Background
Dementia represents a key health issue for older adults, with negative consequences on psycho-social and functional status. Treatments that counteract cognitive deficits in mild cognitive ...impairment (MCI) are needed to prevent or delay it.
Aim
To describe the experimental protocol of the STRENGTH Project. This study investigates a multimodal intervention in older adults with MCI to improve cognitive, functional, biochemical and psycho-social aspects.
Methods
The prospective randomised controlled trial will enrol 300 subjects with MCI (age ≥ 60 years). Participants will be randomly assigned to: (a) the experimental group, which will undergo sessions of adapted tango, music therapy, engagement in social activities, cognitive intervention and psycho-education for 6 months or (b) the control group, which will receive psycho-education and advice on healthy lifestyle for 6 months. All outcomes will be analysed before intervention (baseline), immediately after termination (follow-up 1), after 6 months (follow-up 2) and after 2 years (follow-up 3).
Discussion
We expect that the findings of this multidisciplinary study will be useful to optimize clinical and psycho-social interventions for improving cognitive and functional status of subjects with MCI.
Conclusions
This project could have a meaningful impact on National Health Systems by providing clues on multidisciplinary management of older adults affected by cognitive decline to prevent dementia.
•Hyperpolypharmacy and potentially inappropriate medications (PIMs) are frequent among older patients discharged from hospital.•Hyperpolypharmacy and Beers violations might predict functional decline ...in older patients discharged from hospital.•Hyperpolypharmacy might be associated with functional decline independent of PIMs.
To comparatively investigate the effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients after hospital discharge.
Our series consisted of 733 patients aged ≥65 consecutively enrolled in a multicenter observational longitudinal study. PIMs were defined on the basis of updated versions of Beers and STOPP criteria. The occurrence of functional decline was defined as the loss of independency in at least 1 basic activity of daily living (BADL) from discharge through 3-month follow-up visit.
After adjusting for several potential confounders, hyperpolypharmacy (OR = 2.20; 95%CI = 1.11–4.37) and Beers violations (OR = 1.99; 95%CI = 1.17–3.49) were significantly associated with functional decline, while STOPP (OR = 1.10; 95%CI = 0.64–1.88) and combined Beers + STOPP violations (OR = 1.72; 95%CI = 0.97–3.05) were not. In logistic regression models simultaneously including both hyperpolypharmacy and PIMs, hyperpolypharmacy was always associated with functional decline (OR = 1.98; 95%CI = 1.0–3.97 in the model including Beers violations; OR = 2.19; 95%CI = 1.11–4.35 in the model including STOPP violations; OR = 2.04; 95%CI = 1.02–4.06 in the model including combined Beers and STOPP violations). Beers violations (OR = 1.89; 95%CI = 1.09–3.28) also remained significantly associated with the outcome in this latter analysis, but not STOPP or combined Beers and STOPP violations.
Hyperpolypharmacy, and to a lesser extent Beers violations predict functional decline in older patients discharged from acute care hospitals, whilst STOPP criteria are no longer associated with the outcome after adjusting for potential confounders. Hyperpolypharmacy is associated with functional decline independent of PIMs.
Older hospitalized patients with chronic kidney disease (CKD) are part of the geriatric population with a substantial risk of potentially inappropriate medication (PIM) use. The high rates of ...multimorbidity and polypharmacy, along with the progressive decline of eGFR, contribute to increasing the risk of drug–drug and drug–disease interactions, overdosing, and adverse drug reactions (ADRs). In this multicenter cross-sectional study, we aimed to evaluate the prevalence of CKD under-reporting and PIMs among older patients discharged from acute geriatric and nephrology units throughout Italy. Renal function was determined by estimated glomerular filtration rate (eGFR) through the Berlin Initiative Study (BIS) equation; the prevalence of PIMs was calculated by revising drug prescriptions at discharge according to STOPP criteria, Beers criteria, and summaries of product characteristics (smPCs). A descriptive analysis was performed to compare the clinical and pharmacological characteristics of patients in the two distinct settings; univariate and multivariate logistic regression models were performed to explore factors associated with CKD under-reporting in the discharge report forms and PIM prevalence. Overall, the study population consisted of 2,057 patients, aged 83 (77–89) years, more commonly women, with a median of seven (5–10) drugs prescribed at discharge. CKD under-reporting was present in 50.8% of the study population, with higher rates in geriatric vs. nephrology units (71.1% vs. 10.2%,
p
< 0.001). 18.5% of the study population was discharged with at least one renally inappropriate medication; factors associated with at least one contraindicated drug at discharge were the number of drugs (PR 1.09, 95% CI 1.14–1.19); atrial fibrillation (PR 1.35, 95% CI 1.01–1.81); diabetes (PR 1.61, 95% CI 1.21–2.13); being hospitalized in nephrology units (PR 1.62, 95% CI 1.14–2.31), CKD stage 3b (PR 2.35, 95% CI 1.34–4.13), and stage 4–5 (PR 14.01, 95% CI 7.36–26.72). Conversely, CKD under-reporting was not associated with the outcome. In summary, CKD under-reporting and inappropriate medication use were common in older patients discharged from hospital; the relatively high number of PIMs in both nephrology and geriatric settings underlines the need to improve appropriate prescribing during hospital stay and to decrease the risk of ADRs and side effects in this highly vulnerable population.
