Céline Lazarovici

Assistance Publique – Hôpitaux de Paris, Lutetia Parisorum, Île-de-France, France

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Publications (14)8.38 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives We characterized elderly cancer patients referred to an oncogeriatric unit and sought factors warranting referral for geriatric assessment before or during cancer therapy.
    Journal of Geriatric Oncology 01/2011; 2(3):194-199. · 1.12 Impact Factor
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    ABSTRACT: We studied the factors influencing the choice of admission to Geriatrics units, instead of other acute hospital units after an emergency visit. We report the results from a cohort of 1283 randomly selected patients aged >75 years hospitalized in emergency and representative of the French University hospital system. All patients underwent geriatric assessment. Baseline characteristics of patients admitted to Geriatrics and other units were compared. A center effect influencing the use of Geriatrics units during emergencies was also investigated. Admission to a Geriatrics unit during the acute care episode occurred in 499 cases (40.3%). By multivariate analysis, 4 factors were related to admission to a Geriatrics unit: cognitive disorder: odds ratio (OR)=1.79 (1.38-2.32) (95% confidence interval=95% CI); "failure to thrive" syndrome OR=1.54 (1.01-2.35), depression: OR=1.42 (1.12-1.83) or loss of Activities of Daily Living (ADL): OR=1.35 (1.04-1.75). The emergency volume of the hospital was inversely related to the use of Geriatrics units, with high variation that could be explained by other unstudied factors. In the French University Emergency Healthcare system, the "geriatrics patient" is defined by the existence of cognitive disorder, psychological symptoms or installed loss of autonomy. Nevertheless, considerable nation-wide variation was observed underlining the need to clarify and reinforce this discipline in the emergency healthcare system.
    Archives of gerontology and geriatrics 03/2010; 52(1):40-5. · 1.36 Impact Factor
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    ABSTRACT: Two scores exist to assess the benefits and risks of antithrombotic therapy in patients with atrial fibrillation: CHADS2 [for Congestive heart failure, Hypertension, Age over 75, Diabetes mellitus; and 2 points for a history of Stroke] and HEMORR2HAGES [for Hepatic or renal failure, Ethanol abuse, Malignancy, Older (age over 75), Reduced platelet count or function, 2 points for Rebleeding risk Hypertension (uncontrolled), Anemia, Genetic factors, Excessive fall risk (including neurodegenerative and psychiatric disorders) and history of Stroke]. The potential value of using both scores routinely was studied in order to guide the choice of antithrombotic therapy for geriatric patients. Retrospective calculation of CHADS2 and HEMORR2HAGES scores and discharge treatment were collected for all patients with atrial fibrillation during a six-month period. All files were analysed when there were differences between therapeutic choices and the results of analysis of combining the two scores. 83 patients were identified. Their mean age was 89.2±4.9 years and 30% of them were on oral anticoagulants on discharge. Usual prescription habits of oral anticoagulants correlated strongly with each of the scores and with the difference between the two scores. The clinical usefulness of using the two scores seemed poor since they indicated that two-thirds of the patients had a similar risk of hemorrhagic and ischemic events. Based on this preliminary study, the CHADS2 and HEMORR2HAGES scores are associated with the prescription of oral anticoagulants, but their routine use may not significantly change the choice of antithrombotic therapy for patients with atrial fibrillation.
    Aging clinical and experimental research 12/2009; 22(4):289-94. · 1.01 Impact Factor
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    ABSTRACT: In order to evaluate changes in the functional autonomy of elderly patients after a stay in a medical intensive care unit (ICU), and the impact of post-ICU management in geriatric ward, we included in a randomized controlled trial 45 patients aged>or=75 years. They were assessed for functional autonomy before ICU stay, just after ICU discharge, just after hospital discharge, and 6 months later. The patients were randomly divided into two post-ICU management groups: "geriatric ward" and "standard care". Autonomy was usually recovered rapidly, but the degree of recovery depended on the patient's previous autonomy (p<0.0001). At the last assessment, 41% of the patients had recovered their previous autonomy. The mean Barthel indexes were 81.5+/-30.4 in the geriatric management arm and 70.5+/-33.4 in the standard management arm (p=0.4). The study was prematurely ended due to insufficient recruitment flow. These results underline the rapid loss of autonomy after a stay in a medical ICU. Early specific intervention to improve the autonomy of elderly patients seems an attractive solution that could be assessed by randomized controlled trial. Above all, our results should also serve as a basis for further controlled randomized studies in this setting.
    Archives of gerontology and geriatrics 07/2009; 50(3):e36-40. · 1.36 Impact Factor
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    ABSTRACT: Ageing of population due to improvement in life expectancy has increased blood diseases (BD) incidence in the elderly population. In addition, treatments get more and more complex with increasingly late diagnosis as well as concomitant comorbidities. We describe a series of 54 patients with BD, followed-up in an acute care geriatric department. Autonomy, way of life, nutritional status, comorbidities, treatment, mortality and evolution were analyzed. Mean age at BD was 86+/-6 years (range 75-99) for 29 women and 25 men. Median follow up was 20 months (0-60). Lymphoma was the most frequent BD (44%). Thirty-one patients (57%) received chemotherapy. Mortality rate was 41% (22 patients). Forty patients (74%) were discharged and 25 patients (46%) required enhanced professional assistance. Survival was significantly decreased in patients with albuminemia less than or equal to 30 g/l. IADL score less than or equal to 3, ADL score less than or equal to 5, performance status more than or equal to 2, MMS less than 25 and weight loss more than or equal to 3 kg. After multivariate analysis, only albuminemia less than or equal to 30 g/l tended to predict death (hazard ratio 3.57, 95% confidence interval 0.96-13.3, p=0.06). Our study confirms the importance of nutritional status on survival. A global geriatric evaluation is required for appropriate treatment, as currently available therapeutic protocols are not really adapted for old population. Additional studies should be conducted in this direction.
