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1. The Possible Impact of Aortic Stiffness on Quality of Late Life: An Exploratory Study

Author

Tap L, Dommershuijsen LJ, Corsonello A, Lattanzio F, Bustacchini S, Ziere G, van Saase JLCM, and Mattace-Raso FUS

Subjects
arterial stiffness, health-related quality of life, eq-5d, older persons, Geriatrics, RC952-954.6
Abstract

Lisanne Tap,1 Lisanne J Dommershuijsen,1 Andrea Corsonello,2 Fabrizia Lattanzio,2 Silvia Bustacchini,2 Gijsbertus Ziere,1 Jan LCM van Saase,3 Francesco US Mattace-Raso1 1Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; 2Italian National Research Center on Aging (INRCA), Ancona, Fermo and Cosenza, Italy; 3Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the NetherlandsCorrespondence: Francesco US Mattace-RasoSection Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Room Rg-527, PO BOX 2040, Rotterdam 3000 CA, the NetherlandsTel +31 10703 5979Fax +31 10703 47 68Email f.mattaceraso@erasmusmc.nlPurpose: Aortic stiffness (AS) is associated with cardiovascular events and all-cause mortality in the older population. AS might also influence the health-related quality of life (HRQOL) as a result of the negative effects of AS on cognitive and physical morbidity. We aimed to investigate the possible association between AS and HRQOL in people aged 75 years and over.Patients and Methods: This cross-sectional study was part of the SCOPE study, an international multicenter cohort observational study. The indicators for AS were aortic pulse wave velocity (aPWV) and central pulse pressure (cPP). HRQOL was assessed using the EQ-5D index and the EQ-5D visual analog scale (VAS). ANCOVA and multivariate regression models were used to investigate possible associations.Results: We included 280 Dutch participants of the SCOPE study. Median age was 79 years (IQR 76– 83) and 42.1% were women. Participants reporting any problem on the EQ-5D index (n=214) had higher values of aPWV (12.6 vs 12.2 m/s, p = 0.024) than participants not experiencing any problem (n=66) and comparable values of cPP (44.4 vs 42.0 mmHg, p = 0.119). Estimates only slightly changed after adjustments. No association was found between indicators of AS and EQ-5D VAS.Conclusion: Aortic stiffness was associated with impaired quality of late life. This association could be mediated by subclinical vascular pathology affecting mental and physical health.Keywords: arterial stiffness, health-related quality of life, EQ-5D, older persons

Published
2020

3. The sarcopenia and physical frailty in older people: multi-component treatment strategies (SPRINTT) project: description and feasibility of a nutrition intervention in community-dwelling older Europeans

Author

Jyvakorpi S. K., Ramel A., Strandberg T. E., Piotrowicz K., Blaszczyk-Bebenek E., Urtamo A., Rempe H. M., Geirsdottir O., Vagnerova T., Billot M., Larreur A., Savera G., Soriano G., Picauron C., Tagliaferri S., Sanchez-Puelles C., Cadenas V. S., Perl A., Tirrel L., Ohman H., Weling-Scheepers C., Ambrosi S., Costantini A., Pavelkova K., Klimkova M., Freiberger E., Jonsson P. V., Marzetti E., Pitkala K. H., Landi F., Calvani R., Bernabei R., Boni C., Brandi V., Broccatelli M., Celesti C., Cicchetti A., Collamati A., Coretti S., D'Angelo E., D'Elia M., Landi G., Lorenzi M., Mariotti L., Martone A. M., Ortolani E., Pafundi T., Picca A., Ruggeri M., Salini S., Tosato M., Vetrano D. L., Lattanzio F., Baldoni R., Bernabei S., Bonfigli A. R., Bustacchini S., Carrieri B., Cassetta L., Cherubini A., Cucchi M., Cucchieri G., Costantini A. R., Dell'Aquila G., Espinosa E., Fedecostante M., Fraternali R., Galeazzi R., Mengarelli A., Piomboni S., Posacki E., Severini E., Tregambe T., Trotta F., Maggio M., Lauretani F., Butto V., Fisichella A., Guareschi C., Longobucco Y., Di Bari M., Rodriguez-Manas L., Alamo S., Bouzon C. A., Gonzales Turin J., Zafra O. L. L., Picazo A. L., Sepulveda L. P., SanchezSanchez J. L., Puelles C. S., Aragones M. V., CruzJentoft A. J., Santos J. A., Alvarez-Nebreda L., JimenezJimenez N. F., Nozal J. M. -D., Montero-Errasquin B., Moreno B. P. B. P., Roldan-Plaza C., Vicente A. R. -D., Sanchez-Cadenas V., Sanchez-Castellano C., Sanchez-Garcia E., Vaquero-Pinto M. N., Topinkova E., Bautzka L., Blechova K., Gueye T., Juklickova I., Klbikova T., Krenkova J. J., Madlova P., Mejstrikova H., Melcova R., Michalkova H., Ryznarova I., Drastichova I., Hasalikova E., Hucko R., Jakub S., Janacova M., Kilmkova M., Parizkova M., Redrova M., Ruskova P. P., Sieber C. C., Auerswald T., Engel C., Franke A., Freibergen E., Freiheit U., Gotthardt S., Kampe K., Kob R., Kokott C., Kraska C., Meyer C., Reith V., Rempe H., Schoene D., Sieber G., Zielinski K., Anker S. D., Ebner N., Grutz R., von Haehling S., Schols A. M. W. J., Gosker H., Huysmans S., Quaaden S., Schols J. M., Smeets N., Stevens P., van de Bool C., Weling C., Strandberg T., Jyvakorpi S., Hallikas K., Herranen M., Huusko T., Hytonen L., Ikonen K., Karppi-Sjoblom A., Karvinen K., Kayhty M., Kindsted T., Landstrom E., Leirimaa S., Pitkala K., Punkka A., Saavalainen A. -M., Salo T., Sepa M., Sohlberg K., Vaatamoinen E., Venalainen S., Vanhanen H., Vellas B., Van Kan G. A., Biville V., Brigitte L., Cervera C., Cesari M., Champarnaud M., Cluzan C., Croizet M., Dardenne S., Dorard M., Dupuy C., Durand E., Faisant C., Fougere B., Girard P., Guyonnet S., Hoogendijk E., Mauroux R., Milhet A., Montel S., Ousset P. -J., Teguo M. T., Teysseyre B., Andrieu S., Blasimme A., Dray C., Rial-Sebbag E., Valet P., Dantoine T., Cardinaud N., Castelli M., Charenton-Blavignac M., Ciccolari-Micaldi C., Gayot C., Laubarie-Mouriet C., Marchesseau D., Mergans T., Nguyen T. B., Papon A., Ribet J., Saulinier I., Tchalla A., Rapp T., Sirven N., Skalska A., Blaszcyk E., Cwynar M., Czesak J., Fatyga P., Fedyk-Lukasik M., Grodzicki T., Jamrozik P., Janusz Z., Klimek E., Komoniewska S., Kret M., Ozog M., Parnicka A., Petitjean K., Pietrzyk A., Skalska-Dulinska B., Starzyk D., Szczerbinska K., Witkiewicz B., Wlodarczyk A., Sinclair A., Harris S., Ogborne A., Ritchie S., Sinclair C., Sinclair H., Bellary S., Worthington H., Derejczyk J., Roller-Wirnsberger R., Jonsson P., Bordes P., Arnaud S., Asbrand C., Bejuit R., Durand S., Flechsenhar K., Joly F., Lain R. L., Moncharmont M., Msihid J., Ndja A., Riche B., Weber A. C., Yuan J., Roubenoff R., Kortebein P., Miller R. R., Gorostiaga C., Belissa-Mathiot P., Hu H., Laigle L., Melchor I. M., Russel A., Bennecky M., Haws T., Joshi A., Philpott K., Walker A., Zia G., Giorgi S. D., Feletti L., Marchioro E., Mocci F., Varesio M. G., Cesario A., Cabin B., de Boer W. P., Ignaszewski C., Klingmann I., Vollenbroek-Hutten M., Hermens T., Jansen-Kosterink S., Tabak M., Blandin P., Coutard L., Lenzotti A. -M., Mokhtari H., Rodon N., RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: CAPHRI - R1 - Ageing and Long-Term Care, Health Services Research, Handicap, Activité, Vieillissement, Autonomie, Environnement (HAVAE), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Clinicum, Department of General Practice and Primary Health Care, University of Helsinki, HUS Internal Medicine and Rehabilitation, Timo Strandberg / Principal Investigator, Department of Medicine, Helsinki University Hospital Area, Teachers' Academy, Jyvakorpi S.K., Ramel A., Strandberg T.E., Piotrowicz K., Blaszczyk-Bebenek E., Urtamo A., Rempe H.M., Geirsdottir O., Vagnerova T., Billot M., Larreur A., Savera G., Soriano G., Picauron C., Tagliaferri S., Sanchez-Puelles C., Cadenas V.S., Perl A., Tirrel L., Ohman H., Weling-Scheepers C., Ambrosi S., Costantini A., Pavelkova K., Klimkova M., Freiberger E., Jonsson P.V., Marzetti E., Pitkala K.H., Landi F., Calvani R., Bernabei R., Boni C., Brandi V., Broccatelli M., Celesti C., Cicchetti A., Collamati A., Coretti S., D'Angelo E., D'Elia M., Landi G., Lorenzi M., Mariotti L., Martone A.M., Ortolani E., Pafundi T., Picca A., Ruggeri M., Salini S., Tosato M., Vetrano D.L., Lattanzio F., Baldoni R., Bernabei S., Bonfigli A.R., Bustacchini S., Carrieri B., Cassetta L., Cherubini A., Cucchi M., Cucchieri G., Costantini A.R., Dell'Aquila G., Espinosa E., Fedecostante M., Fraternali R., Galeazzi R., Mengarelli A., Piomboni S., Posacki E., Severini E., Tregambe T., Trotta F., Maggio M., Lauretani F., Butto V., Fisichella A., Guareschi C., Longobucco Y., Di Bari M., Rodriguez-Manas L., Alamo S., Bouzon C.A., Gonzales Turin J., Zafra O.L.L., Picazo A.L., Sepulveda L.P., SanchezSanchez J.L., Puelles C.S., Aragones M.V., CruzJentoft A.J., Santos J.A., Alvarez-Nebreda L., JimenezJimenez N.F., Nozal J.M.-D., Montero-Errasquin B., Moreno B.P.B.P., Roldan-Plaza C., Vicente A.R.-D., Sanchez-Cadenas V., Sanchez-Castellano C., Sanchez-Garcia E., Vaquero-Pinto M.N., Topinkova E., Bautzka L., Blechova K., Gueye T., Juklickova I., Klbikova T., Krenkova J.J., Madlova P., Mejstrikova H., Melcova R., Michalkova H., Ryznarova I., Drastichova I., Hasalikova E., Hucko R., Jakub S., Janacova M., Kilmkova M., Parizkova M., Redrova M., Ruskova P.P., Sieber C.C., Auerswald T., Engel C., Franke A., Freibergen E., Freiheit U., Gotthardt S., Kampe K., Kob R., Kokott C., Kraska C., Meyer C., Reith V., Rempe H., Schoene D., Sieber G., Zielinski K., Anker S.D., Ebner N., Grutz R., von Haehling S., Schols A.M.W.J., Gosker H., Huysmans S., Quaaden S., Schols J.M., Smeets N., Stevens P., van de Bool C., Weling C., Strandberg T., Jyvakorpi S., Hallikas K., Herranen M., Huusko T., Hytonen L., Ikonen K., Karppi-Sjoblom A., Karvinen K., Kayhty M., Kindsted T., Landstrom E., Leirimaa S., Pitkala K., Punkka A., Saavalainen A.-M., Salo T., Sepa M., Sohlberg K., Vaatamoinen E., Venalainen S., Vanhanen H., Vellas B., Van Kan G.A., Biville V., Brigitte L., Cervera C., Cesari M., Champarnaud M., Cluzan C., Croizet M., Dardenne S., Dorard M., Dupuy C., Durand E., Faisant C., Fougere B., Girard P., Guyonnet S., Hoogendijk E., Mauroux R., Milhet A., Montel S., Ousset P.-J., Teguo M.T., Teysseyre B., Andrieu S., Blasimme A., Dray C., Rial-Sebbag E., Valet P., Dantoine T., Cardinaud N., Castelli M., Charenton-Blavignac M., Ciccolari-Micaldi C., Gayot C., Laubarie-Mouriet C., Marchesseau D., Mergans T., Nguyen T.B., Papon A., Ribet J., Saulinier I., Tchalla A., Rapp T., Sirven N., Skalska A., Blaszcyk E., Cwynar M., Czesak J., Fatyga P., Fedyk-Lukasik M., Grodzicki T., Jamrozik P., Janusz Z., Klimek E., Komoniewska S., Kret M., Ozog M., Parnicka A., Petitjean K., Pietrzyk A., Skalska-Dulinska B., Starzyk D., Szczerbinska K., Witkiewicz B., Wlodarczyk A., Sinclair A., Harris S., Ogborne A., Ritchie S., Sinclair C., Sinclair H., Bellary S., Worthington H., Derejczyk J., Roller-Wirnsberger R., Jonsson P., Bordes P., Arnaud S., Asbrand C., Bejuit R., Durand S., Flechsenhar K., Joly F., Lain R.L., Moncharmont M., Msihid J., Ndja A., Riche B., Weber A.C., Yuan J., Roubenoff R., Kortebein P., Miller R.R., Gorostiaga C., Belissa-Mathiot P., Hu H., Laigle L., Melchor I.M., Russel A., Bennecky M., Haws T., Joshi A., Philpott K., Walker A., Zia G., Giorgi S.D., Feletti L., Marchioro E., Mocci F., Varesio M.G., Cesario A., Cabin B., de Boer W.P., Ignaszewski C., Klingmann I., Vollenbroek-Hutten M., Hermens T., Jansen-Kosterink S., Tabak M., Blandin P., Coutard L., Lenzotti A.-M., Mokhtari H., Rodon N., Epidemiology and Data Science, APH - Aging & Later Life, and APH - Quality of Care

