Endoscopic retrograde cholangiopancreatography in the elderly over 75 years old: a survey.

Whilst endoscopic retrograde cholangiopancreatography (ERCP) is being practiced on increasingly older patients, its benefits have not been well studied. This study assessed the clinical benefit of ERCP for subjects aged 75 and over, including follow-up at 3 months of geriatric functional parameters and lifestyle. This is a prospective mono-centric, cohort study. All patients aged 75 and over receiving ERCP were enrolled and monitored for a period of 3 months. We recorded 53 inclusions between November 1st 2014 to 31 May 2015. Our "ill-type" was a fragile polypathology woman of 85 years, living at home, with loss of autonomy for instrumental activities of daily living (IADL). Lithiasis was diagnosed in 56.6% of cases, and malignant stenosis in 35.8% of cases. The success rate was 88.7% with a 5.7% complication rate. At 3 months, we observed no clinically significant change in ADL parameters, IADL and lifestyle. Our follow-up data support the practice of ERCP in geriatric populations.

Evaluation of prescription along three health-care periods in the elderly.

Polypharmacy, potentially inappropriate prescriptions and inadequate coordination between prescribers are among main factors explaining the occurrence of adverse drug events in elderly patients. Prospective and descriptive study of medication prescriptions for elderly patients during a continuous period of health-care: entry in an acute geriatric unit (T1), at discharge (T2) and two months after hospitalization (T3). A global iatrogenic risk was defined: presence of poly-pharmacy and/or PPI (Laroche criteria) and/or absence of quality indicators for prescription according to the French health authority. For the 79 patients (mean age 87), mean number of medication decreased from 7.33 (T1) to 6 (T2) (p=0.0018) and 6 (T3). Number of quality indicators for prescription improved from 6.67 (T1) to 6.92 (T2) (p=0.001) then decreased to 6.84 (T3). Number of PPI decreased from 1.16 to 0.42 between T1 and T2 (p=0.001) then increased to 0.59 at T3. The global iatrogenic risk indicator fluctuated from 80% (T1) to 64% (T2) and 75% (T3). Selected interventions were developed to prevent adverse drug events during hospitalization and ambulatory follow-up. If geriatric intervention can enhance quality of prescription, iatrogenic risk remains frequent all along health-care follow-up. A local study of prescriptions can be a first step to develop an adequate program for adverse drug events prevention.