Florence Benoit

Prevalence of zinc deficiency and its clinical relevance among hospitalised elderly

Zinc is an essential trace element, and constituent of many metallo-enzymes required for normal metabolism. Age may be associated with altered metallothionein metabolism related to changes in zinc metabolism. The objectives of this study were: (i) to assess the prevalence of zinc deficiency among hospitalised elderly patients; (ii) to define the social, functional, pathological and nutritional characteristics of zinc deficient elderly hospitalised patients; and (iii) to assess the relationship between the zinc status and humoral immune function among hospitalised elderly patients. Fifty consecutive patients underwent comprehensive geriatric assessments included evaluations of the medical (index of the severity of the disease(s)), psychiatric (Geriatric depression scale (GDS)), therapeutic, social, functional (Katzs scale), and nutritional problems (Mini Nutritional Assessment (MNA) and biochemical markers (zinc, albumin, prealbumin (PAB), cholesterol) before their discharge. Fourteen patients (28%) presented a zinc concentrations lower than 10.7 micromol/l, this value is usually considered as the cut-off level below which a zinc deficient status is possible. Higher proportions of respiratory infections, cardiac failure, and depression were observed among zinc deficient patients as compared with the group of patients with normal zinc status. The other parameters of comprehensive geriatric assessment did not allow to discriminate the zinc deficient patients. The only slight differences (which remained unsignificant) concerned the prealbumin levels which tended to be higher in the group of patients presenting normal zinc status than in the group with poor zinc status (0.208+/-0.062 versus 0.171+/-0.068 g/l respectively, P=0.06), and the IgG2 levels which tended to be lower in the group of patients with normal zinc status than in the group presenting poor zinc status (2.77+/-1.91 versus 4.06+/-2.56, respectively, P=0.057). A negative correlation was observed between the Zn concentrations and the IgG2 levels (Spearman R=-0.311, P=0.028). To the best of our knowledge, this is the first study presenting zinc status according to a comprehensive geriatric assessment among European hospitalised geriatric patients. We decided to perform this study to known whom of our patients needed to be supplemented with zinc administration. Considering the low energy intake of hospitalised patients (confirmed here in regards of the nutritional assessment), and the insufficient trace element density in European foods, the relevance of providing medical supplements or enriched foods to this population has to be evaluated. Although most of the current diseases may be relevant to long-term interactions between nutrition and ageing, certain states observed in the elderly, like impaired immune and cognitive functions, could still benefit from an appropriate nutritional supplementation.

Management of urinary tract infections in the elderly

Summary Urinary tract infection (UTI) is the most common infection and the first cause of bacteremia in the elderly. With increasing age the female to male ratio decreases and UTI becomes almost half as frequent in men compared to women. Significant bacteriuria exists in about 40% of institutionalized women. But asymptomatic bacteriuria is neither the cause of morbidity nor associated with a higher mortality rate and thus should not be treated. Symptomatic infection in women without complicating factors is most often caused by E. coli and may be treated with 3 or 7 day regimens of trimethoprim-sulfamethoxazole or fluoroquinolones (FQ). In the presence of symptoms of upper tract infection or complicating factors, urine culture is mandatory and will detect multiple and/or resistant microorganisms in most cases. Empirical treatment has to be adapted according to the sensitivity once established and should be administered for at least 10 days. Most of the patients above 65 and virtually all patients above 80 present either with general debility or diabetes or other factors such as bladder outflow obstruction or abnormal bladder function and have to be considered as presenting with complicated UTI. Indwelling catheters should be removed if possible, otherwise be changed.Zusammenfassung Harnwegsinfektionen (HWI) sind die häufigsten Infektionen und die vorrangige Ursache für Bakteriämien bei älteren Menschen. Mit zunehmendem Alter nimmt die Proportion der HWI bei Männern im Verhältnis zu Frauen zu und die HWI wird beim Mann beinahe halb so häufig wie bei der Frau. Eine bedeutsame Bakteriurie besteht bei ungefähr 40% der institutionalisierten Frauen. Aber asymptomatische HWI sind weder die Ursache für Morbidität noch mit einer erhöhten Mortalität verbunden und sollten deshalb nicht behandelt werden. Symptomatische Infektionen bei Frauen ohne Komplikationsfaktoren werden in den meisten Fällen von E. coli verursacht und können 3 oder 7 Tage lang mit Antibiotika wie Trimethoprim-Sulfamethoxazol oder Fluoroquinolonen in geringer Dosis behandelt werden. Sobald Symptome einer Niereninfektion oder Komplikationsfaktoren vorliegen, ist eine Urinkultur unabkömmlich und diese weist in den meisten Fällen mehrfache und/oder resistente Krankheitserreger nach. Empirische Behandlungen müssen dann dem Sensibilitätsspektrum entsprechend angepasst werden, und sollten für mindestens 10 Tage verabreicht werden. Die meisten Patienten über 65 und sozusagen alle Patienten über 80 haben entweder eine allgemeine Schwäche oder Diabetes oder andere Faktoren wie anormale Blasenfunktion oder Blasenabflussstörungen und sollten deshalb für komplizierte HWI behandelt werden. Dauerkatheter sollten wenn möglich entfernt oder zumindest gewechselt werden.