Geriatric Care最新文献

{"title":"The role of hydroxychloroquine sulfate in the geriatric patient with coronavirus disease 2019 (COVID-19). What is useful to know for the geriatrician?","authors":"C. Manzo","doi":"10.4081/gc.2020.9015","DOIUrl":"https://doi.org/10.4081/gc.2020.9015","url":null,"abstract":"The role of hydroxychroloquine (HCQ) sulfate as therapeutic option in coronavirus disease 2019 (COVID-19) patients aroused great interest and hope, so much so as to authorize several studies in the world. Despite the beneficial effects demonstrated in vitro and in some case-series, doubts remain about its clinical use, so that at present more than 20 different therapeutic study protocols have been proposed. Very recently, a protocol has been authorized by the Italian Medicines Agency (AIFA), in order to evaluate the efficacy of out-of-hospital treatment with HCQ in the reducing viral loads and need for hospitalization in symptomatic COVID-19 infected patients who are confined at home. The article describes lights and shadows of HCQ therapy in the elderly and geriatric patients affected by COVID-19, and suggests that the geriatrician should use HCQ only after careful patient selection and be aware of its pharmacokinetic properties and adverse effects, before better-designed studies determine their benefit, if any, in treating COVID-19.","PeriodicalId":30930,"journal":{"name":"Geriatric Care","volume":"119 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4081/gc.2020.9015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41305454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and renal disease in elderly patients","authors":"G. Coppolino, P. Presta, Ramona Nicotera, Giordano Placida, C. Vita, Nazzareno Carullo, M. Andreucci, D. Bolignano, A. Castagna, G. Ruotolo","doi":"10.4081/gc.2020.9029","DOIUrl":"https://doi.org/10.4081/gc.2020.9029","url":null,"abstract":"The pandemic blast of COVID-19 uncovered well known weakness of financial chain and put our economic organizations facing off dramatic consequences if new strategies will not be developed to adapt health-care on detailed sub-groups of patients. The exponential number of older and frail subjects aged >65 years represents a challenge for public health. Patients affected by renal disease are an aged population that showed a particular attitude to contract infection and a higher mortality rate respect to general population. In this brief article, we would point out the focus on the management of issues related to renal patients facing off with coronavirus infection, in particular in a geriatric population particularly exposed to contagion like hemodialysis patients and precautions decided to slow the spread of","PeriodicalId":30930,"journal":{"name":"Geriatric Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4081/gc.2020.9029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45659793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Multidimensional Prognostic Index (MPI) for the prognostic stratification of hospitalized older patients with COVID-19: a prospective multicenter observational cohort study. Objectives, study design and expected outcomes (MPI_COVID-19)","authors":"C. Custodero, A. Cella, N. Veronese, M. Azzini, F. Fimognari, F. Mattace-Raso, M. Polidori, C. Sabbà, A. Pilotto","doi":"10.4081/gc.2020.9038","DOIUrl":"https://doi.org/10.4081/gc.2020.9038","url":null,"abstract":"The emergent coronavirus-19 disease (COVID-19) pandemic posed and still poses serious issues in the management of the inpatients and in the resource allocation, in particular for those patients requiring Intensive Care Unit (ICU) management. Epidemiological data clearly suggest that multimorbid older patients have the poorest prognosis. However, it is conceivable that age and number of comorbidities alone do not reflect the real condition and the expected prognosis of the patients affected by COVID19. A different approach based on comprehensive geriatric assessment (CGA) could help to better identify older patients more at risk of dismal outcomes and who, at some point of their clinical course, will need the ICU admission. The Multidimensional Prognostic Index (MPI) is a well-accepted tool derived from a standard CGA which allows to measure prognosis of older patients in different clinical settings including hospital. Therefore, we designed a multicenter, prospective, observational study to evaluate the role of MPI in predicting risk of ICU admission and in-hospital mortality among 500 COVID-19-positive older subjects admitted to geriatric and internal medicine wards. In addition, risk of re-hospitalization, institutionalization and death after 3 months from discharge will be assessed. The MPI yields a straightforward value from 0 to 1 and might be able to adequately stratify complex, vulnerable COVID-19 patients for best possible decision-making and treatment