To investigate the impact of visit-to-visit systolic blood pressure variability (BPV), diastolic BPV, mean arterial pressure variability, and pulse pressure variability on cognitive decline and incident dementia in noninstitutionalized patients aged ≥65 years. A total of 3319 subjects from the S.AGES (Sujets AGÉS—Aged Subjects) cohort underwent clinical examinations every 6 months during 3 years. Variability was evaluated using standard deviation (SD), coefficient of variation, average real variability, successive variation, variation independent of mean, and residual SD. Cognition was assessed using the Mini-Mental State Examination and dementia with the Diagnostic Statistical Manual of Mental Disorders. Linear mixed models and Cox proportional hazards models were used. Higher systolic BPV was associated with poorer cognition independently of baseline SBP: adjusted 1-SD increase of coefficient of variation: β (SE)=−0.12 (0.06), P =0.04. Similar results were observed for diastolic BPV and mean arterial pressure variability: β (SE)=−0.20 (0.06), P <0.001 for both. Higher pulse pressure variability was no longer associated with cognitive function after adjustment for age, except with residual SD ( P =0.02). Among the 3319 subjects, 93 (2.8%) developed dementia. Higher systolic BPV was associated with greater dementia risk (adjusted 1-SD increase of coefficient of variation: hazard ratios=1.23 [95% CI, 1.01–1.50], P =0.04). Similar results were found for diastolic BPV and mean arterial pressure variability ( P <0.01). Pulse pressure variability was not associated with dementia risk. Beyond hypertension, higher BPV is a major clinical predictor of cognitive impairment and dementia. Further studies are needed to assess whether controlling BP instability could be a promising interventional target in preserving cognition among older adults.

Presenting many advantages, solid oral dosage forms (SODFs) are widely manufactured and frequently prescribed in older populations regardless of the specific characteristics of patients. Commonly, patients with dysphagia (swallowing disorders) experience difficulties taking SODFs, which may lead to non-adherence or misuse. SODF characteristics (e.g., size, shape, thickness) are likely to influence swallowability. Herein, we used the acceptability reference framework (the ClinSearch acceptability score test (CAST))—a 3D-map juxtaposing two acceptability profiles—to investigate the impact of tablet size on acceptability. We collected 938 observer reports on the tablet intake by patients ≥65 years in hospitals or care homes. As we might expect, tablets could be classified as accepted in older patients without dysphagia (n = 790), while not in those with swallowing disorders (n = 146). However, reducing the tablet size had a significant impact on acceptability in this subpopulation: tablets <6.5 mm appeared to be accepted by patients with swallowing disorders. Among the 309 distinct tablets assessed in this study, ranging in size from 4.7 to 21.5 mm, 83% are ≥6.5 mm and consequently may be poorly accepted by institutionalized older people and older inpatients suffering from dysphagia. This underlines the need to develop and prescribe medicines with the best adapted characteristics to reach an optimal acceptability in targeted users.

Background: In institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. As medicines acceptability is a key factor for compliance in the older population, this study investigated the acceptability of oral liquid pharmaceutical products in this targeted population.Methods: An observational, multicenter, prospective study was conducted in eight geriatric hospitals and eight nursing homes in France. Observers reported several behaviours/events describing the many aspects of acceptability for various pharmaceutical products’ uses in patients aged 65 and older. Acceptability scores of oral liquid pharmaceutical products were obtained using an acceptability reference framework (CAST - ClinSearch Acceptability Score Test®): a 3D-map summarizing the different users’ behaviors, with two clusters defining the positively and negatively accepted profiles materialized by the green and red zones, respectively.Results: Among 1288 patients included in the core study and supporting the acceptability reference framework, 340 assessments were related to the administration of an oral liquid pharmaceutical product. The mean age of these patients was 87 (Range [66-104y]; SD = 6.7), 68% were women and 16% had swallowing disorders. Globally, the oral liquid pharmaceutical products were classified as “positively accepted,” the barycenter of the 340 assessments, along with the entire confidence ellipses surrounding it, were positioned on the green zone of the map. Sub-populations presenting a different acceptability profile have also been identified. For patients with swallowing disorders, the oral liquid pharmaceutical products were classified as “negatively accepted,” the barycenter of the 53 assessments along with 87% of its confidence ellipses were associated with this profile. A gender difference was observed for unflavored oral liquids. In women, they were classified “negatively accepted,” the barycenter of the 68 assessments with 75% of its confidence ellipses were located in the red zone, while they were classified “positively accepted” in men.Conclusion: This study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders. To ensure an optimal acceptability, prescribers should also consider the presence of a taste-masker in these oral liquids. As highlighted herein, palatability remains crucial in older populations, especially for women.

