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Biomedical subjects

A Decamps

Publications and source records attributed to A Decamps.

At least 19 recordsLinked to original sources
PubMed2003

Prospective audit of diabetes care and outcomes in a group of geriatric French care homes.

BACKGROUND: In geriatric institutions, diabetes prevalence varies from 10 to 20%. However, little is known about patterns of care and their outcomes. To assess both, an 18-month prospective audit was conducted in 240-bed nursing and 80-bed residential care homes. METHODS: In diabetic subjects, items of care were compared to the corresponding French guideline end-points. Dependency in activities for daily living (ADL) was evaluated at inclusion and at the end of the survey for survivors. Diabetic residents were compared to others for age, sex, mortality and one-year change of iso-resource group ranging (IRG), a need-of-care scale. RESULTS: The 73 diabetic patients among 494 residents (14.8%) were not different from the others for age and sex (respectively age: 76.0 y +/- 7.9 compared to 78.2 y +/- 9.4; M/F sex ratio: 0.59 compared to 0.31). Oral hypoglycemic agents were prescribed in 29 (39.7%) and insulin in 26 (35.6%). Control of diabetes with HbA(1C) was in keeping with guidelines in 23.3%, HbA(1C) was never performed in 26%, and > 8% in 20.5%. Rates of items of guidelines that were never addressed ranged from 2 to 80%. During the stay, ADL dependency worsened in diabetic patients, but their one-year change in GIR range was not different from that in the others. Mortality was 30.1% compared to 37.1% in the others (NS). This mortality rate and the evolution of functional dependency were not influenced by the quality of diabetes control. CONCLUSION: In these disabled elderly patients, diabetes management needs to be improved. However, mortality and the evolution of functional dependency were similar in diabetic people than in others. Interventional studies for controlling with reference to geriatric evaluation, i.e. function, nutrition and mental health, are needed in order to establish specific guidelines based on benefit-burden analysis.

Activities of Daily Living↗
PubMed2001

Antioxidant defences and oxidative stress markers in erythrocytes and plasma from normally nourished elderly Alzheimer patients.

OBJECTIVES: to investigate blood markers of oxidative stress, and enzymatic and non-enzymatic antioxidants in normally nourished elderly people with Alzheimer's disease. DESIGN: case-control study. SUBJECTS: twenty patients with Alzheimer's disease and 23 elderly control subjects, living at home, free from disease and not undergoing any treatment known to have a strong influence on blood oxidative stress markers or antioxidant defence systems. METHODS: we performed a nutritional evaluation, including anthropometric and biological measures and a 3-day dietary record. We determined concentrations of antioxidant vitamins (alpha-tocopherol, retinol) and malondialdehyde in plasma and erythrocytes. We also measured erythrocyte enzymatic activities of glutathione peroxidase and copper-zinc superoxide dismutase. RESULTS: the two groups were similar in age, body mass index, dietary record and serum albumin concentration. After adjustment for age, sex and cardiovascular co-morbidity, mean plasma concentration of alpha-tocopherol was lower in those with Alzheimer disease than in control subjects (15+/-3.5 mg/l compared with 18.2+/-3.5; P=0.002), as was the mean plasma concentration of retinol (0.54+/-0.2 mg/l vs 0.7+/-0.2; P=0.014). The mean concentration of free plasma malondialdehyde was higher in those with Alzheimer's disease (0.70+/-0.2 mmol/l vs 0.5+/-0.1; P=0.036). In Alzheimer disease patients, free plasma malondialdehyde concentrations were inversely correlated with levels of alpha-tocopherol (P=0.002) and retinol (P=0.025). Erythrocyte levels of vitamins and enzymatic activities were similar in the two groups. CONCLUSION: lower plasma concentrations of alpha-tocopherol and retinol in normally nourished elderly patients with Alzheimer's disease than in controls could suggest that these antioxidant vitamins had been consumed as a result of excessive production of free radicals.

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PubMed2000

Incidence and predictors of drug-treated diabetes in elderly French subjects. The PAQUID Epidemiological Survey.