allocation.","PeriodicalId":30930,"journal":{"name":"Geriatric Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4081/gc.2020.9038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45690819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fahr’s disease: familial idiopathic basal ganglia calcification with and without extrapyramidal disorders","authors":"A. Castagna, Carmen Ruberto, R. Cerra, L. Greco, G. Ruotolo","doi":"10.4081/gc.2020.8670","DOIUrl":"https://doi.org/10.4081/gc.2020.8670","url":null,"abstract":"Fahr’s disease (FD), also known as familial idiopathic basal ganglia calcification, is a neurodegenerative disease affecting cerebral micro vessels, mainly in the basal ganglia. It mostly presents with movement disorders, dementia and behavioral abnormalities. It is considered hereditary with an autosomal dominant transmission. Fahr’s disease is often underestimated and under diagnosed. We reported the clinical differences found in two patients with Fahr’s Disease. In particular, we described a case of Fahr’s disease with behavioral alteration with extrapyramidal movement disorders, and a rare case of Fahr’s disease with cognitive and behavioral alterations in absence of extrapyramidal movement disorders.","PeriodicalId":30930,"journal":{"name":"Geriatric Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4081/gc.2020.8670","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44510831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of natural drugs in severe acute respiratory syndrome coronavirus 2: potential beneficial effects in prevention or prior treatment in elderly and cancer patients","authors":"Eugenio Boccalone, Veronica Maria Lanni, V. M. Magro","doi":"10.4081/gc.2020.9016","DOIUrl":"https://doi.org/10.4081/gc.2020.9016","url":null,"abstract":"In 2019, a new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), aroused the attention of the entire world. It causes an acute respiratory disease, by involving the same receptor, i.e. the angiotensin-converting enzyme 2, as that for severe acute respiratory syndrome coronavirus (SARS-CoV), mainly spreads through the respiratory tract. The clinical symptoms in patients with of SARS-CoV-2 include fever, cough, dyspnea, fatigue and in a small percentage of patients also gastrointestinal symptoms have been reported. The elderly and people with underlying diseases, like cancer patients, are susceptible to infection and prone to serious outcomes, which may be associated with acute respiratory distress syndrome (ARDS). The immune systems of cancer patients are often compromised, weakened by the disease and its treatments, putting them at high risk for the severe form of SARS-CoV-2. In this brief report we focused on the updated literature data about the usefulness in elderly and cancer patients of the natural compounds with antiviral activities against SARS-associated coronavirus, like supportive care, in addition to usual treatments (Figure 1). The use of natural drugs in the treatment of SARS-CoV-2 was inspired by the treatment protocols previously adopted for SARS-CoV in the late 2002. Several studies examined the role of natural medicines and now there are some evidences about their beneficial effects in the prevention or prior treatment of SARS-CoV. In China, traditional herbal medicines have been frequently used in conjunction with conventional medicine to treat SARS-CoV. Between November 2002 and July 2003, SARSassociated coronavirus caused, in the Asian countries, a pneumonia epidemic. Since this period some studies were made to identify potential natural drugs with antiviral activities against SARS-associated coronavirus. The natural drugs in China have been used in conjunction with conventional medicine to treat SARS-CoV. In a study of 2007,1 derived from Chinese medicine herbs demonstrated beneficial effects in on the treatment of symptoms of patients with SARS-CoV such as relieving cough, removing the phlegm, and reducing asthma. Glycyrrhizin, an active component of licorice roots, has been reported to show antiviral activity against SARS-CoV in vitro. It was demonstrated that it inhibits the replication of isolates of SARS virus, with a half maximal effective concentration (E50) for the inhibition of viral infection rather high (E50=300 μg/mL). Another study2 identified that lycorine, an active component in the alkaloid portion of the herbal plant Lycoris radiata, shows the best potency (E50=2.4±0.2 μg/mL) against SARSCoV. Moreover, lycorine showed a significant anti-tumor activity . Specifically, it has been reported in literature that lycorine demonstrated an anti-tumor activity against human breast cancer cells (MCF-7) and human leukemia cells (HL-60). Lonicera japonica and GinsenosideRb1, one of the pharmacolog","PeriodicalId":30930,"journal":{"name":"Geriatric Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4081/gc.2020.9016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43620803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brief report on cognitive function and corticosteroid