[Investigation of an outbreak of norovirus gastroenteritis in a geriatric hospital]. / Investigation d'une épidémie de gastro-entérite à norovirus dans un hôpital gériatrique.

In aged-care facilities, gastroenteritis outbreaks are responsible for big trouble in the management of cares to the elderly. In November 2002, a gastroenteritis outbreak was observed in 5 of the 6 wards of the geriatric hospital La Charité, University Hospital of Saint-Etienne, France, with an attack rate of 38.5% in the elderly (70 infected from 182 patients) and of 26.0% in the nursing staff (40 infected from 154 agents). The outbreak lasted 30 days with a peak corresponding to 79.8% of the cases between the 11(th) and the 20(th) of November. The first cases were observed in the two short-term-care wards; then, the outbreak spread rapidly to 3 of the 4 long-term care units. Health care workers were contaminated later than the elderly (P < 0.001 by Kruskal-Wallis test). A self-administered questionnaire was documented by most of the nursing staff; the most frequently observed clinical symptoms in this population were nausea (82.5%), abdominal pain (80.0%), diarrhoea (70.5%), asthenia (67.5%) and vomiting (62.5%). Thirty-five percent of the health care workers ceased their work. The causative agent of the gastroenteritis was identified by RT-PCR in the stools of 5 aged persons as a norovirus close to the Lordsdale strain (genogroup II). These findings illustrate the respective role of elderly and health care workers in the spread of the gastroenteritis outbreak inside the geriatric hospital.

[Is very old age a prognostic factor for outcome after a first stroke?]. / L'âge très élevé constitue-t-il un facteur pronostique du devenir après un premier accident vasculaire cérébral?

AIM: To determine whether very old age, older than 80 years, after a stroke is a significant predictor of mortality, orientation to a specific care pathway after the acute phase and functional status at 6 months after the stroke. PATIENTS: A sample of 112 consecutive patients admitted to the emergency department because of a first stroke, with hemiplegia and/or aphasia over 6 months, who satisfied strict inclusion/exclusion criteria. Forty-seven patients were older than 80. METHOD: After initial diagnosis and enrolment in the study, follow-up assessments were conducted at 48 hours, 15 days and 6 months. Demographic, medical, and radiographic data were collected, and patients were evaluated on the NIHSS, MMSE, Barthel Index, FIM(TM) and FAM scales. Descriptive statistics were generated, as were uni- and multivariate between group comparisons. RESULTS: Our study shows that after a first stroke, old age is significantly associated with a high rate of death, a low rate of orientation to a physical medicine and rehabilitation unit and return to home but not poorer functional outcome. CONCLUSION: Old age is therefore a determinant of post stroke management. Further studies are needed to evaluate whether in patient rehabilitation would result in significant functional benefit, considering the high cost of care, high risk of recurrent stroke, and high rate of death.

[Impact of frailty factors in elderly people older than 75 years with prosthesis of the hip]. / Impact des facteurs de fragilité sur le devenir des sujets âgés de 75 ans et plus opérés d'une prothèse de hanche.

OBJECTIVE: Hip pathology of hip requiring a surgical assumption of responsibility (coxarthrose invalidating, hip fracture) is increasing, and after the year 2025, the number of interventions will double. In parallel, the number of elderly people (older than 75 years) with malnutrition associated with cognitive impairment and reduced autonomy is on the increase. So the concept of frail elderly identified by specific criteria allows for better defining the health needs of heterogeneous elderly people. The objective of this study was to determine the influence of frailty factors on autonomy and clinical outcome after intervention for prosthesis of the hip. METHODOLOGY: This prospective work, completed over 8 months, included 55 patients with total or intermediate prostheses of hip, whatever the cause, recruited from rehabilitation wards. Results from a pre-established questionnaire defined the personal status and social framework of these patients. A medical examination evaluated cognitive function Mini Mental State (MMS), nutritional state (IMC) and the level of autonomy immediately after surgery (the first 2 weeks) by the measurement of functional independence (MIF). The second MIF was carried out by the same operator at the end of the assumption of responsibility by the institution. RESULTS: Three factors of frailty influenced progress at the time of reacquisition of autonomy: cognitive impairment (P < 0001; 1 patient out of 2 [50%] had an MMS score < 22); reduced nutrition? (P < 0.0026; [29% had a BMI score < 20 or a perimeter of the calf < 30 cm]; and accommodations before the intervention (P < 0.028; [15% lived in an institution]). CONCLUSION: Nutritional state, cognitive level and social activity must be evaluated regularly in elderly subjects with hip prosthesis to evaluate optimal load and adaptation.