Subjects
0301 basic medicine, Gerontology, Sarcopenia, [SDV]Life Sciences [q-bio], Population, PROTEIN, RECOMMENDATIONS, law.invention, SUPPLEMENTATION, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intervention (counseling), Cultural diversity, medicine, Nutrition counselling, Nutrition intervention, Humans, 030212 general & internal medicine, Medical prescription, education, Exercise, Aged, 2. Zero hunger, education.field_of_study, 030109 nutrition & dietetics, Frailty, business.industry, Settore MED/09 - MEDICINA INTERNA, ADULTS, medicine.disease, mobility, 3. Good health, Feasibility Studie, Malnutrition, SPRINTT, resistance exercise, muscle mass, Protein intake, 3121 General medicine, internal medicine and other clinical medicine, Feasibility Studies, Energy intake, Independent Living, business, Nutrition counseling, Research Paper, Human
Abstract

Aim To describe the methods and feasibility of the nutritional intervention carried out within the SPRINTT Randomized cotrolled trial. We also illustrate how nutrition interventionists identified participants at risk of malnutrition and the lessons learnt from the nutrition intervention. Findings SPRINTT nutrition intervention was well-received by the majority of the participants. It was mainly carried out using tailored nutrition counselling, but also other means of delivering the intervention were successfully used. Compared with a standard nutrition prescription, an individualized protocol to diagnose malnutrition and follow-up by tailored nutrition counselling helped achieve nutritional targets more effectively in spite of diversity of population in nutritional habits and in some cases reluctance to accept changes. Message The SPRINTT nutrition intervention was feasible and allowed flexibility to the varying needs and cultural differences of this heterogeneous population of frail, older Europeans. It may serve as a model to educate and improve nutrition among community-dwelling older people at risk of mobility limitations. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-020-00438-4., Background The “Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies” (SPRINTT) project sponsored a multi-center randomized controlled trial (RCT) with the objective to determine the effect of physical activity and nutrition intervention for prevention of mobility disability in community-dwelling frail older Europeans. We describe here the design and feasibility of the SPRINTT nutrition intervention, including techniques used by nutrition interventionists to identify those at risk of malnutrition and to carry out the nutrition intervention. Methods SPRINTT RCT recruited older adults (≥ 70 years) from 11 European countries. Eligible participants (n = 1517) had functional limitations measured with Short Physical Performance Battery (SPPB score 3–9) and low muscle mass as determined by DXA scans, but were able to walk 400 m without assistance within 15 min. Participants were followed up for up to 3 years. The nutrition intervention was carried out mainly by individual nutrition counseling. Nutrition goals included achieving a daily protein intake of 1.0–1.2 g/kg body weight, energy intake of 25–30 kcal/kg of body weight/day, and serum vitamin D concentration ≥ 75 mmol/L. Survey on the method strategies and feasibility of the nutrition intervention was sent to all nutrition interventionists of the 16 SPRINTT study sites. Results Nutrition interventionists from all study sites responded to the survey. All responders found that the SPRINTT nutrition intervention was feasible for the target population, and it was well received by the majority. The identification of participants at nutritional risk was accomplished by combining information from interviews, questionnaires, clinical and laboratory data. Although the nutrition intervention was mainly carried out using individual nutritional counselling, other assisting methods were used as appropriate. Conclusion The SPRINTT nutrition intervention was feasible and able to adapt flexibly to varying needs of this heterogeneous population. The procedures adopted to identify older adults at risk of malnutrition and to design the appropriate intervention may serve as a model to deliver nutrition intervention for community-dwelling older people with mobility limitations. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-020-00438-4.

Published
2021

5. The possible impact of aortic stiffness on quality of late life: An exploratory study

Author

Tap, L. (Lisanne), Dommershuijsen, L.J. (Lisanne J.), Corsonello, A. (Andrea), Lattanzio, F. (Fabrizia), Bustacchini, S. (Silvia), Ziere, G. (Gijsbertus), Saase, J.L.C.M. (Jan) van, Mattace Raso, F.U.S. (Francesco), Tap, L. (Lisanne), Dommershuijsen, L.J. (Lisanne J.), Corsonello, A. (Andrea), Lattanzio, F. (Fabrizia), Bustacchini, S. (Silvia), Ziere, G. (Gijsbertus), Saase, J.L.C.M. (Jan) van, and Mattace Raso, F.U.S. (Francesco)

Abstract

Purpose: Aortic stiffness (AS) is associated with cardiovascular events and all-cause mortality in the older population. AS might also influence the health-related quality of life (HRQOL) as a result of the negative effects of AS on cognitive and physical morbidity. We aimed to investigate the possible association between AS and HRQOL in people aged 75 years and over. Patients and Methods: This cross-sectional study was part of the SCOPE study, an international multicenter cohort observational study. The indicators for AS were aortic pulse wave velocity (aPWV) and central pulse pressure (cPP). HRQOL was assessed using the EQ-5D index and the EQ-5D visual analog scale (VAS). ANCOVA and multivariate regression models were used to investigate possible associations. Results: We included 280 Dutch participants of the SCOPE study. Median age was 79 years (IQR 76–83) and 42.1% were women. Participants reporting any problem on the EQ-5D index (n=214) had higher values of aPWV (12.6 vs 12.2 m/s, p = 0.024) than participants not experiencing any problem (n=66) and comparable values of cPP (44.4 vs 42.0 mmHg, p = 0.119). Estimates only slightly changed after adjustments. No association was found between indicators of AS and EQ-5D VAS. Conclusion: Aortic stiffness was associated with impaired quality of late life. This association could be mediated by subclinical vascular pathology affecting mental and physical health.

