Background: In France, emergency departments (EDs) are the fastest and most common means for general practitioners (GPs) to cope with the complex issues presented by elderly patients with multiple conditions. EDs are overburdened, and studies show that being treated in EDs can have a damaging effect on the health of elderly patients. Outpatient care or planned hospitalizations are possible solutions if appropriate geriatric medical advice is provided. In 2013, France’s regional health authorities proposed creating direct telephone helplines, “geriatric hotlines,” staffed by geriatric specialists to encourage interactions between GP clinics and hospitals. These hotlines are designed to improve health care pathways and the health status of the elderly. Objective: This study aims to describe the health care pathways and health status of patients aged 75 years and older hospitalized in short-stay geriatric wards following referral from a geriatric hotline. Methods: The study will be conducted over 24 months in seven French university hospital centers. It will include all patients aged 75 and older, living in their own homes or nursing homes, who are admitted to short-stay geriatric wards following hotline consultation. Two questionnaires will be filled out by medical staff at specific time points: (1) after conducting the telephone consultation and (2) on admitting the patient to a short-stay geriatric medical care. The primary endpoint will be mean hospitalization duration. The secondary endpoints will be intrahospital mortality rate, the characteristics of patients admitted via the hotline, and the types of questions asked and responses given via the hotline. Results: The study was funded by the National School for Social Security Loire department (École Nationale Supérieure de Sécurité Sociale) and the Conference for funders of prevention of autonomy loss for the elderly of the Loire department in November 2017. Institutional review board approval was obtained in April 2018. Data collection started in May 2018; the planned end date for data collection is May 2020. Data analysis will take place in the summer of 2020, and the first results are expected to be published in late 2020. Conclusions: The results will reveal whether geriatric hotlines provide the most effective management of elderly patients, as indicated by shorter mean hospitalization durations. Shorter hospital durations could lead to a reduced risk of complications—geriatric syndromes—and the domino chain of geriatric conditions that follow. We will also describe different geriatric hotlines from different cities and compare how they function to improve the health care of the elderly and pave the way toward new advances, especially in the organization of the care path. Trial Registration: ClinicalTrials.gov NCT03959475; https://clinicaltrials.gov/ct2/show/NCT03959475 International Registered Report Identifier (IRRID): DERR1-10.2196/15423

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: In France, emergency departments (EDs) are the fastest and most common means for general practitioners (GPs) to cope with the complex issues presented by elderly patients with multiple conditions. EDs are overburdened, and studies show that being treated in EDs can have a damaging effect on the health of elderly patients. Outpatient care or planned hospitalizations are possible solutions if appropriate geriatric medical advice is provided. In 2013, France’s regional health authorities proposed creating direct telephone helplines, “geriatric hotlines,” staffed by geriatric specialists to encourage interactions between GP clinics and hospitals. These hotlines are designed to improve health care pathways and the health status of the elderly. Objective: This study aims to describe the health care pathways and health status of patients aged 75 years and older hospitalized in short-stay geriatric wards following referral from a geriatric hotline. Methods: The study will be conducted over 24 months in seven French university hospital centers. It will include all patients aged 75 and older, living in their own homes or nursing homes, who are admitted to short-stay geriatric wards following hotline consultation. Two questionnaires will be filled out by medical staff at specific time points: (1) after conducting the telephone consultation and (2) on admitting the patient to a short-stay geriatric medical care. The primary endpoint will be mean hospitalization duration. The secondary endpoints will be intrahospital mortality rate, the characteristics of patients admitted via the hotline, and the types of questions asked and responses given via the hotline. Results: The study was funded by the National School for Social Security Loire department (École Nationale Supérieure de Sécurité Sociale) and the Conference for funders of prevention of autonomy loss for the elderly of the Loire department in November 2017. Institutional review board approval was obtained in April 2018. Data collection started in May 2018; the planned end date for data collection is May 2020. Data analysis will take place in the summer of 2020, and the first results are expected to be published in late 2020. Conclusions: The results will reveal whether geriatric hotlines provide the most effective management of elderly patients, as indicated by shorter mean hospitalization durations. Shorter hospital durations could lead to a reduced risk of complications—geriatric syndromes—and the domino chain of geriatric conditions that follow. We will also describe different geriatric hotlines from different cities and compare how they function to improve the health care of the elderly and pave the way toward new advances, especially in the organization of the care path. Trial Registration: ClinicalTrials.gov NCT03959475; https://clinicaltrials.gov/ct2/show/NCT03959475

