 2 diabetes or chronic pain. Its objective is to describe the medical management in primary care. This article presents the baseline characteristics of subjects in the diabetes subcohort and compares the results to those from cohorts of older diabetic patients. METHODS From April 2009 to June 2011, 983 patients were included in the diabetes subcohort by 213 primary care providers. Demographic data, geriatric parameters and the history, characteristics and treatment of the diabetes were recorded at baseline. RESULTS The mean age was 76.7 ± 5.9 years. Most patients were living independently, with no cognitive impairment and in relatively good health. The duration of diabetes was 11.3 ± 8.7 years with average HbA1c of 6.9 ± 1.0%. 20% of patients had macrovascular disease, 33% renal failure, 14.6% ocular complication and 7.1% neuropathy. The first-line antidiabetic treatment was metformin (61.2%) and 18% of patients had used insulin. Treatment intensified with the worsening of diabetic symptoms. When compared to those from French and North American cohorts, the results showed increased complications and use of insulin with age, disease duration and severity. CONCLUSION Due to the method of recruitment, S.AGES patients were generally healthy with well-controlled diabetes. However, the results were consistent with those from other cohorts. Three-year follow-up is expected to study the management of diabetic patients aged 65 and over in primary care.
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Affiliation(s)
- Sophie Bucher
- General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre, France; INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexual and Reproductive Health Team, University of Paris-Sud, Le Kremlin-Bicêtre, France.
| | | | | | - Philippe Bertin
- Rheumatology Department, Limoges University Hospital, Limoges, France
| | - Gilles Berrut
- Clinical Gerontology, Nantes University Hospital, France
| | - Emmanuelle Corruble
- INSERM U 669, Paris-Sud Faculty of Medicine, University of Paris-Sud, Psychiatry Department, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Tiba Delespierre
- Pharmacology Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Geneviève Derumeaux
- Cardiovascular Functional Exploration, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Jean Doucet
- Internal Medicine, Geriatry and Therapeutics, Saint Julien University Hospital, Rouen University, Rouen, France
| | - Bruno Falissard
- INSERM U 669, Paris-Sud Faculty of Medicine, University of Paris-Sud, Biostatistics Department, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Le Kremlin-Bicêtre, France
| | - Francoise Forette
- University of Paris Descartes, National Foundation of Gerontology, Paris, France
| | - Olivier Hanon
- University of Paris Descartes, EA 4468, AP-HP, Broca Hospital, Geriatrics Department, Paris, France
| | - Rissane Ourabah
- General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre, France
| | - Florence Pasquier
- University of Lille Nord de France, UDSL, EA 1046, CHU, Lille, France
| | - Celine Piedvache
- Pharmacology Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Michel Pinget
- Endocrinology, Diabetes and Nutrition-Related Diseases (NUDE Unit), Strasbourg University Hospital and the European Centre for the Study of Diabetes (CeeD), University of Strasbourg, Strasbourg, France
| | - Virginie Ringa
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexual and Reproductive Health Team, University of Paris-Sud, Le Kremlin-Bicêtre, France
| | - Laurent Becquemont
- Pharmacology Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
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11
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Healthcare costs associated with elderly chronic pain patients in primary care. Eur J Clin Pharmacol 2015; 71:939-47. [DOI: 10.1007/s00228-015-1871-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
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12
