Since 2017, geriatric medicine has been available as a postgraduate specialty to French year 7 medical students. We investigated the incentives of the 171 French medical students who opted for geriatric medicine as a postgraduate specialty subsequent to year 6 national qualifying examinations in 2017. A prospective quantitative survey-based study was conducted by means of a questionnaire compiled online and sent by email between December 2017 and May 2018. The questionnaire comprised 43 questions, including 14 single or multiple choice questions, 28 scaled questions evaluating factors of influence using a 5-point Likert scale, and one open-ended contingency question. Of the 171 students, 139 responses were received. The national response rate to this questionnaire was 81.2%. One hundred fourteen students (82.6%) had previous experience of training in geriatric medicine, which for 95 (84.0%) students took place between years 3 and 6 of medical training. This training influenced the choice of 102 respondents (90.2%). Factors reported as having exerted a strong or very strong influence were in particular the rewards of working with older adults; positive personal encounters with older adults in the past; the appeal of interprofessional teamwork; the challenge of cases involving complex diagnostic and therapeutic decisions; the challenge of patients with chronic conditions. The present study is the first to focus on the reasons why French students choose to specialise in geriatric medicine. The results emphasise the importance of training programs in geriatric medicine to promote enthusiasm for this specialty.

BackgroundBlood transfusion in chronic anemia is not covered by guidelines specific to older adults. When they consider that this treatment is necessary in elderly patients, French general practitioners (GPs) contact a hospital specialist to plan a transfusion.MethodsTwenty French GPs were questioned individually regarding their approach to blood transfusion using semi-structured interviews. Each interview was recorded, typed up verbatim and then coded using an inductive procedure by theme, in a cross-over design (two researchers) in two phases: analysis and summary, followed by grouping of the recorded comments.ResultsThe criteria for transfusion were hemoglobin level < 8 g/dL and cardiac comorbidities. Some geriatric issues, such as cognitive disorder or dependence, were considered, either as aspects of frailty favoring transfusion or as markers of reduced life expectancy that limit care. Falls and fear of an unpleasant death from anemia prompted GPs to order blood transfusion. The patient’s family provided guidance, but the patient was not routinely consulted. The specialists were rarely asked to participate in decision making. GPs’ perceptions were ambivalent: they considered transfusion to be extraordinary and magical, but also pointless since its effects are transient.ConclusionThe decision to give a transfusion to an elderly patient with chronic anemia is deemed complex, but GPs seem to take it alone, sometimes guided by the patient’s family. The drawing up of an advance care plan could help involve the patient in decision making.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0647-8) contains supplementary material, which is available to authorized users.

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There is a consensus that the use of comprehensive geriatric assessment (CGA) is good clinical practice for older patients with solid tumors or hematological malignancies. To be complete, a CGA must include a geriatric assessment and an intervention plan. According to the SIOG consensus, a CGA should assess several domains: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and the presence of geriatric syndromes. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients in each domain mentioned in the SIOG consensus. An online search of the PubMed database was performed using predefined search algorithms specific for each domain of the CGA. Eligible articles had to have well-defined interventions targeting specific domains of the CGA. We screened 1864 articles, but only a few trials on single-domain interventions were found, and often, these studies involved small groups of patients. This review highlights the scarcity of published studies on this topic. The specific impacts of CGA-based interventions have not yet been demonstrated. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain. New studies are necessary in multiple care contexts, and innovative designs must be used to balance internal and external validity. An accurate description of the intervention and what “usual care” means will improve the external validity of such studies.

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Background: Nursing home (NH) residents accounted for half of the deaths during the 2020 spring wave of the COVID-19 epidemic in France. Our objective was to identify structural and managerial factors associated with COVID-19 outbreaks in NHs. Methods: We conducted in July 2020 a retrospective study by questionnaire addressed to NH directors in the Brittany region of France. The questions related to structural characteristics of the establishment, human resources, and crisis management decisions. The primary endpoint was the occurrence of at least one confirmed case of COVID-19 among residents between 1 March 1 and 31 May 2020. The secondary endpoint was total mortality during this period. We used multivariate regressions to identify factors associated with these outcomes. Results: Responses were collected from 231 NHs hosting 20,881 residents, representing a participation rate of 47%. In 24 (10%) NHs, at least one resident presented confirmed COVID-19. NHs often implemented stringent protective measures, with 65% of them choosing to confine residents to their rooms. In multivariate analysis, factors associated with a reduced risk of case occurrence were in-room meal service, early ban of family visits, and daily access to an outdoor space. No association was found between mortality and the factors studied. Our results show an early and strict implementation of lockdown measures, with good epidemiological results in a context of shortage of personal protective equipment and non-vaccination. Nevertheless, it raises ethical questions concerning respect of residents’ wellbeing and rights. Conclusion: Cessation of communal dining seems to be the main measure likely to be effective in preventive terms. It does not seem that room lockdown and cessation of group activities should be recommended, particularly if mask wearing is possible.

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