Background Vitamin D supplementation has been proposed as a treatment for Coronavirus Disease 201... more Background Vitamin D supplementation has been proposed as a treatment for Coronavirus Disease 2019 (COVID-19) based on experimental data and data from small and uncontrolled observational studies. The COvid19 and VITamin d TRIAL (COVIT-TRIAL) study was conducted to test whether a single oral high dose of cholecalciferol (vitamin D3) administered within 72 hours after the diagnosis of COVID-19 improves, compared to standard-dose cholecalciferol, the 14-day overall survival among at-risk older adults infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Methods and findings This multicenter, randomized, controlled, open-label, superiority trial involved collaboration of 9 medical centers in France. Patients admitted to the hospital units or living in nursing homes adjacent to the investigator centers were eligible if they were ≥65 years, had SARS-CoV-2 infection of less than 3 days, and at least 1 COVID-19 worsening risk factor (among age ≥75 years, SpO2 ≤94%, or...
Coronavirus Disease 2019 (COVID-19) pandemic-triggered mortality is significantly higher in older... more Coronavirus Disease 2019 (COVID-19) pandemic-triggered mortality is significantly higher in older than in younger populations worldwide. Alzheimer’s disease (AD) is related to aging and was recently reported to be among the major risk factors for COVID-19 mortality in older people. The symptomatology of COVID-19 indicates that lethal outcomes of infection rely on neurogenic mechanisms. The present review compiles the available knowledge pointing to the convergence of COVID-19 complications with the mechanisms of autonomic dysfunctions in AD and aging. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is prone to neuroinvasion from the lung along the vagus nerve up to the brainstem autonomic nervous centers involved in the coupling of cardiovascular and respiratory rhythms. The brainstem autonomic network allows SARS-CoV-2 to trigger a neurogenic switch to hypertension and hypoventilation, which may act in synergy with aging- and AD-induced dysautonomias, along with an...
Frailty is a complex geriatric syndrome with multifactorial associated mechanisms that need to be... more Frailty is a complex geriatric syndrome with multifactorial associated mechanisms that need to be examined more deeply to help reverse the adverse health-related outcomes. Specific inflammatory and physical health markers have been associated with the onset of frailty, but the associations between these factors and psycho-social health outcomes seem less studied. This systematic review aimed to identify, in the same study design, the potential associations between frailty and markers of inflammation, and physical or psycho-social health. A literature search was performed from inception until March 2021 using Medline, Psycinfo, and EMBASE. Three raters evaluated the articles and selected 22 studies, using inclusion and exclusion criteria (n = 17,373; 91.6% from community-dwelling samples). Regarding biomarkers, 95% of the included studies showed significant links between inflammation [especially the higher levels of C-reactive protein (CRP) and interleukin-6 (IL-6)], and frailty stat...
The current healthcare systems are built around the traditional paradigm of patients suffering fr... more The current healthcare systems are built around the traditional paradigm of patients suffering from a single acute illness. They are therefore largely unprepared to face the increasing demands for health services arising from the expansion of an older population with specific medical needs related to multiple chronic disorders. As a consequence, the medical conditions of a large and growing segment of the older European population are not efficiently managed by the available healthcare services (1). Among these conditions, the geriatric syndrome of frailty has emerged as a significant public health priority. I
Background: Long-term residential care facilities and nursing homes are known to be particularly ... more Background: Long-term residential care facilities and nursing homes are known to be particularly vulnerable to viral respiratory diseases and have expressed the need for multidisciplinary collaboration to help manage outbreaks when they occur. Method: In April 2020, Tours University Medical Center created a multidisciplinary mobile team to help local nursing homes deal with outbreaks of coronavirus disease 2019 (COVID-19). The team included a geriatrician, infectious disease experts, and palliative care specialists. Results: On April 8th, 2020, the first intervention took place in a 100 residents nursing home with a total of 18 confirmed cases among 26 symptomatic residents and five deaths. The nursing home staffs’ main requests were a multidisciplinary approach, consensus decision-making, and the dissemination of information on disease management. Conclusion: Three lessons emerged from this collaboration: (i) intensify collaborations between hospitals and nursing homes, (ii) limit ...
Background: Long-term residential care facilities and nursing homes are known to be particularly ... more Background: Long-term residential care facilities and nursing homes are known to be particularly vulnerable to viral respiratory diseases and have expressed the need for collaboration to help manage outbreaks when they occur. Method: In April 2020, Tours University Hospital created a mobile multidisciplinary medicine team to help local nursing homes deal with outbreaks of coronavirus disease 2019 (COVID-19). The team included a geriatrician, infectious diseases experts, and palliative care specialists. Results: Here, we provide initial feedback on the mobile support team’s first intervention. The nursing home staff’s main requests were collaborative working, consensus decision-making, and the dissemination of information on disease management.Conclusion: Three lessons emerged from this collaboration: (i) break the nursing home’s isolation, (ii) limit transmission through the use of appropriate hygiene measures, broad screening, and the isolation of sick residents and sick employees,...
