33 results on '"Antonelli Incalzi, R"'
Search Results
2. The cardiopulmonary response to incremental exercise test: The effect of aging
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Fuso, Leonello, Antonelli Incalzi, R., Muzzolon, R., Di Gennaro, M., Gliozzi, F., Pistelli, R., and Carbonin, P. U.
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- 1994
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3. Unrecognized dementia: sociodemographic correlates
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Antonelli Incalzi, R., Marra, C., Gemma, A., Capparella, O., and Carbonin, P. U.
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- 1992
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4. Management of hip fracture in the older people: rationale and design of the Italian consensus on the orthogeriatric co-management
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Luigi Tritapepe, Anna Castaldo, Mauro Roselli, Graziano Onder, Marco Paoletta, Amedeo Zurlo, Astrid Ursula Behr, Marco Bravi, Claudio Cricelli, Mauro Ruggeri, Antonio De Vincentis, Giovanni Iolascon, Giuseppe Bellelli, Fabio Santacaterina, E. Martini, Stefania Maggi, Lucia Galluzzo, Raffaele Antonelli Incalzi, Alberto Momoli, De Vincentis, A, Behr, A, Bellelli, G, Bravi, M, Castaldo, A, Cricelli, C, Galluzzo, L, Iolascon, G, Maggi, S, Martini, E, Momoli, A, Onder, G, Paoletta, M, Roselli, M, Ruggeri, M, Santacaterina, F, Tritapepe, L, Zurlo, A, Antonelli Incalzi, R, De Vincentis, A., Behr, A. U., Bellelli, G., Bravi, M., Castaldo, A., Cricelli, C., Galluzzo, L., Iolascon, G., Maggi, S., Martini, E., Momoli, A., Onder, G., Paoletta, M., Roselli, M., Ruggeri, M., Santacaterina, F., Tritapepe, L., Zurlo, A., and Antonelli Incalzi, R.
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Aging ,Consensus ,Consensu ,Comorbidity ,Elderly ,Hip fracture ,Orthogeriatric co-management ,Aged ,Aged, 80 and over ,Delivery of Health Care ,Hip Fractures ,Humans ,Italy ,Orthopedic Procedures ,Recovery of Function ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Multidisciplinary approach ,80 and over ,Content validity ,medicine ,030212 general & internal medicine ,Health policy ,computer.programming_language ,Out of hospital ,business.industry ,medicine.disease ,Functional recovery ,Orthopedic Procedure ,Geriatrics and Gerontology ,business ,Older people ,computer ,030217 neurology & neurosurgery ,Delphi ,Human - Abstract
Background: Hip fracture (HF) is a burdening health problem in older people. The orthogeriatric approach has been shown to favour functional recovery and reduce mortality, but its implementation in clinical practice cannot rely upon shared management protocols and greatly varies among different healthcare systems. Here, we present the rationale and design of the Italian consensus document on the management of HF in older people. Methods: A panel of multidisciplinary experts from ten Italian scientific societies involved in the care of HF and including geriatricians, orthopaedics, anaesthesiologists, physiatrists and general practitioners, will join to establish the content validity of a list of statements. A Delphi consensus methodology will be applied to obtain the opinions of the panel and to provide the final recommendations. Objectives: The document will include indications on the following relevant topics: (1) optimal care path of older subjects with HF; (2) management of comorbidities and pre-operative alteration of physiological parameters; (3) management of selected categories of patients at expected increased risk of adverse outcomes; (4) continuity of care out of hospital; (5) screening and correction of risk factors for HF in older subjects; (6) information and divulgation of shared management strategies. The objective of the consensus will be to inform clinicians, patients, researchers, and health policy makers about the best management strategies for HF in older people and their inherent limitations, thus facilitating communication between stakeholders and promoting the most cost/effective models of care.
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- 2020
5. Atrial fibrillation and COVID-19 in older patients: how disability contributes to shape the risk profile. An analysis of the GeroCovid registry
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Carlo Fumagalli, Pietro Gareri, Chukwuma Okoye, Caterina Trevisan, Enrico Mossello, Andrea Ungar, Andrea Herbst, Alessandra Coin, G. Pelagalli, Anette Hylen Ranhoff, Susanna Del Signore, Stefano Fumagalli, Gianluca Zia, Giuseppe Bellelli, Alba Malara, Fabio Monzani, Stefano Volpato, Raffaele Antonelli Incalzi, Fumagalli, S, Trevisan, C, Del Signore, S, Pelagalli, G, Fumagalli, C, Herbst, A, Volpato, S, Gareri, P, Mossello, E, Malara, A, Monzani, F, Okoye, C, Coin, A, Bellelli, G, Zia, G, Ungar, A, Ranhoff, A, and Antonelli Incalzi, R
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Male ,Aging ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Prognosi ,Socio-culturale ,Norwegian ,Risk profile ,Risk Assessment ,Atrial fibrillation ,COVID-19 ,Disability ,Older patients ,Oral anticoagulants ,Prognosis ,Older patient ,Risk Factors ,White blood cell ,Internal medicine ,medicine ,Humans ,Registries ,Aged ,Retrospective Studies ,Geriatrics ,Aged, 80 and over ,business.industry ,SARS-CoV-2 ,Anticoagulants ,medicine.disease ,language.human_language ,Stroke ,medicine.anatomical_structure ,language ,Observational study ,Oral anticoagulant ,Original Article ,Geriatrics and Gerontology ,MED/09 - MEDICINA INTERNA ,business - Abstract
Background and aims: Atrial fibrillation (AF) is often complicated by disabling conditions in the elderly. COVID-19 has high mortality in older people. This study aimed at evaluating the relationship of pre-infection AF with characteristics and survival of older COVID-19 patients. Methods: We retrospectively analyzed inpatients aged ≥ 60years enrolled in GeroCovid Observational, a multicenter registry endorsed by the Italian and the Norwegian Societies of Gerontology and Geriatrics. Pre-COVID-19 sociodemographic, functional, and medical data were systematically collected, as well as in-hospital mortality. Results: Between March and June 2020, 808 COVID-19 subjects were enrolled (age 79 ± 9years; men 51.7%). The prevalence of AF was 21.8%. AF patients were older (82 ± 8 vs. 77 ± 9years, p < 0.001), had a higher CHA2DS2-VASc score (4.1 ± 1.5 vs. 3.2 ± 1.5, p < 0.001) and were more likely to present almost all comorbidities. At multivariable analysis, advanced age, white blood cell count, the presence of heart and peripheral artery diseases were significantly associated with the presence of AF. In-hospital mortality was higher in AF patients (36.9 vs. 27.5%; OR = 1.55, 95% CI = 1.09–2.20; p = 0.015). A decision tree analysis showed that, in AF subjects, preserved functional status at admission was the most important factor associated with survival. In patients without AF, baseline COVID-19 severity was the most relevant variable related to clinical prognosis. Conclusions: AF is frequent in older patients with COVID-19, in whom it associates with clinical complexity and high mortality. Pre-infection disability shapes the prognosis of this extremely vulnerable segment of hospitalized subjects. Clinical trial registration: GeroCovid Observational was registered at www.clinicaltrials.gov (NCT04379440).
