Joel Belmin

Université Pierre and Marie Curie - Paris 6 and Hôpital Charles Foix, Ivry-sur-Seine, France · Service de gériatrie - Geriatrics ward

Background Hearing loss impacts health-related quality of life and general well-being and was identified in a Lancet report as one of the largest potentially modifiable factors for the prevention of age-related dementia. There is a lack of robust data on how cochlear implant treatment in the elderly impacts quality of life. The primary objective wa...

Résumé La prévalence de la maladie de Parkinson est d’environ 1 % chez les sujets âgés de plus de 65 ans et de 4 % chez les plus de 80 ans. La maladie de Parkinson est responsable d’un handicap grave après 10 à 15 ans de progression. La plupart des patients atteints de maladie de Parkinson vus en gériatrie ont une maladie de Parkinson à début tardi...

Background: Given an increase in the aging population and its impact on healthcare systems, policy makers for provision of health and social services are aiming to keep older adults in good health for longer, in other words towards 'healthy aging'. Our study objective is to show that rehabilitation with cochlear implant treatment in the elderly wi...

Riassunto L’insufficienza cardiaca (IC) è una patologia grave e frequente nelle persone anziane (PA), caratterizzata da una diagnosi spesso difficile, dall’importanza delle comorbilità, da una morbilità e mortalità elevate e da una maggiore frequenza di forme con frazione di eiezione sistolica conservata. Solo la gestione delle forme con frazione d...

Resumen La insuficiencia cardíaca (IC) es una afección grave y frecuente en las personas ancianas (PA); se caracteriza por tener un diagnóstico que puede ser difícil, por la importancia de las comorbilidades, una morbilidad y una mortalidad elevadas, y por una mayor frecuencia de las formas con fracción de eyección sistólica conservada. Únicamente...

Résumé Objectif Les auteurs exposent les recommandations de la Société française d’oto-rhino-laryngologie et de la chirurgie de la face et du cou (SFORL) concernant les indications de l’implant cochléaire chez l’enfant. Méthodes Un groupe de travail multidisciplinaire a été chargé d’effectuer une revue de la littérature scientifique sur la thémat...

Résumé Les auteurs exposent les recommandations de la Société française d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant les indications d’implant cochléaire chez l’adulte. À partir d’une revue de la littérature scientifique par un groupe de travail multidisciplinaire, des recommandations ont été rédigées, fondées su...

Objectives: The authors present the guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou - SFORL) on the indications for cochlear implantation in children. Methods: A multidisciplinary work group was entrusted with a review of the scientif...

The authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding indications for cochlear implantation in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members’ experience, then read over by an independent reading group to...

Objectives Healthcare professionals are expected to firmly ground their practice in sound evidence. That implies that they know and use evidence-based medicine (EBM). In this study, our aim was to know how often health professionals actually made use of EBM in their daily practice. Design A questionnaire survey of healthcare professionals. Partic...

Points essentiels L’hypotension et notamment une pression artérielle diastolique très basse pourrait être une situation à risque chez les personnes très âgées et fragiles ou coronariennes. L’hypotension permanente chez les personnes ayant une insuffisance cardiaque est un indicateur de mauvais pronostic et gêne la prise en charge thérapeutique. L’h...

Vitamin-K antagonists (VKA) have been the standard for oral anticoagulation. However, they carry several problems in older patients: frequent bleeding complications, complex management, risk of interactions with multiple drugs. Two classes of direct oral anticoagulants (DOA) are currently available in France: (a) direct thrombin inhibitors: dabigat...

Manual dexterity measures can be useful for early detection of age-related functional decline and for prediction of cognitive decline. However, what aspects of sensorimotor function to assess remains unclear. Manual dexterity markers should be able to separate impairments related to cognitive decline from those related to healthy aging. In this pil...

Objectives To analyze long‐term cognitive status and function after cochlear implantation in profoundly deaf individuals. Design Prospective observational longitudinal study. Setting Ten academic medical centers referent for cochlear implantation. Participants Individuals aged 65 and older who qualified for cochlear implantation (N=70). Measure...

La fibrilación auricular (FA) es el trastorno del ritmo más frecuente del anciano. Expone a graves complicaciones, en particular tromboembólicas, que pueden prevenirse en gran medida por un correcto tratamiento anticoagulante. Se ha concretado la conducta práctica ante una FA con base en recomendaciones regularmente actualizadas: establecer el diag...

