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Background: Frailty is a dynamic age-related condition of increased vulnerability characterized by declines across multiple physiologic systems and associated with an increased risk of death. We compared the predictive accuracy for one-month and one-year all-cause mortality of four frailty instruments in a large population of hospitalized older patients in a prospective multicentre cohort study. Methods and Findings: On 2033 hospitalized patients aged ≥65 years from twenty Italian geriatric units, we calculated the frailty indexes derived from the Study of Osteoporotic Fractures (FI-SOF), based on the cumulative deficits model (FI-CD), based on a comprehensive geriatric assessment (FI-CGA), and the Multidimensional Prognostic Index (MPI). The overall mortality rates were 8.6% after one-month and 24.9% after one-year follow-up. All frailty instruments were significantly associated with one-month and one-year all-cause mortality. The areas under the receiver operating characteristic (ROC) curves estimated from age- and sex-adjusted logistic regression models, accounting for clustering due to centre effect, showed that the MPI had a significant higher discriminatory accuracy than FI-SOF, FI-CD, and FI-CGA after one month (areas under the ROC curves: FI-SOF = 0.685 vs. FI-CD = 0.738 vs. FI-CGA = 0.724 vs. MPI = 0.765, p<0.0001) and one year of follow-up (areas under the ROC curves: FI-SOF = 0.694 vs. FI-CD = 0.729 vs. FI-CGA = 0.727 vs. MPI = 0.750, p<0.0001). The MPI showed a significant higher discriminatory power for predicting one-year mortality also in hospitalized older patients without functional limitations, without cognitive impairment, malnourished, with increased comorbidity, and with a high number of drugs. Conclusions: All frailty instruments were significantly associated with short- and long-term all-cause mortality, but MPI demonstrated a significant higher predictive power than other frailty instruments in hospitalized older patients. [ABSTRACT FROM AUTHOR]

Ischemic preconditioning is the effect of brief ischemic episodes which protect the heart from the following more prolonged ischemic episode. This mechanism is effective in younger but not in aged heart. The age-related reduction of ischemic preconditioning has been demonstrated in experimental models and in elderly patients. Preinfarction angina, a clinical equivalent of ischemic preconditioning, reduces mortality in adult but not in elderly patients with acute myocardial infarction. Physical activity or caloric restriction is partially capable to preserve the cardioprotective effect of ischemic preconditioning in the aging heart. More importantly, physical activity and caloric restriction in tandem action completely preserve the protective mechanism of ischemic preconditioning. Accordingly, the protective mechanism of preinfarction angina is preserved in elderly patients with a high grade of physical activity or a low body-mass index. Thus, both physical activity and caloric restriction are confirmed as powerful anti-aging interventions capable to restore age-dependent reduction of a critical endogenous protective mechanism such as ischemic preconditioning. [ABSTRACT FROM AUTHOR]

In this paper we describe an Italian experience of fetal home monitor, organized using a portable phonocardiography system (product by Pentavox, Hungary), and the method utilized to evaluate its effectiveness in providing quality services and patient satisfaction. Patient satisfaction is an important dimension in the evaluation of quality care delivery. We used phonocardiography technique in our experience of fetal home monitoring as it is non invasive and passive in nature, low-cost and easy to use. A lightweight portable phonocardiograph (Fetaphon-home) was assigned to six selected patients, without effective pregnancy risk to monitor fetal heartbeat, uterine contractions and fetal movements at home or wherever they need it. The selected patients were instructed by trained personnel in the use of the monitoring device. Patients were asked to perform the recording two times a week and to transmit 20-min signal to the reference centre. The home monitoring sessions were performed in addition to the routine surveillance at a gynecologist's office; thus, the home monitoring did not replace clinic visits. The women were requested to fill a satisfaction questionnaire in order to evaluate their quality of life and anxiety state. Preliminary results have shown that home fetal surveillance appreciably reduces the need of travel for patients and consequently their stress. Furthermore, our results suggest that, after a short training, pregnant women are able to record and transmit long traces without troubles. Use of telemedicine system was generally well accepted by pregnant women since it increased the possibility of fetal long-term home surveillance which in turn could increase the efficiency of the service offered to them. [ABSTRACT FROM AUTHOR]

