Search

BACKGROUND AND AIMS: Understanding which patients benefit from rehabilitation programs may be useful in balancing resources and needs. The aim of this study was to evaluate whether cognitive and nutritional status are associated with functional improvement after rehabilitation in old persons. METHODS: 2650 patients (aged >/=60 years) consecutively admitted to a geriatric rehabilitation unit in Italy between August 2001 and December 2005, were included. Functional status was evalutated with the Tinetti scale, cognitive status with the Mini-Mental State Examination (MMSE), and nutritional status with the Mini-Nutritional Assessment Short Form (MNA-SF). To identify predictors of functional recovery, multiple logistic regression models were run, with improvement on the Tinetti scale score as dependent variable. RESULTS: Eighty per cent of old persons functionally improved after rehabilitation, ranges being 84% of those with MMSE>/=24 to 58% of those with MMSE<10. Persons with both good cognition and good nutritional status were most likely to improve [odds ratio (OR)=2.5; 95% confidence interval (95% CI)=1.9-3.2]. Stratifying the sample according to cognitive status, we found that in patients with MMSE>/=18 better nutritional status emerged as a factor associated with functional improvement, whereas in patients with severe cognitive impairment (MMSE<18), the only associated factor was a higher MMSE score. CONCLUSIONS: The results of the present study suggest that both good cognition and good nutritional status are associated with functional improvement in older persons. However, patients with poor cognition can also improve, depending on their degree of cognitive impairment, and they should not be routinely excluded from rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Restoring functional independence in elderly people with disabilities is one of the main purposes of a geriatric rehabilitation unit. However, the rehabilitation period may also represent a useful circumstance to identify predictors of long-term health outcomes. The aim of this study was to evaluate a broad spectrum of characteristics in geriatric patients admitted to a rehabilitation unit in order to identify possible predictors of long-term survival., Methods: This cross-sectional and prospective study was carried out in an Evaluation and Rehabilitation unit in Northern Italy. 243 persons aged 65 or older were enrolled over a period of 12 months (2007-8) and followed for 2 years. Possible predictors of survival were identified among a large spectrum of demographic, clinical (Charlson Index, lab data), nutritional (Mini-Nutritional Short-Form, bio-impedance analysis), and respiratory (spirometry) features. Logistic regression models were used to evaluate the association between patients' characteristics and survival., Results: 189 (86.3%) participants were alive after 2 years of follow-up. Younger age, better functional status at discharge, a lower Charlson Index score, higher hemoglobin and albumin values at discharge, lower basal fasting glucose, creatinine, TNF-α levels, and extra-cellular water, as well as higher cholesterol, vital capacity (VC), and inspiratory capacity were significantly associated with survival. In the multivariate model, higher VC (OR=6.2; 95%CI=1.6-24.6) and albumin (OR=3.7; 95%CI=1.2-11.8) were associated with survival, whereas the Charlson Index and male gender showed an inverse correlation (OR=0.77; 95%CI=0.60-0.99 and OR=0.23; 95%CI=0.10-0.95, respectively)., Conclusion: VC was identified as one of the best predictors of survival along with higher albumin and lower Charlson Index score within 2 years of inpatient rehabilitation among older adults., (Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Objectives: Our goal was to evaluate the proportion of community-dwelling elderly people at risk for malnutrition and the effect of different socioeconomic status (SES) indicators as well as social, physical and leisure activities in late life on the risk for malnutrition., Design: A cross-sectional population-based study., Setting: A sub-urban area in Northern Italy., Participants: 698 community-dwelling older persons., Measurements: The nutritional status of participants was assessed through the Mini Nutritional Assessment-Short Form (MNA-SF). SES was defined by means of early-life education, longest occupation, and late-life financial conditions. The following indicators were also evaluated: social contacts, and performing mental, physical and leisure activities during late-life. Chronic diseases, functional, cognitive and affective status were considered as potential confounders when examining the risk for malnutrition by logistic regression models., Results: 8% of the participants (average age 75.6 years, 408 women) were at risk for malnutrition (MNA-SF ≤ 11). Low education, poor financial condition, and lack of physical and leisure activities showed a crude association with risk for malnutrition. Multi-adjusted logistic regression models showed that only low education (OR=2.9; 95% CI=1.2-6.8) and lack of physical activity (OR=4.4;95%CI=2.0-9.7) were independently associated with the risk for malnutrition., Conclusions: Low education and lack of physical activity in late-life may affect the risk for malnutrition in the elderly. Further studies are needed to clarify the cause-effect relationship between lack of physical activity and malnutrition.

Celiac disease is not a negligible cause of malabsorption in the elderly. Diarrhea, loss of weight and abdominal discomfort are often absent so that celiac disease has indeed a subtle, paucisymptomatic, course in the elderly. More than 50% of the patients have extraintestinal symptoms; only 10-40% have typical complaints pointing to small-intestinal biopsy. Elimination of gluten from diet is the cornerstone of the therapy. A 73-year-old woman with hyporexia, loss of weight, depression, bowel abnormalities and progressive deterioration of her abilities in the instrumental activities of daily living was referred to our department. Antigliadin and antiendomysial antibodies were present. A subsequent small-intestinal biopsy of the second and third portion of duodenum showed subtotal villous atrophy, increase of intra-epithelial lymphocytes as well as hyperplastic glands (type III Marsh score). All these pathological findings were compatible with celiac disease diagnosis so that a gluten-free diet was then initiated.

