38 results on '"Zucchelli, Alberto"'
Search Results
2. Instrumental evaluation of gait smoothness and history of falling in older persons: results from an exploratory case–control study
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Zucchelli, Alberto, Lucente, Daniela, Filippini, Chiara, Marengoni, Alessandra, and Lopomo, Nicola Francesco
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- 2023
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3. Risk factors for multimorbidity in adulthood: A systematic review
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Tazzeo, Clare, Zucchelli, Alberto, Vetrano, Davide Liborio, Demurtas, Jacopo, Smith, Lee, Schoene, Daniel, Sanchez-Rodriguez, Dolores, Onder, Graziano, Balci, Cafer, Bonetti, Silvia, Grande, Giulia, Torbahn, Gabriel, Veronese, Nicola, and Marengoni, Alessandra
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- 2023
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4. Frailty, multimorbidity patterns and mortality in institutionalized older adults in Italy
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Damiano, Cecilia, Onder, Graziano, Zazzara, Maria Beatrice, Carfì, Angelo, Zucchelli, Alberto, Marengoni, Alessandra, and Vetrano, Davide L.
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- 2022
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5. Health trajectories in older patients hospitalized for COVID-19: Results from the GeroCovid multicenter study
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Trevisan, Caterina, Tonarelli, Francesco, Zucchelli, Alberto, Parrotta, Ilaria, Calvani, Riccardo, Malara, Alba, Monzani, Fabio, Gareri, Pietro, Zia, Gianluca, and Antonelli Incalzi, Raffaele
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- 2023
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6. COVID-19 as an effect modifier of the relationship between age and in-hospital survival in older patients admitted to an Italian Emergency Department
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Zucchelli, Alberto, Sepe, Catello, Tarozzi, Luca, Garelli, Anna, Benedusi, Francesca, Pignataro, Samuele, Paolillo, Ciro, and Marengoni, Alessandra
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- 2022
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7. Multimorbidity Patterns and 5-Year Mortality in Institutionalized Older Adults
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Vetrano, Davide L., Damiano, Cecilia, Tazzeo, Clare, Zucchelli, Alberto, Marengoni, Alessandra, Luo, Hao, Zazzara, Maria Beatrice, van Hout, Hein, and Onder, Graziano
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- 2022
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8. The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017
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Zucchelli, Alberto, Manzoni, F., Morandi, A., Di Santo, S., Rossi, E., Valsecchi, M. G., Inzitari, M., Cherubini, A., Bo, M., Mossello, E., Marengoni, A., and Bellelli, G.
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- 2022
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9. Multimorbidity Patterns and 6-Year Risk of Institutionalization in Older Persons: The Role of Social Formal and Informal Care
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Marengoni, Alessandra, Tazzeo, Clare, Calderón-Larrañaga, Amaia, Roso-Llorach, Albert, Onder, Graziano, Zucchelli, Alberto, Rizzuto, Debora, and Vetrano, Davide Liborio
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- 2021
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10. Patterns of oral corticosteroids use in primary care patients with severe asthma
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Vetrano, Davide L., Zucchelli, Alberto, Bianchini, Elisa, Marconi, Ettore, Lombardo, Francesco P., Cricelli, Claudio, and Lapi, Francesco
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- 2020
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11. Predictors of iron-deficiency anemia in primary care older adults: a real-world European multi-country longitudinal study
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Vetrano, Davide L., Zucchelli, Alberto, Marconi, Ettore, Levi, Miriam, Pegoraro, Valeria, Cataldo, Nazarena, Heiman, Franca, Cricelli, Claudio, and Lapi, Francesco
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- 2020
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12. CT based radiomic approach on first line pembrolizumab in lung cancer
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Zerunian, Marta, Caruso, Damiano, Zucchelli, Alberto, Polici, Michela, Capalbo, Carlo, Filetti, Marco, Mazzuca, Federica, Marchetti, Paolo, and Laghi, Andrea
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- 2021
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13. Hospital Care of Older Patients With COPD: Adherence to International Guidelines for Use of Inhaled Bronchodilators and Corticosteroids
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Mannucci, Pier Mannuccio, Nobili, Alessandro, Tettamanti, Mauro, Pasina, Luca, Franchi, Carlotta, Corrao, Salvatore, Marengoni, Alessandra, Salerno, Francesco, Cesari, Matteo, Perticone, Francesco, Licata, Giuseppe, Violi, Francesco, Corazza, Gino Roberto, Cortesi, Laura, Ardoino, Ilaria, Prisco, Domenico, Silvestri, Elena, Cenci, Caterina, Emmi, Giacomo, Biolo, Gianni, Zanetti, Michela, Guadagni, Martina, Zaccari, Michele, Vanoli, Massimo, Grignani, Giulia, Pulixi, Edoardo Alessandro, Bernardi, Mauro, Bassi, Silvia Li, Santi, Luca, Zaccherini, Giacomo, Mannarino, Elmo, Lupattelli, Graziana, Bianconi, Vanessa, Paciullo, Francesco, Nuti, Ranuccio, Valenti, Roberto, Ruvio, Martina, Cappelli, Silvia, Palazzuoli, Alberto, Olivieri, Oliviero, Girelli, Domenico, Matteazzi, Thomas, Barbagallo, Mario, Dominguez, Ligia, Cocita, Floriana, Beneduce, Vincenza, Plances, Lidia, Zoli, Marco, Lazzari, Ilaria, Brunori, Mattia, Pasini, Franco Laghi, Capecchi, Pier Leopoldo, Palasciano, Giuseppe, Modeo, Maria Ester, Di Gennaro, Carla, Cappellini, Maria Domenica, Maira, Diletta, Di Stefano, Valeria, Fabio, Giovanna, Seghezzi, Sonia, Mancarella, Marta, Rossi, Paolo Dionigi, Damanti, Sarah, Clerici, Marta, Conti, Federica, Miceli, Emanuela, Lenti, Marco Vincenzo, Pisati, Martina, Dominioni, Costanza Caccia, Murialdo, Giovanni, Marra, Alessio, Cattaneo, Federico, Pontremoli, Roberto, Secchi, Maria Beatrice, Ghelfi, Davide, Anastasio, Luigi, Sofia, Lucia, Carbone, Maria, Cipollone, Francesco, Guagnano, Maria Teresa, Angelucci, Ermanno, Valeriani, Emanuele, Mancuso, Gerardo, Calipari, Daniela, Bartone, Mosè, Delitala, Giuseppe, Berria, Maria, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Zuccalà, Giuseppe, D’Aurizio, Gabriella, Romanelli, Giuseppe, Zucchelli, Alberto, Picardi, Antonio, Gentilucci, Umberto Vespasiani, Gallo, Paolo, Dell’Unto, Chiara, Annoni, Giorgio, Corsi, Maurizio, Bellelli, Giuseppe, Zazzetta, Sara, Mazzola, Paolo, Szabo, Hajnalka, Bonfanti, Alessandra, Arturi, Franco, Succurro, Elena, Rubino, Mariangela, Serra, Maria Grazia, Bleve, Maria Antonietta, Gasbarrone, Laura, Sajeva, Maria Rosaria, Brucato, Antonio, Ghidoni, Silvia, Fabris, Fabrizio, Bertozzi, Irene, Bogoni, Giulia, Rabuini, Maria