Purpose
The aim of our study was to assess respiratory function at the time of clinical recovery and 6 weeks after discharge in patients surviving to COVID-19 pneumonia.
Methods
Our case series ...consisted of 13 patients with COVID-19 pneumonia.
Results
At the time of clinical recovery, FEV1 (2.07 ± 0.72 L) and FVC (2.25 ± 0.86 L) were lower compared to lower limit of normality (LLN) values (2.56 ± 0.53 L,
p
= 0.004, and 3.31 ± 0.65 L,
p
< 0.001, respectively), while FEV1/FVC (0.94 ± 0.07) was higher compared to upper limit of normality (ULN) values (0.89 ± 0.01,
p
= 0.029). After 6 weeks pulmonary function improved but FVC was still lower than ULN (2.87 ± 0.81,
p
= 0.014).
Conclusion
These findings suggest that COVID-19 pneumonia may result in clinically relevant alterations in pulmonary function tests, with a mainly restrictive pattern.
Research suggests that survivors of interpersonal violence have an increasing experience of bodily symptoms. This study aims to scrutinise the association between lifetime abuse and somatic symptoms ...among older women and men, considering demographics/socio-economic, social support and health variables.
A sample of 4,467 community-dwelling persons aged 60-84 years (57.3% women) living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden) was recruited for this cross-sectional study. Lifetime abuse (psychological, physical, sexual, financial and injury) was assessed on the basis of the UK study of elder abuse and the Conflict Tactics Scale-2, while somatic symptoms were assessed by the Giessen Complaint List short version.
Women reported somatic symptoms more frequently than men. Multiple regression analyses revealed that lifetime exposure to psychological abuse was associated with higher levels of somatic symptoms among both women and men, while experiencing lifetime sexual abuse was associated with somatic symptoms only among older women, after adjusting for other demographic and socio-economic variables. Country of residence, older age, and low socio-economic status were other independent factors contributing to a higher level of somatic symptoms.
The positive association between the experience of abuse during lifetime and the reporting of higher levels of somatic symptoms, in particular among older women, seems to suggest that such complaints in later life might also be related to the experience of mistreatment and not only to ageing and related diseases. Violence prevention throughout lifetime could help to prevent somatic symptoms in later life.
Background
The presence of incontinence symptoms might affect the quality of life (QoL) of those providing informal care to people suffering from them, causing social isolation, financial problems, ...psychological and physical exhaustion.
Aims
This study aimed at assessing whether urinary and/or fecal incontinence in people aged 60 and over affects the level of burden in their informal caregivers.
Methods
QoL was assessed amongst 304 informal caregivers of older people suffering from urinary and/or fecal incontinence, and compared to that reported by 305 caregivers of non-incontinent older relatives, all living in Italy. All participants were administered a questionnaire focused on: characteristics and conditions of the cared for; details of the care activity; emotions experienced by caregivers; attitudes of caregivers; reasons for providing care; availability of information and support; demographics.
Results
Findings show that, when no incontinence was reported, the longer was the caregiving situation, the better was the caregivers’ QoL, which was instead negatively affected by the lack of a support network. As for caregivers’ feelings, neither positive nor negative emotions influenced their QoL in a significant way. In terms of caregiver’s role, those who felt overwhelmed or loaded with responsibility reported a lower QoL, while the opposite was found among those who felt rewarded and supported, even when incontinence—of any kind—was present.
Conclusions
The management of incontinence does have a negative impact on caregivers’ QoL, but subjective factors might play a mitigating role on such an impact.
Objectives
To assess if the lockdown period (March–April 2020) during the coronavirus disease‐19 outbreak in Italy influenced the number, presentation, and treatment of urgent admissions to the ...emergency department for ureteral lithiasis, and to evaluate the same variables during the reopening phase (May–June 2020).
Methods
We performed a retrospective analysis of patients admitted to the emergency department of three different hospitals (two coronavirus disease‐19 hubs). Demographics and data on acute pyelonephritis, acute kidney injury, urinoma, hematuria, inpatient admission/discharge home, and type of treatment were gathered and compared with the same periods in 2019.
Results
A total of 516 patients were admitted during the study period, of whom 62.4% were male. Their mean age was 58.86 ± 16.24 years. The number of admissions decreased significantly, by 51.25% (P = 0.003), during lockdown compared to 2019 (78 vs 160 admissions). The number of admissions in the reopening phase (May–June 2020) was in line with that in 2019 (n = 138). The number of hospitalizations (P = 0.005), acute obstructive pyelonephritis (P = 0.019), and complications (P = 0.02) was statistically significantly higher during lockdown compared to 2019. The increase in the rate of surgical procedures nearly reached significance (P = 0.059). The odds of having complications and being hospitalized were almost fivefold (odds ratio 4.68, 95% confidence interval 1.98–11.07) and twofold greater (odds ratio 2.39, 95% confidence interval 1.29–4.43) compared to the same period in 2019. No difference was noted between May–June 2020 and 2019.