Introduction: The Confusion Assessment Method (CAM) is a validated key tool in clinical practice and research programs to diagnose delirium and assess its severity. There is no validated French version of the CAM training manual and coding guide (Inouye SK). The aim of this study was to establish a consensual French version of the CAM and its manu...

Background Factors associated with delirium among community-dwelling older adults have been poorly studied. Our aim was to describe the prevalence of predisposing and precipitating factors for delirium among patients admitted for delirium and to assess whether these factors were appropriately recognized at the first patient assessment at hospital....

Backgrounds: Diagnostic relevance of plasma amyloid β (Aβ) for Alzheimer's disease (AD) process yields conflicting results. Objectives: To assess plasma levels of Aβ42and Aβ40in amnestic mild cognitive impairment (MCI), nonamnestic MCI, and AD patients and to investigate relationships between peripheral and central biomarkers. Methods: One tho...

OBJECTIVE To validate the Greek translation of the Cognitive Disorders Examination (Codex) and to investigate its potential for implementation for the detection of dementia in the Greek population. METHOD Subjects aged ≥60 years with and without dementia, based on the diagnostic criteria DSM-IV-TR, were included in the study. Translation of the tes...

Background: The hemorrhagic risk of antiplatelet drugs in old patients could be higher as usually assumed. Objective: To compare the bleeding risk of antiplatelet drugs and oral anticoagulants in elderly patients. Methods: A systematic review and meta-analysis. We searched PubMed, EMBASE and the Cochrane Library up to January 2016 for randomiz...

Background: Hospitalization for worsening/acute heart failure is increasing in France, and limited data are available on referral/discharge modalities. Aim: To evaluate patients' journeys before and after hospitalization for this condition. Methods: On 1 day per week, between October 2014 and February 2015, this observational study enrolled 26...

Considering the limited effectiveness of drugs treatments in cognitive disorders, the emergence of noninvasive techniques to modify brain function is very interesting. Among these techniques, repetitive transcranial magnetic stimulation (rTMS) can modulate cortical excitability and have potential therapeutic effects on cognition and behaviour. Thes...

Objective: Older people with atrial fibrillation (AF) have an increased embolic risk but they are less frequently treated with anticoagulants. We wanted to assess our current practice in a specialized service. Patients and methods: Prospective observational study including all patients older than 75 years admitted during 3 months in a cardio-ger...

But de l’étudeLes patients âgés atteints de fibrillation atriale (FA) ont un risque embolique élevé mais ils sont moins souvent anticoagulés. Nous voulions évaluer nos pratiques dans un service de gériatrie spécialisé.Patients et méthodeÉtude observationnelle descriptive incluant tous les patients de plus de 75 ans avec une FA hospitalisés pendant...

Herpes zoster (HZ) infection is a common condition in the elderly. Immunosuppression involving cellular immunity favors its occurrence. The pain is the most frequent complications of HZ. It occurs in about 30% of people aged over 70 years. The virological diagnosis of typical HZ is not useful, and the diagnosis is mainly based on clinical data. Ski...

We investigated IL-10 and IL-6 production in amyloid-β (Aβ) stimulated peripheral blood mononuclear cells (PBMCs) in twenty Alzheimer's disease (AD) patients with slow progression, eleven with fast progression, and twenty age-matched controls. Promoter polymorphisms in IL-10 (position -592, -819, -1082), IL-6 (-174), transforming growth factor-β1 (...

Background: Age and short leukocyte telomeres have been associated with a higher risk of Alzheimer's disease (AD). Inflammation is involved in AD and it is suggested that anti-inflammatory interleukin-10 (IL-10) may partly antagonize these processes. Objective: The aim is to correlate telomere length (TL) in peripheral blood mononuclear cells (P...

In dementia, behavioral psychological symptoms are frequent and variable. To assess the value of wrist actigraphy as a measure of disorder in motor behavior especially apathy, aberrant motor behavior, agitation and anxiety. Cross sectional observational study of consecutive patients older than 75 years admitted to an intermediate care unit of a ger...

