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Roche J, Vaillant-Ciszewicz AJ, Guerin O. [Better identifying and understanding post-traumatic stress disorder in the elderly]. Soins Gerontol 2024; 29:14-18. [PMID: 38677805 DOI: 10.1016/j.sger.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Post-traumatic stress disorder (PTSD) is particularly common in the elderly, including those with cognitive impairments. We need to stress the importance of early detection to better understand the specific signs of this disorder in the elderly. Psychotherapies such as cognitive-behavioral therapy and Eye Movement Desensitization and Reprocessing are being explored for their effectiveness and adaptability with the elderly. Identifying post-traumatic stress disorder should be a shared responsibility, for the mental health of the elderly.
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Affiliation(s)
- Jean Roche
- CHU de Lille-Hôpital Fontan 2, 1 rue André-Verhaeghe, 59037 Lille, France.
| | | | - Olivier Guerin
- Centre hospitalier universitaire de Nice, Ircan-Université Côte d'Azur (UCA), Inserm U1081-CNRS UMR 7284, 4 avenue Reine Victoria, 06000 Nice, France
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Rollin L, Guerin O, Petit A, Bourdon L, Guillemette S, Gislard A, Clin B, Bachelet L, Rouget Mejjad I, Rouger F, Benichou J, Gehanno JF, Commune A. Post-traumatic stress disorder in hospital doctors after the COVID-19 pandemic. Occup Med (Lond) 2024; 74:113-119. [PMID: 38330159 DOI: 10.1093/occmed/kqad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Prior studies showed that during the coronavirus disease 2019 (COVID-19) pandemic healthcare workers had a higher risk of developing post-traumatic stress disorder (PTSD) symptoms. However, studies conducted among doctors several years after the beginning of the COVID-19 pandemic are scarce. AIMS To evaluate the prevalence of PTSD among hospital doctors and to describe potential explanatory factors. METHODS The Protec-Cov study was an observational, cross-sectional, multicentre study, which used an anonymous online questionnaire to evaluate PTSD in doctors from six hospitals in France between December 2021 and March 2022. The presence of PTSD was assessed using the Post-traumatic Stress Disorder Checklist Scale (PCLS) questionnaire with a cut-off of 44. RESULTS Among the 307 doctors included, 18% presented a PCLS ≥44. The multivariate analysis showed that factors associated with a PCLS ≥44 were having a higher workload than before the COVID-19 pandemic (odds ratio [OR] = 4.75; 95% confidence interval [CI] 1.68-13.38), not feeling recognized within the professional environment (OR = 2.83; 95% CI 1.26-6.33), and feeling isolated because of the lockdown (OR = 4.2; 95% CI 1.97-8.95). Approximately 30% of hospital doctors (n = 91) felt a need for psychological support but only 31% of them (n = 28) received support. CONCLUSIONS Based on our findings, a high prevalence of PTSD was observed among hospital doctors 2 years after the beginning of the COVID-19 pandemic. This study supports an early diagnosis of PTSD in this category of healthcare workers and warrants further study.
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Affiliation(s)
- L Rollin
- Institute of Occupational Health, Rouen University Hospital, F-76000 Rouen, France
- Inserm, U1142, LIMICS, Laboratoire D'informatique Médicale et D'ingénierie des Connaissances en e-Santé, Sorbonne Université, Paris, France
- Occupational Health Department, Université de Rouen - Normandie, F-76000 Rouen, France
| | - O Guerin
- Department of Biostatistics, Rouen University Hospital, Rouen, France
- Inserm U 1018 CESP, Université Paris-Saclay and Université de Rouen, F-76000 RouenFrance
| | - A Petit
- Institute of Occupational Health, Rouen University Hospital, F-76000 Rouen, France
| | - L Bourdon
- Department of General Practice, Normandie Univ, UNIROUEN, F-76000 Rouen, France
| | - S Guillemette
- Department of General Practice, Normandie Univ, UNIROUEN, F-76000 Rouen, France
| | - A Gislard
- Institute of Occupational Health, Rouen University Hospital, F-76000 Rouen, France
- Occupational Health Department, Groupement Hospitalier du Havre, Le Havre, France
| | - B Clin
- INSERM U1086 ANTICIPE, F-14000 Caen, France
- CHU Caen, Service de Santé au Travail et Pathologie Professionnelle, F-14000 Caen, France
- Occupational Health Department, Université de Caen Normandie, F-14000 Caen, France
| | - L Bachelet
- Institute of Occupational Health, Rouen University Hospital, F-76000 Rouen, France
| | | | - F Rouger
- Institute of Occupational Health, Rouen University Hospital, F-76000 Rouen, France
| | - J Benichou
- Department of Biostatistics, Rouen University Hospital, Rouen, France
- Inserm U 1018 CESP, Université Paris-Saclay and Université de Rouen, F-76000 RouenFrance
| | - J F Gehanno
- Institute of Occupational Health, Rouen University Hospital, F-76000 Rouen, France
- Inserm, U1142, LIMICS, Laboratoire D'informatique Médicale et D'ingénierie des Connaissances en e-Santé, Sorbonne Université, Paris, France
- Occupational Health Department, Université de Rouen - Normandie, F-76000 Rouen, France
| | - A Commune
- Institute of Occupational Health, Rouen University Hospital, F-76000 Rouen, France
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Payne M, Galery K, Plonka A, Lemaire J, Derreumaux A, Fabre R, Mouton A, Sacco G, Guerin O, Manera V, Robert P, Beauchet O, Gros A. Productive art engagement in a hybrid format: effects on emotions of older adults during COVID-19 pandemic. Front Public Health 2024; 12:1257411. [PMID: 38344232 PMCID: PMC10853412 DOI: 10.3389/fpubh.2024.1257411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Previous studies have shown benefits of productive art-activity on frail older adults' mental and physical health. In this study, we investigated the effects of art-producing activities in a hybrid format (in-person and online) in a context of lockdown compared with previous studies taking place in museums and their effects on wellbeing, quality of life, physical frailty, and apathy in older adults. Methods We conducted a randomized unicentric control trial on a sample of 126 seniors older than 65 years (mean age 71.9 ± 2.3, 81% women) living in Nice (France). Participants were randomized in two parallel groups (intervention group with n = 62 vs. control group with n = 64) conducted during pandemic, between March and May 2021. The intervention group involved participatory art-based activities conducted in a hybrid format, either in-person or online, once a week for 2 h over a 12-week period. No specific intervention was proposed to the control group. The main aim was to evaluate how this hybrid format would impact the wellbeing, quality of life, and physical frailty of participants. The secondary aim was to compare our results with the previous studies conducted by Beauchet et al., and the third aim was to evaluate the impact of the intervention on apathy. Validated scales were implemented in RedCap and administered at baseline (M0) and at the end of the third month (M3). Results The intervention group showed significant improvement in their quality of life (p = 0.017) and their level of apathy (p = 0.016) after intervention. Emotional blunting increased significantly in the control group (p = 0.016) while it remained stable in the intervention group. No significant improvement was observed on the frailty, and wellbeing scores remained constant in both groups. Conclusion This randomized control trial confirmed emotional effects on seniors practicing an art-based activity in a hybrid format during pandemic on a weekly basis for 3 months. Clinical Trial Registration ClinicalTrials.gov, identifier: NCT04570813.
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Affiliation(s)
- Magali Payne
- CoBTeK Lab (Cognition Behavior and Technology), Université Cote d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
- Département d'Orthophonie de Nice, Faculté de Médecine de Nice, Nice, France
| | - Kevin Galery
- Research Center of the Institut Universitaire en Geriatrie de Montreal, University of Montreal, Montreal, QC, Canada
| | - Alexandra Plonka
- CoBTeK Lab (Cognition Behavior and Technology), Université Cote d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
- Département d'Orthophonie de Nice, Faculté de Médecine de Nice, Nice, France
| | - Justine Lemaire
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
| | - Alexandre Derreumaux
- CoBTeK Lab (Cognition Behavior and Technology), Université Cote d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
| | - Roxane Fabre
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
- Fédération Hospitalo-Universitaire INOVPAIN, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Aurélie Mouton
- CoBTeK Lab (Cognition Behavior and Technology), Université Cote d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
| | - Guillaume Sacco
- CoBTeK Lab (Cognition Behavior and Technology), Université Cote d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
| | - Olivier Guerin
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
- Université Côte d'Azur, CNRS UMR7284/INSERM U108, Institute for Research on Cancer and Aging Nice, Nice, France
| | - Valeria Manera
- CoBTeK Lab (Cognition Behavior and Technology), Université Cote d'Azur, Nice, France
- Département d'Orthophonie de Nice, Faculté de Médecine de Nice, Nice, France
| | - Philippe Robert
- CoBTeK Lab (Cognition Behavior and Technology), Université Cote d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
- Département d'Orthophonie de Nice, Faculté de Médecine de Nice, Nice, France
| | - Olivier Beauchet
- Research Center of the Institut Universitaire en Geriatrie de Montreal, University of Montreal, Montreal, QC, Canada
- Department of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Auriane Gros
- CoBTeK Lab (Cognition Behavior and Technology), Université Cote d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
- Département d'Orthophonie de Nice, Faculté de Médecine de Nice, Nice, France
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Vaillant-Ciszewicz AJ, Lantermino L, Quin C, Cuni A, Guerin O. [Setting up, running and evaluating NMIs as part of the "ageing well" project]. Soins Gerontol 2023; 28:13-23. [PMID: 37977760 DOI: 10.1016/j.sger.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Non-drug interventions (NDIs) are recommended as a first-line treatment in gerontology to address the psychological and behavioral symptoms of dementia. This article illustrates the NMIs implemented, how they are carried out and how they are evaluated as part of the Bien vieillir project at Nice University Hospital.
