12 results on '"Mossello, E"'
Search Results
2. Comparison of different frailty instruments for prediction of functional decline in older hypertensive outpatients (HYPER-FRAIL pilot study 2).
- Author
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Rivasi G, Ceolin L, Turrin G, Tortù V, D'Andria MF, Capacci M, Testa GD, Montali S, Tonarelli F, Brunetti E, Bo M, Romero-Ortuno R, Mossello E, and Ungar A
- Abstract
Background and Aims: Few studies have evaluated frailty in older hypertensive individuals and the most appropriate tools to identify frailty in this population have yet to be identified. This study compared the performance of six frailty instruments in the prediction of 1-year functional decline in older hypertensive outpatients., Methods: The HYPERtension and FRAILty in Older Adults (HYPER-FRAIL) longitudinal pilot study involved hypertensive participants ≥75 years from two geriatric outpatient clinics at Careggi Hospital, Florence, Italy, undergoing identification of frailty with four frailty scales (Fried Frailty Phenotype, Frailty Index [FI], Clinical Frailty Scale [CFS], Frailty Postal Score) and two physical performance tests (Short Physical Performance Battery [SPPB] and gait speed). Prediction of 1-year functional decline (i.e. a ≥ 10-point Barthel Index decrease between baseline and follow-up) was examined based on ROC curve analysis and multivariable logistic regression., Results: Among 116 participants, 24 % reported functional decline. In the ROC curve analyses, FI (AUC=0.76), CFS (AUC=0.77), gait speed (AUC=0.73) and the SPPB (AUC=0.77) achieved the best predictive performance, with FI ≥0.21 and CFS ≥4 showing the highest sensitivity (82 %) and negative predictive value (91 %). Frailty identified with FI, CFS or physical performance tests was associated with an increased risk of 1-year functional decline, independently of baseline functional status and comorbidity burden., Conclusions: FI, CFS and physical performance tests showed similar predictive ability for functional decline in hypertensive outpatients. The CFS and gait speed might be more suitable for clinical use and may be useful to identify non-frail individuals at lower risk of functional decline., Competing Interests: Declaration of competing interest The authors declare they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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3. Lower extremity performance predicts length of hospital stay in older candidates to elective cardiac surgery.
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Baldasseroni S, Di Bari M, Stefàno P, Pratesi A, Mossello E, Ungar A, Del Pace S, Orso F, Herbst A, Lucarelli G, Fumagalli C, Olivo G, and Marchionni N
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- Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Length of Stay, Lower Extremity surgery, Male, Postoperative Complications epidemiology, Postoperative Complications etiology, Prospective Studies, Cardiac Surgical Procedures adverse effects
- Abstract
Introduction: Prolonged hospital stay must be considered as risk factor for poor outcomes after cardiac surgery; different variables have been advocated as predictors of in-hospital stay. Nevertheless, most patients requiring prolonged hospital stay are frail older subjects; thus, we hypothesized a significant influence of pre-operative physical performance, as a frailty measure, on in-hospital stay after elective cardiac surgery., Methods: In a prospective, single-center, cohort study we enrolled patients aged 75+ years referred to our Division of Cardiac Surgery at Careggi University Hospital, for their first elective cardiac surgery. All participants were preoperatively evaluated by a team composed by a cardiac surgeon, a cardiologist, an anaesthesist, and a geriatrician to assess global cardiac surgery risk; lower extremity performance was measured with the Short Physical Performance Battery-SPPB., Results: A total of 518 patients were included in the study. Mean age was 79.5 ± 3.3 years; 256 (49.4%) were women. Isolated coronary by pass graft was performed in 37 patients (7.1%), isolated valve surgery in 115 (22.0%), and combined cardiac surgery procedures in 366 (70,9%). In a multivariable model, SPPB score was strongly associated with hospital length of stay both as continuous, categorized and dichotomous variable (p < 0.001; p = 0.002; p = 0.002 respectively) in all study population, and in subgroup of patients candidate to cardiac surgery considered by the Society of Thoracic Surgeons calculator score (p = 0.023; p = 0.056; p = 0.013 respectively)., Conclusions: Our findings support the use of pre-operative SPPB evaluation before elective cardiac surgery based on the independent ability to predict length of hospital stay., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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4. Truly unexplained falls after evaluation for syncope: A new diagnostic entity with severe prognosis.
