For older adults, an Emergency Department (ED) visit represents a period of vulnerability that extends beyond the visit itself. This study aimed to determine the impact of the role of caregiver, and geriatric conditions of patients on early unplanned rehospitalization (EUR) within 3 months after an ED visit. This prospective longitudinal experimental study included consecutively 173 patients aged 75 and older admitted in an ED over a 2-week period (18.7 % of the total visits). Only older patients having a caregiver were analyzed (78.0 %, n = 135). Medical conditions and a comprehensive geriatric assessment were recorded for each patient. All caregivers were interviewed about their tasks and emotional impact using the short Zarit Burden Inventory. Three months after, patients or their caregivers were called about the vital status, and EUR of patients. Among the patients included, 64.2 % had an EUR and 28.9 % of their caregivers reported a high level of burden. EUR was strongly associated with a high caregiver burden (OR 8.7, 95 % CI 1.5–49.8). No association was found for patient’s medical or geriatric status. Caregivers reported a significantly high burden when patients were malnourished, or were at risk of adverse health outcomes based on the ISAR scale, and when they had greater disabilities in IADLs and ADLs, or cognitive impairments. Many hospital readmissions after an ED visit may be preventable by identifying caregiver’s high burden. Reasons that lead to this high burden should be checked at the first visit.

Predictive factors for early unplanned rehospitalization of older adults after an ED visit: role of the caregiver burden

In older adults, an adequate diet depends on their ability to procure and prepare food and eat independently or the availability of dietary assistance when needed. Inadequate food intake or increased nutritional requirements lead to poor nutritional status, which is considered a key determinant of morbidity, increased risk of infection, and mortality in elderly individuals. Weight loss among seniors also heralds increased morbidity and mortality. Dietary behaviour disorders affecting food consumption, nutrition status and maintenance of body weight are common in older adults, and have a substantial impact on nutritional status and quality of life among older adults with Alzheimer Dementia (AD). The Nutrition Intervention Study (NIS) is ongoing. It employs a quasi-experimental pre-post intervention design in physically-well, community-dwelling early stage AD patients aged 70y or older. To date, 34 intervention group patients and 25 control group participants have been recruited with their primary caregivers (CG) from 6 hospital-based memory and geriatric clinics in Montreal. The NIS uses clinical dietetics principles to develop and offer tailored dietary strategies to patients and their CG. This paper reports on the application of dietary intervention strategies in two intervention group participants; one was deemed successful while the other was considered unsuccessful. The report documents challenges encountered in assessing and counselling this clientele, and seeks to explain the outcome of intervention in these patients.

Dietary intervention in older adults with early-stage Alzheimer dementia: early lessons learned.

Elderly frailty has been recognized as a distinct clinical syndrome with a physiologic basis. It reflects a decreased functional reserve and consequent reduction in resilience to any stressors. It is important to understand that frailty process could be a transitional state with dynamic properties: normal aging→pre-frail→frailty→complication status. Hence, frailty could be preventable and its progression may be delayed. Furthermore, there is the potential reversibility of many of its features. The earlier stages of frailty might not be clinically apparent, but later stages manifest as significant deficits accumulate. The major phenotype of frailty includes weight loss, sarcopenia, relative inactivity, decreased balance and mobility, decreased cognitive function, and impaired nutritional status. Therefore, frail patients could be implicated by decreased performance status and have a significantly increased risk of cardiovascular diseases, cancer, falls and mortality. Regular exercise, essential amino acid and vitamin D are recommendable to prevent and treat elderly frailty, but hormone replacement therapy does not have consistent evidence yet. In upcoming (super) aging society, the importance of elderly frailty would be more noticed and multidisplinary approach should be actively performed.

/pdf/integrative-approach-to-elderly-frailty-29zmdh37h6.pdf

Integrative Approach to Elderly Frailty

INTRODUCTION:
The number of older people diagnosed with amnestic mild cognitive impairment (aMCI), the prodromal state of Alzheimer's disease (AD), is increasing worldwide. However, some patients with aMCI never convert to the AD type of dementia, with some remaining stable and others reverting to normal. This overdiagnosis bias has been largely overlooked and gone unexplained. There is ample evidence in the laboratory that negative ageing stereotypes (eg, the culturally shared belief that ageing inescapably causes severe cognitive decline) contribute to the deteriorating cognitive performances of healthy older adults, leading them to perform below their true abilities. The study described here is intended to test for the first time whether such stereotypes also impair patients' cognitive performances during neuropsychological examinations in memory clinics, resulting in overdiagnosis of aMCI.

METHODS AND ANALYSIS:
The ongoing study is a 4-year randomised clinical trial comparing patients' physiological stress and cognitive performances during neuropsychological testing in memory clinics. A total of 260 patients attending their first cognitive evaluation will be randomised to either a standard condition of test administration, assumed here to implicitly activate negative ageing stereotypes or a reduced-threat instruction condition designed to alleviate the anxiety arising from these stereotypes. Both groups will be tested with the same test battery and stress biomarkers. For 30 patients diagnosed with aMCI in each group (n=60), biomarkers of neurodegeneration and amyloidopathy will be used to distinguish between aMCI with normal versus abnormal AD biomarkers. A 9-month follow-up will be performed on all patients to identify those whose cognitive performances remain stable, deteriorate or improve.