Background: Controversial data are available on the association between mortality, blood pressure and cognitive impairment in the elderly. Objective: To verify the role of blood pressure on mortality in an elderly population with and without cognitive impairment. Methods: A cross-sectional survey with a 6-year mortality evaluation was conducted in a region of southern Italy in elderly subjects with and without cognitive impairment. Subjects were divided into 4 groups on the basis of systolic, diastolic, mean and pulse blood pressure values. Results: Mortality shows a linear relationship with pulse blood pressure and a U-curve shape for diastolic blood pressure. This phenomenon was more evident in subjects with cognitive impairment showing the greatest risk of mortality at the lowest and highest levels of diastolic blood pressure. Conclusion: The study shows that mortality increases linearly with increasing blood pressure in the elderly. In contrast, mortality shows a U-shape curve for diastolic blood pressure; cognitively impaired patients with the lowest and highest diastolic blood pressures show the greatest relative risk of mortality. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Preinfarction angina, a clinical equivalent of ischemic preconditioning, seems to protect against in-hospital death, cardiogenic shock, and the combined endpoints in adult but not in elderly patients with acute myocardial infarction. Experimental evidence indicates that caloric restriction may restore ischemic preconditioning in aged animals. Objective: The objective was to verify whether body mass index (BMI) influences the cardioprotective effect of preinfarction angina in the elderly. Design: We retrospectively studied 820 patients aged = 65 y with acute myocardial infarction by evaluating BMI and major (death and cardiogenic shock) and minor in-hospital outcomes. Results: In-hospital death, cardiogenic shock, and the combined endpoints were not significantly different between elderly patients with and without preinfarction angina. Interestingly, in-hospital death, cardiogenic shock, and the combined endpoints were significantly fewer in elderly patients with than without preinfarction angina in the subset of patients with the lowest BMI (P < 0.01, < 0.01, and < 0.01, respectively). Regression analysis showed that preinfarction angina did not protect against in-hospital death when analyzed in all patients independently of BMI, whereas it was protective in the subset of patients with the lowest BMI (odds ratio: 0.06; 95% CI: 0.00, 0.54). Conclusions: Preinfarction angina does not protect against inhospital death, cardiogenic shock, or the combined endpoints in elderly patients with acute myocardial infarction. With stratification by quartiles of BMI, the protective effect of preinfarction angina is preserved in elderly patients with the lowest BMI. [ABSTRACT FROM AUTHOR]

Background: Spirometry is more and more frequently used for the diagnosis of respiratory diseases in the elderly people. Unfortunately, reliable predictive values for the spirometric variables in the elderly are lacking. Objectives: Data obtained from 429 subjects participating in the multicenter Italian study SARA on respiratory health in the elderly were analyzed in order to derive reference values for spirometry in the age range of 65-85 years. The second aim of this study was to assess the influence of variables describing many dimensions of the health status on the prediction of spirometric variables in that age range. Methods: Subjects were recruited as consecutive outpatients referred during the study period to 24 geriatric or respiratory institutions distributed throughout Italy. Spirometries were performed using the same equipment by specifically trained and certified personnel supervised by a real-time quality control program. In addition to the standard anthropometric variables, covariates describing the affective, mental, and general health conditions were investigated through standardized questionnaires, to improve the modeling of spirometric outcomes. Results: Reliable predictive values for forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were produced (coefficient of determination, for FVC: R² = 0.64; for FEV1: R² = 0.54). The effect of general health conditions on spirometric outcomes accounted for the most part of the between-gender difference in the ageing-dependent decrease in lung function. Conclusions: We suggest that a multidimensional approach to health problems should be used for a better interpretation of spirometric results in the elderly. [ABSTRACT FROM AUTHOR]

