[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"]. / Connaissances et application des recommandations HAS concernant le diagnostic de la dénutrition chez la personne de 70 ans et plus : une enquête menée en ligne auprès des membres de la Société française de gériatrie et de gérontologie.

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.

Prognosis of Old Intensive Care COVID-19 Patients at a Glance: The Senior COVID Study.

OBJECTIVE: Admission in the intensive care unit of the old patient with coronavirus disease 19 raises an ethical question concerning the scarce resources and their short-term mortality. METHODS: Patients aged over 60 from 7 different intensive care units admitted between March 1, 2020 and May 6, 2020, with a diagnosis of coronavirus disease 19 were included in the cohort. Twenty variables were collected during the admission, such as age, severity (Simplified Acute Physiology Score [SAPS] II), several data on physiological status before intensive care unit comorbidities, evaluation of autonomy, frailty, and biological variables. The objective was to model the 30-day mortality with relevant variables, compute their odds ratio associated with their 95% CI, and produce a nomogram to easily estimate and communicate the 30-day mortality. The performance of the model was estimated with the area under the receiving operating curve. RESULTS: We included 231 patients, among them 60 (26.0%) patients have died on the 30th day. The relevant variables selected to explain the 30-day mortality were Instrumental Activities of Daily Living (IADL) score (0.82 [0.71-0.94]), age 1.12 (1.07-1.18), SAPS II 1.05 (1.02-1.08), and dementia 6.22 (1.00-38.58). A nomogram was computed to visually represent the final model. Area under the receiving operating curve was at 0.833 (0.776-0.889). CONCLUSIONS: Age, autonomy, dementia, and severity at admission were important predictive variables for the 30-day mortality status, and the nomogram could help the physician in the decision-making process and the communication with the family.

Senior-COVID-Rea Cohort Study: A Geriatric Prediction Model of 30-day Mortality in Patients Aged over 60 Years in ICU for Severe COVID-19.

The SARS-COV2 pandemic induces tensions on health systems and ethical dilemmas. Practitioners need help tools to define patients not candidate for ICU admission. A multicentre observational study was performed to evaluate the impact of age and geriatric parameters on 30-day mortality in patients aged ≥60 years of age. Patients or next of kin were asked to answer a phone questionnaire assessing geriatric covariates 1 month before ICU admission. Among 290 screened patients, 231 were included between March 7 and May 7, 2020. In univariate, factors associated with lower 30-day survival were: age (per 10 years increase; OR 3.43, [95%CI: 2.13-5.53]), ≥3 CIRS-G grade ≥2 comorbidities (OR 2.49 [95%CI: 1.36-4.56]), impaired ADL, (OR 4.86 [95%CI: 2.44-9.72]), impaired IADL8 (OR 6.33 [95%CI: 3.31-12.10], p<0.001), frailty according to the Fried score (OR 4.33 [95%CI: 2.03-9.24]) or the CFS ≥5 (OR 3.79 [95%CI: 1.76-8.15]), 6-month fall history (OR 3.46 [95%CI: 1.58-7.63]). The final multivariate model included age (per 10 years increase; 2.94 [95%CI:1.78-5.04], p<0.001) and impaired IADL8 (OR 5.69 [95%CI: 2.90-11.47], p<0.001)). Considered as continuous variables, the model led to an AUC of 0.78 [95% CI: 0.72, 0.85]. Age and IADL8 provide independent prognostic factors for 30-day mortality in the considered population. Considering a risk of death exceeding 80% (82.6% [95%CI: 61.2% - 95.0%]), patients aged over 80 years with at least 1 IADL impairment appear as poor candidates for ICU admission.

Quality of life and sarcopenic patients.