Published
2020
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6. Design and methodology of the screening for CKD among older patients across Europe (SCOPE) study: A multicenter cohort observational study

Author

Corsonello, A. (Andrea), Tap, L. (Lisanne), Roller-Wirnsberger, R. (Regina), Wirnsberger, G. (Gerhard), Zoccali, C. (Carmine), Kostka, T. (Tomasz), Guligowska, A. (Agnieszka), Mattace Raso, F.U.S. (Francesco), Gil, P. (Pedro), Fuentes, L.G. (Lara Guardado), Meltzer, I. (Itshak), Yehoshua, I. (Ilan), Formiga-Perez, F. (Francesc), Moreno-González, R. (Rafael), Weingart, C. (Christian), Freiberger, E. (Ellen), Ärnlöv, J. (Johan), Carlsson, A.C. (Axel C.), Bustacchini, S. (Silvia), Lattanzio, F. (Fabrizia), Bolognini, S. (Silvia), D'Ascoli, P. (Paola), Moresi, R. (Raffaella), Di Stefano, G. (Giuseppina), Cassetta, L. (Laura), Bonfigli, A.R. (Anna Rita), Galeazzi, R. (Roberta), Lenci, F. (Federica), Bella, S.D. (Stefano Della), Bordoni, E. (Enrico), Provinciali, M. (Mauro), Giacconi, R. (Robertina), Giuli, C. (Cinzia), Postacchini, D. (Demetrio), Garasto, S. (Sabrina), Firmani, A.C.R. (Annalisa Cozza Romano), Nacciariti, M. (Moreno), Di Rosa, M. (Mirko), Bernabei, P.F.R. (Paolo Fabbietti Roberto), Bula, C. (Christophe), Haller, H. (Hermann), Jager, K.J. (Kitty), Biesen, W. (Wim) van, Stevens, P.E. (Paul E.), Corsonello, A. (Andrea), Tap, L. (Lisanne), Roller-Wirnsberger, R. (Regina), Wirnsberger, G. (Gerhard), Zoccali, C. (Carmine), Kostka, T. (Tomasz), Guligowska, A. (Agnieszka), Mattace Raso, F.U.S. (Francesco), Gil, P. (Pedro), Fuentes, L.G. (Lara Guardado), Meltzer, I. (Itshak), Yehoshua, I. (Ilan), Formiga-Perez, F. (Francesc), Moreno-González, R. (Rafael), Weingart, C. (Christian), Freiberger, E. (Ellen), Ärnlöv, J. (Johan), Carlsson, A.C. (Axel C.), Bustacchini, S. (Silvia), Lattanzio, F. (Fabrizia), Bolognini, S. (Silvia), D'Ascoli, P. (Paola), Moresi, R. (Raffaella), Di Stefano, G. (Giuseppina), Cassetta, L. (Laura), Bonfigli, A.R. (Anna Rita), Galeazzi, R. (Roberta), Lenci, F. (Federica), Bella, S.D. (Stefano Della), Bordoni, E. (Enrico), Provinciali, M. (Mauro), Giacconi, R. (Robertina), Giuli, C. (Cinzia), Postacchini, D. (Demetrio), Garasto, S. (Sabrina), Firmani, A.C.R. (Annalisa Cozza Romano), Nacciariti, M. (Moreno), Di Rosa, M. (Mirko), Bernabei, P.F.R. (Paolo Fabbietti Roberto), Bula, C. (Christophe), Haller, H. (Hermann), Jager, K.J. (Kitty), Biesen, W. (Wim) van, and Stevens, P.E. (Paul E.)

Abstract

Background: Decline of renal function is common in older persons and the prevalence of chronic kidney disease (CKD) is rising with ageing. CKD affects different outcomes relevant to older persons, additionally to morbidity and mortality which makes CKD a relevant health burden in this population. Still, accurate laboratory measurement of kidney function is under debate, since current creatinine-based equations have a certain degree of inaccuracy when used in the older population. The aims of the study are as follows: to assess kidney function in a cohort of 75+ older persons using existing methodologies for CKD screening; to investigate existing and innovative biomarkers of CKD in this cohort, and to align l

Published
2018
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7. Design and methodology of the screening for CKD among older patients across Europe (SCOPE) study: a multicenter cohort observational study

Author

Corsonello, A, Tap, Lisanne, Roller-Wirnsberger, R, Wirnsberger, G, Zoccali, C, Kostka, T, Guligowska, A, Mattace Raso, F.U.S., Gil, P, Fuentes, LG, Meltzer, I, Yehoshua, I, Formiga-Perez, F, Moreno-Gonzalez, R, Weingart, C, Freiberger, E, Arnlov, J, Carlsson, AC, Bustacchini, S, Lattanzio, F, Corsonello, A, Tap, Lisanne, Roller-Wirnsberger, R, Wirnsberger, G, Zoccali, C, Kostka, T, Guligowska, A, Mattace Raso, F.U.S., Gil, P, Fuentes, LG, Meltzer, I, Yehoshua, I, Formiga-Perez, F, Moreno-Gonzalez, R, Weingart, C, Freiberger, E, Arnlov, J, Carlsson, AC, Bustacchini, S, and Lattanzio, F

Published
2018

8. The economic burden of inappropriate drug prescribing, lack of adherence and compliance, adverse drug events in older people: a systematic review

Author

Chiatti, C, Bustacchini, S, Furneri, G, Mantovani, L, Cristiani, M, Misuraca, C, Lattanzio, F, Chiatti C, Bustacchini S, Furneri G, Mantovani L, Cristiani M, Misuraca C, Lattanzio f, Chiatti, C, Bustacchini, S, Furneri, G, Mantovani, L, Cristiani, M, Misuraca, C, Lattanzio, F, Chiatti C, Bustacchini S, Furneri G, Mantovani L, Cristiani M, Misuraca C, and Lattanzio f

Abstract

Adverse drug events (ADEs) are an increasingly relevant issue for healthcare systems as they are associated with poorer health outcomes and avoidable misuse of resources. The rates of ADEs are higher in the elderly population, as many older patients have comorbidities, multiple drug prescriptions and deteriorated physical and cognitive functioning. The occurrence of ADEs can lead to a perceived lack of therapy efficacy and further underuse or suboptimal adherence in elderly people, with detrimental clinical outcomes. The present article systematically reviews the studies evaluating the economic impact of ADEs occurring as consequence of poor therapy adherence, inappropriate drug use, underuse of effective treatments and poor adherence, medication errors, drug-drug and drug-disease interactions. A Medline systematic literature review of studies evaluating the economic consequences of inappropriate drug prescribing, lack of adherence and compliance, ADEs in older people was performed. English-language articles were screened through a three-step approach (title review, abstract review, full article review) to select pertinent studies quantitatively evaluating costs. We systematically reviewed evidence from767 articles. After title, abstract and full text review, 21 articles were found to measure economic implications ofADEs, inappropriate drug prescribing and poor adherence in elderly patients. Studies suggested that the economic impact of these undesired effects is substantial: hospital costs were the main cost driver, with a relevant part of them being preventable (consequences of inappropriate prescribing). Healthcare costs for unused drug wastage and destruction were also surprisingly high. Although economic evidence in elderly patients is still limited, all studies seemed to confirm that the financial burden due to pharmacological treatment issues is relevant in elderly people. Including economic effects of adverse events in pharmacoeconomic analysis would be bene

Published
2012

9. The economic impact of moderate stage Alzheimer's disease in Italy: Evidence from the UP-TECH randomized trial

Author

Chiatti, C., Furneri, G., Rimland, J. M., Demma, F., Bonfranceschi, F., Cassetta, L., Masera, F. b, Cherubini, Corsonello, A., Lattanzio, F., Baldassarri, D., Bitti, L., Carosi, A., Sabbatini, M., Paolasini, E., Fiori, T., Fronzi, C., Giacchetta, S., Giacomini, V., Giovagnoli, L., Lattanzi, G., Manca, A. M., Marinelli, I., Pigini, V., Pignotti, M., Proietti, M. C., Quarticelli, A., Rovedi, M., Tasso, L., Valeri, V., Antonioli, A., Barabucci, M., Bassani, M., Bollettini, P., Bruttapasta, M. C., Buccolini, C., Carangella, R., Carboni, F., Ceccolini, D., D'Incecco, P., Di Felice, M., Dini, L., Gioia, G., Di Prima, G., Giusepponi, G., Lanciotti, C., Loffreda, A., Luciani, O., Mariani, L., Mastrorilli, F., Moroni, R., Piatkowska, I., Rucoli, R., Scoccia, G., Teodori, N., Tonelli, T., Angeloni, R., Bratti, R. A., Bonafede, G., Lorenzetti, S., Paci, C., Picciotti, G., Pezzola, D., Rea, V., Scialè, V., Signorino, M., Sorvillo, F., Tomassini, P. F., Ciccola, A., Cionfrini, L., Alessandrini, D., De Santis, A., Formica, B., Tacchi, G., Tortorelli, S., Marchegiani, G., Pozzari, G., Santarelli, G., Bartolucci, D., Caraffa, G., Cavallo, Filippo, Di Furia, L., Lacetera, A., Maffei, C. M., Manzoli, L., Postacchini, D., Bevilacqua, R., Bonfigli, A. R., Bustacchini, S., Capasso, M., Civerchia, P., Di Rosa, M., Giuli, C., Marcellini, M., Marinelli, P., Melchiorre, G., Moraca, M. E., Principi, A., Rocchetti, C., Spazzafumo, L., Vincitorio, D., Bartulewicz, K., Olivetti, P., and Rossi, L.

Subjects
Gerontology, Male, very elderly, cost of illness, Public expenditure, morbidity, residential care, community care, Italian (citizen), cost analysis, Surveys and Questionnaires, Health care, Activities of Daily Living, 80 and over, Medicine, organization and management, caregiver, media_common, Aged, 80 and over, Public sector, Mini Mental State Examination, aged, Alzheimer disease, Article, controlled study, daily life activity, disease severity, economic aspect, female, health care, health care cost, human, Italy, major clinical study, mortality, physical performance, prescription, prevalence, randomized controlled trial, scoring system, social care, socioeconomics, welfare, economics, male, quality of life, questionnaire, statistical model, Activities of Daily Living, Aged, Alzheimer Disease, Caregivers, Cost of Illness, Female, Health Expenditures, Humans, Linear Models, Quality of Life, Alzheimer's disease, community-living, RCT, UP-TECH, Psychiatry and Mental health, Clinical Psychology, Alzheimer’s disease, media_common.quotation_subject, Quality of life (healthcare), Dementia, Medical prescription, Socioeconomic status, business.industry, statistical model, medicine.disease, Geriatrics and Gerontology, business, Welfare
Abstract

Background:There is consensus that dementia is the most burdensome disease for modern societies. Few cost-of-illness studies examined the complexity of Alzheimer's disease (AD) burden, considering at the same time health and social care, cash allowances, informal care, and out-of-pocket expenditure by families.Methods:This is a comprehensive cost-of-illness study based on the baseline data from a randomized controlled trial (UP-TECH) enrolling 438 patients with moderate AD and their primary caregiver living in the community.Results:The societal burden of AD, composed of public, patient, and informal care costs, was about €20,000/yr. Out of this, the cost borne by the public sector was €4,534/yr. The main driver of public cost was the national cash-for-care allowance (€2,324/yr), followed by drug prescriptions (€1,402/yr). Out-of-pocket expenditure predominantly concerned the cost of private care workers. The value of informal care peaked at €13,590/yr. Socioeconomic factors do not influence AD public cost, but do affect the level of out-of-pocket expenditure.Conclusion:The burden of AD reflects the structure of Italian welfare. The families predominantly manage AD patients. The public expenditure is mostly for drugs and cash-for-care benefits. From a State perspective in the short term, the advantage of these care arrangements is clear, compared to the cost of residential care. However, if caregivers are not adequately supported, savings may be soon offset by higher risk of caregiver morbidity and mortality produced by high burden and stress. The study has been registered on the website www.clinicaltrials.org (Trial Registration number: NCT01700556).