AIMS: To estimate the incidence and predictors of drug-treated diabetes in elderly subjects. METHODS: The PAQUID epidemiological survey, a population-based study, has followed up 3,777 subjects older than 65 years since 1988. At each visit (baseline, 1, 3, 5 and 8 years), treatment regimen was used to identify new drug-treated diabetic subjects. Potential predictors of drug-treated diabetes were collected during the baseline visit (body mass index (BMI), educational level, cigarette smoking and wine consumption, physical activity, depressive symptomatology, subjective health, treatment, and hypertension) and analysed by using a multivariate backward stepwise regression Cox model with delayed entry. RESULTS: The prevalence rate of drug-treated diabetes was 7.5% at baseline and 7.1% after 8 years' follow-up. The incidence rate of drug-treated diabetes was 3.8/1,000 person-years, 5.9/1,000 person-years in men and 2.4/1,000 person-years in women, with no significant variation according to age group. Male sex (relative risk (RR) 2.4, 95% confidence interval (CI) 1.4-4.0, P < 0.001, attributable risk (AR) 0.36), elevated BMI (for one point increase, RR 1.1, 95% CI 1.1-1.1, P < 0.001, > or = 25 vs. < 25, RR 2.1, 95% CI 1.2-3.5, AR 0.33), thiazide diuretics used alone (RR 5.9, 95% CI 1.8-19.6, P = 0.02), and poorer subjective health ('the same' vs. 'better' RR 1.8, 95% CI 1.0-3.1, P = 0.04; 'worse' vs. 'better' RR 2.3, 95% CI 0.9-5.7, P = 0.06) were independent predictors of drug-treated diabetes in this population. CONCLUSIONS: In older French individuals, men seem to be particularly exposed to drug-treated diabetes although being overweight was found to be a strong predictor as in younger populations.

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PubMed1998

Five-year mortality in elderly French subjects from the PAQUID epidemiologival survey: the burden of diabetes.

We describe the 5-year mortality and its risk factors in a cohort of elderly people with and without known diabetes mellitus. The PAQUID cohort was representative of the population older than 65 living in Gironde, south-west France. Potential mortality risk factors were collected during a baseline evaluation, using a health questionnaire, from 68.9% of a randomly selected sample of over-65s in 1988. A total of 237 subjects (8.5%) had diabetes. Annual review occurred for 5 years and cause of any death was ascertained from family doctors. After 5 years, 623 people (22.3%) had died, of whom 576 were non-demented; 30.0% of the diabetic group versus 20.3% of the non-diabetic group had died. Survival of the known diabetic group was lower than that of the non-diabetic group (p < 0.001), although this excess mortality was significant only in the 65 to 75 age range (relative risk 1.8; 95% confidence interval 1.2 to 2.8, p = 0.04). Cardiovascular mortality rate did not differ between the diabetic and non-diabetic groups (RR 1.2 [0.8-2.0]). Death related to neoplasia was significantly higher in the known diabetic group (RR 2.2 [1.2-3.3], p = 0.01). In the final model, integrating diabetes as a mortality risk factor in the total cohort, known diabetes at the baseline examination was an independent risk factor for mortality (RR 1.4 [1.0-1.8], p = 0.01), in addition to tobacco use, hypertension and functional dependency. These results confirm suggestions that diabetes increases mortality in the over-65 age group, perhaps with an adverse interaction with other pathology.

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PubMed1997

Audit of percutaneous endoscopic gastrostomy in long-term enteral feeding in a nursing home.

OBJECTIVES: Percutaneous endoscopic gastrostomy (PEG) is now easily used in the event of long-term enteral nutrition. Tolerance of long-term enteral feeding has been documented in different populations but the documentation is incomplete in the case of older and frail people. Our aim was to describe early and late tolerance in this population, and to propose ways in which it could be improved. DESIGN: Retrospective study in two parts: tolerance and quality of care; case-control study for tolerance. SETTING: A nursing home with 240 beds in south-west France. who had undergone PEG insertion between January 1990 and June 1994. Fifty-eight patients were involved, 12 under 65 years (48 +/- 10.6), and 46 over 65 (80.7 +/- 9.3). The gastrostomy insertion was performed because of a vegetative state in 6 patients, swallowing difficulties in 31 and anorexia in 21. A control group was gathered in December 1996, which included all patients for whom the question of nutritional support was mentioned books but where no artificial nutrition had been implemented due to the patients' or families' refusal or to a staff decision. This group included 50 patients, 5 younger than 65 years (54 +/- 8.3), and 45 older (84.7 +/- 7.6). In 22 cases the nutritional problem was swallowing difficulties and in 28 cases anorexia. Pressure ulcers were present before insertion in 34 patients in the PEG group and in 7 of the control group (p < 0.001). MAIN OUTCOME MEASURES: Prognosis, early and late cutaneous digestive (ileus, vomiting, gastroesophageal reflux) and pulmonary (bronchorrhea, dyspnea and aspiration pneumonia) complications for PEG and control groups, and patients with signs of poor behavioural tolerance of PEG were recorded in the chart. Audit of quality of care was performed in the PEG group using eight criteria: two concerned the pre-insertion period, two the early follow-up and four the long-term follow-up. RESULTS: Early mortality (4 weeks) was 13.8% in PEG (vs 10%, NS), mid-term mortality (between 4 and 8 weeks) was 12.1% (vs 14%, NS) and late mortality was 19.0% (vs 42.0%, length of follow-up 63.4 +/- 42.1 weeks compared to 53.1 +/- 63.8 weeks, NS). The duration of follow-up of the living patients was 71.6 +/- 61.8 weeks in PEG compared to 48.0 +/- 70.5 in the control group. Only 20% in PEG were free of any cutaneous complication around the insertion site, and 8 abscesses occurred during the first week. Pulmonary complications occurred in 39% of the PEG group (vs 30.0, NS). Aspiration pneumonia was significantly associated with swallowing difficulties in both groups (p < 0.05). Vomiting occurred for 15.5% of the PEG group (vs 12%, NS), ileus in 13.8% (vs 6%, NS). Gastroesophageal reflux was found in 2 PEG patients, compared to 1 case among the control patients. Pressures sores were healing in 20 out of 34 patients in the PEG group (vs 2 out of 7) and new ulcers appeared in 6 out of 24 (vs 8 out of 43). Fifteen (25.8%) of the PEG patients attempted to withdraw the tube.