Introduction: The successful integration of socially assistive robots in geriatric care settings hinges on the attitudes and opinions of healthcare professionals. This study explored their needs, expectations, and perceptions regarding robot use, including facilitating factors and barriers to implementation. Methods: Twenty professionals participated in semi-structured interviews that covered topics such as robot applications, perceived value, acceptance criteria, prerequisites for deployment, ethical considerations, and design attributes. These interviews were analyzed using a deductive qualitative approach guided by the European Network for Health Technology Assessment model (version 3.0). Results: Results indicated that professionals generally viewed robots favorably, noting their usefulness in various non-intimate tasks like meal assistance and toileting. Ease of use was identified as a critical factor for robot adoption in geriatric care. Furthermore, the necessity of educating all stakeholders and providing comprehensive training to professionals emerged as essential for successful implementation. The discussions also included financial and ethical issues related to the introduction of these technologies. Conclusion: These findings will contribute to develop guidelines for designing and deploying socially assistive robots that align with the preferences and requirements of geriatric care professionals.

BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown beneficial effects in heart failure (HF) management, but data on their use in geriatric populations with high comorbidity remain limited. This observational study aimed to assess the real-world efficacy and safety of SGLT2i in elderly patients with HF. METHODS: This prospective multicenter study included 496 patients hospitalized for acute heart failure across 3 geriatric units. The mean age was 90 years, and the mean Charlson Comorbidity Index score was 8.2. Participants were divided into 2 groups: the SGLT2i group (n=260) receiving SGLT2i (empagliflozin or dapagliflozin) alongside standard HF treatment, and the Control group (n=236) receiving only standard HF treatment. The primary outcomes were all-cause mortality, HF rehospitalizations, and adverse events over 1 year. RESULTS: SGLT2i use was associated with lower risks of all-cause mortality (hazard ratio, 0.67 [95% CI, 0.46–0.98]; P =0.031), HF rehospitalization (hazard ratio, 0.64 [95% CI, 0.42–0.97]; P =0.037), and the composite outcome (hazard ratio, 0.60 [95% CI, 0.44–0.82]; P =0.001) at 1 year, after multivariable adjustment. No significant interaction was observed between left ventricular ejection fraction status and SGLT2i use ( P for interaction=0.12). Although urinary and genital infections were more frequently reported in the SGLT2i group, treatment discontinuation remained low (2.7%). CONCLUSIONS: In this elderly population with high comorbidity, SGLT2i therapy was associated with substantial reductions in mortality and HF rehospitalization, and showed good tolerability and an acceptable safety profile.

Although the use of direct oral anticoagulants increases in parallel with the increase in atrial fibrillation (AF) with age, none of the bleeding risk scores (HAS-BLED, HEMORR2HAGES, ATRIA nor RE-LY) have been developed in a geriatric population. Our study aimed to develop a bleeding risk score adapted to this specific population and this therapeutic class. Multicentre, longitudinal, prospective, observational, pharmacoepidemiologic study conducted in 60 French cardiologic and geriatric centres included consecutive patients aged ≥80 years with AF, treated with rivaroxaban and followed for at least 1 year. All thromboembolic, bleeding and clinical events, including falls, hospitalisations or deaths, were recorded every 3 months for 1 year. A predictive risk score based on the clinical variables most associated with bleeding events was developed from the total sample, randomly divided into a training sample and a validation sample. Among the 839 patients included (mean age = 86 year old, 62% women), there were 78 (9.3%) major haemorrhagic events. Variables associated with bleeding were age, anaemia, low albuminemia, amiodarone use and low creatinine clearance estimated with Cockcroft formula, grouped together as the A4C score. The A4C score better identifies bleeding risk in subjects ≥80 years than the scores already validated in younger populations, as its area under the curve in the training sample and in the validation sample was 0.73 and 0.66, respectively, whereas it was 0.49/0.55 for the HAS-BLED score, 0.53/0.50 for the HEMORR2HAGES score, 0.58/0.61 for the ATRIA score and 0.57/0.54 for the RE-LY score. A threshold of the A4C score ≥ 2 identifies subjects ≥80 years at high risk of bleeding.