Association of body mass index with long-term outcomes in older adults hospitalized for COVID-19: an observational study.

Both underweight and obesity have been associated with poor prognosis in COVID-19. In an older populations of patients hospitalized for SARS-CoV-2 infection, we aimed to evaluate the association between body mass index (BMI) and short and long-term prognosis. Among 434 consecutive patients aged ≥ 70 years and hospitalized for suspected COVID-19 at a university hospital, 219 patients (median age of 83 years, 53% male) testing positive for COVID-19 and for whom BMI was recorded at admission, agreed to participate. Among them, 39 had a BMI < 20 kg/m2, 73 had a BMI between 20 and 24.9 kg/m2 and 107 had a BMI ≥ 25 kg/m2. After adjustment for confounders, BMI < 20 kg/m2 was associated with a higher risk of one-year mortality (hazard ratio (HR) [95% confidence interval]: 1.75 [1.00-3.05], p = 0.048), while BMI ≥ 25 kg/m2 was not (HR: 1.04 [0.64-1.69], p = 0.9). However, BMI was linearly correlated with both in-hospital acute respiratory failure (p = 0.02) and cardiovascular events (p = 0.07). In this cohort of older patients hospitalized for COVID-19, low BMI, rather than high BMI, appears as an independent risk factor for death after COVID-19. The pathophysiological patterns underlying this excess mortality remain to be elucidated.

Quality of Life and Needs in Caregivers: Results From the Prospective Multicentric Open-Label Randomized Study of Informal Caregivers of Elderly Patients.

Objectives: To assess health-related quality of life (QoL) in caregivers of elderly patients with chronic disabilities receiving, or not receiving, social worker support. Methods: This multicenter open-label randomized study assigned caregivers to receive an information booklet, exclusively, or with social worker support. Caregivers completed Short Form-36 (SF-36) and Hospital Anxiety Depression Scale quarterly, and Zarit Burden Interview each semester, for 24 months. We reported caregiver QoL mean changes at 12 and 24 months (M12, M24). Longitudinal QoL analysis up to M24 used mixed models for repeated measures (MMRM). Results: Among the 179 caregivers randomized from 2015 to 2019, the SF-36 physical and mental component summary showed no significant changes at M12 and M24, in terms of neither anxiety nor burden. However, depression significantly increased (M12: 1.4 ± 4.0; M24: 1.7 ± 4.1) with significant adjusted mean increase using MMRM at M24: 3.4 [0.6-2.5] in the control group, exclusively. Conclusion: These findings call for better recognition of the social support to prevent caregiver QoL deterioration and alleviate their depression early in the course of the disease. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT02626377.

Associated Factors to Efficacy and Tolerance of Immunotherapy in Older Patients with Cancer Aged 70 Years and Over: Impact of Coprescriptions.

BACKGROUND: Immunotherapy with immune checkpoint blockers (ICB) significantly improves the prognosis for an increasing number of cancers. However, data on geriatric populations taking ICB are rare. OBJECTIVE: This study aimed to identify factors associated with the efficacy and tolerance of ICB in an older population. PATIENTS AND METHODS: This retrospective monocentric study included consecutive patients aged ≥ 70 years with solid cancer who received ICB between January 2018 and December 2019. Efficacy was assessed by progression-free survival (PFS) and tolerance was defined as cessation of immunotherapy due to the occurrence of any adverse event. RESULTS: One hundred and five patients (65.7% men) were included, mainly at the metastatic stage (95.2%); 50.5% had lung cancer. Most (80%) patients were treated with anti-PD1 (nivolumab, pembrolizumab), 19.1% with anti-PD-L1 (atezolizumab, durvalumab, and avelumab) and 0.9% with anti-CTLA4 ICB (ipilimumab). Median PFS was 3.7 months [95% confidence interval (CI) (2.75-5.70)]. PFS was shorter in univariate analysis when ICB was taken concomitantly with an antiplatelet agent (AP) [hazard ratio (HR) = 1.93; 95% CI (1.22-3.04); p = 0.005]. Tolerance was lower in univariate analysis for lung cancer [odds ratio (OR) = 3.03; 95% CI (1.07-8.56), p < 0.05] and in patients taking proton pump inhibitors (PPI) [OR = 5.50; 95% CI (1.96-15.42), p < 0.001]. There was a trend toward poorer tolerance among patients living alone [OR = 2.26; 95% CI (0.76-6.72); p = 0.14]. CONCLUSIONS: In older patients taking ICB for solid cancers, concomitant AP may influence efficacy and concomitant PPI may influence tolerance. Further studies are needed to confirm these results.