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Ungar A, Ceccofiglio A, Mussi C, Bo M, Rivasi G, Rafanelli M, Martone AM, Bellelli G, Nicosia F, Riccio D, Boccardi V, Tonon E, Curcio F, Landi F, Abete P, and Mossello E
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Prognosis, Risk Factors, Dementia complications, Dementia diagnosis, Syncope complications, Syncope etiology
- Abstract
Objective: To compare one-year mortality risk associated with syncope and unexplained fall in older adults with dementia., Methods: 522 patients (aged >65 years) with dementia and history of transient loss of consciousness and/or unexplained falls were evaluated. The diagnosis of syncope was based on European Society of Cardiology guidelines. A "Syncopal Fall" was defined in patients with an initial clinical presentation of unexplained fall, but a final diagnosis of syncope after complete assessment. A "Truly Unexplained Fall" was defined in patients with an initial clinical presentation of unexplained fall, in whom a diagnosis of syncope had been excluded after the diagnostic work-up. One-year follow-up was assessed by phone interview., Results: Follow-up data were available for 501 participants (mean age 83 ± 6 years, 65% female). After a mean follow-up of 324 ± 93 days, death from any cause was reported in 188 participants (24%). Advanced age, male sex, cognitive and functional impairment were associated with a higher mortality rate. Patients with "Truly Unexplained Falls" had a higher mortality risk compared with syncope and "Syncopal Fall". A diagnosis of "Truly Unexplained Falls" remained an independent predictor of one-year all-cause mortality in multivariate model., Conclusions: We propose the novel diagnostic category of "Truly Unexplained Fall", resulting from the application of syncope guidelines to subjects with unexplained falls. This condition in older adults with dementia is a predictor of one-year all-cause mortality. For this new high risk profile, we advice a comprehensive geriatric assessment focused on risk factors for fall, aimed at a possible improvement of prognosis., (Copyright © 2022. Published by Elsevier B.V.)
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- 2022
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5. Monitoring COVID-19 vaccine use in Italian long term care centers: The GeroCovid VAX study.
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Abbatecola AM, Incalzi RA, Malara A, Palmieri A, Di Lonardo A, Fedele G, Stefanelli P, Borselli G, Russo M, Noale M, Fumagalli S, Gareri P, Mossello E, Trevisan C, Volpato S, Monzani F, Coin A, Bellelli G, Okoye C, Del Signore S, Zia G, Bottoni E, Cafariello C, and Onder G
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- Aged, Aged, 80 and over, COVID-19 Vaccines, Humans, Long-Term Care, SARS-CoV-2, COVID-19 prevention & control, Frailty
- Abstract
The COVID-19 pandemic has changed routine care practice for older persons, especially in those with frailty living in long term care (LTC) facilities. Due to the high mortality rates of Nursing home (NH) residents during the first wave of the COVID-19 pandemic, priority for COVID-19 vaccinations was given to this vulnerable population. However, the safety and efficacy of such vaccines in older frail elders remains questionable due to the fact that initial randomized clinical trials (RCTs) for such vaccines did not include this population. This type of discrimination in patient participation in RCTs continues and has been recognized in the literature. Nevertheless, in the context of a worldwide emergency, COVID-19 vaccination in older persons living in LTC facilities may provide a solid basis to protect against negative outcomes, such as COVID-19 infection and death. In this report, we present the protocol of the GeroCovid Vax study, an Italian study that began in February 2021 which is aimed at investigating the safety and efficacy of the anti-SARS-CoV-2 vaccinations in older persons living in LTCs. This protocol specially aims to continuously and closely monitor events related to- and following- the anti-SARS-CoV-2 vaccination in elderly living in LTC facilities. In this report, we will provide information related to the study protocol and describe baseline characteristics of the sample., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
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- 2022
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6. Assessing the impact of COVID-19 on the health of geriatric patients: The European GeroCovid Observational Study.
