Mathieu Houles

Paul Sabatier University - Toulouse III, Tolosa de Llenguadoc, Midi-Pyrénées, France

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Publications (8)6.29 Total impact

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    ABSTRACT: The present review describes and discusses the currently available definitions for sarcopenia from consensus studies. Different sarcopenia definitions have been proposed in these last years. Six main approaches to an operative definition of sarcopenia have been identified. Although the first definitions were solely based on the assessment of the amount of muscle mass, current definitions seem to consistently recognize a bi-dimensional nature of sarcopenia. So, these approaches imply the need of simultaneously assessing both age-related quantitative (i.e. amount of muscle mass) and qualitative (i.e. muscle strength and function) declines of skeletal muscle. Although current consensus exists about a bi-dimensional nature, the proposed approaches to measure sarcopenia are characterized by methodological differences. The majority of the operative definitions proposes to assess muscle mass as an index of appendicular muscle mass divided by squared height (evaluated by dual energy X-ray absorptiometry), assess strength using hand-held dynamometers, and assess function by evaluating gait speed at habitual pace over a short distance. Nevertheless, the clinically relevant thresholds and how to combine the three aspects in an operative definition in order to identify sarcopenia are heterogeneous. A main drawback is that supportive empirical data are missing for these conceptual definitions regarding the risk-assessment of different clinically significant adverse outcomes.
    Current opinion in clinical nutrition and metabolic care. 07/2012; 15(5):436-41.
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    ABSTRACT: Frailty is a common, heterogeneous, geriatric syndrome associated with adverse health events. Over the last years, a growing debate has emerged concerning the inclusion of cognitive impairment in the definition of frailty. In fact, cognitive impairment has been increasingly recognized as a potential contributor to the clinical vulnerability of older persons. This review presents key studies describing the interrelationships between cognition and frailty; in particular we examine the clinical relevance of cognitive impairment in the determination of the frailty syndrome.
    The Journal of Frailty & Aging. 06/2012; 1(2):56-63.
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    ABSTRACT: Phase 3 trials estimate the effectiveness of an intervention to prevent, delay the onset of, or treat sarcopenia. Participants should have sarcopenia or present a sarcopenia risk profile. Control group should be characterized by the best standard of clinical care. This article further develops issues on sarcopenia definition, target population, primary and secondary end points, duration of the trials, muscle mass assessment, strength and physical performance assessment, and control of possible confounders. The challenges to conduct phase 3 trials in the elderly should not offset the opportunities for the development of new strategies to counteract sarcopenia and prevent late-life disability.
    Clinics in Geriatric Medicine 08/2011; 27(3):471-82. · 3.14 Impact Factor
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    ABSTRACT: No clear consensual definition regarding frailty seems to emerge from the literature after 30 years of research in the topic, and a large array of models and criteria has been proposed to define the syndrome. Controversy continues to exist on the choice of the components to be included in the frailty definition. Two main definitions based on clusters of components are found in literature: a physical phenotype of frailty, operationalized in 2001 by providing a list of 5 measurable items of functional impairments, which coexists with a multidomain phenotype, based on a frailty index constructed on the accumulation of identified deficits based on comprehensive geriatric assessment. The physical phenotype considers disability and comorbidities such as dementia as distinct entities and therefore outcomes of the frailty syndrome, whereas comorbidity and disability can be components of the multidomain phenotype. Expanded models of physical frailty (models that included clusters other than the original 5 items such as dementia) increased considerably the predicting capacity of poor clinical outcomes when compared with the predictive capacity of the physical phenotype. The unresolved controversy of the components shapes the clusters of original frailty syndrome, and the components depend very much on how frailty is defined. This update also highlights the growing evidence on gait speed to be considered as a single-item frailty screening tool. The evaluation of gait speed over a short distance emerges from the literature as a tool with the capacity to identify frail older adults, and slow gait speed has been proven to be a strong predictor for frailty-adverse outcomes.