    La Revue de Médecine Interne 08/2008; 29(7):541-9. · 0.90 Impact Factor
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    ABSTRACT: We have little information on the geriatric characteristics of elderly patients visiting the emergency departments (ED) in France. In order to develop an adapted prevention of the arrival of some elderly patients, the determinants of their arrival to the ED deserves to be better known. A one-day cross-sectional study was conducted in French ED. A standardized questionnaire was used for each patient over 80 years (Pts), specifying the sociodemographic characteristics, the circumstances of visit to and care received in the ED, and the orientation of the patients after consulting the ED. On a sample of 1298 Pts, health event leading to ED started at home in 63.8% of cases. When the patients initiated themselves the recourse to health care (RHC), they called less often a general practitioner (61.9% of cases) than when the RHC was triggered by their family (69.6%, p=0.01). When a health care professional initiated the RHC, it was a GP in more than 80% of cases. Return to residence was more frequent when the patient triggered the RHC (34.5% versus 22.9% for the family and 16.0% for the professional health care, p<0,001). The actor of the decision of arrival to the ED has an impact in the RHC, in resources utilisation, and on the patient's orientation after coming in ED. The results of this study may help to design strategies aiming at avoiding unnecessary ED consultations of elderly persons.
    La Revue de Médecine Interne 05/2008; 29(8):618-25. · 0.90 Impact Factor
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    ABSTRACT: The clinical pertinence of score variations on the measurement scales for Alzheimer disease remains uncertain. The metrological qualities of these scales are often uncertain. The population included in clinical trials is different from the population with the disease. Long-term tolerance of acetylcholinesterase inhibitors is not yet known in very elderly subjects who may be taking multiple drugs or psychotropic drugs or have cardiovascular disease, or any combination thereof. The long-term value of these drugs is unknown. Nonpharmacologic management remains the primary treatment option for elderly patients with cognitive decline, even though its results have not yet been assessed in depth.
    La Presse Médicale 03/2008; 37(9):1261-7. · 0.87 Impact Factor
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    ABSTRACT: The clinical pertinence of score variations on the measurement scales for Alzheimer disease remains uncertain. The metrological qualities of these scales are often uncertain. The population included in clinical trials is different from the population with the disease. Long-term tolerance of acetylcholinesterase inhibitors is not yet known in very elderly subjects who may be taking multiple drugs or psychotropic drugs or have cardiovascular disease, or any combination thereof. The long-term value of these drugs is unknown. Nonpharmacologic management remains the primary treatment option for elderly patients with cognitive decline, even though its results have not yet been assessed in depth.
    Presse Medicale. 01/2008; 37(9):1261-1267.
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    ABSTRACT: Background Ageing of population due to improvement in life expectancy has increased blood diseases (BD) incidence in the elderly population. In addition, treatments get more and more complex with increasingly late diagnosis as well as concomitant comorbidities.
    Revue De Medecine Interne - REV MED INTERNE. 01/2008; 29(7):541-549.
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    ABSTRACT: PurposeWe have little information on the geriatric characteristics of elderly patients visiting the emergency departments (ED) in France. In order to develop an adapted prevention of the arrival of some elderly patients, the determinants of their arrival to the ED deserves to be better known.
    Revue De Medecine Interne - REV MED INTERNE. 01/2008; 29(8):618-625.
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    ABSTRACT: Because the elderly tend to have complex and multiple diseases, they are likely to use emergency department (ED) resources at higher rates than other age groups. This study sought to determine the characteristics and resource use of the elderly patients (>or=75 years old) visiting EDs in France and assessed the effect of age on resource use. The sample was selected from the DREES prospective study of 150 French EDs for one week in 2002. A case report form was completed for each patient, stating the reasons for consultation, method of arrival, treatment, and outcome. Data were weighted to produce a representative national description. Of the 9801 patients seen that week, the elderly (n=1153) accounted for 11.8% of all ED visits, that is, 26 676 ED visits weekly nationwide. In this group, the mean age was 83 years and 60.9% were women. Most patients arrived by medical transportation: 55.6% by nonemergency ambulances and 24.6% by emergency medical transport. More than 75% were referred by their general practitioner (GP). Medical problems (69.5%) were much more frequent than trauma (24.8%). Clinical status was stable in 62% of cases. Use of ED resources was high: radiographs for 74.0%, laboratory testing for 71.0% and electrocardiography for 64.0%. The percentage of unnecessary or avoidable visits was small: 8.7% were not admitted, were clinically stable, and came for diagnostic tests that could have been performed on an outpatient basis. Age was an independent factor of pre-ED and ED resource use. Unplanned health care of the elderly uses substantial ED resources. Elderly patients appear to use available resources appropriately. Demographic trends show that their ED use will increase. Accordingly, analysis of the organization and funding of ED services for this population is indispensable.
    La Presse Médicale 01/2007; 35(12 Pt 1):1804-10. · 0.87 Impact Factor
  • Revue De Medecine Interne - REV MED INTERNE. 01/2006; 27.
  • Presse Medicale. 01/2006; 35(12):1804-1810.
  • Journal Européen des Urgences. 17(3).

Publication Stats

22 Citations
8.38 Total Impact Points

Institutions

  • 2011
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2007–2010
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • Service de Réanimation Médicale
      Lutetia Parisorum, Île-de-France, France
  • 2008
    • Université René Descartes - Paris 5
      Lutetia Parisorum, Île-de-France, France