Educational trajectories, health and longevity

The working group of the Academies of Medicine of France and Mexico initiated its work after the first wave of the COVID 19 pandemic, during which the severity of the disease in certain countries was attributed to a lack of basic education of the population. The study continued and expanded to better understand the roles of basic education and health education on overall health and longevity. This work has demonstrated that, alongside genetics, the affective and educational family environment but also the general one greatly interferes from the very first days of life. Thus, epigenetics plays a major role in the determination of health and disease (DOHAD) as well as in the characterization of gender. Other factors such as socio-economic level, parental education, school in urban or rural areas play a major role in the differential acquisition of health literacy. This determines adherence or not to healthy lifestyles, risky behaviors, substance abuse, but also compliance with hygiene rules and adherence to vaccines and treatments. The combination of all these elements and lifestyle choices facilitates the emergence of metabolic disorders (obesity, diabetes) which promote cardiovascular and kidney damages and neurodegenerative diseases, explaining that the less educated have a shorter survival while they spend more years of life in disability. After having demonstrated the impact of the educational level on health and longevity, the members of the inter-academic group propose specific educational actions at three levels: 1) Children, their parents, and teachers, 2) health professionals and 3) aging people, after emphasizing that these crucial actions can only be carried out with the unfailing support of state and academic authorities. © 2023 l'Académie nationale de médecine Le groupe de travail des Académies de Médecine de France et du Mexique a initié son travail après que la sévérité de la première vague de la pandémie Covid 19 de certains pays ait été corrélée à un manque d'éducation de base de leur population. La réflexion s'est poursuivie et étendue pour mieux comprendre les rôles de l'éducation de base et de l'éducation en santé sur la santé globale et la longévité. Ce travail montre qu'à côté de la génétique, l'épigénétique interfère de façon majeure dès les tous premiers jours de la vie dans la détermination de la santé et des maladies (DOHAD) ainsi que dans la caractérisation du genre. D'autres facteurs environnementaux et/ou éducatifs, comme le niveau socioéconomique ou les modalités de scolarisation (urbain ou rural) interviennent également dans l'acquisition différentielle d'une littératie en santé. Celle-ci détermine l'adhésion ou non à des styles de vie saine, à des comportements à risque, à l'abus de substances, mais aussi au respect des règles d'hygiène et à l'adhésion aux vaccins. Tous ces éléments et choix de vie se conjuguent entre eux pour faciliter la survenue ou la gravité de pathologies. Ainsi, les troubles métaboliques (obésité, diabète) surviennent plus souvent chez les moins éduqués, favorisant les atteintes cardiovasculaires, rénales et les maladies neurodégénératives. Globalement, les personnes moins éduquées vivent moins longtemps après avoir passé plus d'années de vie en incapacité fonctionnelle et dépendance. Après avoir démontré l'impact du niveau éducatif sur la santé et la longévité, les membres du groupe interacadémique déclarent l'urgence des actions à entreprendre et proposent des actions éducatives spécifiques à trois niveaux : 1) les enfants, leurs parents et les enseignants, 2) les professionnels de santé et 3) les personnes vieillissantes, tout en soulignant que ces actions cruciales ne pourront être menées qu'avec le soutien indispensable des autorités étatiques et académiques. © 2023 l'Académie nationale de médecine

Rapport 23-04. Rapport inter-académique. Trajectoires éducatives, santé et longévité

