Evaluation of Nutritional Status in an Acute Geriatric Unit: Retrospective Study and Analysis of Frailty Syndrome.

INTRODUCTION: The aim of our study is to evaluate the nutritional status of patients in an acute geriatric unit. METHODS: Patients included in the study were hospitalized in an acute geriatric unit over a period of 6 months. The nutritional status of each patient was evaluated with anthropometric measurements (the BMI and MNA scales), and biological measurements (albumin). Frailty was evaluated using three scales: the Fried scale, the CFS and the modified SEGA scale. RESULTS: A total of 359 patients were included, comprising 251 women (70%) with an average age of 85.28 years. The study showed that 102 elderly subjects were considered undernourished according to the BMI scale, 52 subjects were undernourished according to the MNA scale, and 50 subjects were undernourished according to their albumin levels. The relationships between undernutrition and frailty syndrome studied in our work show that elderly subjects who are undernourished according to the BMI and MNA scales are significantly frail according to Fried and Rockwood, whereas those who are undernourished according to their albumin levels are significantly frail according to Fried and the modified SEGA scale. CONCLUSION: The relationship between undernutrition and the frailty syndrome is close, and their joint screening is necessary, whether on an outpatient or in-hospital basis, in order to prevent negative events related to comorbidities and geriatric syndromes.

Zulfiqar Frailty Scale (ZFS): Concordance Study with the Clinical Frailty Scale (CFS).

Introduction: We designed a new scale for the rapid detection of frailty for use in primary care, referred to as the Zulfiqar Frailty Scale (ZFS). Objective: To evaluate the performance of the "ZFS" tool to screen for frailty as defined in the Clinical Frailty Scale (CFS) criteria in an ambulatory population of patients at least 75 years old. Method: A prospective study conducted in Alsace, France, for a duration of 6 months that included patients aged 75 and over was judged to be autonomous with an ADL (Activity of Daily Living) > 4/6. Results: In this ambulatory population of 124 patients with an average age of 79 years, the completion time for our scale was less than two minutes, and the staff required no training beforehand. Sensibility was 67%, while specificity was 87%. The positive predictive value was 80%, and the negative predictive value was 77%. The Youden index was 59.8%. In our study, we have a moderate correlation between CFS and ZFS (r = 0.674 with 95%CI = [0.565; 0.760]; p-value < 2.2 × 10−16 < 0.05). The Pearson correlations between these two geriatric scores were all strong and roughly equivalent to each other. The kappa of Cohen (k) = 0.46 (Unweighted), moderate concordance between the ZFS and CFS scales according to Fleiss classification. Conclusion: The "ZFS" tool makes it possible to screen for frailty with a high level of specificity and positive/negative predictive value.

Association of Frailty Status with Risk of Fall among Hospitalized Elderly Patients: A Cross-Sectional Study in an Acute Geriatric Unit.

Introduction: The objective was to study the association of frailty status in hospitalized elderly patients with risk of fall in an acute geriatric unit and to characterize elderly "fallers" using a comprehensive gerontological assessment. Patients and Methods: A cross-sectional study was conducted in patients over 65 years of age and hospitalized in an acute geriatric unit. This work was carried out in the Acute Geriatric Medicine Unit, Saint-Julien Hospital, Center Hospitalier Universitaire de Rouen from 1 June 2016 to 15 August 2016. Results: 172 patients were included during the collection period, with a female predominance of 115 patients (66.9%). The average age of the sample was 79.37 years old (65−85). The average CHARLSON score was 6.93 (3−16). Patients came from home in 81.4% of cases (i.e., 140 patients), and from a nursing home in 18.6% of cases (i.e., 32 patients). The risk of falling, as assessed by the Monopodal Support Test, returned as abnormal for 127 patients. In our series, there was a statistically strong link between the risk of falling and the presence of a dementia pathology (p = 0.009), the presence of a vitamin D deficiency (p = 0.03), the presence of frailty, as assessed by the three scales (modified SEGA scale, Fried scale and CFS/7 (<0.001), a high comorbidity score (p = 0.04), and a disturbed autonomy assessment according to IADL (p = 1.02 × 10−5) and according to ADL (p = 6.4 × 10−8). There was a statistically strong link between the risk of falling and the occurrence of death (p = 0.01). Conclusion: The consequences of the fall in terms of morbidity and mortality and the frequency of this event with advancing age and its impact on the quality of life as well as on health expenditure justify a systematic identification of the risk of falling in the elderly population. It is therefore important to have sensitive, specific, and reproducible tools available for identifying elderly people at high risk of falling.