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Trevisan C, Del Signore S, Fumagalli S, Gareri P, Malara A, Mossello E, Volpato S, Monzani F, Coin A, Bellelli G, Zia G, Ranhoff AH, and Antonelli Incalzi R
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- Adult, Aged, Aged, 80 and over, Female, Humans, Italy epidemiology, Male, Middle Aged, Norway, Retrospective Studies, SARS-CoV-2, Spain epidemiology, Treatment Outcome, COVID-19
- Abstract
Background: Despite the growing evidence on COVID-19, there are still many gaps in the understanding of this disease, especially in individuals in advanced age. We describe the study protocol of GeroCovid Observational, a multi-purpose, multi-setting and multicenter initiative that aims at investigating: risk factors, clinical presentation and outcomes of individuals affected by COVID-19 in acute and residential care settings; best strategies to prevent infection in long-term care facilities; and, impact of the pandemic on neuropsychologic, functional and physical health, and on medical management in outpatients and home care patients at risk of COVID-19, with a special focus on individuals with dementia., Methods: GeroCovid involves individuals aged ≥60 years, at risk of or affected by COVID-19, prospectively or retrospectively observed since March 1
st , 2020. Data are collected in multiple investigational sites across Italy, Spain and Norway, and recorded in a de-identified clinical e-Registry. A common framework was adapted to different care settings: acute wards, long-term care facilities, geriatric outpatient and home care, and outpatient memory clinics., Results: At September 16th , 2020, 66 investigational sites obtained their Ethical Committee approval and 1618 cases (mean age 80.6 [SD=9.0] years; 45% men) have been recorded in the e-Registry. The average inclusion rate since the study start on April 25th , 2020, is 11.2 patients/day. New cases enrollment will ended on December 31st , 2020, and the clinical follow-up will end on June 30th , 2021., Conclusion: GeroCovid will explore relevant aspects of COVID-19 in adults aged ≥60 years with high-quality and comprehensive data, which will help to optimize COVID-19 prevention and management, with practical implications for ongoing and possible future pandemics., Trial Registration: NCT04379440 (clinicaltrial.gov)., (Copyright © 2021. Published by Elsevier B.V.)- Published
- 2021
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7. Are vaccines against COVID-19 tailored to the most vulnerable people?
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Antonelli Incalzi R, Trevisan C, Del Signore S, Volpato S, Fumagalli S, Monzani F, Bellelli G, Gareri P, Mossello E, Malara A, Coin A, Zia G, and Ranhoff AH
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- Aged, COVID-19 Vaccines, Frail Elderly, Humans, SARS-CoV-2, COVID-19, Frailty
- Abstract
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2021
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8. Low Creatinine Potentially Overestimates Glomerular Filtration Rate in Older Fracture Patients: A Plea for an Extensive Use of Cystatin C?
- Author
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Iacomelli I, Giordano A, Rivasi G, Rafanelli M, Tortù V, Cartei A, Rostagno C, Di Bari M, Marchionni N, Mossello E, and Ungar A
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- Aged, Aged, 80 and over, Biomarkers, Creatinine, Cystatin C, Glomerular Filtration Rate, Humans, Prospective Studies, Fractures, Bone, Renal Insufficiency, Chronic
- Abstract
Aim: Muscle mass is frequently reduced in older patients experiencing injurious falls and may further reduce during hospitalization for bone fracture. In these patients, renal function may be overestimated, because it is usually calculated using serum creatinine, which is strictly related to muscle mass. We evaluated if creatinine levels change during hospitalization in older patients with fracture. We also assessed the role of cystatin C as a more appropriate marker of renal function, comparing estimated glomerular filtration rate (eGFR) according to different formulas based on creatinine and/or cystatin C levels., Methods: Patients aged 65+ years, consecutively hospitalized for fracture, were enrolled in a prospective cohort study. Creatinine and cystatin C levels were measured at baseline and in the post-operative period; eGFR was calculated using six equations based on creatinine and/or cystatin C., Results: 425 patients were enrolled (mean age 84 years, mean creatinine 0.97 mg/dL, mean cystatin C 1.53 mg/L). Creatinine levels significantly decreased after surgery (p<0.001), while cystatin C remained stable. According to creatinine-based formulas, eGFR was < 60 mL/min/1.73 m
2 in 29-30% at baseline and only in 17% participants in the post-operative period. Conversely, according to equations including cystatin C, eGFR was < 60 mL/min/1.73 m2 in half to three-quarters of the sample at all assessments., Conclusions: In older fractured patients, creatinine levels decline during hospital stay and may possibly overestimate renal function, whereas cystatin C remains stable. Whether cystatin C is a more reliable marker of renal function in this specific population should be further investigated., (Copyright © 2020. Published by Elsevier B.V.)- Published
- 2021
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9. Covid-19 cases in a no-Covid-19 geriatric acute care setting. A sporadic occurrence?
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Fumagalli S, Salani B, Gabbani L, Mossello E, and Ungar A
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- Aged, Aged, 80 and over, COVID-19, Coronavirus Infections therapy, Female, Humans, Italy, Male, Pandemics, Pneumonia, Viral therapy, Retrospective Studies, SARS-CoV-2, Betacoronavirus, Coronavirus Infections diagnosis, Coronavirus Infections epidemiology, Health Services for the Aged, Hospitalization, Pneumonia, Viral diagnosis, Pneumonia, Viral epidemiology, Tertiary Care Centers
- Abstract
Competing Interests: Declaration of Competing Interests The authors declare they have no conflict of interest.
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- 2020
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10. Renal function and delirium in older fracture patients: different information from different formulas?
