Biomedical subjects

J P Emeriau

Publications and source records attributed to J P Emeriau.

At least 19 recordsLinked to original sources

PubMed2002

Nutritional status of healthy elderly persons living in Dordogne, France, and relation with mortality and cognitive or functional decline.

OBJECTIVE: Description of the nutritional status of healthy elderly people and investigation of its longitudinal relationship with mortality and cognitive or functional decline. DESIGN: Longitudinal study. SETTING: In Dordogne, France. SUBJECTS: A total of 169 French elderly community dwellers aged 68 y and older from in the PAQUID (Personnes Agées QUID) study were included. Dietary intake was assessed by a 3 day food record and a dietary history. Self-reported weight and height were used to calculate the body mass index (BMI, kg/m(2)). Mortality, activities of daily living (ADL), instrumental activities of daily living (IADL) and the Mini Mental State Examination (MMSE) were measured at 5 y follow-up. RESULTS: Nutritional intake and BMI vary according to age and sex. Men generally have a higher nutritional intake than women. Intake decreases with age especially in men. Among the 169 subjects, 22 died. When analyzed by logistic regression, there was no relation between markers of risk of poor nutrition and mortality but a BMI greater or equal 27 at baseline was associated with a increased risk of 5 y mortality (OR=6.27, 95% CI 1.29-30.37) adjusted for sex and age. With regard to cognitive decline, subjects with a BMI greater or equal than 23 kg/m(2) had 3.6 times lower chance of presenting a decline in the subsequent 5 y adjusted by age and sex (OR=0.28, 95%, CI 0.09-0.90). BMI ranging between 23 and 27 was associated with a significantly decreased risk of IADL disability (OR=0.31, 95% CI 0.10-0.93) in multivariate analyses. CONCLUSION: In apparently healthy elderly people a BMI ranging between 23 and 27 is associated with lower risks of functional and cognitive declines in the subsequent 5 y.

Activities of Daily Living↗

PubMed2002

[Incidence, risk factors and adequation of early readmission among the elderly].

BACKGROUND: The objectives of the study were to estimate the incidence of readmission one month after discharge, to determine the proportion of planned readmissions and of those avoidable, and to identify risk factors associated with early readmissions in elderly admitted to an acute geriatric unit. METHODS: A prospective study was conducted on a sample of 322 patients, 75 years of age or older, discharged from an acute geriatric service. A phone follow-up was realized one month after discharge. A multivariate logistic regression model was used to identify risk factors for readmission. RESULTS: Global incidence of early readmission was 16.2% (that is 50 rehospitalizations), 18.0% of which were planned. Among the 21 readmissions to the same service, five were avoidable according to the Appropriateness Evaluation Protocol. Logistic regression analysis identified three patient characteristics that were independent predictors of early readmission, which were: a need of help for locomotion (OR=4.38, p=0.002), a negative answer to the question "do you feel that your life is empty?" (OR=2.22, p=0.02) and a short length of stay (p<0.02). CONCLUSION: A better knowledge of risk factors should allow targeting patients at high risk of early hospital readmission, which should profit by preventive interventions during the first hospitalization. Two domains of possible action were identified in this study: a sufficient length of stay and a better attention to patients with reduced autonomy, especially for those who go back home after discharge.

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PubMed2001

[How to determine the diagnosis of Helicobacter pylori infection in the elderly?].

