Abstract Background and Aims Iron deficiency (ID) is a poor prognostic factor in chronic diseases such as chronic kidney disease (CKD). Indeed, independently of anemia, ID is associated with more rapid clinical worsening of CKD and is a risk factor for mortality in this condition. In older patients, CKD is common and often associated with other comorbidities. Method The CARENFER PA study is a national multicenter study designed to evaluate ID in older patients (>75 years) newly hospitalized in a geriatric unit. The primary endpoint was the prevalence of ID, defined as serum ferritin < 100 µg/L and/or transferrin saturation coefficient (TSAT) <20%. Absolute ID was defined as serum ferritin < 100 µg/L and functional ID as serum ferritin ≥ 100 µg/L and TSAT < 20%. In this analysis, we explored ID prevalence according to the degree of CKD. The Short Physical Performance Battery (SPPB) test was used to identify older patients at high risk of adverse events (e.g., disability, falls, hospitalization, death). Results 888 patients (mean age, 85.2 years; women, 63.5%) from 16 French centers were analyzed. Stages of CKD were: stage I, 3.8%; II, 53.2%; IIIa, 22.3%; IIIb, 13.3%; IV, 6.0% and V, 1.4%. ID prevalence in the entire cohort was 57.6% (495/859). When present, ID was absolute in 56.2% (278/495) of cases and functional in 43.8% (217/495). ID prevalence was 54.3% (265/488) in patients with stages I-II, and 61.9% (227/367) in patients with stages III-V (p = 0.0271). In the subgroup of anemic patients, ID prevalence was 58.9% (112/190) and 65.9% (147/223), respectively (p = 0.14). We assessed, according to the stages of CKD, various factors likely to affect or be associated with ID. Thus, in patients with at least three comorbidities, ID prevalence was 56.9% (74/130) in patients with stages I-II and 64.8% (142/219) with stages III-V (p = 0.14); in patients with heart failure, ID was present in 63.2% (36/57) and 60.3% (76/126), respectively (p = 0.71). If patients received treatments with possible effect on ID/anemia (e.g., anticoagulant, proton pump inhibitors, platelet antiaggregant), ID prevalence was 58.4% (192/329) for stages I-II and 62.7% (188/300) for stages III-V (p = 0.27). In patients with CRP ≥ 12 mg/L, ID prevalence was 73.8% (96/130) and 72.2% (117/162), respectively (p = 0.76). In univariate analysis of the entire cohort, degree of CKD (stages III-V vs. I-II), at least three comorbidities, CRP ≥ 12 mg/L, anemia and low serum albumin were significantly associated with ID. In multivariate analysis, CRP ≥ 12 mg was the only independent predictor of ID (odds ratio, 2.78; 95% CI, 1.92–4.08; p < 0.0001). In patients with stages I-II, physical performances were poor (SPPB score 0-6) in 44.5% (77/173) of patients without ID and 57.5% (119/207) with ID; in patients with stages III-V, SPPB scores were low in 55.6% (60/108) of patients without ID and 63.5% (106/167) with ID. Conclusion ID prevalence is high (over half of patients) in older patients admitted to a geriatric unit—particularly those with CKD—and is associated with inflammation and a low SPPB score. These new data underline the importance of more systematic screening for ID in older patients. Future randomized controlled trials should evaluate the efficacy of iron supplementation on the outcome of older patients with ID.

Abstract Background Iron deficiency (ID) is often associated with other comorbidities in older patients and is a factor of morbimortality. However, the prevalence of ID remains poorly documented in this population. Methods The CARENFER PA study was a French multicenter cross-sectional study whose objective was to evaluate ID in patients (> 75 years) admitted to a geriatric unit. The primary endpoint was the ID prevalence defined as: serum ferritin < 100 µg/L and/or transferrin saturation coefficient (TSAT) < 20%. The Short Physical Performance Battery (SPPB) test was used to identify older patients at high risk of adverse events (e.g., disability, falls, hospitalization, death). Results A total of 888 patients (mean age, 85.2 years; women, 63.5%) from 16 French centers were included from October 2022 to December 2022. The prevalence of ID was 57.6% (95% CI, 54.3–60.9) in the cohort of older patients (62.6% in anemic and 53.3% in non-anemic patients; p = 0.0062). ID prevalence increased significantly with the presence of more than three comorbidities (65.6% vs. 55.9%; p = 0.0274), CRP ≥ 12 mg/L (73.0% vs. 49.3%; p < 0.001) and treatment that may influence ID/anemia (60.5% vs. 49.6%; p = 0.0042). In multivariate analysis, only CRP ≥ 12 mg/L was an independent predictive factor of ID (odds ratio, 2.78; 95% CI, 1.92–4.08; p < 0.001). SPPB scores were low (0–6) in 60.5% of patients with ID versus 48.6% of patients without ID (p = 0.0076). Conclusion More than half of older patients had ID, including non-anemic patients. ID was associated with the presence of inflammation and a low SPPB score. Trial registration NCT05514951.