Long-Term Survival After Aspiration Pneumonia in Older Inpatients: A Comparative Study.

OBJECTIVES: Aspiration pneumonia (AsP), a leading cause of death in older people, remains poorly studied. We aimed to evaluate short- and long-term prognosis after AsP in older inpatients. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: All consecutive patients aged ≥75 years hospitalized in a 62-bed acute geriatric unit during a 1-year period. METHODS: We compared clinical characteristics and overall 2-year survival between patients with a main diagnosis of AsP, patients with other types of acute pneumonia (non-AsP), and patients hospitalized for another cause. RESULTS: Among the 1774 patients hospitalized over 1 year (median age: 87 years, 41% female), 125 (7%) had a primary diagnosis of acute pneumonia, of whom 39 (31%) had AsP and 86 (69%) non-AsP. Patients with AsP were more frequently male, lived more frequently in a nursing home, and had a more frequent history of stroke or neurocognitive disorders. Mortality rates were much higher after AsP, reaching 31% at 30 days (vs 15% after Non-AsP and 11% in the rest of the cohort, P < .001), and 69% 2 years after admission (vs 56% and 49%, P < .001). After adjustment for confounders, AsP was significantly associated with mortality but non-AsP was not [adjusted hazard ratio (95% CI): 3.09 (1.72-5.57) at 30 days and 1.67 (1.13-2.45) at 2 years for AsP; 1.36 (0.77-2.39) and 1.14 (0.85-1.52) for non-AsP]. However, among patients who survived at 30 days, mortality did not significantly differ between the 3 groups (P = .1). CONCLUSIONS AND IMPLICATIONS: In an unselected cohort of patients hospitalized in an acute geriatric unit, a third of AsP patients died within the first month after admission. However, among those surviving at 30 days, long-term mortality did not significantly differ from the rest of the cohort. These findings underline the importance of optimizing the early management of AsP.

Neuromuscular fatigability of plantar flexors following continuous and intermittent contractions.

The purpose of this study is to investigate if a continuous muscle contraction (CON) is more fatiguing than an intermittent exercise (INT) performed until task failure. To get a more comprehensive picture of neuromuscular fatigability, in addition to the commonly used maximal voluntary contraction (MVC), we assessed the maximal torque sustainability (i.e., the ability to maintain a high level of torque for 1 min). Fourteen subjects performed a plantar flexors MVC of 1-min duration (MVC1-MIN) before and after CON or INT contractions at 40% MVC until task failure. Despite a greater torque-time integral for the INT task, a similar MVC reduction was found after both exercises. On the contrary, a greater torque loss during the MVC1-MIN was observed after the CON exercise and it was positively correlated to the mean exercise torque. These results reveal that, for exercises performed until exhaustion, the contraction pattern (i.e., CON vs. INT) affects the ability to maintain a high level of torque, but does not influence the maximal torque production capacity. Thus, we demonstrate that maximal torque production and sustainability are two distinct and complementary characteristics of neuromuscular fatigability. Consequently, when considering both capacities, it results that, an exhausting CON contraction is more fatiguing than an exhausting INT effort. This highlights the importance of simultaneously evaluating both capacities when exploring neuromuscular fatigability.NEW & NOTEWORTHY This study provides new information about the influence of the contraction pattern (i.e., continuous and intermittent) on the development of neuromuscular fatigability when exercise is performed until exhaustion. Maximal torque production is similarly reduced by both exercises, whereas maximal torque sustainability is impaired only after the continuous exercise. To evaluate neuromuscular fatigability, we then recommend using a sustained maximal voluntary contraction since this measure allows to concurrently collect information on complementary aspects of neuromuscular fatigability.

Quality of life and perceived burden of the primary caregiver of patients aged 70 and over with cancer 5 years after initial treatment.