Published
2015

10. The economic burden of chronic obstructive pulmonary disease in the elderly: Results from a systematic review of the literature

Author

Bustacchini, S, Chiatti, C, Furneri, G, Lattanzio, F, Mantovani, L, Bustacchini S, Chiatti C, Furneri G, Lattanzio F, Mantovani LG, Bustacchini, S, Chiatti, C, Furneri, G, Lattanzio, F, Mantovani, L, Bustacchini S, Chiatti C, Furneri G, Lattanzio F, and Mantovani LG

Abstract

Purpose of review: Chronic obstructive pulmonary disease (COPD) is a high prevalence condition with a significant clinical and economic burden. In elderly people, COPD is often associated with other chronic comorbidities (i.e. cardiovascular diseases), determining clinical complications and requiring frequent acute healthcare interventions. The aim of this article is to review the economic studies evaluating costs and healthcare resource utilization in elderly (≥65 years) COPD patients. Recent findings: Sixteen of the initial 359 articles retrieved through our research strategy were found to include relevant cost information on elderly COPD patients or to evaluate the effect of older age on healthcare expenditure. Most studies were carried out in the United States and used administrative database claims to determine resource consumption and direct costs (attributable and not). Very few studies focused exclusively on elderly patients. Summary: Results showed a certain variability of cost estimations, mainly due to the different methodologies and adopted cost approach. However, we found a trend of direct cost growth in the elderly population, which can be explained by a more frequent use of acute healthcare services, especially for managing COPD exacerbations. These results cannot be considered definitive and new studies, targeting elderly people, are required in order to confirm these preliminary findings. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Published
2011

11. Frailty and muscle metabolism dysregulation in the elderly

Author

EVANS WJ, ABBATECOLA AM, CORSONELLO A, BUSTACCHINI S, STROLLO F, LATTANZIO F., PAOLISSO, Giuseppe, Evans, Wj, Paolisso, Giuseppe, Abbatecola, Am, Corsonello, A, Bustacchini, S, Strollo, F, and Lattanzio, F.

Published
2010

12. Management of hypertension and dyslipidemia in primary care in Italy

Author

Sturkenboom, M, Mazzaglia, G, Picelli, G, Mozaffari, E, Bustacchini, S, Kramarz, P, Filippi, A, Sturkenboom MC, Mazzaglia G, Picelli G, Mozaffari E, Bustacchini S, Kramarz P, Filippi A, Sturkenboom, M, Mazzaglia, G, Picelli, G, Mozaffari, E, Bustacchini, S, Kramarz, P, Filippi, A, Sturkenboom MC, Mazzaglia G, Picelli G, Mozaffari E, Bustacchini S, Kramarz P, and Filippi A

Abstract

Objectives: Guidelines for the screening, treatment, and monitoring of modifiable cardiovascular risk factors such as hypertension (HTN) and dyslipidemia (DYS), have been developed to assist physicians in lowering the global risk of cardiovascular disease (CVD). This study assessed the management of patients with these conditions in a primary care setting in Italy. Methods: This was a retrospective cohort study conducted in 2000–2002 using the Italian Health Search Database (HSD). The management of HTN (blood pressure [BP] 140/90 mmHg) and DYS (total cholesterol 5 mmol/L [193 mg/dL]) was assessed by measuring the numbers of patients screened for one or both conditions, the numbers treated pharmacologically, and the numbers monitored for treatment success. Management patterns were stratified by history of cardiovascular events. Results: Blood pressure screening at a population level was approximately 35% for HTN in each year whereas for DYS, it increased from 26% in 2000 to 32% in 2002. Over the study period, the prevalence of HTN increased from 19% to 23%, whereas the prevalence for DYS doubled (from 14% to 28%). For both HTN and DYS these prevalences were substantially lower than national survey estimates (23% versus 48% for HTN and 16% versus 57% for DYS in 2001). Among patients with newly identified HTN or DYS, eligible for reimbursed pharmacological treatment, 26% and 82%, respectively, were not treated within 1 year of diagnosis. Treatment levels were higher in patients with a history of CVD, but were still far from optimal. Monitoring of BP and cholesterol in the first year of treatment was sub-optimal e.g. 36% of newly-treated HTN patients had no record of a BP evaluation and 32% of newly-treated DYS patients had no record of a cholesterol assessment. Blood pressure monitoring was slightly higher in patients with a history of CVD. Extrapolation to all new HTN and DYS patients showed that less than 50% of patients with HTN and 12% of those with DYS were adequa

Published
2005

13. Socioeconomic Predictors of the Employment of Migrant Care Workers by Italian Families Assisting Older Alzheimer's Disease Patients: Evidence From the Up-Tech Study

Author

Barbabella, F., Chiatti, C., Rimland, J. M., Melchiorre, M. G., Lamura, G., Lattanzio, F., Baldassarri, D., Bitti, L., Carosi, A., Sabbatini, M., Paolasini, E., Fiori, T., Fronzi, C., Giacchetta, S., Giacomini, V., Giovagnoli, L., Lattanzi, G., Manca, A. M., Pigini, V., Pignotti, M., Proietti, M. C., Quarticelli, A., Rovedi, M., Tasso, L., Valeri, V., Antonioli, A., Barabucci, M., Bassani, M., Bollettini, P., Bruttapasta, M. C., Buccolini, C., Carangella, R., Carboni, F., Ceccolini, D., D'Incecco, P., Di Felice, M., Dini, L., Gioia, G., Di Prima, G., Giusepponi, G., Lanciotti, C., Loffreda, A., Luciani, O., Mariani, L., Mastrorilli, F., Moroni, R., Piatkowska, I., Rucoli, R., Scoccia, G., Teodori, N., Tonelli, T., Angeloni, R., Bratti, R. A., Bonafede, G., Lorenzetti, S., Paci, C., Picciotti, G., Pezzola, D., Rea, V., Scialè, V., Signorino, M., Sorvillo, F., Tomassini, P. F., Ciccola, A., Cionfrini, L., Alessandrini, D., De Santis, A., Formica, B., Tacchi, G., Tortorelli, S., Regional, M., Marchegiani, G., Pozzari, G., Santarelli, G., Bartolucci, D., Caraffa, G., Cavallo, Filippo, Di Furia, L., Lacetera, A., Maffei, C. M., Manzoli, L., Postacchini, D., Bonfigli, A. R., Bonfranceschi, F., Bustacchini, S., Capasso, M., Cassetta, L., Civerchia, P., Demma, F., Di Rosa, M., Furneri, G., Giuli, C., Marcellini, M., Marinelli, P., Melchiorre, G., Moraca, M. E., Principi, A., Rocchetti, C., Spazzafumo, L., Vincitorio, D., Bartulewicz, K., Olivetti, P., and Rossi, L.

Subjects
Gerontology, Migrant care worker, Male, Financing, Government, very elderly, aged, Alzheimer disease, caregiver, economics, educational status, employment, female, financial management, home care, human, Italy, long term care, male, middle aged, migration, socioeconomics, standards, statistics and numerical data, supply and distribution, very elderly, Aged, Aged, 80 and over, Alzheimer Disease, Caregivers, Educational Status, Employment, Female, Financing, Personal, Home Care Services, Humans, Long-Term Care, Middle Aged, Socioeconomic Factors, Transients and Migrants, Alzheimer's disease, Care allowance, Family caregiver, Socioeconomic factors, Up-Tech, Disease, 0302 clinical medicine, 050602 political science & public administration, 80 and over, 030212 general & internal medicine, Family caregivers, 05 social sciences, 0506 political science, Clinical Psychology, Government, population characteristics, Financing, geographic locations, Social Psychology, Social class, Financial management, 03 medical and health sciences, medicine, Personal, Socioeconomic status, Aged, business.industry, medicine.disease, Long-term care, Care workers, Geriatrics and Gerontology, business
Abstract

The availability of family caregivers of older people is decreasing in Italy as the number of migrant care workers (MCWs) hired by families increases. There is little evidence on the influence of socioeconomic factors in the employment of MCWs.We analyzed baseline data from 438 older people with moderate Alzheimer's disease (AD), and their family caregivers enrolled in the Up-Tech trial. We used bivariate analysis and multilevel regressions to investigate the association between independent variables-education, social class, and the availability of a care allowance-and three outcomes-employment of a MCW, hours of care provided by the primary family caregiver, and by the family network (primary and other family caregivers).The availability of a care allowance and the educational level were independently associated with employing MCWs. A significant interaction between education and care allowance was found, suggesting that more educated families are more likely to spend the care allowance to hire a MCW.Socioeconomic inequalities negatively influenced access both to private care and to care allowance, leading disadvantaged families to directly provide more assistance to AD patients. Care allowance entitlement needs to be reformed in Italy and in countries with similar long-term care and migration systems.