Objective: To evaluate the relationship between depressive symptoms, cognition and somatic diseases on functional status of geriatric patients at hospital discharge., Method: Patients 65+ years consecutively admitted to the acute care geriatric ward of the Internal Medicine Department I, Civil Hospital of Brescia, Italy, from February 1998 to December 2000 (n = 830) were examined. Functional disability was defined as need of physical assistance in at least one of the basic Activities of Daily Living (ADL). The Greenfield Index of Disease Severity (IDS) and the Geriatric Index of Comorbidity (GIC) were used to measure number and severity of diseases. The Mini-Mental State Examination (MMSE) assessed cognitive status and the Geriatric Depression Scale (GDS) measured depressive symptoms., Results: Prevalence of functional disability at discharge was 29.3% in the younger age group (65-74 years) and 55.2% in the older age group (75+ years). Using logistic regression models, older age, poorer cognitive status, and depressive symptoms were independently associated with functional disability in the younger and older age group, respectively. Additionally cognitive impairment and depressive symptoms showed an additive association with disability, especially in younger patients, while comorbidity was correlated with functional status only in the oldest old, in particular among those who were cognitively impaired., Conclusion: Functional disability after acute hospitalization is highly prevalent in geriatric patients. Depressive symptoms, comorbidity, and cognitive impairment often coexist, interact and are differentially associated with function depending on age. Considering that depressive symptoms are a modifiable problem, their detection in hospital settings may help clinicians in targeting subjects at high risk of functional disability., (Copyright 2004 John Wiley & Sons, Ltd.)

Background and Aims: This study was carried out to detect the incidence of adverse outcomes in hospitalized older patients and the role of multidimensional assessment in identifying predictors of adverse outcomes, which include in-hospital mortality and the need for admission to rehabilitation units or nursing homes after hospital discharge., Methods: 923 patients at least 65 years old (mean age 78.7 +/- 7.2, 49% women) admitted to the acute care geriatric ward of an internal medicine department were included in the study. On admission, each patient underwent a comprehensive medical, functional, neuropsychological, sociodemographic and nutritional assessment., Results: Incidence of mortality and other adverse outcomes was 6 and 16%, respectively. In-hospital mortality was independently predicted by older age (OR per year: 1.07, 95% CI: 1.02-1.12), male gender (OR: 3.97, 1.99-7.95), higher comorbidity (OR: 2.09, 1.01-4.33), higher heart rate (OR: 2.87, 1.30-6.35), lower systolic blood pressure (OR: 2.22, 1.03-4.81), lower serum albumin values (OR: 3.20, 1.63-6.29) and a lower MMSE score at hospital admission (OR: 5.51, 2.34-12.9). Adverse outcomes were independently predicted by older age (OR per year: 1.03, 1.01-1.06), higher comorbidity (OR: 2.00, 1.35-2.94), lower serum albumin values (OR: 2.57, 1.69-3.90) and a lower admission MMSE score (OR: 2.49, 1.68-3.71)., Conclusions: A multidimensional geriatric assessment should be comprised of simple parameters available early, like serum albumin and MMSE score, that are predictive of adverse outcomes in older hospitalized patients, along with other health Indicators (comorbidity, heart rate and blood pressure).

Although patients admitted to Internal Medicine Departments are often older than 65 years, the "new geriatric culture" comes into conflict with the traditional goals of Medicine (diagnosis-therapy-recovery). Multidimensional assessment permits global evaluation of the needs and problems of the elderly patient and consequently guarantees an adequate and complete therapeutic plan. This approach is particularly valid if applied in a Medical Division because acute illnesses can compromise a functional state that is already in precarious equilibrium due to frequent multiple pathologies. Moreover, thanks to an accurate evaluation of this type, it is possible to recognize patients with cognitive deficits and diagnose dementia early. In the present study, we utilized a geriatric multidimensional assessment in our Department of Internal Medicine to search for cognitive impairment. Dementia was found in 20% of the geriatric patients: 29% were affected by Alzheimer's disease and 44% had vascular dementia. We evaluated the physical health, functional ability, psychological and socio-economical status together with behavioral syndromes.

Chronic obstructive pulmonary disease (COPD) is very common in the elderly, and its treatment needs special concern. Data from two clinical studies (in-patients of an Internal Medicine Department and Nursing-Home, respectively) have been evaluated in order to compare therapeutic approaches to COPD in three separate settings: home, hospital and Nursing-Home. Less than 50% of the overall patients received medical treatment according to the guidelines emerged in the literature. Although cardiovascular problems were highly common in out-patients, their bronchodilator therapy included systemic beta 2-agonists. Theophylline was the main drug prescribed to in-patients discharged from hospital, although inhaling beta 2-agonists were also recommended in few cases. Topical steroids have been widely used. Nursing-Home patients received mostly systemic steroids and few of them had theophylline and inhaling steroids. Anti-cholinergic drugs have never been employed in the overall population of elderly patients. Data concerning medical treatment of infectious respiratory diseases of Nursing-Home patients (both with and without COPD) have also been evaluated. Antimicrobial therapy has been performed according to the special needs of the elderly. During COPD reacutizations, beta 2-agonists and, again, theophylline consumption increased.