PURPOSE: Long-term effects of being the primary caregiver of an older patient with cancer are not known. This study aimed to assess health-related quality of life (HRQoL) in primary caregivers of patients aged 70 and older with cancer, 5 years after initial treatment. Secondly, to compare the HRQoL between former primary caregivers whose caregiving relationship had ceased (primary caregiver no longer directly assisting the patient because of patient death or removal to another city or admission to an institution) and current caregivers, and to determine the perceived burden of the primary caregivers. METHODS: Prospective observational study including primary caregivers of patients aged 70 and older with cancer. HRQoL and perceived burden were assessed using the SF-12 and Zarit Burden Interview (ZBI) at baseline and 5 years after initial treatment. RESULTS: Ninety-six caregivers were initially included; at 5 years, 46 caregivers completed the SF-12 and ZBI between June 15 and October 26, 2020. Primary caregiver's HRQoL scores had significantly decreased over time for physical functioning (mean difference = -10, p=0.04), vitality (MD= -10.5, p=0.02), and role emotional (MD= -8.1, p=0.01) dimensions. The comparison at 5 years according to caregiving status showed no difference for all HRQoL dimensions. There was no decrease in perceived burden at 5 years. CONCLUSION: Some dimensions of HRQoL decreased at 5 years with a stable low perceived burden. TRIAL REGISTRATION: NCT04478903.

[Inappropriate admissions of Ehpad residents to emergency departments]. / Admissions inappropriées des résidents d'Ehpad aux urgences.

After a review of inappropriate admissions of residents of residential care facilities for the dependent elderly (Ehpad) to the emergency room, we propose ways to reduce them. They include giving the coordinating physician a clinical role, organizing continuity and permanence of care in all Ehpad, signing agreements between Ehpad and hospital for direct hospitalization and collaboration with mobile teams and geriatric hotlines, generalizing the level of medical intervention in Ehpad, and deepening the training of Ehpad caregivers in geriatrics.

Direct Oral Anticoagulants versus Vitamin K Antagonists in Individuals Aged 80 Years and Older: An Overview in 2021.

Two main types of oral anticoagulants are available in France: vitamin K antagonists (VKA) and, more recently, direct oral anticoagulants (DOAC). The benefit−risk profile appears to be favorable for DOAC, which is as effective as VKA but safer (fewer cases of severe and cerebral bleeding). In a study in 2017, we observed that older adults did not seem to receive the same modalities of oral anticoagulants as younger individuals for various reasons. To assess anticoagulation prescribing practices over time, we repeated this cross-sectional study by comparing very old individuals taking DOAC to those taking VKA. Ambulatory individuals aged 80 years and older were included. They were affiliated with the Mutualité Sociale Agricole of Burgundy and were refunded for a medical prescription of oral anticoagulation in March 2021. The demographic characteristics, registered chronic diseases (RCD), number and types of prescribed drugs, and mortality of the DOAC group and the VKA group were compared. A total of 4275 subjects were included in the study: 67.44% (2883) received DOAC and 32.56% (1392) received VKA. The two groups were similar in age. In the DOAC group, there were more women (54.98% vs. 46.98%) (p < 0.001), fewer RCD (91.47% vs. 93.68%) (p = 0.014), and lower rates of venous thromboembolism (2.53% vs. 6.75%) (p < 0.001), severe heart failure (56.50% vs. 68.03%) (p < 0.001), and severe kidney diseases (1.38% vs. 3.59%) (p < 0.001), but there were more subjects with Alzheimer's disease (7.49% vs. 4.31%) (p = 0.001). Individuals in the DOAC group had fewer prescriptions of furosemide (48.53% vs. 55.75%) (p < 0.001) and fibrates (2.32% vs. 3.88%) (p = 0.044). They also had more prescriptions of proton pump inhibitors (43.95% vs. 39.44%) (p = 0.006) and antirheumatics (1.60% vs. 0.65%) (p = 0.009) than those in the VKA group. There was no difference in mortality. This study revealed that prescribing practices for DOAC have changed over time.

Apyrexia improves the prognostic value of quick SOFA in older patients with acute pneumonia or bacteremic urinary tract infection.