Published
2014

14. Management of Antihypertensive Drugs in Newly-Diagnosed Hypertensive Patients in Italy: A Retrospective Cohort Study in Primary Care

Author

Mazzaglia, G, Sturkenboom, M, Ruffo, P, Mantovani, L, Bustacchini, S, Filippi, A, Brignoli, O, Caputi, A, Mazzaglia G, Sturkenboom MC, Ruffo P, Mantovani L, Bustacchini S, Filippi A, Brignoli O, Caputi AP, Mazzaglia, G, Sturkenboom, M, Ruffo, P, Mantovani, L, Bustacchini, S, Filippi, A, Brignoli, O, Caputi, A, Mazzaglia G, Sturkenboom MC, Ruffo P, Mantovani L, Bustacchini S, Filippi A, Brignoli O, and Caputi AP

Published
2004

15. Management of hypertension and dyslipidemia in primary care in Italy

Author

Sturkenboom MC, Mazzaglia G, Picelli G, Mozaffari E, Bustacchini S, Kramarz P, Filippi A, Sturkenboom, M, Mazzaglia, G, Picelli, G, Mozaffari, E, Bustacchini, S, Kramarz, P, and Filippi, A

Subjects
Hypertension, dyslipidemia, primary care, electronic healthcare database
Abstract

Objectives: Guidelines for the screening, treatment, and monitoring of modifiable cardiovascular risk factors such as hypertension (HTN) and dyslipidemia (DYS), have been developed to assist physicians in lowering the global risk of cardiovascular disease (CVD). This study assessed the management of patients with these conditions in a primary care setting in Italy. Methods: This was a retrospective cohort study conducted in 2000–2002 using the Italian Health Search Database (HSD). The management of HTN (blood pressure [BP] 140/90 mmHg) and DYS (total cholesterol 5 mmol/L [193 mg/dL]) was assessed by measuring the numbers of patients screened for one or both conditions, the numbers treated pharmacologically, and the numbers monitored for treatment success. Management patterns were stratified by history of cardiovascular events. Results: Blood pressure screening at a population level was approximately 35% for HTN in each year whereas for DYS, it increased from 26% in 2000 to 32% in 2002. Over the study period, the prevalence of HTN increased from 19% to 23%, whereas the prevalence for DYS doubled (from 14% to 28%). For both HTN and DYS these prevalences were substantially lower than national survey estimates (23% versus 48% for HTN and 16% versus 57% for DYS in 2001). Among patients with newly identified HTN or DYS, eligible for reimbursed pharmacological treatment, 26% and 82%, respectively, were not treated within 1 year of diagnosis. Treatment levels were higher in patients with a history of CVD, but were still far from optimal. Monitoring of BP and cholesterol in the first year of treatment was sub-optimal e.g. 36% of newly-treated HTN patients had no record of a BP evaluation and 32% of newly-treated DYS patients had no record of a cholesterol assessment. Blood pressure monitoring was slightly higher in patients with a history of CVD. Extrapolation to all new HTN and DYS patients showed that less than 50% of patients with HTN and 12% of those with DYS were adequately treated or monitored. Conclusion: The differences between the prevalence of recorded HTN or DYS and national survey results suggest extensive underscreening and underdiagnosis of these conditions. Overall, this study highlights the need to improve the management of patients with HTN and DYS.

Published
2005

20. Estimating renal function to reduce the risk of adverse drug reactions

Author

Corsonello, A, Onder, Graziano, Bustacchini, S, Provinciali, M, Garasto, S, Gareri, P, Lattanzio, F., Onder, Graziano (ORCID:0000-0003-3400-4491), Corsonello, A, Onder, Graziano, Bustacchini, S, Provinciali, M, Garasto, S, Gareri, P, Lattanzio, F., and Onder, Graziano (ORCID:0000-0003-3400-4491)

Abstract

The aging process is characterized by relevant changes in pharmacokinetics. Renal function is known to decline with aging. However, as a result of reduced muscle mass, older individuals frequently have a depressed glomerular filtration rate (GFR) despite normal serum creatinine, and such a concealed renal insufficiency may impact significantly on the clearance of hydrosoluble drugs, as well as the risk of adverse drug reactions (ADRs) from hydrosoluble drugs. The assessment of renal function should thus be a mandatory item in the global examination of patient characteristics. Equations for estimating GFR have become very popular in recent years. However, different equations may yield significantly different estimated glomerular filtration rate (eGFR) values, which have important implications in dosing drugs cleared by the kidney. Current knowledge suggests that eGFR based on the Chronic Kidney Disease-Epidemiological Collaboration (CKD-EPI) study equation outperformed eGFR based on the Modification of Diet in Renal Disease (MDRD) study equation and creatinine clearance estimate based on the Cockcroft-Gault formula as a predictor of ADRs from kidney cleared drugs. More recently, the combined creatinine-cystatin C equation was shown to perform better than equations based on either of these markers alone in diagnosing CKD, even in older patients. However, its accuracy in predicting ADRs and usefulness in drug dosing is still to be investigated.

Published
2012

32. Prognostic significance of the short physical performance battery in older patients discharged from acute care hospitals.

Author

Corsonello A, Lattanzio F, Pedone C, Garasto S, Laino I, Bustacchini S, Pranno L, Mazzei B, Passarino G, Incalzi On Behalf Of The Pharmacosurveillance In The Elderly Care Pvc Study Investigators RA, Corsonello, Andrea, Lattanzio, Fabrizia, Pedone, Claudio, Garasto, Sabrina, Laino, Irma, Bustacchini, Silvia, Pranno, Luigi, Mazzei, Bruno, Passarino, Giuseppe, and Incalzi, Raffaele Antonelli

Published
2012
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34. Antidiabetic oral treatment in older people: does frailty matter?

Author

Abbatecola AM, Paolisso G, Corsonello A, Bustacchini S, and Lattanzio F

Abstract

Life expectancy has significantly increased over the past 30 years, with a greater prevalence of diverse disease states, especially type 2 diabetes mellitus. As older persons are a very heterogeneous group with an increased prevalence of comorbidities and a relative inability to tolerate the adverse effects of oral antidiabetic agents, the treatment of type 2 diabetes is particularly demanding. The principles of its management are similar to those in younger patients, but with special considerations linked to comorbidities and clinical status. The available oral antidiabetic drugs include insulin secretagogues (meglitinides and sulfonylureas), biguanides (metformin), [alpha]-glucosidase inhibitors, thiazolidinediones and newly introduced inhibitors of glucagon-like peptide 1 degrading enzyme dipeptidyl peptidase 4 (DPP-4). In addition, clinical aspects complicate diabetes care in the elderly, including cognitive disorders, physical disability and geriatric syndromes, such as frailty. The European Diabetes Working Party for Older Persons has increased glycaemic recommendations for target haemoglobin A1c from <7% to <=8% in the presence of frailty. This working party updated their guidelines in 2008 and their aim is to ensure that older Europeans with type 2 diabetes have high-quality diabetes care throughout their lives. The working party has created guidelines for the use of many drugs, and we will discuss some of these guidelines on the use of oral antidiabetic agents and their importance in the presence of frailty. Furthermore, as type 2 diabetes progresses in older persons, polypharmacy intensification is usually required to reach adequate glycaemic control, with the risk of adverse effects. In particular, clinical evidence shows that the use of sulfonylureas is associated with a greater risk of hypoglycaemica, whereas metformin and [alpha]-glucosidase inhibitors are associated with an increased risk of adverse gastrointestinal effects. The adverse effects of the recently introduced DPP-4 inhibitors are nasopharyngitis and/or upper respiratory tract infections. The literature suggests that oral antidiabetic agents are suitable for older persons; however, underappreciated risk factors, such as cognitive decline in frail individuals, have an important impact on oral antidiabetic treatment options. [ABSTRACT FROM AUTHOR]

Published
2009
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35. Variability in the prescription of cardiovascular medications in older patients: correlates and potential explanations.

Author

Maraldi C, Lattanzio F, Onder G, Gallerani M, Bustacchini S, De Tommaso G, and Volpato S

Abstract

In western countries approximately a quarter of the population is 65 years and older. People in this age group often have several coexisting medical problems and take multiple drugs, and older people receive the greatest proportion of dispensed prescriptions. The prevalence of cardiovascular diseases, the leading cause of death and a major cause of physical and cognitive disability, increases steeply with increasing age. Drugs for the prevention and treatment of cardiovascular conditions account for a large proportion of medication prescription in older persons. Despite a number of published guidelines and expert recommendations supporting a standardized use of many cardiovascular agents, there is growing evidence of a tremendous variability in cardiovascular drug prescriptions according to demographics, health characteristics, and setting of care. In particular, evidence shows an inverse relationship between treatment propensity and age. To date, there is little evidence of benefit of most pharmacotherapy in frail, older subjects or elderly individuals with multiple comorbidities and polypharmacotherapy. However, effective treatment should not be denied solely on the basis of age. A major challenge in geriatric practice is to ensure safe and effective pharmacological treatments, avoiding the risk of polypharmacy and inappropriate drug prescription. [ABSTRACT FROM AUTHOR]

Published
2009
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36. Cu to Zn ratio, physical function, disability, and mortality risk in older elderly (ilSIRENTE study)

Author

Silvia Giovannini, Silvia Bustacchini, Ettore Capoluongo, Fabrizia Lattanzio, Francesco Piacenza, Roberto Bernabei, Marco Malavolta, Enrico Guffanti, Eugenio Mocchegiani, Andrea Russo, Andrea Basso, Angela Marie Abbatecola, Francesco Landi, Mocchegiani, E, Malavolta, M, Lattanzio, F, Piacenza, F, Basso, A, Abbatecola, Am, Russo, A, Giovannini, S, Capoluongo, E, Bustacchini, S, Guffanti, Ee, Bernabei, R, and Landi, F

Subjects
Male, Gerontology, Aging, Longitudinal study, medicine.medical_specialty, Frail Elderly, Nutritional Status, Context (language use), Motor Activity, Article, Risk Factors, Cause of Death, Internal medicine, Activities of Daily Living, Linear regression, medicine, Humans, Disabled Persons, Muscle Strength, Prospective Studies, Prospective cohort study, Survival rate, Cause of death, Aged, 80 and over, invecchiamento, business.industry, Settore MED/09 - MEDICINA INTERNA, Hazard ratio, General Medicine, Prognosis, Survival Rate, Zinc, Italy, Biomarker (medicine), Female, Geriatrics and Gerontology, business, Biomarkers, Copper, Fragilità, Follow-Up Studies
Abstract

Associations between copper to zinc ratio (CZr) and mortality have suggested CZr as a biomarker of aging. Nevertheless, very limited data exist on the association between serum CZr and physical or functional status of very old people. We examined the relationship between serum CZr and physical performance, muscle strength, functional status, and survival from the ilSIRENTE Study: a longitudinal study of persons aged 80 years or older (n = 346). An adjusted linear regression model was subsequently performed to calculate the regression coefficients of the associations between baseline physical and functional measures (dependent variable) with CZr or “Cu and Zn” alone taking also into account the influence of other relevant factors, including hematological (albumin, cholesterol, and urea) and inflammatory biomarkers (IL-6 and CRP) that were significantly different across CZr tertiles. CZr showed significant and stronger relationships than Cu or Zn alone with all baseline physical and functional measures in models that did not include adjustments for inflammatory parameters. CZr was also associated with physical decline, measured as “SPPB% decline” at 2 years of follow-up and mortality at 4 years of follow-up. Subjects in the high CZr tertile had a higher risk of death with an adjusted hazard ratio of 1.92 (95% CI, 1.12–3.29; p = 0.02). In conclusion, we have confirmed the role of CZr as a predictor of mortality, whereas the role of CZr as a biomarker or predictor of physical or functional performance seems to be the consequence of its strict relationships with inflammatory parameters. In this context, further investigations need to be carried out.