Résumé Le groupe de travail des Académies de Médecine de France et du Mexique a initié son travail après que la sévérité de la première vague de la pandémie Covid 19 de certains pays ait été corrélée à un manque d'éducation de base de leur population. La réflexion s'est poursuivie et étendue pour mieux comprendre les rôles de l'éducation de base et de l'éducation en santé sur la santé globale et la longévité. Ce travail montre qu'à côté de la génétique, l'épigénétique interfère de façon majeure dès les tous premiers jours de la vie dans la détermination de la santé et des maladies (DOHAD) ainsi que dans la caractérisation du genre. D'autres facteurs environnementaux et/ou éducatifs, comme le niveau socioéconomique ou les modalités de scolarisation (urbain ou rural) interviennent également dans l'acquisition différentielle d'une littératie33Littératie en santé : capacité pour une personne de comprendre et utiliser des informations médicales dans l'objectif de gérer sa santé et de pouvoir communiquer avec les divers services de soins. en santé. Celle-ci détermine l'adhésion ou non à des styles de vie saine, à des comportements à risque, à l'abus de substances, mais aussi au respect des règles d'hygiène et à l'adhésion aux vaccins. Tous ces éléments et choix de vie se conjuguent entre eux pour faciliter la survenue ou la gravité de pathologies. Ainsi, les troubles métaboliques (obésité, diabète) surviennent plus souvent chez les moins éduqués, favorisant les atteintes cardiovasculaires, rénales et les maladies neurodégénératives. Globalement, les personnes moins éduquées vivent moins longtemps après avoir passé plus d'années de vie en incapacité fonctionnelle et dépendance. Après avoir démontré l'impact du niveau éducatif sur la santé et la longévité, les membres du groupe interacadémique déclarent l'urgence des actions à entreprendre et proposent des actions éducatives spécifiques à trois niveaux : 1) les enfants, leurs parents et les enseignants, 2) les professionnels de santé et 3) les personnes vieillissantes, tout en soulignant que ces actions cruciales ne pourront être menées qu'avec le soutien indispensable des autorités étatiques et académiques. Summary The working group of the Academies of Medicine of France and Mexico initiated its work after the first wave of the COVID 19 pandemic, during which the severity of the disease in certain countries was attributed to a lack of basic education of the population. The study continued and expanded to better understand the roles of basic education and health education on overall health and longevity. This work has demonstrated that, alongside genetics, the affective and educational family environment but also the general one greatly interferes from the very first days of life. Thus, epigenetics plays a major role in the determination of health and disease (DOHAD) as well as in the characterization of gender. Other factors such as socio-economic level, parental education, school in urban or rural areas play a major role in the differential acquisition of health literacy. This determines adherence or not to healthy lifestyles, risky behaviors, substance abuse, but also compliance with hygiene rules and adherence to vaccines and treatments. The combination of all these elements and lifestyle choices facilitates the emergence of metabolic disorders (obesity, diabetes) which promote cardiovascular and kidney damages and neurodegenerative diseases, explaining that the less educated have a shorter survival while they spend more years of life in disability. After having demonstrated the impact of the educational level on health and longevity, the members of the inter-academic group propose specific educational actions at three levels: 1) Children, their parents, and teachers, 2) health professionals and 3) aging people, after emphasizing that these crucial actions can only be carried out with the unfailing support of state and academic authorities.

[After the COVID crisis, what solutions for the future nursing home?] / Rapport 22-02. Après la crise COVID, quelles solutions pour l'EHPAD de demain ?

The ageing of the population induces situations of large vulnerability and dependence. Home care usually remains the best response to comply with the person's wish, the family's desire, and the civil society's interest. However, there are circumstances where patient management in a nursing home (EHPAD) is the only solution. The present pandemic of coronavirus COVID-19 has highlighted the issue of EHPAD and their limitations to provide high quality care. To analyze the current position of EHPAD into the care chain and to understand difficulties to their functioning, it seems essential to seek out accelerated changes in the EHPAD since their establishment in 1999 and then in the light of the current crisis, propose possible solutions with a positive view of the role which each EHPAD will have to ensure for future.

Low thoracic skeletal muscle index is associated with negative outcomes in 244 patients with respiratory COVID-19.