INTRODUCTION:Population-based studies show a significant increase in the prevalence of visual impairment in older patients. However, older patients and patients with lower Mini-Mental State Examination (MMSE) scores have few ophthalmological assessments. The main objective of our study was to evaluate the feasibility of tele-ophthalmological screening for ophthalmological diseases in older patients referred for cognitive assessment.METHODS:This monocentric prospective study included patients referred to a memory clinic for cognitive assessment. All patients underwent a geriatric assessment comprising a cognitive assessment associated with tele-ophthalmological screening undertaken by an orthoptist, including undilated retinal photography. The retinal photographs were subsequently sent to an ophthalmologist. We identified patients who were not eligible for ophthalmological assessment, for patients that had to come back due to poor-quality retinal photographs and finally for detected eye diseases. The association between the geriatric variable and newly detected eye diseases was analysed in univariable and multivariable analyses.RESULTS:The mean age of the 298 patients included was 83.5 years  ± 5.65; 29.5% were male. The mean MMSE score was 20.8 ± 5.2; 66.3% of patients had a diagnosis of dementia. Eighteen patients (6.0%) were not eligible for ophthalmological examination and 13 patients (4.6%) were asked to come back owing to poor-quality retinal photographs. Forty-one patients (13.7%) had a newly detected eye disease. In multivariable analysis, patients with a lower MMSE had significantly more newly identified eye diseases.DISCUSSION:The tele-ophthalmological screening method identified unknown ophthalmological diseases requiring specialised management in this older population with cognitive complaints.