Victoria, Cosi, Elisabetta, Manfredini, Roberto, Fabbian, Fabio, Boari, Benedetta, De Giorgi, Alfredo, Tiseo, Ruana, Paolisso, Giuseppe, Rizzo, Maria Rosaria, Borghi, Claudio, Strocchi, Enrico, De Sando, Valeria, Pareo, Ilenia, Sabbà, Carlo, Vella, Francesco Saverio, Suppressa, Patrizia, Agosti, Pasquale, Schilardi, Andrea, Loparco, Francesca, Fenoglio, Luigi, Bracco, Christian, Giraudo, Alessia Valentina, Fargion, Silvia, Periti, Giulia, Porzio, Marianna, Tiraboschi, Slivia, Peyvandi, Flora, Rossio, Raffaella, Ferrari, Barbara, Colombo, Giulia, Monzani, Valter, Savojardo, Valeria, Folli, Christian, Ceriani, Giuliana, Pallini, Giada, Dallegri, Franco, Ottonello, Luciano, Liberale, Luca, Caserza, Lara, Salam, Kassem, Liberato, Nicola Lucio, Tognin, Tiziana, Bianchi, Giovanni Battista, Giaquinto, Sabrina, Purrello, Francesco, Di Pino, Antonino, Piro, Salvatore, Rozzini, Renzo, Falanga, Lina, Spazzini, Elena, Ferrandina, Camillo, Montrucchio, Giuseppe, Petitti, Paolo, Salmi, Raffaella, Gaudenzi, Piergiorgio, Perri, Ludovica, Landolfi, Raffaele, Montalto, Massimo, Mirijello, Antonio, Guasti, Luigina, Castiglioni, Luana, Maresca, Andrea, Squizzato, Alessandro, Molaro, Marta, Grossi, Alessandra, Bertolotti, Marco, Mussi, Chiara, Libbra, Maria Vittoria, Dondi, Giulia, Pellegrini, Elisa, Carulli, Lucia, Colangelo, Lidia, Falbo, Tania, Stanghellini, Vincenzo, De Giorgio, Roberto, Ruggeri, Eugenio, Vecchio, Sara del, Salvi, Andrea, Leonardi, Roberto, Damiani, Giampaolo, Gabrielli, Armando, Capeci, William, Mattioli, Massimo, Martino, Giuseppe Pio, Biondi, Lorenzo, Pettinari, Pietro, Ghio, Riccardo, Col, Anna Dal, Minisola, Salvatore, Colangelo, Luciano, Afeltra, Antonella, Marigliano, Benedetta, Pipita, Maria Elena, Castellino, Pietro, Blanco, Julien, Zanoli, Luca, Pignataro, Samuele, Saracco, Valter, Fogliati, Marisa, Bussolino, Carlo, Mete, Francesca, Gino, Miriam, Cittadini, Antonio, Vigorito, Carlo, Arcopinto, Michele, Salzano, Andrea, Bobbio, Emanuele, Marra, Alberto Maria, Sirico, Domenico, Moreo, Guido, Gasparini, Francesca, Prolo, Silvia, Pina, Gloria, Ballestrero, Alberto, Ferrando, Fabio, Berra, Sergio, Dassi, Simonetta, Nava, Maria Cristina, Graziella, Bruno, Baldassarre, Stefano, Fragapani, Salvatore, Gruden, Gabriella, Galanti, Giorgio, Mascherini, Gabriele, Petri, Cristian, Stefani, Laura, Girino, Margherita, Piccinelli, Valeria, Nasso, Francesco, Gioffrè, Vincenza, Pasquale, Maria, Scattolin, Giuseppe, Martinelli, Sergio, Turrin, Mauro, Sechi, Leonardo, Catena, Cristina, Colussi, Gianluca, Passariello, Nicola, Rinaldi, Luca, Berti, Franco, Famularo, Giuseppe, Patrizia, Tarsitani, Castello, Roberto, Pasino, Michela, Ceda, Gian Paolo, Maggio, Marcello Giuseppe, Morganti, Simonetta, Artoni, Andrea, Del Giacco, Stefano, Firinu, Davide, Losa, Francesca, Paoletti, Giovanni, Montalto, Giuseppe, Licata, Anna, Malerba, Valentina, Antonino, Lasco, Basile, Giorgio, Antonino, Catalano, Malatino, Lorenzo, Stancanelli, Benedetta, Terranova, Valentina, Di Marca, Salvatore, Mecocci, Patrizia, Ruggiero, Carmelinda, Boccardi, Virginia, Meschi, Tiziana, Lauretani, Fulvio, Ticinesi, Andrea, Minuz, Pietro, Fondrieschi, Luigi, Pirisi, Mario, Fra, Gian Paolo, Sola, Daniele, Porta, Massimo, Riva, Piero, Quadri, Roberto, Scanzi, Giorgio, Mengoli, Caterina, Provini, Stella, Ricevuti, Laura, Simeone, Emilio, Scurti, Rosa, Tolloso, Fabio, Tarquini, Roberto, Valoriani, Alice, Dolenti, Silvia, Vannini, Giulia, Tedeschi, Alberto, Trotta, Lucia, Volpi, Riccardo, Bocchi, Pietro, Vignali, Alessandro, Harari, Sergio, Lonati, Chiara, Cattaneo, Mara, and Proietti, Marco
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- 2019
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14. Triple inhaled therapy in COPD patients: determinants of prescription in primary care
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Vetrano, Davide L., Zucchelli, Alberto, Bianchini, Elisa, Cricelli, Claudio, Piraino, Alessio, Zibellini, Marco, Ricci, Alberto, Onder, Graziano, and Lapi, Francesco
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- 2019
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15. Frailty predicts short-term survival even in older adults without multimorbidity
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Zucchelli, Alberto, Vetrano, Davide L., Marengoni, Alessandra, Grande, Giulia, Romanelli, Giuseppe, Calderón-Larrañaga, Amaia, Fratiglioni, Laura, and Rizzuto, Debora
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- 2018
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16. Living Longer But Frailer? Temporal Trends in Life Expectancy and Frailty in Older Swedish Adults.
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Tazzeo, Clare, Rizzuto, Debora, Calderón-Larrañaga, Amaia, Dekhtyar, Serhiy, Zucchelli, Alberto, Xia, Xin, Fratiglioni, Laura, and Vetrano, Davide Liborio
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LIFE expectancy ,FRAILTY ,AGE ,CONFIDENCE intervals - Abstract
Background This study aims to examine temporal trends in frailty state transitions, and years spent frail, in older Swedish adults. Methods We followed the Swedish National Study on Aging and Care in Kungsholmen participants from baseline (2001–2004) for 15 (median: 9.6) years. A 40-deficit frailty index (FI) was constructed to identify 3 frailty states: robust (FI ≤ 0.125), mild frailty (0.125 < FI ≤ 0.25), and moderate and severe frailty (FI > 0.25). Multistate survival analyses were implemented to obtain hazard ratios (HRs) for frailty state transitions, with birth year and sex as predictors. To examine temporal trends, frailty state-specific life expectancies at age 60 were forecasted for robust persons born in different years (1900, 1910, 1920, 1930, and 1940), also by sex. Results At baseline, the 2 941 participants' mean age was 75 years and 65% were women. Predicted life expectancy and time spent frail from age 60 followed an increasing trend by birth year. Hazards of transitioning from mild frailty to death (HR: 0.89; 95% confidence interval [CI]: 0.83–0.97) and moderate and severe frailty to death (HR: 0.98; 95% CI: 0.97–1.00) were lower for those born later. Women were less likely to transition from robust to mild frailty (HR: 0.81; 95% CI: 0.70–0.93), mild frailty to moderate and severe frailty (HR: 0.80; 95% CI: 0.68–0.93), and moderate and severe frailty to death (HR: 0.68; 95% CI: 0.59–0.78), but spent more time frail. Conclusions Our results point to an expansion of time spent frail among older Swedish adults over time. [ABSTRACT FROM AUTHOR]
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- 2024
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17. Comparing the prognostic value of geriatric health indicators: a population-based study
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Zucchelli, Alberto, Vetrano, Davide L., Grande, Giulia, Calderón-Larrañaga, Amaia, Fratiglioni, Laura, Marengoni, Alessandra, and Rizzuto, Debora
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- 2019
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18. Beyond Chronological Age: A Multidimensional Approach to Survival Prediction in Older Adults.