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Affiliation(s)
| | | | - Cassandra Quin
- Projet Bien vieillir, Laboratoire CoBTeK EA 72-76, France
| | - Alice Cuni
- Projet Bien vieillir, Laboratoire CoBTeK EA 72-76, France
| | - Olivier Guerin
- Inserm U1081, IRCAN, CNRS UMR 7284, Université Côte-d'Azur, CHU de Nice, 4 avenue Reine-Victoria, 06000 Nice, Alpes-Maritimes, France
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Piche E, Gerus P, Zory R, Jaafar A, Guerin O, Chorin F. Effects of muscular and mental fatigue on spatiotemporal gait parameters in dual task walking in young, non-frail and frail older adults. Aging Clin Exp Res 2023; 35:2109-2118. [PMID: 37535312 DOI: 10.1007/s40520-023-02506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Dual-task (DT) walking is of great interest in clinical evaluation to evaluate frailty or cognitive declines in older adults. Frail older adults are known to adopt different walking strategy to overcome fatigue. However, no studies evaluated the effect of muscular or mental fatigue on dual-task walking strategy and the difference between frail and non-frail older adults. AIMS Evaluate the effect of mental and muscular fatigue on spatio-temporal parameters in dual-task walking in young, non-frail and frail older adults. METHODS 59 participants divided into 20 young (Y) (24.9 ± 3 years old), 20 non-frail (NF) (75.8 ± 4.9 years old) and 19 frail older adults (F) (81 ± 4.7 years old) performed single-task (ST) walking, single-task cognitive (serial subtraction of 3), and dual-task (subtraction + walking) for 1 min at their fast pace. Gait speed, step length, step length variability, stance and swing phase time, single and double support time, cadence, gait speed variability were recorded in single- and dual-task walking. The dual-task effect (DTE) was calculated as ((DT - ST)/ST) × 100). Generalized linear mixed models (GLMM) were used to compare the effects of mental and muscular fatigue on gait and cognitive variables between the groups. RESULTS The DTE walking parameters were worse in F compared to NF or Y but no significant effect of fatigue were highlighted except for swing time and single support time DTEs. CONCLUSIONS The results were mitigated but a clear difference in dual-task spatio-temporal parameters was found between F and NF which brings hope into the capacity of DT to better reveal frailty.
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Affiliation(s)
- Elodie Piche
- Université Côte d'Azur, LAMHESS, Nice, France.
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France.
| | | | - Raphaël Zory
- Université Côte d'Azur, LAMHESS, Nice, France
- Institut Universitaire de France, Paris, France
| | - Amyn Jaafar
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
| | - Olivier Guerin
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
- Université Côte d'Azur, CNRS UMR 7284/INSERM U108, Institute for Research on Cancer and Aging Nice (IRCAN), Faculté de médecine, Nice, France
| | - Frédéric Chorin
- Université Côte d'Azur, LAMHESS, Nice, France
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
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Buckinx F, Bonnefoy M, Raynaud A, Jeandel C, Lahaye C, Paillaud E, Haine M, Berrut G, Sanchez M, Guerin O, Rolland Y, Aquino JP, Bruyere O. [Knowledge and application of the HAS recommendations concerning the diagnosis of undernutrition in people aged 70 and above: an international online survey among members of the "Société Française de Gériatrie et de Gérontologie"]. Geriatr Psychol Neuropsychiatr Vieil 2023; 21:307-318. [PMID: 38093567 DOI: 10.1684/pnv.2023.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVES To assess the knowledge and the use in clinical practice of the "French National Authority for Health" (HAS) 2021 recommendations on the diagnosis of malnutrition in older adults aged 70 years and above. METHODS An online survey was developed by the working Group on Geriatrics and Nutrition (GEGN) of the "Société Française de Gériatrie et de Gérontologie (SFGG)" and conducted among members of the SFGG. A self-administered questionnaire composed of 21 closed questions was used. RESULTS A total of 132 (10.2 %) members of the SFGG responded to the survey. The respondents were aged 43.4 ± 9.94 years old and 97 (73.5 %) were women. Almost half of them were medical doctors (n = 53 ; 40.2 %). Of the respondents, 81 % had already heard of the HAS 2021 recommendations. This percentage is higher for doctors (96 %) than for other professions (74 %). French respondents were more likely to have heard of these -recommendations (84 %) than respondents from other countries (42.9 %). However, only 41.6 % of the respondents believe they know these recommendations in detail. On a visual analogue scale from 0 (never) to 100 (always), respondents use these recommendations in their professional practice at 76.8 ± 20.2 %. However, on a scale from 0 (never difficult) to 100 (always difficult), some barriers to their use in clinical practice were highlighted. These mainly concerned the measurement of muscle mass (84.4 ± 17.2 %) and muscle strength (79.5 ± 19.9 %) in patients. CONCLUSION Although the majority of respondents use the HAS 2021 recommendations in their professional practice, they often have difficulties in measuring muscle strength and muscle mass of their patients. The assessment of sarcopenia still needs to be implemented in clinical routine. Until then, better communication about simple alternatives that do not require special equipment is needed.
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Affiliation(s)
- Fanny Buckinx
- Service de Santé Publique, Epidémiologie et Economie de la Santé, Université de Liège, Belgique. Centre collaborateur de l'OMS pour l'épidémiologie da santé musculo-squelettique et du vieillissement
| | - Marc Bonnefoy
- CHU de Lyon, Service de Médecine gériatrique, Lyon, France
| | - Agathe Raynaud
- Département de gériatrie, hôpital Bichat, CHU Paris Nord Val de Seine, Paris, France
| | - Claude Jeandel
- Centre de gérontologie clinique Antonin Balmes, CHU Montpellier, Montpellier, France ; CHU de Nice, Pôle Réhabilitation Autonomie Vieillissement (RAV), Nice, France
| | - Clément Lahaye
- Service de médecine gériatrique, CHU de Clermont-Ferrand, France
| | - Elena Paillaud
- Université Paris Cité, service de gériatrie, hôpital européen Georges Pompidou, Paris Cancer Institute CARPEM, Assistance-Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Max Haine
- Service de médecine gériatrique, Centre Hospitalier Villefranche-sur-Saône, France
| | - Gilles Berrut
- Service de médecine gériatrique, Hopital Bellier, CHU Nantes, Nantes, France
| | - Manuel Sanchez
- Département de gériatrie, hôpital Bichat, CHU Paris Nord Val de Seine, Paris, France
| | - Olivier Guerin
- Centre de gérontologie clinique Antonin Balmes, CHU Montpellier, Montpellier, France ; CHU de Nice, Pôle Réhabilitation Autonomie Vieillissement (RAV), Nice, France
| | - Yves Rolland
- Gérontopôle, CHU Toulouse, Inserm UMR 1027, Toulouse, France
| | - Jean-Pierre Aquino
- Site Ambroise-Paré, Assistance publique-Hôpitaux de Paris, université Paris-Saclay
| | - Olivier Bruyere
- Service de Santé Publique, Epidémiologie et Economie de la Santé, Université de Liège, Belgique. Centre collaborateur de l'OMS pour l'épidémiologie da santé musculo-squelettique et du vieillissement, Département des Sciences de la Motricité, Université de Liège, Belgique
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Beauchet O, Matskiv J, Gaudreau P, Allali G, Vaillant-Ciszewicz AJ, Guerin O, Gros A. Frailty, Cognitive Impairment, and Incident Major Neurocognitive Disorders: Results of the NuAge Cohort Study. J Alzheimers Dis 2023:JAD230006. [PMID: 37355893 DOI: 10.3233/jad-230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
BACKGROUND Frailty is associated with an increased risk of major neurocognitive disorders (MNCD). OBJECTIVE This study aims to compare the Fried physical model and the CARE deficit accumulation model for their association with incident major neurocognitive disorders (MNCD), and to examine how the addition of cognitive impairment to these frailty models impacts the incidence in community-dwelling older adults. METHODS A subset of community dwellers (n = 1,259) who participated in the "Quebec Longitudinal Study on Nutrition and Successful Aging" (NuAge) were selected in this Elderly population-based observational cohort study with 3 years of follow-up. Fried and CARE frailty stratifications into robust, pre-frail and frail groups were performed using the NuAge baseline assessment. Incident MNCD (i.e., Modified Mini Mental State (3MS) score < 79/100 and Instrumental Activity Daily Living (IADL) score < 6/8) were collected each year over a 3-year follow-up period. RESULTS A greater association with incident MNCD of the CARE frail state was observed with an increased predictive value when combined with cognitive impairment in comparison to Fried's one, the highest incidences being observed using the robust state as the reference. Results with the Fried frail state were more heterogenous, with no association with the frail state alone, whereas cognitive impairment alone showed the highest significant incidence. CONCLUSION The association of the CARE frail state with cognitive impairment increased the predictive value of MNCD, suggesting that the CARE frailty model may be of clinical interest when screening MCND in the elderly population.