PURPOSE: Apyrexia is increasingly recognized as an indicator of inadequate inflammatory response in older patients with suspected infection. We aimed to evaluate whether temperature at admission could improve the prognostic value of the Quick Sequential Organ Failure Assessment (qSOFA) for predicting in-hospital mortality after acute infection. METHODS: We created a new score, named qSOFAGE (qSOFA in GEriatrics), by adding apyrexia as an item to the existing qSOFA (+ 1 point if temperature at admission ≤ 38 °C). We compared the prognostic value of the qSOFA, the qSOFAGE and temperature at admission for predicting in-hospital mortality after acute infection in two cohorts including older patients with acute pneumonia (AP) or bacteremic urinary tract infection (UTI). RESULTS: 217 consecutive patients aged ≥ 75 hospitalized for AP (first cohort) and 105 for bacteremic UTI (second cohort) were recorded. Temperature at admission was strongly inversely correlated with in-hospital mortality in both cohorts (Odds Ratios per °C (95% Confidence Interval): 0.60 (0.45-0.80) and 0.46 (0.27-0.79) for AP and UTI. respectively). Adding the temperature ≤ 38 °C item to the qSOFA markedly improved its predictive value for in-hospital mortality in the two groups: C-statistics for qSOFAGE vs. qSOFA: 0.63 (0.53-0.73) vs. 0.56 (0.46-0.67) in AP cohort; 0.74 (0.58-0.89) vs. 0.69 (0.53-0.85) in UTI cohort. For patients with qSOFAGE ≥ 3, in-hospital mortality reached 37% after AP and 55% after bacteremic UTI. CONCLUSION: Temperature at admission was strongly correlated with mortality in these two cohorts of older patients hospitalized for acute infection. The next step will be to validate this score in cohorts of older patients with suspected infection.

[Physical activity in the elderly with a major neurocognitive disorder]. / Activité physique chez le sujet âgé atteint d'un trouble neurocognitif majeur (2/2).

A better knowledge of major neurocognitive disorders and motor learning allows us to propose motor rehabilitation (MR) adapted to subjects with Alzheimer's disease. Recent neuroscientific data on motor functions and cognition allow the construction of physical activity and MR programs, for which the dose-response relationship, content and instructions are determining factors. Further studies are needed to confirm the effectiveness of the methods used.

[Physical activity in the elderly with other major neurocognitive disorders]. / Activité physique chez le sujet âgé atteint d'un trouble neurocognitif majeur.

For decades, the literature was skeptical about the feasibility of motor rehabilitation and its impact, as well as that of physical activity (PA), in subjects with major neurocognitive disorders (MNCD), including Alzheimer's disease. Now, authors report several benefits of PA, both physical and cognitive, by promoting brain perfusion, neurogenesis and synaptic plasticity, as well as decreasing oxidative stress and inflammation. PA should be recommended in cases of TNCM.

T-cell immune response predicts the risk of critical SARS-Cov2 infection in hospitalized COVID-19 patients.

INTRODUCTION: This study aimed to identify markers of disease worsening in patients hospitalized for SARS-Cov2 infection. PATIENTS AND METHODS: Patients hospitalized for severe recent-onset (<1 week) SARS-Cov2 infection were prospectively included. The percentage of T-cell subsets and plasma IL-6 at admission (before any steroid therapy) were compared between patients who progressed to a critical infection and those who did not. RESULTS: Thirty-seven patients (18 men, 19 women) were included; 11 (30%) progressed to critical infection. At admission, the critical infection patients were older (P = 0.021), had higher creatinine levels (P = 0.003), and decreased percentages of circulating B cells (P = 0.04), T cells (P = 0.009), and CD4+ T cells (P = 0.004) than those with a favorable course. Among T cell subsets, there was no significant difference between the two groups except for the percentage of Th17 cells, which was two-fold higher in patients who progressed to critical infection (P = 0.028). Plasma IL-6 at admission was also higher in this group (P = 0.018). In multivariate analysis, the percentage of circulating Th17 cells at admission was the only variable associated with higher risk of progression to critical SARS-Cov2 infection (P = 0.021). CONCLUSION: This study suggests that an elevated percentage of Th17 cells in patients hospitalized for SARS-Cov2 infection is associated with an increased risk of progression to critical disease. If these data are confirmed in a larger study, this marker could be used to better target the population of patients in whom tocilizumab could decrease the risk of progression to critical COVID-19.