Sarcopenia is defined as a progressive and generalised loss of muscle strength, muscle mass and physical performance with advancing age. Among the multiple consequences of sarcopenia, the reduction in the quality of life associated with it can undeniably be considered as a major consequence. Quality of life is measured via generic or specific questionnaires. Current research, mainly using so-called "generic" questionnaires, has identified a reduced quality of life in patients with primary age-related sarcopenia, mainly in areas related to functional status and physical performance. A specific quality of life questionnaire could, in combination with a generic questionnaire, provide more precise data on the impact that sarcopenia has on patient's quality of life. The first quality of life questionnaire specific to sarcopenia, the SarQoL®, was developed in 2015. Psychometric validation of the SarQoL® has been carried out in several international patient populations indicating excellent internal consistency, reliability and convergent validity and sensitivity to change, as well as an absence of floor and ceiling effects. In combination with a generic questionnaire, this specific questionnaire is therefore suitable for measuring the quality of life of populations suffering from sarcopenia, both in research and in clinical practice and in the context of both observational or interventional evaluations.

[Which quality of life for the sarcopenic patient?] / Quelle qualité de vie pour le patient sarcopénique ?

Sarcopenia is defined as a progressive and generalized loss of muscle strength, muscle mass and physical performance with advancing age. Among the multiple consequences of sarcopenia, the reduction in the quality of life associated with it can undeniably be considered as a major consequence. Quality of life is measured via generic or specific questionnaires. Current research, mainly using so-called "generic" questionnaires, identifies a reduced quality of life in patients with primary age-related sarcopenia, mainly in areas related to functional status and physical performance. A specific quality of life questionnaire could, in combination with a generic questionnaire, provide more precise data on the impact that sarcopenia has on the quality of life of patients. It was in 2015 that the first quality of life questionnaire specific to sarcopenia, the SarQoL®, was developed. Psychometric validation of the SarQoL® has been carried out in several international patient populations indicating excellent internal consistency, reliability and convergent validity and sensitivity to change as well as an absence of floor and ceiling effects. In combination with a generic questionnaire, this specific questionnaire is therefore suitable for measuring the quality of life of populations suffering from sarcopenia, both in research and in clinical practice, both in the context of observational or interventional evaluations.

Feasibility of a prehabilitation programme dedicated to older patients with cancer before complex medical-surgical procedures: the PROADAPT pilot study protocol.

BACKGROUND: Ageing is associated with an increased prevalence of comorbidities and sarcopenia as well as a decline of functional reserve of multiple organ systems, which may lead, in the context of the disease-related and/or treatment-related stress, to functional deconditioning. The multicomponent 'Prehabilitation & Rehabilitation in Oncogeriatrics: Adaptation to Deconditioning risk and Accompaniment of Patients' Trajectories (PROADAPT)' intervention was developed multiprofessionally to implement prehabilitation in older patients with cancer. METHODS: The PROADAPT pilot study is an interventional, non-comparative, prospective, multicentre study. It will include 122 patients oriented to complex medical-surgical curative procedures (major surgery or radiation therapy with or without chemotherapy). After informed consent, patients will undergo a comprehensive geriatric assessment and will be offered a prehabilitation kit that includes an advice booklet with personalised objectives and respiratory rehabilitation devices. Patients will then be called weekly and monitored for physical and respiratory rehabilitation, preoperative renutrition, motivational counselling and iatrogenic prevention. Six outpatient visits will be planned: at inclusion, a few days before the procedure and at 1, 3, 6 and 12 months after the end of the procedure. The main outcome of the study is the feasibility of the intervention, defined as the ability to perform at least one of the components of the programme. Clinical data collected will include patient-specific and cancer-specific characteristics. ETHICS AND DISSEMINATION: The study protocol was approved by the Ile de France 8 ethics committee on 5 June 2018. The results of the primary and secondary objectives will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03659123. Pre-results of the trial.

Risk factors for vancomycin-resistant enterococcus acquisition during a large outbreak in patients aged 65 years and older.