PURPOSE: The real prevalence of Helicobacter pylori (H. pylori) infection is difficult to determine in the elderly because of the frequency of drug intake (antibiotics or anti-secretory drugs). The aim of this study was to evaluate the diagnostic performance of five tests in the elderly. METHODS: The study population consisted of consecutive patients undergoing a routine endoscopy between August 1998 and December 1999. We evaluated the diagnostic performance of four tests in all of the included patients: culture and histology of biopsy specimens, serology (ELISA) and urea breath test (13C-UBT). Detection of H. pylori antigens in stool samples (HpSA) was realized in a subgroup. Patients were considered H. pylori + when result for culture was positive or when two tests were positive. RESULTS: One hundred and sixty-seven patients were included in this study (55 men, 112 women; mean age: 85.6 +/- 5.1 years). Only 38 (22.8%) patients were H. pylori+. Test performances showed the following results: serology sensitivity: 90.9% (IC 95%: 75.6-98.1) versus 86.9% (IC 95%: 63.6-96.9) for culture versus 77.8% (IC 95%: 60.8-89.9) for histology and 74.3% (IC 95%: 56.7-87.5) for 13C-UBT. Eighty-nine (53.3%) took antibiotics or anti-secretory drugs, only 13C-UBT performances decreased significantly (sensitivity: 94.4% [72.7-99.8] versus 52.9% [27.8-77]; P < 10(-6)). When gastric or duodenal ulcer were endoscopically diagnosed in older patients, both histology and 13C-UBT could not improve the diagnosis of H. pylori infection. HpSA was realized in 107 patients (sensitivity: 74.1%, specificity: 98.7%). We showed no statistical difference between HpSA performances and drug intake. CONCLUSION: Diagnostic performances decreased in older patients especially because of drug intake.

Age Factors↗

PubMed2001

[Annual incidence and risk factors for nosocomial bacterial infections in an acute care geriatric unit].

PURPOSE: Elderly inpatients are particularly exposed to the risk of nosocomial infections, thus the study of their risk factors and consequences is of interest. METHODS: Among 1,565 subjects referred to a short-term geriatric unit, patients hospitalised for a year for an acute event and unable to move themselves were followed up for the occurrence of nosocomial infections. RESULTS: Among these 402 immobilised patients (age: 86.3 +/- 7.6 years), 102 nosocomial infections occurred in 91 patients (22.6%), whereas the estimation of the incidence in the total hospitalised population (1,565 subjects, age: 85.1 +/- 6.2 years) was 9.4% (95% confidence interval [CI] 8.3-11.2). Forty-seven point seven percent of nosocomial infections were urinary tract nosocomial infections, 27.5% were lower respiratory nosocomial infections, 9.2% were cutaneous nosocomial infections, 7.3% were septicaemia and 8.2% were of unknown origin. The relative risk (RR) of NI linked to functional dependency for mobility was 5.5 (95% CI: 3.93-7.7, P < 0.001). Other risk factors were: for all nosocomial infections: cancer diagnosis (RR 1.1, 95% CI: 1.1-1.2, P = 0.01); and respectively for urinary tract NI: bladder indwelling (RR 4.8, 95% CI: 2.9-7.7, P < 0.001), pulmonary NI: swallowing disorders (RR 5.4, 95% CI: 2.8-10.5, P < 0.001); and septicaemia: venous catheter (RR 5.4, 95% CI: 1.3-23.3, P = 0.002). NI were associated with an increased length of stay (22.1 +/- 11.7 days in infected patients vs 16.3 +/- 9.5 days in immobilised non-infected subjects, P < 0.001). The mean length of stay for the 1,565 subjects was 10.3 +/- 7.6 days. Death was attributed to nosocomial infections in 13 subjects. In conclusion, functional dependency for mobility, bladder indwelling, venous catheter, swallowing disorders and diagnosis of cancer were risk factors for nosocomial infections in hospitalised elderly subjects in an acutecare setting.

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PubMed2001

Antioxidant defences and oxidative stress markers in erythrocytes and plasma from normally nourished elderly Alzheimer patients.