    Clinics in Geriatric Medicine 05/2010; 26(2):275-86. · 3.14 Impact Factor
  • M. Houlès
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    ABSTRACT: Il existe un intérêt grandissant en gériatrie pour les sujets âgés vivant à domicile. Il y a cependant peu d’études concernant l’aspect économique de ce type de prise en charge. Cet article traite de l’analyse coût-efficacité du Dutch Geriatric Intervention Program (DGIP), du point de vue du système de santé, comparé au suivi usuel après six mois de suivi chez des sujets âgés vulnérables. Cette évaluation économique a été conduite au cours d’un essai contrôlé randomisé en simple insu (Dutch EASYcare Study: ClinicalTrials.gov Identifier NCT00105378). La différence dans l’effet des traitements a été calculée comme étant la différence des proportions de patients traités avec succès (prévention du déclin fonctionnel et amélioration de la qualité de vie). Les coûts supplémentaires des traitements ont été calculés comme étant la différence par rapport aux coûts totaux moyens des soins. L’Incremental Cost-Effectiveness Ratio (ICER) a été exprimé comme étant le coût total par traitement réussi. Des analyses bootstrap ont été utilisées pour déterminer les intervalles de confiance de ces mesures. There is a growing interest in geriatric practice directed at elderly people living at home. There are, however, few studies on the economic aspects of this type of care. This article deals with a cost-effectiveness analysis of the Dutch Geriatric Intervention Program (DGIP) from the standpoint of the health system, compared with that of usual management, after six months follow-up in elderly vulnerable subjects. This cost analysis was carried out during the course of a randomised, controlled, single-blind study (DutchEASYcareStudy: ClinicalTrials.gov Identifier NCT00105378). The difference in treatment effect was calculated as the difference in proportions of patients who were treated successfully (prevention of functional deterioration and improvement in quality of life). Additional treatment costs were calculated as being the excess over mean total cost of care. The Incremental Cost-Effectiveness Ratio (ICER) was expressed as total cost per successful treatment. Bootstrap analysis was used to determine the confidence intervals of these values. Mots clésÉvaluation économique-Intervention pluridisciplinaire-Bien-être-Autonomie-Analyse coût-efficacité KeywordsEconomic evaluation-Multi-disciplinary intervention-Well-being-Autonomy-Cost-effectiveness analysis
    Les cahiers de l année gérontologique 01/2010; 2(3):169-172.
  • M. Houlès
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    ABSTRACT: L’efficacité des modèles d’intervention gériatrique pour les sujets âgés vulnérables reste controversée. Cette étude a évalué une intervention multidisciplinaire fondée sur les problèmes présentés par des sujets âgés vulnérables, celle-ci visait une meilleure efficacité que le suivi usuel grâce à un engagement accru des patients et des médecins généralistes. Cent cinquante et un patients (âge moyen 82,2 ans, 74,8 % de femmes) ont été recrutés par des médecins généralistes pour des problèmes cognitifs, nutritionnels, comportementaux, de troubles de l’humeur et de la marche. Il s’agissait d’un essai randomisé en pseudo-grappes avec un suivi de six mois. Quatre-vingt-cinq patients ont été inclus dans le groupe intervention et 66 dans le groupe suivi usuel. Dans le groupe intervention, des infirmières formées à la gériatrie réalisaient des visites à domicile pour une évaluation et une prise en charge en relation avec le médecin généraliste et un gériatre. Des analyses en intention de traiter se sont concentrées sur les différences entre les groupes concernant l’autonomie (Groningen Activity Restriction Scale 3) et le bien-être mental (partie santé mentale de la Medical Outcomes Study MOS 20) en utilisant un modèle mixte linéaire. À trois mois, l’autonomie a été améliorée de 2,2 points (IC à 95 %: 0,3–4,2) et le bien-être mental de 5,8 points (IC à 95 %: 0,1–11,4) dans le groupe intervention. Après six mois, l’effet bénéfique se majorait pour le bien-être de 9,1 points (IC à 95 %: 2,4–15,9), mais l’effet sur l’autonomie n’était plus significatif (−1,6 point, IC à 95 %, −0,7 à 3,9). The effectiveness of geriatric models of intervention for the vulnerable elderly remains controversial. This study evaluated a multi-disciplinary care package based on the problems these patients have. Its objective was to provide more effective care than the usual standard care, through a greater commitment of patients and family doctors. 