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Biomedical subjects

T Constans

Publications and source records attributed to T Constans.

At least 19 recordsLinked to original sources
PubMed2005

[Hypodermoclysis: benefits and indications in geriatrics].

PURPOSE: Older people are at high risk of dehydration. Oral intakes are often inadequate routinely. Intravenous infusion may be difficult in these patients and harmful. Subcutaneous infusion or hypodermoclysis is a useful technique for the cure of a moderate dehydration in elderly patients and especially for its prevention. Moreover, this technique is of great interest in end-life patients. CURRENT KNOWLEDGE AND KEY POINTS: When it is used correctly and when its contraindications are respected (emergency situations), hypodermoclysis is a simple, safe, sure, effective and comfortable technique. It does not need trained supervision and can be used both in an institution and at home, thus avoiding hospitalization of older subjects and reducing health costs. This technique has considerable benefits both psychologically and financially. FUTURE PROSPECTS AND PROJECTS: The numerous advantages of hypodermoclysis should encourage its wider use in older patients at home as well as in institutions. Moreover, new indications need to be evaluated. In this way, subcutaneous infusion of therapeutics or prevention of protein-energy malnutrition by hypodermoclysis of amino acids need further investigations.

Aged↗
PubMed2005

Plasma glucose goals and therapeutic management in elderly diabetic patients.

In the elderly diabetic patient, therapeutic decision making is not entirely based on evidence acquired from large-scale studies conducted in young adults. In this population autonomy, co-morbidity and prognosis are all objective parameters which must be taken into consideration. Frail patients run the risk of hypoglycaemia if the therapeutic goal is too strict. Frail patients can be distinguished from autonomous patients free of serious co-morbidity using evaluation scales validated for geriatric patients enabling the establishment of appropriate goals for the treatment of diabetes without compromising the patients' quality-of-life.

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PubMed2005

Diabetic hyperosmolarity: a consequence of loss of autonomy.

Diabetic hyperosmolarity is a serious acute metabolic disorder mainly occurring in the frail elderly subject presenting age-related favoring factors (reduced sensation of thirst, altered endocrine regulation), disease-related favoring factors (cognitive impairment, poor nutritional status and/or loss of autonomy), and a triggering factor, generally infection. Diabetic hyperosmolarity can occur in a previously non-diabetic patient. Intense dehydration dominants the clinical picture. The prognosis depends largely on the underlying chronic disease.

Diabetes Mellitus↗
PubMed2004

[Editorial].

Explore the source record for details and available documents.

France↗
PubMed2001

Outcome of older patients requiring ventilatory support in intensive care: impact of nutritional status.

OBJECTIVES: To determine predictors of mortality in the intensive care unit (ICU) and at 6 months after discharge; to assess the lifestyles of survivors 6 months after discharge. DESIGN: Prospective cohort study of patients screened upon admission and 6 months after discharge from the ICU. SETTING: The ICU of a university hospital. PARTICIPANTS: One hundred sixteen consecutive patients age 70 and older admitted to the ICU and treated by mechanical ventilation for at least 24 hours. MEASUREMENTS: A comprehensive medical, functional, nutritional, and social assessment was undertaken for each patient upon admission to the ICU. Functional status and residence were recorded for patients still living 6 months after discharge from the ICU. RESULTS: Mortality in the ICU and 6 months after discharge was 31% and 52%, respectively. The predictors of in-ICU mortality on multivariate analysis were a high omega score per day in the ICU and a high simplified acute physiologic score corrected for points related to age (SAPS IIc). The predictors of mortality at 6 months were a high omega score per day in the ICU, a high SAPS IIc, and a mid-arm circumference (MAC) under the 10th percentile for the older French population in good health. Six months after discharge from the ICU, 91% of the surviving patients had the same residential status and 89% had a similar or improved functional status compared with pre-admission status. CONCLUSIONS: Although severity of illness remains an important predictor of in-ICU mortality and mortality at 6 months after release from ICU, we found that impaired nutritional status upon admission was related to 6-month mortality. These results emphasize the need for a systematic nutritional assessment in older patients admitted to the ICU and treated by mechanical ventilation.

