Philippe Chassagne

Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis.

PURPOSE This study was conducted to evaluate the incidence, identify the risk factors, and assess the prognosis of elderly institutionalized patients who develop fecal incontinence. PATIENTS AND METHODS We enrolled 1,186 patients 60 years of age and older living in long-term care facilities who did not have fecal incontinence. We assessed their medical history, treatment, mobility, and cognitive function. Patients were followed up for 10 months to determine the incidence of fecal incontinence, defined as at least one involuntary loss of feces. Independent risk factors associated with fecal incontinence were identified using Cox proportional hazards models. The prognosis of incontinent patients was assessed by comparing their survival rate with that in the continent patients. RESULTS Fecal incontinence occurred in 234 patients (20%), and was usually associated with acute diarrhea or fecal impaction. We identified five risk factors for the development of fecal incontinence: a history of urinary incontinence (rate ratio [RR]: 2.0, 95% confidence interval [CI] 1.5 to 2.6); neurological disease (RR: 1.9, 95% CI 1.0 to 3.4); poor mobility (RR: 1.7, 95% CI 1.2 to 2.4); severe cognitive decline (RR: 1.4, 95% CI 1.1 to 1.9); and age older than 70 years (RR: 1.7, 95% CI 1.0 to 2.8). Ten-month mortality in the 89 patients with long-term (> or = 8 days) incontinence was 26%, significantly greater than that observed in the continent group (6.7%) or in the 145 patients with transient incontinence (10%). CONCLUSIONS Long-lasting or permanent fecal incontinence was associated with increased mortality, suggesting that this symptom is a marker of poor health in older patients. Actions that improve mobility might help prevent fecal incontinence in elderly patients.

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.

Is presentation of bacteremia in the elderly the same as in younger patients

OBJECTIVE To compare the presentation of bacteremia in young and elderly patients. PATIENTS AND METHODS Seventy-one elderly (mean age 80.4 years) and 34 younger inpatients (mean age 45.7 years) with bacteremia were prospectively studied. These were compared with a control group of 187 geriatric patients (mean age 81.3 years) with clinical signs of bacteremia but in whom blood cultures were negative. Bacteremia was defined as one or more positive blood cultures showing a pathogenic bacteria in patients with clinical signs of bacteremia. In all 105 patients with bacteremia, 16 common clinical or biological signs of the disease were immediately investigated after blood culture. Patients were classified into three groups: elder patients and young patients with bacteremia and elderly patients without bacteremia. RESULTS Only three clinical findings of the 16 studied were found in at least 70% of the bacteremic elderly patients: fever, increased erythrocyte sedimentation rate, and a clinical indication of the source of infection. These three signs were found statistically more often in bacteremic elderly compared with nonbacteremic elderly patients (P < 0.01). Seven other signs (hypothermia, altered mental state, leukopenia, and lymphopenia) had a specificity above 80%. On a logistic regression analysis, four variables were significantly and independently associated with bacteremia in the elderly: rapid onset of infection (defined as a period < or = 48 hours between the earliest manifestation of bacteremia and the time of blood blood sample), fever, altered general state, and clinical indication of the source of infection. Younger infected patients had more chills, sweating, alter general state, altered mental state or lymphopenia than did the bacteremic elderly patients. Bacteremic elderly patients had statistically few symptoms than the young infected patients (P < 0.001). CONCLUSIONS In elderly patients with early stage bacteremia, most of the signs or symptoms that are considered typical in the literature appear irregularly. None appeared pathognomonic. Elderly patients with bacteremia had fewer signs or symptoms than younger infected patients.

Does Age Play a Role in Clinical Presentation of Hypothyroidism

OBJECTIVE: To determine if aging modifies the clinical presentation of hypothyroidism.

Underuse of Oral Anticoagulation for Individuals with Atrial Fibrillation in a Nursing Home Setting in France: Comparisons of Resident Characteristics and Physician Attitude

To describe the characteristics of nursing home residents diagnosed with atrial fibrillation (AF) and eligible for oral anticoagulants who did not receive these drugs and to detail the conditions that physicians who decide not to prescribe anticoagulants take into account.

Clinical Presentation of Hypernatremia in Elderly Patients: A Case Control Study

OBJECTIVES: To assess early clinical signs and their prognostic value in elderly patients with hypernatremia.

PURPLE URINE BAGS: A GERIATRIC PRESENTATION OF LOWER URINARY TRACT INFECTION

Critical to the program’s philosophy and operations is the maintenance of a network of personal relationships. The community workers know the patients in their own homes, know their neighbors and friends, and know the surrounding community. (Some patients are so attached to particular workers that special planning for vacations is necessary.) The workers regularly visit the outpatient clinic, where they know the nurses, physicians, and pharmacists, all of whom may pause to discuss how best to address a particular diffi-

Does age influence the gastric emptying of solids

TO THE EDITOR: I am happy to clarify my position on first trimester ERCP for Dr. Cohen et al., and anyone else I may have “confused” (1). My statement that “ERCP is easy in early pregnancy” would have been more eloquently conveyed as “shielding the fetus from radiation during ERCP is technically easiest in the first trimester” (when the uterine fundus is still in the pelvis). My colleagues seem to be proscribing first trimester ERCP altogether, which I believe is wrong. I was careful in my commentary to stress the importance of only using ERCP in pregnancy when the circumstances indicate that it is the safest and most effective way to manage a problem. I have personally performed three first trimester ERCPs with sphincterotomy and stone removal for cholangitis: in each case, dosimeters revealed negligible radiation exposure to the fetus, which was well shielded by a lead apron covering most of the mother’s abdomen. There were no complications and three healthy babies were delivered at term. Each mother underwent interval cholecystectomy in the postpartum period. Historically, surgeons have been taught to avoid opening the abdomen during the first trimester because of the well documented risk of fetal loss. There are no data to suggest that ERCP carries equivalent risk. The greatest danger posed to the first trimester fetus by ERCP is that of severe pancreatitis. So far, no case of severe maternal pancreatitis resulting from ERCP during pregnancy has been reported. Obviously, that risk exists and must be considered whenever ERCP is being contemplated in a pregnant woman. Dr. Cohen and his colleagues can take comfort from the fact that of 15 ERCPs that I have personally performed in pregnant women, only three (20%) have been in the first trimester. So, this should be a rare dilemma for most endoscopists.

Bulky Solid Tumors in Elderly Adults: Beware of Spontaneous Tumor Lysis Syndrome

tumor bleeding and probable inflammatory syndrome (Creactive protein 16 mg/L then 49 mg/L). Moreover, she was in renal failure (serum creatinine 176 lmol/L, normal 45–84 lmol/L; uremia 45 mmol/L, normal 2.1–7.1 mmol/ L). Immediate management consisted of hemostasis of the tumor bleeding point, clean dressing, hydration, and red blood cell transfusion. Her general health improved rapidly, with a moderate increase in hemoglobin and normalization of serum creatinine and uremia levels. Histopathological analysis of tumor biopsy revealed in situ, lentigo maligna-type melanoma of the left lower eyelid. Surgery was excluded. Local care was continued. She was then transferred to a rehabilitation unit to await radiotherapy.