Withdrawal of nutrition and hydration at the end of life

Thibaud De Blauwe (1), Michèle Pieterbourg (2) Published in the journal : April 2023 Category : Geriatry

Discontinuing nutrition and hydration at the end of life can be a difficult decision for both caregivers and families. It is a process with an enormous symbolic significance value, involving high emotional and affective charge. There is a lack of knowledge among healthcare teams about the pathophysiology of stopping nutrition and hydration, creating a fear of “starving or dehydrating” the patient. The understanding of the pathophysiological mechanisms and symptoms related to prolonged fasting were acquired thanks to the American and British experiences during the Second World War. Therefore, we are able to explain this process to families or teams in pain to try to alleviate their apprehension regarding the situation. The present work attempts to summarize these issues in order to provide caregivers with avenues to anticipate their questions and those of the patients’ families regarding nutrition and hydration withdrawal in the advanced palliative situation.


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Covid-19 related suffering: patients and geriatricians on an equal footing

Dominique Piette, Catherine Magnette Published in the journal : October 2021 Category : Geriatry

This article describes the case of two elderly patients suffering from COVID-19 and admitted to a geriatric ward. It refers to the physical but, above all, psychological suffering that affects both the patients and their geriatricians at their bedside. Based on international literature, we analyze the severity of COVID-19 consequences on mental health. Moreover, we also add recommendations to be implemented so as to limit the impact of this long-term suffering.

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COVID-19: clinical presentation and mortality of the first 50 geriatric patients hospitalized at the Cliniques universitaires Saint-Luc in spring 2020

Cédric Mahiat, Séverine Henrard, Isabelle Gilard, Nicolas Lanthier, Peter Stärkel, Isabelle De Brauwer, Pascale Cornette, Benoit Boland Published in the journal : November 2020 Category : Geriatry

Objectives. Although the majority of COVID-19-related in-hospital deaths were reported in patients over 75 years of age, this population has been scarcely described so far. This study was aimed at describing the clinical presentation and in-hospital mortality rate of these geriatric patients.

Methods. This retrospective cohort studied the first 50 patients that were affected with COVID-19 and admitted to geriatric wards at Cliniques universitaires Saint-Luc.

Results. Before admission, the patients (median age: 88 years) were vulnerable (16%), mildly/moderately frail (32%), and severely/very severely frail (52%) according to the clinical frailty scale, whilst presenting with geriatric syndromes (cognitive impairment in 54%, recurrent falls in 44%, and malnutrition in 40%). In 36% of patients, the initial COVID-19 presentation was atypical, consisting of delirium-related or digestive symptoms. The in-hospital mortality rate was high (52%), while being not associated with the degree of frailty; the patients’ mortality rate was associated upon diagnosis with older age, lower systolic blood pressure, higher serum lactate dehydrogenase levels, and marked lung infiltrates.

Conclusions. Concerning the first geriatric COVID-19-affected patients, the initial symptom was often misleading, and the in-hospital mortality rate was high (52%),whereas the prognosis factors still need to be better defined, particularly as for the impact of clinical frailty.

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A geriatric care unit dedicated to COVID-19 elderly patients

Isabelle Gilard, Isabelle De Brauwer, Pascale Cornette Published in the journal : May 2020 Category : Geriatry

This article describes the transformation of a geriatric care unit into a COVID-19 geriatric care unit. Besides ensuring proper treatment, the multidisciplinary team adapted its care practice and procedures with the objective of preserving the patients’ functional capacities. Each dimension of health is taken into account and the adaptations are described in the light of this challenge. Along with the severity of our patients' medical and functional situations, infectious isolation is the parameter that most influences the adaptations and generates the most complexity.

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2019 innovations in geriatry

François-Xavier Sibille, Catherine Pétein, Perrine Evrard, Ariane Mouzon, Stefanie Thevelin, Marie de Saint-Hubert, Anne Spinewine Published in the journal : February 2020 Category : Geriatry

Deprescription is the process of stopping, reducing, or switching an inappropriate medication to another deemed more appropriate, which is supervised by a healthcare professional (either a physician, pharmacist, or nurse) in order to improve health and reduce costs. It has gradually become a major topic in the (appropriate) prescription domain, especially in the elderly and end-of-life patients.

While its global security and benefits are commonly accepted, routine implementation and optimization still needs to be further investigated in many research paths. We will first review the viewpoints of actors involved in the deprescribing process, namely patients and relatives, as well as health care professionals. Evidences concerning a specific medication class, benzodiazepine receptor agonists, will be reviewed. Finally, the article will outlinehow deprescription can be implemented in nursing home residents and end-of-life patients.