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Affiliation(s)
- Olivier Beauchet
- Department of Medicine, University of Montreal and Research Centre of the Geriatric University Institute of Montreal, Montreal, Quebec, Canada
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Jacqueline Matskiv
- Department of Medicine, University of Montreal and Research Centre of the Geriatric University Institute of Montreal, Montreal, Quebec, Canada
| | - Pierrette Gaudreau
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Gilles Allali
- Leenaards Memory Centre, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Olivier Guerin
- Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
| | - Auriane Gros
- Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
- Laboratoire CoBTeK, Université Côte d'Azur, Nice, France
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Michel E, Champigny N, Annweiler C, Guerin O, Sacco G. Association between Body Mass Index and functional recovery among older adults with stroke. Minerva Med 2023; 114:96-100. [PMID: 32166928 DOI: 10.23736/s0026-4806.20.06420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emeline Michel
- Laboratory of Human Motricity, Expertise in Sports and Health (LAMHESS) (EA6312), Côte d'Azur University, Nice, France.,Service of Geriatric and Therapeutic Medicine, Nice University Hospital, Côte d'Azur University, Nice, France
| | - Noémie Champigny
- Service of Geriatric and Therapeutic Medicine, Nice University Hospital, Côte d'Azur University, Nice, France
| | - Cédric Annweiler
- Laboratory of Psychology of the Pays de la Loire (LPPL) (UPRES EA4638), University of Angers, Angers, France.,Research Center on Autonomy and Longevity (CeRAL), Service of Geriatrics, Angers University Hospital, Angers, France.,Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Olivier Guerin
- Service of Geriatric and Therapeutic Medicine, Nice University Hospital, Côte d'Azur University, Nice, France.,CNRS UMR 7284/INSERM U108, Institute for Research on Cancer and Aging Nice (IRCAN), Faculty of Medicine, Côte d'Azur University, Nice, France
| | - Guillaume Sacco
- Laboratory of Psychology of the Pays de la Loire (LPPL) (UPRES EA4638), University of Angers, Angers, France - .,Research Center on Autonomy and Longevity (CeRAL), Service of Geriatrics, Angers University Hospital, Angers, France
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Vaillant-Ciszewicz AJ, Quin C, Michel E, Sacco G, Guerin O. La réalité virtuelle personnalisée sur les troubles de l’humeur en établissement d’hébergement pour personnes âgées dépendantes et unité de soin de longue durée : étude de cas chez un résident présentant des troubles cognitifs modérés. Annales Médico-psychologiques, revue psychiatrique 2022. [DOI: 10.1016/j.amp.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Vaillant-Ciszewicz AJ, Palazzolo J, Guerin O. Psychological well-being of the elderly: New approaches and innovative actions for integrative and multidisciplinary support. Encephale 2022; 48:359-360. [DOI: 10.1016/j.encep.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Beauchet O, Matskiv J, Launay CP, Gaudreau P, Benatar D, Ptito A, Chou P, Allali G, Prate F, Vaillant-Ciszewicz AJ, Guerin O. CARE frailty e-health scale: Association with incident adverse health outcomes and comparison with the Cardiovascular Health Study frailty scale in the NuAge cohort. Maturitas 2022; 162:37-43. [PMID: 35537241 DOI: 10.1016/j.maturitas.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 01/30/2023]
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Piche E, Gerus P, Chorin F, Jaafar A, Guerin O, Zory R. The effect of different dual tasks conditions on gait kinematics and spatio-temporal walking parameters in older adults. Gait Posture 2022; 95:63-69. [PMID: 35453085 DOI: 10.1016/j.gaitpost.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dual-task (DT) walking has increasingly been investigated over the last decade because of its valuable role as a clinical marker of both cognitive impairment and fall risk in older adults based on cognitive and motor performance (DTEcog, DTEmotor). However, there is still a lack of information on what type of dual task to choose and which is the most adapted to the population of interest. RESEARCH QUESTION To evaluate the effect of different dual-tasks (DT3, DT7, FLU, STROOP) on the spatiotemporal and kinematic parameters of hip, knee, and ankle joints. METHODS Thirty-eight older adults were recruited (9 men, 29 women, mean age = 77.5 +/- 6.5 years, mean height = 163.6 +/- 8.6 cm, mean weight = 67.5 +/- 15.3 kg). They performed a single and dual-task walk with the 4 types of tasks during 1 min, equipped with an inertial system. Dual-task effect (DTE) on spatiotemporal and kinematic variables as well as cognitive score and speed were calculated. RESULTS An alteration in most of the spatiotemporal parameters was observed in each DT condition (p < 0.05), especially in arithmetic tasks (DT3, DT7), while no DT effect was noticed on kinematic parameters (RMSE<3°) except on hip and knee angular velocities (RMSE>15°). Arithmetic tasks seemed to alter more spatiotemporal and kinematic parameters than the verbal fluency or STROOP test. However, DT7 appeared to be too difficult for the population of interest. SIGNIFICANCE Arithmetic tasks seemed to be very pertinent as a clinical dual-task protocol for older adults. The use of an inertial system to retrieve kinematic variables is an improvement in these dual-task protocols.
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Affiliation(s)
- Elodie Piche
- Université Côte d'Azur, LAMHESS, Nice, France; Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France.
| | | | - Fréderic Chorin
- Université Côte d'Azur, LAMHESS, Nice, France; Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
| | - Amyn Jaafar
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
| | - Olivier Guerin
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France; Université Côte d'Azur, CNRS UMR 7284/INSERM U108, Institute for Research on Cancer and Aging Nice (IRCAN), Faculté de médecine, Nice, France
| | - Raphaël Zory
- Université Côte d'Azur, LAMHESS, Nice, France; Institut Universitaire de France, France
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Blay JY, Boucher S, Le Vu B, Cropet C, Chabaud S, Perol D, Barranger E, Campone M, Conroy T, Coutant C, De Crevoisier R, Debreuve-Theresette A, Delord JP, Fumoleau P, Gentil J, Gomez F, Guerin O, Jaffré A, Lartigau E, Lemoine C, Mahe MA, Mahon FX, Mathieu-Daude H, Merrouche Y, Penault-Llorca F, Pivot X, Soria JC, Thomas G, Vera P, Vermeulin T, Viens P, Ychou M, Beaupere S. Delayed care for patients with newly diagnosed cancer due to COVID-19 and estimated impact on cancer mortality in France. ESMO Open 2021; 6:100134. [PMID: 33984676 PMCID: PMC8134718 DOI: 10.1016/j.esmoop.2021.100134] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France. PATIENTS AND METHODS The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses. RESULTS A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years. CONCLUSIONS In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years.
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Affiliation(s)
- J Y Blay
- Centre Leon Berard, Lyon, France.
| | | | | | - C Cropet
- Centre Leon Berard, Lyon, France
| | | | - D Perol
- Centre Leon Berard, Lyon, France
| | | | - M Campone
- Institut de Cancerologie de l'Ouest, Nantes et Angers, France
| | - T Conroy
- Institut de Cancerologie de Lorraine, Nancy, France
| | - C Coutant
- Centre George Francoise Leclerc, Dijon, France
| | | | | | - J P Delord
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | - J Gentil
- Centre George Francoise Leclerc, Dijon, France
| | - F Gomez
- Centre Leon Berard, Lyon, France
| | - O Guerin
- Institut de Cancerologie de l'Ouest, Nantes et Angers, France
| | | | | | - C Lemoine
- Institut Paoli-Calmettes, Marseille, France
| | - M A Mahe
- Centre François Baclesse, Caen, France
| | | | - H Mathieu-Daude
- Institut de Cancerologie de Montpellier, Montpellier, France
| | | | | | - X Pivot
- Centre Paul Strauss/ICANS, Strasbourg, France
| | | | - G Thomas
- Centre François Baclesse, Caen, France
| | - P Vera
- Centre Henri Becquerel, Rouen, France
| | | | - P Viens
- Institut Paoli-Calmettes, Marseille, France
| | - M Ychou
- Institut de Cancerologie de Montpellier, Montpellier, France
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Roche N, Chorin F, Gerus P, Deshayes M, Guerin O, Zory R. Effects of age, gender, frailty and falls on spatiotemporal gait parameters: a retrospective cohort study. Eur J Phys Rehabil Med 2021; 57:923-930. [PMID: 34002975 DOI: 10.23736/s1973-9087.21.06831-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many studies have explored spatial and temporal gait parameters in the elderly, and showed that frailty status, fall history, age, and gender may individually strongly influence these parameters. However, it appears necessary to investigate the confounding factors more deeply in order to better know the specific role of each of these factors impacting the evolution of gait with the increase of age. AIM The aim of the present study was to determine the influence of frailty status, fall history, age and gender on spatiotemporal gait parameters. We hypothesized that frailty was the factor that most influence gait parameters. SETTING This is a monocentric retrospective study performed at Nice University Hospital Center on older out-patients. POPULATION Older adults were included in the study. This study explored for the first time how frailty status, age, gender and history of falls impact the multiple spatiotemporal parameters of gait using linear mixed models (LMM). RESULTS 479 older adults (360 women and 119 men; 213 non-frail, 228 pre-frail and 38 frail; aged from 65 to 94 years; 403 non-fallers and 73 fallers). Frailty status explained fully: i) the gait speed; ii) the cadence: iii) the initial double contact: DS1; iv) the percentage of the single support phase v) the final double contact: DS2; v) the percentage of the swing phase of the gait cycle. CONCLUSIONS The results of this study allow a deeper understanding of the confounding factors since LMM highlighted the importance of frailty status for explaining all the spatiotemporal gait parameters. CLINICAL REHABILITATION IMPACT These results showed that to improve gait, clinical intervention should focus on reducing frailty status. It is also interesting to note that a history of falls explains none of the spatiotemporal gait parameters which suggests that it may be possible to improve gait in all frail subjects irrespective of their history of falls.
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Affiliation(s)
| | - Frédéric Chorin
- LAMHESS, Université Côte d'Azur, Nice, France.,CHU, Service de médecine gériatrique et thérapeutique, Université Côte d'Azur, Nice, France
| | | | - Maxime Deshayes
- CHU, Service de médecine gériatrique et thérapeutique, Université Côte d'Azur, Nice, France.,CHROME - Equipe APSY-v, Université de Nîmes, EA 7352 Nîmes, France
| | - Olivier Guerin
- CHU, Service de médecine gériatrique et thérapeutique, Université Côte d'Azur, Nice, France.,IRCAN, Université Côte d'Azur, Nice, France
| | - Raphael Zory
- LAMHESS, Université Côte d'Azur, Nice, France.,Institut Universitaire de France (IUF), Paris, France
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Boulahssass R, Chand ME, Gal J, Dittlot C, Schiappa R, Rambaud C, Gonfrier S, Guerin O, Hannoun-Levi JM. Quality of life and Comprehensive Geriatric Assessment (CGA) in older adults receiving Accelerated Partial Breast Irradiation (APBI) using a single fraction of Multi-Catheter Interstitial High-Dose Rate Brachytherapy (MIB). The SiFEBI phase I/II trial. J Geriatr Oncol 2021; 12:1085-1091. [PMID: 33994151 DOI: 10.1016/j.jgo.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/01/2021] [Accepted: 04/30/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The SiFEBI trial demonstrated that a post-operative Multicatheter Interstitial Brachytherapy (MIB) appears feasible and with acceptable toxicity in older adults aged 70 years and older presenting with low-risk breast cancer. The aim of the present ancillary study was to analyze the quality of life and Comprehensive Geriatric Assessment (CGA) domains within 6 months in older adults receiving Accelerated Partial Breast Irradiation (APBI) using a single fraction of MIB. MATERIALS AND METHODS From 11/2012 to 09/2014, 37 patients were included and 26 were evaluable. Patients (pts) aged 70 years and older with a Balducci score of 1 or 2 and presenting with low-risk breast cancer were prospectively enrolled in this phase I/II trial (NCT01727011). After lumpectomy, intra-operative catheter implantation was performed for post-operative APBI after pathological findings. Quality of life (QoL) evaluation and CGA were scheduled at baseline and 1, 3, and 6 months after APBI. Autonomy decline was defined as a 1-point decrease in Activities of Daily Living (ADL). RESULTS Mean age was 77 years. Within the first 6 months of follow-up, no autonomy decline was observed in ADL, 3 patients had an autonomy decline in Instrumental Activities of Daily Living (IADL) and 2 patients had a slower gait speed but no changes in cognitive function, nutritional status, and depression screening. Global QoL was quite similar at baseline compared to 1, 3, and 6 months. No differences were observed for functional items. CONCLUSION APBI based on a single fraction of MIB in older adults with low-risk breast cancer appears to be feasible with a minimal loss of autonomy regarding IADL, no loss of autonomy in ADL, an acceptable decrease in other CGA domains, and with no impact on global quality of life.