Introduction L’hypercalcémie est une manifestation fréquente pouvant révéler de nombreuses étiologies. Parmi celle-ci l’hypercalcémie médiée par le calcitriol, forme active de la vitamine D, peut compliquer certaines maladies systémiques ou hémopathies dans de rares cas. Observation Une femme de 83 ans est hospitalisée en juillet 2018 pour altération de l’état général et syndrome confusionnel. Ses antécédents comportent une cirrhose éthylique sevrée Child Pugh A6 sans hypertension portale, un carcinome mammaire droit traité par tumorectomie et hormonothérapie en 2016, une fibrillation atriale permanente, un AVC ischémique capsulo-lenticulaire gauche sans séquelles, une HTA, une insuffisance veineuse chronique compliquée d’ulcères veineux et une coxarthose évoluée avec limitation importante du périmètre de marche.L’examen clinique objective une hépatomégalie indurée et sensible, sans signes d’hypertension portale ou d’insuffisance hépato-cellulaire. Hormis la confusion, l’examen neurologique est sans particularité. Le poids est de 56kg pour un indice de masse corporelle de 23,3kg/m2, pas de perte de poids récente.Les analyses biologiques mettent en évidence une hypercalcémie corrigée à 3,74mmol/L (N : 2,2–2,6mmol/L) associée à une PTH abaissée à 8,5pg/mL (N : 10–50pg/mL), une phosphorémie normale à 0,86mmol/L (N : 0,81–1,45mmol/L), et une 25-OH vitamine D à 25ng/mL(N : 30–60ng/mL). L’hémogramme est normal en dehors d’une leucopénie liée à une lymphopénie isolée à 1 G/L. Il existe une cholestase anictérique et une cytolyse hépatique modérée (ASAT : 2N ; ALAT : 1,5N). L’alphafoetoprotéine est à 2,9μg/L (N : 0–15μg/L).La scintigraphie osseuse au 99mTc n’apporte pas d’arguments en faveur de lésions osseuses secondaires. L’échographie abdomino-pelvienne montre un foie dysmorphique, siège de multiples nodules hypoéchogènes diffus supra-centimétriques et adénopathies hilaires hépatiques juxta-centimétriques. La TDM thoraco-abdomino-pelvienne confirme l’aspect hétéro-multinodulaire hépatique sans argument pour un carcinome hépatocellulaire. Par ailleurs, présence d’un nodule pulmonaire lobaire inférieur gauche de 23mm, associé à une adénopathie hilaire gauche supra-centimétrique, sans autre anomalie parenchymateuse. Le myélogramme est normal avec une plasmocytose non dystrophique à 4 %.La patiente est traitée par hydratation intra veineuse et par cures itératives de zolédronate IV. Malgré ce traitement la calcémie reste élevée à 2,9mmol/L. La PTHrp est négative. En revanche la 1,25-di OH Vitamine D est augmentée à 173pg/mL (N : 19,9–79,3pg/mL), en faveur d’une hypercalcémie médiée par le calcitriol. L’enzyme de conversion de l’angiotensine est élevée à 82 UI/L (N : 20–70 UI/L). Compte tenu d’une granulomatose très probable, une corticothérapie orale est débutée à 1mg/kg/jour permettant un contrôle de la calcémie autour de 2,6mmol/L. La recherche de BK (tubages) est négative, La ponction-biopsie hépatique met en évidence un lymphome B diffus à grandes cellules, de phénotype GC, sans expression de c-myc.Il n’est pas noté d’aspect granulomateux sur les prélèvements, mais quelques cellules plurinuclées au sein de la prolifération tumorale.Compte tenu des comorbidités, et de la faible autonomie de la patiente (performance status (3), il est convenu d’une prise en charge palliative et d’une corticothérapie à visée symptomatique. La patiente décéde le 20 octobre, 3 mois après le diagnostic. Discussion L’hypercalcémie est une manifestation rare mais classique des hémopathie malignes [1]. Elle peut résulter de différents mécanismes : hypercalcémie médiée par le calcitriol (synthèse ectopique tumorale de 1α hydroxylase), synthèse de PTHrp ou lésions ostéolytiques. Les hémopathies malignes représentent la deuxième cause d’hypercalcémie médiée par le calcitriol, derrière la sarcoïdose [2]. Une tuberculose doit également être évoquée. La fréquence de survenue d’une hypercalcémie au cours des lymphomes non-Hodgkiniens est estimée entre 7 et 34 %, majoritairement médiée par le calcitriol [3]. La présence d’une hypercalcémie témoigne souvent d’une hémopathie agressive, et associée à un plus mauvais pronostic. Néanmoins des hypercalcémies ont été décrites au cours des lymphomes de bas grade. Conclusion Les hémopathies malignes sont la deuxième cause d’hypercalcémie médiée par le calcitriol :– L’hypercalcémie est le plus souvent un témoin d’une hémopathie agressive.– Une corticothérapie doit être mise en œuvre rapidement, suivie du traitement étiologique.

Atrial fibrillation is the most frequent rhythm disorder in elderly patients. Moreover, the risk of stroke and the bleeding risk under anticoagulant treatment are the highest in this population. Vitamin K antagonists were until now the reference treatment of the anticoagulant treatment and they demonstrated a net benefit, including in elderly patients. The availability of the new oral anticoagulants, which do not require biological monitoring, simplified the anticoagulant treatment. However, data for the use of these molecules in elderly population remain limited. The benefit-risk ratio must not be assessed for this therapeutic class taken as a whole but for each molecule and according to the patient profile.