Study Objectives: This study investigated to what extent a diagnosis of COPD is erroneously made or the disease remains unrecognized in elderly asthmatic patients, and identified factors leading to misdiagnosis and underdiagnosis of asthma in such patients.Design: A multicenter study involving 24 Italian pulmonary or geriatric institutions.Patients: One hundred twenty-eight asthmatic patients (98 women, 76.6%) aged 73 +/- 6.4 years (mean +/- SD) were selected from the cohort of the Salute Respiratoria nell'Anziano (respiratory health in the elderly) study.Methods: All patients underwent a clinical evaluation that included clinical history and spirometry with a bronchodilator test. A diagnosis of asthma was based on criteria proposed by international guidelines adapted to the elderly population. A multidimensional geriatric assessment was performed to estimate physical and cognitive impairments and mood state. Finally, the diagnosis of respiratory disease previously made by a doctor, if any, was recorded.Results: Of asthmatic patients, COPD had been improperly diagnosed in 19.5%, whereas 27.3% of asthmatic patients did not report any previous diagnosis of asthma. The main correlates of misdiagnosis were older age and disability. Conversely, underdiagnosis was associated with better functional conditions, expressed by spirometry, even when wheezing or a significant response to the bronchodilator test occurred.Conclusions: Asthma in the elderly is frequently confused with COPD. Misdiagnosis can be related to older age and to greater degree of disability. Asthma in patients with mild functional impairment may be underdiagnosed in spite of overt respiratory symptoms suggestive of asthma. [ABSTRACT FROM AUTHOR]

Examines the efficacy and age-related effects of nitric oxide (NO)-releasing aspirin (NCX-4016) on experimental restenosis. Comparison of the effects of NCX-1016 and aspirin on adult and elderly rats; Relevance of NO-dependent pathways after balloon injury in vascular aging.

Focuses on the efficacy of thrombolysis in younger and older adult patients suffering from acute myocardial infarction (AMI). Prognosis of older patients with AMI; Characteristics of thrombolysis; Reduction of mortality rates in older adults through thrombolysis.

Objectives: To compare the effects of asthma and COPD on health status (HS) in elderly patients, and to assess the correlation between disease-specific and generic instruments assessing HS. Design: Multicenter, cross-sectional, observational study. Setting: The Salute Respiratoria nell' Anziano (respiratory health in the elderly) Study network of outpatient departments. Patients: One hundred ninety-eight asthma patients and 230 COPD patients ≤ 65 years old. Measurements: HS was assessed by the Saint George's Respiratory Questionnaire (SGRQ) and five generic outcomes: Barthel's index, 6-min walk test, mini mental state examination, geriatric depression scale (GDS), and quality-of-sleep index. Independent correlates of SGRQ scores were assessed by logistic regression. Patients were considered to have a "good" HS or "poor" HS according to whether they did or did not perform worse than 75% of the corresponding population of asthma or COPD patients, on at least two of the five generic outcomes. Results: On average, COPD patients had poorer HS than asthma patients on the SGRQ. Only polypharmacy (more than three respiratory drugs) and diagnosis of COPD qualified as independent correlates of the SGRQ score. The SGRQ "Activity" and "Impacts" scores shared the following independent correlates: polypharmacy, Barthel's index < 92, and GDS > 6. Further correlates were waist/hip ratio > 1 for the Activity score, and age and occiput-wall distance > 9 cm for the Impacts score. All sections of the SGRQ except for the Symptoms score could significantly distinguish patients with good HS and poor HS. Conclusions: Individual dimensions of HS recognize different determinants. COPD outweighs asthma as a cause of distressing respiratory symptoms. A high degree of concordance exists between SGRQ and generic health outcomes, except for the Symptoms dimension in COPD patients. [ABSTRACT FROM AUTHOR]

Background: Hearing impairment (HI) is a very common condition in elderly people and the epidemiology together with hearing-related problems is still poorly investigated. Moreover, the cognitive status may be impaired in relation to hearing function.Objective: The goal of the study was to evaluate: (a) the prevalence of HI in a random sample of elderly people aged 65 and over (n = 1,750) living in Campania, a region of southern Italy; (b) the cross-sectional relationship between hearing function and cognitive status and also depressive symptomatology and disability, and (c) to assess the role of hearing aids on depressive symptomatology.Methods: Cross-sectional study on a random sample of elderly population.Results: The overall participation rate in the study was 74.8% (n = 1,332, mean age was 74.2 +/- 6.4 years). The prevalence rate of HI (evaluated by questionnaire) was 27.2%, cognitive impairment prevalence (evaluated by the Mini-Mental State Examination (MMSE)) was 27.9%, mean depressive symptomatology score (evaluated by Geriatric Depression Scale (GDS)) was 11.4 +/- 6.6, while disability assessed by Activity of Daily Living (ADL) was present in 7.0% of the whole population. A strong relationship was found between both decreasing hearing function and MMSE decline, independently by the effect of age and education (r = 0.97; p < 0.01). A positive relationship (r = 0.85; p < 0.01) between GDS score and hearing function was also found. Moreover, at an increased level of hearing loss, a lower ADL score was recorded (r = 0.98; p < 0.01). Finally, the use of hearing aids reduced GDS score. In logistic regression analysis, gender, age and educational level indicate that hearing loss risk increased with age (odds ratio 1.60; 95% confidence interval 1.53-1.71), whereas education plays a protective role (odds ratio 0.75; 95% confidence interval 0.72-0.80).Conclusion: HI is very prevalent among elderly people and is associated with either cognitive impairment and/or depression and reduction of functional status. This study suggests that hearing aids may protect against cognitive impairment and disability, improving quality of life of aged people. Copyrightz1999S.KargerAG,Basel [ABSTRACT FROM AUTHOR]