APACHE↗
PubMed2000

[Protein-energy malnutrition. Diagnostic methods and epidemiology].

EPIDEMIOLOGY: Protein-calorie malnutrition (PCM) is highly prevalent among elderly persons living in the community (4%), hospitalized in acute care units or geriatric rehabilitation units (50%), or in long-term care facilities (30-40%). PCM is the first predictor of poor prognosis in the elderly. DIAGNOSIS: Parameters used to establish the diagnosis of PCM and identify its pathophysiology are both simple and inexpensive: body mass index, plasma albumin and CRP, arm circumference and skin fold thickness. CONSEQUENCES: Because of its frequency and consequences on morbidity and mortality in the elderly, PCM is an important public health problem in industrialized countries.

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PubMed2000

[Influence of nutrition and physical activity on muscle in the very elderly].

AGE-RELATED LOSS IN MUSCLE MASS: Aging is associated with a progressive decline in muscle mass (sarcopenia). Age-related sarcopenia results in a 50% decrease in muscle fiber area, especially type II fiber area. There are many consequences related to this reduction in muscle mass including decline in muscle strength and function and impaired functional capacity. PROTEIN INTAKE: Sarcopenia also results in a reduction in the body's major protein pool. Adequate dietary protein to replace obligatory nitrogen loss and to support protein turnover is essential for maintaining muscle mass. It is usually suggested that protein requirements in older subjects are above 1 g/kg/d. PHYSICAL EXERCISE: Sedentary lifestyle may contribute to loss of skeletal mass in elderly people. Exercise can help reverse this deficit and may improve the regeneration potential of muscle fibers.

Activities of Daily Living↗
PubMed1997

Comparison of subcutaneous and intravenous administration of a solution of amino acids in older patients.

OBJECTIVE: To compare the plasma amino acid (AA) concentrations obtained by the infusion of an AA solution (660 mOsm/L, pH 7) using the subcutaneous (SC) with that using the intravenous (i.v.) route in older patients. DESIGN: A prospective, randomized, cross-over study. SETTING: A hospital geriatric ward. PARTICIPANTS: Six patients with a mean age of 84 years. MEASUREMENTS: The infusion of the AA solution (IV or SC) lasted 6 hours. Blood was sampled at 0, 2, 4, 6, 8, 10, 14, 18, and 24 hours from the start of the infusion to determine plasma AA level by the phenyl-isothiocyanate method. RESULTS: Compared with baseline values, plasma AA concentrations increased to a significantly higher level from the second to the tenth hour and from the second to the fourteenth hour during i.v. and SC infusions, respectively. Plasma AA levels did not differ between the two routes. SC infusion was well tolerated. CONCLUSION: Assuming that nutritional sufficiency is the desired result of plasma AA infusion, we conclude the SC route is well tolerated and offers the possibility of nitrogen supplementation for older patients over short periods of time, when oral protein intake is transiently insufficient or impossible, as a way to limit, but not to treat, protein-energy malnutrition.

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PubMed1995

Outcome of elderly patients requiring ventilatory support in intensive care.

The objectives of the study were: 1) to evaluate mortality in elderly patients requiring ventilatory support in Intensive Care Unit (ICU) and at 6, 12 and 18 months after discharge from ICU; 2) (main objective) to determine predictors of mortality in ICU and after discharge; and 3) to assess the life-style of survivors. One hundred and ten consecutive hospitalized patients > or = 70 years were included in this retrospective study. Follow-up evaluation was conducted by telephone interview. Mortality in ICU and after discharge was the outcome variable. Fifteen parameters were recorded at admission and during hospitalization. Residence, health status, and self-sufficiency were evaluated after discharge. 1) Mortality in ICU and at 6, 12 and 18 months after discharge was 38%, 60%, 63% and 67% respectively. 2) The predictors of mortality in ICU were admission in shock, and use of major therapeutic interventions. Predictors of mortality at 6 months were admission in shock, previous impaired health status and marital status. 3) Eighteen months after discharge 92% of the surviving patients (N = 33) had the same residence, 75% had the same health status, and 78% had the same autonomy compared with pre-admission status. We concluded that shock and previous health status but not age are predictors of short- and long-term prognoses in elderly patients hospitalized in ICU for mechanical ventilation.