Abstract
Background
Fear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older ...community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF.
Methods
Our series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported “not at all” at baseline and “somewhat/fairly/very concerned” at follow-up, or “not at all” at follow-up, and “somewhat/fairly/very concerned” at baseline, and P-FoF was defined as participants answered “somewhat/fairly/very concerned” in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis.
Results
The mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03–4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12–5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31–5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23–10.1) and living alone (OR = 2.44, 95%CI = 1.17–5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16–3.27), BMI (OR = 1.08, 95%CI = 1.02–1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02–1.13) and depression (OR = 2.55, 95%CI = 1.33–4.88) were significant predictors of P-FoF.
Conclusions
T-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls.
Trial registration
The SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016).
Executive abilities are frequently impaired in patients with chronic obstructive pulmonary disease (COPD). We aimed at investigating the association between trail making test (TMT) and survival. Our ...series consisted of 68 stable COPD outpatients followed-up every 6 months for 52.6 ± 27.6 months. Enrolled patients underwent a baseline comprehensive neuropsychological assessment, including mini
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mental state exam, attentional matrices, digit span, Rey auditory verbal learning, Rey–Osterrieth complex figure, copy drawing, tokens test, verbal fluency, category fluency, frontal assessment battery, Raven’s progressive matrices, TMT-A, -B and -B-A. The association between neuropsychological deficits and overall mortality was investigated by Cox regression. During follow-up period, 41 patients (60.3%) died. After adjusting for potential confounders, TMT-B was significantly associated with mortality (HR = 2.42, 95% CI = 1.10–5.31), along with age (HR = 1.06, 95% CI = 1.0–1.13), overall comorbidity (HR = 1.29, 95% CI = 1.02–1.62) and use of noninvasive ventilation (HR = 2.16, 95% CI = 1.05–4.45). Defective TMT-B may be associated with long-term mortality in patients with stable COPD.
Background
This study aimed to investigate personality traits associated with depression in breast cancer women (BCW).
Methods
Sample: 236 BCW recently diagnosed (early stages). Tests: ...SASB-Structural-Analysis of Social-Behavior; IPAT-CDQ-Depression. Statistical analysis: cluster K-Means analysis to explore SASB personality-traits considering the 8 SASB clusters (Cl); CDQ scores dichotomized by 50th percentile cutoff (high/low); Pearson’s chi square test to compare CDQ levels and SASB traits.
Results
Cluster analysis results supported two distinguishable SASB personality traits (for all SASB Cl-Scales P < .001) classified as “Love and Autonomy” (62.2%) and “Control and Hate” (37.8%). Patients with Love/Autonomy traits are spontaneous, accept their deepest feelings and desire to be close to other people (Cl1, Cl2, Cl3, Cl4). They show a medium value of self-control and a low tendency to self-abusive and self-critical behaviors (Cl5, Cl6). They pay attention to themselves and to their needs at emotional and physical levels also if may be occasionally engaged in self-destructive behaviors (Cl7, Cl8). Women with Control/Hate traits are not spontaneous and do not always express emotions (C1, Cl2, Cl3, Cl4) and flexibility in their relationship with others (Cl5, Cl6). In stressful situations, they may ignore the option of choices for self-growth and neglect their needs and those of others (Cl7, Cl8). BCWs with Control/Hate traits scored higher in depression (P <.001) than those with the Love/Autonomy profile.
Conclusions
Healthcare professionals should be aware of these personality traits and their association with depression to identify the psychologically most vulnerable BCW and improve the care they provide them. The psychotherapeutic intervention should be planned to face on the personality problems.
Aim
To assess the predictors of readmission among older adults hospitalized in acute care wards.
Methods
A prospective cohort study was carried out among 921 hospitalized older adults participating ...in the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) project. The primary outcome of the study was rehospitalization within 1 year after discharge from acute care hospitals. We assessed the participants with a questionnaire including 350 items about demographic, social and clinical characteristics. We analyzed all factors at discharge that could be considered predictors of readmission.
Results
The mean age of the participants was 81.2 years (SD 7.4 years), and 509 were women (55.3%). Overall, 280 of 921 patients (30.4%) were rehospitalized during the 1‐year follow up of the study. Patients with a Mini‐Mental State Examination score equal to or higher than 24 had a higher probability of rehospitalization, as compared with those who performed lower than 24 (OR 1.76, 95% CI 1.04–2.83). In addition, heart failure (OR 1.77, 95% CI 1.14–2.24), the number of falls during 1‐year follow up (OR 1.15, 95% CI 1.05–1.28) and the number of drugs during first hospitalization (OR 1.15, 95% CI 1.01–1.07) were significantly associated with rehospitalization, whereas no significant association was shown for age, sex and walking speed for minimum size (OR 1.15, 95% CI 0.99–2.00).