Published
2011

37. The pharmacoeconomic impact of amlodipine use on coronary artery disease

Author

Simona de Portu, Luciana Scalone, Lorenzo G. Mantovani, Enrica Menditto, Silvia Bustacchini, Claudio Cricelli, DE PORTU, S, Menditto, Enrica, Scalone, L, Bustacchini, S, Cricelli, C, and Mantovani, Lg

Subjects
Adult, Male, medicine.medical_specialty, Cost effectiveness, Cost-Benefit Analysis, medicine.medical_treatment, Coronary Artery Disease, Revascularization, Coronary artery disease, medicine, Humans, Amlodipine, Intensive care medicine, health care economics and organizations, Aged, Randomized Controlled Trials as Topic, Pharmacology, biology, Cost–benefit analysis, Unstable angina, business.industry, cost-effectiveness analysis, Euros, Health Care Costs, Middle Aged, Calcium Channel Blockers, medicine.disease, biology.organism_classification, Hospitalization, Italy, Economic evaluation, Emergency medicine, Costs and Cost Analysis, Female, business, medicine.drug
Abstract

The most frequent cause of mortality and morbidity in industrialized countries is coronary artery disease (CAD), which in Europe alone is responsible for around two million deaths per year. In 2001 it accounted for about 260,000 hospital discharges in Italy. The costs of CAD treatment in Italy--which were borne by the Italian state, the third-party payer--amounted to 800 million euros. We propose to assess the pharmacoeconomic implications of using amlodipine besylate treatment in Italy for patients with coronary artery disease. The study is based on a post-hoc cost-effectiveness analysis that compared standard care supplemented by amlodipine besylate with ordinary standard care over a 36-month time horizon. The clinical outcome data were based on the prospective randomized evaluation of vascular effect of norvasc trial (PREVENT). Direct medical costs referred to the purchase costs of amlodipine besylate and the cost of National Health Service (NHS) hospitalization. The costs were discounted back at an annual rate of 5%. Patients administered amlodipine besylate exhibited a significant risk reduction with respect to any major vascular event or procedure when compared to the placebo group. The reduction mainly referred to unstable angina events and revascularization procedures. We estimated that the total cost of adding amlodipine besylate to standard care amounted to 139,050 euros per 1000 patients treated for 36 months. This represents a cost of 1780 euros per patient remaining free of any vascular event. Results were sensitive to both clinical and economic variables. The incremental costs of the alternative therapy ranged from 296 euros to 5066 per patient free of any event in, respectively, the best and worst scenario. Amlodipine besylate therapy can be a cost-effective strategy for CAD treatment in Italy. Our economic evaluation demonstrated, first, that by reducing vascular events and the need for revascularization procedures savings were achieved in hospital expenditure, and, second, that such savings could significantly offset drug costs.

Published
2006

38. The economic burden of inappropriate drug prescribing, lack of adherence and compliance, adverse drug events in older people: a systematic review

Author

Lorenzo G. Mantovani, Marco Cristiani, Gianluca Furneri, Clementina Misuraca, Fabrizia Lattanzio, Carlos Chiatti, Silvia Bustacchini, Chiatti, C, Bustacchini, S, Furneri, G, Mantovani, L, Cristiani, M, Misuraca, C, Lattanzio, F, Mantovani, LORENZO GIOVANNI, and Lattanzio, F.

Subjects
Pharmacology, medicine.medical_specialty, inappropriateness, Drug-Related Side Effects and Adverse Reactions, business.industry, MEDLINE, Poison control, Inappropriate Prescribing, Toxicology, medicine.disease, Occupational safety and health, Medication Adherence, Systematic review, Cost of Illness, Injury prevention, Health care, medicine, Humans, Pharmacology (medical), Medical emergency, Medical prescription, business, Adverse effect, Intensive care medicine, Aged
Abstract

Adverse drug events (ADEs) are an increasingly relevant issue for healthcare systems as they are associated with poorer health outcomes and avoidable misuse of resources. The rates of ADEs are higher in the elderly population, as many older patients have comorbidities, multiple drug prescriptions and deteriorated physical and cognitive functioning. The occurrence of ADEs can lead to a perceived lack of therapy efficacy and further underuse or suboptimal adherence in elderly people, with detrimental clinical outcomes. The present article systematically reviews the studies evaluating the economic impact of ADEs occurring as consequence of poor therapy adherence, inappropriate drug use, underuse of effective treatments and poor adherence, medication errors, drug-drug and drug-disease interactions. A Medline systematic literature review of studies evaluating the economic consequences of inappropriate drug prescribing, lack of adherence and compliance, ADEs in older people was performed. English-language articles were screened through a three-step approach (title review, abstract review, full article review) to select pertinent studies quantitatively evaluating costs. We systematically reviewed evidence from767 articles. After title, abstract and full text review, 21 articles were found to measure economic implications ofADEs, inappropriate drug prescribing and poor adherence in elderly patients. Studies suggested that the economic impact of these undesired effects is substantial: hospital costs were the main cost driver, with a relevant part of them being preventable (consequences of inappropriate prescribing). Healthcare costs for unused drug wastage and destruction were also surprisingly high. Although economic evidence in elderly patients is still limited, all studies seemed to confirm that the financial burden due to pharmacological treatment issues is relevant in elderly people. Including economic effects of adverse events in pharmacoeconomic analysis would be beneficial to improve the reliability of results. Preliminary evidence suggests that programmes aimed at comprehensively assessing geriatric conditions, detecting 'high-risk' prescriptions and training patients to comply with prescribed therapies could be costeffective measures to reduce the burden of ADE. Adis © 2012 Springer International Publishing AG. All rights reserved.

Published
2012

39. The economic burden of chronic obstructive pulmonary disease in the elderly: Results from a systematic review of the literature

Author

Fabrizia Lattanzio, Silvia Bustacchini, Gianluca Furneri, Lorenzo G. Mantovani, Carlos Chiatti, Bustacchini, S, Chiatti, C, Furneri, G, Lattanzio, F, Mantovani, L, S., Bustacchini, C., Chiatti, G., Furneri, F., Lattanzio, and Mantovani, LORENZO GIOVANNI

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Cost-Benefit Analysis, Psychological intervention, MEDLINE, Comorbidity, elderly, chronic obstructive pulmonary disease, Pulmonary Disease, Chronic Obstructive, Indirect costs, Cost of Illness, direct cost, exacerbations, Health care, Prevalence, Humans, Medicine, Intensive care medicine, Aged, COPD, Cost–benefit analysis, business.industry, Health Care Costs, medicine.disease, United States, humanities, Hospitalization, Relevant cost, Physical therapy, Female, business
Abstract

Purpose of review: Chronic obstructive pulmonary disease (COPD) is a high prevalence condition with a significant clinical and economic burden. In elderly people, COPD is often associated with other chronic comorbidities (i.e. cardiovascular diseases), determining clinical complications and requiring frequent acute healthcare interventions. The aim of this article is to review the economic studies evaluating costs and healthcare resource utilization in elderly (≥65 years) COPD patients. Recent findings: Sixteen of the initial 359 articles retrieved through our research strategy were found to include relevant cost information on elderly COPD patients or to evaluate the effect of older age on healthcare expenditure. Most studies were carried out in the United States and used administrative database claims to determine resource consumption and direct costs (attributable and not). Very few studies focused exclusively on elderly patients. Summary: Results showed a certain variability of cost estimations, mainly due to the different methodologies and adopted cost approach. However, we found a trend of direct cost growth in the elderly population, which can be explained by a more frequent use of acute healthcare services, especially for managing COPD exacerbations. These results cannot be considered definitive and new studies, targeting elderly people, are required in order to confirm these preliminary findings. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Published
2011

40. Antidiabetic oral treatment in older people: does frailty matter?

Author

Andrea Corsonello, Giuseppe Paolisso, Silvia Bustacchini, Fabrizia Lattanzio, Angela Marie Abbatecola, Abbatecola, Am, Paolisso, Giuseppe, Corsonello, A, Bustacchini, S, and Lattanzio, F.

Subjects
Polypharmacy, medicine.medical_specialty, business.industry, Frail Elderly, Administration, Oral, Type 2 Diabetes Mellitus, Type 2 diabetes, medicine.disease, Surgery, Metformin, Cognition, Diabetes Mellitus, Type 2, Sitagliptin, Diabetes mellitus, medicine, Humans, Hypoglycemic Agents, Pharmacology (medical), Geriatrics and Gerontology, Cognitive decline, Intensive care medicine, business, Adverse effect, Aged, medicine.drug
Abstract

Life expectancy has significantly increased over the past 30 years, with a greater prevalence of diverse disease states, especially type 2 diabetes mellitus. As older persons are a very heterogeneous group with an increased prevalence of comorbidities and a relative inability to tolerate the adverse effects of oral antidiabetic agents, the treatment of type 2 diabetes is particularly demanding. The principles of its management are similar to those in younger patients, but with special considerations linked to comorbidities and clinical status. The available oral antidiabetic drugs include insulin secretagogues (meglitinides and sulfonylureas), biguanides (metformin), alpha-glucosidase inhibitors, thiazolidinediones and newly introduced inhibitors of glucagon-like peptide 1 degrading enzyme dipeptidyl peptidase 4 (DPP-4). In addition, clinical aspects complicate diabetes care in the elderly, including cognitive disorders, physical disability and geriatric syndromes, such as frailty. The European Diabetes Working Party for Older Persons has increased glycaemic recommendations for target haemoglobin A(1c) from

Published
2009

41. Pharmacoeconomic consequences of amlodipine besylate therapy in patients undergoing PTCA

Author

Simona de Portu, Claudio Cricelli, Luciana Scalone, Lorenzo G. Mantovani, Enrica Menditto, Francesca Rossetti, Silvia Bustacchini, Rossetti, F, DE PORTU, S, Menditto, Enrica, Scalone, L, Bustacchini, S, Cricelli, S, and Mantovani, Lg

Subjects
Male, medicine.medical_specialty, Cost effectiveness, Cost-Benefit Analysis, medicine.medical_treatment, Population, Coronary Artery Disease, Revascularization, Coronary Restenosis, Coronary artery disease, Pharmacotherapy, Restenosis, Angioplasty, Internal medicine, medicine, Humans, Amlodipine, Angioplasty, Balloon, Coronary, education, health care economics and organizations, Randomized Controlled Trials as Topic, Pharmacology, education.field_of_study, business.industry, cost-effectiveness analysis, Middle Aged, medicine.disease, Italy, Emergency medicine, Cardiology, Female, business, medicine.drug
Abstract

In Italy, revascularization interventions increased from 44,600 in 1996 to more than 100,000 in 2001. In particular, the occurrence of percutaneous transluminal coronary angioplasty (PTCA) increased from 239 cases per million population in 1994 to about 1300 cases per million population in 2001. This trend has caused a concomitant increase in revascularization costs, which have doubled in few years, rising from Euro 421 millions in 1996 to Euro 850 millions in 2001. In 2001, PTCA amounted to 55% of total cost of revascularizations. The aim of this study was to assess the pharmacoeconomic consequences of amlodipine besylate therapy administered in patients at high risk of restenosis after PTCA. We conducted a cost-effectiveness analysis comparing therapy with amlodipine besylate added to standard care versus standard care alone. Information on clinical outcomes was drawn from the Coronary Angioplasty Amlodipine Restenosis Study (CAPARES). Medical costs were estimated with reference to drug therapy and hospitalizations for coronary events and revascularization procedures. The study was conducted from the perspective of the Italian third party payer (National Health Service). The analysis was applied to a time horizon of 4 months. Amlodipine besylate resulted less expensive and more effective than standard care. It reduced mortality, morbidity for coronary reasons and the need of revascularization procedures. The cost per 1000 patients was estimated at Euro 1,166,000 in the placebo and Euro 950,000 in the amlodipine besylate group, resulting into a cost saving of Euro 216,000, that is 18.5% of total cost of standard care. Results are sensitive to the cost of amlodipine besylate and the cost of hospitalizations, but therapy with amlodipine besylate resulted dominant even in the most unfavorable hypothesis.

