[The education level of elderly diabetics]. / Le niveau d'éducation des diabétiques âgés.

OBJECTIVE: The education of diabetic subjects has been the object of numerous studies which have demonstrated its importance as an integral part of treatment. Few studies have focused on the particular problem of education in the elderly. PATIENTS AND METHODS: An inquiry was conducted in 60 elderly patients with diabetes in order to assess their knowledge of the disease, comparing those who had received specific education and those who had not, and to determine the characteristic features of patients who had received education. A specific questionnaire was designed for this study. The maximal score was 50. RESULTS: Mean age of the 60 patients was 77 years (range 65-94). Lack of knowledge was most patent concerning acute metabolic decompensation with hypoglycemia an hyperglycemia and concerning foot care. Only one-third of the patients had received diabetic education. The average score in the educated group was 42 +/- 0.4 versus 23 +/- 7 in the non-educated group (p = 0.0001). The best results were obtained in educated and younger patients. The inquiry showed that education had been distributed preferentially to the youngest patients, to men, and to patients treated with insulin. CONCLUSIONS: Our findings demonstrate that elderly diabetics can benefit from an education program and prove a real insufficiency in current education of elderly diabetics. These results should also lead to further work on an educational tool specifically designed for elderly diabetics.

Ambulatory blood pressure monitoring and postprandial hypotension in elderly persons with falls or syncopes.

BACKGROUND: Postprandial hypotension (PPH) is increasingly recognized as a common cause of falls and syncope in elderly persons. Noninvasive ambulatory blood pressure monitoring (ABPM) has been recommended for detecting PPH. This study investigates postprandial blood pressure (BP) changes by means of ABPM in elderly patients experiencing falls or syncopes. METHODS: Twenty-four-hour ABPM was performed in 156 inpatients (111 women, mean age 80.4 +/- 8.1 years). Among them, 45 had been admitted for falls and 75 for syncope; 36 with no history of falls or syncope served as controls. Postprandial change in systolic blood pressure (deltaSBP) was calculated by subtracting the mean SBP within the 2 hours following the meal from the mean SBP within the 2 hours preceding the meal. PPH was defined by a deltaSBP > or = 20 mm Hg. RESULTS: For the entire group, mean SBP decreased after the three meals. On average, the decline in SBP was greater after breakfast than after lunch or dinner, and the number of patients experiencing PPH was greater after breakfast. Average maximal deltaSBP was significantly larger in the syncope group than in the other groups ( p < .05). Moreover, the number of patients experiencing PPH was significantly higher in the syncope/fall group than in the control group (23% vs 9%; p = .03). Compared with patients without PPH, patients with PPH were more likely to have a history of diabetes mellitus (p < .01) or to use more than three different drugs daily ( p = .04), and they showed greater daytime SBP variability (p < .0001). Furthermore, there was a strong positive correlation between preprandial SBP and deltaSBP after breakfast. CONCLUSIONS: About one out of four elderly patients with falls or syncope experiences PPH, usually after breakfast. Postprandial decline in BP contributes to BP variability. deltaSBP and preprandial SBP are positively correlated.

[Incidence and consequences of nosocomial infections in a geriatric short-stay department]. / Incidence et conséquences des infections nosocomiales dans un service de court séjour gériatrique.

OBJECTIVES: Although large epidemiological studies have demonstrated that elderly people experience a greater incidence and mortality attributable to nosocomial infections, few studies have yet focused on this problem in geriatrics. PATIENTS AND METHODS: In order to assess the importance of nosocomial infections in geriatric short-stay department, we carried out a prospective study during a one-year period. RESULTS: Eighty-two nosocomial infections were recorded in 67 patients. The incidence was 10.3 nosocomial infections per 1000 patient-days. Pneumonia was the second most frequent type of nosocomial infection after urinary tract infections, but caused the highest rate of death. For infected patients, hospital stay was twice as long (31 versus 13 days) and mortality four times higher (26.9 versus 8.2%). CONCLUSION: These results confirm that elderly patients make up a high-risk population and that the prevention of nosocomial infections must be a priority in geriatrics.

[Confusion in primary hyperparathyroidism. An uncommon manifestation in the elderly. 3 cases]. / Forme confusionnelle de l'hyperparathyroïdie primaire. Un mode de révélation particulier chez le sujet âgé. Trois observations.

Three cases of primary hyperparathyroidism disclosed by neuropsychiatric disorders in very elderly are reported. The frequency of these disorders and their almost constant association with muscle weakness are emphasized. Pre-operative imaging of the adenoma is often difficult. Surgical treatment is innocuous and considerably improves mental status.

[Antidiuretic hormone levels (arginine-vasopressin) in cases of peripheral hypothyroidism. 26 cases]. / Taux d'hormone antidiurétique (arginine-vasopressine) en cas d'hypothyroïdie périphérique. 26 observations.

Plasma arginine-vasopressin (AVP) levels were measured by radioimmunoassay in 26 untreated myxoedematous patients and 27 healthy subjects. In 22 patients, in spite low osmolality AVP values were not significantly different from those found in controls, but they were considerably increased in 4 patients with severe myxoedema and very low osmolality. Statistical analysis showed negative correlation between AVP values and osmolality in the patients. On the other hand, no correlation was found between AVP values and aldosterone or plasma renin activity values. These results suggest inappropriate secretion of antidiuretic hormone in myxoedema.

[Study of antidiuretic hormones (arginine vasopressin) in 24 cases of primary adrenal insufficiency]. / Etude de l'hormone antidiurétique (arginine-vasopressine) dans 24 cas d'insuffisance surrénale primitive.

24 Addisonian patients were compared to 27 healthy subjects. Radioimmunoassay of plasma antidiuretic hormone showed higher concentrations of Arginine-vasopressin (AVP) in Addisonians than in normals, in spite of lower natremia and plasma osmolality. Statistical analysis showed a negative correlation between AVP and osmolality in Addisonian patients. On the other hand, no correlation was found between AVP and cortisol, or AVP and PRA. These results suggested an inadequate secretion of antidiuretic hormone in Addison disease. Under substitutive treatment, glucocorticoids alone didn't completely lower AVP concentration which was only normalized after administration of mineralocorticoids.