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Affiliation(s)
- Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG), PACA Est CHU de NICE, France; FHU ONCOAGE, Nice, France; University of Nice-Sophia Antipolis, France.
| | | | - Jocelyn Gal
- University of Nice-Sophia Antipolis, France; Epidemiology and Biostatistics Department, Lacassagne Center, Nice, France
| | - Claire Dittlot
- Geriatric Coordination Unit for Geriatric Oncology (UCOG), PACA Est CHU de NICE, France; Department of Surgical Oncology, Lacassagne Center, Nice, France
| | - Renaud Schiappa
- University of Nice-Sophia Antipolis, France; Epidemiology and Biostatistics Department, Lacassagne Center, Nice, France
| | - Cyrielle Rambaud
- Geriatric Coordination Unit for Geriatric Oncology (UCOG), PACA Est CHU de NICE, France
| | - Sebastien Gonfrier
- Geriatric Coordination Unit for Geriatric Oncology (UCOG), PACA Est CHU de NICE, France
| | - Olivier Guerin
- Geriatric Coordination Unit for Geriatric Oncology (UCOG), PACA Est CHU de NICE, France; FHU ONCOAGE, Nice, France; University of Nice-Sophia Antipolis, France
| | - Jean Michel Hannoun-Levi
- University of Nice-Sophia Antipolis, France; Department of Radiotherapy, Lacassagne Center, Nice, France
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Hanon O, Chaussade E, David J, Boulloche N, Vinsonneau U, Fauchier L, Krolak-Salmon P, Jouanny P, Sacco G, Lilamand M, Paillaud E, Guerin O, Bonnefoy M, Mahe I, Toulza O, Berrut G, Vidal J. SAFIR cohort: One-year prospective follow-up of very old and frail patients treated with direct oral anticoagulant, rivaroxaban. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Hanon O, Vidal J, Chaussade E, David JP, Boulloche N, Vinsonneau U, Fauchier L, Krolak-Salmon P, Jouanny P, Sacco G, Lillamand M, Paillaud E, Guerin O, Bonnefoy M, Berrut G. 482Direct oral anticoagulant rivaroxaban in very old and frail patients: A one-year prospective follow-up of a large-scale cohort (SAFIR-AC). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Age is one of the strongest predictors/risk factors for ischemic stroke in subjects with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) have been shown to be effective in the prevention of this condition; however, clinical evidence on bleeding risk with this therapeutic strategy in very old and frail geriatric patients is poor.
Purpose
To assess bleeding risk in French geriatric patients aged ≥80 years and diagnosed with AF newly treated with rivaroxaban.
Methods
Subjects, presenting to one of 33 geriatric centers, with non-valvular AF and recent initiation of a treatment with rivaroxaban were enrolled in the study and followed-up every 3 months for 12 months. Clinical and routine laboratory data and evaluation scores, such as HAS-BLED, HEMORR2HAGES, ATRIA, and CHA2DS2-VASc, as well as comprehensive geriatric evaluation were reported. Major bleeding, as defined in ROCKET AF study, was reported at each visit, and this primary outcome was adjudicated by an independent committee. Results of this cohort were compared with findings from a similar cohort treated with vitamin K antagonists (VKAs) from the same centers (n=924).
Results
A total of 1045 subjects were enrolled in the study of whom 995 (95%) had a one-year follow-up (analyzed population). The mean (standard deviation (SD)) age was 86.0 (4.3) years, with the majority of patients being female (61%), 23% aged 90 years or older, and 48% having an estimated glomerular filtration rate (eGFR) <50 mL/min. The main comorbidities were hypertension in 77% of subjects, malnutrition 49%, anemia 43%, dementia 39%, heart failure 36%, and falls 27%. The mean (SD) score for CHA2DS2-VASc was 4.8 (1.4), HAS-BLED 2.4 (0.9), Mini-Mental State Examination (MMSE) 21.5 (6.9), Activities of Daily Living (ADL) 4.4 (1.9), and Charlson Comorbidity Index 6.7 (2.0). The one-year rate of major bleeding events was 6.4% of which 0.8% were fatal and 1.1% intracranial hemorrhages (ICH), whereas the one-year rate of ischemic stroke was 1.4% and all-cause mortality 17.9%. Computed with VKA cohort findings and adjusted for age, gender, eGFR and Charlson score, this would result in a hazard ratio of 0.54 (95% confidence interval [CI], 0.38 to 0.78) for major bleeding, 0.36 (0.17 to 0.76) for ICH, 0.62 (0.29 to 1.33) for ischemic stroke, and 0.82 (0.65 to 1.02) for all-cause mortality, in favor of rivaroxaban.
Conclusions
This is the first large-scale prospective study in geriatric population in AF subjects treated with DOAC (rivaroxaban) Major bleeding risk appeared higher in very old than younger population, however major bleeding and ICH rates were significantly lower with rivaroxaban than with VKAs when used in the same geriatric population. This study indicates that Rivaroxaban can be used in very old and frail patients for the treatment of non-valvular AF.
Acknowledgement/Funding
Unrestricted grant from Bayer
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Affiliation(s)
- O Hanon
- Assistance Publique des Hopitaux de Paris, Hopital Broca, Paris, France
| | - J Vidal
- Assistance Publique des Hopitaux de Paris, Hopital Broca, Paris, France
| | - E Chaussade
- Assistance Publique des Hopitaux de Paris, Hopital Broca, Paris, France
| | - J P David
- University Hospital Henri Mondor, Hopital Mondor, Creteil, France
| | - N Boulloche
- Centre hospitalier de Montauban, Montauban, France
| | - U Vinsonneau
- Polyclinique Keraudren, Cadiology, Brest, France
| | - L Fauchier
- Chru Trousseau, Chambray Les Tours, France
| | | | - P Jouanny
- University Hospital of Dijon, Dijon, France
| | - G Sacco
- Nice University Medical Center - Hopital de Cimiez, Nice, France
| | - M Lillamand
- Hospital Bichat-Claude Bernard, Paris, France
| | - E Paillaud
- University Hospital Henri Mondor, Hopital Mondor, Creteil, France
| | - O Guerin
- Nice University Medical Center - Hopital de Cimiez, Nice, France
| | | | - G Berrut
- Nice University Medical Center - Hopital de Cimiez, Nice, France
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Boulahssass R, Gonfrier S, Ferrero JM, Champigny N, Rambaud C, Largillier R, Chauviere D, Barranger E, Bereder JM, Benizri E, Borchiellini D, Durand M, Baque P, Delotte J, Barriere J, Hannoun-Levi JM, Guigay J, Piche T, FRANCOIS E, Guerin O. Guided geriatric interventions (GI) in older adults with cancer: What, how, and for whom? The French PACA EST Cohort Experience. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11548 Background: Some previous studies in geriatric oncology have described the GI and their adherence. Today’s challenge is to screen patients needing specific GI and repeated Comprehensive Geriatric Assessments (CGA). We recently analyzed a phenotype of patients requiring more GI (Boulahssass et al, Cancers 2019). The main purpose of the present study is to compare types of GI implemented, according to patient frailty levels, in order to better understand the necessary care plan. Methods: Between April 2012 and May 2018, 3530 consecutive patients with solid tumors were enrolled in this multicentric, prospective cohort. 3140 patients (mean age:82y) were finally included and a CGA was performed at Baseline. Twelve GI were standardized, individualized or based on experience if no guidelines were available. Within 1 month, geriatricians including patients in the cohort received standardized training. Logistic regression was performed to compare types of GI in the 3 groups using the Balducci Score (B1/B2/B3). Results: 8819 GI were implemented for the 3140 patients. On average, fit patients had 1.5 GI (n = 146), vulnerable patients 2.4 GI (n = 1568) and frail patients 3.3 GI (n = 1426). We observed no significant differences between the 3 groups concerning specific pain management (Fit vs B2: p = 0.19; Fit vs B3: p = 0.57) and psychological care (Fit vs B2:p = 0.03; Fit vs B3:p = 0.24). In vulnerable and frail patients, we recorded more significant GI for nutritional care, delirium prevention, comorbidity management, nursing interventions, social worker interventions, treatment modifications for optimization or iatrogenic disorders and physiotherapy, with the highest Odds Ratio for nursing interventions (Fit vs B2 OR:2.9 p = 0.011; Fit vs B3 OR:9 P < 0.001) and physiotherapy (Fit vs B2:OR 4.3 p < 0.001; Fit vs B3:OR:9 p < 0.001). B3 patients had significantly more GI on care pathways modifications (OR:3.1, p = 0.002) and caregiver care (OR:2, p = 0.049). Conclusions: Fit patients also needed GI. We observed differences in types of GI between the groups. However, the aims and levels also seemed to differ and need further studies to analyze their impact.
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Affiliation(s)
- Rabia Boulahssass
- Centre Hospitalier Universitaire de Nice, Hôpital de Cimiez, Nice, France
| | | | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joel Guigay
- Department of Medical Oncology, Antoine Lacassagne Comprehensive Cancer Centre, FHU OncoAge, Université Côte d'Azur, Nice, France
| | | | - Eric FRANCOIS
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Olivier Guerin
- Department of Geriatric Medicine, Cimiez Hospital, FHU Oncoage, University Côte d’Azur, Nice, France
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Boulahssass R, Gonfrier S, Champigny N, Lassalle S, François E, Hofman P, Guerin O. The Desire to Better Understand Older Adults with Solid Tumors to Improve Management: Assessment and Guided Interventions-The French PACA EST Cohort Experience. Cancers (Basel) 2019; 11:cancers11020192. [PMID: 30736406 PMCID: PMC6406576 DOI: 10.3390/cancers11020192] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 12/17/2022] Open
Abstract
Todays challenge in geriatric oncology is to screen patients who need geriatric follow-up. The main goal of this study was to analyze factors that identify patients, in a large cohort of patients with solid tumors, who need more geriatric interventions and therefore specific follow-up. Between April 2012 and May 2018, 3530 consecutive patients were enrolled in the PACA EST cohort (France). A total of 3140 patients were finally enrolled in the study. A Comprehensive Geriatric Assessment (CGA) was performed at baseline. We analyzed the associations between factors at baseline (geriatric and oncologic factors) and the need to perform more than three geriatric interventions. The mean age of the population was 82 years old with 59% of patients aged older than 80 years old. A total of 8819 geriatric interventions were implemented for the 3140 patients. The percentage of patients with three or more geriatric interventions represented 31.8% (n = 999) of the population. In multivariate analyses, a Mini Nutritional assessment (MNA) <17, an MNA ≤23·5 and ≥17, a performans status (PS) >2, a dependence on Instrumental Activities of Daily Living (IADL), a Geriatric Depression Scale (GDS) ≥5, a Mini Mental State Examination (MMSE) <24, and a Screening tool G8 ≤14 were independent risk factors associated with more geriatric interventions. Factors associated with more geriatric interventions could assist practitioners in selecting patients for specific geriatric follow-up.