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Salignon, Jérôme, Rizzuto, Debora, Calderón-Larrañaga, Amaia, Zucchelli, Alberto, Fratiglioni, Laura, Riedel, Christian G, and Vetrano, Davide L
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AGE ,OLDER people ,RECEIVER operating characteristic curves ,WALKING speed - Abstract
Background There is a growing interest in generating precise predictions of survival to improve the assessment of health and life-improving interventions. We aimed to (a) test if observable characteristics may provide a survival prediction independent of chronological age; (b) identify the most relevant predictors of survival; and (c) build a metric of multidimensional age. Methods Data from 3 095 individuals aged ≥60 from the Swedish National Study on Aging and Care in Kungsholmen. Eighty-three variables covering 5 domains (diseases, risk factors, sociodemographics, functional status, and blood tests) were tested in penalized Cox regressions to predict 18-year mortality. Results The best prediction of mortality at different follow-ups (area under the receiver operating characteristic curves [AUROCs] 0.878–0.909) was obtained when 15 variables from all 5 domains were tested simultaneously in a penalized Cox regression. Significant prediction improvements were observed when chronological age was included as a covariate for 15- but not for 5- and 10-year survival. When comparing individual domains, we find that a combination of functional characteristics (ie, gait speed, cognition) gave the most accurate prediction, with estimates similar to chronological age for 5- (AUROC 0.836) and 10-year (AUROC 0.830) survival. Finally, we built a multidimensional measure of age by regressing the predicted mortality risk on chronological age, which displayed a stronger correlation with time to death (R = −0.760) than chronological age (R = −0.660) and predicted mortality better than widely used geriatric indices. Conclusions Combining easily accessible characteristics can help in building highly accurate survival models and multidimensional age metrics with potentially broad geriatric and biomedical applications. [ABSTRACT FROM AUTHOR]
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- 2023
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19. Technologies for the Instrumental Evaluation of Physical Function in Persons Affected by Chronic Obstructive Pulmonary Disease: A Systematic Review.
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Zucchelli, Alberto, Pancera, Simone, Bianchi, Luca Nicola Cesare, Marengoni, Alessandra, and Lopomo, Nicola Francesco
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CHRONIC obstructive pulmonary disease , *PHYSICAL mobility , *SCIENCE databases , *INHALERS , *NEAR infrared spectroscopy , *MATTRESSES - Abstract
Several systems, sensors, and devices are now available for the instrumental evaluation of physical function in persons with Chronic Obstructive Pulmonary Disease (COPD). We aimed to systematically review the literature about such technologies. The literature search was conducted in all major scientific databases, including articles published between January 2001 and April 2022. Studies reporting measures derived from the instrumental assessment of physical function in individuals with COPD were included and were divided into application and validation studies. The quality of validation studies was assessed with the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) risk of bias tool. From 8752 articles retrieved, 21 application and 4 validation studies were included in the systematic review. Most application studies employed accelerometers, gait analysis systems, instrumented mattresses, or force plates to evaluate walking. Surface electro-myography or near-infrared spectroscopy were employed in four studies. Validation studies were heterogeneous and presented a risk of bias ranging from inadequate to doubtful. A variety of data regarding physical function can be retrieved from technologies used in COPD studies. However, a general lack of standardization and limitations in study design and sample size hinder the implementation of the instrumental evaluation of function in clinical practice. [ABSTRACT FROM AUTHOR]
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- 2022
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20. Mechanical Ventilation in COVID-19 Patients: Insights into the Role of Age and Frailty from a Multicentre Observational Study.
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Ecarnot, Fiona, Rebora, Paola, Focà, Emanuele, Zucchelli, Alberto, Citerio, Giuseppe, Grazia Valsecchi, Maria, Marengoni, Alessandra, and Bellelli, Giuseppe
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COVID-19 pandemic ,FRAGILITY (Psychology) ,AGE groups ,HOSPITAL care - Abstract
In patients with COVID-19, frailty has been shown to better predict outcomes than age alone. We investigated factors associated with mechanical ventilation (MV) during hospitalization for COVID-19 among older adults in a multicentre study during the first two waves in Italy. Using data from the FRACOVID project, we included consecutive patients admitted to the participating centres during the first and second waves. We recorded sociodemographics, comorbidities, time since symptom onset, ventilatory support at admission, and chest X-ray findings. Frailty was assessed using a frailty index (FI). Results are reported as hazard ratios (HR) with 95%CI. 1,344 patients were included; 487 females (36.2%), median age 68 (56; 79) years; 52.4% had hypertension, 10.6% had chronic obstructive pulmonary disease, 15.2% were obese. Median FI was 0.088 (0.03, 0.20), and 67% had bilateral consolidations at admission. Median time since symptom onset was 7 days (4, 10). During hospitalization, 47 patients (3.6%, 95%CI 0.33-13.6%) received MV. Multivariable Cox regression analysis found that the likelihood of intubation decreased with increasing age (HR 0.945 (95%CI 0.921-0.969), p<0.0001), while heart rate >110bpm (HR 3.429 (95%CI 1.583-7.429), p=0.0018), and need for continuous positive airway pressure (CPAP) at admission (HR 2.626 (95%CI 1.330-5.186), p=0.0054) were significantly associated with a greater likelihood of intubation. Older patients are less likely to receive intubation, while those with heart rate >110 bpm and need for CPAP at admission are more likely to receive MV during hospitalization for COVID-19. [ABSTRACT FROM AUTHOR]
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- 2022
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21. Prevalence of use and appropriateness of antidepressants prescription in acutely hospitalized elderly patients