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Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin CWC, Day RO, McLachlan AJ, Ferreira ML. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015; 350:h1225. [PMID: 25828856 PMCID: PMC4381278 DOI: 10.1136/bmj.h1225] [Citation(s) in RCA: 309] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of paracetamol (acetaminophen) in the management of spinal pain and osteoarthritis of the hip or knee. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, AMED, CINAHL, Web of Science, LILACS, International Pharmaceutical Abstracts, and Cochrane Central Register of Controlled Trials from inception to December 2014. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials comparing the efficacy and safety of paracetamol with placebo for spinal pain (neck or low back pain) and osteoarthritis of the hip or knee. DATA EXTRACTION Two independent reviewers extracted data on pain, disability, and quality of life. Secondary outcomes were adverse effects, patient adherence, and use of rescue medication. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst possible pain or disability). We calculated weighted mean differences or risk ratios and 95% confidence intervals using a random effects model. The Cochrane Collaboration's tool was used for assessing risk of bias, and the GRADE approach was used to evaluate the quality of evidence and summarise conclusions. RESULTS 12 reports (13 randomised trials) were included. There was "high quality" evidence that paracetamol is ineffective for reducing pain intensity (weighted mean difference -0.5, 95% confidence interval -2.9 to 1.9) and disability (0.4, -1.7 to 2.5) or improving quality of life (0.4, -0.9 to 1.7) in the short term in people with low back pain. For hip or knee osteoarthritis there was "high quality" evidence that paracetamol provides a significant, although not clinically important, effect on pain (-3.7, -5.5 to -1.9) and disability (-2.9, -4.9 to -0.9) in the short term. The number of patients reporting any adverse event (risk ratio 1.0, 95% confidence interval 0.9 to 1.1), any serious adverse event (1.2, 0.7 to 2.1), or withdrawn from the study because of adverse events (1.2, 0.9 to 1.5) was similar in the paracetamol and placebo groups. Patient adherence to treatment (1.0, 0.9 to 1.1) and use of rescue medication (0.7, 0.4 to 1.3) was also similar between groups. "High quality" evidence showed that patients taking paracetamol are nearly four times more likely to have abnormal results on liver function tests (3.8, 1.9 to 7.4), but the clinical importance of this effect is uncertain. CONCLUSIONS Paracetamol is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis. These results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42013006367.
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Affiliation(s)
- Gustavo C Machado
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW 2000, Australia
| | - Chris G Maher
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW 2000, Australia
| | - Paulo H Ferreira
- Faculty of Health Sciences, University of Sydney, Sydney, NSW 2141, Australia
| | - Marina B Pinheiro
- Faculty of Health Sciences, University of Sydney, Sydney, NSW 2141, Australia
| | - Chung-Wei Christine Lin
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW 2000, Australia
| | - Richard O Day
- Department of Clinical Pharmacology, St Vincent's Hospital and University of New South Wales, Sydney, NSW 2010, Australia School of Medical Sciences, Department of Medicine, University of New South Wales, Sydney, NSW 2033, Australia
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, Sydney, NSW 2050, Australia Centre for Education and Research on Ageing, Concord Hospital, Sydney, NSW 2139, Australia
| | - Manuela L Ferreira
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW 2000, Australia Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW 2065, Australia
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13
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Becquemont L, Bauduceau B, Benattar-Zibi L, Berrut G, Bertin P, Bucher S, Corruble E, Danchin N, al-Salameh A, Derumeaux G, Doucet J, Falissard B, Forette F, Hanon O, Pasquier F, Pinget M, Ourabah R, Piedvache C. Association between Cardiovascular Drugs and Chronic Kidney Disease in Non-Institutionalized Elderly Patients. Basic Clin Pharmacol Toxicol 2015; 117:137-43. [DOI: 10.1111/bcpt.12376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/05/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Laurent Becquemont
- Pharmacology Department; Faculty of Medicine Paris-Sud; APHP; Bicêtre university Hospital; University Paris-Sud; Le Kremlin Bicêtre France
| | | | | | - Gilles Berrut
- Clinical Gerontology; Nantes university hospital; Nantes France
| | - Philippe Bertin
- Rheumatology Department; Limoges University Hospital; Limoges France
| | - Sophie Bucher
- General Practice Department; Faculty of Medicine Paris-Sud; University Paris-Sud; Le Kremlin-Bicêtre France