The effect of increased cholinergic activity on reperfusion induced ventricular arrhythmias was studied in alpha chloralose anaesthetised dogs by administering neostigmine during a 25 min occlusion of the anterior left descending coronary artery. The dogs were divided into five groups, each of 10 animals: the control group received only saline solution; group 1 neostigmine 0.03 mg·kg−1 iv at 20 min of coronary occlusion (that is, 5 min before reperfusion); group 2 atropine 0.4 mg·kg−1 iv at 10 min of coronary occlusion and neostigmine 0.03 mg·kg−1 iv at 20 min; and group 3 neostigmine 0.03 mg·kg−1 iv at 20 min of coronary occlusion and at the same time underwent atrial pacing at the same rate as that of the sinus node just before neostigmine administration. In group 4 heart rate was slowed (junctional rhythm) by destroying the sinus node at 20 min of coronary occlusion. The results obtained showed that ventricular tachycardia and fibrillation, which occur at the beginning of reperfusion, were significantly less frequent in group 1 (p<0.001) and in group 4 (p<0.001). The protective action of neostigmine was abolished by previous administration of atropine (group 2) and modified by preventing the decrease in the heart rate by atrial pacing (group 3). In group 3 ventricular tachycardia was more frequent but the incidence of ventricular fibrillation was reduced significantly compared with the control and atropine groups.Thus cholinergic activity has a protective role in reperfusion arrhythmias by decreasing the heart rate before release of the coronary occlusion and therefore reduces the incidence of ventricular fibrillation. [ABSTRACT FROM PUBLISHER]

The effect of oral salt loading (400 mmol per day of NaCl for 7 days) on cardiac and pancreatic β-receptor responsiveness has been evaluated in 12 patients with established essential hypertension and in seven age-matched control subjects.Cardiac β-receptor responsiveness was evaluated by assessing the dose of isoprenaline which increased a stable heart rate by 25% (chronotropic dose 25%, CD 25%). Pancreatic β-receptor responsiveness was measured by the incremental areas of insulin secretion induced by iv infusion of increasing amounts of isoprenaline.Before salt load, CD 25% was significantly higher in hypertensives compared with controls (7.84± 1.34 μg vs 3.9±0.48 μg, P<0.05) while there was no difference in the isoprenaline-induced insulin secretion between the two groups of subjects.After salt loading, CD 25% was significantly reduced in hypertensive patients but was not modified in normal subjects. Therefore, the difference in CD 25% was no longer detectable between the two groups (5.5±1.42 μg vs 3.2±0.48 μg in normal subjects and in hypertensives, respectively, NS). Furthermore, salt loading failed to induce any change in isoprenaline-induced insulin secretion in either groups.These results support the existence of a relationship between sodium intake and adrenergic β-receptor responsiveness in human hypertension. [ABSTRACT FROM PUBLISHER]

The baroreflex response to changes in transmural pressure throughout the arterial tree or limited to the carotid sinus was evaluated in ten borderline hypertensives and compared with that observed in ten normal subjects and in ten established hypertensives. Baroreceptor sensitivity was tested by evaluating both heart rate response to phenylephrine-induced increase in arterial pressure and heart rate and blood pressure changes induced by increased neck tissue pressure by means of a neck chamber. The heart rate response to phenylephrine (evaluated by the regression of the R-R interval versus the systolic blood pressure) was depressed both in borderline and established hypertensives as compared with controls. Similarly, the heart rate and the pressor response to increased neck tissue pressure were depressed in both groups of hypertensives. In borderline, but not in established hypertensives, neostigmine administration improved consistently the pressor baroreflex response to increased neck tissue pressure and the heart rate reflex response to both the employed stimuli. These findings indicate that a reduced parasympathetic activity is one of the components involved in the altered baroreflex sensitivity in borderline hypertensives. [ABSTRACT FROM PUBLISHER]