Conclusion
The coronavirus disease‐19 lockdown period provoked a meaningful reduction in symptomatic ureteral lithiasis admission. Most patients presented with complicated disease, which required an increased rate of interventional procedures compared to the equivalent period in 2019. Admissions reverted to normal levels during the reopening phase.
Elder abuse is a growing public health question among policy makers and practitioners in many countries. Research findings usually indicate women as victims, whereas male elder abuse still remains ...under-detected and under-reported. We aimed to investigate the prevalence, severity and chronicity of abuse (psychological, physical, physical injury, sexual, and financial) against older men, and to scrutinize factors (e.g. demographics) associated with high chronicity of any abuse.
Randomly selected older men (n = 1908) aged 60-84 years from seven European cities (Ancona, Athens, Granada, Kaunas, Stuttgart, Porto, Stockholm) were interviewed in 2009 via a cross-sectional study concerning abuse exposure during the past 12 months.
Findings suggested that prevalence of abuse towards older men varied between 0.3% (sexual) and 20.3% (psychological), with severe acts between 0.2% (sexual) and 8.2% (psychological). On the whole, higher chronicity values were for injury, followed by psychological, financial, physical, and sexual abuse. Being from Sweden, experiencing anxiety and having a spouse/cohabitant/woman as perpetrator were associated with a greater "risk" for high chronicity of any abuse. For men, severity and chronicity of abuse were in some cases relatively high.
Abuse towards older men, in the light of severe and repeated acts occurring, should be a source of concern for family, caring staff, social work practice and policy makers, in order to develop together adequate prevention and treatment strategies.
This paper elucidates the relationship between possible changes in volunteering experienced by older people during the COVID-19 pandemic, and their motivation to volunteer, as well as the direct or ...indirect experience of COVID-19 symptoms. Given the well-known positive benefits of volunteering in older age both for individuals (in terms of improved health and wellbeing) and society at large, there is a paucity of studies on older volunteers in the time of COVID-19. In this context, older people's volunteering was highly challenged due to age-based physical and social restrictions put in place by national governments, which have been considered as ageist by a large part of the gerontological scientific community. This study was carried out on a sample of 240 Italian older volunteers. The results suggest that during the COVID-19 pandemic, especially older volunteers driven by social goals (e.g., opportunities to have relationships with others) were able to continue volunteer activities without needing to change them. The study also clarified that having directly or indirectly experienced COVID-19 symptoms did not influence changes in voluntary activities of older people. These results have important policy implications, given the indication that through volunteering, older individuals may try to counter the undesired calls by the governments for self-isolation and physical distancing. It is important that in emergency situations involving older people, policy makers should not treat them as only recipients of health and social care, but also as useful providers of help in the community.
We aimed to evaluate oncological and functional outcomes of index lesion HIFU ablation with Focal-One
.
We prospectively assessed treatment-naïve men with localized prostate cancer between 2017 and ...2019. Inclusion criteria were stage cT ≤ 2, ≥5 years of life expectancy, grade group ≤3. Multiparametric magnetic resonance was performed before ablation. Patients with a prostate volume of ≥80 ml underwent debulking. Treatment failure was defined as a histologically confirmed tumor that required salvage treatment or androgen deprivation therapy.
One hundred and eighty nine patients were enrolled. Data are presented as median and Interquartile Range (IQR). Median age was 70(11) years. Median baseline PSA was 5.8(3) ng/ml. Fourteen (7.4%) patients had prostate debulking before ablation. 104 (55%) patients underwent targeted ablation, 45 (23.8%) extended targeted ablation, 31 (16.4%) hemiablation, and 9 (4.8%) extended hemiablation. Median targeted ablated volume was 14(9) ml. Ninety-three complications occurred in 63/189 (33.3%) patients within 90 days. There were 77/93 (82.8%) minor (Clavien grade 1-2) and 16/93 (17.2%) major complications (Clavien grade 3a). Thirty-nine patients suffered from genito-urinary infections (Clavien grade 2). Fifteen patients required transurethral resection of the prostate/urethrotomy for recurrent urinary retention (Clavien grade 3a). One patient developed a recto-urethral fistula (Clavien grade 3a) and two long-lasting urinary incontinence. Median PSA nadir was 2.2(2.9) ng/ml. At a median follow-up of 29(15) months, 21/177 (11.9%) patients were treatment failures, 26 on monitoring, and 26 had a further ablation. Multivariable logistic regression found that failure patients had higher PSA (7.8 vs 5.7 ng/ml,p0.001) and double PSA nadir (4.8 vs 2.0 ng/ml, p < 0.001). Higher PSA nadir correlated with a 74% higher probability of failure (OR 1.74 95% CI 1.40-2.16). Cancer in the anterior stroma increased the odds of failure of three folds (OR 3.36 95% CI 1.18-9.53). Two mixed effect models (one for IPSS and one for IEEF-15) were estimated and they showed that time reaches the statistical significance coefficient only for the IEEF-15, meaning that subsequent evaluations of the indicators were significantly lower at each time point.
