Alain Franco

European silver paper on the future of health promotion and preventive actions, basic research and clinical aspects of age related disease

Background. In September 2008, under the French Presidency of the European Union and with the support of the Polish Minister of Health, a European Summit on Age-Related Disease was organised in Wroclaw (Poland). At this meeting, European politicians, gerontologists and geriatricians gathered to discuss a common approach to future challenges related to age-related disease. Politicians and decision-makers from the European Union and Ministers of Health and their deputies from many European countries raised the problems and difficulties to be tackled in a growing population with a high burden of disease, and asked scientists to write a consensus document with recommendations for future actions and decisions. Scientists and clinicians worked in parallel in three different groups, on health promotion and preventive actions, basic research in age-related disease, and clinical aspects of disease in older people. Beforehand, the format of the paper with recommendations was discussed, and it was finally agreed that, for a better understanding by decision-makers, it would be divided in two different columns: one with facts that were considered settled and agreed by most experts (under the heading We know), and a second with recommendations related to each fact (We recommend). No limit on the number of topics to be discussed was settled. After careful and detailed discussion in each group, which in most cases included the exact wording of each statement, chairpersons presented the results in a plenary session, and new input from all participants was received, until each of the statements and recommendations were accepted by a large majority. Areas with no consensus were excluded from the document. Immediately after the Summit, the chairpersons sent the document both to the main authors and to a list of experts (see footnote) who had made presentations at the summit and agreed to review and critically comment on the final document, which is presented below. As regards the scientific aspects of the planning of the Summit, several organisations, under the leadership of the EUGMS, were asked both to review the program and to suggest names of speakers and participants. After the Summit, the Boards of these organizations (European Union Geriatric Medicine Society (EUGMS), International Association of Gerontology and Geriatrics-European Region (IAGG-ER), European Association of Geriatric Psychiatry (EAGP), International Society of Gerontechnology (ISG) and International Society for the Study of the Aging Male (IS-SAM) agreed to consider the document as an official paper, and help with its dissemination. The name Silver Paper was used, recalling the grey or silvery hair of our older citizens, as an easy reference. It has been sent officially to several bodies of the European Union and to Health Ministers of most European countries; and will be published in other languages in local purnals. Its declared intention is to foster changes in policies which may, in the future, reduce the burden of disease in old age.

Silver paper: the future of health promotion and preventive actions, basic research, and clinical aspects of age-related disease--a report of the European Summit on Age-Related Disease.

Background. In September 2008, under the French Presidency of the European Union and with the support of the Polish Minister of Health, a European Summit on Age-Related Disease was organised in Wroclaw (Poland). At this meeting, European politicians, gerontologists and geriatricians gathered to discuss a common approach to future challenges related to age-related disease. Politicians and decision-makers from the European Union and Ministers of Health and their deputies from many European countries raised the problems and difficulties to be tackled in a growing population with a high burden of disease, and asked scientists to write a consensus document with recommendations for future actions and decisions. Scientists and clinicians worked in parallel in three different groups, on health promotion and preventive actions, basic research in age-related disease, and clinical aspects of disease in older people. Beforehand, the format of the paper with recommendations was discussed, and it was finally agreed that, for a better understanding by decision-makers, it would be divided in two different columns: one with facts that were considered settled and agreed by most experts (under the heading We know), and a second with recommendations related to each fact (We recommend). No limit on the number of topics to be discussed was settled. After careful and detailed discussion in each group, which in most cases included the exact wording of each statement, chairpersons presented the results in a plenary session, and new input from all participants was received, until each of the statements and recommendations were accepted by a large majority. Areas with no consensus were excluded from the document. Immediately after the Summit, the chairpersons sent the document both to the main authors and to a list of experts (see footnote) who had made presentations at the summit and agreed to review and critically comment on the final document, which is presented below. As regards the scientific aspects of the planning of the Summit, several organisations, under the leadership of the EUGMS, were asked both to review the program and to suggest names of speakers and participants. After the Summit, the Boards of these organizations (European Union Geriatric Medicine Society (EUGMS), International Association of Gerontology and Geriatrics-European Region (IAGG-ER), European Association of Geriatric Psychiatry (EAGP), International Society of Gerontechnology (ISG) and International Society for the Study of the Aging Male (IS-SAM) agreed to consider the document as an official paper, and help with its dissemination. The name Silver Paper was used, recalling the grey or silvery hair of our older citizens, as an easy reference. It has been sent officially to several bodies of the European Union and to Health Ministers of most European countries; and will be published in other languages in local purnals. Its declared intention is to foster changes in policies which may, in the future, reduce the burden of disease in old age.