Physical Activity in the Elderly and Frailty Syndrome: A Retrospective Study in Primary Care.

OBJECTIVES: Physical activity carries numerous therapeutic benefits, and it is more effective when applied before the onset of symptoms. The objective of this study is to compare the correlation of the evaluation of physical activity carried out using the Ricci and Gagnon test and the frailty profile measured by the mSEGA scale in a population of patients consulting in general medicine. METHODS: We conducted a retrospective study within a general practitioner clinic in Chaumont and Bologne (Haute-Marne department) during a 3-month period. Patients aged 65 years and up were screened for frailty using the modified SEGA (mSEGA) assessment, and physical activity was measured using the Ricci-Gagnon questionnaire. RESULTS: A total of 44 patients were selected, with a slightly female predominance (59.1%). Of these, 21 patients reported having worked in manual labor. Seven patients were found to be frail using the SEGAm assessment, while 10 (22.73%) patients had an inactive profile according the Ricci-Gagnon score. Malnutrition was detected in six patients (13.64%) using the MNA survey. Frailty as defined by the mSEGA scale had no statistical correlation (p = 0.68) with the Ricci-Gagnon score. A Ricci-Gagnon inactive profile showed statistical correlations with fall indicators (unipedal balance test, p = 0.014) and malnutrition scores using the MNA (p = 0.0057) as well as with the Charlson Comorbidity Index (p = 0.027). CONCLUSION: A systematic survey of the elderly by a general practitioner implementing a regular and suitable physical activity regimen would allow a better screening of frailty, minimizing its complications.

Obesity and Frailty Syndrome in the Elderly: Prospective Study in Primary Care.

Background: Obesity is a chronic pathology that affects people of all ages, from infants to the elderly, residing in both developed and developing countries. Objective: Our aim is to study the link between obesity and frailty in the elderly. Method: A prospective study was carried out in 12 General Medicine practices in Champagne-Ardenne, in the Departments of Marne and the Ardennes, France, for a period of 12 months (from 2 May 2019 through 30 April 2020). All patients included were aged 65 or older, in consultation with a general practitioner, and had an ADL (Activity of Daily Living) greater than or equal to 4. Frailty was measured using the Fried scale and the simplified ZULFIQAR frailty scale. Results: 268 patients aged 65 and over were included, with an average age of 77.5 years. A total of 100 were obese according to BMI. The mean Fried (/5) in the series was 1.57, and the mean sZFS (/5) was 0.91. Our study shows that obesity is not significantly correlated with frailty according to the FRIED sarcopenic scale, but is significantly correlated with frailty according to the sZFS scale. Conclusions: The link between obesity and frailty remains much debated, with the underlying emergence of sarcopenic obesity equally prevalent among the elderly. This is a preliminary study that should be followed by large-scale outpatient studies to better clarify the links between sarcopenia and obesity.

Concordance in mSEGA Tool to Frailty Diagnosis between Medical Doctors and Nurses.