Prise en charge de sujets âgés chuteurs en atelier « Équilibre et prévention des chutes ¼ en hôpital de jour gériatrique : étude observationnelle prospective.

Résumé Introduction. Cette étude évaluait l'impact d'un atelier équilibre en hôpital de jour gériatrique sur la prévention des chutes chez le sujet âgé. Méthode. Il s'agissait d'une étude prospective et monocentrique. Des tests moteurs ont été réalisés ainsi qu'un bilan psychologique à 2 mois (M2), à 6 mois (M6) et à 1 an (M12). Résultats. Soixante-cinq patients ont été inclus, d'âge moyen de 82,0 ans, dont 58 femmes. Il existait une amélioration significative des différents tests moteurs durant le suivi. La durée du Timed Up and Go (s), passait de 19,1 ± 8,2 à l'inclusion, à 15,8 ± 6,6 à M2 (P = 0,01 ), à 16,4 ± 6,9 à M6 (P = 0,04 inclusion vs M6) et à 16,3 ± 6,4 à M12 (P = 0,04 inclusion vs M12). Il existait aussi une amélioration psychologique significative. Le score à l'échelle Falls Efficacy Scale International-I passait de 11,6 ± 6,1 à l'inclusion à 8,2 ± 5,5 à M2 (P = 0,001), à 9,2 ± 6,0 à M6 (P = 0,02 inclusion vs M6) et à 9,0 ± 6,1 à M12 (P = 0,02 inclusion vs M12). CONCLUSION: Cette étude souligne l'intérêt des ateliers équilibre en soins primaires. Abstract Introduction. Falls are a major public health problem as a result of the high frequency of these events and morbidity/mortality among elderly persons. A prevention policy is a potential means to reduce the incidence of falls. This study aimed to assess the impact of a balance workshop in a geriatric day-hospital (GDH) on the prevention of falls in olderadults. METHOD: This was a prospective, single centre study conducted in the GDH of a general hospital. Motor tests and a psychological assessment were performed at 2 months (M2), 6 months (M6)and 1 year (M12). RESULTS: Sixty-five patients were included, aged 82.0 ± 7.7 years. Fifty-eight were women (89.2%). The statistical analyses showed a significant improvement in all motor tests during the follow-up at the defined intervals. The Timed Up and Go test (s) significantly decreased between inclusion, 19.1 ± 8.2, and M2, 15.8 ± 6.6 (P = 0.01 inclusion vs M2), then was stable at M6, 16.4 ± 6.9 (P = 0.04 inclusion vs M6) and at M12, 16.3 ± 6.4 (P = 0.04 inclusion vs M12). There was also significant psychological improvement throughout follow-up. The score on the Falls Efficacy Scale International-I decreased from 11.6 ± 6.1 at inclusion to 8.2 ± 5.5 at M2 (P = 0.001 inclusion vs. M2), 9.2 ± 6.0 at M6 (P = 0.02 inclusion vs. M6), and 9.0 ± 6.1 at M12 (P = 0.02 inclusion vs. M12). CONCLUSION: This study highlights the value and the need for balancing workshops in primary care.

Cognition Impairment and Gait Disorders in Older Adults.

Thanks to the increase in life expectancy linked to scientific and medical progress and improvements in hygiene conditions, the population of people aged 75 years and over continues to grow worldwide, particularly in industrialized countries [...].

Mid-Term Mortality in Older Anemic Patients with Type 2 Myocardial Infarction: Does Blood Transfusion sImprove Prognosis?

(1) Anemia often predisposes older patients to type 2 myocardial infarction (T2MI). However, the management of this frequent association remains uncertain. We aimed to evaluate the impact of red blood cell transfusion during the acute phase of T2MI in older anemic inpatients. (2) Methods and results: We performed a retrospective study using a French regional database. One hundred and seventy-eight patients aged 65 years or older, presenting with a T2MI and anemia, were selected. Patients were split into two groups: one that received a red blood cell transfusion (≥1 red blood cell unit) and one that did not. A propensity score was built to adjust for potential confounders, and the association between transfusion and 30-day mortality was evaluated with an inverse propensity score weighted Cox model. Transfusion was not associated with 30-day all-cause mortality (propensity score weighted hazard ratio (HR) 1.59 (0.55-4.56), p = 0.38). However, 1-year all-cause mortality was significantly higher in the transfusion group (propensity score weighted HR 2.47 (1.22-4.97), p = 0.011). (3) Conclusion: Our findings in older adults with anemia suggest that blood transfusion in the acute phase of T2MI could not be associated with improved short-term prognosis. Prospective studies are urgently needed to assess the impact of transfusion on longer-term prognosis.