OBJECTIVES: to investigate blood markers of oxidative stress, and enzymatic and non-enzymatic antioxidants in normally nourished elderly people with Alzheimer's disease. DESIGN: case-control study. SUBJECTS: twenty patients with Alzheimer's disease and 23 elderly control subjects, living at home, free from disease and not undergoing any treatment known to have a strong influence on blood oxidative stress markers or antioxidant defence systems. METHODS: we performed a nutritional evaluation, including anthropometric and biological measures and a 3-day dietary record. We determined concentrations of antioxidant vitamins (alpha-tocopherol, retinol) and malondialdehyde in plasma and erythrocytes. We also measured erythrocyte enzymatic activities of glutathione peroxidase and copper-zinc superoxide dismutase. RESULTS: the two groups were similar in age, body mass index, dietary record and serum albumin concentration. After adjustment for age, sex and cardiovascular co-morbidity, mean plasma concentration of alpha-tocopherol was lower in those with Alzheimer disease than in control subjects (15+/-3.5 mg/l compared with 18.2+/-3.5; P=0.002), as was the mean plasma concentration of retinol (0.54+/-0.2 mg/l vs 0.7+/-0.2; P=0.014). The mean concentration of free plasma malondialdehyde was higher in those with Alzheimer's disease (0.70+/-0.2 mmol/l vs 0.5+/-0.1; P=0.036). In Alzheimer disease patients, free plasma malondialdehyde concentrations were inversely correlated with levels of alpha-tocopherol (P=0.002) and retinol (P=0.025). Erythrocyte levels of vitamins and enzymatic activities were similar in the two groups. CONCLUSION: lower plasma concentrations of alpha-tocopherol and retinol in normally nourished elderly patients with Alzheimer's disease than in controls could suggest that these antioxidant vitamins had been consumed as a result of excessive production of free radicals.

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PubMed2001

Functional and metabolic early changes in calf muscle occurring during nutritional repletion in malnourished elderly patients.

BACKGROUND: Metabolic alterations in skeletal muscle associated with malnutrition and the potential reversibility of such alterations during refeeding are not fully understood. OBJECTIVE: We characterized early changes in muscle during refeeding in malnourished, hospitalized elderly subjects. DESIGN: Muscle function, metabolism, and mass were evaluated in 24 clinically stable patients (11 were malnourished) by using isokinetic plantar flexor torque measurements and nuclear magnetic resonance (NMR) imaging for medial gastrocnemius mass assessment and 31P and 13C NMR spectroscopy for inorganic phosphate (Pi), phosphocreatine, and glycogen quantitation. RESULTS: Malnourished subjects had lower muscle mass (P < 0.02) and tended to have lower strength than did control subjects. In malnourished subjects, muscle strength increased after refeeding (P < 0.01) whereas muscle mass was unchanged. The ratio of Pi to ATP was lower in malnourished than in control subjects (P < 0.001) and increased during refeeding (P < 0.01). The mean ratio of phosphocreatine to ATP was lower in malnourished than in control subjects (P < 0.01) and increased to control values after refeeding. Muscle glycogen showed a scattered distribution for malnourished subjects; the mean value did not differ significantly from that of control subjects, either at baseline or after refeeding. CONCLUSIONS: The lower ratio of phosphocreatine to ATP in malnourished subjects could have resulted from either lower total muscle creatine or reduced oxidative capacities. High or normal glycogen associated with a low Pi-to-ATP ratio in malnourished subjects suggested preferential use of lipid over carbohydrate for energy supply, which is known to reduce muscle performance. The data suggest that normalization of muscle metabolite content after refeeding improves muscle strength in malnourished subjects.

Adenosine Triphosphate↗

PubMed2001

A comparison of indapamide SR 1.5 mg with both amlodipine 5 mg and hydrochlorothiazide 25 mg in elderly hypertensive patients: a randomized double-blind controlled study.

OBJECTIVE: To analyse the efficacy of indapamide sustained-release (SR) 1.5 mg in reducing blood pressure versus amlodipine 5 mg and hydrochlorothiazide 25 mg, in elderly hypertensive patients. DESIGN: Double-blind, randomized, 12 week study using three parallel groups. SETTING: European teaching hospitals and general practices. PATIENTS: Randomized patients, (n = 524) including 128 patients with isolated systolic hypertension (ISH); mean age: 72.4 years; mean systolic/diastolic blood pressures (SBP/DBP): 174.5/97.9 mmHg. MAIN OUTCOME MEASURES: Clinic systolic and diastolic blood pressure variations. RESULTS: Indapamide SR 1.5 mg demonstrates a similar efficacy to that of amlodipine 5 mg, as well as to that of hydrochlorothiazide 25 mg (equivalence P < 0.001); the mean decreases in SBP/DBP were -22.7/-11.8 mmHg, -22.2/-10.7 mmHg and -19.4/-10.8 mmHg, respectively. In the ISH subgroup, indapamide SR 1.5 mg tends to have greater efficacy than hydrochlorothiazide 25 mg in reducing the SBP (-24.7 versus -18.5 mmHg, respectively; equivalence P = 0.117), while similar results are obtained with amlodipine 5 mg (-23 mmHg, equivalence P < 0.001). The normalization rate was relatively high for indapamide SR 1.5 mg (75.3%), when compared with amlodipine (66.9%) and hydrochlorothiazide (67.3%), especially in the subgroup of isolated systolic hypertensive patients: 84.2 versus 80.0% for amlodipine, and versus 71.4% for hydrochlorothiazide. CONCLUSIONS: Indapamide SR 1.5 mg shows similar antihypertensive efficacy to amlodipine 5 mg and hydrochlorothiazide 25 mg in elderly hypertensive patients, while in patients with isolated systolic hypertension, indapamide SR 1.5 mg shows a similar efficacy to amlodipine 5 mg but a greater efficacy than hydrochlorothiazide 25 mg.

