RESUMEN

INTRODUCTION: Owing to the very great age and the polypathology of the patients in geriatrics, we are often confronted to the palliative care decision. PURPOSE: The purposes of this retrospective study were both to define the criteria leading to palliative care and to analyse the evolution of patients. METHOD: We analysed 40 files of patients hospitalised in Geriatric internal medicine or Geriatric rehabilitation departments over 11 months. RESULTS: Mean age was 85.4 years and 62.5% of patients were females. Infections, heart failure, general weakness, orthopaedic affections, strokes and cancers were the main causes of hospitalisation. Patients had 3 medical or surgical histories of chronic or cured serious diseases and a MMSE average value of 17.7. The rate of malnutrition was 92% and 90% of patients were very dependent. Severe infections, cancers, heart failure and severe pressure ulcers were the main affections for decision of palliative care. The latter was always decided by the staff with patients or families taking part in 8 cases and being informed in other cases. The palliative care lasted 7 days on average. Morphine was used in 31 cases. No artificial nutrition was introduced. CONCLUSION: The decision of palliative care is very complex since great age, polypathology, great dependence and high prevalence of cognitive disorders are frequent in this population.

Asunto(s)

RESUMEN

BACKGROUND: No previous studies have demonstrated either a nutritional improvement, or a survival benefit from tube placement in an institutionalized population. OBJECTIVE: The aim of this study was to determine current indications for tube feeding in French geriatric centers and to evaluate clinical outcome and mortality rates in these frail very old patients. DESIGN: Between November 1, 2000 and April 31, 2001, we prospectively recruited all hospitalized or institutionalized patients who received enteral nutrition (EN) in 7 Departments of Geriatric Medicine in France. Nutritional parameters and main indications of EN were recorded at the time of feeding tube placement. Pneumonia and mortality rates were observed over a period of one year. RESULTS: 57 patients of mean age 81.6 7.8 yrs underwent placement of a feeding tube. Mean BMI value was 20.7 4.8 and mean serum albumin level 26.1 6.1 g/L. The most frequent indications for EN included stoke (39%) and other neurologic diseases (42%). Fourteen patients (25%) died within 30 days, and 27 (47%) died over the 12-month follow-up period. During the first month, an episode of pneumonia was noted in 26 cases (55%). CONCLUSION: The similarity between rates of early mortality reported in our study and those reported in several previous studies involving younger, ambulatory subjects is surprising because we might expect poorer survival in our frail elderly patients. We can think that French geriatric teams have changed their attitudes toward EN in recent years, EN being less frequently used in patients with advanced dementia and at the end-stage of life.

RESUMEN

Postural insufficiency, gait disorders and fear of falling have been observed after falling in frail older patients. The aim of this study was to assess the benefit of a specific rehabilitation program in patients demonstrating 'post fall syndrome'. The studied population consisted in 13 females aged 70 years and over who were admitted to hospital after falling. They suffered from post-fall syndrome. 'Get-Up and Go' and 'Timed Get-Up and Go' tests, and assessment of functional activities and postural abilities (AFAPA) were performed at hospital admission (T1), then at hospital discharge (T2) again. A specific rehabilitation program was performed during the hospital stay. The main goal of this rehabilitation program was to correct postural insufficiency and to improve motor patterns, which underlie independence in ADL. The results showed a significant improvement in score and time of 'Get up and Go' test between T1 and T2. In the same way, a great number of subjects showed better performances in several items of AFAPA between T1 and T2, and rising from the floor with support was performed by 6 out of the 13 subjects at T2 compared to 0 subject at T1. This study highlights the efficiency of specific rehabilitation programs in frail elderly people demonstrating 'post fall syndrome'.

RESUMEN

To evaluate the features of primary hyperparathyroidism (HPT) with normal serum intact parathyroid hormone (iPTH) levels, we studied 271 consecutive patients undergoing surgery for primary HPT. In 20 patients, serum iPTH levels were within the normal range (10-65 ng/l). In their records, the most common clinical features were fatigue (n=13), polyuria (n=6), renal stone (n=5), and hypertension (n=5). Mean serum calcium and phosphorus were 2.78 and 0.85 mmol/l, respectively: 14 had serum phosphorus within the normal range. Mean serum iPTH was 48.5 ng/l, and was <45 ng/l in nine patients. Cervical ultrasound demonstrated a parathyroid adenoma in nine, and was normal in four. Tc sestamibi parathyroid scintigraphy always demonstrated an adenoma (9/9). In eight patients, normal iPTH values delayed diagnosis. Physicians should be aware of the possibility of HPT in patients with hypercalcaemia, even when serum phosphorus and iPTH levels are within the normal limits. Particularly, HPT cannot be excluded when serum iPTH levels are below the upper part of the normal range. In such cases, cervical imaging, which has the same sensitivity as in other HPT, should be undertaken. These explorations are useful, because many patients are symptomatic and can take advantage of surgery.

Asunto(s)

Asunto(s)