ABSTRACT
Prevalence of anemia in the elderly is high, increases with age and is most often mild. Etiological diagnosis is made in about 70 % of cases, leaving 30 % of unexplained anemia. The unexplained cases are probably multifactorial in relation to usual etiologies of anemia but not detected due to inappropriate diagnosis criteria for advanced age. Recent studies show other potential etiologies for unexplained anemia with new perspectives for treatments.
La prévalence de l'anémie chez la personne âgée est élevée, augmente avec l'âge et est le plus souvent légère. Le diagnostic étiologique est possible dans environ 70 % des cas, laissant 30 % d'anémie inexpliquée. Les causes de l'anémie inexpliquée sont probablement multifactorielles en lien avec des étiologies habituelles de l'anémie mais non détectées en raison de critères diagnostiques inappropriés pour l'âge avancé. Des études récentes montrent également d'autres étiologies potentielles à l'anémie inexpliquée avec de nouvelles perspectives de traitements.
Subject(s)
Anemia , Aged , Humans , Anemia/diagnosis , Anemia/epidemiology , Anemia/etiologyABSTRACT
From the age of fifty onwards a progressive loss of muscle mass may be observed, it often leads to real sarcopenia. Sedentary life style and unbalanced feeding habits represent major risk factors. The decrease in muscle tone leads to a loss of function and an altered quality of life, not to mention socioeconomic factors. The molecular mechanisms of sarcopenia are complex but our understanding of them is increasing. There is no pharmaceutical treatment of sarcopenia of use in current practice. Regular, several times a week, practice of a combination of adapted muscle building physical and endurance exercises, associated with protein intake have shown there use. These exercises must be followed on the long term.
A partir de la cinquantaine, une perte musculaire progressive est observée, elle débouche souvent sur une sarcopénie avérée. Un mode de vie sédentaire et une alimentation mal équilibrée représentent des facteurs de risque majeur. La diminution de la force musculaire se solde par une perte fonctionnelle et une altération de la qualité de vie, sans parler des lourdes conséquences socio-économiques. Les mécanismes moléculaires de la sarcopénie sont complexes mais de mieux en mieux compris. Il n'y a aucun traitement pharmacologique utilisable en pratique courante. La réalisation pluri-hebdomadaire d'une combinaison d'exercices de musculation et d'endurance, adaptés aux possibilités individuelles, associés à un apport protéique et calorique a montré son efficacité. Ces exercices sont à poursuivre sur le long terme.
Subject(s)
Exercise Therapy/methods , Exercise/physiology , Sarcopenia/prevention & control , Aged , Aging/physiology , Humans , Middle Aged , Quality of Life , Risk Factors , Sarcopenia/etiology , Sarcopenia/physiopathology , Sedentary Behavior , Time FactorsABSTRACT
While dementias represent an important problem of social health, they remained underdiagnosed. Data from the literature suggests that only 30% of cognitive impairment are detected and correctly evaluated, while most of the patient (up to 90%) and caregivers (up to 70-80%) ask for a precise diagnosis. Proper evaluation increase diagnostic accuracy from 30% to 80% but 20% of diagnoses remains inexact. Diagnostic disclosure seems to have a positive impact on patient's affective symptoms but is associated to an increase of suicide during the following 3 months, and thus must be a progressive and controlled process. Accompanying a patient in this process necessitates complexes competencies from the primary care physician. Difficulties related to this disclosure are counterbalanced by benefits for both patient and families.
Subject(s)
Dementia/diagnosis , Disclosure , Attitude of Health Personnel , Dementia/etiology , Dementia/psychology , Dementia/therapy , Diagnosis, Differential , Expert Testimony , Health Knowledge, Attitudes, Practice , Humans , Neurologic Examination/standards , Patient Education as Topic/standards , Risk AssessmentABSTRACT
BACKGROUND: Transcutaneous measurements of arterial blood gases (ABG) may decrease the need for repeated arterial puncture in older patients treated for acute cardiac or pulmonary disorders. However, age-related changes in skin perfusion, metabolism, or thickness may alter the validity of the technique. OBJECTIVE: To analyse the agreement between transcutaneous and arterial measurement of PaO2 and PaCO2 in older adults. DESIGN: Prospective descriptive study performed in the intermediate-care unit of a geriatric university hospital and a pulmonary rehabilitation centre. METHODS: 40 patients, aged 82.5+/-8 years (66-97), hemodynamically stable, without vasopressor treatment, underwent simultaneous measurement of arterial blood gases (ABG) and transcutaneous CO2 (TcPCO2) and O2 (TcPO2) with a Radiometer TINA TCM3 capnograph, and a probe T degrees set at 43 degrees C. RESULTS: Correlation between PaCO2 and TcPCO2 was high (r2=0.86) with a low bias (-0.1 mm Hg) and limits of agreement quite compatible with clinical use: (8.3; -8.5 mm Hg). The probe was well tolerated without any cutaneous lesion even after prolonged recordings (up to 8 h). Conversely, although TcPO2 and PaO2 were significantly correlated, the variability around the regression line precludes the use of transcutaneous measurements for monitoring PaO2)in a clinical setting. CONCLUSION: In older subjects, TcPCO2 (but not TcPO2) measurements are reliable when repeated assessment of ABG is warranted.
Subject(s)
Blood Gas Analysis/methods , Monitoring, Physiologic/methods , Age Factors , Aged , Aged, 80 and over , Blood Gas Analysis/instrumentation , Blood Gas Monitoring, Transcutaneous/methods , Body Mass Index , Female , Humans , Male , Monitoring, Physiologic/instrumentation , Prospective Studies , Pulmonary Disease, Chronic Obstructive/blood , Reproducibility of Results , Respiratory Tract Infections/blood , Ventricular Dysfunction, Left/bloodABSTRACT
An 81-y-old woman was hospitalized because of persistent cough, fever, fatigue and weight loss. Disseminated tuberculosis (pulmonary, bronchial, lymph node and urinary involvement) associated with human immunodeficiency virus disease, CDC stage C3 was diagnosed. Antiretroviral therapy initiated 2 months after the introduction of tuberculostatic treatment was well tolerated, with a 12 month follow-up.