ETHICS AND DISSEMINATION:
This protocol has been approved by the French National Agency for Medicines and Health Products Safety and the Sud-Est I French Ethics Committee (2017-A00946-47). Results will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER:
NCT03138018.

https://bmjopen.bmj.com/content/bmjopen/9/10/e032265.full.pdf

Ageing stereotypes and prodromal Alzheimer's disease (AGING): study protocol for an ongoing randomised clinical study

The objective of this study was to verify the effects of physical rehabilitation on the decline of Alzheimer's disease in Tunisian male older adult patients. We focused mainly on effects on motor functions mainly stride length, walking speed and postural stability. 21 patients carefully selected were separated into two groups. The first group of nine patients served as control. However, the second group is composed of twelve patients was submitted for six months at three sessions of 60 minutes per week in a physical training program. Our results showed that physical activity improves significantly motor functions in Alzheimer's disease patients, namely stride length, walking speed, double limb support time and postural stability. We conclude that the physical training could be an interesting approach for the control of Alzheimer's disease in Tunisian male older adult patients.

/pdf/physical-activity-and-management-of-motor-functions-in-41p1k5sml5.pdf

Physical Activity and Management of Motor Functions in Tunisian Elderly Adult Affected by Alzheimer's Disease

Creee, il y a plus de 20 ans, par les Prs J.L. Albarede, J. Pous et P. Vellas, l’Annee gerontologique a evolue d’annee en annee. Ce fut tout d’abord un recueil annuel d’articles qui apportait aux gerontologues et aux geriatres une synthese des avancees dans les domaines de la gerontologie sociale, clinique ou biologique. Par la suite, l’Annee gerontologique a permis de publier des volumes plus specifiques sur certains grands aspects de la gerontologie. Dans ce volume, les differents articles permettent de mieux apprehender la prise en charge specifique des personnes âgees fragiles, et cela, dans les differents domaines de la medecine. Enfin, durant ces dix dernieres annees, l’Annee gerontologique a regulierement publie les actes de la SFGG. Le contenu et la diversite des communications lors de ce congres temoignent du dynamisme, de la croissance et du developpement de la gerontologie et de la medecine geriatrique en France. Du fait du grand nombre d’articles soumis pour publication chaque annee, nous avons decide en collaboration avec les Editions Springer de publier parallelement au volume annuel de l’Annee gerontologique : les Cahiers de l’annee gerontologique. Chaque numero sera coordonne par l’un des redacteurs associes : les Prs Chassagne (Rouen), Jeandel (Montpellier), Nourhashemi (Toulouse), Vellas (Toulouse) et Verny (Paris) ; l’objectif est de prolonger l’action de l’Annee gerontologique a la fois dans le domaine de la formation, mais aussi de la recherche clinique dans les thematiques importantes que sont celles specifiques au vieillissement, notamment la nutrition, la fragilite, l’evaluation gerontologique, la cancerologie du sujet âge, la maladie d’Alzheimer, la prevention, etc. L’Annee gerontologique et Les cahiers de l’annee gerontologique restent ouverts a tous les cliniciens et chercheurs investis dans le domaine du vieillissement. Cela nous permettra de continuer a publier vos contributions, qu’il s’agisse d’articles de synthese ou de travaux originaux, de facon encore plus rapide.

/pdf/l-annee-gerontologique-et-les-cahiers-de-l-annee-5aem1an1cp.pdf

L’Année gérontologique et Les cahiers de l’année gérontologique

Le patient âge fragile est un sujet a haut risque de fracture de hanche. Toutefois, il accede peu a l’organisation aux mesures prevenant la chute et rarement a l’approche diagnostique et therapeutique de l’osteoporose. Cette revue de la litterature porte sur les liens entre le syndrome de fragilite et le risque de fracture de hanche. Elle fut discutee lors d’une reunion d’un groupe de geriatres, d’endocronologues, de rhumatologues et de gynecologistes. Le concept de fragilite permet d’envisager une approche differente du risque de fracture de hanche des sujets âges. Des perspectives de prevention, d’organisation des soins specifiques semblent pertinentes au sein de cette population. Le modele classique, voulant que l’on traite individuellement chaque pathologie, se prete mal a la prise en charge du sujet fragile. L’approche diagnostique de l’osteoporose axee sur la majoration de la densite minerale osseuse (DMO) est necessaire mais probablement insuffisante dans cette population. L’objectif therapeutique ne peut pas se limiter a l’augmentation de la DMO. La prevention de la chute en ameliorant les facteurs determinant du syndrome de fragilite (force, statut nutritionnel, activite physique, cognition) sont des approches therapeutiques qui devraient limiter l’incidence des fractures. Des etudes supplementaires, orientees vers le sujet fragile, permettraient de mieux comprendre les effets de la prise en charge de la fragilite sur la fracture. En parallele, la prise en charge plus systematique de l’osteoporose devrait limiter le risque d’une personne âgee robuste de devenir fragile et d’une personne fragile de devenir dependante.

Fragilité, ostéoporose et fracture du col du fémur: causes, conséquences et perspectives thérapeutiques

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L’Année gérontologique et Les cahiers de l’année gérontologique

Fragilité, ostéoporose et fracture du col du fémur: causes, conséquences et perspectives thérapeutiques