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BACKGROUND: The aim was to determine whether there is any available evidence on the efficacy of photobiomodulation therapy (PBMT) in older adults. METHODS: A literature search was performed including all articles published up to February 2024. Studies reporting data on PBMT in older adults were included. This study was registered with PROSPERO. RESULTS: In total, 406 studies were identified. After eliminating duplicates and irrelevant studies, 10 records were included in the final review. In all included studies, the protocols used to deliver PBMT were different in terms of type of device, wavelength, irradiation duration, and pulse frequency. In neurodegenerative diseases, two studies reported non-significant results, while two studies reported efficacy of PBMT. In wounds and ulcers, two out of three studies reported efficacy of PBMT. In macular degeneration, one study reported efficacy of PBMT. One study on hyposalivation reported efficacy of PBMT. CONCLUSION: PBMT appears to be a promising complementary treatment. All studies reported good compliance and safety throughout the treatment. In the future, it will be essential to harmonize PBMT parameters. Further studies are warranted to define the best indications, the most effective protocols, and the right population to target for use in routine practice.

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OBJECTIVE: We aimed to identify risk factors for nursing home (NH) entry 36 months after hospitalization via the emergency department (ED) in a population of patients aged 75 years or older. METHODS: This was a prospective multicentre cohort. Patients were recruited from the emergency departments (EDs) of nine hospitals. Subjects had been hospitalised in a medical ward in the same hospital as the ED to which they were initially admitted. Subjects who experienced NH entry prior to ED admission were excluded. NH entry has been defined as the incident admission either into an NH or other long-term care facility within the follow-up period. Variables from a comprehensive geriatric assessment of patients were entered into a Cox model with competing risks to predict NH entry during 3 years of follow-up. RESULTS: Among 1306 patients included in the SAFES cohort, 218 (16.7%) who were already in an NH were excluded. The remaining 1088 patients included in the analysis were aged 84 ± 6 years on average. During 3 years of follow-up, 340 (31.3%) entered an NH. The independent risk factors for NH entry were that they: living alone (Hazard ratio (HR) 2.00, had a 95% confidence interval (CI) 1.59-2.54, p < 0.0001), could not independently perform activities of daily living (HR 1.81, 95% CI 1.24-2.64, p = 0.002), and had balance disorders (HR 1.37, 95% CI 1.09-1.73, p = 0.007), dementia syndrome (HR 1.80, 95% CI 1.42-2.29, p < 0.0001) and a risk of pressure ulcers (HR 1.42, 95% CI 1.10-1.82, p = 0.006). CONCLUSION: The majority of the risk factors for NH entry within 3 years after emergency hospitalization are amenable to intervention strategies. It is therefore reasonable to imagine that targeting these features of frailty could delay or prevent NH entry and improve the quality of life of these individuals before and after NH entry.

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PURPOSE OF REVIEW: Although the chikungunya virus was discovered more than 60 years ago, it has only really been studied since the outbreak in La Reunion in 2005-2006. Ten years later, between 2014 and 2015, the chikungunya virus spread throughout the Americas, affecting millions of people. The objective of this review is to describe the contributions of research on chikungunya virus infection gained from epidemic in the West Indies and the Guiana Shield. RECENT FINDINGS: Prevalence data were similar to those found in the Indian Ocean or Asia during epidemics. Clinically, there is now a better understanding of the typical, atypical, and severe forms. Several studies have insisted on the presence of neurological forms of chikungunya infection, such as encephalitis or Guillain-Barré syndrome. Cases of septic shock due to chikungunya virus as well as thrombotic thrombocytopenic purpura were described for the first time. Given the magnitude of the epidemic and the large number of people affected, this has led to a better description and new classifications of chikungunya virus infections in specific populations such as pregnant women, the elderly, and children. Several studies also described the behavior of populations faced with an emerging disease. SUMMARY: Current epidemiological data from tropical regions highlights the risk of spreading emerging diseases at higher latitudes, especially concerning arboviruses, since the vector Aedes albopictus is already established in many parts of northern countries. A better understanding of the disease and its epidemic dynamics will foster better management, the crucial importance of which was demonstrated during the COVID-19 epidemic.

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Improving immunisation coverage for older adults is a public health issue. Since 2008, nurses have been authorised to vaccinate this population against influenza without a medical prescription. One study examined the opinions of a sample of 78 private duty nurses in Martinique on influenza and anti-tetanus vaccination of elderly populations. The majority of nurses said they were not in favour of vaccination.

