Caroline Laborde

Platelet aggregation inhibitors (PAI) have widely proven their efficiency for the prevention of ischemic cardiovascular events. We aimed to describe PAI prescription in an elderly multimorbid population and to determine the factors that influence their prescription, including the impact of age, comorbidities and frailty, evaluated through a comprehensive geriatric assessment. This cross-sectional study included all patients admitted to the acute geriatric department of a university hospital from November 2016 to January 2017. We included 304 consecutive hospitalized patients aged 88.7 ± 5.5 years. One third of the population was treated with PAI. A total of 133 (43.8%) patients had a history of cardiovascular disease, 77 of whom were on PAI. For 16 patients, no indication was identified. The prescription or the absence of PAI were consistent with medical history in 61.8% of patients. In the multivariate analysis, among the 187 patients with an indication for PAI, neither age (odds ratio (OR) = 1.00; 95% confidence interval (CI): [0.91–1.08], per year of age), nor comorbidities (OR = 0.97; 95% CI: [0.75–1.26], per point of Charlson comorbidity index), nor cognitive disorders (OR = 0.98; 95% CI [0.91–1.06] per point of Mini Mental State Examination), nor malnutrition (OR = 1.07; 95% CI [0.96–1.18], per g/L of albumin) were significantly associated with the therapeutic decision. PAI were less prescribed in primary prevention situations, in patients taking anticoagulants and in patients with a history of bleeding. In conclusion, a third of our older comorbid population of inpatients was taking PAI. PAI prescription was consistent with medical history for 61.8% of patients. Age, multimorbidity and frailty do not appear to have a significant influence on therapeutic decision-making. Further research is needed to confirm such a persistence of cardiovascular preventive strategies in frail older patients from other settings and to assess whether these strategies are associated with a clinical benefit in this specific population.

In 2015, a major increase in incident hospital-onset Clostridioides difficile infections (HO-CDI) in a geriatric university hospital led to the implementation of a diagnosis-centered antibiotic stewardship program (ASP). We aimed to evaluate the impact of the ASP on antibiotic consumption and on HO-CDI incidence. The intervention was the arrival of a full-time infectiologist in the acute geriatric unit in May 2015, followed by the implementation of new diagnostic procedures for infections associated with an antibiotic withdrawal policy. Between 2015 and 2018, the ASP was associated with a major reduction in diagnoses for inpatients (23% to 13% for pneumonia, 24% to 13% for urinary tract infection), while median hospital stays and mortality rates remained stable. The reduction in diagnosed bacterial infections was associated with a 45% decrease in antibiotic consumption in the acute geriatric unit. HO-CDI incidence also decreased dramatically from 1.4‰ bed-days to 0.8‰ bed-days in the geriatric rehabilitation unit. The ASP focused on reducing the overdiagnosis of bacterial infections in the acute geriatric unit was successfully associated with both a reduction in antibiotic use and a clear reduction in the incidence of HO-CDI in the geriatric rehabilitation unit.

Dans l'enquête Biographies et entourage réalisée par l'Ined en 2001, la reconstitution des événements factuels qui jalonnent les trajectoires familiale, résidentielle et professionnelle des personnes a été assortie d'éléments subjectifs. Il s'agissait de prendre en compte le regard porté a posteriori sur leur vie, par les enquêtés qui étaient ainsi amenés à proposer un découpage explicité de leur trajectoire, à identifier et à interpréter les périodes significantes de leur vie, les tournants et la tonalité générale de leur biographie ainsi que événements considérés comme marquants. Les premières analyses de ce matériau foisonnant montrent la façon dont la trajectoire des individus se structure autour de certains jalons factuels, en particulier ceux qui marquent la vie conjugale. Le vécu et la caractérisation des événements ne sont cependant pas donnés a priori et l'on constate l'intérêt de ces évaluations rétrospectives, qui s'avèrent nuancées et non conventionnelles. La possibilité de confronter le sens que les individus confèrent au déroulement de leur vie et les éléments factuels de celle-ci constitute une véritable richesse d'information pour l'interprétation des tournants et ruptures biographiques. /// The life course survey Biographies et entourage, conducted by INED in 2001, recorded not only the respondents' reports of the factual events in their family, residential and occupational histories but also some subjective elements. The aim was to take into account the way respondents saw their lives in retrospect. Respondents were asked to divide their lives so far into periods, explain and interpret these significant phases, and identify the turning points, the general tone of each period and what they saw as the landmark events. Our initial analyses of this abundant material show how individuals' life courses are structured around certain factual landmarks, especially landmarks in their conjugal lives -- but the respondents' subjective experience and characterization of events prove to be varied, non-conventional and not readily predictable. The study shows the usefulness of recording such retrospective assessments in a life course survey. Being able to compare the meanings that individuals confer on their lives with the factual events concerned provides a wealth of information for interpreting turning points and ruptures in the life course. /// En la encuesta "Biografías y Entorno" realizada por el Instituto Nacional de Estudios Demográficos (INED) en 2001, la reconstitución de los acontecimientos que marcan las trayectorias familiar, residencial y profesional de las personas está compuesta de diversos elementos subjetivos. En ella había que tener en cuenta lo que pensaban a posteriori los encuestados de su vida, incitándoles así, a proponer un desglose explícito de su trayectoria, y a identificar e interpretar los períodos significativos de su vida, los momentos cruciales, la tonalidad general de su biografía, y los eventos considerados como memorables. Los primeros análisis de este abundante material muestran cómo la trayectoria de los individuos se estructura alrededor de momentos destacados, en especial aquéllos que marcan la vida conyugal. Sin embargo, la vivencia y caracterización de los acontecimientos no se exponen a priori, constatándose, asimismo, el interés de sus evaluaciones retrospectivas que se revelan matizadas y no convencionales. La posibilidad de confrontar el sentido que los individuos dan al desarrollo de su vida con los elementos fácticos de ésta constituye una auténtica riqueza de información para la interpretación de los momentos cruciales y de rupturas biográficos.