[Characteristics of pain and pain management in the elderly]. / Particularités de la douleur et de sa prise en charge chez les personnes âgées.

A COMMON SYMPTOM: Pain is a common and underestimated problem in older people who are likely to suffer from many acute and chronic conditions. DIFFICULT ASSESSMENT: Clinical assessment of pain often depends on the patient's ability to communicate his or her experience. If self-assessment of pain is not possible, behavioral hetero-evaluation instruments have been built for easy pain assessment by caregivers. ADJUSTED PAIN MANAGEMENT: As for younger patients, the most common strategy for pain management is the use of analgesic drugs. Special care should be taken however when such drugs are initiated in the elderly because increased sensitivity, prolonged drug half-life and adverse effects and drug interactions are more likely.

[Palliative care of the aged]. / Soins palliatifs chez les personnes âgées.

Palliative care is no longer limited to patients with terminal cancer but now includes other diseases at terminal stage such as advanced Alzheimer disease. Accompanying the elderly at the end of life involves medical, psychological and social approaches. The expression of symptoms, and especially that of pain, can be atypical. Medical prescription should take into account both the change in drug metabolism and the more frequent occurrence of side effects in the elderly. Accompanying the patient at the end of life is an increasing part of care in geriatric institutions. Indispensable factors today are adapted personnel, training, specific support and social actualization.

Serum dehydroepiandrosterone sulfate levels as an individual marker.

To assess the significance of the serum dehydroepiandrosterone sulfate (DHEAS) concentration as a parameter of the individual hormonal milieu, two different groups of subjects were studied: DHEAS levels were determined 3 times at 6-month intervals in 47 elderly hospitalized women, aged 71-94 yr (group 1), and 6 times over 2 consecutive weeks in 10 healthy male volunteers, aged 24-30 yr (group 2). For reference, serum cortisol (F) levels were determined concomitantly. In each group and on each sampling occasion, the subjects were ranked according to their DHEAS or F values. The stability over time of the ranking was much higher for DHEAS than for F; estimated concordance coefficients were 92% (group 1) and 88% (group 2) for DHEAS vs. 51% (group 1) and 49% (group 2) for F. We conclude that due to a comparatively low within- to between-subject variability ratio, DHEAS is a highly specific individual marker.

Dermatoglyphic patterns in dementia of the Alzheimer type: a case-control study.

STUDY OBJECTIVE: The aim was to compare digital and palmar dermatoglyphics in subjects with dementia of Alzheimer type and in mentally healthy elderly controls. DESIGN: This design was a case-control study. SETTING: The study was carried out in geriatric units and retirement communities in the Paris area. PARTICIPANTS: Cases were women with clinically diagnosed Alzheimer type dementia according to DSM III-R criteria (n = 82), mainly with late onset of the disease. Controls were women aged 85 years or older without cognitive deterioration (n = 76). MEASUREMENTS AND MAIN RESULTS: Finger and palm prints obtained from both hands by the classical ink method were examined. Fingerprints were classified into four types of figures. On palms, palmar flexion creases, palmar axial triradii, true patterns of the hypothenar area, and main line terminations were described. Examinations were performed by two examiners blind to the subjects's diagnostic category. For the different patterns studied, no major differences between dementia patients and elderly controls were found. Nor was there evidence of high frequencies of features commonly observed in Down's syndrome (trisomy 21), which have previously, though sporadically, been reported. CONCLUSIONS: On one of the largest samples of Alzheimer dementia patients studied, and with evaluation blind to diagnosis, no evidence has been found that particular dermatoglyphic patterns occur like those observed in Down's syndrome, a disease which is related to dementia of the Alzheimer type.

Effect of vitamin D3 administration on serum 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3 and osteocalcin in vitamin D-deficient elderly people.