Nitrous Oxide-Oxygen Mixture During Care of Bedsores and Painful Ulcers in the Elderly : A Randomized, Crossover, Open-Label Pilot Study

Bedsore and ulcer care can often be painful and no standardized analgesic method exists today for pain relief during treatment in adults and the elderly. To evaluate the analgesic efficacy of a nitrous oxide-oxygen mixture vs. morphine during painful bedsore and ulcer care in adult and elderly patients, we conducted a randomized, crossover, multicenter, prospective, open-label, pilot study. Thirty-four inpatients, aged 53-96 years (median 84 years), were recruited in Grenoble University Hospital, Annecy Hospital and Chambéry Hospital, France, from January to June 2001. Each of the 34 patients received morphine (M), nitrous oxide-oxygen mixture (E), or morphine+nitrous oxide-oxygen mixture (ME) during painful care in a crossover protocol. Treatments were changed every two days and the study duration was six days. Analgesia was evaluated before and after each care session using a behavioral scale to evaluate pain in noncommunicating adults (ECPA), a visual analog scale (VAS), a global hetero-evaluation scale (GHES), and the DOLOPLUS-2 scale. There was a significant overall difference (P<0.01) among the three treatments. On the ECPA, the average difference after and before care was +5.2+/-8.6 (M), -0.3+/-8 (E), and -0.6+/-7.4 (ME), respectively. There was a significant difference between M and E, and M and ME (each P<0.01). No difference was found between E and ME (P=0.97). There were similar significant differences in the GHES and DOLOPLUS-2 scales (all tests P<0.01). Post hoc comparisons showed a significant difference (P<0.01) between M and E, and between M and ME without any additional effect for M+E. No differences were found with regard to safety or tolerability. This pilot study demonstrates the superiority of nitrous oxide-oxygen mixture over morphine for analgesia. This experience suggests that this mixture has ease of use, rapid effect, and limited contraindications when used during painful bedsore and ulcer care in elderly patients. Furthermore, it is well accepted by these patients and by nursing staff.

Nosocomial bacteremia in very old patients: predictors of mortality

Background and aims: Nosocomial Bacteremia (NB) is associated with high mortality in elderly patients. To determine specific prognostic factors for 7- and 30-day mortality in elderly patients with NB, we analysed the characteristics of 62 NB patients, retrospectively. Methods: This retrospective study concerns 62 cases of NB diagnosed within a 3-year period in a geriatric department. Bacteremia is described according to CDC definitions. Epidemiological characteristics, co-morbidities, clinical (activities of daily living (ADL) before NB) and biological findings (neutrophil count, lymphocyte count, albuminemia before NB) were collected for each patient. A systemic clinical reaction was defined by the presence of one of the following parameters: chills, hypothermia <36°C or hyperthermia >38.5°C, or shock. Types of micro-organism and source of NB were also collected. All variables were analysed for mortality at day 7 (7-day mortality) and at day 30 (30-day mortality). Results: The 7-day mortality rate was 21% and the 30-day rate was 45%. In multivariate analysis, 7-day mortality was only associated with the absence of systemic clinical reaction [OR 9.7 (3.7–25.7)]. Again, in multivariate analysis, 30-day mortality was associated with an ADL score <2 [OR 8.3 (4.3–16.4)] and cocci gram positive NB [OR= 3.6 (1.9–6.9)]. Conclusions: The absence of any systemic clinical reaction as a single independent predictor for 7-day mortality suggests either a poorer immune response to nosocomial bacteremia or a delay in diagnosis. Functional status was the strongest predictor for 30-day mortality. In this population, further prospective studies need to include these factors to evaluate predictors of mortality for serious infectious diseases.

Geriatricians and Technology

Modern geriatricians must face the challenges arising from the clash of 2 paradigms. They can be proud of their education, culture, skills, and clinical practice; this is the Hippocratic paradigm. However, currently, they need to be familiar with, accept, and use technology to sustain daily functioning and enhance the quality of care and quality of life of their aging and aged patients (the functional paradigm).1 They need to be more engaged in “gerontechnology,” which is defined as an interdisciplinary academic and professional field combining “gerontology” and “technology,” a concept referring to the fusion of the sciences of aging and engineering.2 Gerontechnology is a fast-developing field based on innovations including userand usage-centered concepts.2 As the field of technology is growing faster than the field of aging, it is increasingly difficult to understand the various meanings of the different terms and tools hidden behind the label “gerontechnology.”3 Moreover, geriatricians need to be aware of the practical applications of these tools, from individuals aging “in place”4 to nursing home residents.5,6

European silver paper on the future of health promotion and preventive actions, basic research, and clinical aspects of age-related disease

The current article is a statement of the meeting with international and multidisciplinary participation, held in Wrocław, Poland on September 11–13, 2008. The meeting was devoted to working out a position focusing on the challenge for individuals, health care systems, biological, psychosocial, epidemiological, medical, and public health sciences in the ageing populations of the twenty-first century. The statement is presented as an overview, in tabular format, of the current European situation regarding basic biological research on ageing, health promotion and preventive action, clinical care for older people, and recommendations for future actions. (Pol J Endocrinol 2009; 60 (5): 408–414)

