Mathieu Houles

University of Toulouse, Tolosa de Llenguadoc, Midi-Pyrénées, France

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Publications (8)6.38 Total impact

  • Gabor Abellan van Kan · Mathieu Houles · Bruno Vellas
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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.
    No preview · Article · Jul 2012
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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.
    Full-text · Article · Jun 2012
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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.
    No preview · Article · Aug 2011 · Clinics in Geriatric Medicine
  • M. Houlès
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    ABSTRACT: 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.
    No preview · Article · Sep 2010 · Les cahiers de l année gérontologique
  • M. Houlès
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    ABSTRACT: 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).
    No preview · Article · Sep 2010 · Les cahiers de l année gérontologique
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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.
    No preview · Article · May 2010 · Clinics in Geriatric Medicine
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    ABSTRACT: Introduction The 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. Methods A 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. Results Gait 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). Conclusion Although 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.
    Full-text · Article · Mar 2010 · Les cahiers de l année gérontologique
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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;
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