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PubMed1997

Prevalence of diabetes and effect on quality of life in older French living in the community: the PAQUID Epidemiological Survey.

OBJECTIVES: To evaluate the prevalence of diabetes mellitus in older French subjects and to examine the different aspects of quality of life in an older diabetic population. DESIGN: From a random sample of 2792 people older than age 65 living in the community, a diabetic sample was selected using three items from a questionnaire: Are you diabetic? Are you on a diabetic diet? What kind of medications do you take daily? Validation of the questionnaire was carried out previously to correct the observed prevalence. MEASUREMENTS: The questionnaire assessed social and demographic aspects, physical, mental, and subjective health, and functional disabilities. Because quality of life assessment was mainly subjective, demented subjects were excluded. RESULTS: The diabetic group consisted of 237 subjects from the older sample of 2792 (8.5%). No age difference was demonstrated between the two groups (mean, distribution), but the male/female ratio was significantly higher in those with diabetes (49.4% vs 39.3%, P = .003). Corrected prevalence of diabetes was 10.3%. After exclusion of demented subjects, 230/2726 people were investigated. Diabetic subjects were heavier (P < .001), had higher systolic blood pressure (P < .001), and had more frequent symptoms of ischemic heart disease (P < .001) and painful peripheral arterial disease (P < .001) and dyspnea (P < .001), but antecedents of stroke were similar in both groups. Diabetics were more often lacking in autonomy according to the IADL Lawton scale (P < .001), Rosow and Breslow scale (P < .001), and Mobility scale (P = .043), but not according to the Katz ADL scale. They more often exhibited symptoms of depression on the CES-D self-rating scale (21.3% vs 12.7%, P < .001), but evaluation of cognitive function was similar in both groups. Thirteen percent of diabetics, compared with 7.6% of non-diabetics, were unsatisfied with their own situation (P = .002). Health was rated as fair, bad, or very bad by 67.8% of diabetics compared with 49% of non-diabetics (P < .001). Diabetics rated themselves as feeling worse than others (15.3% vs 9.2%, P < < .001) and worried more about their health status (78% vs 63%, P < < .001). CONCLUSION: The observed prevalence of diabetes in older French people living in the community was 8.5%. Quality of life in older diabetics was poorer than that of other people of the same age.

Activities of Daily Living↗
PubMed1996

31P magnetic resonance spectroscopy of human liver in elderly patients: changes according to nutritional status and inflammatory state.

Magnetic resonance spectroscopy (MRS) was used to determine the phosphorylated metabolite content in the liver of elderly patients in various nutritional states: normal, with protein deprivation, and with acute inflammatory syndrome. 31P-MRS investigations were performed at 1.5 T, and localized liver spectra were recorded using a two-dimensional chemical shift imaging sequence. Comparison to control spectra recorded on 10 healthy volunteers (age, 30.5 +/- 2.1 years) showed that the aging process does not significantly modify 31P-MRS liver spectra. Patients with protein deprivation exhibited a higher value than controls for the phosphomonoesters/nucleoside triphosphates (PME/NTP) ratio (P < .05). This increase was not due to the decrease of NTP, since the ratio of inorganic phosphate to NTP (Pi/NTP) remained constant. A decrease in the phosphodiesters to NTP (PDE/NTP) ratio (P < .04) contributed to the observed increase in the PME/PDE ratio (P < .01). In contrast, no significant difference in 31P-MRS spectra was found between elderly patients with hypoalbuminemia associated with inflammatory syndrome and the control group. We conclude that elderly patients with protein deprivation displayed changes in the level of phosphorylated metabolites in the liver that were not observed in the case of inflammatory syndrome despite lower serum albumin (Alb) concentrations.

