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ABSTRACT: Our aim was to describe the living conditions of disabled elderly subjects aged 75 years and more living at home.
This study was conducted in 1996-97 in the Alsace region in France and included two parts. First, a sample survey was mailed to 15,600 subjects randomly selected from a pension funds list. This survey provided with a reliable representation of the study population in terms of disabilities using the Colvez classification. In the second part, the most disabled individuals were selected and, among them, 1,259 subjects were visited at home. Their disabilities and living conditions were noted using a predefined set of questions.
An estimated 71,000 subjects aged 75 years and more lived at home in the study region. The vast majority were free of significant disability. Help to wash and dress was needed by 6,000 until 1,500 were bedridden or confined to an armchair. Between 4,350 and 5,400 met the criteria for iso-resource grades (IRG) 1 to 3. Disability was associated with age, female gender, cognitive impairment and some social and professional characteristics. Family support was routine in almost every aspect of everyday life including personal hygiene. Professional support was mostly limited to technical interventions. Professional nursing care concerned only the most dependent persons. Nevertheless, needs for help in home and social activities remained high even in the least dependent individuals and were strongly age-dependent. Only 10% of individuals with IRG 1 to 3 complained of inadequate help. More than 80% of the elderly felt comfortable with their living conditions at home and were not thinking of moving from home to an institution for old people.
The present study confirms the important commitment of family members and their close relationships toward their elderly.
Revue d Épidémiologie et de Santé Publique 05/2005; 53(2):153-65. · 0.78 Impact Factor
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ABSTRACT: PURPOSE: Most of the antibiotic-associated diarrhea (AAD) cases result from a transient disturbance in the function of the normal intestinal flora and are spontaneously solved when discontinuing the antibacterial therapy. However, a mild diarrhea lasting several days may induce a dehydration or worsen a denutrition in frail elderly people. CURRENT KNOWLEDGE AND KEY POINTS: The incidence of AAD varies between 5 and 25% depending on the concerned antibiotic. Only 10-20% of all AAD cases are caused by infection, especially with Clostridium difficile, for which advanced age is a major risk factor. The first biological exam to perform when severe AAD or in frail people is the detection of C. difficile toxins, especially in elderly patient treated with beta-lactam antibiotics. Nevertheless, other infectious organisms causing AAD may be considered, as Staphylococcus aureus when predominant in stool cultures from patients treated with fluoroquinolones or as Klebsiella oxytoca when isolated in bloody diarrhea from patients treated with ampicillin. Elevated fecal counts of Candida spp. found in patients treated with antibiotics is rather the consequence of therapy than the cause of AAD. The prevention of AAD is based on a rational antibiotic use to avoid endogenous selection of C. difficile and on the improvement of the hygiene measures to limit the exogenous transmission of the bacteria or related spores by spoiled hands. FUTURE PROSPECTS: Simultaneous prescription of non-pathogenic living organisms, capable of re-establishing the equilibrium of the intestinal flora, should be better described, especially in elderly people, because of its important economic impact.
La Revue de Médecine Interne 02/2004; 25(1):46-53. · 0.61 Impact Factor
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ABSTRACT: The aim of this study was to specify the characteristics of enterobacterial urinary infections producing wide spectrum beta-lactamase (WSBL) and the management strategies for these patients infected in geriatric wards.
The prevalence, bacteriological characteristics and treatment regimens of enterobacterial urinary infections producing WSBL, diagnosed in a geriatric department of internal medicine from May 1977 to April 2001, were studied retrospectively.
Sixty-six enterobacterial urinary infections producing WSBL were diagnosed, with 53 (80%) of them acquired in the ward. They represented 1.6% of admissions and concerned 24 men and 42 women (sex ratio: 0.57), with a mean age of 87 years. Their prevalence was of 20 in the 1st year, 11 in the 2nd, 9 in the third and 26 in the 4th year. The mean duration of hospitalization of infected patients was 4.5-fold longer (90 vs. 20 days) and the mortality rate 2-fold higher (32 vs. 14%). Enterobacter aerogenes were responsible for half (46%) of the WSBL urinary infections. The skin was invaded by enterobacteria in 67% and the feces in 57% of cases. More than one third of the urinary infections treated relapsed, and digestive decontamination was only efficient in half of the patients treated.