In response to demographic challenges, primary care need to get familiar with the concept of frai... more In response to demographic challenges, primary care need to get familiar with the concept of frailty and the early detection of cognitive impairment. The « Frailty and Alzheimer's disease prevention into primary care » (FAP) project introduced a geriatric evaluation with a nurse in primary care in order to assess older patients. Our work aimed to evaluate the general practitioner's (GPs) opinion involved in FAP project. METHODS This is an observational descriptive study performed in Occitanie region. 26 GPs have involved in this project. The gathering of information was performed through an online survey. RESULTS GPs estimated that most of the patients benefiting from a primary care geriatric evaluation would have declined hospital evaluation. 92% of the surveyed GPs gave a strongly positive or positive opinion regarding the detection of previously unidentified health issues and the improvement of patient care following this evaluation. 42% of the GPs found that the personal...
BACKGROUND Since 2004, the definition of the frailty syndrome has shifted from purely physical cr... more BACKGROUND Since 2004, the definition of the frailty syndrome has shifted from purely physical criteria to a more comprehensive consideration of the individual, including their psychosocial criteria. In this study, qualitative research methods were used as a complementary approach in order to enrich the existing quantitative results in this area. OBJECTIVE To understand the views of older persons on the risk of loss of independence. METHODS The study population comprised people over 75 years of age who were living at home in the south-west of France and were considered to be at risk of losing their independence. Data were collected using individual semi-structured in-depth interviews, accompanied by observations. Inductive analysis was carried out according to grounded theory methods. RESULTS Fifteen individual interviews were conducted to achieve theoretical data saturation. Analysis of the content of the interviews revealed seven risk factors for the loss of independence: poor men...
Background With the lack of effective therapy, chemoprevention, and vaccination against SARS-CoV-... more Background With the lack of effective therapy, chemoprevention, and vaccination against SARS-CoV-2, focusing on the immediate repurposing of existing drugs gives hope of curbing the COVID-19 pandemic. A recent unbiased genomics-guided tracing of the SARS-CoV-2 targets in human cells identified vitamin D among the three top-scoring molecules manifesting potential infection mitigation patterns. Growing pre-clinical and epidemiological observational data support this assumption. We hypothesized that vitamin D supplementation may improve the prognosis of COVID-19. The aim of this trial is to compare the effect of a single oral high dose of cholecalciferol versus a single oral standard dose on all-cause 14-day mortality rate in COVID-19 older adults at higher risk of worsening. Methods The COVIT-TRIAL study is an open-label, multicenter, randomized controlled superiority trial. Patients aged ≥ 65 years with COVID-19 (diagnosed within the preceding 3 days with RT-PCR and/or chest CT scan)...
Background Vitamin D supplementation has been proposed as a treatment for Coronavirus Disease 201... more Background Vitamin D supplementation has been proposed as a treatment for Coronavirus Disease 2019 (COVID-19) based on experimental data and data from small and uncontrolled observational studies. The COvid19 and VITamin d TRIAL (COVIT-TRIAL) study was conducted to test whether a single oral high dose of cholecalciferol (vitamin D3) administered within 72 hours after the diagnosis of COVID-19 improves, compared to standard-dose cholecalciferol, the 14-day overall survival among at-risk older adults infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Methods and findings This multicenter, randomized, controlled, open-label, superiority trial involved collaboration of 9 medical centers in France. Patients admitted to the hospital units or living in nursing homes adjacent to the investigator centers were eligible if they were ≥65 years, had SARS-CoV-2 infection of less than 3 days, and at least 1 COVID-19 worsening risk factor (among age ≥75 years, SpO2 ≤94%, or...
Coronavirus Disease 2019 (COVID-19) pandemic-triggered mortality is significantly higher in older... more Coronavirus Disease 2019 (COVID-19) pandemic-triggered mortality is significantly higher in older than in younger populations worldwide. Alzheimer’s disease (AD) is related to aging and was recently reported to be among the major risk factors for COVID-19 mortality in older people. The symptomatology of COVID-19 indicates that lethal outcomes of infection rely on neurogenic mechanisms. The present review compiles the available knowledge pointing to the convergence of COVID-19 complications with the mechanisms of autonomic dysfunctions in AD and aging. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is prone to neuroinvasion from the lung along the vagus nerve up to the brainstem autonomic nervous centers involved in the coupling of cardiovascular and respiratory rhythms. The brainstem autonomic network allows SARS-CoV-2 to trigger a neurogenic switch to hypertension and hypoventilation, which may act in synergy with aging- and AD-induced dysautonomias, along with an...
Frailty is a complex geriatric syndrome with multifactorial associated mechanisms that need to be... more Frailty is a complex geriatric syndrome with multifactorial associated mechanisms that need to be examined more deeply to help reverse the adverse health-related outcomes. Specific inflammatory and physical health markers have been associated with the onset of frailty, but the associations between these factors and psycho-social health outcomes seem less studied. This systematic review aimed to identify, in the same study design, the potential associations between frailty and markers of inflammation, and physical or psycho-social health. A literature search was performed from inception until March 2021 using Medline, Psycinfo, and EMBASE. Three raters evaluated the articles and selected 22 studies, using inclusion and exclusion criteria (n = 17,373; 91.6% from community-dwelling samples). Regarding biomarkers, 95% of the included studies showed significant links between inflammation [especially the higher levels of C-reactive protein (CRP) and interleukin-6 (IL-6)], and frailty stat...