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PubMed2001

Nutritional strategy in the management of heart failure in adults.

The incidence of congestive heart failure (CHF) is increasing in Westernized countries, and patients with CHF experience poor quality of life (functional impairment, high hospitalization rate and high mortality). Malnutrition occurring during the course of CHF is referred to as cardiac cachexia and is associated with higher mortality independent of the severity of CHF. Cardiac cachexia involving a loss of more than 10% of lean body mass can clinically be defined as a bodyweight loss of 7.5% of previous dry bodyweight in a period longer than 6 months. The energy requirements of patients with CHF, whether cachectic or not, are not noticeably modified since the increase in resting energy expenditure is compensated by a decrease in physical activity energy expenditure. Malnutrition in CHF has been ascribed to neurohormonal alterations, i.e. anabolic/catabolic imbalance and increased cytokine release. Anorexia may occur, particularly during acute decompensation of CHF. Function is impaired in CHF, because of exertional dyspnea and changes in skeletal muscle. Decreased exercise endurance seems to be related to decreased mitochondrial oxidative capacities and atrophy of type 1 fibers, which are attributed to alteration in muscle perfusion and are partially reversible by training. Malnutrition could also impair muscle function, because of decreased muscle mass and strength associated with decreased glycolytic capacities and atrophy of type 2a and 2b fibres. With respect to the putative mechanisms of cardiac cachexia, anabolic therapy (hormones or nutrients) and anticytokine therapy have been proposed, but trials are scarce and often inconclusive. In surgical patients with CHF, perioperative (pre- and postoperative) nutritional support has been shown to be effective in reducing the mortality rate. Long term nutritional supplementation trials in patients with CHF and cachexia are thus required to establish recommendations for the nutritional management of patients with CHF.

Alcohol Drinking↗

PubMed2000

Efficacy of naftidrofuryl in patients with vascular or mixed dementia: results of a multicenter, double-blind trial.

BACKGROUND: Dementia is a cerebral disorder resulting in a progressive deterioration of intellectual function that compromises the patient's ability to function. The diagnostic criteria for dementia are primarily clinical and are based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The Hachinski score and computed tomography of the brain help distinguish between degenerative and vascular dementias. OBJECTIVE: This study examined the efficacy of naftidrofuryl in patients with vascular or mixed dementia. METHODS: This multicenter, randomized, double-blind study compared naftidrofuryl 600 mg/d with placebo for 1 year in patients with vascular or mixed dementia. A preliminary 2-month washout period allowed selection of patients who were compliant with treatment. The end point was change in the scores on the Alzheimer Disease Assessment Scale cognitive subscale and the Mini-Mental State Examination. RESULTS: Eighty-four patients were assessable on an intent-to-treat basis, and 74 were assessable for the per-protocol analysis (on-treatment). Statistically significant improvements in cognitive and global function were observed in patients receiving naftidrofuryl. Naftidrofuryl was well tolerated, and produced no clinically significant abnormalities in laboratory test results. CONCLUSION: The results of this study suggest that naftidrofuryl is effective and well tolerated in treating the symptoms of vascular and mixed dementia.

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PubMed2000

[Evolution of drug treatments in the aged living at home].