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Affiliation(s)
- Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France.
- FHU OncoAge, Nice 06000, France.
- University Côte d'Azur, 06000 Nice, France.
| | - Sebastien Gonfrier
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France.
| | - Noémie Champigny
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France.
| | - Sandra Lassalle
- FHU OncoAge, Nice 06000, France.
- University Côte d'Azur, 06000 Nice, France.
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, 06000 Nice, France.
- Hospital-related Biobank (BB-0033-00025), 06000 Nice, France.
| | - Eric François
- Department of Medical Oncology, Lacassagne Center, 06000 Nice, France.
| | - Paul Hofman
- FHU OncoAge, Nice 06000, France.
- University Côte d'Azur, 06000 Nice, France.
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, 06000 Nice, France.
- Hospital-related Biobank (BB-0033-00025), 06000 Nice, France.
| | - Olivier Guerin
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France.
- FHU OncoAge, Nice 06000, France.
- University Côte d'Azur, 06000 Nice, France.
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Boulahssass R, Gonfrier S, Ferrero JM, Sanchez M, Mari V, Moranne O, Rambaud C, Auben F, Hannoun Levi JM, Bereder JM, Bereder I, Baque P, Turpin JM, Frin AC, Ouvrier D, Borchiellini D, Largillier R, Sacco G, Delotte J, Arlaud C, Benchimol D, Durand M, Evesque L, Mahamat A, Poissonnet G, Mouroux J, Barriere J, Benizri E, Piche T, Guigay J, Francois E, Guerin O. Predicting early death in older adults with cancer. Eur J Cancer 2018; 100:65-74. [PMID: 30014882 DOI: 10.1016/j.ejca.2018.04.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Predicting early death after a comprehensive geriatric assessment (CGA) is very difficult in clinical practice. The aim of this study was to develop a scoring system to estimate risk of death at 100 days in elderly cancer patients to assist the therapeutic decision. METHODS This was a multicentric, prospective cohort study approved by an ethics committee. Elderly cancer patients aged older than 70 years were enrolled before the final therapeutic decision. A standardised CGA was made before the treatment decision at baseline. Within 100 days, event (death), oncologic and geriatric data were collected. Multivariate logistic regression was used to select the risk factors for the overall population. Score points were assigned to each risk factor using the β coefficient. Internal validation was performed by a bootstrap method. Calibration was assessed with the Hosmer-Lemeshow goodness of fit test and accuracy with the mean c-statistic. FINDINGS One thousand fifty patients (mean age: 82 years) joined the study from April 2012 to December 2014. The independent predictors were metastatic cancers (odds ratio [OR] 2.5; 95% confidence interval [CI], [1.7-3.5] p<0 .001); gait speed<0.8 m/s (OR 2.1; 95% CI [1.3-3.3] p=0.001); Mini Nutritional Assessment (MNA) < 17 (OR 8; 95% CI; [3.7-17.3] p<0.001), MNA ≤23.5 and ≥ 17 (OR 4.4; 95% CI, [2.1-9.1) p<0.001); performance status (PS) > 2 (OR 1.7; 95% CI, [1.1-2.6)] p=0.015) and cancers other than breast cancer (OR 4; 95% CI, [2.1-7.9] p<0.001). We attributed 4 points for MNA<17, 3 points for MNA between ≤23.5 and ≥ 17, 2 points for metastatic cancers, 1 point for gait speed <0.8 m/s, 1 point for PS > 2 and 3 points for cancers other than breast cancer. The risk of death at 100 days was 4% for 0 to 6 points, 24% for 7 to 8 points, 39% for 9 to 10 points and 67% for 11 points. INTERPRETATION To our knowledge, this is the first score which estimates early death in elderly cancer patients. The system could assist in the treatment decision for elderly cancer patients.
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Affiliation(s)
- Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France; FHU ONCOAGE; Nice, France.
| | - Sebastien Gonfrier
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Jean-Marc Ferrero
- University of Nice Sophia Antipolis, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Marine Sanchez
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Véronique Mari
- Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Olivier Moranne
- Department of Nephrology, Hopital Caremeau Nimes, France; Institut Universitaire de Recherche Clinique - EA2415 - Epidémiologie, Biostatistiques et Santé Publique/University of Montpellier; Nice, France.
| | - Cyrielle Rambaud
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Francine Auben
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Jean-Michel Hannoun Levi
- University of Nice Sophia Antipolis, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Jean-Marc Bereder
- Department of Surgical Digestive Oncology, CHU de Nice; Nice, France.
| | | | - Patrick Baque
- University of Nice Sophia Antipolis, France; University of Nice Sophia Antipolis, Emergency Surgery Unit, CHU de Nice; Nice, France.
| | - Jean Michel Turpin
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France.
| | - Anne-Claire Frin
- Unit of Medical Oncology, Department of Gastroenterology, CHU Nice, Nice, France.
| | - Delphine Ouvrier
- Unit of Medical Oncology, Department of Gastroenterology, CHU Nice, Nice, France.
| | | | - Remy Largillier
- Cancer Center: Centre Azuréen de Cancérologie; Mougins, France.
| | - Guillaume Sacco
- University of Nice Sophia Antipolis, France; Geriatric Department CHU de NICE, France; CoBtek, France.
| | - Jerome Delotte
- University of Nice Sophia Antipolis, France; Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine, CHU de Nice; Nice, France.
| | | | - Daniel Benchimol
- University of Nice Sophia Antipolis, France; Department of Surgical Digestive Oncology, CHU de Nice; Nice, France.
| | - Matthieu Durand
- University of Nice Sophia Antipolis, France; Department of Urology, CHU de Nice, University of Nice Sophia-Antipolis; Nice, France.
| | - Ludovic Evesque
- Department of Medical Oncology, Lacassagne Center; Nice, France.
| | | | | | - Jérôme Mouroux
- University of Nice Sophia Antipolis, France; Department of Thoracic and Cardiovascular Surgery, Hopital Pasteur, CHU Nice, Nice, France.
| | - Jérôme Barriere
- Department of Medical Oncology: Clinic Saint Jean; Cagnes sur Mer France.
| | - Emmanuel Benizri
- University of Nice Sophia Antipolis, France; Geriatric Department CHU de NICE, France.
| | - Thierry Piche
- University of Nice Sophia Antipolis, France; Unit of Medical Oncology, Department of Gastroenterology, CHU Nice, Nice, France.
| | - Joel Guigay
- FHU ONCOAGE; Nice, France; University of Nice Sophia Antipolis, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Eric Francois
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France; Department of Medical Oncology, Lacassagne Center; Nice, France.
| | - Olivier Guerin
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de NICE, France; FHU ONCOAGE; Nice, France; University of Nice Sophia Antipolis, France.
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Retornaz F, Guillem O, Gholam D, Codoul JF, Brativesic C, Morvan F, Rinaldi Y, Barriere N, Nahon S, Butaud C, Guerin O, Boulahssass R, Grino M, Rousseau F. Predicting chemotherapy toxicity and death in older adults with colon cancer: Results of MOST (Massilia Oncologic Senior Tests) study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Dany Gholam
- Centre Hospitalier de la Dracenie, Draguignan, France
| | | | | | | | | | | | - Sophie Nahon
- Centre Hospitalier d'Aix en Provence, Aix En Provence, France
| | | | - Olivier Guerin
- Department of Geriatric Medicine, Cimiez Hospital, FHU Oncoage, University Côte d’Azur, Nice, France
| | | | - Michel Grino
- Centre Gérontologique Départemental de Marseille, Marseille, France
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Antoine V, Belmin J, Blain H, Bonin-Guillaume S, Goldsmith L, Guerin O, Kergoat MJ, Landais P, Mahmoudi R, Morais JA, Rataboul P, Saber A, Sirvain S, Wolfklein G, de Wazieres B. [The Confusion Assessment Method: Transcultural adaptation of a French version]. Rev Epidemiol Sante Publique 2018; 66:187-194. [PMID: 29625860 DOI: 10.1016/j.respe.2018.01.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/22/2017] [Accepted: 01/02/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The Confusion Assessment Method (CAM) is a validated key tool in clinical practice and research programs to diagnose delirium and assess its severity. There is no validated French version of the CAM training manual and coding guide (Inouye SK). The aim of this study was to establish a consensual French version of the CAM and its manual. METHODS Cross-cultural adaptation to achieve equivalence between the original version and a French adapted version of the CAM manual. RESULTS A rigorous process was conducted including control of cultural adequacy of the tool's components, double forward and back translations, reconciliation, expert committee review (including bilingual translators with different nationalities, a linguist, highly qualified clinicians, methodologists) and pretesting. A consensual French version of the CAM was achieved. CONCLUSION Implementation of the CAM French version in daily clinical practice will enable optimal diagnosis of delirium diagnosis and enhance communication between health professionals in French speaking countries. Validity and psychometric properties are being tested in a French multicenter cohort, opening up new perspectives for improved quality of care and research programs in French speaking countries.