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Mannucci, Pier Mannuccio, Nobili, Alessandro, Pietrangelo, Antonello, Perticone, Francesco, Licata, Giuseppe, Violi, Francesco, Corazza, Gino Roberto, Corrao, Salvatore, Marengoni, Alessandra, Salerno, Francesco, Cesari, Matteo, Tettamanti, Mauro, Pasina, Luca, Franchi, Carlotta, Cortesi, Laura, Miglio, Gabriella, Ardoino, Ilaria, Novella, Alessio, Prisco, Domenico, Silvestri, Elena, Emmi, Giacomo, Bettiol, Alessandra, Caterina, Cenci, Biolo, Gianni, Zanetti, Michela, Guadagni, Martina, Zaccari, Michele, Chiuch, Massimiliano, Vanoli, Massimo, Grignani, Giulia, Pulixi, Edoardo Alessandro, Bernardi, Mauro, Bassi, Silvia Li, Santi, Luca, Zaccherini, Giacomo, Lupattelli, Graziana, Mannarino, Elmo, Bianconi, Vanessa, Paciullo, Francesco, Alcidi, Riccardo, Nuti, Ranuccio, Valenti, Roberto, Ruvio, Martina, Cappelli, Silvia, Palazzuoli, Alberto, Girelli, Domenico, Busti, Fabiana, Marchi, Giacomo, Barbagallo, Mario, Dominguez, Ligia, Cocita, Floriana, Beneduce, Vincenza, Plances, Lidia, Natoli, Giuseppe, Mularo, Salvatore, Raspanti, Massimo, Cavallaro, Federica, Zoli, Marco, Lazzari, Ilaria, Brunori, Mattia, Fabbri, Elisa, Magalotti, Donatella, Arnò, Raffaella, Pasini, Franco Laghi, Capecchi, Pier Leopoldo, Palasciano, Giuseppe, Modeo, Maria Ester, Gennaro, Carla Di, Cappellini, Maria Domenica, Maira, Diletta, Di Stefano, Valeria, Fabio, Giovanna, Seghezzi, Sonia, Mancarella, Marta, De Amicis, Margherita Migone, De Luca, Giacomo, Scaramellini, Natalia, Rossi, Paolo Dionigi, Damanti, Sarah, Clerici, Marta, Conti, Federica, Bonini, Giulia, Ottolini, Barbara Brignolo, Di Sabatino, Antonio, Miceli, Emanuela, Lenti, Marco Vincenzo, Pisati, Martina, Dominioni, Costanza Caccia, Murialdo, Giovanni, Marra, Alessio, Cattaneo, Federico, Pontremoli, Roberto, Beccati, Valentina, Nobili, Giulia, Secchi, Maria Beatrice, Ghelfi, Davide, Anastasio, Luigi, Sofia, Lucia, Carbone, Maria, Cipollone, Francesco, Guagnano, Maria Teresa, Valeriani, Emanuele, Rossi, Ilaria, Mancuso, Gerardo, Calipari, Daniela, Bartone, Mosè, Delitala, Giuseppe, Berria, Maria, Pes, Chiara, Delitala, Alessandro, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Zuccalà, Giuseppe, D’Aurizio, Gabriella, Romanelli, Giuseppe, Zucchelli, Alberto, Manzoni, Francesca, Volpini, Andrea, Picardi, Antonio, Gentilucci, Umberto Vespasiani, Gallo, Paolo, Dell’Unto, Chiara, Annoni, Giorgio, Corsi, Maurizio, Bellelli, Giuseppe, Zazzetta, Sara, Mazzola, Paolo, Szabo, Hajnalka, Bonfanti, Alessandra, Arturi, Franco, Succurro, Elena, Rubino, Mariangela, Tassone, Bruno, Sesti, Giorgio, Interna, Medicina, Serra, Maria Grazia, Bleve, Maria Antonietta, Gasbarrone, Laura, Sajeva, Maria Rosaria, Brucato, Antonio, Ghidoni, Silvia, Fabris, Fabrizio, Bertozzi, Irene, Bogoni, Giulia, Rabuini, Maria Victoria, Cosi, Elisabetta, Scarinzi, Paolo, Amabile, Annalisa, Omenetto, Elisabetta, Prandini, Tancredi, Manfredini, Roberto, Fabbian, Fabio, Boari, Benedetta, Giorgi, Alfredo De, Tiseo, Ruana, De Giorgio, Roberto, Paolisso, Giuseppe, Rizzo, Maria Rosaria, Borghi, Claudio, Strocchi, Enrico, Ianniello, Eugenia, Soldati, Mario, Sabbà, Carlo, Vella, Francesco Saverio, Suppressa, Patrizia, Schilardi, Andrea, Loparco, Francesca, De Vincenzo, Giovanni Michele, Comitangelo, Alessio, Amoruso, Emanuele, Fenoglio, Luigi, Falcetta, Andrea, Bracco, Christian, Fracanzani, Anna L., Fargion, Silvia, Tiraboschi, Silvia, Cespiati, Annalisa, Oberti, Giovanna, Sigon, Giordano, Peyvandi, Flora, Rossio, Raffaella, Ferrari, Barbara, Colombo, Giulia, Agosti, Pasquale, Monzani, Valter, Savojardo, Valeria, Folli, Christian, Ceriani, Giuliana, Pallini, Giada, Dallegri, Franco, Ottonello, Luciano, Liberale, Luca, Caserza, Lara, Salam, Kassem, Liberato, Nicola Lucio, Tognin, Tiziana, Bianchi, Giovanni Battista, Giaquinto, Sabrina, Purrello, Francesco, Di Pino, Antonino, Piro, Salvatore, Rozzini, Renzo, Falanga, Lina, Spazzini, Elena, Ferrandina, Camillo, Montrucchio, Giuseppe, Petitti, Paolo, Peasso, Paolo, Favale, Edoardo, Poletto, Cesare, Salmi, Raffaella, Gaudenzi, Piergiorgio, Perri, Ludovica, Landolfi, Raffaele, Montalto, Massimo, Mirijello, Antonio, Guasti, Luigina, Castiglioni, Luana, Maresca, Andrea, Squizzato, Alessandro, Campiotti, Leonardo, Grossi, Alessandra, Bertolotti, Marco, Mussi, Chiara, Lancellotti, Giulia, Libbra, Maria Vittoria, Dondi, Giulia, Pellegrini, Elisa, Carulli, Lucia, Galassi, Matteo, Grassi, Yasmine, Perticone, Maria, Battaglia, Rosa, FIlice, Marco, Maio, Raffaele, Stanghellini, Vincenzo, Ruggeri, Eugenio, del Vecchio, Sara, Salvi, Andrea, Leonardi, Roberto, Damiani, Giampaolo, Capeci, William, Gabrielli, Armando, Mattioli, Massimo, Martino, Giuseppe Pio, Biondi, Lorenzo, Pettinari, Pietro, Ghio, Riccardo, Col, Anna Dal, Minisola, Salvatore, Colangelo, Luciano, Cilli, Mirella, Labbadia, Giancarlo, Afeltra, Antonella, Marigliano, Benedetta, Pipita, Maria Elena, Castellino, Pietro, Zanoli, Luca, Pignataro, Samuele, Gennaro, Alfio, Blanco, Julien, Saracco, Valter, Fogliati, Marisa, Bussolino, Carlo, Mete, Francesca, Gino, Miriam, Cittadini, Antonio, Vigorito, Carlo, Arcopinto, Michele, Salzano, Andrea, Bobbio, Emanuele, Marra, Alberto Maria, Sirico, Domenico, Moreo, Guido, Gasparini, Francesca, Prolo, Silvia, Pina, Gloria, Ballestrero, Alberto, Ferrando, Fabio, Berra, Sergio, Dassi, Simonetta, Nava, Maria Cristina, Graziella, Bruno, Baldassarre, Stefano, Fragapani, Salvatore, Gruden, Gabriella, Galanti, Giorgio, Mascherini, Gabriele, Petri, Cristian, Stefani, Laura, Girino, Margherita, Piccinelli, Valeria, Nasso, Francesco, Gioffrè, Vincenza, Pasquale, Maria, Scattolin, Giuseppe, Martinelli, Sergio, Turrin, Mauro, Sechi, Leonardo, Catena, Cristina, Colussi, Gianluca, Passariello, Nicola, Rinaldi, Luca, Berti, Franco, Famularo, Giuseppe, Tarsitani, Patrizia, Castello, Roberto, Pasino, Michela, Ceda, Gian Paolo, Maggio, Marcello Giuseppe, Morganti, Simonetta, Artoni, Andrea, Del Giacco, Stefano, Firinu, Davide, Losa, Francesca, Paoletti, Giovanni, Costanzo, Giulia, Montalto, Giuseppe, Licata, Anna, Malerba, Valentina, Montalto, Filippo Alessandro, Lasco, Antonino, Basile, Giorgio, Catalano, Antonino, Malatino, Lorenzo, Stancanelli, Benedetta, Terranova, Valentina, Di Marca, Salvatore, Di Quattro, Rosario, La Malfa, Lara, Caruso, Rossella, Mecocci, Patrizia, Ruggiero, Carmelinda, Boccardi, Virginia, Meschi, Tiziana, Lauretani, Fulvio, Ticinesi, Andrea, Nouvenne, Antonio, Minuz, Pietro, Fondrieschi, Luigi, Pirisi, Mario, Fra, Gian Paolo, Sola, Daniele, Porta, Massimo, Riva, Piero, Quadri, Roberto, Larovere, Erica, Novelli, Marco, Scanzi, Giorgio, Mengoli, Caterina, Provini, Stella, Ricevuti, Laura, Simeone, Emilio, Scurti, Rosa, Tolloso, Fabio, Tarquini, Roberto, Valoriani, Alice, Dolenti, Silvia, Vannini, Giulia, Tedeschi, Alberto, Trotta, Lucia, Volpi, Riccardo, Bocchi, Pietro, Vignali, Alessandro, Harari, Sergio, Lonati, Chiara, Cattaneo, Mara, Napoli, Federico, Carlotta, Franchi, Raffaella, Rossio, Ilaria, Ardoino, Alessandro, Nobili, and Mannuccio, Mannucci Pier
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- 2019
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22. The effect of frailty on in-hospital and medium-term mortality of patients with COronaVIrus Disease-19: the FRACOVID study.
