[Urinary tract infections in the elderly]. / Infections urinaires du sujet âgé.

DEFINITIONS: Age over 65 years is generally used to define the elderly population. Urinary tract infections are increasingly frequent after this age. Comorbidity and living conditions in the elderly have a particular incidence on the clinical expression and the bacterial flora involved. Besides these elements, altered cognitive capacity and abnormal urinary function prior to the infection and lead to an atypical clinical presentation. ASYMPTOMATIC BACTERIURIA: Systematic screening has produced a large body of literature on asymptomatic bacteriuria. Our review of the literature leads to the conclusion that systematic bacteriology tests are not warranted in the elderly population in general due to the subsequent risk of germ selection and erroneous diagnosis. PRACTICAL ATTITUDE: The diagnosis of urinary infection must be evidence-based, taking into account the patient's history and ruling out other diagnoses. In all cases, antibiotics must be carefully adapted to the patient's situation and titrated to kidney function.

[Attitude of general practitioners facing patients at the end of life in home care]. / Opinions de médecins généralistes face aux fins de vie à domicile.

OBJECTIVES: General practitioners (GPs) are directly confronted with patients experiencing end-of-life situations in their homes. We conducted a survey to ascertain the GPs' approach as there has been little work in France concerning this type of situation. METHODS: A questionnaire was sent to 478 general practitioners in the Essonne department who are corresponding physicians at the Louis-Michel hospital in Evry. There were 233 responses (49.8%). RESULTS: The main findings demonstrated that important decisions concerning dying patients are made on a consensus basis in 58.8% of the cases. Problems related to end-of-life situations are discussed with persons close to patients with incurable conditions (for 85% of the responding GPs) and with the patient (74%). Patients participating in the discussion express the desire to continue living in 65.7% of the cases. The familial situation appears to be the essential element for managing these patients in their home and is the number one reason for hospitalization. This contrasts with the opinion of general practitioners who favor home management (82% of the responding physicians). CONCLUSION: Our study demonstrates an important gap in medical education since 66.5% of the practitioners felt they had not received appropriate training in this area. It also emphasizes the lack of sufficient communication between general practitioners and hospital physicians and the need to organize a network which would better respond to patient, family, and physician demands.