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BACKGROUND: The French West-Indies rank first for both prostate cancer incidence and mortality rates. Analyzing diagnostic and therapeutic procedures among patients with prostate cancer, using data from a population-based cancer registry, is essential for cancer surveillance and research strategies. METHODS: This retrospective observational cohort study was based on data from the Martinique Cancer Registry. Records of 452 patients diagnosed with prostate cancer in 2013 were retrieved from the registry. Data extracted were: socio-demographic and clinical characteristics, circumstances of diagnosis, PSA level at diagnosis, Gleason score and risk of disease progression. Stage at diagnosis and patterns of care among prostate cancer patients were analyzed. RESULTS: Mean age at diagnosis was 67 ± 8 years; 103 (28.5%) were symptomatic at diagnosis. Digital rectal exam was performed in 406 (93.8%). Clinical stage was available in 385 (85.2%); tumours were localized in 322/385 (83.6%). Overall, 17.9% were at low risk, 36.4% at intermediate and 31.9% at high risk; 13.8% were regional/metastatic cancers. Median PSA level at diagnosis was 8.16 ng/mL (range 1.4-5000 ng/mL). A total of 373 patients (82.5%) received at least one treatment, while 79 (17.5%) had active surveillance or watchful waiting. Among patients treated with more than one therapeutic strategy, the most frequent combination was external radiotherapy with androgen deprivation (n = 102, 22.6%). CONCLUSIONS: This study provides detailed data regarding the quality of diagnosis and management of patients with prostate cancer in Martinique. Providing data on prostate cancer is essential for the development of high-priority public health measures for the Caribbean.

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PURPOSE: Recording cancer data in cancer registries is essential for producing reliable population-based data for service planning, monitoring and evaluation. Prostate cancer (PCa) remains the most frequent type of cancer in terms of incidence and mortality in men in the Caribbean. The quality of life PCa cohort will assess quality of life and patient outcomes in Martinique using a digital platform for patient-reported outcome measures. PARTICIPANTS: The Martinique Cancer Registry database is the largest clinical database among the French population-based cancer registries in the Caribbean, including more than 38 000 cancer cases, with 1650 new cancer cases per year, including 550 new PCa cases per year (2010-2014 latest period). In 2018, follow-up will include vital status, assessment of quality of life with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ) Core 30 and the Prostate cancer module QLQ-PR25. Urinary incontinence and erectile dysfunction recorded prior to treatment will be analysed 1 and 5 years after treatment. FINDINGS TO DATE: The registry includes data on circumstances of diagnosis, clinical stage at diagnosis. For PCa, the registry includes blood prostate-specific antigen level at the time of diagnosis, Gleason score and primary treatment. FUTURE PLANS: Further studies will provide detailed data regarding the quality of diagnosis and management of patients with PCa in Martinique; analysing quality of care will be the next challenge.Quality of life and patient outcomes will be evaluated using a digital platform for patient-reported outcome measurement and electronic records.

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OBJECTIVE: The primary objective was to identify predictive factors of inhospital death in a population of patients aged 65 years or older hospitalised with Chikungunya virus (CHIKV) infection. The secondary aim was to develop and validate a predictive score for inhospital death based on the predictors identified. DESIGN: Longitudinal retrospective study from January to December 2014. SETTING: University Hospital of Martinique. PARTICIPANTS: Patients aged ≥65 years, admitted to any clinical ward and who underwent reverse transcription PCR testing for CHIKV infection. OUTCOME: Independent predictors of inhospital death were identified using multivariable Cox regression modelling. A predictive score was created using the adjusted HRs of factors associated with inhospital death. Receiver operating characteristic curve analysis was used to determine the best cut-off value. Bootstrap analysis was used to evaluate internal validity. RESULTS: Overall, 385 patients aged ≥65 years were included (average age: 80±8 years). Half were women, and 35 (9.1%) died during the hospital stay. Seven variables were found to be independently associated with inhospital death (concurrent cardiovascular disorders: HR 11.8, 95% CI 4.5 to 30.8; concurrent respiratory infection: HR 9.6, 95% CI 3.4 to 27.2; concurrent sensorimotor deficit: HR 7.6, 95% CI 2.0 to 28.5; absence of musculoskeletal pain: HR 2.6, 95% CI 1.3 to 5.3; history of alcoholism: HR 2.5, 95% CI 1.1 to 5.9; concurrent digestive symptoms: HR 2.4, 95% CI 1.2 to 4.9; presence of confusion or delirium: HR 2.1, 95% CI 1.1 to 4.2). The score ranged from 0 to 25, with an average of 6±6. The area under the curve was excellent (0.90; 95% CI 0.86 to 0.94). The best cut-off value was a score ≥8 points, with a sensitivity of 91% (82%-100%) and specificity of 75% (70%-80%). CONCLUSIONS: Signs observed by the clinician during the initial examination could predict inhospital death. The score will be helpful for early management of elderly subjects presenting within 7 days of symptom onset in the context of CHIKV outbreaks.