La prévalence des maladies chroniques augmente fortement avec l’âge, et leur traitement est complexe chez les personnes très âgées du fait de comorbidités multiples, de perte d’autonomie, de fragilité, de troubles cognitifs et/ou de troubles sensoriels. L’éducation thérapeutique devient un élément important de la gestion des maladies chroniques. Le...

The Test Your Memory (TYM) test has been proposed for screening dementia. We present a French version and its validation in memory clinics. F-TYM was administered to 201 patients with memory complaints visiting five secondary referral hospital centers. Final diagnosis was dementia in 34%, amnestic mild cognitive impairment (MCI) in 32%, non-amnesti...

Lower respiratory tract infections are frequent in patients living in nursing homes. It is very important to distinguish the pneumonia from the bronchitis in order to give the most appropriate treatment and to increase the rational use of antibiotics. We propose herein a decision tree to help the therapeutic challenge.

Preoperative cognitive impairment has been identified as a major risk factor for postoperative delirium in older people. The aim of this study was to evaluate whether a validated and rapid screening cognitive test - COgnitive Disorder EXamination (CODEX) - performed preoperatively before proximal femoral fracture repair, was associated with a risk...

The prevalence of atrial fibrillation (AF) increase with ageing. In France AF affects between 400,000 to 660,000 people aged 75 years or more. In the elderly, AF is a major risk factor of stroke and a predictive factor for mortality. Comorbidities are frequent and worsen the prognosis of AF. They can be the cause or the consequence of AF and their...

Atrial fibrillation (AF) is a common and serious condition in the elderly. AF affects between 600,000 and one million patients in France, two-thirds of whom are aged above 75 years. AF is a predictive factor for mortality in the elderly and a major risk factor for stroke. Co-morbidities are frequent and worsen the prognosis. The management of AF in...

Les traitements par antivitamine K (AVK) sont actuellement les anticoagulants oraux de référence. Cependant, ils ont plusieurs inconvénients chez le patient âgé : une iatrogénie fréquente par complications hémorragiques, la complexité de leur maniement, le risque d’interactions médicamenteuses chez des patients souvent nécessitant une polymédicatio...

La vaccination est un moyen préventif efficace devant conduire le praticien à apporter une attention toute particulière notamment envers la vaccination contre la grippe, le tétanos et le pneumocoque. Rappelons également l’importance de la vaccination grippale du personnel soignant au contact des sujets âgés. S’il paraît évident que l’arrêt du tabac...

La prévalence des maladies chroniques augmente fortement avec l’âge, et le traitement de ces maladies est complexe chez les personnes très âgées en raison de comorbidités multiples, la perte de l’indépendance et/ou de leur fragilité. En outre, les troubles cognitifs, les démences, les troubles sensoriels sont fréquents dans cette population. L’éduc...

Au cours du vieillissement, se produit un remodelage progressif des arteres, caracterise par une augmentation du calibre des gros troncs et un remaniement de la paroi. Les fibres elastiques de la paroi sont alterees et le contenu en collagene augmente. Le collagene, qui subit une glycosylation non enzymatique, devient plus rigide et plus resistant...

The prevalence of chronic diseases strongly increases with age, and the treatment of these diseases is complex in very old persons due to multiple comorbidities, loss of independence and/or frailty. In addition, cognitive troubles, dementia, sensorial disturbances are common. Patient education is becoming an important component of chronic disease m...

Vaccination especially influenza, tetanus and pneumococcus should be used by the physician as an effective preventive measure. Stop smoking prevents the occurrence of cardiovascular event as the control of blood pressure in elderly healthy. It is very important to treat atrial fibrillation in elderly. In elderly aged over 80 years, primary preventi...

Vitamin-K antagonists (VKA) are the current standard for oral anticoagulation. However, they carry several problems in older patients: frequent bleeding complications, complex management, risk of interactions with multiple drugs. Two new classes of oral anticoagulants (NOA) are now available: direct thrombin inhibitors (dabigatran); and direct fact...

Objectives: The aim of the study was to compare the accuracy of three formulae that estimate creatinine clearance (CL(CR)), in elderly hospitalized patients: the Cockcroft-Gault (CG) formula and the Modification of Diet in Renal Disease formulae with 4 and 6 variables (MDRD4 and MDRD6). Methods: A prospective, cross-sectional, observational stud...