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REBORA, Paola, FOCÀ, Emanuele, TORI, Andrea SALVA, ZUCCHELLI, Alberto, OLO, Isabella CERAV, ORNAGO, Alice M., FINAZZI, Alberto, ARSUFFI, Stefania, BONFANTI, Paolo, CITERIO, Giuseppe, MAZZOLA, Paolo, ECARNOT, Fiona, VA LSECCHI, Maria G., MARENGONI, Alessandra, and BELLELLI, Giuseppe
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- 2022
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23. Comorbidity status of deceased COVID-19 in-patients in Italy.
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Vetrano, Davide Liborio, Tazzeo, Clare, Palmieri, Luigi, Marengoni, Alessandra, Zucchelli, Alberto, Lo Noce, Cinzia, Onder, Graziano, Italian National Institute of Health Covid-Mortality Group, Andrianou, Xanthi, Barbariol, Pierfrancesco, Bella, Antonino, Bellino, Stefania, Benelli, Eva, Bertinato, Luigi, Boros, Stefano, Brambilla, Gianfranco, Calcagnini, Giovanni, Canevelli, Marco, Castrucci, Maria Rita, and Censi, Federica
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Background: Most COVID-19-related deaths have occurred in older persons with comorbidities. Specific patterns of comorbidities related to COVID-19 deaths have not been investigated. Methods: A random sample of 6085 individuals in Italy who died in-hospital with confirmed COVID-19 between February and December 2020 were included. Observed to expected (O/E) ratios of disease pairs were computed and logistic regression models were used to determine the association between disease pairs with O/E values ≥ 1.5. Results: Six pairs of diseases exhibited O/E values ≥ 1.5 and statistically significant higher odds of co-occurrence in the crude and adjusted analyses: (1) ischemic heart disease and atrial fibrillation, (2) atrial fibrillation and heart failure, (3) atrial fibrillation and stroke, (4) heart failure and COPD, (5) stroke and dementia, and (6) type 2 diabetes and obesity. Conclusion: In those deceased in-hospital due to COVID-19 in Italy, disease combinations defined by multiple cardio-respiratory, metabolic, and neuropsychiatric diseases occur more frequently than expected. This finding indicates a need to investigate the possible role of these clinical profiles in the chain of events that lead to death in individuals who have contracted SARS-CoV-2. [ABSTRACT FROM AUTHOR]
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- 2021
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24. Multimorbidity burden and dementia risk in older adults: The role of inflammation and genetics.
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Grande, Giulia, Marengoni, Alessandra, Vetrano, Davide L., Roso‐Llorach, Albert, Rizzuto, Debora, Zucchelli, Alberto, Qiu, Chengxuan, Fratiglioni, Laura, and Calderón‐Larrañaga, Amaia
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Introduction: We investigate dementia risk in older adults with different disease patterns and explore the role of inflammation and apolipoprotein E (APOE) genotype. Methods: A total of 2,478 dementia‐free participants with two or more chronic diseases (ie, multimorbidity) part of the Swedish National study on Aging and Care in Kungsholmen (SNAC‐K) were grouped according to their multimorbidity patterns and followed to detect clinical dementia. The potential modifier effect of C‐reactive protein (CRP) and apolipoprotein E (APOE) genotype was tested through stratified analyses. Results: People with neuropsychiatric, cardiovascular, and sensory impairment/cancer multimorbidity had increased hazards for dementia compared to the unspecific (Hazard ration (HR) 1.66, 95% confidence interval [CI] 1.13‐2.42; 1.61, 95% CI 1.17‐2.29; 1.32, 95% CI 1.10‐1.71, respectively). Despite the lack of statistically significant interaction, high CRP increased dementia risk within these patterns, and being APOE ε4 carriers heightened dementia risk for neuropsychiatric and cardiovascular multimorbidity. Discussion: Individuals with neuropsychiatric, cardiovascular, and sensory impairment/cancer patterns are at increased risk for dementia and APOE ε4, and inflammation may further increase the risk. Identifying such high‐risk groups might allow tailored interventions for dementia prevention. [ABSTRACT FROM AUTHOR]
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- 2021
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25. Beyond Chronological Age: Frailty and Multimorbidity Predict In-Hospital Mortality in Patients With Coronavirus Disease 2019.
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Marengoni, Alessandra, Zucchelli, Alberto, Vetrano, Davide Liborio, Armellini, Andrea, Botteri, Emanuele, Nicosia, Franco, Romanelli, Giuseppe, Beindorf, Eva Andrea, Giansiracusa, Paola, Garrafa, Emirena, Ferrucci, Luigi, Fratiglioni, Laura, Bernabei, Roberto, and Onder, Graziano
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COVID-19 , *HOSPITAL mortality , *AGE , *COMORBIDITY , *DEATH rate - Abstract
Background: We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age.Method: A total of 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Predisease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of ≥2 diseases in the same patient. The hazard ratio (HR) of in-hospital mortality as a function of CFS score and number of chronic diseases in the whole population and in those aged 70+ years were calculated.Results: Among the 165 patients, 112 were discharged, 11 were transferred to intensive care units, and 42 died. Patients who died were older (81.0 vs 65.2 years, p < .001), more frequently multimorbid (97.6 vs 52.8%; p < .001), and more likely frail (37.5 vs 4.1%; p < .001). Less than 2.0% of patients without multimorbidity and frailty, 28% of those with multimorbidity only, and 75% of those with both multimorbidity and frailty died. Each unitary increment in the CFS was associated with a higher risk of in-hospital death in the whole sample (HR = 1.3; 95% CI = 1.05-1.62) and in patients aged 70+ years (HR = 1.29; 95% CI = 1.04-1.62), whereas the number of chronic diseases was not significantly associated with higher risk of death. The CFS addition to age and sex increased mortality prediction by 9.4% in those aged 70+ years.Conclusions: Frailty identifies patients with COVID-19 at risk of in-hospital death independently of age. Multimorbidity contributes to prognosis because of the very low probability of death in its absence. [ABSTRACT FROM AUTHOR]- Published
- 2021
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26. The impact of delirium on outcomes for older adults hospitalised with COVID-19.