PURPOSE: Although overprescription and overconsumption of drugs are common in the elderly, their features are still not well known since retrospective data on drug intake in this population is very limited. This study was therefore aimed at assessing the evolution of drug intake in the elderly. METHODS: In a study undertaken in the context of the PAQUID project, drug intake was assessed in a group of elderly subjects living at home in either Gironde or Dordogne in south-western France. Each subject was visited by an investigator in successively 1988-89, 1991-92, 1993-94, and 1996-97. Three thousand seven hundred and seventy-seven subjects were included in the study since 1988. Their mean age was 75.4 years (CI 95%: 75.2-75.6 years) and the sex ratio was 0.72. RESULTS: Eighty-nine percent of the subjects took at least one drug per day; 49% took one to four drugs per day; and 40% took more then five drugs per day. The total drug consumption showed an increase in drug intake during the 8-year follow-up, whether the subjects were or not dependent according to their IADL score. CONCLUSION: Analysis of drug intake evolution according to age, sex and daily drug intake at inclusion in the study showed that during follow-up drug intake increased in younger people who had no treatment at study inclusion, while it decreased in older subjects receiving multiple medications. This decrease might be due to either adverse side-effects, drug interactions, or repeated episodes of hospitalization.

Age Factors↗

PubMed2000

A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d'Evaluation.

The purpose of this study was to assess the effect of nutritional supplementation on dietary intake and on pressure ulcer development in critically ill older patients. The multi-center trial involved 19 wards stratified according to specialty and recruitment for critically ill older patients; 9 wards were randomly selected for nutritional intervention (nutritional intervention group), consisting of the daily distribution of two oral supplements, with each supplement containg 200 kcal, for 15 d. Pressure ulcer incidence was prospectively recorded for grades I (erythema), II (superficial broken skin), and III (subcutaneous lesion) for 15 d. Nutritional intake was monitored by using estimates in units of quarters validated by comparison with weight measurement. There were 672 subjects older than 65 y, and 295 were in the nutritional intervention group versus 377 in the control group. The patients were similar for age, sex ratio, and C-reactive protein. In comparison with the control group, the nutritional intervention group included more patients with stroke, heart failure, and dyspnea and fewer with antecedent falls, delirium, lower limb fractures, and digestive disease. The nutritional intervention group had a lower risk of pressure ulcers according to the Norton score but was less dependent (Kuntzman score) and had a lower serum albumin level. During the trial, energy and protein intakes were higher in the nutritional intervention group (day 2: 1081 +/- 595 kcal versus 957 +/- 530 kcal, P = 0.006; 45.9 +/- 27.8 g protein versus 38.3 +/- 23.8 g protein in the control group, P < 0.001). At 15 d, the cumulative incidence of pressure ulcers was 40.6% in the nutritional intervention group versus 47.2% in the control group. The proportion of grade I cases relative to the total number of cases was 90%. Multivariate analysis, taking into account all diagnoses, potential risk factors, and the intra-ward correlation, indicated that the independent risk factors of developing a pressure ulcer during this period were: serum albumin level at baseline, for 1 g/L decrease: 1.05 (95% confidence interval: 1.02 to 1.07, P < 0.001); Kuntzmann score at baseline, for 1-point increase: 1.22 (0.32 to 4.58, P = 0.003); lower limb fracture: 2.68 (1.75 to 4.11, P < 0.001); Norton score < 10 versus > 14: 1.28 (1.01 to 1.62, P = 0.04); and belonging to the control group: 1.57 (1.03 to 2.38, P = 0.04). In conclusion, it was possible to increase the dietary intake of critically ill elderly subjects by systematic use of oral supplements. This intervention was associated with a decreased risk of pressure ulcer incidence.

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PubMed2000

Incidence and predictors of drug-treated diabetes in elderly French subjects. The PAQUID Epidemiological Survey.