Context: Few large studies have been conducted to assess the relationship between circulating IGF and late-life cognition. Objective: The aim of the study was to assess the relationship between IGF-I and IGF binding protein-3 (IGFBP-3) serum levels and cognitive impairment, including Alzheimer's disease (AD). Methods: In this multicentric cros...

Two new classes of oral anticoagulants are now available: direct thrombin inhibitors: dabigatran; direct factor Xa inhibitors: rivaroxaban, apixaban, and others. These drugs have a rapid absorption and action, are administered at fixed doses and do not require regular monitoring coagulation tests. In large randomized trials, they have been equivale...

To evaluate care provided by primary care physicians in community practice to older patients presenting with cognitive impairment and dementia. Secondary analysis of an intervention study. Primary care clinics. 101 patients 75 years and older enrolled in the ACOVE-2 study who presented with a new cognitive problem, new dementia, or prevalent dement...

Background: Atrial fibrillation is the most frequent sustained arrhythmia. Atrial fibrillation frequently recurs after restoration of normal sinus rhythm. Antiarrhythmic drugs have been widely used to prevent recurrence, but the effect of these drugs on mortality and other clinical outcomes is unclear. This is an update of a review previously publ...

Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease. This chapter covers the following aspects: prevalence, risk factors, signs and symptoms, differential diagnosis including tremor and extrapyramidal syndromes, advanced PD and management of PD, including pharmacological treatments, especially with...

This chapter covers the following aspects of pneumonia in the elderly: causative agents, clinical presentation, differential diagnosis, hospitalization and further investigations, therapy and prevention. Further topics include heart failure and pulmonary embolism, cancer and other diseases of the lung, chest imaging, biological tests and anti-infec...

La paralysie supranucléaire progressive (PSP) est une maladie très rare chez les adultes jeunes, mais elle n’est pas exceptionnelle chez les sujets âgés. Il faut savoir penser à ce diagnostic chez les patients de plus de 60 ans atteints d’un syndrome extrapyramidal résistant à la lévodopa, de troubles cognitifs et/ou de paralysie de la verticalité...

Alternative sensitivity analyses on ADAS-Cog according to the intent-to-treat population. Tabulated data for ADAS-Cog response rate and ADAS-Cog change relative to baseline according to the sensitivity analysis approaches of: (1) the observed cases dataset; 2) last observation carried forward; and (3) considering missing data as nonresponders.

Neuroinflammation is thought to be important in Alzheimer's disease pathogenesis. Mast cells are a key component of the inflammatory network and participate in the regulation of the blood-brain barrier's permeability. Masitinib, a selective oral tyrosine kinase inhibitor, effectively inhibits the survival, migration and activity of mast cells. As t...

Background: EHT0202 (etazolate hydrochloride) is a new compound exhibiting both potential disease-modifying and symptomatic treatment properties in Alzheimer's Disease increasing alpha-secretase activity and sAPP alpha secretion, as well as acting as a GABA-A receptor modulator and as a PDE-4 inhibitor. Methods: This pilot, random-ized, double-blin...

Health care professionals need a simple and pragmatic clinical approach for the management of recurrent fallers in clinical routine. To develop clinical practice recommendations with the aim to assist health care professionals, especially in primary care in the management of recurrent falls. A systematic English and French review was conducted usin...

The observational diagnosis phase of the VESTA study was aimed to determine the composite profiles of vaccinated/non-vaccinated HCWs by analyzing reasons to accept/decline influenza vaccination. Between June and September 2005, 2485 HCWs (female: 82.9%; nursing auxiliaries: 42.1%; vaccination coverage: 23.4%) from 53 French geriatric HCSs were incl...

Background: Health care professionals need a simple and pragmatic clinical approach for the management of recurrent fallers in clinical routine. Objective: To develop clinical practice recommendations with the aim to assist health care professionals, especially in primary care in the management of recurrent falls. Methods: A systematic English and...

Varicella-Zoster virus, an exclusively human herpes virus is responsible for chickenpox and herpes zoster. After the primary infection, the virus becomes permanently latent in the dorsal-root sensory ganglias and may be reactivated several decades later causing a vesicular dermatomal rash, traditionally metameric. Old adults can present severe pain...

Background Vitamin K antagonists (VKA) are widely used in old patients with atrial fibrillation or venous thromboembolism. Safety is a major concern, especially in old patients. International normalised ratio (INR)>5 is associated with an increased risk of bleeding and is considered as a near miss error. Aim To reduce the incidence of episodes of...