Conclusions
Predictors of readmission in older people are an intact cognitive status; the presence of a geriatric condition, such as heart failure and falls; and a high number of drugs during first hospitalization. Further studies are required to assess the impact of home care for avoiding readmission in patients with an intact cognitive status, and supporting and treating patients with dementia. Geriatr Gerontol Int 2017; 17: 1588–1592.
Background
Chronic kidney disease (CKD) is a common condition in older people and represents a global health issue since it increases the risk of associated comorbidities and all-cause mortality. ...Furthermore, older people with reduced renal function might be at higher risk for developing functional limitation and disability. Moreover, the current creatinine-based measures of renal function are influenced by several factors in older population. The aims of the CKD-3D project are to perform an observational study to expand the knowledge about CKD-disability relationship and to investigate the use of novel biomarkers of kidney function.
Methods
An observational, multicenter, prospective cohort study will be conducted in 75 + old patients consecutively admitted to acute care wards of geriatric medicine at participating hospitals. The study planned to enroll 440 patients undergoing clinical and laboratory evaluations at baseline and after 12 months. Face-to-face follow-up at 6 months and telephone follow-up at 3 and 9 months will be carried out. Comprehensive Geriatric Assessment (CGA) and the measurement of Cystatin C, Beta-Trace Protein and Beta2-Microglobulin levels will be included.
Discussion
This study will provide useful information to prevent CKD-related disability by collecting real-life data over 1-year period. The combined approach of CGA and the investigation of innovative existing biomarkers will make it possible to develop new recommendations and guidelines for a patient-centered approach. It is believed that such a study may lead to an improvement of knowledge on CKD in elderly patients and may also have implications in daily clinical practice and in decision-making process.
Physical exercise and social activities play a role of primary importance in the prevention of diseases and in maintaining functional abilities in old age, nevertheless, maintaining a regular habit ...of exercise is considered a challenge during the aging process. Motivation to start and maintain physical activity is an essential factor. In the case of older people, promoting exercise by means of activities intrinsically pleasurable is preferable to physical activity programs based on health improvements. From this perspective, our study is aimed to understand if preventative interventions combining physical activity, self-efficacy, and social participation in the context of a natural environment might be of help in increasing the level of physical activity. The sample was composed of 95 subjects, of which 40 were excluded because declared to be already engaged in regular physical activity at baseline. Considering the final sample of 55 subjects with low or no physical activity at baseline, 21 subjects (38.2%) improved the intensity of their physical activity at follow-up. They were younger (52.4% with age >=70 vs 82.4; p=0.017), mostly women (85.7% vs 58.8%; p = 0.036), and had a higher balance test score with respect to the others (3.6 ± 0.7 vs 2.8 ± 1.0; p=0.005). Results should be able to strengthen the concept that having a good level of physical conditions, such as good balance, facilitates the path for greater physical improvements and better quality of life among older adults. Balance issues may be cause of fear of falling and psychological difficulties which may have limited the effects of the programme.
ALS is a heterogeneous disease in which different factors such as mitochondrial phenotypes act in combination with a genetic predisposition. This study addresses the question of whether homoplasmic ...(total mitochondrial genome of a sample is affected) and/or heteroplasmic mutations (wildtype and mutant mitochondrial DNA molecules coexist) might play a role in familial ALS. Blood was drawn from familial ALS patients with a possible maternal pattern of inheritance according to their pedigrees, which was compared to blood of ALS patients without maternal association as well as age-matched controls. In two cohorts, we analyzed the mitochondrial genome from whole blood or isolated white blood cells and platelets using a resequencing microarray (Affymetrix MitoChip v2.0) that is able to detect homoplasmic and heteroplasmic mitochondrial DNA mutations and allows the assessment of low-level heteroplasmy.
We identified an increase in homoplasmic ND5 mutations, a subunit of respiratory chain complex I, in whole blood of ALS patients that allowed maternal inheritance. This effect was more pronounced in patients with bulbar onset. Heteroplasmic mutations were significantly increased in different mitochondrial genes in platelets of patients with possible maternal inheritance. No increase of low-level heteroplasmy was found in maternal ALS patients.
Our results indicate a contribution of homoplasmic ND5 mutations to maternally associated ALS with bulbar onset. Therefore, it might be conceivable that specific maternally transmitted rather than randomly acquired mitochondrial DNA mutations might contribute to the disease process. This stands in contrast with observations from Alzheimer's and Parkinson's diseases showing an age-dependent accumulation of unspecific mutations in mitochondrial DNA.
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