AIMS: To estimate the incidence and predictors of drug-treated diabetes in elderly subjects. METHODS: The PAQUID epidemiological survey, a population-based study, has followed up 3,777 subjects older than 65 years since 1988. At each visit (baseline, 1, 3, 5 and 8 years), treatment regimen was used to identify new drug-treated diabetic subjects. Potential predictors of drug-treated diabetes were collected during the baseline visit (body mass index (BMI), educational level, cigarette smoking and wine consumption, physical activity, depressive symptomatology, subjective health, treatment, and hypertension) and analysed by using a multivariate backward stepwise regression Cox model with delayed entry. RESULTS: The prevalence rate of drug-treated diabetes was 7.5% at baseline and 7.1% after 8 years' follow-up. The incidence rate of drug-treated diabetes was 3.8/1,000 person-years, 5.9/1,000 person-years in men and 2.4/1,000 person-years in women, with no significant variation according to age group. Male sex (relative risk (RR) 2.4, 95% confidence interval (CI) 1.4-4.0, P < 0.001, attributable risk (AR) 0.36), elevated BMI (for one point increase, RR 1.1, 95% CI 1.1-1.1, P < 0.001, > or = 25 vs. < 25, RR 2.1, 95% CI 1.2-3.5, AR 0.33), thiazide diuretics used alone (RR 5.9, 95% CI 1.8-19.6, P = 0.02), and poorer subjective health ('the same' vs. 'better' RR 1.8, 95% CI 1.0-3.1, P = 0.04; 'worse' vs. 'better' RR 2.3, 95% CI 0.9-5.7, P = 0.06) were independent predictors of drug-treated diabetes in this population. CONCLUSIONS: In older French individuals, men seem to be particularly exposed to drug-treated diabetes although being overweight was found to be a strong predictor as in younger populations.

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PubMed2000

A national survey of heart failure in French hospitals. The Myocardiopathy and Heart Failure Working Group of the French Society of Cardiology, the National College of General Hospital Cardiologists and the French Geriatrics Society.

Rationale The epidemiology of heart failure and patient management procedures may vary from one country to another. This study was designed to analyse the spectrum of patients hospitalized in France for heart failure. Patients and Methods A registry involving 120 departments (cardiology, general medicine and geriatrics) and 1058 patients.Results The patients' median age was 76 years, and the male/female ratio was 55/45. Echocardiography was performed in 77% of the cases: the left ventricular ejection fraction was <30% in 22%, between 30 and 40% in 25% and greater than 40% in 53%. Angiotensin-converting enzyme (ACE) inhibitors were prescribed to, respectively, 78% and 63% of patients with ejection fractions above and below 40%. Conclusion In France, patients hospitalized for heart failure tend to be old and are often women; about one in two have relatively preserved left ventricular systolic function. ACE inhibitor prescription seems to be more frequent than currently reported. This survey confirms the clear gap between the populations in clinical trials and those in routine clinical practice.

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PubMed1999

Prospective audits of quality of PEM recognition and nutritional support in critically ill elderly patients.

BACKGROUND AND AIMS: Undereating is a frequent concern in acute care geriatric settings and is supposed to worsen the outcomes of the underlying diseases, while the quality of nutritional support could be improved. METHODS: Two consecutive and prospective audits (A and B) with team training over a 1 year period investigated the quality of malnutrition recognition and nutritional support and outcomes in immobilized, critically ill elderly subjects. RESULTS: Audit A included 170 patients (86.3+/-6.1 years old) and audit B, 232 patients (86.3+/-6.3), respectively 20.6% and 31.4% of the hospitalized population. Misclassifications occurred in A in 54.0% compared to 34.05% in B (P < 0.001). 32.6% in A versus 86.9% in B adequately received oral supplements (P = 0.02). Significant risk factors for the adverse outcomes in the combined two audits were: dementia (RR: 1.8, 95%CI: 1.0 to 3.0, P= 0.04) and dehydration (RR: 2.0, 95%CI:1.0 to 4.1, P= 0.05) for pressure ulcer incidence; stroke (RR: 8.8, 95%CI: 4.8 to 16.0, P < 0.001) for pressure ulcer prevalence at discharge; neoplasms (RR: 1.1, 95%CI: 1.0 to 1.2, P = 0.02) for nosocomial infections; bladder indwelling for urinary tract infections (RR: 4.8, 95%CI: 2.9 to 7.7, P<< 0.001); swallowing problems for pulmonary infections (RR: 5.4, 95%CI: 2.8 to 10.5, P < 0.001); venous indwelling for septicaemia (RR: 5.4, 95%CI: 1.3 to 23. 3, P= 0.02). However, after adjustment on significant risk factors, the outcome rate was similar in audit B: death rate: A (15.6%), B (14.2%); length of stay: A (17.3+/-10.4 days), B (17.4+/-10.0); pressure ulcer incidence: A (26.4%), B (20.2%), (83% were erythema); pressure ulcer prevalence at discharge: A (14.7%), B (10.3%), (40% were erythema); nosocomial infections: A (26.4%), B (19.0%). CONCLUSION: The improvement of malnutrition recognition and nutritional support was not followed by a perceptible decrease in adverse outcome rate, this latter being mainly related to the underlying conditions of these critically ill elderly patients.