BACKGROUND:The aim of this study was to determine the level of adherence to oral anticoagulants in the population of elderly patients treated for a non-valvular atrial fibrillation (AF) in the era of direct oral anticoagulants.PATIENTS AND METHOD:This transversal study used Morisky scale to assess adherence to oral anticoagulants. We also collected patients' reviews about the treatment and factors explaining a poor adherence.RESULTS:Between January and June 2015, 64 patients were included in Loire Atlantique. Average age was 77.8 years, CHA2DS2-VASc score was 4.06 and treatment (vitamin K antagonists [VKAs] in 78% patients) was prescribed since 4.3 years. According to Morisky scale, 84.4% of patients had a good adherence. There was 88% of good adherence with AVK versus 71% with direct oral anticoagulant, there was no statistically significant difference. The prescriber and the knowledge of anticoagulant treatment role seemed to be determinant factors.CONCLUSIONS:The level of adherence for oral anticoagulant appears higher than in most published studies. Diversification of therapeutic options could constitute an aid to personalize the prescription in order to improve it.

The patient population staying in nursing homes is increasingly vulnerable and dependent and should benefit from a direct access to an acute care geriatric unit. Nevertheless, the easy access by a simple phone call from the general practitioner to the geriatrician, as well as the lack of orientation of these patients by emergency units, might lead to inappropriate admissions. This work studied the appropriateness of direct admissions of 40 patients living in nursing home in an acute care geriatric unit. Based on the AEPf assessment grid, 82.5% of these admissions were considered as appropriate (52.5%) or justified (30% based on an expert panel decision), and 17.5% were inappropriate. In conclusion, the process of direct admission does not seem to increase the rate of inappropriate admissions. Some actions could decrease this rate: implementation of geriatric mobile teams or psychogeriatric mobile teams intervening in nursing home, a better and more adapted use of ambulatory structures, a better information to the general practitioners. In order to reduce the intervention of the panel of experts, an adaptation of the AEPf assessment grid to these geriatric patients has been proposed. The "AEPg" assessment grid should benefit from a validation study.

Treatment with vitamin K antagonists are subject to a common iatrogenic mainly characterized by hemorrhagic stroke. Their narrow therapeutic range associated with variability largely explains this phenomenon. New oral anticoagulants (NOAC) are now available. dabigatran (Pradaxa®) is a direct and specific thrombin inhibitor. It is excreted mainly by the kidney and is the only which can be dialyzed. Rivaroxaban (Xarelto®) and apixaban (Eliquis®) are factor X activated direct inhibitors. They are highly bound to plasma proteins and are metabolized mainly by the liver, via CYP3A4. All NOAC are substrates of P-glycoprotein (P-gp). Due to pharmacological changes, some populations at risk were identified: patients with hepatic impairment, renal impairment, elderly patients or low weight. Some pharmacokinetic or pharmacodynamic drug interactions alter the concentration and the expected impact of NOAC. The NOAC does not require biological monitoring. They interfere with the routine coagulation tests which should be interpreted with caution. Specific tests exist and can be used in case of emergencies. Currently, no antidote is available. The new oral anticoagulant look promising in the elderly. However, certain rules must be followed to reduce the risk of iatrogenic.

UNLABELLED The atrial fibrillation (AF) is one of the most important cause of arythmia and cerebrovascular disease in clinical practice. Comorbidity is defined as the association of active chronical diseases and a target disease. METHOD comparison between burden illness of the patients in interventional (n=4) and observational studies, form Medline database (n=4), was performed. RESULTS the level of comorbidity tend to be higher in patients from interventional than large observational studies. DISCUSSION in interventional studies, the level cerebro-vascular risk was calculated to compare interventional and control groups. So contrary to what was expected the patients of the general population who can receive anticoagulants have a lesser burden of illness. A recent paper studying new anticoagulants in general population finds this difference again, and would indicate that the risk related to the use of new anticoagulants would not be upper to that observed in the princeps pivotal studies.