Transfusion in Older Anemic Patients: Should the Troponin Value Be Taken into Account?

BACKGROUND: Anemia is common in older individuals, but it is not known whether the prognostic impact of transfusion differs according to cardiac troponin concentration. METHODS: During this 2-year retrospective study in an acute geriatric unit, 514 patients with hemoglobin <10 g/dL and troponin sampling were included. Thirty-day and 1-year mortality were compared according to transfusion status and troponin and hemoglobin levels. RESULTS: Of the 514 anemic patients included (median age 88 years), 157 (31%) had elevated troponin concentrations. These patients were more likely to die at 30 days (49% vs 27%, P < .001) and 1 year (65% vs 51%, P = .004) than patients with normal values. Among patients with elevated troponin concentrations, 30-day mortality tended to be lower in transfused than in not-transfused patients (hazard ratio 0.48; 95% confidence interval, 0.21-1.08; P = .07). This association was not found in patients without troponin elevation (hazard ratio 1.09; 95% CI, 0.61-1.93; P = .8). Transfusion was associated with 30-day survival in patients with hemoglobin ≤8 g/dL. It was also associated with excess 1-year mortality in patients with hemoglobin >8 g/dL. CONCLUSIONS: This pilot study suggests that transfusion could be associated with better 30-day outcomes in older anemic patients with anemia-related myocardial injury. Thus, troponin levels could be involved in decision-making relative to transfusion in anemic older patients. Clinical trials are needed to establish the benefit of transfusion in patients with elevated troponins.

New horizons in Type 2 myocardial infarction: pathogenesis, assessment and management of an emerging geriatric disease.

Type 2 myocardial infarction (MI) is characterised by a functional imbalance between myocardial oxygen supply and demand in the absence of a thrombotic process, leading to myocardial necrosis. This type of MI was relatively unknown among clinicians until the third universal definition of MI was published in 2017, differentiating Type 2 from Type 1 MI, which follows an acute atherothrombotic event. The pathogenesis, diagnostic and therapeutic aspects of Type 2 MI are described in the present review. Type 2 MI is a condition that is strongly linked to age because of vascular ageing concerning both epicardic vessels and microcirculation, age-related atherosclerosis and stress maladaptation. This condition predominantly affects multimorbid individuals with a history of cardiovascular disease. However, the conditions that lead to the functional imbalance between oxygen supply and demand are frequently extra-cardiac (e.g. pneumonia or anaemia). The great heterogeneity of the underlying etiological factors requires a comprehensive approach that is tailored to each case. In the absence of evidence for the benefit of invasive reperfusion strategies, the treatment of Type 2 MI remains to date essentially based on the restoration of the balance between oxygen supply and demand. For older co-morbid patients with Type 2 MI, geriatricians and cardiologists need to work together to optimise etiological investigations, treatment and prevention of predisposing conditions and precipitating factors.

Use of Digital Tools, Social Isolation, and Lockdown in People 80 Years and Older Living at Home.

The COVID-19 crisis and associated lockdowns have exposed the extent of social isolation among older adults (OAs). Currently, the French government and medical, social, and charitable organizations are working to find means of limiting the multiple psychological and physical consequences of social isolation on the health of OAs. One proposal is to help the elderly become more comfortable using digital tools (DTs). However, the ability of DTs to reduce social isolation is disputed in the literature. This study aimed to collect the views of OAs on social isolation; to identify the determinants of the use or not of DTs, in particular in the context of a lockdown; and the role of DTs in the strategy to reduce social isolation. This qualitative study was based on 27 semi-structured individual interviews with OAs ≥ 80 years, in Côte-d'Or and Haute-Marne (French departments), from March to May 2021. A total of 96.3% of participants had already owned one or more DTs (mobile phone, tablet, or computer) for several years. The lockdown had not prompted the population to equip themselves more. The most common reason for using DTs was to maintain contact with relatives, and 63% of the participants said that DTs have a positive impact in reducing social isolation. However, there is a significant need for assistance and training in their use, especially since many services are now offered online. The participants suggested that the key to minimizing social isolation remained the maintenance of social contacts. In conclusion, DTs appear to be useful for helping the elderly maintain social links with relatives and, therefore, have a strategic place in the reduction of social isolation. However, these tools should not replace in-person interactions.

