Acquired deforming hypertonia and contractures in elderly subjects: Definition and prevalence in geriatric institutions (ADH survey)

ObjectiveBy proposing a new terminology (acquired deforming hypertonia or ADH) and a new definition for contractures, the main objective of this study was to establish their prevalence among institutionalized elderly patients. Secondary objectives were to analyze the negative impact of ADH and collect the opinions of clinicians on the possible treatments available.MethodologyA multicenter cross-sectional study was conducted among residents of 39 geriatric institutions (29 EHPAD and 10 USLD). All subjects presenting at least one ADH were surveyed over a one-week period.ResultsAmong 3145 observed patients (mean age 88.9 ± 9.7 years) 22% (n = 692) presented at least one ADH. In average, each patient presented 4.4 ± 3.2 ADHs. Negative consequences on self-care, nursing and difficulties in getting dressed were most frequently observed. Only 25.4% of clinicians considered the ADH to be potentially reversible. Physical therapy was the therapeutic option most frequently chosen over medication and surgery.ConclusionThis study confirms the important prevalence of ADH among elderly institutionalized patients. Consequences on the level of dependence were significant. It seems relevant to elaborate hierarchical therapeutic strategies in order to counter these disorders and the fatalism that ensues.     

Hypertension artérielle,atteinte rénale et génétique chez le sujet noir : mise au point

The incidence and prevalence of hypertension is markedly elevated in Afro-American populations vs Caucasians. The development of end-stage renal disease is also more frequent in Afro-American subjects, independently of blood pressure control. As compared to Caucasians, Afro-American subjects have a higher risk of end-stage renal disease when they are infected with HIV or have lupus. For decades, these data remained mysterious. Within the last 3 years, results from studies in the field of genetics and infectious diseases have transformed our view on this problem. The aim of this paper is to explain how these results have changed our understanding of hypertension and its consequences in Afro-American subjects.     

Role of cardiologists in control of risk factors and prescription of secondary-preventive drugs in elderly patients with atherosclerotic cardiovascular disease. The French ELIAGE-MG survey

Little information is available as regards risk factor control and use of secondary prevention medications in elderly populations with documented atherosclerotic disease. The ELIAGE-MG survey included 3247 patients with cardiovascular disease seen in ambulatory practice. Overall, both the control of risk factors and the use of secondary prevention medications was suboptimal in these patients. However, those having consulted a cardiologist at any time during the previous year had better control of risk factors (and particularly LDL cholesterol and smoking) and were more often prescribed recommended secondary prevention medications.     

Radiothérapie hypofractionnée des cancers ORL chez le sujet âgé

Thirty percent of patients with head and neck cancer are over 70 years. Radiotherapy approach in elderly is a challenge. On one hand, radiotherapy side effects, as well as the number of sessions required, could be a burden. On the other hand, omission of local treatment is not an option due to the symptoms of the tumor. Patients in good general condition may receive standard fractionnated radiotherapy. For frail patients unsuitable for standard fractionated radiotherapy, more convenient shorter course of radiotherapy are commonly used. Physicians have to choose the best radiotherapy schedule according to the objective of the treatment. In case of palliative intend: hypofractionated radiotherapy delivered with a single short course could be recommanded. This course could be followed by other subsequent courses if the patient's condition improves during the treatment. For patients treated in curative intend, the choice of hypofractionation schedule depends on the general condition: split course hypofractionated radiotherapy for unfit patients, or accelerated radiotherapy with concomitant boost for fit patients. In all cases, a high-quality radiotherapy technique and appropriate supportive care are mandatory to minimize the side effects. The ELAN RT trial, soon to be completed, will rule on the non-inferiority of hypofractionated radiotherapy compared to standard radiotherapy for unfit patients.