- Published
- 2021
6. Effects of chronic airway disease on health status of geriatric patients
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Claudio Imperiale, Filippo Catalano, Riccardo Pistelli, Raffaele Antonelli Incalzi, Vincenzo Bellia, Nicola Scichilone, ANTONELLI INCALZI R, PISTELLI R, IMPERIALE C, CATALANO F, SCICHILONE N, and BELLIA V
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Aging ,Chronic bronchitis ,medicine.medical_specialty ,Health Status ,Settore MED/10 - Malattie Dell'Apparato Respiratorio ,Pulmonary Disease, Chronic Obstructive ,Internal medicine ,medicine ,Health Status Indicators ,Humans ,Respiratory function ,Bronchitis ,Asthma ,Aged ,COPD ,business.industry ,Anthropometry ,medicine.disease ,Comorbidity ,respiratory tract diseases ,Airway disease ,Chronic Disease ,Physical therapy ,aging, quality of life, COPD ,Geriatrics and Gerontology ,business ,Algorithms - Abstract
Background and aims: The impact of chronic airway disease on the health status of elderly patients is only to some extent explained by indexes of airflow limitation. The present study was designed to assess to what extent: 1) asthma, chronic obstructive pulmonary disease (COPD) and chronic bronchitis with normal FEV1 (simple bronchitis) differ in their impact on health status; 2) health status depends upon non-respiratory factors. Methods: A total of 1601 outpatients over 65 - 198 with asthma, 228 with COPD, 91 with simple bronchitis, and 1084 with non-respiratory illnesses (control group) -were studied by collection of five health status indexes and multidimensional assessment. Discriminant analysis was used to identify health status profiles of groups. Demographic, anthropometric, clinical and respiratory function correlates of selected health status profiles were identified. Results: Only 26 and 28% of asthma and COPD patients vs 43% of simple bronchitis and 50% of non-respiratory patients showed group-specific health status profiles. These profiles were characterized by lower 6-min walked distance and greater index of disturbed sleep in asthmatics, and by worse performance on Barthel Index, 6-min walking test and Mini-Mental State Examination in COPD patients. More severe bronchial obstruction, a greater index of comorbid-ity and a longer occiput-wall distance characterized COPD patients with the worst health status. Conclusions: The health status of elderly patients with COPD or asthma is highly heterogeneous. On average, COPD is characterized by more severe physical impairment, and asthma by poorer quality of sleep. Comorbidity and severity of bronchial obstruction, but not age, contribute toward defining a subset of COPD patients with the worst health status.
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- 2004
7. Advancing healthcare through thoracic ultrasound research in older patients.
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Scarlata S, Okoye C, Zotti S, Lauretani F, Nouvenne A, Cerundolo N, Bruni AA, Torrini M, Finazzi A, Mazzarone T, Lunian M, Zucchini I, Maccioni L, Guarino D, Fabbri Della Faggiola S, Capacci M, Bianco MG, Guarona G, Bellelli G, Monzani F, Virdis A, Antonelli Incalzi R, Ungar A, and Ticinesi A
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- Humans, Aged, Ultrasonography methods, Delivery of Health Care, Pneumonia, Viral, COVID-19, Pleural Effusion diagnostic imaging
- Abstract
This paper reports the proceedings of a meeting convened by the Research Group on Thoracic Ultrasound in Older People of the Italian Society of Gerontology and Geriatrics, to discuss the current state-of-the-art of clinical research in the field of geriatric thoracic ultrasound and identify unmet research needs and potential areas of development. In the last decade, point-of-care thoracic ultrasound has entered clinical practice for diagnosis and management of several respiratory illnesses, such as bacterial and viral pneumonia, pleural effusion, acute heart failure, and pneumothorax, especially in the emergency-urgency setting. Very few studies, however, have been specifically focused on older patients with frailty and multi-morbidity, who frequently exhibit complex clinical pictures needing multidimensional evaluation. At the present state of knowledge, there is still uncertainty on the best requirements of ultrasound equipment, methodology of examination, and reporting needed to optimize the advantages of thoracic ultrasound implementation in the care of geriatric patients. Other issues regard differential diagnosis between bacterial and aspiration pneumonia, objective grading of interstitial syndrome severity, quantification and monitoring of pleural effusions and solid pleural lesions, significance of ultrasonographic assessment of post-COVID-19 sequelae, and prognostic value of assessment of diaphragmatic thickness and motility. Finally, application of remote ultrasound diagnostics in the community and nursing home setting is still poorly investigated by the current literature. Overall, the presence of several open questions on geriatric applications of thoracic ultrasound represents a strong call to implement clinical research in this field., (© 2023. The Author(s).)
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- 2023
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8. Frailty in the chronic respiratory patient: association with mortality and clinical features in obstructive, restrictive, and mixed spirometric patterns.
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Scarlata S, Zotti S, Finamore P, Osadnik CR, Scichilone N, Antonelli Incalzi R, Claudio P, and Cesari M
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- Humans, Aged, Lung, Spirometry, Proportional Hazards Models, Frailty complications, Pulmonary Disease, Chronic Obstructive complications
- Abstract
Background: Frailty associates with increased vulnerability to adverse health outcomes and reduced tolerance to medical interventions. Its impact on patients with chronic respiratory diseases, particularly beyond chronic obstructive pulmonary disease (COPD), remains poorly understood., Aims: To evaluate the association between frailty index and 5-year mortality across different "spirometric" patterns and the variation in their occurring frailty determinants., Methods: This study analyzed data from the SARA study, which enrolled 1968 older adults, to evaluate the association between frailty and 5-year mortality across different spirometric patterns. Frailty was assessed using the frailty index (FI), and spirometry was performed to determine lung function patterns. Hazard ratios (HRs) were calculated using Cox regression models, adjusting for age and sex., Results: Among the study participants, 16% were classified as frail. Frailty was associated with a significantly increased risk of mortality across all spirometric patterns. The 5-year mortality rates were 34.3% in subjects with normal spirometry, 45.1% in those with obstructive defects, 55% in those with restrictive defects, and 42.6% in those with mixed airflow defects. The unadjusted HRs for mortality were 2.64 (95% CI 2.10-3.32) for the overall cohort, 2.24 (95% CI 1.48-3.40) for obstructive defects, 2.45 (95% CI 1.12-5.36) for restrictive defects, and 2.79 (95% CI 1.41-3.17) for mixed airflow defects. After adjusting for age and sex, the HRs remained statistically significant: 2.25 (95% CI 1.37-2.84) for the overall cohort, 2.08 (95% CI 1.37-3.18) for obstructive defects, 2.27 (95% CI 1.04-1.17) for restrictive defects, and 2.21 (95% CI 1.20-3.08) for mixed airflow defects., Conclusion: Frailty is a common syndrome and is associated with a significantly increased risk of mortality. The FI provides valuable information for risk profiling and personalized interventions beyond age and lung function parameters. Including frailty assessment in clinical evaluations can aid in resource allocation and improve patient care in respiratory diseases., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
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- 2023
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9. Frailty and hyperactive delirium in hospitalized older patients with COVID-19: an insight from GeroCovid registry.