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Affiliation(s)
- V Antoine
- Service de médecine interne gériatrique, CHU Carémeau, place Robert Debré, 30000 Nîmes, France.
| | - J Belmin
- Service de gériatrie, CHU Paris-Ivry-sur-Seine, 94200 Ivry-sur-Seine, France
| | - H Blain
- Pôle de gérontologie, EUROMOV, MACVIA, Montpellier university, CHU Montpellier, 34000 Montpellier, France
| | - S Bonin-Guillaume
- Service de gériatrie, hôpital Sainte-Marguerite, CHU Marseille, 13009 Marseille, France
| | - L Goldsmith
- Division of geriatric medicine institut universitaire de gériatrie de Montréal, Montréal, Canada
| | - O Guerin
- Service de gériatrie, hôpital de Cimiez, CHU Nice, 06000 Nice, France
| | - M-J Kergoat
- Département de médecine spécialisée, institut universitaire de gériatrie de Montréal, faculté de Médecine, université de Montréal, Montréal, Canada
| | - P Landais
- Service d'épidémiologie et biostatistique, CHU de Nîmes, 30000 Nîmes, France
| | - R Mahmoudi
- Service de gériatrie, CHU Reims, 51100 Reims, France
| | - J A Morais
- Division of geriatric medicine, McGill University, Montréal, Canada
| | - P Rataboul
- Service d'épidémiologie et biostatistique, CHU de Nîmes, 30000 Nîmes, France
| | - A Saber
- École Normale Supérieure, 94230 Cachan, France
| | - S Sirvain
- Service de gériatrie, centre hospitalier d'Alès, 30100 Alès, France
| | - G Wolfklein
- Division of geriatric medicine, North Shore University Hospital, New York, États-Unis
| | - B de Wazieres
- Service de gériatrie, CHU Nîmes, 30000 Nîmes, France
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Caillet P, Liuu E, Raynaud Simon A, Bonnefoy M, Guerin O, Berrut G, Lesourd B, Jeandel C, Ferry M, Rolland Y, Paillaud E. Association between cachexia, chemotherapy and outcomes in older cancer patients: A systematic review. Clin Nutr 2017; 36:1473-1482. [DOI: 10.1016/j.clnu.2016.12.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/13/2016] [Accepted: 12/08/2016] [Indexed: 12/11/2022]
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Rambaud C, Gonfrier S, Arlaud C, Fallot J, Guerin O, Amiel J, Chevallier D, Durand M. Rétention urinaire chronique : suivi à 6 mois des patients ayant bénéficié d’une alternative au sondage vésicale définitif, à l’issu d’une réunion multidisciplinaire uro-gériatrique. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Boulahssass R, Gonfrier S, Sanchez M, Rambaud C, Gary A, Turpin J, Bereder I, Guerin O. A CLINICAL SCORE TO PREDICT THE EARLY DEATH AT 100 DAYS IN ELDERLY METASTATIC CANCERS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - M. Sanchez
- CHU de Nice UCOG PACA East, Nice, France
| | - C. Rambaud
- CHU de Nice UCOG PACA East, Nice, France
| | - A. Gary
- CHU de Nice UCOG PACA East, Nice, France
| | - J. Turpin
- CHU de Nice UCOG PACA East, Nice, France
| | - I. Bereder
- CHU de Nice UCOG PACA East, Nice, France
| | - O. Guerin
- CHU de Nice UCOG PACA East, Nice, France
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Rambaud C, Boulahssass R, Gonfrier S, Sanchez M, Borchiellini D, Durand M, Sacco G, Guerin O. THE NONAGENARIAN PATIENTS WITH CANCER IN THE UCOG PACA-EST COHORT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C. Rambaud
- Soins de suite et de réadaptation, Hôpital de Cimiez, CHU Nice, Université Nice Sophia Antipolis, Nice, France,
| | - R. Boulahssass
- UCOG, Hôpital de Cimiez, CHU Nice, Université Nice Sophia Antipolis, Nice, France,
| | - S. Gonfrier
- USLD, Hôpital de Cimiez, CHU Nice, Université Nice Sophia Antipolis, Nice, France,
| | - M. Sanchez
- UCOG, Hôpital de Cimiez, CHU Nice, Université Nice Sophia Antipolis, Nice, France,
| | | | - M. Durand
- Service d’Urologie, d’Andrologie et de Transplantation, Hôpital Pasteur 2, CHU Nice, Université Nice-Sophia-Antipolis, Nice, France,
- INSERM, U1189, ONCO-THAI, F-59037, Lille, France,
| | - G. Sacco
- Soins de suite et de réadaptation, Hôpital de Cimiez, CHU Nice, Université Nice Sophia Antipolis, Nice, France,
| | - O. Guerin
- Hôpital de Cimiez, CHU Nice, Université Nice Sophia Antipolis, Nice, France,
- Unité CNRS UMR6267/INSERM U998, Nice, France
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Hofman P, Beaulande M, Ben Hadj S, Erb G, Pomerol JF, Lassalle S, Butori C, Long E, Washetine K, Guerin O, Guigay J, Mouroux J, Leroy S, Marquette CH, Hofman V, Ilie M. Automated brightfield multiplex immunohistochemistry to quantify biomarkers related to immune senescence: Relationships with survival in non-small cell lung cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20500 Background: Elderly patients have an eroded immune characterized by a progressive decline in immune surveillance that favors infection and cancer development. Tumor cells can escape immune surveillance by upregulating inhibitory immune checkpoint such as PD-L1. High expression of PD-L1 was reported in association with CD8+T-cell exhaustion and increased levels of CD33+ myeloid-derived suppressor cells. Although low CD4/CD8 ratio is associated with increased mortality, the status of the CD4+T-cells as a clinical marker of immunosenescence is less well characterized in the field of aging. The aim of this study was to determine the presence of immunosenescence biomarkers according to age in non-small cell lung cancer (NSCLC) patients and to evaluate them as predictive biomarkers of patients’ outcome. Methods: One hundred NSCLC patients, matched by age (50 patients < 70 years, 50 patients ≥70 years) were included. An automated 4-Plex optical IHC assay was developed on the Discovery ULTRA automated stainer using monoclonal antibodies PD-L1 (SP263), CD4, CD8, and CD33. The stained slides were scanned with Nanozoomer HT 2.0 Scanner, and analyzed with Calopix software. Results: The CD4/CD8 ratio and PD-L1 expression in tumor and immune cells were significantly lower in elderly NSCLC patients ≥70 years than in age-paired patients, while absolute count of CD33+ was increased. Patients with CD4/CD8 ratio higher than two, high PD-L1 density and low CD33+ frequency achieved increase in median disease-free survival. Conclusions: Distribution of PD-L1, CD4, CD8, and CD33 cells was influenced by age in NSCLC patients. The proportion of CD8 + CD28- T cells, CD4+ T cells and CD4/CD8 ratio may be used as predictive biomarkers of anti-PD-L1 therapy efficacy in NSCLC patients. The automated 4-Plex IHC assay together with its respective digital analysis could serve as a tool for further characterizing tumors and their microenvironment and provide a better understanding of which patients may benefit from immunotherapy.
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Affiliation(s)
- Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
| | | | | | - Gilles Erb
- Roche Diagnostics France, EMEA-LATAM division, Meylan, France
| | | | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
| | - Catherine Butori
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
| | - Elodie Long
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
| | - Kevin Washetine
- Hospital-Related Biobank (BB-0033-00025), FHU OncoAge, University Côte d’Azur, Nice, France
| | - Olivier Guerin
- Department of Geriatric Medicine, Cimiez Hospital, FHU Oncoage, University Côte d’Azur, Nice, France
| | - Joel Guigay
- Department of Medical Oncology, Antoine Lacassagne Comprehensive Cancer Centre, FHU Oncoage, Nice, France
| | | | - Sylvie Leroy
- Department of Pneumology, Pasteur Hospital, FHU Oncoage, Nice, France
| | | | - Veronique Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
| | - Marius Ilie
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
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Boulahssass R, Gonfrier S, Isabelle B, Evesque L, Gary A, Hannoun Levi JM, Borchiellini D, Brocker P, Cavaglione G, Barranger E, Benizri E, Frin AC, Creisson A, Kreitmann T, Bernard JL, Poissonnet G, Amiel J, Guigay J, Francois E, Guerin O. Influence of the comprehensive geriatric assessment (CGA) in elderly metastatic cancer patients. Analysis from a prospective cohort of 1048 patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Boulahssass R, Gonfrier S, Ferrero JM, Marine S, Saja D, Mari V, Piche T, Bereder JM, Delotte J, Turpin JM, Ouvrier D, Barrière J, Largillier R, Rambaud C, Benchimol D, Follana P, Otto J, Guigay J, Francois E, Guerin O. A clinical score to predict the early death at 100 days after a comprehensive geriatric assessment (CGA) in elderly metastatic cancers , analysis from a prospective cohort study with 1048 patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Boulahssass R, Gonfrier S, Ferrero JM, Auben F, Rambaud C, Mari V, Turpin JM, Piche T, Isabelle B, Bereder JM, Hannoun Levi JM, Delotte J, Largillier R, Evesque L, Follana P, Borchiellini D, Benchimol D, Guigay J, Francois E, Guerin O. A clinical score to predict early death at 100 days after a comprehensive geriatric assessment (CGA) in elderly cancer patients: A prospective study with 815 patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Philippe Follana
- Département d'Oncologie Médicale, Centre Antoine Lacassagne, Nice, France
| | | | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Sacco G, Turpin JM, Marteu A, Sakarovitch C, Teboul B, Boscher L, Brocker P, Robert P, Guerin O. Inertial sensors as measurement tools of elbow range of motion in gerontology. Clin Interv Aging 2015; 10:491-7. [PMID: 25759568 PMCID: PMC4345924 DOI: 10.2147/cia.s70452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Musculoskeletal system deterioration among the aging is a major reason for loss of autonomy and directly affects the quality of life of the elderly. Articular evaluation is part of physiotherapeutic assessment and helps in establishing a precise diagnosis and deciding appropriate therapy. Reference instruments are valid but not easy to use for some joints. The main goal of our study was to determine reliability and intertester reproducibility of the MP-BV, an inertial sensor (the MotionPod(®) [MP]) combined with specific software (BioVal [BV]), for elbow passive range-of-motion measurements in geriatrics. METHODS This open, monocentric, randomized study compared inertial sensor to inclinometer in patients hospitalized in an acute, post-acute, and long-term-care gerontology unit. RESULTS Seventy-seven patients (mean age 83.5±6.4 years, sex ratio 1.08 [male/female]) were analyzed. The MP-BV was reliable for each of the three measurements (flexion, pronation, and supination) for 24.3% (CI 95% 13.9-32.8) of the patients. Separately, the percentages of reliable measures were 59.7% (49.2-70.5) for flexion, 68.8% (58.4-79.5) for pronation, and 62.3% (51.2-73.1) for supination. The intraclass correlation coefficients were 0.15 (0.07-0.73), 0.46 (0.27-0.98), and 0.50 (0.31-40 0.98) for flexion, pronation, and supination, respectively. CONCLUSION This study shows the convenience of the MP-BV in terms of ease of use and of export of measured data. However, this instrument seems less reliable and valuable compared to the reference instruments used to measure elbow range of motion in gerontology.