This 4-year study emphasizes the limits of antibiotherapy in eradicating WSBL-producing enterobacteria and the fact that only the strict respect of hygiene by all caregivers (isolation of patients exhibiting WSBL and washing-disinfection of the hands between each patient) limits the incidence of such infections.
La Presse Médicale 09/2002; 31(26):1211-5. · 0.67 Impact Factor
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ABSTRACT: Candidemia, principally affecting neutropenic patients in departments of oncohematology and frail patients in intensive care units, can also be observed in frail elderly people in geriatrics.
Authors report four observations of candidemia diagnosed in elderly dependent patients having several different diseases. Clinical sign was a persistent or recurrent fever after a wide-spectrum antibiotic therapy. Patients were treated by fluconazole leading to negative blood cultures in several days. Three out of four patients died within the weeks following antifungal therapy due to severity of associated diseases.
These observations show that a diagnosis of candidemia should be made when a persistent fever is observed in a frail elderly person. Fluconazole, as efficient as amphotericin B and well tolerated by elderly people, should be the first treatment of candidemia in non-neutropenic patients.
La Revue de Médecine Interne 04/2002; 23(3):328-31. · 0.61 Impact Factor
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Age and Ageing 02/2001; 30(1):90-1. · 3.09 Impact Factor
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ABSTRACT: Spontaneous fractures (stress and bone insufficiency fractures) are well described in young healthy patients; however, few studies were conducted in the elderly.
A 30-month prospective clinical and epidemiological survey including elderly patients from long-term nursing homes (LTNH) of the Société de Gérontologie de l'Est (70 centers; 11,495 elderly patients in total) was conducted.
Sixty-seven spontaneous fractures were encountered in 30 LTNH (3,052 elderly patients) (five stress fractures of the foot, 62 bone insufficiency fractures). The mean age of bedridden patients was 85 +/- 7 years. The prevalence of spontaneous fractures (calculated from the number of patients admitted consecutively in LTNHs) was 0.34% in the whole population (11,495 beds). When the calculation was based on LTNH reports of spontaneous fractures (3,052 elderly patients), the prevalence reached 1.3%. Fractures of long bones were common in elderly patients and included 15 fractures of the femoral neck, 14 fractures of either the tibia or fibula, 13 fractures of the femoral shaft, and 11 fractures of the humerus. Fractures of the femoral shaft were associated with the highest mortality: seven out of 13 patients died versus two out of 15 patients with regard to fractures of the femoral neck (P < 0.05).
Bone insufficiency fractures have not the same course in young healthy patients as those in elderly nursing home patients: they more often concern long bones and their prognosis is worse. Means of prevention still have to be defined.