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Parrotta I, Bencivenga L, Okoye C, Bellelli G, Fumagalli S, Mossello E, and Antonelli Incalzi R
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- Aged, Female, Humans, Male, Frail Elderly psychology, Retrospective Studies, Risk Factors, SARS-CoV-2, Geriatric Assessment, Frailty complications, COVID-19 complications, Delirium
- Abstract
Background: Delirium is an acute neuropsychiatric condition associated with unfavourable outcomes, frequent in older hospitalized people. In the context of the SARS-CoV-2 pandemic, few studies have specifically focused on the inflammatory status of older, frail patients with hyperactive delirium (HD) hospitalized for COVID-19., Aim: To identify biological correlates of HD at hospital admission and to assess the independent effect of delirium and physical frailty on in-hospital mortality., Methods: Data were retrospectively extracted by the multicenter registry GeroCovid Observational Study. Individuals aged ≥ 60 years were included if the information on the presence of HD, frailty based on the modified Fried criteria and inflammatory status had been collected. The risk of mortality was evaluated using a Kaplan-Meier estimator, according to frailty and delirium. Logistic and restricted cubic-spline regressions were employed to assess the relationship between inflammatory markers and HD., Results: Three-hundred-thirty-seven older adults were included in the analysis [mean age (SD) 77.1 (9.5) years, 50.1% females], and 11.5% presented with HD. A significant association of both PaO
2 /FiO2 ratio (p = 0.015) and serum lactate dehydrogenase (p = 0.04) with delirium was observed. By Cox multivariable regression, frail and non-frail patients with HD had a 4.42 and 2.85 higher mortality risk compared with non-frail, non-delirious patients., Conclusions: Hyperactive delirium at hospital admission is related with markers of lung failure among older adults, especially when physical frailty coexists. Delirium is associated with increased in-hospital mortality risk, which is doubled by the coexistence of physical frailty., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)- Published
- 2023
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10. Humoral immunity induced by mRNA COVID-19 vaccines in Nursing Home Residents previously infected with SARS-CoV-2.
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Fedele G, Palmieri A, Damiano C, Di Lonardo A, Leone P, Schiavoni I, Trevisan C, Abbatecola AM, Cafariello C, Malara A, Minchella P, Panduri G, Antonelli Incalzi R, Palamara AT, Stefanelli P, and Onder G
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- Humans, COVID-19 Vaccines, Immunity, Humoral, SARS-CoV-2, RNA, Messenger, BNT162 Vaccine, Pandemics, Nursing Homes, Viral Vaccines, COVID-19 prevention & control
- Abstract
Background: Nursing home (NH) residents suffered the greatest impact of the COVID-19 pandemic. Limited data are available on vaccine-induced immunity and on the protection ensured by a prior infection in this population., Aims: The present study aims to monitor antibody levels and their persistence over a 6-month period in NH residents according to the history of prior SARS-CoV-2 infection., Methods: We measured anti-trimeric Spike IgG antibody levels in a sample of 395 residents from 25 NHs in 6 Italian Regions at study enrolment (prior to the first dose of vaccine, T0) and then after 2 (T1) and 6 months (T2) following the first vaccine dose. All participants received mRNA vaccines (BNT162b2 or mRNA-1273). Analyses were performed using log-transformed values of antibody concentrations and geometric means (GM) were calculated., Results: Superior humoral immunity was induced in NH residents with previous SARS-CoV-2 infection. (T0: GM 186.6 vs. 6.1 BAU/ml, p < 0.001; T1: GM 5264.1 vs. 944.4 BAU/ml, p < 0.001; T2: GM 1473.6 vs. 128.7 BAU/ml, p < 0.001). Residents with prior SARS-CoV-2 infection receiving two vaccine doses presented significantly higher antibody concentration at T1 and T2. A longer interval between previous infection and vaccination was associated with a better antibody response over time., Discussion: In a frail sample of NH residents, prior SARS-CoV-2 infection was associated with a higher humoral response to vaccination. Number of vaccine doses and the interval between infection and vaccination are relevant parameters in determining humoral immunity., Conclusions: These findings provide important information to plan future immunization policies and disease prevention strategies in a highly vulnerable population., (© 2022. The Author(s).)
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- 2022
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11. Chronic cough in adults: recommendations from an Italian intersociety consensus.
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De Vincentis A, Baldi F, Calderazzo M, Caliceti U, Guarnieri G, Lombardi F, Lombardo FP, Maggi S, Onder G, Vaghi A, Zanasi A, and Antonelli Incalzi R
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- Aged, Chronic Disease, Consensus, Humans, Italy, Cough diagnosis, Cough etiology, Cough therapy, Quality of Life
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Background: Chronic cough (CC) is a burdensome health problem in adult and older people, with a major impact on quality of life. Its management is often troublesome, and many guidelines have been released. Notwithstanding, a proportion of cases still do not reach a definite diagnosis and resolutive treatment. A coordinated approach between different specialists would be highly recommended, but its implementation in clinical practice suffers from the lack of shared protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues., Aims: To develop evidence-based recommendations for the management of adults with CC., Methods: A 12-member expert task force of general practitioners, geriatricians, pneumologists, allergologists, otorhynolaringologists and gastroenterologists was established to develop evidence-based recommendations for the diagnostic and therapeutic approach to subjects with CC. A modified Delphi approach was used to achieve consensus, and the US Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence., Results: A total of 56 recommendations were proposed, covering 28 topics and concerning definitions and epidemiology, pathogenesis and etiology, diagnostic and therapeutic approach along with the consideration of specific care settings., Conclusion: These recommendations should ease the management of subjects with CC by coordinating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
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- 2022
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12. Reply to the Letter: "Low levels of transaminase and mortality risk in older people with special reference to sarcopenia".
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Gallo P, De Vincentis A, Bandinelli S, Ferrucci L, Picardi A, Antonelli Incalzi R, and Vespasiani-Gentilucci U
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- Aged, Geriatric Assessment, Humans, Transaminases, Sarcopenia mortality
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- 2022
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13. Atrial fibrillation and COVID-19 in older patients: how disability contributes to shape the risk profile. An analysis of the GeroCovid registry.