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Affiliation(s)
- G Sacco
- Memory Center, Claude Pompidou Institut, Department of Geriatrics, University Hospital of Nice, Nice, France ; Centre d'Innovation et d'Usages en Santé (CIU-S), University Hospital of Nice, Cimiez Hospital, Nice, France ; CoBTeK Cognition Behaviour Technology EA 7276, Research Center Edmond and Lily Safra, Nice Sophia-Antipolis University, Nice, France
| | - J M Turpin
- CoBTeK Cognition Behaviour Technology EA 7276, Research Center Edmond and Lily Safra, Nice Sophia-Antipolis University, Nice, France ; Rehabilitation Unit, Department of Geriatrics, University Hospital of Nice, Cimiez Hospital, Nice, France
| | - A Marteu
- Rehabilitation Unit, Department of Neurosciences, University Hospital of Nice, L'Archet Hospital, Nice, France
| | - C Sakarovitch
- Department of Clinical Research and Innovation, University Hospital of Nice, Cimiez Hospital, Nice, France
| | - B Teboul
- Centre d'Innovation et d'Usages en Santé (CIU-S), University Hospital of Nice, Cimiez Hospital, Nice, France
| | - L Boscher
- Rehabilitation Unit, Department of Geriatrics, University Hospital of Nice, Cimiez Hospital, Nice, France ; Rehabilitation Unit, Department of Neurosciences, University Hospital of Nice, L'Archet Hospital, Nice, France
| | - P Brocker
- Rehabilitation Unit, Department of Geriatrics, University Hospital of Nice, Cimiez Hospital, Nice, France
| | - P Robert
- Memory Center, Claude Pompidou Institut, Department of Geriatrics, University Hospital of Nice, Nice, France ; Centre d'Innovation et d'Usages en Santé (CIU-S), University Hospital of Nice, Cimiez Hospital, Nice, France ; CoBTeK Cognition Behaviour Technology EA 7276, Research Center Edmond and Lily Safra, Nice Sophia-Antipolis University, Nice, France
| | - O Guerin
- Centre d'Innovation et d'Usages en Santé (CIU-S), University Hospital of Nice, Cimiez Hospital, Nice, France ; CoBTeK Cognition Behaviour Technology EA 7276, Research Center Edmond and Lily Safra, Nice Sophia-Antipolis University, Nice, France ; Acute Geriatrics Unit, Department of Geriatrics, University Hospital of Nice, Cimiez Hospital, Nice, France
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Delotte J, Arias T, Guerin O, Boulahssass R, Bereder I, Bongain A, Benchimol D, Bereder JM. Hyperthermic intraperitoneal chemotherapy for the treatment of recurrent ovarian cancer in elderly women. Acta Obstet Gynecol Scand 2015; 94:435-9. [DOI: 10.1111/aogs.12577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 12/29/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Jérôme Delotte
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine; University Hospital Center of Archet II; University of Nice-Sophia Antipolis; Nice France
| | - Tatiana Arias
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine; University Hospital Center of Archet II; University of Nice-Sophia Antipolis; Nice France
| | - Olivier Guerin
- Department of Geriatrics; UCOG Paca-Est; University Hospital Center of Cimiez; University of Nice-Sophia Antipolis; Nice France
| | - Rabia Boulahssass
- Department of Geriatrics; UCOG Paca-Est; University Hospital Center of Cimiez; University of Nice-Sophia Antipolis; Nice France
| | - Isabelle Bereder
- Department of Geriatrics; UCOG Paca-Est; University Hospital Center of Cimiez; University of Nice-Sophia Antipolis; Nice France
| | - André Bongain
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine; University Hospital Center of Archet II; University of Nice-Sophia Antipolis; Nice France
| | - Daniel Benchimol
- Department of General Surgery and Digestive Oncology; University Hospital Center of Archet II; University of Nice-Sophia Antipolis; Nice France
| | - Jean Marc Bereder
- Department of General Surgery and Digestive Oncology; University Hospital Center of Archet II; University of Nice-Sophia Antipolis; Nice France
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Couderc AL, Camalet J, Schneider S, Turpin JM, Bereder I, Boulahssass R, Gonfrier S, Bayer P, Guerin O, Brocker P. Cobalamin deficiency in the elderly: aetiology and management: a study of 125 patients in a geriatric hospital. J Nutr Health Aging 2015; 19:234-9. [PMID: 25651452 DOI: 10.1007/s12603-014-0525-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cobalamin deficiency is frequent in elderly patients and the main aetiologies are food-cobalamin malabsorption and pernicious anaemia. The aim of our retrospective study was to identify the causes and methods of management of cobalamin deficiency at Nice geriatric university hospital. METHODS A retrospective monocentric study was conducted over 14 months at Nice geriatric hospital, which included patients with cobalamin deficiency having received supplementation. The clinical and paraclinical data, etiological diagnosis, treatment and follow-up modalities were analyzed retrospectively. RESULTS We studied 125 elderly patients whose median age was 85.5 ± 7 years. The etiological diagnosis was food-cobalamin malabsorption for 72 patients (57.6 %), nutritional cobalamin deficiency for 15 patients (12 %), pernicious anaemia for 12 patients (9.6 %) and there was no etiological diagnosis for 26 patients (20.8 %). Concerning cobalamin therapy, 111 patients (88.8 %) received oral therapy and 14 (11.2 %) intramuscular therapy. Vitamin B12 levels increased significantly after supplementation (p<0.001) but cobalamin administration varied according to the diagnoses (p<0.001) and was less effective in patients with dementia (p=0.04) and food-cobalamin malabsorption. CONCLUSION Our study showed the importance of food-cobalamin malabsorption in etiological diagnosis in accordance with the literature, but also the non-negligible share of nutritional cobalamin deficiency. Mainly oral cobalamin supplementation was used in our study with a significant increase in vitamin B12 levels. An oral cobalamin regimen is proposed for elderly patients with cobalamin deficiency but with no severe neurological signs.
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Affiliation(s)
- A-L Couderc
- A.L. Couderc, Hôpital de Cimiez, Nice, France,
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Boulahssass R, gonfrier S, Auben F, Mari V, Rambaud C, Turpin J, Brocker P, François E, Guerin O. Poor nutritional status is an independent factor of worse outcomes in the second group of Balducci score. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Delotte J, Boulahssass R, Auben F, Quaranta D, Rambaud C, Mounier N, Eric F, Guerin O. [Gynecological cancers in elderly women]. Soins Gerontol 2014:33-37. [PMID: 25373267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pelvic gynaecological cancers are common in elderly women. Diagnosis and the decision to treat require multidisciplinary expertise. An oncologic, surgical and geriatric evaluation contributes to a split decision and personalised care. The care team is involved in the geriatric evaluation, information, education and patient monitoring throughout the treatment plan.
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Boulahssass R, Mari V, Gonfrier S, Auben F, Rambaud C, Ferrero JM, Turpin JM, Bereder JM, Isabelle B, Mahamat A, Cavaglione G, Saada E, Follana P, Benizri E, Otto J, Delotte J, Benchimol D, Brocker P, Francois E, Guerin O. Predictive factors of early death during 100 days after a comprehensive geriatric assessment in older patients with cancer: A prospective cohort study of 576 patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Jean-Marc Ferrero
- Centre Antoine Lacassagne, Department d'Oncologie Medicale, Nice, France
| | | | | | | | | | | | | | - Philippe Follana
- Département d'Oncologie Médicale, Centre Antoine Lacassagne, Nice, France
| | | | | | | | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Retornaz F, Guillem O, Gholam D, Codoul JF, Bratisevic C, Morvan F, Rinaldi Y, Barriere N, Nahon S, Butaud C, Guerin O, Boulahssass R, Rousseau F. Frailty markers for prediction of mortality in first-line chemotherapy for colon cancer patients: Results of MOST/ASRO 101 study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Dany Gholam
- Centre Hospitalier de la Dracenie, Draguignan, France
| | | | | | | | | | | | - Sophie Nahon
- Centre Hospitalier d'Aix en Provence, Aix en Provence, France
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Boulahssass R, Auben F, Gonfrier S, Mari V, Ferrero JM, Borchiellini D, Bernard JL, Turpin JM, Rambaud C, Gary A, Sacco G, Dittlot C, Mailland V, Benchimol D, Brocker P, Hannoun-Levi JM, Francois E, Guerin O. Treatment decisions for older patients with cancer: Influence of the Comprehensive Geriatric Assessment (CGA) and the choice of the patient and their caregiver. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Jean-Marc Ferrero
- Centre Antoine Lacassagne, Department d'Oncologie Medicale, Nice, France
| | | | | | | | | | | | | | | | | | | | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Mari V, Fogliarini A, Boulahssass R, Ciais C, Francois E, Guerin O. What about the elderly cancer patients’ living wills? J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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40
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Boulahssass R, Mari V, Gonfrier S, Auben F, Abakar-Mahamat A, Ludovic E, Borchiellini D, Brocker P, Francois E, Guerin O. Early death in older patients with cancer: risk factors of worse outcomes? J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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41
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Boulahssass R, Auben F, Gonfrier S, Turpin J, Bereder I, Mari V, Licausi V, Brocker P, Francois E, Guerin O. Geriatric interventions in the management of older patients with cancer. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Rolland Y, de Souto Barreto P, Abellan Van Kan G, Annweiler C, Beauchet O, Bischoff-Ferrari H, Berrut G, Blain H, Bonnefoy M, Cesari M, Duque G, Ferry M, Guerin O, Hanon O, Lesourd B, Morley J, Raynaud-Simon A, Ruault G, Souberbielle JC, Vellas B. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging 2013; 17:402-12. [PMID: 23538667 DOI: 10.1007/s12603-013-0007-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of vitamin D insufficiency is very high in the nursing home (NH) population. Paradoxically, vitamin D insufficiency is rarely treated despite of strong clinical evidence and recommendations for supplementation. This review aims at reporting the current knowledge of vitamin D supplementation in NH and proposing recommendations adapted to the specificities of this institutional setting. DESIGN Current literature on vitamin D supplementation for NH residents was narratively presented and discussed by the French Group of Geriatrics and Nutrition. RESULT Vitamin D supplementation is a safe and well-tolerated treatment. Most residents in NH have vitamin D insufficiency, and would benefit from vitamin D supplement. However, only few residents are actually treated. Current specific and personalized protocols for vitamin D supplementation may not be practical for use in NH settings (e.g., assessment of serum vitamin D concentrations before and after supplementation). Therefore, our group proposes a model of intervention based on the systematic supplementation of vitamin D (1,000 IU/day) since the patient's admission to the NH and throughout his/her stay without the need of a preliminary evaluation of the baseline levels. Calcium should be prescribed only in case of poor dietary calcium intake. CONCLUSION A population-based rather than individual-based approach may probably improve the management of vitamin D insufficiency in the older population living in NH, without increasing the risks of adverse health problems. The clinical relevance and cost effectiveness of this proposal should be assessed under NH real-world conditions to establish its feasibility.
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Affiliation(s)
- Y Rolland
- Department of Geriatric Medicine, CHU Toulouse, Institute of aging, F-31059 Toulouse, France.