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PubMed1998

Five-year mortality in elderly French subjects from the PAQUID epidemiologival survey: the burden of diabetes.

We describe the 5-year mortality and its risk factors in a cohort of elderly people with and without known diabetes mellitus. The PAQUID cohort was representative of the population older than 65 living in Gironde, south-west France. Potential mortality risk factors were collected during a baseline evaluation, using a health questionnaire, from 68.9% of a randomly selected sample of over-65s in 1988. A total of 237 subjects (8.5%) had diabetes. Annual review occurred for 5 years and cause of any death was ascertained from family doctors. After 5 years, 623 people (22.3%) had died, of whom 576 were non-demented; 30.0% of the diabetic group versus 20.3% of the non-diabetic group had died. Survival of the known diabetic group was lower than that of the non-diabetic group (p < 0.001), although this excess mortality was significant only in the 65 to 75 age range (relative risk 1.8; 95% confidence interval 1.2 to 2.8, p = 0.04). Cardiovascular mortality rate did not differ between the diabetic and non-diabetic groups (RR 1.2 [0.8-2.0]). Death related to neoplasia was significantly higher in the known diabetic group (RR 2.2 [1.2-3.3], p = 0.01). In the final model, integrating diabetes as a mortality risk factor in the total cohort, known diabetes at the baseline examination was an independent risk factor for mortality (RR 1.4 [1.0-1.8], p = 0.01), in addition to tobacco use, hypertension and functional dependency. These results confirm suggestions that diabetes increases mortality in the over-65 age group, perhaps with an adverse interaction with other pathology.

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PubMed1998

[Drug prescriptions for the elderly].

The assessment od drugs taken by elderly people remains a difficult subject since epidemiological data on drug intake in this population is very limited. In a study undertaken in the context of the PAQUID project, drug use was screened in a group of 3,777 elderly people living at home in the Gironde and Dordogne regions of south-west France. In this group, 89.1% of subjects take at least one drug per day, with an average daily intake of 4.1 drugs by 41% of the group. One third of these elderly people take a benzodiazepine drug. Excessive intake of drugs by elderly people is a phenomenon encountered in Scandinavia and Italy but not in the United Kingdom.

Age Factors↗

PubMed1997

Audit of percutaneous endoscopic gastrostomy in long-term enteral feeding in a nursing home.