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Fumagalli S, Trevisan C, Del Signore S, Pelagalli G, Fumagalli C, Herbst A, Volpato S, Gareri P, Mossello E, Malara A, Monzani F, Okoye C, Coin A, Bellelli G, Zia G, Ungar A, Ranhoff AH, and Antonelli Incalzi R
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- Aged, Aged, 80 and over, Anticoagulants, Humans, Male, Registries, Retrospective Studies, Risk Assessment, Risk Factors, SARS-CoV-2, Atrial Fibrillation epidemiology, COVID-19, Stroke
- Abstract
Background and Aims: Atrial fibrillation (AF) is often complicated by disabling conditions in the elderly. COVID-19 has high mortality in older people. This study aimed at evaluating the relationship of pre-infection AF with characteristics and survival of older COVID-19 patients., Methods: We retrospectively analyzed inpatients aged ≥ 60 years enrolled in GeroCovid Observational, a multicenter registry endorsed by the Italian and the Norwegian Societies of Gerontology and Geriatrics. Pre-COVID-19 sociodemographic, functional, and medical data were systematically collected, as well as in-hospital mortality., Results: Between March and June 2020, 808 COVID-19 subjects were enrolled (age 79 ± 9 years; men 51.7%). The prevalence of AF was 21.8%. AF patients were older (82 ± 8 vs. 77 ± 9 years, p < 0.001), had a higher CHA
2 DS2 -VASc score (4.1 ± 1.5 vs. 3.2 ± 1.5, p < 0.001) and were more likely to present almost all comorbidities. At multivariable analysis, advanced age, white blood cell count, the presence of heart and peripheral artery diseases were significantly associated with the presence of AF. In-hospital mortality was higher in AF patients (36.9 vs. 27.5%; OR = 1.55, 95% CI = 1.09-2.20; p = 0.015). A decision tree analysis showed that, in AF subjects, preserved functional status at admission was the most important factor associated with survival. In patients without AF, baseline COVID-19 severity was the most relevant variable related to clinical prognosis., Conclusions: AF is frequent in older patients with COVID-19, in whom it associates with clinical complexity and high mortality. Pre-infection disability shapes the prognosis of this extremely vulnerable segment of hospitalized subjects., Clinical Trial Registration: GeroCovid Observational was registered at www.clinicaltrials.gov (NCT04379440)., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)- Published
- 2022
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14. Combined evaluation of aminotransferases improves risk stratification for overall and cause-specific mortality in older patients.
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Gallo P, De Vincentis A, Bandinelli S, Ferrucci L, Picardi A, Antonelli Incalzi R, and Vespasiani-Gentilucci U
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- Aged, Alanine Transaminase, Aspartate Aminotransferases, Humans, Prospective Studies, Risk Assessment, Cause of Death
- Abstract
Background: Recent studies identified low levels of alanine aminotransferase (ALT) as strong predictors of mortality in older people., Aims: Here we verified if the combined evaluation of aminotransferases may improve risk stratification for adverse outcomes in older patients., Methods: Data are from 761 participants aged more than 65 years from a prospective population-based database (InCHIANTI study), without known baseline chronic liver disease or malignancies. Associations between aminotransferase levels and the risk of all-cause, cardiovascular- and cancer-death were assessed by Cox-models with time-dependent covariates., Results: The association of ALT and aspartate aminotransferase (AST) with mortality was non-linear, mirroring a J- and a U-shaped curve, respectively. Based on quintiles of transaminase activities and on their association with overall mortality, low, intermediate (reference group) and high levels were defined. Having at least one transaminase in the low range [aHR 1.76 (1.31-2.36), p < 0.001], mainly if both [(aHR 2.39 (1.81-3.15), p < 0.001], increased the risk of overall mortality, as well as having both enzymes in the high range [aHR 2.14 (1.46-3.15), p < 0.001]. While similar trends were confirmed with respect to cardiovascular mortality, subjects with the highest risk of cancer mortality were those with both enzymes in the high range [aHR 3.48 (1.43-8.44), p = 0.006]. Low levels of transaminases were associated with frailty, sarcopenia and disability, while high levels did not capture any known proxy of adverse outcome. Conclusions and discussion The prognostic information is maximized by the combination of the 2 liver enzymes. While both aminotransferases in low range are characteristically found in the most fragile phenotype, both enzymes in high range are more likely to identify new-onset vascular/infiltrative diseases with adverse outcome., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
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- 2021
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15. Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus.
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Pietrogrande L, Roselli M, Ruggeri M, Ruggiero C, Santacaterina F, Tritapepe L, Zurlo A, and Antonelli Incalzi R
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- Aged, Consensus, Geriatricians, Humans, Italy, Health Services for the Aged, Hip Fractures surgery
- Abstract
Background: Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues., Aim: To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF., Methods: A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence., Results: A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics)., Conclusion: These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
- Published
- 2021
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16. Association between frailty index, lung function, and major clinical determinants in chronic obstructive pulmonary disease.
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Scarlata S, Finamore P, Laudisio A, Cardaci V, Ramaccia M, D'Alessandro F, Pedone C, Antonelli Incalzi R, and Cesari M
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- Aged, Humans, Lung, Respiratory Function Tests, Severity of Illness Index, Frailty, Pulmonary Disease, Chronic Obstructive complications
- Abstract
Background: Airflow limitation alone is unable to capture the complexity of chronic obstructive pulmonary disease (COPD), better explained by comprehensive disease-specific indexes. Frailty is a clinical condition characterized by high vulnerability to internal and external stressors and represents a strong predictor of adverse outcomes., Aims: Primary objective was to test the association between indexes of lung function and COPD severity with frailty index (FI), and secondary to evaluate the association between FI and comorbidities, cognitive and physical function, BODE index, and mortality., Methods: 150 stable COPD outpatients were enrolled and followed up to 4 years. At baseline, participants performed a geriatric multidimensional assessment, pulmonary function tests, arterial blood gas analysis, 6-min walking test, and bioimpedance analysis. BODE and FI were calculated. Spearman's ρ was used to assess correlations. Mortality was assessed using Kaplan-Meier curves., Results: Participants were followed up for a median of 39 months. Mean age was 73 years and median frailty index 0.15 (IQR 0.11-0.19). FI was higher in frequent exacerbators (≥ 2/year) (mean 0.18 vs 0.15, p 0.01) and dyspnoeic patients (mMRC ≥ 2) (mean 0.21 vs 0.14, p < 0.01) and correlated with lung volumes, expiratory flows, and pressure of arterial oxygen. FI was positively correlated with the number of comorbidities, depressive symptoms, cognitive decline, and BODE index. Mortality was higher in patients with BODE higher than 3 (HR 3.6, 95% CI 1.2-10.9), and not associated with FI., Discussion: FI positively correlates with all clinical drivers orienting the choice of treatment in COPD., Conclusions: FI associates with lung function and COPD severity, but does not associate with mortality., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
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- 2021
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17. Clustering of patients with end-stage chronic diseases by symptoms: a new approach to identify health needs.