While being the main potential beneficiaries of therapeutic fasting’s health benefits, the elderly are frequently thought of as being too fragile to fast. The main objective of our survey was to review the knowledge, practices, and acceptability of therapeutic fasting in subjects aged 65 years and over. From September 2020 to March 2021, an online questionnaire was sent to subjects aged 65 and over, using the mailing list of local organizations working in the field of aging. The mean age of the 290 respondents was 73.8 ± 6.5 years, 75.2% were women and 54.1% had higher education. Among the respondents, 51.7% had already fasted and 80.7% deemed therapeutic fasting interesting, 83.1% would be willing to fast if it was proven beneficial for their health, and 77.2% if it was proven to decrease the burden of chronic diseases. Subjects aged 65 to 74 years considered themselves as having the greatest physical and motivational abilities to perform therapeutic fasting. People aged 65 years, or more, are interested in therapeutic fasting and a large majority would be ready to fast if such practice was proven beneficial. These results pave the way for future clinical trials evaluating therapeutic fasting in elderly subjects.

BACKGROUND In France, for general practitioners (GP), the Emergency Department (EDs) is the quickest and most common way to respond to the complexity of caring for elderly patients with multiple conditions. The study shows that the pathway through the EDs would sometimes have deleterious effects on the health of older adults. In 2013, France’s regional health authorities offered to implement telephone hotlines in order to promote GP clinic-hospital interactions. OBJECTIVE The main objective of the study was to analyse if telephone hotlines enable fewer hospital admissions and, especially EDs passage, through the solutions provided by the responding physicians. METHODS It is an observational, multicentre, and descriptive study conducted from April 2018 to April 2020 at seven French investigation sites. The telephone hotline physicians filled two questionnaires: the first one while receiving a call, and the second one when a patient arrived in the geriatric short-stay department after having been referred via the hotline. In this study, our interest will be on the first questionnaire RESULTS The study population concerned by the phone call questionnaire gathered 4 137 individuals who fulfilled the inclusion and exclusion criteria. Among the 4 137 phone calls received, 64.2% (n=2 657) were for advice and 35.8% (n=1 480) for emergency hospitalization. Among the 1 480 phone calls for emergency hospitalization, 285 calls ended up in hospital admission in the emergency room (19.3%), and 658 calls in the geriatric short stay (44.5%). Among the 2 657 calls for advice/consultation/delayed hospitalization, 9.7% were also answered by emergency hospital admission. CONCLUSIONS This study shows the value of hotlines in guiding the care of older adults. The results show the effectiveness of hotlines in avoiding unnecessary hospital admissions or in identifying cases requiring hospital admission in the emergency room. Hotlines can help improve the care pathway for older adults and pave the way for future progress, such as new patient care modalities, the development of more appropriate responses for this population, and the drop of inappropriate emergency room visits. CLINICALTRIAL Registered under Clinical Trial Number NCT03959475. This study was approved and peer-reviewed by the committee for the protection of persons of Sud Est V of Grenoble University Hospital Center (registered under 18-CETA-01 No.ID RCB 2018-A00609-46). INTERNATIONAL REGISTERED REPORT RR2-10.2196/15423

Frailty is a partially reversible geriatric syndrome. Its prevention requires a structured screening, and is a major public health issue given the increasing life expectancy of the population. The observance of the recommendations made after a screening of the frailty patients is not well known. The objective of our research was to describe the characteristics of patients evaluated in a frailty-day-hospital and followed up recommendation adherence at 3 and 6 months. Methods: patients aged over 65 years old with an ADL score of at least 5 out of 6, were evaluated according to the Fried score to classify patients into pre-frailty or frailty patients. According to the standardized geriatric assessment, recommendations were prescribed for each medico-social situation according to HAS recommendations. A follow-up assessment of these measures was carried out at home basis at 3 and 6 months. Results: 82 patients were included, with mean age of 83.7 +/- 5.7 years. 99% were pre-frail or frail and received an average of 3.7 +/- 1.7 recommendations. At 3 months, there is an inverse correlation between number and follow-up compliance (r=-0.340, p=0.008), as well as at 6 months (r=-0.352, p=0.006). Between 3 and 6 months, there is a significant increase recommendation number followed (r=0.707, p=0.000). Conclusion: at 6 months, 74.3% recommendations were realized, with a significant increase of recommendation number between the 3rd and 6th month. This result is encouraging by showing the benefit of home support in recommendations follow-up.