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PubMed1995

The PAQUID survey and correlates of subclinical hypothyroidism in elderly community residents in the southwest of France.

The aim of this study was to assess the prevalence of increased thyroid-stimulating hormone (TSH) levels (subclinical or undiagnosed hypothyroidism) in a representative sample of a community-living elderly population and to examine the relationships with cognitive functions and depressive symptoms. An epidemiological study was made of a cohort of 2792 subjects over 65 years of age. A blood sample was obtained from 425 volunteers of this cohort and assayed for TSH. Every subject participating in the study was interviewed and given a battery of neuropsychological tests by a psychologist. Three hundred and eighty-one subjects (89.7%) had normal TSH levels; 18 subjects (4.2%) had TSH lower than 0.4 microU/ml, associated in two of them with hyperthyroxinaemia. Twenty-six subjects (6.1%) had increased TSH levels, associated in 18 of them with a normal free thyroxine level and in eight with a low free thyroxine level. Increased TSH levels were significantly linked with female sex and with the presence of symptoms of depression on the CES-D scale but not with impairment of cognitive function.

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PubMed1993

[Prevalence of dementia in Gironde (France)].

The objective of the study is to estimate the prevalence of dementia using the data of the Paquid cohort. A sample of 3,149 subjects aged 65 years and older living at home or in institution was randomly chosen in Gironde (France). A questionnaire and psychometric tests were used to evaluate cognitive functioning and the presence of dementia was assessed through DSM III Diagnostic and Statistical Manual of mental disorders (ed. III) criteria. Hachinski scale and work group NINCDS-ADRDA criteria were applied to confirm the presence of dementia and identify Alzheimer's disease. Overall prevalence was estimated to 4.3%. No difference was found between men and women. The prevalence increased with age with nearly a doubling every 5 years of age. In institution, dementia frequency remained stable. The relative risk of a demented subject to be institutionalized with regard to a non demented subject decreased with age.

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PubMed1990

[Indications and limitations of anticoagulant treatment in elderly patients].

Anticoagulants constitute the rational treatment of thromboembolic accidents occurring in elderly people, but they are often not prescribed because of the risk of haemorrhage. The chronological age by itself is not a contra-indication, the limitations being the diseases associated with ageing. Anticoagulants may be used as curative treatment in atrial fibrillation with dilated left atrium (greater than 45 mm at echocardiography), in myocardial infarction, embolic strokes and complicated arteritis. They may also be used as preventive and curative treatment in phlebitis and pulmonary embolism. The complications of anticoagulant therapy will be better prevented by using the international normalized ratio and by prescribing doses that are adequate for each indication.

4-Hydroxycoumarins↗
PubMed1988

Hypertension in the elderly.

The incidence of definite hypertension increases with advancement of age, and one third of the elderly population is affected. Isolated systolic hypertension is frequent in this population (10 to 12 percent in subjects between 65 and 74 years of age). The role of hypertension as a cardiovascular risk factor has been confirmed in the elderly population by the increase in cerebrovascular accidents, and by the incidence of myocardial infarction with the rise in blood pressure. The relationship between elevated diastolic and systolic blood pressure and mortality rates in the elderly is also well documented (Framingham). Effective treatment of hypertension significantly reduces the risk of associated complications: cardiovascular death, congestive heart failure, and stroke. However, the goal of antihypertensive therapy in the elderly should be not only to reduce morbidity and mortality rates, but also to do so without adverse effects on the functional well-being of patients.

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PubMed1983

A comparison of the effects of vitamin B12 and aspirin in three experimental pain models in rats and mice.

The effects of vitamin B12 are compared to those of aspirin and 0.9% saline in three different experimental pain models in rats and mice; an electric shock test, the hot-plate test, and the phenylbenzoquinone writhing test. Neither cyanocobalamin nor hydroxocobalamin showed any antinociceptive activity in any of the three tests at any of the doses used, whether the drug was administered as a single injection or as a series of daily injections lasting 7 days. These results run counter to those of clinical trials in man, though close scrutiny of the experimental procedures used in these trials often reveals a lack of rigor which casts doubts on their validity. This consideration, together with the negative findings reported here, suggests that the clinical use of vitamin B12 as an analgesic may be inappropriate.

Analgesics↗
PubMed1981

Red cell filterability and chronic renal failure.

Filterability has been studied during chronic renal failure (with creatinin level above 350 mumol/l); red cells were washed thrice with 9 g/l NaCl or 40 g/l human serum albumin), adjusted to give a PCV of 0.3 and filtered on polycarbonate sieves with pore sizes of 5 micrometer. In the uremic patients groups, the results are heterogeneous and show a significant reduction of the red cell filterability. The filtration time is not well correlated with the degree of uraemia but with the haemoglobin level.

Erythrocyte Membrane↗