[Assessment of frailty in the elderly and use of geriatric scores in emergencies]. / Évaluation de la fragilité de la personne âgée et utilisation des scores gériatriques aux urgences.

According to the WHO, frailty in the elderly is a geriatric syndrome resulting from a reduction in functional reserves, limiting the body's ability to respond to even minor stress, leading to increased vulnerability to the risk of falling, hospitalization and functional decline. Being sometimes reversible, it is essential to detect fragility early, in order to prevent it. Several scores are validated for the evaluation and diagnosis of the frailty of the elderly person hospitalized but not in the emergency room. From where the need for their adaptation and the creation of new scores and decision-making algorithms appropriate to the particular context of emergencies.

Selon l'OMS, la fragilité de la personne âgée est un syndrome gériatrique résultant d'une réduction des réserves fonctionnelles, limitant les capacités de l'organisme à répondre à un stress, même mineur, et entraînant une vulnérabilité accrue au risque de chute, d'hospitalisation et de déclin fonctionnel. Étant parfois réversible, il est capital de détecter précocement la fragilité, afin de la prévenir. Plusieurs scores sont validés pour l'évaluation et le diagnostic de la fragilité de la personne âgée hospitalisée, mais pas aux urgences. D'où la nécessité de leur adaptation et de la création de nouveaux scores et algorithmes décisionnels appropriés au contexte particulier des urgences.

Executive function and prospective falls: a 6-year longitudinal study in community-dwelling older adults.

BACKGROUND: Older people with impaired executive function (EF) might have an increased fall risk, but prospective studies with prolonged follow-up are scarce. This study aimed to investigate the association between a) EF at baseline; b) 6-year decline in EF performance; and fall status 6 years later. METHODS: Participants were 906 community-dwelling adults aged 65-69 years, enrolled in the Lausanne 65 + cohort. EF was measured at baseline and at 6 years using clock drawing test (CDT), verbal fluency (VF), Trail Making Test (TMT) A and B, and TMT ratio (TMT-B - TMT-A/TMT-A). EF decline was defined as clinically meaningful poorer performance at 6 years. Falls data were collected at 6 years using monthly calendars over 12 months. RESULTS: Over 12-month follow-up, 13.0% of participants reported a single benign fall, and 20.2% serious (i.e., multiple and/or injurious) falls. In multivariable analysis, participants with worse TMT-B performance (adjusted Relative Risk Ratio, adjRRRTMT-B worst quintile = 0.38, 95%CI:0.19-0.75, p = .006) and worse TMT ratio (adjRRRTMT ratio worst quintile = 0.31, 95%CI:0.15-0.64, p = .001) were less likely to report a benign fall, whereas no significant association was observed with serious falls. In a subgroup analysis among fallers, participants with worse TMT-B (OR:1.86, 95%CI = 0.98-3.53, p = .059) and worse TMT ratio (OR:1.84,95%CI = 0.98-3.43,p = .057) tended to have higher odds of serious falls. EF decline was not associated to higher odds of falls. CONCLUSIONS: Participants with worse EF were less likely to report a single benign fall at follow-up, while fallers with worse EF tended to report multiple and/or injurious falls more frequently. Future studies should investigate the role of slight EF impairment in provoking serious falls in active young-old adults.

[Dementia: management and prevention]. / Prise en charge et prévention des pathologies démentielles.

Dementia represents a great challenge for health care providers. Detection of cognitive impairment is critical for early diagnosis of dementia. Early diagnosis allows to initiate individualized management that focuses on maintaining patient's autonomy and supporting their caregivers. Proposed multimodal interventions include physical activity, cognitive training, mediterranean diet, and management of cardiovascular risk factors. Before the initiation of pro-cognitive therapy, medication review is essential to evaluate current treament and determine specific therapeutic objectives, based on patient's overall health and preferences. Overall risk reduction for dementia revolves around similar measures that target physical activity, cognition, diet and management of cardiovascular risk factors.

[Review in geriatric medicine 2014]. / Gériatrie.

Several studies contributed to improving the diagnostic and prognostic assessment of delirium in hospitalized older patients. Direct patient education proved efficient in benzodiazepines withdrawal. A position statement of the American Geriatrics Society does not recommend tube feeding when eating difficulties arise in older persons suffering from advanced dementia. Several studies emphasized once again the potential importance of preventative interventions (in particular physical activity) to prevent or delay dementia occurrence. Two randomized controlled trials of monoclonal antibodies that bind amyloid did not show benefit in patients with mild-to-moderate Alzheimer's dementia (AD). In contrast, vitamin E reduced functional decline in these patients, and citalopram reduced agitation among AD patients as well as their caregiver's stress.

[Geriatric assessment in old patients candidate to transcatheter aortic implantation]. / Evaluation gériatrique des patients agés candidats a un remplacement valvulaire aortique percutané.

Aortic stenosis mostly occurs among old-old patients. Once symptoms appear, prognosis is guarded, with 2-year mortality as high as 50%. Transcatheter Aortic Valve Implantation (TAVI) is a new therapeutic option in patients at very high surgical risk, who are mostly older persons. However, TAVI is associated with some complications, and patient selection remains a challenge. Comprehensive geriatric assessment (CGA) identifies patients with medical and functional problems likely to affect the TAVI post-operative course. Collaboration between cardiologists and geriatricians will likely become a standard approach to enhance the assessment of these frail patients and identify those most likely to benefit from TAVI.