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Finamore P, Spruit MA, Schols JMGA, Antonelli Incalzi R, Wouters EFM, and Janssen DJA
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- Chronic Disease, Cluster Analysis, Humans, Quality of Life, Heart Failure therapy, Pulmonary Disease, Chronic Obstructive therapy
- Abstract
Background: End-stage chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and chronic renal failure (CRF) are characterized by a high burden of daily symptoms that, irrespective of the primary organ failure, are widely shared., Aims: To evaluate whether and to which extent symptom-based clusters of patients with end-stage COPD, CHF and CRF associate with patients' health status, mobility, care dependency and life-sustaining treatment preferences., Methods: 255 outpatients with a diagnosis of advanced COPD (n = 95), advanced CHF (n = 80) or CRF requiring dialysis (n = 80) were visited in their home environment and underwent a multidimensional assessment: clinical characteristics, symptom burden using Visual Analog Scale (VAS), health status questionnaires, timed "Up and Go" test, Care Dependency Scale and willingness to undergo mechanical ventilation or cardiopulmonary resuscitation. Three clusters were obtained applying K-means cluster analysis on symptoms' severity assessed via VAS. Cluster characteristics were compared using non-parametric tests., Results: Cluster 1 patients, with the least symptom burden, had a better quality of life, lower care dependency and were more willing to accept life-sustaining treatments than others. Cluster 2, with a high presence and severity of dyspnea, fatigue, cough, muscle weakness and mood problems, and Cluster 3, with the highest occurrence and severity of symptoms, reported similar care dependency and life-sustaining treatment preferences, while Cluster 3 reported the worst physical health status., Discussion: Symptom-based clusters identify patients with different health needs and might help to develop palliative care programs., Conclusion: Clustering by symptoms identifies patients with different health status, care dependency and life-sustaining treatment preferences.
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- 2021
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18. Symptom-based clusters in patients with advanced chronic organ failure identify different trajectories of symptom variations.
- Author
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Finamore P, Janssen DJA, Schols JMGA, Verstraeten ERN, Antonelli Incalzi R, Wouters EFM, and Spruit MA
- Subjects
- Humans, Longitudinal Studies, Quality of Life, Syndrome, Heart Failure diagnosis, Pulmonary Disease, Chronic Obstructive
- Abstract
Background: Healthcare needs are complex and heterogeneous in advanced chronic organ failure. However, based on symptom clusters, groups of patients with similar quality of life, care dependency and life-sustaining treatment preferences can be identified., Aims: To evaluate the stability of symptom-based clusters over time, and whether and to what extent the clusters are able to predict patients' 2-year survival and hospitalization rates., Methods: This is a secondary analysis of a longitudinal observational study including 95 outpatients with chronic obstructive pulmonary disease (COPD) GOLD stage III-IV, 80 outpatients with chronic heart failure (CHF) NYHA stage III-IV and 80 outpatients with chronic renal failure (CRF) requiring dialysis. Patients were clustered into three groups applying K-means algorithm on baseline symptoms' severity and were then longitudinally evaluated. 2-year survival and hospital admissions during 1 year were estimated using Kaplan-Meier curves and Cox models. 1-year tendencies in symptom variation, using mixed linear models, and clusters comparison over time were performed., Results: The three clusters were unable to predict patients' survival and hospital admissions. Noteworthy, they show different trajectories of symptom variation, with Cluster 1 patients experiencing a worsening of symptoms, associated with an increased care dependency, and Cluster 2 and Cluster 3 patients being stable or having a relief in some symptoms. Although Cluster 1 is becoming more similar to Cluster 2, the three clusters preserve the overall characteristics and differences., Discussion: Symptom-based clusters might help to identify patients with different trajectories of symptom variations., Conclusion: Symptom clusters do not predict survival and hospital admissions and are stable over time.
- Published
- 2021
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19. Management of heart failure: an Italian national survey on fellows/specialists in geriatrics.
- Author
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Lelli D, Pedone C, Leosco D, Onder G, and Antonelli Incalzi R
- Subjects
- Aged, Humans, Italy, Specialization, Stroke Volume, Surveys and Questionnaires, Geriatrics, Heart Failure diagnosis, Heart Failure drug therapy
- Abstract
Background: Heart failure (HF) is often managed by geriatricians. Few data are available on their knowledge and attitudes about this condition., Aims: To compare perceptions and knowledge on HF of specialists/fellows in geriatrics working in Italy., Methods: This nation-wide survey carried out by the Italian Society of Gerontology and Geriatrics in May-June 2019 enrolled 283 specialists/fellows in geriatrics in Italy. Results were stratified by qualification (specialist/fellow) and performance (lower/higher quartile of correct answers)., Results: About half (55.5%) of the participants worked in acute care wards, 190 were residents, and 93 specialists. The overall proportion of correct answers was 70.8%, with no differences between specialists and fellows. There was a poor knowledge, with no differences between groups, about the target doses of ACE-inhibitors (36% of correct answers), the pharmacological treatment of HF with preserved ejection fraction (HFpEF) (37% of correct answers), and the inotropes indicated in acute HF (35% of correct answers). Compared to specialists, fellows performed better on indication (88% vs 76%, P = 0.019) and mechanism of action (93% vs 84%, P = 0.023) of sacubitril/valsartan, and on therapeutic indications of patients with atrial fibrillation (92% vs 75%, P < 0.001)., Conclusions: Globally, there was a good knowledge of the latest guidelines on the diagnosis and management of HF. However, for some important topics, such as HFpEF, that is the most common HF manifestation in older adults, the observed performance was relatively poor, indicating the need for focused educational campaigns.
- Published
- 2020
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- View/download PDF
20. Correction to: Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus.
- Author
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Aceto P, Antonelli Incalzi R, Bettelli G, Carron M, Chiumiento F, Corcione A, Crucitti A, Maggi S, Montorsi M, Pace MC, Petrini F, Tommasino C, Trabucchi M, and Volpato S
- Abstract
The article Perioperative Management of Elderly patients (PriME).
- Published
- 2020
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- View/download PDF
21. Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus.
- Author
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Aceto P, Antonelli Incalzi R, Bettelli G, Carron M, Chiumiento F, Corcione A, Crucitti A, Maggi S, Montorsi M, Pace MC, Petrini F, Tommasino C, Trabucchi M, and Volpato S
- Subjects
- Aged, Aged, 80 and over, Comorbidity, Consensus, Humans, Italy, Geriatric Assessment, Geriatricians
- Abstract
Background: Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue., Aims: To develop evidence-based recommendations for the integrated care of geriatric surgical patients., Methods: A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria., Results: A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items)., Conclusions: These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient's conditions.
