OBJECTIVE: To determine nutritional intake and vitamin status in a sample of homeless people who had been on the streets of Paris for more than 2 y. DESIGN: The nutritional status was evaluated by a 24 h recall questionnaire and by assay of circulating levels of vitamins A, B 1 , B 6 , B 12 , C and E. SETTING: The study was conducted in four accommodation centres of the SAMU Social of Paris (CHUSI units) from July 1999 to May 2000. SUBJECTS: A total of 329 homeless people were interviewed. Only 87 subjects, aged 26 -76 y, were recruited based on seven selection criteria (over 18 y old, being homeless for more than 2 y, interviewed before taking a meal in the CHUSI units, good understanding of French, in a calm state, not coming from hospital or another CHUSI units, without any acute condition that might affect usual dietary habits), and completed the dietary questionnaire. Out of these 87, 71 agreed to blood sampling. RESULTS: In all 84% of the subjects declared that they drank alcoholic beverages regularly (175 AE 167 g=day of alcohol), and 75.5% of the subjects also declared that they smoked. The mean total energy intake was 2111 AE 1482 kcal=day for the men (8823.98 AE 6194.76 kJ=day) and 1523 AE 531 kcal=day for the women (6366.14 AE 2219.58 kJ=day). Alcohol accounted for 44 AE 30% and 19 AE 17% of the total energy intakes (TEI) for the men and women, respectively. Proteins, lipids and carbohydrates accounted for 21 AE 9, 23 AE 14 and 57 AE 16%, respectively, of the energy intake without alcohol for men, and 15 AE 5, 22 AE 11 and 62 AE 14% EIWA for women. For all micronutrients, except for iron in the men, more than 50% of the population studied had intakes below the French recommendations for the adult population. All the women had calcium, vitamin E and vitamin B 1 intakes below the recommendations for French women (900, 12 and 1.3 mg=day, respectively) in the general population. For the men, 98.7, 96.1 and 93.5% of the subjects had vitamin E, B 1 and C intakes below the recommendations for French males in the general population (12, 1.5 and 80 mg=day, respectively). It is of note that subjects who ate in the CHUSI units more than once a day per week had significantly (P ¼ 0.018) higher intakes of vitamin C (27 AE 38 mg=day) than did the subjects who ate in the CHUSI units less than once a day (8 AE 12 mg=day). Measurement of serum vitamin levels demonstrated a deficiency in 95% of the subjects, mainly for vitamin C. The mean concentration in serum was 16 AE 8 mmol=l, although 72% of the subjects had levels of 6 mmol=l. In contrast, 50.7, 42.2 and 35.2% of the subjects had high levels of vitamin B 6 , B 12 and B 1 , respectively (100 nmol=l, 420 pmol=l and 40 mmol=l). CONCLUSION: Alcohol takes a high place in the diet of these homeless people. Although the total energy intake was too low, macronutrient intakes seem to be satisfactory in quality (well-balanced). However, calcium and vitamin C intakes were too low, and these deficiencies favour the development of disease (scurvy, asthenia, ecchymosis), in ad...

Key Points Question Does a multimodal nonpharmacological approach prevent delirium in older patients undergoing elective surgical procedures? Findings This stepped-wedge cluster trial recruited 1470 patients 70 years and older who were randomized in 5 clusters to patient-centered evidence-based intervention (ie, personalized stimulation, company, relaxation) vs routine care. The intervention reduced delirium incidence after various major procedures, most significantly in patients undergoing noncardiac surgery; the intervention did not change cardiac surgery postoperative delirium incidence. Meaning Results of this stepped-wedge cluster trial suggest the implementation of this multimodal nonpharmacological delirium prevention program may improve delivery of targeted care and patient outcomes in older patients undergoing elective noncardiac surgical procedures.

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The incidence of risk factors for RFS was relatively high in older individuals acutely admitted in geriatric hospital units, suggesting that, RFS maybe more frequent among older persons than we are aware of. Patients with low serum levels of phosphate and magnesium and higher weight loss are at increased risk of RFS. The clinical characteristics of the older participants at risk of RFS indicate that these patients had a relatively poor nutritional status which can help us better understand the potential scale of RFS on admission or during the hospital stay.