BACKGROUND: Sarcopenia is associated with negative outcomes in intensive care unit (ICU) patients and during chronic diseases. We aimed to evaluate if low skeletal muscle index (SMI) measured by computed tomography (CT) at the thoracic level is associated with poor outcomes in hospitalized patients with respiratory COVID-19. METHODS: Patients admitted to the hospital between March 1st and June 9, 2020 with a confirmed diagnosis of respiratory COVID-19 in the Emergency Department were included in this retrospective cohort study. SMI was assessed from a transverse CT image at the T12 level. We analysed the association between thoracic SMI and mortality, ICU admissions, infections, length of stay and gravity scores. RESULTS: We included 244 patients, whose median age was 62 (20-95) years, mean body mass index was 28,6 kg/m2, and 34% were obese patients. 102 patients (41,8%) had low thoracic SMI. On multivariable analysis, low thoracic SMI was associated with more infections (OR = 1,88 [1,06-2,98]) and increased length of stay (OR = 1,87 [1,14-3,49]) but not with mortality (OR = 1.37 [0.54-3.52]), whereas it was inversely associated with ICU admission (OR = 5,56 [1,96-16,67]. CONCLUSION: Low SMI measured by CT at the thoracic level T12 is associated with negative outcomes in patients with respiratory COVID-19.

Enhancing Immunization Clinical Decision Support to Support Personalized Guidance and Shared Decision Making Recommendations

Background: Immunization clinical decision support (CDS) systems provide much needed guidance for clinicians in interpreting immunization guidelines and determining when vaccinations are due. In most circumstances, patients should be vaccinated according to the standard Advisory Committee on Immunization Practices (ACIP) schedule. However, for some patients the standard recommendations encoded into the CDS fail to address individual health. For example, underspecfication in ICD-10 codes for immunocompromised status led to confusion about whether a patient should or should not be given vaccines. Additionally, the system we currently used only allowed for limited 'on' and 'off' designations, resulting in some families choosing to self-select as “no to all vaccines” even there were some vaccines they were interested in their child receiving such as school required vaccines. As some new vaccines have included a shared decision making recommendation, including the meningitis B vaccine and the COVID vaccines, we recognized the need for a more finite level of control in our immunization CDS. Methods: We overhauled our immunization CDS backend to provide increased flexibility in rule interpretation and recommendation presentation. First, we switched from a binary interpretation of rules (due or not due) to a three-level interpretation (due and default selected, due but not default selected, or not due). Diagnoses that previously had shut off notices that a vaccine were due were re-interpreted to note that the vaccine would be due, but that a specific diagnosis in the chart indicated it should not be defaulted as selected. We developed a provider portal accessible by the clinician in real time to update rule recommendations at the patient level allowing a clinician to control for a patient what immunizations would be recommended at the antigen level. To facilitate ease of use for the clinician, we included pre-populated selections for reasons a parent may elect to defer on default immunizations. Additionally, we provided links to content on supporting shared decision making for immunizations. Results: The updated immunization CDS successfully allowed clinicians to modify recommended vaccinations at the patient and antigen level. Multiple scenarios were tested including personal history of varicella, which can be driven by problem list entries, and history of hepatitis A infection with natural immunity, for which diagnosis data is insufficient for altering the recommendations. In all cases clinicians were able to unselect default recommendation for immunizations. Conclusion: Immunization CDS, which previously only allowed for default selection of immunizations was successfully modified to support personal preferences, finite recommendations related to previously inaccessible information within the EHR, and to allow for future implementation of shared decision making recommendation level immunizations. The interphase developed allowed for clinician updating of immunization recommendations in realtime at the patient level and antigen level. After the rules engine has determined which vaccines are potentially due, presentation of products occurs through this order screen. Products with a shared decision making recommendation status as per ACIP are not defaulted. Where possible, patient data from the EHR is used to support recommendation evaluated (e.g. for varicella). Where notpossible due to underspecification of ICD-10 codes, clinician entered information is used to enhance the specificity of alerts. Narrative text describing all modifications to recommendations, including the source of the modification, is displayed. This is the user interface used by clinicians to modify recommendations at the patient level. With a single click clinicians can add or remove personalizations to the routinely recommended immunizations. By default all antigens are recommended. When a clinician unselected a check box products containing that antigen are still listed as due, but no longer defaulted. Any combination products containing that an igen are not recommended so that the system can have other portions of the combination product still be default ordered.

Interactive Voice Response Service to Improve High School Students Covid-19 Literacy in Burkina Faso: A Usability Study.