Introduction la vitesse de propagation de l’onde de pouls (VOP), n’est pas correlee a l’âge au niveau du membre superieur alors qu’elle l’est au niveau de l’aorte et des membres inferieurs. Objectif Etudier la relation entre le vieillissement arteriel et un indice base sur les temps de transit (tt) de l’onde de pouls au doigt (ttd) et a l’orteil (tto). Patients et methodes 300 patients en medecine de travail et en consultation ont ete mesures apres 5 minutes de repos, utilisant un appareil (pOpmetre ® – Axelife SAS – France). Depuis l’onde R de l’ECG, la difference (DOD) entre tto et ttd est calculee. Et en se basant sur des abaques par rapport a la taille, nous avons calcule la VOPdo [VOPdo = k *taille/DOD] en m/s, et l’indice de velocite pOpscore ® (VOP orteil/VOP doigt). Resultats sur 300 patient, on a etudie 147 (93 hommes et 54 femmes âges de (M +/–ETM) 45 ans ± 2 vs 40 ± 2; p = 0,048) qui presentaient 0 ou 1 facteur de risque conventionnel. En analyse univariee, âge (10-4), PAS (10-4), PAD (p ® etait dependant de l’âge uniquement (p 0,07). Conclusion 1 – pOpmetre ® est une mesure prometteuse pour la determination en routine du vieillissement arteriel en soin primaire, 2 – Toutes les variables pOpmetre ® correlaient avec l’âge et la pression arterielle en analyse univariee, 3 – pOpscore ® est lie a l’âge independamment de la pression arterielle en analyse multivariee pas a pas.

Reminder Inflammatory myopathy presenting as head dropHead drop is an abnormal forward flexion of the cervical spine that increases while standing and typically disappears in the supine position.Patients are able to straighten their head with the aid of a support.An 80-year-old woman presented with a 2-month history of mechanical back pain, weight loss and difficulty in standing up straight.Physical examination showed an involuntary neck flexion in orthostatism that resolved in supine position (Figure 1).We found elevated levels of creatine kinase, antinuclear antibodies and a pulmonary fibrosis.Deltoid muscle biopsy showed inflammatory myopathy.Head drop is a clinical syndrome characterised by progressive weakness of the spinal extensor muscles due to fatty infiltration of paravertebral muscles or increased tone of the flexor muscles, associated with various neuromuscular diseases (myasthenia gravis, amyotrophic lateral sclerosis … ) [1].Other causes include notably inflammatory myopathies described by Troyanov [2, 3].Our patient presented autoimmune inflammatory myositis associated with positive auto-antibodies and pulmonary fibrosis, suggesting overlap myositis.

We revue the epidemiology of cardiovascular disease in the elderly, their relationship to arterial stiffness. The measurement of arterial stiffness is of considerable increasing interest in this early 21 century. This paper is focusing on modeling, in different measurement methods. Several measurement techniques are presented. A review of the bibliography that explain the link between cardiovascular risk factors and arterial stiffness is summarized, as are the relationships between the various risk factors and arterial stiffness. The current role of these measurement methods seems to be time consuming although the European consensus recommends the measure once a year in the management of vascular patients. New techniques for the assessment of the arterial stiffness, more reproducible and easy to use, could ultimately trivialize this measurement, contributing in medical practice to the assessment and the management of the vascular risk.

UNLABELLEDFall in elderly subject is a main event by its medical and social consequences, but few studies were dedicated to the prognosis from hospitalization in geriatric acute care unit.AIMDescribe the outcome of elderly subjects hospitalized after a fall in geriatric acute care unit.METHODSLongitudinal study of 6 months follow-up, 100 patients of 75 and more years old hospitalized after a fall in acute care geriatric unit.RESULTSOn a total of 128 patients hospitalized for fall, 100 agreed to participate in the study, 3 died during the hospitalization, so 97 subjects were able to be followed. During 6 months after the hospitalization, 14 patients died (14.9%), 51 (58%) have fallen again (58%) and 11 (22%) of them suffer from severe injuries. Thirty seven (39.7%) were rehospitalized and 10 of them related to fall. Among the patients coming from their home, 25 had been institutionalized. The main risk factor which have been identified to be associated with a new fall during the follow-up was a known dementia at the entry.CONCLUSIONThe medical and social prognosis of an elderly subject hospitalized in an acute care unit is severe. The main comorbidity which influences the medical and social outcome is a known dementia, in addition to a history of previous fall.

Osteoporosis concerns 50% of women over 80 years. Prevalence of energizing and protein malnutrition is high as for institutional elderly people as for community dwelling elderly people. Malnutrition, physical inactivity and many etiological factors lead to tissular losses especially on protein compartment, named sarcopenia. Among the common etiological factors, some cytokines have an effect on proteolysis and bone restructuring, interfering with osteoclast metabolism. Inflammation or stress, mechanisms which product cytokines, are responsible for unfavourable bone restructuring and for a loss of protein mass, deteriorating the muscular functional prognostic. We researched articles on Medline® between 1980 and 2010 about relations between protein compartment, malnutrition and bone density. Several studies in literature suggest that increase in protein intake in daily caloric needs could have a positive effect on bone mineral density and functional performances (in primary prevention as in secondary prevention). So, primary and secondary preventive measures must comprise an increase in protein intake and a sufficient physical activity.