Aged↗
PubMed1995

Metabolic and hormonal changes induced by hypodermoclysis of glucose-saline solution in elderly patients.

BACKGROUND: Hypodermoclysis, i.e., infusion of solutions into the subcutaneous tissues, is an alternative method for hydration. The aim of our study was to describe the metabolic changes induced by hypodermoclysis of a glucose-saline solution in elderly patients. METHODS: Twelve experiments were conducted in a random cross-over study, intravenous infusion (IV) vs subcutaneous infusion (SC), in 6 hospitalized patients (81.5 +/- 9.8 years). The solution (1000 mL of 5% glucose solution containing 4 g NaCl) was infused over 6 hours in fasted patients who remained in bed. Blood was sampled at -10, 0, 30, 60, 90, 120, 180, 240, 300, and 360 minutes for measurement of plasma concentrations of glucose, insulin, free fatty acids, and beta-hydroxybutyrate. Plasma concentration of cortisol was analyzed only at T-10, T0, T180, and T360. RESULTS: The increases in glucose and insulin and the decrease in plasma concentrations of free fatty acids were lower with SC infusion than with IV infusion. The decrease in beta-hydroxybutyrate plasma concentration was lower at T300 with SC infusion than with IV infusion. The decrease in cortisol did not differ with the route. Plasma concentrations of all compounds were similar at T360. CONCLUSION: We conclude that hypodermoclysis of glucose-saline solution induced similar but smaller metabolic and hormonal changes than the IV infusion.

Aged↗
PubMed1994

Anthropometric values in an elderly French population.

We compared anthropometric indices in samples of elderly people aged 65 years and over living in two French areas. The samples were divided into four age-groups (65-69, 70-74, 75-79 and over 80 years). We observed interregional differences in women aged 65-69 years and in men aged 65-74 years. Weight and anthropometric variables related to body fat percentage and to muscle mass showed a decline with age as already reported by others. We established anthropometric percentile values according to sex in pooled subjects when no integrated difference was found. The 50th percentile of arm circumference, muscle arm circumference and triceps skinfold was higher, and the 50th percentile of body mass index was lower than the one reported for the same indices from an elderly Welsh population. Our results show that an interregional difference in anthropometric indices exists in the elderly. The differences which are observed between our results and those reported from a British population emphasize the importance of establishing local values for the elderly population.

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PubMed1992

Protein-energy malnutrition in elderly medical patients.

STUDY OBJECTIVE: To evaluate (1) the prevalence of protein-energy malnutrition in elderly patients; (2) the changes in nutritional status during the hospital stay; and (3) (main objective) the relationship between simple nutritional parameters and short-term in-hospital mortality. DESIGN: Prospective time series at admission and on the 15th day of hospitalization. SETTING: Medical care unit in a teaching hospital. PARTICIPANTS: Consecutive sample of 324 hospitalized patients greater than or equal to 70 years (86.4% of eligible patients). Norms of measurements were obtained from a referred sample of healthy control subjects (26 males and 36 females). MAIN OUTCOME MEASURES: Mid-arm circumference, triceps skinfold thickness, serum albumin, prealbumin, and retinol-binding protein levels were measured in patients at admission and on the 15th day. RESULTS: (1) Prevalence of PEM was 30% in male and 41% in female patients. (2) Both mid-arm circumference and serum albumin level decreased over the first 15 days of hospital stay (53 patients, paired t test, P less than 0.05). Triceps skinfold thickness did not change. (3) A step-wise discriminant-function analysis determined the utility of the parameters at admission as predictors of in-hospital mortality before the 15th day. Mid-arm circumference, triceps skinfold thickness, albumin, and prealbumin levels, as well as age, are predictors of in-hospital mortality, with 73% sensitivity, 69% specificity, and 70% of correctly classified patients of both sexes. CONCLUSIONS: Parameters used are predictors for short-term in-hospital mortality of elderly patients hospitalized in an acute medical unit. The lean body mass is preferentially mobilized for energy during hospitalization.

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