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PURPOSE: To determine whether self-rated health (SRH) is an independent predictor for mortality in older Afro-Caribbean patients hospitalised for an acute condition. METHODS: Prospective cohort of patients recruited from the University Hospitals of Martinique Acute Care for Elders unit. Patients aged 75 or older and hospitalised for an acute condition were eligible. The outcome was time to death within the 36-week follow-up. SRH was the explanatory variable of interest. Cox's Proportional Hazards model was used to estimate the relationship between SRH and mortality. RESULTS: The 223 patients included in the study were aged 85.1 ± 5.5 years. In total, 123 patients reported "very good to good" health, and 100 "medium to very poor" health. Crude mortality rates at six months, 1, 2, and 3 years were 30.5, 34.8, 48.4, and 57.0%, respectively. By multivariate analysis, SRH reached significant relationship for all mortality timepoints. The adjusted hazard ratios for subjects who perceived their health as medium, poor or very poor was 1.6-2.7 times greater than that of subjects who reported good or very good health. CONCLUSION: Assessment of SRH could have implications for clinical practice, particularly in helping practitioners to better estimate prognosis in the acute care settings.

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OBJECTIVES: We aimed to determine whether the presentation of Chikungunya virus (CHIKV) infection differs between older and younger adults with regard to clinical form during the acute phase defined by the World Health Organization: acute clinical, atypical, and severe acute. DESIGN: Cross-sectional, retrospective. SETTING: University Hospital of Martinique. PARTICIPANTS: Individuals aged 65 and older (n = 267, mean age 80.4 ± 87.9) who attended the emergency department with a positive biological diagnosis of CHIKV (reverse transcriptase polymerase chain reaction) between January and December 2014 and a randomly selected sample of individuals younger than 65 (n = 109, mean age 46.2 ± 12.7). RESULTS: Typical presentation was present in 8.2% of older adults and 59.6% of younger individuals (P < .001), atypical presentation in 29.6% of older adults and 5.6% of younger individuals (P < .001), and severe presentation in 19.5% of older adults and 17.4% of younger individuals (P = .65). One hundred fourteen (42.7%) of the older group and 19 (17.4%) of the younger group could not be classified in any category (absence of fever, absence of joint pain, or both) (P < .001). CONCLUSION: Only 8.2% of the older adults presenting in the acute phase of CHIKV have typical forms, suggesting that the most-frequent clinical presentation of CHIKV in older adults differs from that in younger individuals.

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BACKGROUND: This study aimed to derive and validate a score for Chikungunya virus (CHIKV) infection screening in old people admitted to acute care units. METHODS: This study was performed in the Martinique University Hospitals from retrospective cases. Patients were aged 65+, admitted to acute care units for suspected CHIKV infection in 2014, with biological testing using Reverse Transcription Polymerase Chain Reaction (RT-PCR). RT-PCR was used as the gold standard. A screening score was created using adjusted odds ratios of factors associated with positive RT-PCR derived from a multivariable logistic regression model. A ROC curve was used to determine the best cut-off of the score. Bootstrap analysis was used to evaluate its internal validity. RESULTS: In all, 687 patients were included, 68% with confirmed CHIKV infection, and 32% with laboratory-unconfirmed CHIKV infection. Mean age was 80±8 years, 51% were women. Four variables were found to be independently associated with positive RT-PCR (fever: 3 points; arthralgia of the ankle: 2 points; lymphopenia: 6 points; absence of neutrophil leucocytosis: 10 points). The best cut-off was score ≥12; sensitivity was 87% (83%-90%) and specificity was 70% (63%-76%). CONCLUSION: This score shows good diagnostic performance and good internal validation and could be helpful to screen aged people for CHIKV infection.

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The mini mental state examination (MMSE) has become a benchmark for the screening and follow-up of cognitive impairment. The numerous translations of the MMS into other languages attest to its popularity. Clinical practice suggests that the consensual French version from the Greco (Groupe de réflexion sur les évaluations cognitives - Research working group for cognitive assessment) is not adapted to the West-Indies population because of the low socio-economic level and the widespread use of the Creole language among the elderly population. Modification of certain items by a multidisciplinary committee made it possible to adapt the instrument to the Creole culture. This procedure increases comprehension of the instrument, and should lead to improved detection of cognitive impairment in the West-Indies.

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BACKGROUND: Chikungunya is an endemo-epidemic infection, which is still considered as an emerging public health problem. The aim of this study was to evaluate in a 65+ population, the accuracy of two chikungunya screening scores that were developed in younger people. METHODS: It was performed in the Martinique University Hospitals from retrospective cases. Patients were 65+, admitted to acute care units, for suspected Chikungunya virus infection (CVI) in 2014, with biological testing using Reverse Transcription Polymerase Chain Reaction. Mayotte tool and Reunion Island tool were also computed. Sensitivity, specificity, positive predictive value, negative predictive value, and Youden's statistic were calculated. RESULTS: In all, 687 patients were included, 68% with confirmed CVI, and 32% with laboratory-unconfirmed CVI. Fever (73.1%) and arthralgia (51.4%) were the most frequent symptoms. Sensitivity ranged from 6% (fever+headache) to 49% (fever+polyarthralgia); and Youden's index ranged from 1% (fever + headache) to 30% (fever+polyarthralgia). PPV and NPV ranged from 70% to 95%, and from 32% to 43%, respectively. CONCLUSION: Performances were very poor for both tools, although specificity was good to excellent. Our results suggest that screening scores developed in young population are not accurate in identifying CVI in older people.

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