Mobile technology is widely used in healthcare. However, designers and developers in many cases have focused on developing solutions that are often tailored to highly literate people. While the advent of the pandemic has called for people to seek and use Covid-19 related information to adapt their behaviors, it is relatively difficult for low literate to get easily access to health information through digital technologies. In this study, we present a Mobile based Interactive Voice Response service designed particularly for low-literate people which provides validated Covid-19 related health information in local African languages. We conducted a field study, among high school students, through a usability study to assess users' perception. The service received an excellent numerical usability score of 78.75.

Flexible work arrangements and employee health: a meta-analytic review. (Special Issue: Literature reviews in occupational health psychology.)

Flexibility regarding where and when work is completed is becoming increasingly available to employees, especially following the COVID-19 outbreak and subsequent shift in the nature of work. There is a plethora of research linking various flexible work arrangements (FWA) to a variety of positive outcomes across domains including reduced work-family conflict, better psychological health, and increased role satisfaction. While several studies have suggested that FWA are related to positive health, others have found no relationship between flexible work arrangements and health outcomes. To clarify these inconsistent findings, the current meta-analytic review (k = 33, n = 90,602) examines the relationship between flexible work arrangements available to employees and health behaviours and outcomes, specifically physical health, absenteeism, somatic symptoms, and physical activity. Results demonstrate that FWA are associated with better physical health, reduced absenteeism, and fewer somatic symptoms, suggesting that flexible work arrangements can facilitate employees in maintaining their health. There was no association between FWA and physical activity, though these results should be interpreted cautiously given the limited number of primary studies examining this relationship. These findings hold implications for future research and practice, including support for offering individualised flexible work arrangements as means of promoting employee health.

COVID-19 and HIV testing: different viruses but similar prejudices and psychosocial impacts

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) high infectivity and perceived substantial fatality rates are causing negative psychosocial effects, including the increased psychiatric and economic burden. Research has demonstrated that a severe diagnosis triggers various responses in a person, including depression, sense of hopelessness, shame, and self-destructive behaviours. This manuscript explores the reasons why people did not follow the recommendations to be tested for SARS-CoV-2.

Rationale and design of the CORE (COrticosteroids REvised) study: protocol.

INTRODUCTION: Corticosteroids are an important pillar in many anti-inflammatory and immunosuppressive treatment regimens and are available in natural and synthetic forms, which are considered equipotent if clinical bioequivalence data are used. Current clinical bioequivalence data are however based on animal studies or studies with subjective endpoints. Furthermore, advancement in steroid physiology with regard to metabolism, intracellular handling and receptor activation have not yet been incorporated. Therefore, this study aims to re-examine the clinical bioequivalence and dose effects of the most widely used synthetic corticosteroids, prednisolone and dexamethasone. METHODS AND ANALYSIS: In this double-blind, randomised cross-over clinical trial, 24 healthy male and female volunteers aged 18-75 years, will be included. All volunteers will randomly receive either first a daily dose of 7.5 mg prednisolone for 1 week, immediately followed by a daily dose of 30 mg prednisolone for 1 week, or first a presumed clinical bioequivalent dose of 1.125 mg dexamethasone per day, immediately followed by 4.5 mg of dexamethasone per day for 1 week. After a wash-out period of 4-8 weeks, the other treatment will be applied. The primary study endpoint is the difference in free cortisol excretion in 24 hours urine. Secondary endpoints will include differences in immunological parameters, blood pressure and metabolic measurements. ETHICS AND DISSEMINATION: This study has been approved by the Medical Ethics Committee of the University Medical Center Groningen (METC 2020.398). The results of this study will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (Identifier: NCT04733144), and in the Dutch trial registry (NL9138).

Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands.

INTRODUCTION: We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. METHODS: We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. RESULTS: A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. CONCLUSIONS: During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.

Education, Healthy Ageing and Vaccine Literacy.