therapy in elderly","authors":"A. Castagna, G. Coppolino, Carmen Ruberto, G. Ruotolo, C. Manzo","doi":"10.4081/gc.2020.8785","DOIUrl":"https://doi.org/10.4081/gc.2020.8785","url":null,"abstract":"Glucocorticoids (GCs) are drugs commonly used for the treatment of a great number of acute or chronic pathological conditions. In a cross-sectional study we analyze a cohort of elderly patients treated for at least four weeks with a glucocorticoid (GC), exactly prednisone therapy, for a renal or rheumatological condition pointing out on functional, mental and clinical status. The main purpose was to assess change in cognitive performances. Corticosteroids administration also at low dosage in older subjects could enhance cognitive function. This observation should be proved in larger population and underlying mechanisms studied in deep.","PeriodicalId":30930,"journal":{"name":"Geriatric Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4081/gc.2020.8785","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43405674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The unavoidable costs of frailty: a geriatric perspective in the time of COVID-19","authors":"M. Polidori, S. Maggi, F. Mattace-Raso, A. Pilotto","doi":"10.4081/gc.2020.8989","DOIUrl":"https://doi.org/10.4081/gc.2020.8989","url":null,"abstract":"Maria Cristina Polidori,1 Stefania Maggi,2 Francesco Mattace-Raso,3 Alberto Pilotto4 1Professor of Geriatrics and Head Ageing Clinical Research, Department Medicine II, University Hospital of Cologne and Cologne Excellence Cluster on Cellular Stress Responses in Aging-associated Diseases, CECAD, University of Cologne, Germany; 2Director Aging Section, National Research Council (CNR), Padova, Italy; 3Head Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands; 4Director Department Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova; Professor of Geriatrics, Department of Interdisciplinary Medicine, University of Bari, Italy","PeriodicalId":30930,"journal":{"name":"Geriatric Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4081/gc.2020.8989","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48601299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polymyalgia rheumatica following intravesical bacillus Calmette-Guerin instillation: coincidence or true association? A case report and literature review","authors":"C. Manzo","doi":"10.4081/gc.2020.8868","DOIUrl":"https://doi.org/10.4081/gc.2020.8868","url":null,"abstract":"We report the case of a 73-year-old male patient suffering from non muscle invasive bladder cancer (NMIBC) who had violent pains in his neck and shoulders associated with general discomfort and fever, following the second intravesical instillation of bacillus Calmette-Guerin (BCG), with further worsening after the third instillation. During his hospitalization, laboratory tests showed a significant raise of inflammatory markers. An ultrasound (US) examination of his shoulders showed bilateral longhead-biceps exudative tenosynovitis and subdeltoid bursitis. An 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) associated with total body computed tomography (CT) showed pathological inflammatory findings in neck and shoulders, with exclusion of pathological findings in other sites. Cystoscopy was negative for NMIBC recurrence. Polymyalgia rheumatica (PMR) was diagnosed and BCG instillations was stopped. The patient had fast improvement of clinical manifestations and laboratory tests, but when he resumed them a few weeks later, the same manifestations recurred.","PeriodicalId":30930,"journal":{"name":"Geriatric Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4081/gc.2020.8868","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42700889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive efficacy of multidimensional prognostic index in the elderly with heart failure and reduced ejection fraction in a real world sample: the Post-Acute Long-Term Care setting","authors":"Eleonora Pittui, C. Doré, Irene Mameli, A. Scuteri, M. Dettori, A. Uneddu","doi":"10.4081/gc.2020.8407","DOIUrl":"https://doi.org/10.4081/gc.2020.8407","url":null,"abstract":"The multidimensional prognostic index (MPI) is an accurate predictor of mortality validated in hospitalized older patients. Aim of this study was to evaluate the reliability of the MPI in predicting shortand long-term mortality in patients with heart failure (HF), particularly in those with reduced left ventricular ejection fraction (HFrEF). The study population included all patients older than 65 years admitted in a Post-Acute Long-Care Unit from 2013 to 2018. Patients were divided into two groups: patients with HF (N=143) and patients without HF as controls (N=1254). Furthermore, patients affected by HF were subdivided according to echocardiographic left ventricular ejection fraction (LVEF), i.e. reduced, mid-range and preserved LVEF (respectively HFrEF, HFmrEF, HFpEF). All patients underwent a comprehensive geriatric assessment (CGA) to calculate the MPI based on information on functional, cognitive, nutritional and mobility status, comorbidity, poli-pharmacy and co-habitation. Mortality rates in the HF group was 46% in patients MPI-1 or MPI-2 groups versus 59% in patients included in the MPI3 group. In particular, of 32 HF patients with HFrEF 67.7% were in the MPI-3 class compared to 43% of 14 patients with HFmrEF group and to 41% of 63 patients with HFpEF. These findings suggest that MPI is a reliable predictor of mortality in HF patients and that it was particularly useful in the subgroup of patients with HFrEF. Introduction Heart failure (HF) is a clinical syndrome characterized by typical symptoms that may be accompanied by signs caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress.1 HF has a prevalence of 1-2% in developed countries with around 20 million cases worldwide. It affects about 10% of patients over 70 years, representing one of the main cause of hospitalization in this age group.2 Although the available treatments have allowed an improvement in mortality, HF continues to have a poor prognosis with a high mortality both in hospitalized patients and in the outpatient care setting.3 Studies have shown that patients discharged from the hospital with a diagnosis of HF have a high risk of mortality (11.3% at 30 days and 33.1% at 1 year)4,5 and rehospitalization (about 40% in the 6-month follow-up period after their index hospitalization).6 The Cardiovascular Health Study, a U.S. longitudinal cohort of communitydwelling older adults, reported 1-year, 5year, and 10-year mortality rates of 19%, 56%, and 83% following the onset of HF, respectively.7 Administrative data from the Canadian Chronic Disease Surveillance System confirm that once HF develops, mortality increases exponentially with age.8 This study focused on HF patients admitted to a Post-Acute Long-Term Care (LPA) Unit. The majority of patients were older subjects. Given their complexity, the great number of comorbidities and the high rate of frailty, all patients in","PeriodicalId":30930,"journal":{"name":"Geriatric Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4081/gc.2020.8407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46498855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practitioner attitudes and confidence to deprescribing for elderly patients","authors":"P. Rossi, S. Hegarty, V. Maio, M. Lombardi, A. Pizzini, A. Mozzone, Marzio Uberti, S. Miozzo","doi":"10.4081/gc.2020.8703","DOIUrl":"https://doi.org/10.4081/gc.2020.8703","url":null,"abstract":"Deprescribing is a patient-centered process of medication withdrawal intended to achieve improved health outcomes through discontinuation of one or more medications that are either potentially harmful or no longer required. The objective of this study was to assess the perceptions of primary care physicians on deprescribing and potential barriers to deprescribing in the Local Health Authority (LHA) of Turin, Piedmont, Italy. Secondary objective was to evaluate educational needs of primary care physician. Cross sectional survey of primary care physicians working in the LHA of Turin, Piedmont, Italy. 439 GPs (71.3% of the total number of primary care physicians) attended an educational session related to deprescribing and were asked to anonymously answer a paper survey. Participants were asked to complete a previously published questionnaire about deprescribing and potential factors affecting the deprescribing process. A correlation coefficient was calculated to assess the association between physicians’ confidence in deprescribing and attitudes or barriers associated with deprescribing. Many GPs (71%) reported general confidence in their ability to deprescribe. Most respondents (83%) reported they were comfortable deprescribing preventive medications, however almost half expressed doubts regarding deprescribing when medication was initially prescribed by a colleague (45%) or when patient and/or caregiver supported the opportunity to continue the assumption (49%). Around a third of doctors maintain that the absence of strong evidence supporting deprescribing prevents them from considering it (38%), that they do not have the necessary time to effectively go through the process of deprescribing (29%), and that fear of possible effects due on withdrawal prevents them from deprescribing (31%). There was no strong correlation between physicians’ confidence and attitudes or barriers associated with deprescribing. The present study confirms that general practitioners sense the importance of deprescribing and feel prepared to face it managing communication with patients and caregivers, but find barriers when enacting the practice in a real-life context.","PeriodicalId":30930,"journal":{"name":"Geriatric Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4081/gc.2020.8703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45148099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}