In elderly institutionalized people, confined to bedroom and receiving no vitamin D supplementation, the frequency of vitamin D deficiency is found very high. Systematic administration of vitamin D has, therefore, been proposed to correct vitamin D deficiency. Within this context, we studied 40 elderly institutionalized subjects (mean age 80.5 + 7.2 yr) with low 25(OH)D3 concentrations (4.4 + 1.8 micrograms/l). Sixteen of them (Group I) had low serum calcium concentrations (less than 2.3 mmol/l) and 24 (Group II) had normal serum calcium concentrations (from 2.3 to 2.6 mmol/l). As hypocalcemia has been shown to regulate 1,25(OH)D3 production independent of PTH in animals and in humans, we compared their respective responses to the administration of vitamin D3. Subjects received a total dose of 15 mg (600,000 IU) of vitamin D3 divided into 3 i.m. injections at one month intervals and were explored before therapy and one and 6 months after the last dose of vitamin D3. The treatment induced a similar marked rise in 25(OH)D3 levels (from 4.1 + 1.7 to 24.4 + 8.7 micrograms/l for group I and from 5.1 + 1.8 to 27.2 + 8.0 micrograms/l for group II) in both groups but increased the 1,25(OH)2D3 concentrations only in group I (from 22.9 + 6.9 to 32.6 + 11.3 ng/l). Meanwhile serum calcium concentrations rose in group I (to low normal range i.e. 2.31 + 0.07 mmol/l) and were unaffected in group II. These results suggest that hypocalcemia is a potent stimulator of renal 1-hydroxylase in elderly people. Furthermore, a transient significant (P less than 0.01) increase in serum osteocalcin (from 10.6 + 4.1 to 14.1 + 5.9 micrograms/l) could be observed in group I which demonstrates for the first time that the osteocalcin response of osteoblasts to stimulation by 1,25(OH)2D3 is retained in very old people.

[Resection of the prostate after 75 years]. / La résection de prostate après soixante-quinze ans.

The authors report a series of 100 endoscopic resections performed in patients over the age of 75 years. In patients with no risk factors, there was no mortality and the morbidity was 5%. In patients with one risk factor, mortality was 5% and morbidity was 10%.

[Vitamin D deficiency in long-stay geriatric patients. Study of a therapeutic protocol adapted to the institutional milieu]. / Carence en vitamine D chez le vieillard hospitalisé en long séjour. Etude d'un protocole de correction adapté au milieu institutionnel.

A vitamin D deficiency was observed in 22 women and 6 men aged 66 to 94 years, hospitalised in a long-stay department in the Paris region for an average of 5 years and incapable of going out. The diagnosis was confirmed by measuring serum 25 (OH) D: 1.89 +/- 0.18 ng/ml during the month of June (11.5 +/- 4.2 ng/ml at the same period in II healthy young adults). The patients were randomly divided into two groups of 11 (Group I) and 17 patients (Group II). The first group was given an improved diet in calcium and Vit. D; the second group received, in addition, an intramuscular supplement of 30 mg of Vit. D3 in monthly injections of 5 or 10 mg. The serum 25 (OH) D levels were measured each month in both groups. Patients with intramuscular supplements showed a slow rise until the total injected dose exceeded 20 mg, followed by a sudden rise to values greater than 30 ng/ml. Eight months after the last injection, mean serum 25 (OH) D was still 24.7 +/- 4.6 ng/ml compared to only 3.6 +/- 3 ng/ml in Group I. Vitamin D deficiency in geriatric patients cannot be corrected by dietary supplement alone, but parenteral Vit. D3 using an easily applicable therapeutic protocol is effective and well tolerated at the suggested dosage.

Glycosylated haemoglobin concentrations and clinitest results in insulin-dependent diabetes.

In 11 insulin-dependent diabetic outpatients, haemoglobin AIc (HbAIc) was measured by an electrofocusing method. Diabetic control was evaluated by the semiquantitative urine test for sugar, 'Clinitest', three times a day every day in the 8 weeks before the HbAIc determination. 24-hour glycosuria and fasting and postprandial blood-glucose levels were measured one to five times during this period. The HbAIc concentration correlated highly with the semi-quantitative urinary-sugar-concentration index but not with the other parameters.