The benefits of vaccination in older adults are well documented yet there is poor uptake of such preventive measures, and one of the main reasons in France is a lack of recommendation and support from healthcare professionals. To address this issue a multidisciplinary group of experts has developed an educational tool, Vaxisenior, to assist in the...

An 87-year-old female patient presented an osteoporotic vertebral compression fracture responsible for severe pain and functional impotence. Analgesic drugs were badly tolerated. A percutaneous vertebroplasty was carried out under local anesthesia. It had a spectacular effect on pain and allowed a rapid recovery of walking functions and restoration...

This study is based on the general finding that non-pharmacological factors such as interior design and architectural characteristics of environments can help reduce symptoms of Dementia of the Alzheimer Type (DAT). The research presented here is the result of an experimental study of the effects of environmental personalization on behavioral disor...

We report herein the case of an old women patient with a delayed diagnosis of achalasia. The discussion deals with the important role of esophageal manometry in the upper digestive tract investigation of a dysphagia in frail elderly subjects.

Effectiveness of cardiovascular drugs in the treatment of several cardiovascular diseases is widely demonstrated. These drugs may be the source of potentially serious adverse events in the old individuals and fear of these events may partly explain why beta-blockers and angiotensin converting enzyme inhibitors are underused in elders with heart fai...

Cardiovascular diseases are responsible for disability, quality of life impairment and mortality in the elderly. Although it is efficient, cardiovascular prevention is underused in old individuals. Coronary heart disease can be prevented by antihypertensive agents in old subjects with hypertension, and by statins and antiplatelet agents in high ris...

Vaccination is an important component of disease prevention in the elderly; however, immunization coverage in this population is low. There is a clear need to improve vaccine coverage among this age group. To this end, various strategies can be employed. Raising awareness and improving the education of physicians and health care workers in the fiel...

Coronary heart disease is a common and serious condition in patients aged over 80 years. The presenting clinical symptoms are all the more atypical and the prognosis poorer when it occurs in patients with multiple comorbid diseases. The presence of comorbidities dictates the need for a standardized geriatric assessment to screen for the existence o...

L a prescription médicamenteuse appropriée fait référence à la prescription de médicaments (i) qui ont fait la preuve de leur efficacité dans une indication donnée; (ii) qui sont bien tolé-rés; (iii) qui présentent des rapports coût-efficacité et risque-bénéfice favorables; et (iv) qui, particulièrement dans la population âgée, prennent en considér...

The French institute for study of geriatric infection risk (ORIG) has run a multiphase multicenter study (VESTA) to develop and implement active programs promoting healthcare worker (HCW) influenza vaccination. The present article reports results after implementation of the first active program. A cluster-randomized controlled trial was conducted f...

STOPP-START is a screening tool for detecting inappropriate prescriptions in older people. Recently validated in its English-language version, it is a reliable and easy-to-use tool, allowing assessment of prescription drugs often described as inappropriate (STOPP) or unnecessarily underused (START) in this population. An adaptation of the tool into...

To evaluate the effect of staff influenza vaccination on all-cause mortality in nursing home residents. Pair-matched cluster-randomized trial. Forty nursing homes matched for size, staff vaccination coverage during the previous season, and resident disability index. All persons aged 60 and older residing in the nursing homes. Influenza vaccine was...

To compare the accuracy of the two most popular creatinine clearance (CrCl) estimation formulae (Cockcroft-Gault (CG) and Modification Diet in Renal Disease (MDRD)) in older hospitalized patients. Prospective, cross-sectional, observational study. Two hospital geriatric wards. Consecutive patients aged 70 and older with an indwelling urinary cathet...

Prevention is an important but neglected issue in geriatric medicine. Vaccination plays a major role in prevention of infectious diseases, but its implementation in clinical practice is far from perfect. To improve practice, a group of French experts composed of geriatricians and infectious disease specialists prepared a set of educational material...

Under the auspices of the Société Française de Gériatrie et Gérontologie, a multi-disciplinary group of specialists in geriatrics, neurology, epidemiology, psychiatry, neuroradiology and nuclear medicine met with the aim of drawing up references on the methods for diagnosing and treating mild Alzheimer’s disease. The critical analysis of internatio...