Importance and Objective: The Covid pandemic is a timely opportunity to try to broaden our understanding of the links between education and health literacy and explore the vaccine-decision process with a view to identifying interventions that will positively influence vaccine uptake. EVIDENCE: Health and vaccine literacy encompass people's knowledge, motivation, and competence to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention and health promotion. FINDINGS: Appropriate vaccine communication, which depends greatly on personal and contextual determinants, as well as on societal and environmental circumstances, is essential to reassure people about vaccine efficacy, safety, and possible side effects. However, vaccine confidence is not solely a question of trust in the vaccine's efficacy, safety. and individual protective benefit of vaccination. It also encompasses the mechanism(s) of vaccine activity, immunization schedules, organization and trust in the healthcare system that promotes and delivers the vaccines, and at what costs. When healthcare professionals as science brokers of vaccine knowledge attempt to increase vaccine knowledge and confidence, they must adjust their communication to the educational or health literacy level of their intended audience. Even if their messages are apparently clear and simple, they absolutely need to verify that they are properly understood. RELEVANCE: Specific vaccine communication training appears essential to increase vaccine communication skills among healthcare providers. Moreover, further randomized controlled studies are warranted to improve vaccine empowerment among different populations, from a variety of educational backgrounds.

Geriatric day-hospitals and COVID-19. What management? What difficulties? What can we learn?

The COVID-19 pandemic has led to an unprecedented health crisis. In the subsequent response, geriatric day-hospitals paid a heavy price in the organizational restructuring of the hospital environment, with almost instantaneous closures enforced by the authorities. A survey was therefore conducted under the aegis of the APHJPA among day-hospitals to learn the lessons from the management of this crisis and to reflect on the role of these structures in context of this nature. Fifty day-hospitals throughout the country answered. Most of the professionals were immediately redeployed to classic hospitalization services, whether or not the population area was heavily impacted by COVID-19. Some of them then provided assistance to nursing homes or patients confined to their homes and their families. Although they accepted the closures during the acute period of the crisis, the lack of clarity about the reopening of their units despite the precautionary measures envisaged was not well received, often with the feeling that the authorities and sometimes the management of their establishments were not well acquainted with their role in the care of the elderly. The lockdown and discontinuation of care led to decompensations, especially among patients with neurodegenerative pathologies. Situated at the interface between the community and hospital health sectors, day-hospitals play a major role in the care of the elderly. This survey highlights the ability of professionals to adapt and commit themselves, demonstrating the relevance of day-hospitals in the field of chronic diseases (diagnosis, follow-up, rehabilitation) and also in prevention, identification and follow-up of frailty factors in elderly patients. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (French) La pandemie COVID-19 a engendre une crise sanitaire inedite. Pour y faire face, les hopitaux de jour geriatriques ont paye un lourd tribut dans le cadre de la restructuration organisationnelle du milieu hospitalier avec une fermeture quasi instantanee imposee par les tutelles. Une enquete a ete menee sous l'egide de l'APHJPA aupres des hopitaux de jour geriatriques pour tirer les enseignements de la gestion de cette crise et mener une reflexion sur le role de ces structures dans un tel contexte. Cinquante hopitaux de jour repartis sur l'ensemble du territoire national ont repondu. Les professionnels ont d'emblee ete redeployes dans les services d'hospitalisation classique, que le bassin de population soit fortement impacte par la COVID-19 ou pas. Certains ont assure une assistance aupres des EHPAD ou des patients confines a domicile et de leur entourage. S'ils ont accepte les fermetures lors de la periode aigue de la crise, l'absence de lisibilite sur la reouverture de leur unite, malgre les mesures de precaution envisagees, a ete mal vecue, avec souvent le sentiment d'une meconnaissance de leur role dans le parcours de soins de la personne agee par les tutelles et parfois, par leur propre direction. Le confinement et les ruptures de prise en charge ont pu entrainer des << decompensations notamment chez les patients ayant des pathologies neurodegeneratives. Situes a l'interface ville-hopital, les hopitaux de jour ont un role majeur dans la prise en soins des personnes agees. L'enquete met ainsi en avant une capacite d'adaptation et d'engagement des professionnels pour affirmer la place des hopitaux de jour dans la prise en charge des pathologies chroniques (diagnostic, suivi et readaptation) mais aussi leur role dans la prevention, le reperage et le suivi des patients fragiles. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Clinical features of patients who had two COVID-19 episodes: a European multicentre case series.