OBJECTIVES: Percutaneous endoscopic gastrostomy (PEG) is now easily used in the event of long-term enteral nutrition. Tolerance of long-term enteral feeding has been documented in different populations but the documentation is incomplete in the case of older and frail people. Our aim was to describe early and late tolerance in this population, and to propose ways in which it could be improved. DESIGN: Retrospective study in two parts: tolerance and quality of care; case-control study for tolerance. SETTING: A nursing home with 240 beds in south-west France. who had undergone PEG insertion between January 1990 and June 1994. Fifty-eight patients were involved, 12 under 65 years (48 +/- 10.6), and 46 over 65 (80.7 +/- 9.3). The gastrostomy insertion was performed because of a vegetative state in 6 patients, swallowing difficulties in 31 and anorexia in 21. A control group was gathered in December 1996, which included all patients for whom the question of nutritional support was mentioned books but where no artificial nutrition had been implemented due to the patients' or families' refusal or to a staff decision. This group included 50 patients, 5 younger than 65 years (54 +/- 8.3), and 45 older (84.7 +/- 7.6). In 22 cases the nutritional problem was swallowing difficulties and in 28 cases anorexia. Pressure ulcers were present before insertion in 34 patients in the PEG group and in 7 of the control group (p < 0.001). MAIN OUTCOME MEASURES: Prognosis, early and late cutaneous digestive (ileus, vomiting, gastroesophageal reflux) and pulmonary (bronchorrhea, dyspnea and aspiration pneumonia) complications for PEG and control groups, and patients with signs of poor behavioural tolerance of PEG were recorded in the chart. Audit of quality of care was performed in the PEG group using eight criteria: two concerned the pre-insertion period, two the early follow-up and four the long-term follow-up. RESULTS: Early mortality (4 weeks) was 13.8% in PEG (vs 10%, NS), mid-term mortality (between 4 and 8 weeks) was 12.1% (vs 14%, NS) and late mortality was 19.0% (vs 42.0%, length of follow-up 63.4 +/- 42.1 weeks compared to 53.1 +/- 63.8 weeks, NS). The duration of follow-up of the living patients was 71.6 +/- 61.8 weeks in PEG compared to 48.0 +/- 70.5 in the control group. Only 20% in PEG were free of any cutaneous complication around the insertion site, and 8 abscesses occurred during the first week. Pulmonary complications occurred in 39% of the PEG group (vs 30.0, NS). Aspiration pneumonia was significantly associated with swallowing difficulties in both groups (p < 0.05). Vomiting occurred for 15.5% of the PEG group (vs 12%, NS), ileus in 13.8% (vs 6%, NS). Gastroesophageal reflux was found in 2 PEG patients, compared to 1 case among the control patients. Pressures sores were healing in 20 out of 34 patients in the PEG group (vs 2 out of 7) and new ulcers appeared in 6 out of 24 (vs 8 out of 43). Fifteen (25.8%) of the PEG patients attempted to withdraw the tube.

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PubMed1997

Prevalence of diabetes and effect on quality of life in older French living in the community: the PAQUID Epidemiological Survey.

OBJECTIVES: To evaluate the prevalence of diabetes mellitus in older French subjects and to examine the different aspects of quality of life in an older diabetic population. DESIGN: From a random sample of 2792 people older than age 65 living in the community, a diabetic sample was selected using three items from a questionnaire: Are you diabetic? Are you on a diabetic diet? What kind of medications do you take daily? Validation of the questionnaire was carried out previously to correct the observed prevalence. MEASUREMENTS: The questionnaire assessed social and demographic aspects, physical, mental, and subjective health, and functional disabilities. Because quality of life assessment was mainly subjective, demented subjects were excluded. RESULTS: The diabetic group consisted of 237 subjects from the older sample of 2792 (8.5%). No age difference was demonstrated between the two groups (mean, distribution), but the male/female ratio was significantly higher in those with diabetes (49.4% vs 39.3%, P = .003). Corrected prevalence of diabetes was 10.3%. After exclusion of demented subjects, 230/2726 people were investigated. Diabetic subjects were heavier (P < .001), had higher systolic blood pressure (P < .001), and had more frequent symptoms of ischemic heart disease (P < .001) and painful peripheral arterial disease (P < .001) and dyspnea (P < .001), but antecedents of stroke were similar in both groups. Diabetics were more often lacking in autonomy according to the IADL Lawton scale (P < .001), Rosow and Breslow scale (P < .001), and Mobility scale (P = .043), but not according to the Katz ADL scale. They more often exhibited symptoms of depression on the CES-D self-rating scale (21.3% vs 12.7%, P < .001), but evaluation of cognitive function was similar in both groups. Thirteen percent of diabetics, compared with 7.6% of non-diabetics, were unsatisfied with their own situation (P = .002). Health was rated as fair, bad, or very bad by 67.8% of diabetics compared with 49% of non-diabetics (P < .001). Diabetics rated themselves as feeling worse than others (15.3% vs 9.2%, P < < .001) and worried more about their health status (78% vs 63%, P < < .001). CONCLUSION: The observed prevalence of diabetes in older French people living in the community was 8.5%. Quality of life in older diabetics was poorer than that of other people of the same age.

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