The synthesis of blue-turquoise V–ZrSiO4 pigment from an aqueous solution of Na2O·2.5SiO2·5H2O (soluble glass) and the citrate complexes of zirconium and vanadium was investigated as a function of V2O5 contents, mineralizers (NaF and/or LiNO3) addition and thermal cycle. Blue V–ZrSiO4 was obtained without mineralizers addition for the (ZrO2)(SiO2)(V2O5)0.09 composition; QPA analysis shows that a thermal cycle 3 h long, Tmax = 800 °C, can lead to a 78.0 wt.% of ZrSiO4. The addition of mineralizers gave rise to 73.0 wt.% of ZrSiO4 for the (ZrO2)(SiO2)(NaF)0.16(V2O5)0.09(LiNO3)0.09 composition and a thermal cycle 2 h long, Tmax = 800 °C. LiNO3 can favour both ZrSiO4 formation and a fairly blue colour, up to LiNO3 = 0.09 moles; NaF seems effective on ZrSiO4 formation only when mixed with LiNO3 through the formation of LiF. HT-XRD analysis of this composition agrees with QPA results at the corresponding temperature; ZrSiO4 was present (64.0 wt.%) at 730 °C and good colour parameters were obtained.

Les mesures de prévention, d'isolement et d'hygiène, proposées bien avant la découverte des antibiotiques antituberculeux, restent d'actualité. Les mesures d'isolement en chambre seule peuvent concerner le sujet contaminateur (en pratique les malades BAAR+, dès la suspicion diagnostique) et les sujets très réceptifs (principalement petits enfants et sujets VIH+). Le risque de contamination baisse rapidement dès la mise sous traitement. En absence de notion de résistance, un isolement de 3 jours à 3 semaines semble raisonnable selon le contexte. Une ventilation permettant 6 renouvellements d'air par heure, une chambre fermée et en pression négative sont recommandées. La lumière ultraviolette de 254 nm de longueur d'onde inactive 65 % des BK. Les masques de visite ou de soin en papier ne sont pas adaptés à la protection du BK. Les masques chirurgicaux à 4 attaches assurent une légère protection. Les masques antiprojections, le plus souvent de couleur orange sont capables de filtrer 99 % des particules de 1μ. Les masques particulaires sont recommandés aux USA. Pour les malades traités au domicile, la seule mesure utile est le traitement précoce et la séparation des sujets très réceptifs. En cas de tuberculose multirésistante, les mesures d'isolement seront d'emblée strictes. Ce n'est qu'au terme d'une démarche d'évaluation du risque (risk assessment), et de prise en compte de ce risque (risk managment) que l'on pourra déterminer quelles sont les mesures d'isolement à mettre en oeuvre pour protéger le personnel au niveau souhaité.Isolement, hygiene and preventive measures implemented before antibiotics era for tuberculosis remain effective. Isolation in one person room may concern potential contaminator (AFB+) or potential receiver (children or HIV+) patients as soon as tuberculosis diagnosis was suspected. Contamination risk decrease gradually as soon as the antituberculous treatment was initiated. Except for MDR-TB a 3 days to 3 weeks isolation was recommended. In isolation room, negative pressure and 6 air replacement by hour was recommanded. UV light 254 nm inactive 65 % of bacilli. Visitor and nurse mask were not effective. Surgical mask give law protection. Anti projection mask gave a convenient protection for more 99 % of particle of 1 μ, particular mask was recommended in USA. For patient treated at home, a separation from receptive subject was need. No specific isolation measure were need as soon treatment was initiated. In case of multidrug resistant tuberculosis isolation measures had to be strictly applied. Risk assessment and risk management studies were need before the adoption of precise guidelines for decreasing the risk of TB in Health Care Workers at reasonable level.