The current healthcare systems are built around the traditional paradigm of patients suffering fr... more The current healthcare systems are built around the traditional paradigm of patients suffering from a single acute illness. They are therefore largely unprepared to face the increasing demands for health services arising from the expansion of an older population with specific medical needs related to multiple chronic disorders. As a consequence, the medical conditions of a large and growing segment of the older European population are not efficiently managed by the available healthcare services (1). Among these conditions, the geriatric syndrome of frailty has emerged as a significant public health priority. I
Background: Long-term residential care facilities and nursing homes are known to be particularly ... more Background: Long-term residential care facilities and nursing homes are known to be particularly vulnerable to viral respiratory diseases and have expressed the need for multidisciplinary collaboration to help manage outbreaks when they occur. Method: In April 2020, Tours University Medical Center created a multidisciplinary mobile team to help local nursing homes deal with outbreaks of coronavirus disease 2019 (COVID-19). The team included a geriatrician, infectious disease experts, and palliative care specialists. Results: On April 8th, 2020, the first intervention took place in a 100 residents nursing home with a total of 18 confirmed cases among 26 symptomatic residents and five deaths. The nursing home staffs’ main requests were a multidisciplinary approach, consensus decision-making, and the dissemination of information on disease management. Conclusion: Three lessons emerged from this collaboration: (i) intensify collaborations between hospitals and nursing homes, (ii) limit ...
Background: Long-term residential care facilities and nursing homes are known to be particularly ... more Background: Long-term residential care facilities and nursing homes are known to be particularly vulnerable to viral respiratory diseases and have expressed the need for collaboration to help manage outbreaks when they occur. Method: In April 2020, Tours University Hospital created a mobile multidisciplinary medicine team to help local nursing homes deal with outbreaks of coronavirus disease 2019 (COVID-19). The team included a geriatrician, infectious diseases experts, and palliative care specialists. Results: Here, we provide initial feedback on the mobile support team’s first intervention. The nursing home staff’s main requests were collaborative working, consensus decision-making, and the dissemination of information on disease management.Conclusion: Three lessons emerged from this collaboration: (i) break the nursing home’s isolation, (ii) limit transmission through the use of appropriate hygiene measures, broad screening, and the isolation of sick residents and sick employees,...
In response to demographic challenges, primary care need to get familiar with the concept of frai... more In response to demographic challenges, primary care need to get familiar with the concept of frailty and the early detection of cognitive impairment. The « Frailty and Alzheimer's disease prevention into primary care » (FAP) project introduced a geriatric evaluation with a nurse in primary care in order to assess older patients. Our work aimed to evaluate the general practitioner's (GPs) opinion involved in FAP project. METHODS This is an observational descriptive study performed in Occitanie region. 26 GPs have involved in this project. The gathering of information was performed through an online survey. RESULTS GPs estimated that most of the patients benefiting from a primary care geriatric evaluation would have declined hospital evaluation. 92% of the surveyed GPs gave a strongly positive or positive opinion regarding the detection of previously unidentified health issues and the improvement of patient care following this evaluation. 42% of the GPs found that the personal...
BACKGROUND Since 2004, the definition of the frailty syndrome has shifted from purely physical cr... more BACKGROUND Since 2004, the definition of the frailty syndrome has shifted from purely physical criteria to a more comprehensive consideration of the individual, including their psychosocial criteria. In this study, qualitative research methods were used as a complementary approach in order to enrich the existing quantitative results in this area. OBJECTIVE To understand the views of older persons on the risk of loss of independence. METHODS The study population comprised people over 75 years of age who were living at home in the south-west of France and were considered to be at risk of losing their independence. Data were collected using individual semi-structured in-depth interviews, accompanied by observations. Inductive analysis was carried out according to grounded theory methods. RESULTS Fifteen individual interviews were conducted to achieve theoretical data saturation. Analysis of the content of the interviews revealed seven risk factors for the loss of independence: poor men...
Background With the lack of effective therapy, chemoprevention, and vaccination against SARS-CoV-... more Background With the lack of effective therapy, chemoprevention, and vaccination against SARS-CoV-2, focusing on the immediate repurposing of existing drugs gives hope of curbing the COVID-19 pandemic. A recent unbiased genomics-guided tracing of the SARS-CoV-2 targets in human cells identified vitamin D among the three top-scoring molecules manifesting potential infection mitigation patterns. Growing pre-clinical and epidemiological observational data support this assumption. We hypothesized that vitamin D supplementation may improve the prognosis of COVID-19. The aim of this trial is to compare the effect of a single oral high dose of cholecalciferol versus a single oral standard dose on all-cause 14-day mortality rate in COVID-19 older adults at higher risk of worsening. Methods The COVIT-TRIAL study is an open-label, multicenter, randomized controlled superiority trial. Patients aged ≥ 65 years with COVID-19 (diagnosed within the preceding 3 days with RT-PCR and/or chest CT scan)...
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Papers by Bertrand Fougère