Introduction: It is currently considered that screening for frailty in elderly subjects is a major public health issue. Methods: a cross-sectional pilot study involving elderly subjects (over 75 years of age) admitted at the emergency department of the hospital of Troyes, France in the period from 24 August to 30 August 2017 was conducted. The patients were screened for frailty using the modified SEGA (Short Emergency Geriatric Assessment) (part A) grid (mSEGA), correlated with the subjective opinion of the triage nurse and the senior physician. Results: 100 patients were included during the pilot study period, the mean age was 84.34 years (range: 75-97), 56 patients (56%) were female, and the average CHARLSON score was 4.28 (range: 0-11). The patients' previous medical histories were remarkable for cardiovascular diseases. The main reason for hospital admission was fall (26 subjects, 26%). Hospitalization was required for 52 subjects (52%). The average mSEGA score was 6.3 +/- 3.59. The completion time for the SEGAm (part A) score was about 5 minutes. According to Cohen's kappa, the concordance between the subjective opinion of the triage nurse and the mSEGA grid was average, while the concordance between the subjective opinions of the senior physicians was good. Conclusion: The mSEGA score appears to be well-suited and useful in the emergency department. It is easy to use, allows an overall evaluation of the patient, and is not time-consuming.

[Covid19 in a polypathological subject]. / Pneumopathie a covid19 chez un sujet polypathologique.

In December 2019, an outbreak of pneumonia due to the 2019 novel coronavirus, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), broke out in Wuhan, Hubei, China. This betacoronavirus causes a sometimes severe respiratory pathology, named COVID-19 by the World Health Organization (WHO). The WHO declared COVID-19 as a pandemic in March 2020. It is Mrs. RM, 71 years old of French nationality who consults for dyspnea on exertion for 8 days associated with a dry cough, an intermittent fever with periods of spontaneous remissions, a chest pain accentuated by the efforts of cough, a physical asthenia, non-selective anorexia, diarrhea and vomiting. The physical examination found respiratory distress with 72% desaturation in ambient air, requiring oxygen-requisition with 96% oxygen saturation under 10 liters with no sign of respiratory struggle; crackling rales with 2 more predominant lung fields on the right, mucocutaneous jaundice, edema of the lower limbs. The management was intubation upon admission with mechanical ventilation, oral administration of hydroxychloroquine 200 mg due to 2 tablets morning and evening for 24 hours then 1 tablet morning and evening for 04 days, antibiotic therapy based on ceftriaxone 1g morning and evening was implemented, in the absence of bacteriological evidence. The course was unfavorable with a death with the absence of clinical improvement and a very precarious hematosis escaping any treatment alternative. CONCLUSION: Covid19 is a very serious virus with a poor prognosis in multiple pathological patients.

En décembre 2019, une épidémie de pneumonie due au nouveau coronavirus 2019, le SARS-CoV-2 (sévère acute respiratory syndrome coronavirus 2) a éclaté à Wuhan, Hubei, Chine. Ce bétacoronavirus provoque une pathologie respiratoire parfois sévère, nommée COVID-19 par l'organisation mondiale de la santé (OMS). L'OMS a déclaré en mars 2020, la COVID-19 comme une pandémie. Il s'agit de madame RM, 71 ans de nationalité française qui consulte pour dyspnée d'effort depuis 8 jours associée à une toux sèche, une fièvre intermittente avec des périodes de remissions spontanées, une douleur thoracique accentuée par les efforts de toux, une asthénie physique, une anorexie non sélective, des diarrhées et vomissements. L'examen physique retrouve une détresse respiratoire avec une désaturation à 72% en air ambiant, nécessitant une oxygeno-réquerance avec une saturation en oxygène à 96% sous 10 litres sans signe de lutte respiratoire ; des rales crépitants aux 2 champs pulmonaires plus prédominants à droite, un ictère cutanéomuqueux, des œdèmes des membres inférieurs. La prise en charge a été une intubation dès son admission avec ventilation mécanique, l'administration par la voie orale de l'hydroxychloroquine 200 mg en raison de 2 comprimés matin et soir pendant 24heures puis 1comprimé matin et soir pendant 04 jours, l'antibiothérapie à base de ceftriaxone 1g matin et soir a été mis en place, en l'absence de preuve bactériologique. L'évolution fut défavorable par un décès avec l'absence d'amélioration clinique et une hématose très précaire échappement à toute alternative thérapeutique. CONCLUSION: La covid19 est une virose très grave au pronostic sombre chez les patients poly- pathologiques.