Level of Medical Intervention in Geriatric Settings: Decision Factors and Correlation With Mortality

Putot, Sophie; Jouanny, P.; Barben, Jérémy; Mazen, Emmanuel; Silva, Sofia da; Dipanda, Mélanie; Asgassou, Sanaa; Nuss, Valentine; Laborde, Caroline; Mihai, Anca M.; Vovelle, Jérémie; Manckoundia, Patrick; Putot, Alain

doi:10.1016/j.jamda.2021.04.014

Cited by 8 publications

(3 citation statements)

References 32 publications

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“…The collected geriatric data were: (1) age-adjusted Charlson comorbidity index (ACCI) [ 8 ], (2) number of medications at admission (polypharmacy was defined by the consumption of at least 5 different drugs per day [ 9 ]), (3) place of residence, (4) Mini Mental State Examination (MMSE) score, (5) baseline ambulatory status (the OP was considered “independent” if walking without help or with a cane and “dependent” if requiring a walker and/or assistance during transfers or bed-chair confinement, (6) score on the Activity Daily Living (ADL) scale [ 10 ], and (7) level of medical intervention [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

Prescription of Blood Lymphocyte Immunophenotyping in the Diagnosis of Lymphoid Neoplasms in Older Adults

Vovelle¹,

Row

Larosa³

et al. 2022

JCM

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Lymphoid neoplasms are a heterogeneous group of lymphoid neoplastic diseases with multiple presentations, and varying prognoses. They are especially frequent in older patients (OPs) and the atypism of this frail elderly population can make the diagnostic process even more difficult. Blood lymphocyte immunophenotyping (BLI) is essential in rapid noninvasive diagnosis orientation and guides complementary investigations. To our knowledge, BLI prescription has never been evaluated in OPs. We hypothesized that, when there is a suspicion of lymphoid neoplasm in the geriatric population, a BLI is performed in view of various clinical or biological abnormalities. This study aimed to: (1) describe the characteristics of hospitalized OPs having undergone BLI for suspected lymphoid neoplasm, (2) identify the causes leading to BLI prescription, and (3) identify the most profitable criteria for BLI prescription. This was a descriptive retrospective study on 151 OPs aged ≥75 years who underwent BLI over a 2-year period. Regarding BLI prescriptions, eight had lymphocytosis, constituting the “lymphocytosis group” (LG+), while the 143 others had BLI prescribed for reasons other than lymphocytosis (LG−), mainly general weakness and anemia. In the LG−, we compared OPs with positive and negative BLI results. The criteria found to be profitable for BLI prescription were lymphadenopathy, splenomegaly, lymphocytosis, and thrombocytopenia. BLI identified circulating lymphoid neoplasms (positive BLI) in 21/151 OPs, mainly marginal zone lymphoma and chronic lymphocytic leukemia. In polymorbid OPs, as per our study population, the diagnostic and therapeutic complexity explained in part the sole use of indirect and minimally invasive diagnostic techniques such as BLI.

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Section: Methodsmentioning

confidence: 99%

Prescription of Blood Lymphocyte Immunophenotyping in the Diagnosis of Lymphoid Neoplasms in Older Adults

Vovelle¹,

Row

Larosa³

et al. 2022

JCM

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“…For instance, a French study suggests that patients with neurocognitive disorders or who are unable to perform activities of daily living are more likely to be assigned a higher LMI which, however, is not significantly associated with mortality. ( 15 ) In addition, significant variability between practitioners is reported, with experienced practitioners more likely to assign a higher LMI to their patients. ( 15 ) Another study conducted in the United States suggests that white-race patients, and those using hospice services, are more likely to have been assessed for LMI in the past.…”

Section: Introductionmentioning

confidence: 99%

“…( 15 ) In addition, significant variability between practitioners is reported, with experienced practitioners more likely to assign a higher LMI to their patients. ( 15 ) Another study conducted in the United States suggests that white-race patients, and those using hospice services, are more likely to have been assessed for LMI in the past. ( 16 ) Both studies bring into question the factors that are at stake in the decision to assess LMI.…”

Section: Introductionmentioning

confidence: 99%

Levels of Medical Intervention and End-of-Life Practices in Long-Term Care Centres

Leclerc-Loiselle¹,

Gendron²,

Côté³

et al. 2022

Can Geriatr J

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BackgroundLevels of medical intervention (LMI) are legal documents in which physicians record patient preferences, or those of their designated substitute decision-makers, concerning end-of-life care. Studies suggest that, although LMI are intended to orient clinical practice, their function tends to be limited to logistical aspects of care. How LMI shapes or guides patient-centred, end-of-life care remains unclear. The aim of this study was to examine possible associations between LMI and certain aspects of end-of-life care practices in LTCC, such as nurse-documented patient experiences of pain, and prescription and administration of medication. MethodsA retrospective descriptive study of 100 files retrieved from a clinical database of deceased patients in LTCCs located in an urban integrated health and social service organization in Québec, Canada, was conducted. ResultsSignificant associations between last documented LMI and frequency of narcotic prescription and administration, at either regular intervals or PRN, are highlighted. The time delay between last LMI assessment and patient death was one week or less for 39.4% of cases. ConclusionThese results suggest that LMI assessment practices may not correspond to their intended use. A short time frame between last LMI (L-LMI) assessment and patient death may suggest less-than-optimal patient comfort in end-of-life care.

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Transfusion in Older Anemic Patients: Should the Troponin Value Be Taken into Account?

Thevenin

Putot

Manckoundia

et al. 2022

The American Journal of Medicine

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Level of Medical Intervention in Geriatric Settings: Decision Factors and Correlation With Mortality

Cited by 8 publications

References 32 publications

Prescription of Blood Lymphocyte Immunophenotyping in the Diagnosis of Lymphoid Neoplasms in Older Adults

Prescription of Blood Lymphocyte Immunophenotyping in the Diagnosis of Lymphoid Neoplasms in Older Adults

Levels of Medical Intervention and End-of-Life Practices in Long-Term Care Centres

Transfusion in Older Anemic Patients: Should the Troponin Value Be Taken into Account?

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