Cervical cancer in older women: Does age matter?

OBJECTIVES: Cervical cancer is frequently diagnosed in older women, but few studies have focused on cervical cancer in this specific population. The objectives of this study were to provide an overview of the demographic profile and therapeutic care of women with cervical cancer, and to identify whether age is a prognostic factor. STUDY DESIGN: Retrospective population-based study from a gynecological cancer registry in a French Regional University Hospital and Comprehensive Cancer Center. 292 women diagnosed with cervical cancer between January 1, 2005, and December 31, 2015, were included. They were classified into younger women (YW), that is, under 70 years of age (N = 228), and older women (OW), that is, aged 70 years or more (N = 64). MAIN OUTCOME MEASURES: The primary outcome was overall survival (OS). Cox proportional hazards models were developed to assess the impact of age on OS. RESULTS: Compared with YW, larger proportions of OW had comorbidities (14% vs 7% with a score ≥ 2 on the Charlson Comorbidity Index, P <0.001) and more advanced tumors (37.3% vs 19.7% with FIGO IV, P <0.001); the OW group had a lower treatment rate (81.3% vs 95.6%, P <0.001), and a smaller proportion had undergone surgery (37.5% vs 81.7%, P<.001) but a larger proportion had radiotherapy (67.2% vs 49.6%, P = .01). One-year, 5-year and 10-year OS rates were: 91.6%, 74.1% and 63.9% for YW, and 69.9%, 36.4% and 12.3% for OW, respectively (P <0.001). The hazard ratio for death was twice as high in OW compared with YW with cervical cancer (HR = 2.19 [1.41 - 3.40], P <0.001), independently of FIGO stage, histology, and comorbidities. CONCLUSIONS: The prognosis for cervical cancer depends on age. Screening with the G8 tool followed by a comprehensive geriatric assessment could lead to more suitable treatment being offered to older patients.

Prescription of Blood Lymphocyte Immunophenotyping in the Diagnosis of Lymphoid Neoplasms in Older Adults.

Lymphoid neoplasms are a heterogeneous group of lymphoid neoplastic diseases with multiple presentations, and varying prognoses. They are especially frequent in older patients (OPs) and the atypism of this frail elderly population can make the diagnostic process even more difficult. Blood lymphocyte immunophenotyping (BLI) is essential in rapid noninvasive diagnosis orientation and guides complementary investigations. To our knowledge, BLI prescription has never been evaluated in OPs. We hypothesized that, when there is a suspicion of lymphoid neoplasm in the geriatric population, a BLI is performed in view of various clinical or biological abnormalities. This study aimed to: (1) describe the characteristics of hospitalized OPs having undergone BLI for suspected lymphoid neoplasm, (2) identify the causes leading to BLI prescription, and (3) identify the most profitable criteria for BLI prescription. This was a descriptive retrospective study on 151 OPs aged ≥75 years who underwent BLI over a 2-year period. Regarding BLI prescriptions, eight had lymphocytosis, constituting the "lymphocytosis group" (LG+), while the 143 others had BLI prescribed for reasons other than lymphocytosis (LG-), mainly general weakness and anemia. In the LG-, we compared OPs with positive and negative BLI results. The criteria found to be profitable for BLI prescription were lymphadenopathy, splenomegaly, lymphocytosis, and thrombocytopenia. BLI identified circulating lymphoid neoplasms (positive BLI) in 21/151 OPs, mainly marginal zone lymphoma and chronic lymphocytic leukemia. In polymorbid OPs, as per our study population, the diagnostic and therapeutic complexity explained in part the sole use of indirect and minimally invasive diagnostic techniques such as BLI.