Hypoxia is the most effective and consistent stimulus to pulmonary hypertension in all species; however, the genesis of this phenomenon is still unclear. Histamine has been proposed as the possible mediator of this response and extensively studied. However, there remain doubts as to its behaviour in the different vascular districts during hypoxia. Accordingly, in seven dogs, histamine content was measured in the distal vena cava, hepatic vein, pulmonary artery and aorta; pulmonary artery pressure and systemic arterial pressure were also recorded. All measurements were repeated after 5 min of breathing a mixture containing 8% oxygen. Histamine content in the pulmonary artery blood was significantly increased during hypoxia (from 29 ± 3 to 36 ± 3 ng·cm−3 P<0.05) while it was unchanged in the aorta. Therefore, the difference between histamine content in the pulmonary artery and aorta increased. Moreover, the inferior vena cava content of this substance rose from 24 ± 4 to 32 ± 4 ng·cm−3 (P <0.05) and it did not change in the hepatic vein. Simultaneously pulmonary artery pressure rose from 1.6 ± 0.1 to 2.4 ± 0.1 kPa (12 ± 1 to 18 ± 1 mmHg) (P <0.01) and systemic arterial pressure changed only slightly. These experiments seem to demonstrate that histamine is released by the muscle during hypoxia, since it is increased in the distal vena cava and uptake by the lungs, as shown by the increase in the pulmonary artery and aorta. The role, if there is any, of the muscle-released histamine in the hypoxic pulmonary hypertension is still to be elucidated. [ABSTRACT FROM PUBLISHER]

The vascular steal phenomenow, that is, the shunting of blood from ischemic to normally perfused areas, is commonly observed during exercise in the affected limbs of patients with peripheral arterial insufficiency. Propranolol was administered to 18 arteriopathic patients before the exercise to ascertain whether the reverse situation can be induced. The results indicate that before propranolol administration, Jantsch's index (used to quantify the plethysmographic waves) decreased from 0.53 ± 0.05 to 0.33 ± 0.04 (P < 0.001) at 1 minute, and to 0.38 ± 0.04 (P < 0.001) at 5 minutes after the end of the exercise. When the exercise was repeated after propranolol, Jantsch's index did not change. These findings indicate that propranolol can inhibit exercise-induced vascular steal. [ABSTRACT FROM AUTHOR]

In most arteriopathic patients, the release of a transitory ischemia in the affected limb reduces blood flow, instead of increasing it as in normal subjects. In this study the effects of propranolol administration on this paradoxical response have been investigated. After rheographic tracings were recorded in 14 arteriopathic patients in the basal condition and in the postischemic period, 10 mg of propranolol was administered IV and the protocol was then repeated. The blood flow in the affected area, measured as Jantsch's index of the rheographic tracings, was 0.63 ± 0.04 in the basal condition and was reduced to 0.51 ± 0.05 (P ≤ 0.001) in the postischemic period. When the ischemia was repeated after propranolol administration, Jantsch's index rose from 0.57 ± 0.04 to 0.85 ± 0.09 (P ≤ 0.01). The reversion of the paradoxical response to the ischemia induced by propranolol administration suggests that the beta-adrenergic blockade can increase blood flow to the ischemic area, probably through a constrictive action on arterovenous connections. [ABSTRACT FROM AUTHOR]

Summary: Orthostatic hypotension (OH) is a debilitating condition very common in the elderly that may leads to syncope. There is no single drug able to limit the fall in blood pressure in patients affected by OH when standing. In addition, the presence of hyperkinetic arrhythmias may worsen the fall in orthostatic blood pressure especially in elderly patients affected by OH. Unfortunately most of antiarrhythmic therapies lead to a decrease in blood pressure contrasting the effect of OH treatment. By contrast, disopyramide seems to have an anticholinergic effect that could play an important role in limiting the fall in blood pressure in participants with hyperkinetic arrhythmias and OH. We report a case of successful combination therapy of fludrocortisone, disopyramide and nonpharmacologic treatment in an elderly participant affected by neurogenic orthostatic OH and hyperkinetic arrhythmias with a poor quality of life and frequent syncope episodes. [Copyright &y& Elsevier]