[Effectiveness of falls prevention strategies for elderly subjects who live in the community with performance assessment of physical activities (before-after)]. / Impact d'un programme de prévention multidisciplinaire de la chute chez le sujet âgé autonome vivant à domicile, avec analyse avant-après des performances physiques.

OBJECTIVES: The development of falls prevention strategies is an essential health concern in elderly people. However, a global consensus does not exist for elderly subjects who live independently in the community. The aim of the study was to evaluate the benefit of an exercises program. MATERIALS AND METHODS: A control group (153 subjects) and an "Intervention" group (150 subjects) were tested before and after a 1-year prospective study. The "Intervention" group performed ten training sessions of physical activity, based on balance, muscular activity and coordination. We compared the incidence of falls, and the performances in several tests between the two groups. RESULTS: The clinical features were similar between the two groups: mean age 71 years, 83% of females, subjects who were independent for activities of daily living. However, all subjects presented risk for factors for falls: 38% were not able to maintain the unipodal position more than five seconds, 29% had already fallen during the previous year. For the "Intervention" group, the comparison of the performances before and after the physical activity program showed significant increases (p < 0.001) for all the tests, and specifically for the unipodal position and for the exercises performed with eyes closed. After one year follow-up, the incidence rate of falls was lower in the "Intervention" group compared with the control group, but the difference was not significant (p = 0.32). However, falls occurred significantly latter in the "Intervention" group (p = 0.02). CONCLUSION: Ten training sessions of physical activity allowed to improve the performance of elderly people in several tests. This result suggests that a fall prevention program based on collective and regular exercises, may be efficient for elderly subjects who still have an active and independent way of live.

[Influence of a specific cognitive task on spatial-temporal walking parameters in elderly frail individuals]. / Etude de l'influence d'une tâche cognitive explicite sur les paramètres spatio-temporels de la marche du sujet âgé fragile.

OBJECTIVE: Walking is a complex voluntary rhythmic motor behaviour. Its implicit nature suggests that reduced attention resources are required for its execution. The aim of this study was to demonstrate that, to perform a mental calculation while walking, might modify the spatial-temporal parameters of walking in fragile elderly patients. METHODS: We compared the walking, in a straight line over a distance of 10 meters, of 30 fragile elderly subjects (mean age 82.6 +/- 7.1 years) with that of 30 healthy controls (mean age 37.5 +/- 11.5 years). Two walking conditions were studied: with and without a counting task. The time, number of steps, lateral deviations and stops were recorded on a video camera. RESULTS: The condition of a double-task provoked three types of effects on walking: an increase in time and the number of steps in both groups, but significantly greater in the elderly patients than in the control group of patients (6.4 s and 4.6 steps in the elderly versus 0.5 s and 0.4 steps in the controls); a reduction in the cadence and length of the step, only significant in the elderly patients, and a significant increase in the number of lateral deviations and stops in the double-task condition in the elderly patients. CONCLUSION: Globally, these results indicate that walking requires more attention resources in the elderly than in the middle-aged. The loss of the implicit character of walking to the benefit of cognitive attention resources may partly explain the high risk of falling in fragile elderly subjects.

[Combined sclerosis of the spinal cord revealing vitamin B 12 deficiency: geriatric characteristics apropos of a case evaluated by MRI]. / Sclérose combinée médullaire révélatrice d'une carence en vitamine B12: particularités gériatriques à propos d'un cas évalué par imagerie par résonance magnétique nucléaire.