Published
2006

42. Improving the prognostic value of multimorbidity through the integration of selected biomarkers to the comprehensive geriatric assessment: An observational retrospective monocentric study.

Author

Piacenza F, Di Rosa M, Fedecostante M, Madotto F, Montesanto A, Corsonello A, Cherubini A, Provinciali M, Soraci L, Lisa R, Bustacchini S, Bonfigli AR, and Lattanzio F

Abstract

Background: Multimorbidity (MM) burdens individuals and healthcare systems, since it increases polypharmacy, dependency, hospital admissions, healthcare costs, and mortality. Several attempts have been made to determine an operational definition of MM and to quantify its severity. However, the lack of knowledge regarding its pathophysiology prevented the estimation of its severity in terms of outcomes. Polypharmacy and functional impairment are associated with MM. However, it is unclear how inappropriate drug decision-making could affect both conditions. In this context, promising circulating biomarkers and DNA methylation tools have been proposed as potential mortality predictors for multiple age-related diseases. We hypothesize that a comprehensive characterization of patients with MM that includes the measure of epigenetic and selected circulating biomarkers in the medical history, in addition to the functional capacity, could improve the prognosis of their long-term mortality., Methods: This monocentric retrospective observational study was conducted as part of a project funded by the Italian Ministry of Health titled "imProving the pROgnostic value of MultimOrbidity through the inTegration of selected biomarkErs to the comprehensive geRiatric Assessment (PROMOTERA)." This study will examine the methylation levels of thousands of CpG sites and the levels of selected circulating biomarkers in the blood and plasma samples of older hospitalized patients with MM ( n = 1,070, age ≥ 65 years) recruited by the Reportage Project between 2011 and 2019. Multiple statistical approaches will be utilized to integrate newly measured biomarkers into clinical, demographic, and functional data, thus improving the prediction of mortality for up to 10 years., Discussion: This study's results are expected to: (i) identify the clinical, biological, demographic, and functional factors associated with distinct patterns of MM; (ii) improve the prognostic accuracy of MM patterns in relation to death, hospitalization-related outcomes, and onset of new comorbidities; (iii) define the epigenetic signatures of MM; (iv) construct multidimensional algorithms to predict negative health outcomes in both the overall population and specific disease and functional patterns; and (v) expand our understanding of the mechanisms underlying the pathophysiology of MM., 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 © 2022 Piacenza, Di Rosa, Fedecostante, Madotto, Montesanto, Corsonello, Cherubini, Provinciali, Soraci, Lisa, Bustacchini, Bonfigli and Lattanzio.)

Published
2022
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43. Prognostic Interplay of Functional Status and Multimorbidity Among Older Patients Discharged From Hospital.

Author

Corsonello A, Soraci L, Di Rosa M, Bustacchini S, Bonfigli AR, Lisa R, Liperoti R, Tettamanti M, Cherubini A, Antonicelli R, Pelliccioni G, Postacchini D, and Lattanzio F

Subjects
Adult, Aged, Functional Status, Hospitals, Humans, Prognosis, Prospective Studies, Multimorbidity, Patient Discharge
Abstract

Objectives: The purpose of this study was to investigate the prognostic weight of multimorbidity and functional impairment over long-term mortality among older patients discharged from acute care hospitals., Design: A prospective multicenter observational study., Setting and Participants: Our series consisted of 1967 adults aged ≥65 years consecutively admitted to acute care wards in Italy, in the context of the Report-AGE project., Methods: After signing a written informed consent, all patients underwent comprehensive geriatric assessment by Inter-RAI Minimum Data Set acute care. The primary endpoint of the present study was long-term mortality. Patients were grouped into 3 functional clusters and 3 disease clusters using the K-medians cluster analysis. The association of functional clusters, disease clusters, and Charlson score categories with long-term mortality was investigated through Cox regression analysis and the intercluster classification agreement was further estimated. Finally, the additive effect of either disease clusters or Charlson score on predictive ability of functional clusters was assessed by using changes in Harrell's C-index and categorical Net Reclassification Index (NRI)., Results: Functional clusters, disease clusters, and Charlson score were significant predictors of long-term mortality, but the interclassification agreement was poor. Functional clusters predicted mortality with greater accuracy [C-index 0.66, 95% confidence interval (CI) 0.65-0.68] compared with disease clusters (C-index 0.54, 95% CI 0.53-0.56), and Charlson score (C-index 0.58, 95% CI 0.56-0.59). Adding multimorbidity (NRI 0.23, 95% CI 0.14-0.31) or Charlson score (NRI 0.13, 95% CI 0.03-0.20) to functional cluster model slightly improved the accuracy of prediction., Conclusions and Implications: Functional impairment may better predict prognosis compared with multimorbidity, which may be relevant to optimally address individuals' needs and to design tailored preventive interventions., (Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Published
2022
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44. Design and methodology of the screening for CKD among older patients across Europe (SCOPE) study: a multicenter cohort observational study.

Author

Corsonello A, Tap L, Roller-Wirnsberger R, Wirnsberger G, Zoccali C, Kostka T, Guligowska A, Mattace-Raso F, Gil P, Fuentes LG, Meltzer I, Yehoshua I, Formiga-Perez F, Moreno-González R, Weingart C, Freiberger E, Ärnlöv J, Carlsson AC, Bustacchini S, and Lattanzio F

Subjects
Aged, Albuminuria, Biomarkers blood, Biomarkers urine, Clinical Protocols, Creatinine blood, Creatinine urine, Europe epidemiology, Glomerular Filtration Rate, Humans, Prospective Studies, Renal Insufficiency, Chronic epidemiology, Geriatric Assessment, Mass Screening, Renal Insufficiency, Chronic diagnosis
Abstract

Background: Decline of renal function is common in older persons and the prevalence of chronic kidney disease (CKD) is rising with ageing. CKD affects different outcomes relevant to older persons, additionally to morbidity and mortality which makes CKD a relevant health burden in this population. Still, accurate laboratory measurement of kidney function is under debate, since current creatinine-based equations have a certain degree of inaccuracy when used in the older population. The aims of the study are as follows: to assess kidney function in a cohort of 75+ older persons using existing methodologies for CKD screening; to investigate existing and innovative biomarkers of CKD in this cohort, and to align laboratory and biomarker results with medical and functional data obtained from this cohort. The study was registered at ClinicalTrials.gov, identifier NCT02691546, February 25th 2016., Methods/design: An observational, multinational, multicenter, prospective cohort study in community dwelling persons aged 75 years and over, visiting the outpatient clinics of participating institutions. The study will enroll 2450 participants and is carried out in Austria, Germany, Israel, Italy, the Netherlands, Poland and Spain. Participants will undergo clinical and laboratory evaluations at baseline and after 12 and 24 months- follow-up. Clinical evaluation also includes a comprehensive geriatric assessment (CGA). Local laboratory will be used for 'basic' parameters (including serum creatinine and albumin-to-creatinine ratio), whereas biomarker assessment will be conducted centrally. An intermediate telephone follow-up will be carried out at 6 and 18 months., Discussion: Combining the use of CGA and the investigation of novel and existing independent biomarkers within the SCOPE study will help to provide evidence in the development of European guidelines and recommendations in the screening and management of CKD in older people., Trial Registration: This study was registered prospectively on the 25th February 2016 at clinicaltrials.gov ( NCT02691546 ).

Published
2018
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45. Preadmission Functional Decline Predicts Functional Improvement Among Older Patients Admitted to Acute Care Hospital.

Author

Gagliardi C, Corsonello A, Di Rosa M, Fabbietti P, Cherubini A, Mercante O, Mazzei B, Postacchini D, Deales A, Bustacchini S, and Lattanzio F

Subjects
Activities of Daily Living, Aged, Aged, 80 and over, Aging physiology, Female, Humans, Kaplan-Meier Estimate, Male, Outcome Assessment, Health Care statistics & numerical data, Physical Functional Performance, Proportional Hazards Models, Diagnostic Tests, Routine methods, Diagnostic Tests, Routine statistics & numerical data, Geriatric Assessment methods, Geriatric Assessment statistics & numerical data, Hospitalization statistics & numerical data
Abstract

Background: Functional decline from preadmission to admission may represent an important predictor of functional trajectories during hospitalization among older patients. Therefore, we aimed at describing the impact of preadmission decline on functional trajectories among older hospitalized patients., Methods: Our series consisted of 2,011 patients aged 65 years or more consecutively admitted to four acute care wards of Geriatric Medicine participating to a multicenter observational study. Enrolled patients underwent comprehensive geriatric assessment (CGA) by Inter-RAI Minimum Data Set. Main outcomes were functional decline or improvement from hospital admission to discharge based on Activities of Daily Living (ADL) scale. The main exposure variable was ADL decline during the preadmission period (ie, 3 days before the onset of acute illness), and its impact on functional trajectories during stay was investigated by Cox regression models after adjusting for potential confounders., Results: After adjusting for potential confounders, preadmission functional decline was significantly associated with functional improvement during stay (hazard ratio [HR] = 6.65; 95% confidence interval [CI] = 5.01-8.84), but not with functional decline. Severe cognitive impairment (HR = 0.28, 95% CI = 0.13-0.60), visual impairment (HR = 0.60, 95% CI = 0.41-0.89), and weight loss (HR = 0.67, 95% CI = 0.47-0.94) were associated with functional improvement during stay. Hearing impairment (HR = 1.94, 95% CI = 1.17-3.23) and mild (HR = 2.54, 95% CI = 1.41-4.58) or severe cognitive impairment (HR = 2.72, 95% CI = 1.13-6.56) were associated with functional decline during stay., Conclusions: Patients experiencing recent preadmission functional decline should be considered as those for which the geriatric approach may lead to the better functional result in the acute care setting. CGA allows to individuate risk factors to be addressed in the acute care setting.