In order to determine if the height of a subject could be a reliable surrogate variable to determine the pulse wave travelling distance within the aorta, we investigated the anatomical distance between the aortic valve nidus and the hyoid bone. Using 28 patient’s chest CT-scans. From MPR reconstructed oblique plans we measured 1) the length of the aortic arch from the aortic valve (AV) to the intercept of an horizontal line passing through the aortic valves and crossing the descending aorta at mark HD (see figure), and 2) the distance between the HD mark to the Hyoid Bone (HB). There was a correlation between the AV-HD distance and the HD-HB distance (non parametric r = 0.66, p <0.0001) and the AV-HD distance were positively correlated to the height of the subjects (r = 0.60, p < 0.002). 1- The AV-HD distance projects to a constant anatomical landmark (i.e. the hyoid bone) 2- The size of this arterial segment is significantly correlated to the height of the subjects. These preliminary results could be useful for a more accurate determination of the pulse wave velocity.

Hypothesis PWV don’t correlate with age in the upper limb but in the aorta and lower limb. Aim To study the relationship between ageing and indices based on pulse wave transit time (PWTT) between the toe and the finger. Material and methods measurements were performed in 300 patients in primary care and occupational practice, after 5 minutes of supine rest using a new device (pOpmetre® - Axelife SAS - France) which measures the toe and finger PWTT relative to R-ECG wave. Difference of PWTT between the toe and finger (DTF) was computed and, using a chart based on body height, we calculated the PWVtf [PWVtf = k *subject’s height / DTF] and the pOpscore® (toePWV / fingerPWV) indices. Results Of the tested 300 patients, 147 (93 men and 54 women aged 45yrs ± 2 vs. 40yrs ± 2, p = 0.048 respectively) with 0 or only 1 conventional risk factor and without known POAD or Vasodilator therapy. Sex anova (F; p) Age (years) (r 2 ; p) Weight (Kg) (r 2 ; p) Height (cm) (r 2 ; p) SBP (mmHg) (r 2 ; p) DBP (mmHg) (r 2 ; p) MBP (mmHg) (r 2 ; p) BMI (Kg/m 2 ) (r 2 ; p) DTF (sec) 0.01;ns 0.69;10 −4 0.001;ns 0.02;0.08 0.29;10 −4 0.07;10 −3 0.18; 10 −4 0.04;0.01 PWVtf (m/s) 0.10;ns 0.69;10 −4 0.003;ns 0.01;ns 0.22;10 −4 0.03;0.02 0.12; 10 −4 0.014; ns pOpscore® 0.04;ns 0.60;10 −4 0.008;ns 0.01;ns 0.23;10 −4 0.07;10 −3 0.15; 10 −4 0.02;0.04 Using stepwise regression analysis, (variables to enter: Age, BMI, SBP, DBP, MBP), 1) DTF was dependent with age (p <0.0001) and SBP (p <0.01); 2) PWVtf with age (p <0.0001), SBP (p <0.01) and DBP (p <0.05); 3) pOpscore® was dependent only with age (p <0.0001) not with SBP (p > 0.07). Conclusion: In this study 1- All variables were correlated to age and blood pressure. 2- pOpscore® is related only to ageing independently from blood pressure. 3- pOpmètre® is a promising technique for the routine determination of vascular ageing in primary care medicine.

BACKGROUND AND AIM Institutionalized people represent 9 to 37% of the patients hospitalized in emergency. The aim of this study is to clarify practical conditions of decision and realization of an hospitalization in emergency from an institution. PATIENTS AND METHOD This is a prospective and descriptive longitudinal study of the hospitalizations in emergency of institutionalized elderly during six months, from 11 nursing homes. RESULTS The patients hospitalized in emergency are old (86.7 ± 7.3 years), more than 80% are women, widows and dependent (GIR 3). Main reasons for hospitalization in emergency are falls in a third of cases and cardio-pulmonary failure (27%). The alert is given by nurses and auxiliary nurses in 60% of cases. The decision of hospitalization is medical in more than 80% of cases. The medical opinion is only on phone in 24.4% of cases. After hospitalizations, 85% of patients came back straight to their institution and 10% died during their stay at the hospital. CONCLUSION The terms of hospitalization in emergency of institutionalized patients must be improved. Nursing homes are an integral part of the geriatric network.