- Published
- 2020
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- View/download PDF
22. Vaccines in older age: moving from current practice to optimal coverage-a multidisciplinary consensus conference.
- Author
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Antonelli Incalzi R, Bernabei R, Bonanni P, Conversano M, Ecarnot F, Gabutti G, Maggi S, Paolini D, and Sandri F
- Subjects
- Aged, Aged, 80 and over, Consensus, Humans, Vaccination, Geriatrics, Healthy Aging, Vaccines
- Abstract
Vaccines are a key strategy to promote healthy aging, but vaccine coverage remains below target levels in at-risk adults and older individuals. We present here the results of a multidisciplinary consensus conference convened to perform a multidimensional assessment of vaccination in geriatric medicine, with a view to developing a well-defined strategy for the promotion of vaccines in older people. We discuss recommended vaccines in older individuals, and describe the wide regional heterogeneity between regions in the Italian context. The main obstacles to implementation of vaccines in practice are reviewed, as well as potential strategies to remove these barriers. Finally, the importance of including vaccines and vaccination in undergraduate and postgraduate medical education is underlined. The information summarized in this document is expected to help develop educational and promotional initiatives to achieve greater uptake of vaccines among older individuals, as a key means to promote healthy aging.
- Published
- 2020
- Full Text
- View/download PDF
23. Management of hip fracture in the older people: rationale and design of the Italian consensus on the orthogeriatric co-management.
- Author
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Cricelli C, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Roselli M, Ruggeri M, Santacaterina F, Tritapepe L, Zurlo A, and Antonelli Incalzi R
- Subjects
- Aged, Aged, 80 and over, Comorbidity, Consensus, Delivery of Health Care, Hip Fractures epidemiology, Humans, Italy epidemiology, Orthopedic Procedures, Recovery of Function, Hip Fractures surgery
- Abstract
Background: Hip fracture (HF) is a burdening health problem in older people. The orthogeriatric approach has been shown to favour functional recovery and reduce mortality, but its implementation in clinical practice cannot rely upon shared management protocols and greatly varies among different healthcare systems. Here, we present the rationale and design of the Italian consensus document on the management of HF in older people., Methods: A panel of multidisciplinary experts from ten Italian scientific societies involved in the care of HF and including geriatricians, orthopaedics, anaesthesiologists, physiatrists and general practitioners, will join to establish the content validity of a list of statements. A Delphi consensus methodology will be applied to obtain the opinions of the panel and to provide the final recommendations., Objectives: The document will include indications on the following relevant topics: (1) optimal care path of older subjects with HF; (2) management of comorbidities and pre-operative alteration of physiological parameters; (3) management of selected categories of patients at expected increased risk of adverse outcomes; (4) continuity of care out of hospital; (5) screening and correction of risk factors for HF in older subjects; (6) information and divulgation of shared management strategies. The objective of the consensus will be to inform clinicians, patients, researchers, and health policy makers about the best management strategies for HF in older people and their inherent limitations, thus facilitating communication between stakeholders and promoting the most cost/effective models of care.
- Published
- 2020
- Full Text
- View/download PDF
24. Coronary flow response to remote ischemic preconditioning is preserved in old cardiac patients.
- Author
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Santillo E, Migale M, Balestrini F, Postacchini D, Bustacchini S, Lattanzio F, and Antonelli-Incalzi R
- Subjects
- Aged, Aged, 80 and over, Blood Flow Velocity physiology, Coronary Vessels diagnostic imaging, Echocardiography, Female, Heart, Humans, Male, Ultrasonography, Cardiac Rehabilitation methods, Coronary Vessels physiology, Ischemic Preconditioning, Myocardial methods
- Abstract
Background: The effect of remote ischemic preconditioning (RIPC) on coronary flow in elderly cardiac patients has not been investigated yet. Thus, we aimed to study the change of coronary flow subsequent to RIPC in old patients with heart diseases and to identify its main correlates., Methods: Ninety-five elderly patients (aged ≥ 65 years) accessing cardiac rehabilitation ward underwent transthoracic ultrasound evaluation of peak diastolic flow velocity of left anterior descending artery. Measurements of coronary flow velocity were performed on baseline and after an RIPC protocol (three cycles of 5 min ischemia of right arm alternating 5 min reperfusion). Differences between subjects with coronary flow velocity change over or equal the 75° percentile (high-responders) and subjects with a coronary flow velocity change under the 75° percentile (low-responders) were assessed., Results: In enrolled elderly heart patients, coronary flow velocity significantly augmented from baseline after RIPC [0.23 m/s (0.18-0.28) vs 0.27 m/s (0.22-0.36); p < 0.001 by Wilcoxon test]. High-responders to RIPC were significantly younger and in better functional status than low-responders. Heart failure resulted as the main variable associated with impairment of RIPC responsiveness (R
2 = 0.202; p = 0.002)]., Conclusions: Our sample of old cardiac patients presented a significant median increment of coronary flow velocity after RIPC. The magnitude of the observed change of coronary flow velocity was comparable to that previously described in healthy subjects. The coronary response to RIPC was attenuated by heart failure. Further research should define whether such RIPC responsiveness is associated with cardioprotection and carries prognostic implications.- Published
- 2018
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25. Relationship between FEV 1 and arterial stiffness in elderly people with chronic obstructive pulmonary disease.
- Author
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Costanzo L, Pedone C, Battistoni F, Chiurco D, Santangelo S, and Antonelli-Incalzi R
- Subjects
- Aged, Arginine metabolism, Biomarkers metabolism, Endothelium, Vascular physiopathology, Female, Forced Expiratory Volume, Humans, Italy, Male, Middle Aged, Risk Factors, Statistics as Topic, Vascular Stiffness, Arginine analogs & derivatives, C-Reactive Protein metabolism, Cardiovascular Diseases epidemiology, Cardiovascular Diseases physiopathology, Inflammation metabolism, Inflammation physiopathology, Interleukin-6 metabolism, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Disease, Chronic Obstructive epidemiology, Pulmonary Disease, Chronic Obstructive physiopathology
- Abstract
Background: Chronic obstructive pulmonary disease (COPD) is highly prevalent in the elderly, and both COPD and age per se are associated with cardiovascular morbidity., Aims: We tested the hypothesis that in elderly COPD patients airflow limitation is associated with arterial stiffness and the relationship, if any, is related to endothelial function and systemic inflammation., Methods: We evaluated lung function, augmentation index (AIx), flow-mediated dilation (FMD), Interleukin-6 (IL-6), and asymmetric dymethilarginine (ADMA) levels in 76 subjects (mean age 73.9 years, SD 6.2) attending a geriatric outpatient clinic., Results: Participants with COPD (N = 41) and controls (N = 35) did not differ in terms of AIx (30 vs 28.2 %, P = 0.30) and FMD (14.2 vs 12.3 %, P = 0.10). Similarly, the two groups did not differ with respect to mean concentrations of inflammation markers (IL-6 and C-reactive protein) and ADMA. Among COPD participants there was an inverse correlation between AIx and Forced Expiratory Volume in the first second (r = -0.349, P = 0.02). This relationship remained significant after correction for potential confounders, including markers of inflammation and ADMA levels (β = -0.194, P = 0.001)., Discussion: According to the results of this study, among COPD patients, bronchial patency and AIx are inversely related, and the relationship is explained neither by endothelial function nor by systemic inflammation., Conclusions: In elderly COPD people, increased arterial stiffness is related to reduced pulmonary function and it seems worth testing as a potential marker of higher cardiovascular risk.