La Revue de Médecine Interne 09/2000; 21(9):747-55. · 0.61 Impact Factor
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ABSTRACT: ObjectifEstimation de la dépendance, description des conditions de vie (aides apportées par des professionnels et l’entourage non professionnel, équipement technique et aménagement du logement), des besoins non comblés et des perspectives de maintien à domicile des personnes âgées vivant à domicile en Alsace.MéthodeRéalisée en 1996-97 en Alsace, cette enquête se compose de deux parties. Une enquête postale sur un échantillon de 15 600 personnes âgées de 75 ans et plus, tiré au sort à partir des listes d’affiliation des caisses de retraites. Cette enquête apporte une image fiable de la population en terme de désavantage selon la classification de Colvez. Dans un second temps, une enquête à domicile auprès de 1 259 personnes sélectionnées essentiellement parmi les plus désavantagées au sein de l’échantillon initial, a été réalisée afin de décrire leurs conditions de vie et leur dépendance. La situation des différents groupes de dépendance (GIR) a été comparée en matière d’aides humaines, d’équipements techniques et de conditions de logement.RésultatsOn a estimé la population des 75 ans ou plus vivant à domicile à près de 71 000 individus en Alsace. Selon l’enquête postale, la grande majorité (68 %) vit sans désavantage. Mais 6 000 personnes (8 %) ont besoin d’une aide pour la toilette et l’habillage dont 1 500 (2 %) restent confinées au lit ou au fauteuil. Selon l’enquête à domicile, entre 4 350 et 5 400 appartiennent aux groupes iso-ressources (GIR) 1 à 3. Dans notre enquête, la dépendance est liée à l’âge et au sexe. L’aide apportée par l’entourage familial et/ou les proches est systématique et concerne l’ensemble des activités de la vie quotidienne, même les plus intimes. Les professionnels n’interviennent le plus souvent qu’en complément et pour des activités techniques. Les services de gardes à domicile et en soins infirmiers ne concernent que les plus dépendants. Chez ceux-ci, l’aide de l’entourage est trois fois plus important que l’aide des professionnels en terme de nombre d’activités prises en charge. Seuls 11 % des personnes GIR 1 à 3 considèrent être insuffisamment aidés. L’équipement technique des logements est correcte, exclusion faite de la téléalarme. Dans ce cas, l’absence d’équipement correspond soit à un manque d’information soit à un refus d’aménagement. Plus de 80 % des personnes âgées sont satisfaites de cette situation et n’envisagent pas d’entrée en institution.ConclusionCette étude confirme l’importante solidarité des familles et des proches envers leurs aînés.Objective
Our aim was to describe the living conditions of disabled elderly subjects aged 75 years and more living at home.DesignThis study was conducted in 1996-97 in the Alsace region in France and included two parts. First, a sample survey was mailed to 15,600 subjects randomly selected from a pension funds list. This survey provided with a reliable representation of the study population in terms of disabilities using the Colvez classification. In the second part, the most disabled individuals were selected and, among them, 1,259 subjects were visited at home. Their disabilities and living conditions were noted using a predefined set of questions.ResultsAn estimated 71,000 subjects aged 75 years and more lived at home in the study region. The vast majority were free of significant disability. Help to wash and dress was needed by 6,000 until 1,500 were bedridden or confined to an armchair. Between 4,350 and 5,400 met the criteria for iso-resource grades (IRG) 1 to 3. Disability was associated with age, female gender, cognitive impairment and some social and professional characteristics. Family support was routine in almost every aspect of everyday life including personal hygiene. Professional support was mostly limited to technical interventions. Professional nursing care concerned only the most dependent persons. Nevertheless, needs for help in home and social activities remained high even in the least dependent individuals and were strongly age-dependent. Only 10% of individuals with IRG 1 to 3 complained of inadequate help. More than 80 % of the elderly felt comfortable with their living conditions at home and were not thinking of moving from home to an institution for old people.Conclusion
The present study confirms the important commitment of family members and their close relationships toward their elderly.
Revue d'Épidémiologie et de Santé Publique. 53(2):153-165.
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ABSTRACT: Introduction. – Candidemia, principally affecting neutropenic patients in departments of onco-haematology and frail patients in intensive care units, can also be observed in frail elderly people in geriatrics.Exegesis. – Authors report four observations of candidemia diagnosed in elderly dependant patients having several different diseases. Clinical sign was a persistent or recurrent fever after a wide-spectrum antibiotic therapy. Patients were treated by fluconazole leading to negative blood cultures in several days. Three out of four patients died within the weeks following antifungal therapy due to severity of associated diseases.Conclusion. – These observations show that a diagnosis of candidemia should be made when a persistent fever is observed in a frail elderly person. Fluconazole, as efficient as amphotericin B and well tolerated by elderly people, should be the first treatment of candidemia in non-neutropenic patients.
La Revue de Médecine Interne. 23(3):328-331.