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Marengoni, Alessandra, Zucchelli, Alberto, Grande, Giulia, Fratiglioni, Laura, and Rizzuto, Debora
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DELIRIUM , *GERIATRICS , *HOSPITAL patients , *LENGTH of stay in hospitals , *EVALUATION of medical care , *POLYMERASE chain reaction , *MULTIPLE regression analysis , *REVERSE transcriptase polymerase chain reaction , *DESCRIPTIVE statistics , *COVID-19 , *OLD age - Abstract
Introduction Delirium is a frequent condition in hospitalized older patients and it usually has a negative prognostic value. A direct effect of SARS-COV-2 on the central nervous system (CNS) has been hypothesized. Objective To evaluate the presence of delirium in older patients admitted for a suspected diagnosis of COVID-19 and its impact on in-hospital mortality. Setting and subjects 91 patients, aged 70-years and older, admitted to an acute geriatric ward in Northern Italy from March 8th to April 17th, 2020. Methods COVID-19 cases were confirmed by reverse transcriptase-polymerase chain reaction assay for SARS-Cov-2 RNA from nasal and pharyngeal swabs. Delirium was diagnosed by two geriatricians according to the Diagnostic and Statistical Manual of Mental Disorders V (DMS V) criteria. The number of chronic diseases was calculated among a pre-defined list of 60. The pre-disease Clinical Frailty Scale (CFS) was assessed at hospital admission. Results Of the total sample, 39 patients died, 49 were discharged and 3 were transferred to ICU. Twenty-five patients (27.5%) had delirium. Seventy-two percent of patients with delirium died during hospitalization compared to 31.8% of those without delirium. In a multivariate logistic regression model adjusted for potential confounders, patients with delirium were four times more likely to die during hospital stay compared to those without delirium (OR = 3.98;95%CI = 1.05–17.28; p = 0.047). Conclusions Delirium is common in older patients with COVID-19 and strongly associated with in-hospital mortality. Regardless of causation, either due to a direct effect of SARS-COV-2 on the CNS or to a multifactorial cause, delirium should be interpreted as an alarming prognostic indicator in older people. [ABSTRACT FROM AUTHOR]
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- 2020
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27. Heart failure, frailty, and pre-frailty: A systematic review and meta-analysis of observational studies.
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Marengoni, Alessandra, Zucchelli, Alberto, Vetrano, Davide L., Aloisi, Gaetano, Brandi, Vincenzo, Ciutan, Marius, Panait, Carmen Lavinia, Bernabei, Roberto, Onder, Graziano, and Palmer, Katie
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META-analysis , *SCIENTIFIC observation , *LONGITUDINAL method , *HEART failure patients , *HEART failure , *PUBLICATION bias - Abstract
Frailty is a syndrome characterized by reduced physiological reserves, increased vulnerability to stressors and adverse health outcomes. Frailty can change the prognosis and treatment approach of several chronic diseases, including heart failure (HF). The aim of this study was to conduct a systematic review and meta-analysis assessing the association of HF with frailty and pre-frailty. We employed PRISMA guidelines for reporting the results. We searched PubMed, Web of Science, and Embase from 01/01/2002 to 29/11/2019.The quality of the studies was evaluated with the Newcastle Ottawa Scale. Pooled estimates were obtained through random-effect models and Mantel-Haenszel weighting. Homogeneity (I2) and publication bias were assessed. We selected 54 studies (52 cross-sectional, one longitudinal, and one with both designs). The pooled prevalence of pre-frailty in individuals with HF was 46% (95% CI = 38–53; I2 = 93.1%) and 40% (95% CI = 31–48; I2 = 97%) for frailty. The proportion of pre-frail individuals with HF was 20% (95%CI = 15–25; I2 = 99.2%) and the proportion of frail individuals with HF was 31% (95% CI = 17–45; I2 = 98.7%). Two studies using the same frailty definition reported estimates for the association between frailty and HF (pooled OR = 3.44; 95% CI = 0.75–15.73; I2 = 95.8%). In conclusion, frailty and pre-frailty are frequent in people with HF. Persons with HF have 3.4-fold increased odds of frailty. Longitudinal studies examining bidirectional pathophysiological pathways between HF and frailty are needed to further clarify this relationship and to assess if specific treatment for HF may prevent or delay the onset of frailty and vice versa. • Frailty and pre-frailty are common among individuals affected by heart failure. • Frailty may help risk stratification in patients with heart failure. • Studies investigating their longitudinal association are lacking. [ABSTRACT FROM AUTHOR]
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- 2020
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28. The impact of COVID-19 on health status of home-dwelling elderly patients with dementia in East Lombardy, Italy: results from COVIDEM network.
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Caratozzolo, Salvatore, Zucchelli, Alberto, Turla, Marinella, Cotelli, Maria Sofia, Fascendini, Sara, Zanni, Mara, Bianchetti, Angelo, Psy, Matteo Peli, Rozzini, Renzo, Boffelli, Stefano, Cappuccio, Melania, Psy, Federica Gottardi, Psy, Chiara Vecchi, Bellandi, Daniele, Caminati, Claudia, Gentile, Simona, Psy, Elena Lucchi, Di Fazio, Ignazio, Psy, Marina Zanetti, and Vezzadini, Giuliana
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Background: COVID-19 outbreak has led to severe health burden in the elderly. Age, morbidity and dementia have been associated with adverse outcome. Aims: To evaluate the impact of COVID-19 on health status in home-dwelling patients. Methods: 848 home-dwelling outpatients with dementia contacted from April 27 to 30 and evaluated by a semi-structured interview to evaluate possible health complication due to COVID-19 from February 21 to April 30. Age, sex, education, clinical characteristics (including diagnosis of dementia) and flu vaccination history were obtained from previous medical records. Items regarding change in health status and outcome since the onset of the outbreak were collected. COVID-19 was diagnosed in patients who developed symptoms according to WHO criteria or tested positive at nasal/throat swab if hospitalized. Unplanned hospitalization, institutionalization and mortality were recorded. Results: Patients were 79.7 years old (SD 7.1) and 63.1% were females. Ninety-five (11.2%) patients developed COVID-19-like symptoms. Non COVID-19 and COVID-19 patients differed for frequency of diabetes (18.5% vs. 37.9%, p < 0.001), COPD (7.3% vs. 18.9%, p < 0.001), and previous flu vaccination (56.7% vs. 37.9%, p < 0.001). Diabetes and COPD were positively associated with COVID-19, whereas higher dementia severity and flu vaccination showed an inverse association. Among COVID-19 patients, 42 (44.2%) were hospitalized while 32 (33.7%) died. Non COVID-19 patients' hospitalization and mortality rate were 1.9% and 1.2%, respectively. COVID-19 and COPD were significantly associated with the rate of mortality. Discussion/conclusions: A high proportion of adverse outcome related to COVID-19 was observed in home-dwelling elderly patients with dementia. Active monitoring though telehealth programs would be useful particularly for those at highest risk of developing COVID-19 and its adverse outcomes. [ABSTRACT FROM AUTHOR]
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- 2020
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29. Adherence to COPD free triple inhaled therapy in the real world: a primary care based study.
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Zucchelli, Alberto, Vetrano, Davide L., Bianchini, Elisa, Lombardo, Francesco Paolo, Piraino, Alessio, Zibellini, Marco, Ricci, Alberto, Marengoni, Alessandra, Lapi, Francesco, and Cricelli, Claudio
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OBSTRUCTIVE lung diseases , *PRIMARY care , *PATIENT compliance , *PERIPHERAL vascular diseases , *QUALITY of life - Abstract
Introduction: The development of new pharmacological treatments for chronic obstructive pulmonary disease (COPD) has improved health‐related quality of life of patients. However, suboptimal adherence may limit its potential. Objective: The aim of the present study was to assess the adherence to free triple inhaled therapy and to investigate poor adherence determinants among primary care patients. Methods: Data were derived from a primary care database in Italy. Patients aged 40+ affected by COPD and prescribed with inhaled corticosteroids, long‐acting beta agonists and long‐acting muscarinic antagonists (N = 3177) were enrolled. Low adherence was defined as a proportion of days covered (PDC) by medications prescription lower than 80%. Predictors of low adherence were tested using logistic regression models. Results and conclusions: The 85% of enrolled patients showed poor adherence to free triple inhaled therapy. Comorbidities, such as heart failure (OR 1.78, 95%CI 1.19‐2.75), depression (OR 1.41, 95%CI 1.06‐1.88) and peripheral vascular disease (OR 1.32, 95%CI 1.01‐1.74) were associated with poor adherence. Former (OR 0.52, 95%CI 0.34‐0.78) or current smokers (OR 0.61, 95%CI 0.41‐0.93) and patients with more severe airways obstruction or history of severe exacerbations (OR 0.64, 95%CI 0.52‐0.79) were less likely to exhibit poor adherence. Real‐world adherence to triple inhaled therapy with different inhalers is generally low. Higher GOLD airways obstruction stage and current or former smoking status are associated with increased adherence to treatment. Reduced perceived benefit on symptoms control is probably linked to poorer adherence to free triple therapy. [ABSTRACT FROM AUTHOR]
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- 2020
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30. Depression and heart failure: an intricate relationship.