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Mossello E, Rivasi G, Tortù V, Giordano A, Iacomelli I, Cavallini MC, Rafanelli M, Ceccofiglio A, Cartei A, Rostagno C, Di Bari M, and Ungar A
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- Aged, Aged, 80 and over, Creatinine, Glomerular Filtration Rate, Humans, Delirium epidemiology, Fractures, Bone, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic epidemiology
- Abstract
Objectives: the association between renal function and delirium has not been investigated in older fracture patients. Creatinine is frequently low in these subjects, which may influence the association between delirium and renal function as estimated with creatinine-based formulas. Cystatin C could be a more reliable filtration marker in these patients., Aim: to confirm the association between renal function and delirium in older fracture patients comparing creatinine- and cystatin-based estimated glomerular filtration rate (eGFR) METHODS: patients aged 65+ requiring surgery for traumatic bone fractures were included. Six equations were used to calculate eGFR, based on serum creatinine and/or cystatin C obtained within 24 h of admission: Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology (CKD-EPI
cr , CKD-EPIcys , CKD-EPIcr-cys ) and Berlin Initiative Study equations (BIS-1, BIS-2). Delirium was identified with a chart-based method., Results: 571 patients (mean age 83) were enrolled. Delirium occurred in the 34% and was associated with a lower eGFR regardless of the equation used. In a multivariable model, the association between moderate renal impairment (eGFR 30-60 ml/min/1.73 m2 ) and delirium remained significant in patients aged 75-84 and only when estimated with cystatin-based or BIS-1 equations. Only dementia was significantly associated with delirium in subjects 85+., Conclusions: in older fracture patients, moderate renal impairment was independently associated with delirium only among subjects aged 75-84, when eGFR was estimated with cystatin-based or BIS 1 equations, and not with the most commonly used equations (MDRD, CKD-EPIcr )., Competing Interests: Declaration of Competing Interest None., (Copyright © 2019. Published by Elsevier B.V.)- Published
- 2020
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11. Differential diagnosis of unexplained falls in dementia: Results of "Syncope & Dementia" registry.
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Mossello E, Ceccofiglio A, Rafanelli M, Riccardi A, Mussi C, Bellelli G, Nicosia F, Bo M, Riccio D, Martone AM, Langellotto A, Tonon E, Noro G, Abete P, and Ungar A
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- Aged, Aged, 80 and over, Dementia drug therapy, Diagnosis, Differential, Female, Geriatric Assessment, Humans, Italy, Logistic Models, Male, Mental Status and Dementia Tests, ROC Curve, Registries, Syncope drug therapy, Accidental Falls statistics & numerical data, Dementia diagnosis, Syncope diagnosis
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- 2018
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12. Different motor tasks impact differently on cognitive performance of older persons during dual task tests.
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Simoni D, Rubbieri G, Baccini M, Rinaldi L, Becheri D, Forconi T, Mossello E, Zanieri S, Marchionni N, and Di Bari M
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- Activities of Daily Living, Analysis of Variance, Biomechanical Phenomena, Cross-Sectional Studies, Exercise Test, Female, Humans, Male, Walking physiology, Aged physiology, Cognition physiology, Gait physiology, Task Performance and Analysis, Verbal Behavior physiology
- Abstract
Background: Dual task paradigm states that the introduction of a second task during a cognitive or motor performance results in a decreased performance in either task. Treadmill walk, often used in clinical applications of dual task testing, has never been compared to overground walk, to ascertain its susceptibility to interference from a second task. We compared the effects of overground and treadmill gait on dual task performance., Methods: Gait kinematic parameters and cognitive performance were obtained in 29 healthy older adults (mean age 75 years, 14 females) when they were walking freely on a sensorized carpet or during treadmill walking with an optoelectronic system, in single task or dual task conditions, using alternate repetition of letters as a cognitive verbal task., Findings: During overground walking, speed, cadence, step length stride length, and double support time (all with P value<0.001) and cognitive performance (number of correct words, P<0.001) decreased substantially from single to dual task testing. When subjects walked at a fixed speed on the treadmill, cadence decreased significantly (P=0.005), whereas cognitive performance remained unaffected., Interpretation: Both motor and cognitive performances decline during dual task testing with overground walking. Conversely, cognitive performance remains unaffected in dual task testing on the treadmill. In the light of current dual task paradigm, these findings may have relevant implication for our understanding of motor control, as they suggest that treadmill walk does not involve brain areas susceptible to interference from the introduction of a cognitive task., (Copyright © 2013 Elsevier Ltd. All rights reserved.)
- Published
- 2013
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