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Geriatrics , the rise of a “young” discipline

Thibaud De Blauwe Published in the journal : January 2020 Category : Geriatry

Long before our time, the Egyptians, Greeks, and medieval scholars were already interested in the pathologies and other illnesses related to old age. In addition to a brief summary of the history of geriatrics, this article offers a reflection on the origin of this young discipline. Geriatrics took off quite rapidly, proposing innovations in the care of frail elderly patients and their relatives, creation of a care program, partnerships, as well as the integration of multidisciplinarity and interdisciplinarity. Many areas are still evolving, such as sarcopenia, frailty, or care of elderly patients within the emergency room, as well as optimization of elderly patient care at the hospital.

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Clinical manifestations of depression in the elderly

François-Xavier Sibille (1), Emilie Verreckt (1), Pierre Philippot (2), Stéphane Agrigoroaei (2), Pierre Gobiet (3), Laurence Mees (1), Marie Masse (1), Didier Schoevaerdts (1) Published in the journal : December 2019 Category : Geriatry

This article provides some insight into the clinical presentation of depression among the elderly, along with some management paths pertaining to this common, morbid, and at times potentially lethal syndrome. Diagnosis may be challenging because of complaints frequently related to ageing, comorbidities, and polypharmacy. Nonetheless, diagnosis should be made as early as possible. As first step, we must emphasize the relevance of spending time with seniors, thereby improving their communication skills. Several methods borrowed from cognitive rehabilitation may be proposed thereafter. This article is a summary of the twentieth annual meeting organized by the geriatric service association of the CHU, UCL Namur, Belgium.

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Geriatric Day Hospital : an ambulatory interface for elderly people

Didier Schoevaerdts (1), Christophe Dumont (2), Pierre Hanotier (3), Alain Fournier (4), Dominique Piette (5), Carole Almpanis (6), Serge Biettlot (1), Françoise Detraux (1), Mélanie Sentrie (1), François-Xavier Sibille (1), Pascale Cornette (7) Published in the journal : September 2019 Category : Geriatry

The Geriatric Day Hospital is an ambulatory structure where a diagnostic and therapeutic approach is offered to old frail adults. This is a good therapeutic option, considered to be an alternative to a conventional hospital stay. This article was aimed to describe Belgian geriatric day hospitals based on existing medical literature. It also reports on the history of these geriatric day hospitals, both in Belgium and worldwide. This article has also presented and commented the results, along with comments, pertaining to a meta-analysis and national surveys published since 2007. Compared to published studies, Belgian Geriatric Day Hospitals are more oriented to diagnosis rather than rehabilitation, which is less developed. Day hospitals represent a good opportunity for a comprehensive geriatric assessment performed by an interdisciplinary team and designed to assess geriatric syndromes reflected by functional decline, frailty, falls, memory complaints, poor nutrition, etc. They are considered to constitute a good link between hospitals, general practitioners, and the healthcare network.

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Model of co-management in geriatric rehabilitation: a 10-year experience

Julie Paul (1), Amaya Lopez-Sierra (1), Sara Palumbo (2), Pascale Cornette (3), Patricia Dessart (2) Published in the journal : July 2019 Category : Geriatry

Many geriatric patients are discharged from acute hospitalization, exhibiting functional decline. This acute functional decline constitutes a reason for the patient to be considered for an admission to the rehabilitation ward. The inpatient rehabilitation process is particularly challenging for these complex patients. This process requires medical skills to be able manage the medical complications in relation with co-morbidities, along with geriatric skills to be able to cope with various geriatric syndromes (polymedication, denutrition, cognitive disorder, and falls). Finally, some know-how in rehabilitation medicine is also required to be able to supervise a specific rehabilitation process (weight bearing and resistance exercises, dysphagia, incontinence rehabilitation, or orthotics and prosthesis).

A co-management model associating a geriatrician and physical medicine specialists is a possible approach to address this complex issue. In this paper, we further describe this co-management model, along with our particular experience at Valida hospital in this field.

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Two clinical cases of chronic intestinal pseudo-obstruction in a geriatric care unit: a rare and complex situation

Henrianne Levie, Itziar Clement Corral, Anne Van de Vyvere, Christophe Dumont Published in the journal : September 2017 Category : Geriatry

The article describes two cases of chronic intestinal pseudo-obstruction (CIPO). This rare intestinal motility disease is associated with high morbidity and mortality. The obstruction is functional, without any radiologically or surgically detectable obstacle, in contrast to volvulus that is a purely mechanical obstruction. Symptoms are recurrent and evolve over several months or years. Based on a literature review, we here present a coherent pluridisciplinary approach used to optimize the diagnosis and treatment necessary to help an elderly multimorbid and often polymedicated population. Since CIPO is an incurable disease, the main therapeutic objectives are the control of symptoms and ionic disorders, enteral nutrition, and maintenance of mobility.

Key Words

Chronic intestinal pseudo-obstruction (CIPO), volvulus, chronic constipation, elderly

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