| | - Emmanuelle Corruble
- INSERM U 669; Faculty of Medicine Paris-Sud; Department of Psychiatry; Bicêtre University Hospital; APHP; University Paris-Sud; Le Kremlin Bicêtre France
| | | | - Abdallah al-Salameh
- Pharmacology Department; Faculty of Medicine Paris-Sud; APHP; Bicêtre university Hospital; University Paris-Sud; Le Kremlin Bicêtre France
| | - Geneviève Derumeaux
- Cardiovascular Functional Exploration; Louis Pradel Hospital; HCL; Bron France
| | - Jean Doucet
- Internal Medicine, Geriatrics and Therapeutics; Saint Julien University Hospital; Rouen University; Rouen France
| | - Bruno Falissard
- INSERM U 669; Faculty of Medicine Paris-Sud; Biostatistics Department; APHP; Hôpital Paul Brousse; University Paris-Sud; Le Kremlin-Bicêtre France
| | - Francoise Forette
- National Foundation of Gerontology; University Paris Descartes; Paris France
| | - Olivier Hanon
- Geriatrics Department; EA 4468, AP-HP; Broca university hospital; University Paris Descartes; Paris France
| | - Florence Pasquier
- UDSL; EA 1046, CHU; University of Lille Nord de France; Lille France
| | - Michel Pinget
- Endocrinology, Diabetes and Diseases of Nutrition; University Hospital of Strasbourg; European Centre for the Study of Diabetes (CeeD); University of Strasbourg; Strasbourg France
| | - Rissane Ourabah
- General Practice Department; Faculty of Medicine Paris-Sud; University Paris-Sud; Le Kremlin-Bicêtre France
| | - Celine Piedvache
- Pharmacology Department; Faculty of Medicine Paris-Sud; APHP; Bicêtre university Hospital; University Paris-Sud; Le Kremlin Bicêtre France
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14
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Lazkani A, Delespierre T, Benattar-Zibi L, Bertin P, Corruble E, Derumeaux G, Falissard B, Forette F, Hanon O, Piedvache C, Becquemont L. Do male and female general practitioners differently prescribe chronic pain drugs to older patients? PAIN MEDICINE 2014; 16:696-705. [PMID: 25521663 DOI: 10.1111/pme.12659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify the relationship between general practitioner (GP) gender and prescribing practice of chronic pain drugs in older adults. DESIGN Cross-sectional observational study. SETTING GPs in private practice throughout France. SUBJECTS Two hundred and sixty GPs (80.8% male and 19.2% female) enrolled 1,379 (28.4% male and 71.6% female) noninstitutionalized patients over 65 years of age, suffering from chronic pain. METHODS A comparison of prescribing habits between male and female GPs was performed on baseline data with univariate analyses followed by multivariate analyses after taking several confounding factors into account. RESULTS No significant differences were found when comparing male and female GPs' prescriptions of World Health Organization step 1, step 2, and step 3 analgesics. Male GPs were more likely than female GPs to prescribe antineuropathic pain drugs (11.3% of patients with male GPs versus 4.8% of patients with female GPs, P = 0.004) and less likely to prescribe symptomatic slow-acting drugs for osteoarthritis (SySADOA) (10.2% of male GPs' patients versus 18.8% of female GPs' patients, P = 0.0003). After adjusting for several confounding factors, male GPs were still more likely to prescribe antineuropathic pain drugs (OR 2.43, 95% CI 1.15-5.14, P = 0.02) and less likely to prescribe symptomatic slow-acting drugs (OR 0.64, 95% CI 0.42-0.97, P = 0.03). CONCLUSION Male and female GPs prescribe analgesics in a similar manner. However, male GPs prescribe more antineuropathic pain drugs, but fewer SySADOA.
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Affiliation(s)
- Aida Lazkani
- Pharmacology Department, Faculty of Medicine Paris-Sud, University Paris-Sud; Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France
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15
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Becquemont L, Delespierre T, Bauduceau B, Benattar-Zibi L, Berrut G, Corruble E, Danchin N, Derumeaux G, Doucet J, Falissard B, Forette F, Hanon O, Pasquier F, Pinget M, Ourabah R, Bucher S, Lazkani A, Piedvache C, Bertin P. Consequences of dextropropoxyphene market withdrawal in elderly patients with chronic pain. Eur J Clin Pharmacol 2014; 70:1237-42. [DOI: 10.1007/s00228-014-1722-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/21/2014] [Indexed: 11/29/2022]
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