Published
2018
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46. Coronary flow response to remote ischemic preconditioning is preserved in old cardiac patients.

Author

Santillo E, Migale M, Balestrini F, Postacchini D, Bustacchini S, Lattanzio F, and Antonelli-Incalzi R

Subjects
Aged, Aged, 80 and over, Blood Flow Velocity physiology, Coronary Vessels diagnostic imaging, Echocardiography, Female, Heart, Humans, Male, Ultrasonography, Cardiac Rehabilitation methods, Coronary Vessels physiology, Ischemic Preconditioning, Myocardial methods
Abstract

Background: The effect of remote ischemic preconditioning (RIPC) on coronary flow in elderly cardiac patients has not been investigated yet. Thus, we aimed to study the change of coronary flow subsequent to RIPC in old patients with heart diseases and to identify its main correlates., Methods: Ninety-five elderly patients (aged ≥ 65 years) accessing cardiac rehabilitation ward underwent transthoracic ultrasound evaluation of peak diastolic flow velocity of left anterior descending artery. Measurements of coronary flow velocity were performed on baseline and after an RIPC protocol (three cycles of 5 min ischemia of right arm alternating 5 min reperfusion). Differences between subjects with coronary flow velocity change over or equal the 75° percentile (high-responders) and subjects with a coronary flow velocity change under the 75° percentile (low-responders) were assessed., Results: In enrolled elderly heart patients, coronary flow velocity significantly augmented from baseline after RIPC [0.23 m/s (0.18-0.28) vs 0.27 m/s (0.22-0.36); p < 0.001 by Wilcoxon test]. High-responders to RIPC were significantly younger and in better functional status than low-responders. Heart failure resulted as the main variable associated with impairment of RIPC responsiveness (R 2  = 0.202; p = 0.002)]., Conclusions: Our sample of old cardiac patients presented a significant median increment of coronary flow velocity after RIPC. The magnitude of the observed change of coronary flow velocity was comparable to that previously described in healthy subjects. The coronary response to RIPC was attenuated by heart failure. Further research should define whether such RIPC responsiveness is associated with cardioprotection and carries prognostic implications.

Published
2018
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47. Adverse Events of Proton Pump Inhibitors: Potential Mechanisms.

Author

Corsonello A, Lattanzio F, Bustacchini S, Garasto S, Cozza A, Schepisi R, Lenci F, Luciani F, Maggio MG, Ticinesi A, Butto V, Tagliaferri S, and Corica F

Subjects
Animals, Bacterial Infections etiology, Cardiovascular Diseases etiology, Fractures, Bone etiology, Humans, Kidney Diseases etiology, Nervous System Diseases etiology, Nutrition Disorders etiology, Proton Pump Inhibitors adverse effects
Abstract

Objective: We aimed at summarizing current evidence about mechanisms for potentially harmful effects of Proton Pump Inhibitors (PPIs)., Methods: A Pubmed search was performed, and 207 studies concerning the relationship between use of PPIs and cardiovascular diseases, kidney impairment, nutritional disorders, fractures, infections, functional decline, and mortality were selected and reviewed., Results: PPIs may cause potentially harmful effects by several mechanisms, including endothelial dysfunction, hypomagnesemia, drug interactions, reduced absorption of selected nutrients, increased gastric microbiota and small intestine bacterial overgrowth, reduced immune response, tubular-interstitial inflammation, increased bone turnover, accumulation of amyloid in the brain. Clinical and epidemiologic evidence is not consistent in regard to some negative outcomes during PPI treatment. Data from randomized clinical trials seem to deny most of them, but they are usually designed to investigate efficacy of drugs in ideal conditions and are not powered enough to detect adverse events. Besides being at special risk of experiencing negative outcomes during long-term treatment with PPIs, older and complex patients treated with polypharmacy regimens are persistently excluded from randomized clinical trials. Thus, large observational studies involving real-world patients should be considered as an important informative source about potential risks related to PPIs., Conclusions: Current evidence suggests that use of PPIs may be associated with negative outcomes by eliciting several different pathophysiologic mechanisms. While short-term PPIs could be considered effective and safe in adult patients with acid-related disorders, their long-term and often inappropriate use in patients carrying vulnerability to adverse events and/or high risk of drug-interactions should be avoided., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Published
2018
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48. Special considerations for the treatment of chronic kidney disease in the elderly.

Author

Corsonello A, Fusco S, Bustacchini S, Chiatti C, Moresi R, Bonfigli AR, Di Stefano G, and Lattanzio F

Subjects
Aged, Humans, Renal Insufficiency, Chronic therapy, Renal Replacement Therapy methods
Abstract

Chronic kidney disease (CKD) is common in older adults, and its burden is expected to increase in older populations. Even if the knowledge on the approach to older patient with CKD is still evolving, current guidelines for pharmacological management of CKD does not include specific recommendations for older patients. Additionally, decision-making on renal replacement therapy (RRT) for older patients is far from being evidence-based, and despite the improvement in dialysis outcomes, RRT may cause more harm than benefit compared with conservative care when prognostic stratification is not carefully assessed. The use of comprehensive geriatric assessment tools could help clinicians in applying a more informed decision-making. Finally, physical exercise and rehabilitation interventions also represents a promising therapeutic strategy.

Published
2016
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49. The Report-AGE project: a permanent epidemiological observatory to identify clinical and biological markers of health outcomes in elderly hospitalized patients in Italy.

Author

Bustacchini S, Abbatecola AM, Bonfigli AR, Chiatti C, Corsonello A, Di Stefano G, Galeazzi R, Fabbietti P, Lisa R, Guffanti EE, Provinciali M, and Lattanzio F

Subjects
Aged, Aged, 80 and over, Comorbidity, Critical Care statistics & numerical data, Female, Health Status Disparities, Hospitalization statistics & numerical data, Humans, Italy epidemiology, Male, Risk Factors, Aging physiology, Biomarkers blood, Frail Elderly statistics & numerical data, Geriatric Assessment methods, Nutritional Status physiology, Patient Discharge statistics & numerical data
Abstract

Background: Italy is expected to experience the largest growth in persons ≥65 years (>20% by 2020). This demographic shift allows for geriatric research on predictive clinical and biological markers of outcomes related to frailty, re-hospitalization and mortality., Aims: To describe rationale and methods of the Report-AGE study project of acute care patients in Italian National Research Center on Aging (INRCA) research hospitals., Methods: Report-AGE study is a large observational study on health conditions and outcomes of hospitalized elderly patients (≥65 years). The primary objective of the study is to create a high-level data resource of demographics, comprehensive geriatric assessments, clinical and diagnostic information, as well as biological and molecular markers in all older patients admitted to INRCA Hospitals. Assessments in physical and nutritional parameters, co-morbid health conditions, and associations with frailty parameters are ongoing in older hospitalized adults following an acute event. Study collection began in September 2011., Results: Up to date, there are 3479 patients ≥65 years (mean age: 85 ± 7years) with 1543 men and 1936 women enrolled. Data have been recorded regarding functional and clinical parameters before, during hospital admission and at discharge. Data collection for primary outcome analyses related to re-hospitalization and mortality is estimated for September 2016., Discussion: This study aims at collecting precise clinical data, comprehensive geriatric assessment, risk factors, and biological data from acute care patients. Data will also be used to identify mechanisms underlying frailty in this specific population., Conclusion: This study provides a descriptive epidemiological collection of the health conditions of older in-patients.

Published
2015
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50. The UP-TECH project, an intervention to support caregivers of Alzheimer's disease patients in Italy: preliminary findings on recruitment and caregiving burden in the baseline population.

Author

Chiatti C, Rimland JM, Bonfranceschi F, Masera F, Bustacchini S, and Cassetta L

Subjects
Activities of Daily Living, Adult, Aged, Alzheimer Disease epidemiology, Alzheimer Disease psychology, Caregivers education, Female, Health Knowledge, Attitudes, Practice, Humans, Italy epidemiology, Male, Middle Aged, Outcome and Process Assessment, Health Care, Prevalence, Prospective Studies, Psychiatric Status Rating Scales, Reproducibility of Results, Socioeconomic Factors, Surveys and Questionnaires, Adaptation, Psychological, Alzheimer Disease therapy, Caregivers psychology, Cost of Illness, Quality of Life
Abstract

Objectives: The paper describes recruitment results and characteristics of the UP-TECH clinical trial sample, including level of care services use, informal caregiver burden and its determinants., Methods: UP-TECH is designed to test innovative care solutions for community-dwelling patients with moderate stage Alzheimer's disease and their caregivers in Italy. Four hundred and fifty patient-caregiver dyads were randomized into three arms receiving different combinations of services, composed of case management interventions, nurse visits, assistive technology and educational brochures. The research nurses administered a questionnaire comprising an in-depth socio-demographic assessment and several clinical scales, such as Novak's Caregiver Burden Inventory. Analyses of baseline data were conducted using uni- and bi-variate statistics. Linear regressions were computed to identify de-confounded correlates of caregiver burden., Results: Four hundred and thirty-eight patient-caregiver dyads were recruited and randomized. In our sample, patients are predominantly women (71.5%), with an average age of 81.5 years and a mean Mini-Mental State Examination score of 16.2. Caregivers are mostly women (66.2%) and offspring (55.7%), with a mean caregiver burden score of 27.6. They provide more than 50 hours of care per week, while receiving an almost negligible support from public services. Factors associated with caregiver burden are female gender, kinship and the patient's behavioral disturbances. The most important factor associated with lower burden is the employment of a live-in care worker., Conclusion: The paper provides a comprehensive description of moderate stage Alzheimer's disease patients and their caregivers, suggesting useful markers of caregiver burden. The well-balanced randomization assures the reliability of the study data-set for prospective evaluation of care strategies.

Published
2015
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