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Sacco G, Joumier V, Darmon N, Dechamps A, Derreumaux A, Lee JH, Piano J, Bordone N, Konig A, Teboul B, David R, Guerin O, Bremond F, Robert P. Detection of activities of daily living impairment in Alzheimer's disease and mild cognitive impairment using information and communication technology. Clin Interv Aging 2012; 7:539-49. [PMID: 23271900 PMCID: PMC3526878 DOI: 10.2147/cia.s36297] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND One of the key clinical features of Alzheimer's disease (AD) is impairment in daily functioning. Patients with mild cognitive impairment (MCI) also commonly have mild problems performing complex tasks. Information and communication technology (ICT), particularly techniques involving imaging and video processing, is of interest in order to improve assessment. The overall aim of this study is to demonstrate that it is possible using a video monitoring system to obtain a quantifiable assessment of instrumental activities of daily living (IADLs) in AD and in MCI. METHODS The aim of the study is to propose a daily activity scenario (DAS) score that detects functional impairment using ICTs in AD and MCI compared with normal control group (NC). Sixty-four participants over 65 years old were included: 16 AD matched with 10 NC for protocol 1 (P1) and 19 MCI matched with 19 NC for protocol 2 (P2). Each participant was asked to undertake a set of daily tasks in the setting of a "smart home" equipped with two video cameras and everyday objects for use in activities of daily living (8 IADLs for P1 and 11 for P2, plus 4 temporal execution constraints). The DAS score was then computed from quantitative and qualitative parameters collected from video recordings. RESULTS In P1, the DAS score differentiated AD (DAS(AD,P1) = 0.47, 95% confidence interval [CI] 0.38-0.56) from NC (DAS(NC,P1) = 0.71, 95% CI 0.68-0.74). In P2, the DAS score differentiated MCI (DAS(MCI,P2) = 0.11, 95% CI 0.05-0.16) and NC (DAS(NC,P2) = 0.36, 95% CI 0.26-0.45). CONCLUSION In conclusion, this study outlines the interest of a novel tool coming from the ICT world for the assessment of functional impairment in AD and MCI. The derived DAS scores provide a pragmatic, ecological, objective measurement which may improve the prediction of future dementia, be used as an outcome measurement in clinical trials and lead to earlier therapeutic intervention.
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Affiliation(s)
- Guillaume Sacco
- EA CoBTeK, Université de Nice Sophia-Antipolis, Sophia-Antipolis, France.
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Villars H, Oustric S, Andrieu S, Baeyens JP, Bernabei R, Brodaty H, Brummel-Smith K, Celafu C, Chappell N, Fitten J, Frisoni G, Froelich L, Guerin O, Gold G, Holmerova I, Iliffe S, Lukas A, Melis R, Morley JE, Nies H, Nourhashemi F, Petermans J, Ribera Casado J, Rubenstein L, Salva A, Sieber C, Sinclair A, Schindler R, Stephan E, Wong RY, Vellas B. The primary care physician and Alzheimer's disease: an international position paper. J Nutr Health Aging 2010; 14:110-20. [PMID: 20126959 DOI: 10.1007/s12603-010-0022-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert's opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP's intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver's confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a "case finding" strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies 'typical' cases. In typical cases, among older subjects, the diagnosis of "probable AD" can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and "emergency" hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients' right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force.
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Affiliation(s)
- H Villars
- Gérontopôle, Alzheimer's Disease Research and Clinical Center, Toulouse University Hospital, Toulouse, France.
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Boulahssass R, Chamorey E, Bereder I, Francois E, Follana P, Guerin O. P21 Observational data in a retrospective study about 59 older patients with cancers after a comprehensive geriatric assessment (CGA). Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Boulahssass R, Guerin O, Bereder I, Chamorey E, Ouderc A, Mari V, Francois E, Pras P, Brocker P, Thyss A. P20 Impact of comprehensive geriatric assessment in oncology. A retrospective study about 59 older patients with cancers. Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70058-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zouba N, Bremond F, Thonnat M, Anfosso A, Pascual É, Malléa P, Mailland V, Guerin O. A computer system to monitor older adults at home: Preliminary results. ACTA ACUST UNITED AC 2009. [DOI: 10.4017/gt.2009.08.03.011.00] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bereder I, Guerin O, Boulahssass R, Couderc A, Mailland V, Macone F, Mounier N, Habre J, Karimdjee- Soilihi B, Bereder J. Cytoreductive surgery combined with peritoneal intraoperative heated chemotherapy for management of peritoneal carcinomatosis in 59 adults older than age 65. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20657 Background: Peritoneal carcinomatosis (PC) has long been regarded as a terminal disease with short median survival. Recent success of new approach, combining surgery and intraperitoneal heated chemotherapy (HIPEC) are reported. But in the most studies patients over 65 years are excluded. We report our experience in this selected group of patients. Methods: A retrospective study was performed to evaluate toxicity and to identify the principal prognostic indicators with this combined treatment. All patients had cytoreductive surgery and HIPEC. This population of patients was compared with younger over the same period. We have excluded patient with frailty by comprehensive onco-geriatric assessment based upon cognitive, nutritional assessment and cormorbidities. Results: The study included 291 procedures in 249 patients between 2000 and 2008. 64 procedures were performed in 59 older patients (group 1) and 227 procedures in 190 younger patients (group 2). The principal etiologies of PC in group1 were recurrent ovarian cancer (N=33), colorectal cancer (N=9), peritoneal mesothelioma (N=6), pseudomyxoma (N=9) and sarcomatosis (N=2). No death occurred in post operative course and the procedure related morbidity rate was 10%. 5 years overall and free survival rate were respectively 33% and 15%. Median overall survival was 44 months and median disease free survival was 13 months. There were no difference between group1 and 2 for survival. Independent prognostic factors for survival by multivariate analysis were extent of carcinomatosis, completeness of cytoreductive surgery and performance status. Conclusions: Therapeutic approach combining cytoreductive surgery with HIPEC may achieve long-term survival in a selected group of patients with PC with acceptable mortality and morbidity. For elderly patients, this treatment could be performed in selected cases without frailty. No significant financial relationships to disclose.
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Affiliation(s)
- I. Bereder
- University Hospital CIMIEZ, France, France; University Hospital CIMIEZ, Nice, France; University Hospital ARCHET, Nice, France
| | - O. Guerin
- University Hospital CIMIEZ, France, France; University Hospital CIMIEZ, Nice, France; University Hospital ARCHET, Nice, France
| | - R. Boulahssass
- University Hospital CIMIEZ, France, France; University Hospital CIMIEZ, Nice, France; University Hospital ARCHET, Nice, France
| | - A. Couderc
- University Hospital CIMIEZ, France, France; University Hospital CIMIEZ, Nice, France; University Hospital ARCHET, Nice, France
| | - V. Mailland
- University Hospital CIMIEZ, France, France; University Hospital CIMIEZ, Nice, France; University Hospital ARCHET, Nice, France
| | - F. Macone
- University Hospital CIMIEZ, France, France; University Hospital CIMIEZ, Nice, France; University Hospital ARCHET, Nice, France
| | - N. Mounier
- University Hospital CIMIEZ, France, France; University Hospital CIMIEZ, Nice, France; University Hospital ARCHET, Nice, France
| | - J. Habre
- University Hospital CIMIEZ, France, France; University Hospital CIMIEZ, Nice, France; University Hospital ARCHET, Nice, France
| | - B. Karimdjee- Soilihi
- University Hospital CIMIEZ, France, France; University Hospital CIMIEZ, Nice, France; University Hospital ARCHET, Nice, France
| | - J. Bereder
- University Hospital CIMIEZ, France, France; University Hospital CIMIEZ, Nice, France; University Hospital ARCHET, Nice, France
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Paillocher N, Lacourtoisie SA, Fondrinier É, Catala L, Morand C, Boursier J, Guerin O, Descamps P. [Infiltrating breast cancer in women younger than 25 years: 13 cases]. Presse Med 2007; 35:1618-1624. [PMID: 17086115 DOI: 10.1016/s0755-4982(06)74869-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To study the prognosis of breast cancer in woman younger than 25 years and to compare it with that of other age groups to identify prognostic and histologic factors specific to this group. METHOD Retrospective study of all cases of infiltrating ductal carcinoma treated at our hospital from January 1977 through July 2005, examining clinical, histologic, and treatment variables as well as 5-year overall survival and 5-years disease-free survival rates. RESULTS The study included 13 women younger than 25 years at diagnosis. Their average age at diagnosis was 23.3 years (CI=1 year). Time from initial signs of disease until diagnosis averaged 6.6 months (CI=2.5). Clinically, the average tumor size was 28.78 mm (CI=6.06), with 46% classified as T1, 31% as T2 and 23% as T4d. We found 92.3% to be invasive ductal carcinoma, with 30% including an in-situ component; 53.8% were SBR grade 3 and 23% included axillary node invasion. Hormone receptors were present in 61.5% of tumors. During the follow-up period, we observed two deaths (with a 5-year overall survival rate, however, of 91%) and 6 recurrences (5-year disease-free survival: 66.5%). CONCLUSION Prognosis appears unfavorable among young women (younger than 40 years) with breast cancer. In our series, neither prognosis nor clinical or histologic characteristics differed in the subgroup of very young women (younger than 26 years).
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Affiliation(s)
| | | | - Éric Fondrinier
- Service d'oncologie chirurgicale, centre Paul Papin, Angers (49)
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50
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Gillette Guyonnet S, Abellan Van Kan G, Alix E, Andrieu S, Belmin J, Berrut G, Bonnefoy M, Brocker P, Constans T, Ferry M, Ghisolfi-Marque A, Girard L, Gonthier R, Guerin O, Hervy MP, Jouanny P, Laurain MC, Lechowski L, Nourhashemi F, Raynaud-Simon A, Ritz P, Roche J, Rolland Y, Salva T, Vellas B. IANA (International Academy on Nutrition and Aging) Expert Group: weight loss and Alzheimer's disease. J Nutr Health Aging 2007; 11:38-48. [PMID: 17315079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Weight loss, together with psychological and behavioural symptoms and problems of mobility, is one of the principal manifestations of Alzheimer's disease (AD). Weight loss may be associated with protein and energy malnutrition leading to severe complications (alteration of the immune system, muscular atrophy, loss of independence). Various explanations have been proposed such as atrophy of the mesial temporal cortex, biological disturbances, or feeding behaviours; however, none has been proven. Prevention of weight loss in AD is a major issue. It requires regular follow-up and must be an integral part of the care plan. The aim of this article is to review the present state of scientific knowledge on weight loss associated with AD. We will consider four points: the natural history of weight loss, its known etiological factors, its consequences and the various management options.
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