Nadir Kadri

Drug‐Drug Interactions Related to Hospital Admissions in Older Adults: A Prospective Study of 1000 Patients

OBJECTIVE: To investigate the frequency, nature, and side effects of drug‐drug interactions (DDI) in a group of geriatric inpatients.

Differences in the Signs and Symptoms of Hyperthyroidism in Older and Younger Patients

OBJECTIVES: To determine if aging modifies the clinical presentation of hyperthyroidism and the signs of thyrotoxicosis in older people.

Antiplatelet drugs in the elderly: prescriptions often inappropriate and reduced tolerance by associated diseases and drugs.

To assess the conditions of prescriptions and tolerance of antiplatelet drugs (APD) in the elderly and to detail the parameters that influence the tolerance of these drugs. Prospective survey in a Department of Geriatric Medicine. Two hundred nineteen patients 70 years and older treated with one or two APD prior to admission were included during 7 months in 2008. We recorded the type of APD, associated diseases, main associated or co‐prescribed drugs which could interact with APD and the bleeding adverse events including cutaneous bleeding. The mean age of the 219 patients was 84.5 ± 6.7 years (70–101 years), women 59.4%. Among patients 64.8% received aspirin (mainly 75 mg), 28.3% received clopidogrel and 6.8% received their combination; 16.9% of prescriptions were off‐label; 51.6% of patients had an associated disease and/or an associated drug which could have increased risk of bleeding event. Among the patients who received a gastric‐protective drug, the prescription followed the recommendations of the French Health Authority in 38.9%. We recorded bleeding events in 24.2% of patients at admission and in 18.3% of patients during the hospitalization. Bleeding events were significantly more frequent in patients treated with aspirin than clopidogrel (40.8 vs. 24.2%, P < 0.05) and/or with an associated drug (OR = 2.36, 95% CI 1.34–4.14, P < 0.01) and/or an associated disease (OR = 1.22, 95% CI 1.01–3.42, P < 0.05). APD treatment was stopped in 28.8% of patients, mainly because lack of indication or bleeding adverse events. Off‐label prescriptions of APD were not rare in the elderly, and adverse events are frequent. The results of this preliminary study evoke that medical situations at increased risk of bleeding are perhaps insufficiently evaluated, either in case of prescription of associated drugs with increased bleeding risk or during the follow‐up of patients with associated diseases. Cutaneous bleeding events should be more taken into account in prospective studies.

La confusion mentale chez les sujets âgés

Points essentials ● La prevalence hospitaliere de la confusion mentale apres 80 ans est entre 35 et 50 %. ● Le debut est brutal, la reversibilite inconstante et le diagnostic differentiel principal est le syndrome dementiel; la confusion hypo-active est une forme clinique a connaitre. ● Le pronostic est severe, avec une reduction fonctionnelle et une mortalite accrue. ● Les facteurs de risque sont le grand âge (plus de 80 ans), le syndrome dementiel, la privation sensorielle, la deshydratation, les troubles du sommeil, l’immobilite. ● La prise en charge initiale doit etre centree sur l’identification de la (ou des) cause(s). ● Une prevention primaire de la confusion non medicamenteuse chez les sujets a risque est possible et efficace.

Anemia and frailty in the elderly hospitalized in an acute unit: Preliminary results

Anemia is a frequent reason for hospitalization in acute geriatric units. The elderly are particularly susceptible and can condition the prognosis in cases of poor tolerance. The main objective is to research the link between anemia and weakness according to FRIED.

22. L’anémie chez la personne âgée

L’anemie est une anomalie biologique frequente, notamment chez le sujet tres âge, au retentissement clinique, fonctionnel et pronostic non negligeable. Il est important de pouvoir determiner l’origine de celle-ci, afin d’ameliorer le quotidien. L’ensemble des professionnels de sante medicaux et paramedicaux doivent etre attentifs devant la survenue d’une anemie. (R.E.)

Audit pharmacoclinique sur l’usage des digitaliques chez les sujets âgés de plus de 75 ans hospitalisés en unité gériatrique aiguë

Digitalis remains a treatment that is difficult to manage, especially in the elderly. METHODS A retrospective, unicentric study carried out within the unit of Internal medicine and geriatrics, Reims University Hospital Center, between January and June 2014. Collection of all patients hospitalized, after 75 years, receiving treatment with digitalis, either as soon as they enter (present on the usual prescription of the patient), during their hospitalization and on their exit. RESULTS 20 patients were included. The median age was 89 years (range: 78-94). Digitalis was only used in slowing down the ventricular rate during atrial fibrillation; 7 patients (35%) had a high serum digoxin concentration, of which 4 had renal failure. Three patients presented a digital cup on the electrocardiogram. In our series, in digoxin overdosage, 3 patients with electrical signs of digoxin overdosage have all 3 digoxin-beta-blockers. We are in the limit of the significance, for the connection between digoxinemia and the appearance of electrical signs of overdose in digitalis (p=0.06). CONCLUSION Digoxin therefore remains a drug that is difficult to manage, mainly in the elderly, as there are many clinical, biological drug and therapeutic constraints. Failure to comply with the rules for the use and monitoring of digoxin may prove fatal in the elderly.

Conduite à tenir devant une hypervitaminémie B12 chez le sujet âgé

Hypervitanimia B12 is an early marker of serious pathologies. These include solid neoplasms, malignant blood diseases and acute/chronic hepatopathies. Hypervitaminemia B12 in geriatrics is thereby an indicator in the diagnosis and prognosis of these conditions.

Hypervitaminia B12: A Useful Additional Biomarker for the Diagnosis and Monitoring of Liver Diseases

B12 hypervitaminemia is a biological abnormality, yet one that is significantly underestimated. According to the literature, high levels of vitamin B12 is associated or linked with a range of conditions, the majority of which are serious. These conditions include solid neoplasia (whether metastatic or otherwise) and, either acute or chronic, malignant haematological disorders. But there are others causes like liver disorders, which are described in the literature, but poorly known.