OBJECTIVE: To investigate the clinical features of patients who had two demonstrated coronavirus disease 2019 (COVID-19) episodes. METHODS: Data of patients with both COVID-19 episodes were recruited from 22 March to 27 December 2020. The following outcomes were studied: epidemiological, comorbidities, prevalence and severity of general and otolaryngological symptom, olfactory, aroma, and gustatory dysfunctions. A comparison between first and second episodes was performed. RESULTS: Forty-five patients reported having two confirmed COVID-19 episodes. The majority of patients had mild infections in both episodes. The second clinical episode was significantly similar to the first. The symptom duration of the second episode was shorter than the first. The occurrence of loss of smell was unpredictable from the first to the second episode. CONCLUSION: The recurrence of COVID-19 symptoms is associated with a similar clinical picture than the first episode in patients with initial mild-to-moderate COVID episode. The pathophysiological mechanisms underlying the development of second episode remain uncertain and may involve either true reinfection or virus reactivation from sanctuaries.

HDJ gériatriques et Covid-19 Quelle gestion? Quelles difficultés? Quels enseignements?

Résumé La pandémie Covid-19 a engendré une crise sanitaire inédite. Pour y faire face, les hôpitaux de jour gériatriques ont payé un lourd tribut dans le cadre de la restructuration organisationnelle du milieu hospitalier avec une fermeture quasi instantanée imposée par les tutelles. Une enquête a été menée sous l’égide de l’APHJPA auprès des hôpitaux de jour gériatriques pour tirer les enseignements de la gestion de cette crise et mener une réflexion sur le rôle de ces structures dans un tel contexte. Cinquante hôpitaux de jour répartis sur l’ensemble du territoire national ont répondu. Les professionnels ont d’emblée été redéployés dans les services d’hospitalisation classique, que le bassin de population soit fortement impacté par la Covid-19 ou pas. Certains ont assuré une assistance auprès des EHPAD ou des patients confinés à domicile et de leur entourage. S’ils ont accepté les fermetures lors de la période aiguë de la crise, l’absence de lisibilité sur la réouverture de leur unité, malgré les mesures de précaution envisagées, a été mal vécue, avec souvent le sentiment d’une méconnaissance de leur rôle dans le parcours de soins de la personne âgée par les tutelles et parfois, par leur propre direction. Le confinement et les ruptures de prise en charge ont pu entraîner des « décompensations » notamment chez les patients ayant des pathologies neuro-dégénératives. Situés à l’interface ville-hôpital, les hôpitaux de jour ont un rôle majeur dans la prise en soins des personnes âgées. L’enquête met ainsi en avant une capacité d’adaptation et d’engagement des professionnels pour affirmer la place des hôpitaux de jour dans la prise en charge des pathologies chroniques (diagnostic, suivi et réadaptation) mais aussi leur rôle dans la prévention, le repérage et le suivi des patients fragiles. Summary The COVID-19 pandemic generated an unprecedented health crisis. In the subsequent response, geriatric day hospitals paid a heavy price in the organizational restructuring of the hospital environment, with almost instantaneous closures imposed by the authorities. A survey was conducted under the aegis of the APHJPA among day hospitals to learn the lessons from the management of this crisis and to reflect on the role of these structures in contexts of this nature. 50 day hospitals throughout the country answered. Most of the professionals were immediately redeployed to classic hospitalization services, whether or not the population area was heavily impacted by COVID-19. Some of them provided assistance to nursing homes or patients confined to their homes and their families. Although they accepted the closures during the acute period of the crisis, the lack of clarity about the reopening of their units despite the precautionary measures envisaged was not well received, often with the feeling that the authorities and sometimes the management of their establishments were not well acquainted with their role in the care of the elderly. The lockdown and discontinuation of care led to de-compensations, especially among patients with neurodegenerative pathologies. Situated at the interface between the community and hospital health sectors, day hospitals play a major role in the care of the elderly. This survey highlights the ability of professionals to adapt and commit themselves, demonstrating the relevance of day hospitals in the field of chronic diseases (diagnosis, follow-up, rehabilitation) and also in prevention, identification and follow-up of frail patients.