Index lesion HIFU ablation demonstrated satisfactory early oncological outcome but anteriorly located tumors had inadequate ablation. Urinary function was well preserved. Sexual function slightly decreased during follow-up.
Background
Polypharmacy and potentially inappropriate medications (PIMs) are known to affect several negative outcomes in older patients. However, studies comparatively assessing polypharmacy and ...PIMs in relation to readmission are distinctively lacking.
Aims
To compare the impact of polypharmacy and PIMs on 3-month readmission among older patients discharged from acute care hospital.
Methods
Our series consisted of 647 patients consecutively enrolled in a multicenter observational study. The outcome of the study was the occurrence of any admission during the 3-month follow-up after discharge. Polypharmacy was defined as use of more than eight medications. PIMs were identified using 2015 version of Beers and Screening Tool of Older Persons Prescriptions (STOPP) criteria. Statistical analysis was performed using logistic regression models.
Results
After adjusting for potential confounders, polypharmacy (OR 2.72, 95% CI 1.48–4.99) was found associated with the outcome, while Beers (OR 0.85, 95% CI 0.46–1.56), STOPP (OR 1.60, 95% CI 0.85–3.01), or combined Beers and STOPP violations (OR 0.99, 95% CI 0.57–1.74) were not. The association between polypharmacy and 3-month readmission was confirmed in logistic regression models including Beers (OR 2.88, 95% CI 1.55–5.34), STOPP (OR 2.64, 95% CI 1.43–4.87), or combined Beers and STOPP violations (OR 2.80, 95% CI 1.51–5.21).
Discussion
Besides confirming that polypharmacy should be considered as a marker for readmission risk among older patients discharged from acute care hospital, our findings suggest that the association between polypharmacy and 3-month readmission is substantially independent of use of PIMs.
Conclusions
Polypharmacy, but not PIMs was significantly associated with readmission. Hospitalization should always be considered as a clue to individuate unnecessary polypharmacy and to reduce the burden of medications whenever possible.
Although the active ageing concept generally has positive connotations, with expected benefits at the micro, meso and macro levels, the application of this concept in terms of policy making presents ...challenges and risks to be avoided (for instance, a predominantly productivist interpretation and a top-down imposition with limited possibilities for bottom-up exchanges; or a disregard for the risk of excluding older people with more disadvantaged backgrounds). Two crucial strategies to minimise risks are the implementation of policies by considering and respecting territorial diversity, and the involvement of all the relevant stakeholders in a participatory consultative and co-decisional approach. This paper entwines both strategies together by focusing on Italian in-country differences in terms of active ageing, and employing the Active Ageing Index for policy-making purposes. This activity is part of a governmental national pilot project aimed at promoting multilevel co-managed co-ordination of active ageing policies across Italy. The analysis identified five groups of regions that differ from the classical, geographic and socio-economic division between the North, Centre and South. Additional in-group analyses were conducted to investigate within-cluster differences. This study will inform a large multilevel stakeholder network for evidence-based policies and their monitoring at both the national and regional levels, in line with the perspective of mainstreaming ageing.
Within the active ageing framework, this study was carried out during the COVID-19 pandemic on older volunteers, in order to explore the possible relation between, on the one hand, changes in their ...health, social relationships and quality of life due to the pandemic and, on the other hand, volunteers’ motivations and (direct or indirect) experience of the COVID-19 contagion. Although various active-ageing-related issues have been studied during the pandemic, the studies did not cover the topic of the present study. Therefore, the results of this study advance the knowledge on the matter. A sample of 240 older volunteers was surveyed in Italy in July–August 2021. Bivariate analyses and multivariable logistic regression models were performed. The results highlighted that during the COVID-19 pandemic, for older people, volunteering in order to avoid thinking about personal problems was related to worsened health, while volunteering for social reasons was inversely related to a worsening quality of life. Having indirectly (by acquaintances) experienced the COVID-19 contagion was protective against the worsening physical health of older volunteers. The discussion includes the policy implications of the results.
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