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Aloisi, Gaetano, Zucchelli, Alberto, Aloisi, Bruno, Romanelli, Giuseppe, and Marengoni, Alessandra
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SEROTONIN uptake inhibitors ,GERIATRIC Depression Scale ,HEART failure ,PSYCHOTHERAPY patients ,BECK Depression Inventory - Abstract
In patients with heart failure (HF), depression is common and associated with adverse outcomes such as reduced adherence to treatment, poor quality of life, increased hospitalizations and elevated mortality. Despite these adverse impacts, depression remain underdiagnosed in HF patients. We performed a target review of the literature to identify the association between HF and depression, to examine the mechanisms that link these two conditions and to identify instruments for an accurate diagnosis and treatment of depression in HF patients. Depression is associated with the development and progression of HF, including increased rates of mortality, mediated by behavioral and pathophysiological mechanisms. The overlap of symptoms between depression and HF often makes the diagnosis of depression difficult and late. Currently, specific guidelines for depression screening in HF patients are lacking, partly because evidences showing that depression screening improves cardiac outcomes are insufficient. European guidelines suggest the early use of instruments such as the Beck Depression Inventory (BDI) and the Geriatric Depression Scale (GDS), both characterized by accuracy and administration simplicity. There is limited evidence of pharmacological treatment and psychotherapy efficacy in patients with HF. However, cognitive-behavioral therapy has been shown to improve outcomes HF patients, and selective serotonin reuptake inhibitors appear safe in this cohort. [ABSTRACT FROM AUTHOR]
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- 2019
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31. Drug Prescription and Delirium in Older Inpatients: Results From the Nationwide Multicenter Italian Delirium Day 2015-2016.
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Aloisi, Gaetano, Marengoni, Alessandra, Morandi, Alessandro, Zucchelli, Alberto, Cherubini, Antonio, Mossello, Enrico, Bo, Mario, Di Santo, Simona G., Mazzone, Andrea, Trabucchi, Marco, Cappa, Stefano, Fimognari, Filippo L., Incalzi, Raffaele Antonelli, Gareri, Pietro, Perticone, Francesco, Campanini, Mauro, Montorsi, Marco, Latronico, Nicola, Zambon, Antonella, and Bellelli, Giuseppe
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- 2019
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32. Special Issue—"Multimorbidity Development and Evolution: Clinical Implications".
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Zucchelli, Alberto, Calderón-Larrañaga, Amaia, and Vetrano, Davide Liborio
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COMORBIDITY , *COVID-19 , *SENIOR housing , *PROGNOSIS , *ARTIFICIAL intelligence - Abstract
Multimorbidity, the co-existence of multiple chronic diseases in the same individual, is not only extremely common in older persons but is also strongly associated with several poor health outcomes [[1]]. Based on data from more than 4750 persons, Ricci-Cabello et al. [[11]] investigated the association between self-reported safety outcomes and multimorbidity. The mixed methods systematic review by González-González and colleagues [[12]] synthesized the results of 22 studies evaluating early clarification of end-of-life care preferences in persons with multimorbidity. [Extracted from the article]
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- 2021
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33. Multimorbidity Patterns and Unplanned Hospitalisation in a Cohort of Older Adults.
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Akugizibwe, Roselyne, Calderón-Larrañaga, Amaia, Roso-Llorach, Albert, Onder, Graziano, Marengoni, Alessandra, Zucchelli, Alberto, Rizzuto, Debora, and Vetrano, Davide L.
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OLDER people ,COMORBIDITY ,CLUSTER analysis (Statistics) ,MENTAL illness ,SLEEP disorders - Abstract
The presence of multiple chronic conditions (i.e., multimorbidity) increases the risk of hospitalisation in older adults. We aimed to examine the association between different multimorbidity patterns and unplanned hospitalisations over 5 years. To that end, 2,250 community-dwelling individuals aged 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) were studied. Participants were grouped into six multimorbidity patterns using a fuzzy c-means cluster analysis. The associations between patterns and outcomes were tested using Cox models and negative binomial models. After 5 years, 937 (41.6%) participants experienced at least one unplanned hospitalisation. Compared to participants in the unspecific multimorbidity pattern, those in the cardiovascular diseases, anaemia and dementia pattern, the psychiatric disorders pattern and the metabolic and sleep disorders pattern presented with a higher hazard of first unplanned hospitalisation (hazard ratio range: 1.49–2.05; p < 0.05 for all), number of unplanned hospitalisations (incidence rate ratio (IRR) range: 1.89–2.44; p < 0.05 for all), in-hospital days (IRR range: 1.91–3.61; p < 0.05 for all), and 30-day unplanned readmissions (IRR range: 2.94–3.65; p < 0.05 for all). Different multimorbidity patterns displayed a differential association with unplanned hospital care utilisation. These findings call for a careful primary care follow-up of older adults with complex multimorbidity patterns. [ABSTRACT FROM AUTHOR]
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- 2020
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34. Early Onset Delirium During Hospitalization Increases In-Hospital and Postdischarge Mortality in COVID-19 Patients: A Multicenter Prospective Study.
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Trevisan C, Grande G, Rebora P, Zucchelli A, Valsecchi MG, Focà E, Ecarnot F, Marengoni A, and Bellelli G
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- Humans, Aged, Prospective Studies, Aftercare, Patient Discharge, Hospitalization, Hospitals, COVID-19, Delirium
- Abstract
Objective: Delirium is a common feature in COVID-19 patients. Although its association with in-hospital mortality has previously been reported, data concerning postdischarge mortality and delirium subtypes are scarce. We evaluated the association between delirium and its subtypes and both in-hospital and postdischarge mortality., Methods: This multicenter longitudinal clinical-based study was conducted in Monza and Brescia, Italy. The study population included 1,324 patients (median age: 68 years) with COVID-19 admitted to 4 acute clinical wards in northern Italy during the first pandemic waves (February 2020 to January 2021). Delirium within 48 hours of hospital admission was assessed through validated scores and/or clinically according to DSM-5 criteria. The association of delirium-and its subtypes-with in-hospital and postdischarge mortality (over a median observation period of 257 [interquartile range: 189-410] days) was evaluated through Cox proportional hazards models., Results: The 223 patients (16.8%) presenting delirium had around 2-fold increased in-hospital (hazard ratio [HR] = 1.94; 95% CI, 1.38-2.73) and postdischarge (HR = 2.01; 95% CI, 1.48-2.73) mortality than those without delirium. All delirium subtypes were associated with greater risk of death compared to the absence of delirium, but hypoactive delirium revealed the strongest associations with both in-hospital (HR = 2.03; 95% CI, 1.32-3.13) and postdischarge (HR = 2.22; 95% CI, 1.52-3.26) mortality., Conclusions: In patients with COVID-19, early onset delirium is associated not only with in-hospital mortality but also with shorter postdischarge survival. This suggests that delirium detection and management are crucial to improving the prognosis of COVID-19 patients., Trial Registration: ClinicalTrials.gov identifier: NCT04412265., (© Copyright 2023 Physicians Postgraduate Press, Inc.)