BACKGROUND: In the context of an aging population, identifying risk factors for Vancomycin-resistant enterococci (VRE), specific to older people, is important. However, if age is a known risk factor for VRE infection, a limited number of studies have focused on older patients. This study aimed to identify potential risk factors for VRE acquisition in a population aged 65 years and older, during a large VRE outbreak that occurred in a teaching hospital in Lyon, France, from December 2013 to July 2014. METHODS: The present retrospective, multi-center, descriptive, and analytical study used part of a previous cohort, and included only a sub-group of patients aged 65 years and older. The analysis of the factors included in the original study was completed with factors more specific to geriatric patients. Inclusion criteria were patients aged 65 years and older, in contact with a VRE index patient. Patients were screened by rectal swabs. Univariate and multivariate logistic regression analyses were performed. RESULTS: A total of 180 VRE contacts were included and 18 patients became carriers. Multivariate analysis showed that risk factors for VRE acquisition in older people included major contact type (RR: 5.31, 95%CI [1.33; 21.19]), number of antibiotics used (RR: 1.36, 95%CI [1.04; 1.76]), a score of McCabe = 2 (RR: 116.39, 95%CI [5.52; 2455.98]), ethylism (RR: 5.50, 95%CI [1.49; 20.25]), and dementia (RR: 7.50, 95%CI [1.89; 29.80]). CONCLUSIONS: This study was able to demonstrate risk factors for VRE acquisition in older people. These risk factors should be taken into account when in the presence of older people in a VRE infected unit.

[Protein supplementation to prevent loss in muscle mass and strength in frail older patients: a review]. / Quels bénéfices attendre de la supplémentation en protéines pour limiter la perte de masse et de fonction musculaire chez le sujet âgé fragile ?

Minimum levels of protein intake are essential for the preservation of muscle mass and function, which is a major preventive issue of successful aging. Epidemiological studies suggest strong associations between protein intake and the different elements of sarcopenia, namely maintenance of lean mass and muscle strength. Most often, protein intakes among older patients are below requirements, independently from situations of under nutrition. This opens the path for nutritional interventions to prevent the consequences of sarcopenia in older patients. Isolated amino-acids such as leucine have shown positive effects in the short term only. The positive effects of protein supplementations on muscle strength and function are currently not established in the absence of concomitant exercise training. The highest level of evidence supports interventions combining exercise and nutrition.

Age Nutrition Chirugie (ANC) study: impact of a geriatric intervention on the screening and management of undernutrition in elderly patients operated on for colon cancer, a stepped wedge controlled trial.

BACKGROUND: Undernutrition prior to major abdominal surgery is frequent and increases morbidity and mortality, especially in older patients. The management of undernutrition reduces postoperative complications. Nutritional management should be a priority in patient care during the preoperative period. However undernutrition is rarely detected and the guidelines are infrequently followed. Preoperative undernutrition screening should allow a better implementation of the guidelines. METHODS/DESIGN: The ANC ("Age Nutrition Chirurgie") study is an interventional, comparative, prospective, multicenter, randomized protocol based on the stepped wedge trial design. For the intervention, the surgeon will inform the patient of the establishment of a systematic preoperative geriatric assessment that will allow the preoperative diagnosis of the nutritional status and the implementation of an adjusted nutritional support in accordance with the nutritional guidelines. The primary outcome measure is to determine the impact of the geriatric intervention on the level of perioperative nutritional management, in accordance with the current European guidelines. The implementation of the intervention in the five participating centers will be rolled-out sequentially over six time periods (every six months). Investigators must recommend that all patients aged 70 years or over and who are consulting for a surgery for a colorectal cancer should consider participating in this study. DISCUSSION: The ANC study is based on an original methodology, the stepped wedge trial design, which is appropriate for evaluating the implementation of a geriatric and nutritional assessment during the perioperative period. We describe the purpose of this geriatric intervention, which is expected to apply the ESPEN and SFNEP recommendations through the establishment of an undernutrition screening and a management program for patients with cancer. This intervention should allow a decrease in patient morbidity and mortality due to undernutrition. TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov NCT02084524 on March 11, 2014 (retrospectively registered).

Hydrocephalus due to extreme dilation of Virchow-Robin spaces.

Virchow-Robin spaces (VRS) are extensions of the subarachnoid space surrounding perforating blood vessels entering the brain parenchyma. VRS are fluid filled, but almost virtual and only visible on MRI of the brain when dilated. Such dilations are commonly asymptomatic. In rare cases, extreme dilations can be observed; the clinical repercussions of which remain unclear. We report the case of a patient presenting symptoms of normal pressure hydrocephalus due to extreme VRS mesencephalon dilations.