Relevance of G8 scale in referring elderly patients with aortic stenosis requiring a TAVI for a geriatric consultation.

Aortic stenosis (AS) may soon become a significant public health issue. Referring elderly suffering from aortic stenosis for a transcatheter aortic valve implantation (TAVI) versus surgical valve replacement might be difficult and requires a multidisciplinary staff. G8 is a geriatric screening scale for frailty, validated in oncogeriatry. We study sensibility and specificity of G8 used by cardiologists in comparison to a comprehensive geriatric assessment (CGA) performed by geriatrician. Prospective study, from February to July 2015, in Bordeaux university Hospital, France. Every elderly admitted for a TAVI had a G8 scale performed by cardiologist and CGA by a geriatrician in blind. Comorbidities were assessed using Cumulative Illness Rating Scale in his geriatric version (CIRS-G). CGA was abnormal if: MMSE <24/30 or GDS ≥7/15 or ADL ≤5/6 or IADL ≤7/8 or TUG ≥20 seconds or if malnutrition was noticed. G8 was abnormal if ≤14/17. We calculated sensibility, specificity, positive and negative predictive value in comparison to gold-standard CGA. 49 patients were included (55.1% women, mean age 84.8 years old). Nearly half of the patients (48.96%) had multiple comorbidities (CIRS G score >3 for at least three items excluding the cardiology item). 38 CGA were abnormal (77.55%) and 41 G8 (83.67%). G8 had a sensibility of 100% (IC 95% [0.9-1]), a specificity of 72.7% (IC 95% [0.43-0.9]), a positive predictive value of 92.6% and a negative prospective value of 100% (IC: 95%). G8 scale seems to be an efficient geriatric screening tool for frailty in elderly undergoing TAVI in comparison to CGA. Simple and useful, G8 scale could be performed by cardiologists in older patients with AS for identifying patients with a geriatric risk profile in consultation before surgery. Further studies with bigger samples are needed to confirm these results.

Drug-related readmissions to medical units of older adults discharged from acute geriatric units: results of the Optimization of Medication in AGEd multicenter randomized controlled trial.

OBJECTIVES: To assess the effect of an intervention on drug-related problem (DRP; adverse drug reactions, adherence problems, underuse)-related readmission rates in older adults. DESIGN: Ancillary study from a 6-month, prospective, randomized, parallel-group, open-label trial. SETTING: Six acute geriatric units in Paris and suburbs. PARTICIPANTS: Six hundred sixty-five consecutively admitted individuals were included: 317 in the intervention group (IG) and 348 in the control group (CG) (aged 86.1 ± 6.2, 66% female). INTERVENTION: Discharge-planning intervention combining chronic drug review, education, and enhanced transition-of-care communication. MEASUREMENTS: Chronic drugs at discharge of the two groups were compared. An expert committee blinded to group assignment adjudicated whether 6-month readmission to the study hospitals was related to drugs. RESULTS: Six hundred thirty-nine individuals were discharged and followed up (300 IG, 339 CG). The intervention had no significant effect on drug regimen at discharge, characterized by prescriptions that are mostly appropriate but increase iatrogenic risk. Three hundred eleven readmissions occurred during follow-up (180 CG, 131 IG), of which 185 (59.5%) were adjudicated (102 CG, 83 IG). For 16, DRP imputability was doubtful. Of the remaining 169, DRPs were the most frequent cause for readmission, with 38 (40.4%) readmissions in the CG and 26 (34.7%) in the IG (relative risk reduction = 14.3%, 95% confidence interval = 14.0-14.5%, P = .54). The intervention was associated with 39.7% fewer readmissions related to adverse drug reactions (P = .12) despite the study's lack of power. CONCLUSION: Drug-related problem prevention in older people discharged from the hospital should be a priority, with a focus on improving the monitoring of drugs with high iatrogenic risk.

[Impact of low-molecular-weight heparin practice guidelines in a geriatric hospital]. / Impact d'un guide de bon usage des anticoagulants sur la prescription des héparines de bas poids moléculaire dans un hôpital gériatrique.

The purpose of this study was to assess the impact of good use of anticoagulants guidelines implementation on low molecular weight heparin (LMWH) prescription in a french geriatric hospital. This interventional "before and after" study was conduced by the same geriatrician on a d-day in 2006 and 2009. Guidelines for anticoagulant's prescription based on selected references in the literature was established by an expert's consensus and implemented in 2008. Data were collected in all departments at the Sainte-Perine geriatric hospital for each patient with an LMWH prescription. Assessment was based on quality judgment criteria (indication, dosage, treatment duration, biological monitoring of LMWH). Data were collected for 72 prescriptions prior to the guidelines implementation and for 54 after. Sex-ratio, mean age and percentage of LMWH prescription did not differ significantly between the two periods. There was a better conformity for LMWH dosage prescription (p = 0.002) and biological monitoring prescription (p = 0.036) after the guidelines implementation. Conformity of LMWH indication and treatment duration were improved but the difference remained not significant (respectively p = 0.49 and p = 0.80). Implementing guidelines for LMWH use in geriatrics can improve quality of prescription. The impact was effective but limited. These guidelines are now in general use in the Sainte-Perine hospital.

Patterns of loss of basic activities of daily living in Alzheimer patients: A cross-sectional study of the French REAL cohort.

BACKGROUND/AIMS: To characterize loss of basic activities of daily living (BADL) in 687 Alzheimer's disease (AD) community-dwelling patients included in the French REAL cohort. METHODS: Patients had mild to moderately severe AD, and the mean age was 77.8 years. Patterns of loss of the 6 BADL were described at inclusion using the Lawton scale. RESULTS: With 6 binary BADL scores, each patient presented at inclusion a set of losses. For 53% of women, the sets of losses were included within each other or were identical, adding losses in physical ambulation, grooming, bathing, dressing, toilet and feeding, respectively. For 47% of men, a similar sequence was identified, with loss of dressing occurring secondly. A global cohesion of sets of losses was found for 87% of women and 86% of men. The Lawton scale is very useful for the assessment of AD patients.