European Silver Paper. Documento europeo sobre el futuro de la promoción de la salud y las acciones preventivas, la investigación básica y los aspectos clínicos de las enfermedades relacionadas con el envejecimiento

El envejecimiento de la población es uno de los mayores logros de la humanidad y Europa está a la cabeza de esta historia de éxitos. Sin embargo, el envejecimiento y las enfermedades relacionadas con la edad suponen también un desafı́o creciente para las personas, para los sistemas de asistencia sanitaria y para las ciencias de salud pública, biológicas, psicosociales, epidemiológicas y médicas. Muchos cientı́ficos de todas las áreas cientı́ficas y del conocimiento mencionadas trabajan activamente para entender mejor el envejecimiento y hacer frente a los retos que este fenómeno plantea a los individuos del siglo XXI. No se pueden afrontar estos retos desde un punto de vista único. Para enfrentarse a ellos es necesario un frente unido, activo y coordinado de muchas disciplinas, y también una estrategia que, partiendo de la investigación básica, alcance todos los aspectos del envejecimiento. Esto supone que la investigación traslacional es un requisito esencial y que los avances que surjan de la investigación deberı́an fluir rápidamente, a través de la formación de los profesionales, hasta influir en la promoción de estilos de vida saludables, para permitir que la asistencia sanitaria y social resuelvan las necesidades de las personas mayores. Se deben adoptar estrategias durante todo el ciclo vital, basadas en la evidencia, adaptadas en su caso a las personas mayores, que

Téléassistance en hospitalisation à domicile: Le programme ViSaDom

OBJECTIVE The purpose of this project was to study the clinical feasibility of videophone-based communication between patients in their homes, and the care teams who work in the Home Hospitalization department (HH). METHODS This pilot study of videophone users compared them with a group of control patients also in HH. They came from either the adult, maternity or pediatric departments. Patients who met the inclusion criteria and consented to participate in the study were randomly assigned to one of two groups: those who had a videophone installed in their homes (telemedicine group), and those who received the standard HH care (control group). Sixteen patients in the telemedicine group were matched with 16 from the control group, according to age, Karnofsky Index score, and the reason for HH admission. RESULTS The mean videophone call lasted six minutes, and patients averaged 23 calls each over the study period (0.7 calls per patient per working day). The videophone enabled better follow-up of wounds: for example, the nurse could transmit photos from the patients home for real-time coordination. It was also useful for following patients suffering from pain, for technical nursing care, and for educating patients and their caregivers. Anxiety (measured with the Hospital Anxiety and Depression Scale) diminished during the study period for the telemedicine patients, compared with the control group (p=0.048). Within the telemedicine group, all patients and their families were very satisfied or satisfied with their care and with the communication (15/15), although the staffs level of satisfaction was slightly lower (14/16); there were no significant differences between groups. CONCLUSION The ViSaDom program indicates that videophone communication is feasible and acceptable and could be a useful tool for improving the quality, efficiency and effectiveness of care.Resume Objectif Evaluer la faisabilite clinique de la communication visiophonique, entre un malade a son domicile et les equipes soignantes d’un reseau d’Hospitalisation a domicile (HAD). Methodes Etude cas-temoins, concernant les secteurs adulte, maternite et pediatrie du reseau HAD. Apres accord de participation, les patients qui remplissaient les criteres d’inclusion ont ete tires au sort pour leur appartenance au groupe telemedecine (appareil de visiophonie au domicile) ou au groupe temoin (prise en charge habituelle en HAD). Le groupe telemedecine comportait 16 patients apparies a 16 autres qui constituaient le groupe temoin. Les criteres d’appariement etaient l’âge, l’indice de Karnofsky et l’objectif d’admission en HAD. Resultats La duree de communication visiophonique a ete en moyenne de 6 minutes. Le nombre moyen d’appels a ete de 23 par patient, soit 0,7 appels par jour ouvrable. La visiophonie a permis une coordination en temps reel et un meilleur suivi des plaies avec prise de photos. C’etait un apport pour le suivi de patients douloureux, les soins techniques infirmiers, l’education du patient ou de son entourage. Le score d’anxiete a l’echelle HAD ( Hospital Anxiety Depression scale ) a diminue significativement au cours de la prise en charge des patients du groupe telemedecine contrairement a ceux du groupe temoin (p = 0,048). Dans le groupe telemedecine, tous les patients et leur entourage ont ete tres satisfaits ou satisfaits de la prise en charge et de la communication (15 cas sur 15), alors que 88 % des soignants le sont (14 cas sur 16), sans difference significative avec le groupe temoin. Conclusion Le programme ViSaDom a confirme la faisabilite et l’acceptabilite de la communication visiophonique. C’est un outil prometteur pour la qualite et l’efficacite des soins en HAD.