- Published
- 2017
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26. The burden of comorbidity is associated with symptomatic polymicrobial urinary tract infection among institutionalized elderly.
- Author
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Laudisio A, Marinosci F, Fontana D, Gemma A, Zizzo A, Coppola A, Rodano L, and Antonelli Incalzi R
- Subjects
- Aged, Aged, 80 and over, Comorbidity, Female, Homes for the Aged statistics & numerical data, Humans, Italy epidemiology, Logistic Models, Male, Middle Aged, Nursing Homes statistics & numerical data, Coinfection diagnosis, Coinfection epidemiology, Coinfection physiopathology, Cost of Illness, Institutionalization statistics & numerical data, Urinary Tract Infections diagnosis, Urinary Tract Infections epidemiology, Urinary Tract Infections microbiology, Urinary Tract Infections physiopathology
- Abstract
Background: Urinary tract infections (UTIs), often sustained by polymicrobial flora (p-UTIs), are a common finding among nursing home patients, and associated with adverse outcomes and increased healthcare costs. P-UTIs have been extensively studied with regard to microbiological aspects. However, little is known about the characteristics of the host., Aims: The aim of this study is to verify to which extent comorbidity characterizes elderly nursing home patients with p-UTIs., Methods: We enrolled 299 patients with culture-positive UTI consecutively admitted to the nursing home of the "Fondazione San Raffaele Cittadella della Carità", Taranto, Italy. P-UTI was diagnosed when two uropathogens were simultaneously isolated. The burden of comorbidity was quantified using the Charlson comorbidity score index. Logistic regression analysis was used to assess the adjusted association of the variables of interest with the presence of p-UTI., Results: P-UTIs were detected in 118/299 (39%) patients. According to logistic regression, the presence of p-UTIs was independently associated with the Charlson index (OR 1.70; 95% CI 1.06-2.72; P = .026). This association remained also after excluding participants without urinary catheter (OR 1.88; 95% CI 1.13-3.11; P = .015)., Discussion: The presence of P-UTIs is associated with the burden of comorbidity, but not with individual diseases., Conclusions: Older nursing home patients with comorbidity should be screened for the presence of p-UTIs; further studies are needed to evaluate the impact of early detection and treatment of p-UTIs on the development of comorbidity.
- Published
- 2015
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27. Fever of unknown origin in a very old patient: beware of the kidney!
- Author
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Giua R, Pedone C, Onetti Muda A, and Antonelli Incalzi R
- Subjects
- Aged, 80 and over, Creatinine blood, Hematuria diagnosis, Humans, Hypertension complications, Pulmonary Disease, Chronic Obstructive complications, Vasculitis complications, Antibodies, Antineutrophil Cytoplasmic blood, Fever of Unknown Origin diagnosis
- Abstract
ANCA-associated vasculitis affects more than 20 per million of the population per year and prevails in the elderly. Renal involvement, either isolated or in the context of systemic vasculitis, is common. We report the case of an 86-year-old patient who presented with a histologically proven renal limited vasculitis and with fever and fatigue but with normal renal function and urine analysis. Serum creatinine increased and microscopic hematuria became evident only 3 weeks after symptoms onset, whereas ANCA positivity was the only early key to the diagnosis. This case shows that in the elderly an ANCA-related pauci-immune glomerulonephritis in its earliest stages should be suspected in the presence of a fever of unknown origin even if serum and urine analyses are normal.
- Published
- 2014
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28. Reliability of equations to estimate glomerular filtration rate in the very old.
- Author
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Pedone C, Semeraro R, Chiurco D, D'Andria F, Gigante M, Coppola A, Corsonello A, and Antonelli-Incalzi R
- Subjects
- Aged, Aged, 80 and over, Creatinine blood, Creatinine urine, Female, Frail Elderly, Humans, Male, Nursing Homes, Reproducibility of Results, Sex Factors, Aging, Glomerular Filtration Rate, Kidney Failure, Chronic diagnosis, Kidney Function Tests standards
- Abstract
Background and Aims: Few studies have investigated the reliability of formulas estimating renal function in very old people., Methods: We studied 154 elderly people (mean age: 82 yrs). Serum creatinine (SC) was measured by the Jaffé method, and creatinine clearance (CrCl) with 24-h urine collection. Agreement was measured with the average ratio estimated/measured CrCl, and precision with the 95% agreement intervals (95% AI). We calculated the proportion of residents correctly classified as having renal insufficiency (accuracy)., Results: The Cockcroft-Gault (CG) and Modification of Diet in Renal Disease 1 (MDRD1) formulas showed good average agreement with measured CrCl (0.95 and 1.016, respectively); the MDRD2 formula was more biased. Results were consistent in women, whereas the MDRD1 was more biased in men (average ratio: 1.196). The 95% AI showed that all formulas can yield results as low as 50% or as high as 200% of measured CrCl. The proportion of people with CrCl<60 ml/min misclassified by the CG, MDRD1, and MDRD2 formulas as having normal renal function was 21.4%, 27.0%, and 38.8%, respectively. These results were consistent across the various subgroups, especially in subjects with normal SC., Conclusions: The clinical usefulness of formulas commonly used to estimate CrCl was limited, regardless of subjects' characteristics.
- Published
- 2008
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29. Orthogeriatric Unit: a thinking process and a working model.
- Author
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Antonelli-Incalzi R, Gemma A, and Capparella O
- Subjects
- Aged, Geriatrics organization & administration, Humans, Italy, Models, Theoretical, Orthopedics organization & administration, Health Services for the Aged organization & administration, Hospital Units organization & administration
- Published
- 2008
- Full Text
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30. Relationship between the occiput-wall distance and physical performance in the elderly: a cross sectional study.