INTRODUCTION: Cobalamin deficiency is common in the elderly. However, most of the patients are asymptomatic or present with few symptoms. A subacute combined degeneration of the spinal cord accounts for only 10% of the neurological complications. Revealing forms of this myelopathy are exceptional, and were rarely documented by magnetic resonance imaging (MRI) study. EXEGESIS: We report a case of subacute combined degeneration of spinal cord in an 81-year-old woman evaluated by a spinal cord MRI. We discuss the role of the spinal cord radiographic study in the diagnosis, the etiopathogeny of cobalamin deficiency and the benefit of vitamin supplementation even at a late stage of the disease in geriatrics patients. CONCLUSION: The spinal cord MRI is useful in the diagnosis of late-form combined spinal cord degeneration. The high frequency of atrophic gastritis in elderly prevents the identification of a deficiency of the cobalamin etiology. The treatment relies on vitamin therapy even in the late stages. The severe disability of cobalamin deficiency neurological complications must encourage an earlier diagnosis in elderly patients.

[Factors contributing to falls in elderly subjects leading to acute-care hospitalization]. / Facteurs explicatifs de la chute du sujet âgé, motif d'admission en médecine aiguë.

OBJECTIVE: Falls are a frequent reason for hospitalization in short-stay geriatric units. Paradoxically, the factors determining such hospitalization remain unknown. The objective of our study was to identify the explanatory factors of falls leading to acute-care hospitalization of elderly subjects. PATIENTS AND METHODS: We prospectively compared patients hospitalized for falls and those hospitalized for another reason in a short-stay geriatric unit. Data were collected over a 6-month period starting with a questionnaire and a physical examination. RESULTS: Patients admitted for falls were predominantly women (76.9%) living alone (76.9%). Falls depended mainly on intrinsic factors. The precipitating factor was a medical condition (84%) and acute (96%). The pattern of multiple disease conditions was not specific for patients who fell. Inversely, osteoarthritis and visual and auditory deficits with direct effects on motor functions were correlated with falls. The environment played a determining role, but was primarily a predisposing and not a precipitating factor as is was directly the cause of falls in only 4% of cases. The loss of self-sufficiency for daily activities was also significantly more frequent in patients who fell. DISCUSSION: The explanatory factors of falls as the reason for hospitalization of elderly subjects in short-stay geriatric units are intrinsic factors. They are associated with a precipitating factor which is usually an acute medical condition and a chronic multiple disease state having an effect on postural balance leading to the fall. These factors are combined in a context of social and environmental isolation.

Urine glycyl-L-proline increase and skin trophicity.

Glycyl-L-proline (gly-pro) is an end product of collagen metabolism that is further cleaved by prolidase (EC 3.4.13.9); the resulting proline molecules are recycled into collagen or other proteins. We postulated a relationship between defective gly-pro hydrolysis, increased collagen degradation and skin destruction. This relationship was tested using HPLC to measure the gly-pro in urine. 24 hour urine samples were collected from 27 old people (86 +/- 6 years old), of whom 15 were suffering from skin pressure sores of the sacrum or calcaneus. The urine from patients with pressure sores contained significantly more gly-pro than the urine from the control. A cut-off at 7 mumol/mmol creatinine gave the test a positive predictive value of 70%. Collagen breakdown was also increased as indicated by the increase of hydroxyproline (hyp) in the urine. But this breakdown seemed to stop at the gly-pro step.

Relation between locomotion impairment, functional independence in retirement, and occupational strain resulting from work carried out during working life. Study of a sample population of 350 miners in the Loire valley in France.

STUDY OBJECTIVES: To analyse long term effects of working conditions experienced at an advanced age, and after retirement by quantifying occupational strain, impairment, and disability to establish their interrelation. DESIGN: Retrospective study. PARTICIPANTS: Retired miners from The French Coal Board who had worked in the coal fields of the Loire valley. From a potential population of 507 retired miners, 350 were completely evaluated. MEASUREMENT: The study examines the occupational strain experienced by each subject, measured using both auto-evaluation and evaluation by experts and the locomotion impairment and the functional independence. MAIN RESULTS: A significant relation between the evaluation of occupational strain and functional independence and locomotion impairment of the low back was found and also a significant relation between locomotion impairment of the low back and the length of time spent working at the coal face. CONCLUSIONS: This study confirms other studies as regards the effects of occupation on health status and on the aging process, but it goes further to show the consequences of this relation on functional independence.