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- 2023
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35. Development and validation of an electronic database-based frailty index to predict mortality and hospitalization in a population-based study of adults with SARS-CoV-2.
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Rebora P, Scirè CA, Occhino G, Bortolan F, Leoni O, Cideni F, Zucchelli A, Focà E, Marengoni A, Bellelli G, and Valsecchi MG
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Background: Electronic health databases are used to identify people at risk of poor outcomes. Using electronic regional health databases (e-RHD), we aimed to develop and validate a frailty index (FI), compare it with a clinically based FI, and assess its association with health outcomes in community-dwellers with SARS-CoV-2., Methods: Data retrieved from the Lombardy e-RHD were used to develop a 40-item FI (e-RHD-FI) in adults (i.e., aged ≥18 years) with a positive nasopharyngeal swab polymerase chain reaction test for SARS-CoV-2 by May 20, 2021. The considered deficits referred to the health status before SARS-CoV-2. The e-RHD-FI was validated against a clinically based FI (c-FI) obtained from a cohort of people hospitalized with COVID-19 and in-hospital mortality was evaluated. e-RHD-FI performance was evaluated to predict 30-day mortality, hospitalization, and 60-day COVID-19 WHO clinical progression scale, in Regional Health System beneficiaries with SARS-CoV-2., Results: We calculated the e-RHD-FI in 689,197 adults (51.9% females, median age 52 years). On the clinical cohort, e-RHD-FI correlated with c-FI and was significantly associated with in-hospital mortality. In a multivariable Cox model, adjusted for confounders, each 0.1-point increment of e-RHD-FI was associated with increased 30-day mortality (Hazard Ratio, HR 1.45, 99% Confidence Intervals, CI: 1.42-1.47), 30-day hospitalization (HR per 0.1-point increment = 1.47, 99%CI: 1.46-1.49), and WHO clinical progression scale (Odds Ratio = 1.84 of deteriorating by one category, 99%CI 1.80-1.87)., Conclusion: The e-RHD-FI can predict 30-day mortality, 30-day hospitalization, and WHO clinical progression scale in a large population of community-dwellers with SARS-CoV-2 test positivity. Our findings support the need to assess frailty with e-RHD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rebora, Scirè, Occhino, Bortolan, Leoni, Cideni, Zucchelli, Focà, Marengoni, Bellelli and Valsecchi.)
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- 2023
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36. Multimorbidity burden and dementia risk in older adults: The role of inflammation and genetics.
- Author
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Grande G, Marengoni A, Vetrano DL, Roso-Llorach A, Rizzuto D, Zucchelli A, Qiu C, Fratiglioni L, and Calderón-Larrañaga A
- Subjects
- Aged, Aged, 80 and over, Apolipoprotein E4 genetics, C-Reactive Protein analysis, Cohort Studies, Female, Humans, Male, Risk Factors, Sweden, Dementia genetics, Genetic Predisposition to Disease, Genotype, Inflammation, Multimorbidity
- Abstract
Introduction: We investigate dementia risk in older adults with different disease patterns and explore the role of inflammation and apolipoprotein E (APOE) genotype., Methods: A total of 2,478 dementia-free participants with two or more chronic diseases (ie, multimorbidity) part of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were grouped according to their multimorbidity patterns and followed to detect clinical dementia. The potential modifier effect of C-reactive protein (CRP) and apolipoprotein E (APOE) genotype was tested through stratified analyses., Results: People with neuropsychiatric, cardiovascular, and sensory impairment/cancer multimorbidity had increased hazards for dementia compared to the unspecific (Hazard ration (HR) 1.66, 95% confidence interval [CI] 1.13-2.42; 1.61, 95% CI 1.17-2.29; 1.32, 95% CI 1.10-1.71, respectively). Despite the lack of statistically significant interaction, high CRP increased dementia risk within these patterns, and being APOE ε4 carriers heightened dementia risk for neuropsychiatric and cardiovascular multimorbidity., Discussion: Individuals with neuropsychiatric, cardiovascular, and sensory impairment/cancer patterns are at increased risk for dementia and APOE ε4, and inflammation may further increase the risk. Identifying such high-risk groups might allow tailored interventions for dementia prevention., (© 2020 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)
- Published
- 2021
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37. An Incidental Diagnosis of SARS-CoV-2 Pneumonia With Magnetic Resonance Imaging.
- Author
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Di Girolamo M, Muscogiuri E, Zucchelli A, and Laghi A
- Abstract
The Coronavirus disease 2019 (COVID-19) is caused by the human severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. The most common clinical findings related to COVID-19 are fever and cough, with the proportion of patients developing interstitial pneumonia. Other symptoms include dyspnea, expectoration, headache, anosmia, ageusia, myalgia and malaise. To date, the diagnostic criteria for COVID-19 include nasopharyngeal and oropharyngeal swabs. Computed tomography (CT) scans of the thorax showing signs of interstitial pneumonia are important in the management of respiratory disease and in the evaluation of lung involvement. In the literature, there are few cases of COVID-19 pneumonia diagnosis made using magnetic resonance imaging (MRI). In our report, we describe a case of accidental detection of findings related to interstitial pneumonia in a patient who underwent abdominal MRI for other clinical reasons. A 71-year-old woman was referred to our department for an MRI scan of the abdomen as her oncological follow-up. She was asymptomatic at the time of the examination and had passed the triage carried out on all the patients prior to diagnostic tests during the COVID-19 pandemic. The images acquired in the upper abdomen showed the presence of areas of altered signal intensity involving asymmetrically both pulmonary lower lobes, with a patchy appearance and a preferential peripheral subpleural distribution. We considered these features as highly suspicious for COVID-19 pneumonia. The nasopharyngeal swab later confirmed the diagnosis of SARS-CoV-2 infection. There are limited reports about MRI features of COVID-19 pneumonia, considering that high-resolution chest CT is the imaging technique of choice to diagnose pneumonia. Nevertheless, this clinical case confirmed that it is possible to detect MRI signs suggestive of COVID-19 pneumonia. The imaging features described could help in the evaluation of the lung parenchyma to assess the presence of signs suggestive of COVID-19 pneumonia, especially in asymptomatic patients during the pandemic phase of the disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Di Girolamo et al.)
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- 2020
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38. Using a genetic algorithm to derive a highly predictive and context-specific frailty index.
- Author
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Zucchelli A, Marengoni A, Rizzuto D, Calderón-Larrañaga A, Zucchelli M, Bernabei R, Onder G, Fratiglioni L, and Vetrano DL
- Subjects
- Aged, Aged, 80 and over, Female, Frailty epidemiology, Humans, Incidence, Male, Sweden epidemiology, Aging, Algorithms, Frail Elderly statistics & numerical data, Frailty genetics, Geriatric Assessment methods
- Abstract
The frailty index (FI) is one of the most widespread tools used to predict poor, health-related outcomes in older persons. The selection of clinical and functional deficits to include in a FI is mostly based on the users' clinical experience. However, this approach may not be sufficiently accurate to predict health outcomes in particular subgroups of individuals. In this study, we implemented an optimization algorithm, the genetic algorithm , to create a highly performant (FI) based on our prediction goals, rather than on a predetermined clinical selection of deficits, using data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) and 109 potential deficits identified in the dataset. The algorithm was personalized to obtain a FI with high discrimination ability in the prediction of mortality. The resulting FI included 40 deficits and showed areas under the curve consistently higher than 0.80 (range 0.81-0.90) in the prediction of 3-year and 6-year mortality in the whole sample and in sex and age subgroups. This methodology represents a promising opportunity to optimize the exploitation of medical and administrative databases in the construction of clinically relevant frailty indices.
- Published
- 2020
- Full Text
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