151 patients (mean age 82.2 years, 74.8% women) were recruited by family doctors for cognitive, nutritional and behavioural problems, mood disturbance or difficulties in walking. This was a pseudo-cluster randomised trial with a 6 month follow-up. There were 85 patients in the intervention group and 66 in the usual care group. Geriatrics trained nurses visited the patients in the intervention group at home to assess them and look after them in collaboration with the family doctor and a geriatrician. An intention to treat analysis of data was focused on differences between the groups for independence (Groningen Activity Restriction Scale 3) and for mental well-being (mental health section of the Medical Outcomes Study MOS 20) using a linear mixed model. At 3 months, independence had improved in the intervention group by 2.2 points (95% CI: 0.3–4.2) and mental well-being by 5.8 points (95% CI: 0.1–11.4). After 6 months the beneficial effect for well-being had increased by 9.1 points (CI: 2.4–15.9) but the effect for independence was no longer significant (−1.6 points, 95% CI: −0.7–3.9). Mots clésIntervention pluridisciplinaire-Domicile-Sélection par le médecin généraliste-Randomisation en pseudo-grappes-Bien-être-Autonomie KeywordsMulti-disciplinary intervention-Home-Selection by the family doctor-Pseudo-cluster randomisation-Well-being-Autonomy
    Les cahiers de l année gérontologique 01/2010; 2(3):166-168.
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    ABSTRACT: IntroductionLe recours à un outil d’évaluation simple et rapide pour repérer les personnes âgées fragiles vivant à domicile serait une aide précieuse en gériatrie. L’objectif de cet article est de rapporter les conclusions d’un groupe de travail (formé au sein de l’International Academy on Nutrition and Aging) sur la vitesse de marche en tant qu’outil de repérage de la fragilité. MéthodeLe groupe a réalisé une revue systématique de la littérature scientifique sur le sujet, permettant l’écriture d’un document écrit débattu par la suite lors d’une réunion de deux jours. RésultatsLa vitesse de marche à allure normale apparaît comme étant un facteur de risque significatif de perte d’autonomie, d’institutionnalisation, de chutes et/ou de décès. Pour prédire la survenue d’événements péjoratifs, la vitesse de marche semble au moins aussi sensible que les outils composites (Fried’s criteria, Short Physical Performance Battery). ConclusionLa vitesse de marche semble un outil intéressant et utile en pratique clinique pour identifier parmi les personnes autonomes vivant au domicile, celles qui sont à risque d’événements péjoratifs. L’évaluation sur 4 m est la méthode la plus utilisée dans la littérature. IntroductionThe use of a simple, safe and easy to perform assessment tool, like gait speed, to evaluate vulnerability to adverse outcomes in community-dwelling older people is appealing, but its predictive capacity is still questioned. The present manuscript summarises the conclusions of an expert panel (from International Academy on Nutrition and Aging) in the domain of physical performance measures and frailty in older people. MethodsA systematic review of literature was performed prior to the meeting (Medline search and additional pearling of reference lists and key-articles supplied by Task Force members). Manuscripts were retained for the present revision and reviewed and discussed during a 2-day meeting. ResultsGait speed at usual pace was found to be a consistent risk factor for disability, cognitive impairment, institutionalization, falls, and/or mortality. In predicting these adverse outcomes over time, gait speed was at least as sensible as composite tools (Fried’s criteria, Short Physical Performance Battery). ConclusionAlthough more specific surveys need to be performed, there is sufficient evidence to state that gait speed identifies nondisabled community-dwelling older people at risk of adverse outcomes and can be used as a single-item assessment tool. The assessment at usual pace over 4 m was the most often used method in literature and might represent a quick, safe, inexpensive, and highly reliable instrument to be implemented. Mots clésVitesse de marche-Épidémiologie-Événement péjoratif-Sujet âgé-Facteur de risque KeywordsGait speed-Epidemiology-Adverse outcome-Older adult-Risk factor
    Les cahiers de l année gérontologique 01/2010; 2(1):13-23.
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    ABSTRACT: Export Date: 23 March 2012, Source: Scopus, doi: 10.1007/s12612-009-0036-6, Language of Original Document: French, Correspondence Address: Houles, M.; Gérontopôle Service de Gériatrie, CHU de Purpan, 170, avenue de Casselardit, F-31059 Toulouse cedex 09, France; email: mathieuhoules@gmail.com, References: Abellan Van Kan, G., Rolland, Y., Bergman, H., Frailty assessment of older people in clinical practice. Expert opinion of a geriatric advisory panel (2007) J Nutr Health Aging, 12, pp. 29-37;
    Cahiers de l'Annee Gerontologique. 2(1):13-23.

Publication Stats

98 Citations
6.29 Total Impact Points

Institutions

  • 2012
    • Paul Sabatier University - Toulouse III
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2011
    • Centre Hospitalier Universitaire de Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2010
    • University of Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France