- Author
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Antonelli-Incalzi R, Pedone C, Cesari M, Di Iorio A, Bandinelli S, and Ferrucci L
- Subjects
- Aged, Aged, 80 and over, Bone Density, Cross-Sectional Studies, Female, Frail Elderly, Humans, Male, Sex Factors, Walking, Gait, Kyphosis physiopathology, Postural Balance
- Abstract
Background and Aims: The occiput-wall distance (OWD), a measure of kyphosis, has been associated with postural instability, osteoporosis, disability and depression. The association between OWD and measures of physical performance was evaluated., Methods: Data from the Invecchiare in Chianti (InCHIANTI) study on home-dwelling people were used. People younger than 65 years and with overt disability at baseline assessment were excluded. The sample population was divided into three groups according to the OWD distribution (1st quartile: short OWD; 2nd and 3rd quartiles: medium OWD; 4th quartile: long OWD). Performance scores were expressed as the percentage of the best performance in this population., Results: 783 persons (55% women) were studied. The mean age for men was 73.8 (SD 6.34) and 75.0 (SD 6.85) for women. In men, a longer OWD was associated with reduced balance and walking speed, but not with impaired performance at the chair standing test. Overall, the association between increased OWD and reduced physical function was weak. In women, OWD was associated with a reduced walking speed, expressed as a percentage of the best performance (mean [SD]: 77% [12], 72% [14], 66% [15] in short, medium and long OWD groups, respectively), and impaired balance (mean [SD]: 97% [11], 95% [13], 90% [21] for short, medium and long OWD groups, respectively)., Conclusions: Our findings suggest that OWD is an easily measurable marker of poor physical function in women. Further research should verify whether OWD predicts incident disability.
- Published
- 2007
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31. Effects of chronic airway disease on health status of geriatric patients.
- Author
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Antonelli Incalzi R, Pistelli R, Imperiale C, Catalano F, Scichilone N, and Bellia V
- Subjects
- Aged, Algorithms, Asthma diagnosis, Bronchitis diagnosis, Chronic Disease, Health Status, Humans, Pulmonary Disease, Chronic Obstructive diagnosis, Asthma physiopathology, Bronchitis physiopathology, Health Status Indicators, Pulmonary Disease, Chronic Obstructive physiopathology
- Abstract
Background and Aims: The impact of chronic airway disease on the health status of elderly patients is only to some extent explained by indexes of airflow limitation. The present study was designed to assess to what extent: 1) asthma, chronic obstructive pulmonary disease (COPD) and chronic bronchitis with normal FEV1 (simple bronchitis) differ in their impact on health status; 2) health status depends upon non-respiratory factors., Methods: A total of 1601 outpatients over 65-198 with asthma, 228 with COPD, 91 with simple bronchitis, and 1084 with non-respiratory illnesses (control group)--were studied by collection of five health status indexes and multidimensional assessment. Discriminant analysis was used to identify health status profiles of groups. Demographic, anthropometric, clinical and respiratory function correlates of selected health status profiles were identified., Results: Only 26 and 28% of asthma and COPD patients vs 43% of simple bronchitis and 50% of non-respiratory patients showed group-specific health status profiles. These profiles were characterized by lower 6-min walked distance and greater index of disturbed sleep in asthmatics, and by worse performance on Barthel Index, 6-min walking test and Mini-Mental State Examination in COPD patients. More severe bronchial obstruction, a greater index of comorbidity and a longer occiput-wall distance characterized COPD patients with the worst health status., Conclusions: The health status of elderly patients with COPD or asthma is highly heterogeneous. On average, COPD is characterized by more severe physical impairment, and asthma by poorer quality of sleep. Comorbidity and severity of bronchial obstruction, but not age, contribute toward defining a subset of COPD patients with the worst health status.
- Published
- 2004
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- View/download PDF
32. Management of chronic obstructive pulmonary disease in the elderly.
- Author
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Antonelli Incalzi R
- Subjects
- Age Factors, Aged, Comorbidity, Health Status, Humans, Prognosis, Risk Factors, Smoking Cessation, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive therapy
- Abstract
Chronic obstructive pulmonary disease (COPD), a leading cause of death and disability in the elderly, is frequently unrecognized or misinterpreted as heart disease. Comorbidity plays a primary role, both as a determinant of health status and as a prognostic marker in older populations with COPD. Multidimensional assessment tailored to the distinctive needs of respiratory patients and thus including selected respiratory function indexes, is mandatory for proper staging COPD and monitoring of its course and response to therapy. In stable COPD, a mix of pharmacological and non-pharmacological measures may improve health, but only by stopping smoking and, in the event of respiratory insufficiency, applying continuous oxygen therapy can the progression of the disease be delayed and life expectancy prolonged. In exacerbated COPD, age per se is a negative prognostic marker and, while many very old patients can successfully recover, they will experience some decline in personal independence. Thus, older patients with COPD should ideally be the object of a continuum of care throughout all the stages of their disease, in order to minimize the decline in personal independence and worsening health. In this perspective, COPD patients qualify as optimal candidates for dedicated programs of continuous geriatric care.
- Published
- 2004
- Full Text
- View/download PDF
33. Trends in prescribing ACE-inhibitors for congestive heart failure in elderly people.
- Author
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Antonelli Incalzi R, Pedone C, Pahor M, Onder G, and Carbonin PU
- Subjects
- Aged, Aged, 80 and over, Data Collection, Digitalis Glycosides therapeutic use, Diuretics therapeutic use, Drug Utilization, Humans, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Heart Failure drug therapy, Practice Patterns, Physicians' trends
- Abstract
Background and Aims: The aim of this study was to analyze trends in the use of ACE-inhibitors in patients aged 65 and older with congestive heart failure (CHF) in the period from 1988 to 1998., Methods: We studied 2985 patients (mean age 79.7 +/- 7 years), hospitalized for CHF in 12 different bimonthly periods. Home therapy prior to hospitalization was assessed retrospectively, and data on in-hospital therapy and discharge prescriptions were collected prospectively., Results: Diuretics and digitalis were the most commonly used and prescribed drugs. The use of ACE-inhibitors between 1988 and 1998 increased from 13.4 to 46.7% prior to hospitalization, and from 25.8 to 59.2% as a discharge prescription. The most important factors associated with a prescription of ACE-inhibitors at discharge were previous use (OR 4.35, 95% CI=3.65-5.19), hypertension (OR 1.76, 95% CI=1.47-2.11), valvular heart diseases (OR 2.06, 95% CI=1.51-2.81) and diabetes (OR 1.58, 95% CI=1.29-1.93). Physical impairment was associated with a decreased use of ACE-inhibitors at discharge (OR 0.55, 95% CI=0.45-0.67)., Conclusions: The use of ACE-inhibitors for the treatment of CHF progressively increased both at home and in hospital wards of general medicine and geriatrics in the 10-year period studied. Nevertheless, digitalis and diuretics continue to be the most commonly prescribed drugs. A widespread educational effort is needed to increase physicians' awareness of the rationale for prescribing ACE-inhibitors for CHF patients.
- Published
- 2002
- Full Text
- View/download PDF
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