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4. The Interplay among Respiratory Failure, Delirium, Frailty and Severity of Illness in Hospitalized Older Medical Patients: A Nationwide Multicenter Observational Study

Author

Fimognari, F, Tassistro, E, Rossi, E, Bambara, V, Valsecchi, M, Cherubini, A, Marengoni, A, Mossello, E, Inzitari, M, Morandi, A, Bellelli, G, Fimognari F. L., Tassistro E., Rossi E., Bambara V., Valsecchi M. G., Cherubini A., Marengoni A., Mossello E., Inzitari M., Morandi A., Bellelli G., Fimognari, F, Tassistro, E, Rossi, E, Bambara, V, Valsecchi, M, Cherubini, A, Marengoni, A, Mossello, E, Inzitari, M, Morandi, A, Bellelli, G, Fimognari F. L., Tassistro E., Rossi E., Bambara V., Valsecchi M. G., Cherubini A., Marengoni A., Mossello E., Inzitari M., Morandi A., and Bellelli G.

Abstract

Background: Prevalence, correlates and outcomes of respiratory failure (RF) were never studied in large populations of older patients hospitalized in acute care medical settings. Little is known about the possible association between RF and delirium, and whether these two syndromes, alone or in combination, may affect short-term mortality. Objectives: To investigate prevalence and features of RF, the association between delirium and RF, and their effect on short-term mortality. Design: Prospective cross-sectional study with data collection on an index day and 30-day follow up. Setting and Participants: 1493 patients aged ≥ 65 years hospitalized in Italian acute medical wards from the 2017 Delirium Day database. Methods: RF was identified according to the detection of peripheral oxygen saturation ≤ 91% on the index day, or to ongoing oxygen therapy or non-invasive ventilation on the index day or the day before. A modified National Early Warning Score (NEWS), obtained removing the “Oxygen Saturations” and “Any Supplemental Oxygen” items, measured non-hypoxemic severity of acute illness. Results: 300 patients (20.1%) had RF. Mortality was 16.6% in the RF group and 8.2% in the non-RF group (p<0.001). Delirium prevalence was 31.3% in RF (94 patients, 72 of whom with hypoactive or mixed delirium) and 22% in non-RF patients (p<0.001). Age, frailty, modified NEWS, steroids use, presence of urinary catheters or other major devices, but not delirium, were independent RF correlates. RF alone (OR [odds ratio]: 1.83; 95% CI [confidence interval]: 1.02–3.29) predicted 30-day mortality after adjustment for confounders, including modified NEWS. Without adjustment for modified NEWS, the combination of delirium and RF also significantly predicted 30-day mortality (OR: 2.26; 95% CI 1.08–4.72). Conclusions: In hospitalized older medical patients, RF was a prevalent syndrome which was frequently complicated by delirium. RF was featured by older age, frailty and severe illness, and

Published
2024

12. Dysphagia in older patients admitted to a rehabilitation setting after an acute hospitalization: the role of delirium

Author

Grossi, E, Rocco, C, Stilo, L, Guarneri, B, Inzitari, M, Bellelli, G, Gentile, S, Morandi, A, Grossi E., Rocco C., Stilo L., Guarneri B., Inzitari M., Bellelli G., Gentile S., Morandi A., Grossi, E, Rocco, C, Stilo, L, Guarneri, B, Inzitari, M, Bellelli, G, Gentile, S, Morandi, A, Grossi E., Rocco C., Stilo L., Guarneri B., Inzitari M., Bellelli G., Gentile S., and Morandi A.

Abstract

Introduction: Dysphagia is a swallowing disorder that affects 8% of the world population. However, data are lacking on its prevalence in a heterogeneous group of older patients. The aim of this study is to evaluate the prevalence of dysphagia at admission and at discharge, and its related factors, in particular delirium, in older patients admitted to a rehabilitation setting. Methods: Retrospective cohort study of patients 65 years and older admitted to a rehabilitation ward after an acute hospitalization. The presence of dysphagia at admission was screened with the 3OZ Test and confirmed by a speech-therapist. The association between clinical factors and dysphagia was investigated with a multivariate logistic regression analysis. Results: We included 1040 patients, (65% females, mean age 81.9 ± 7.2 years). The prevalence of dysphagia at admission was 14.8% and 12.8% at discharge, while the prevalence of delirium among patients with dysphagia was of 31.2% vs 6.4% among patients without dysphagia. The severity of dysphagia was moderate. In the multivariate logistic regression, delirium was associated with dysphagia at admission (OR 2.06; Confidence Interval, CI 1.08–3.23) along with a pre-hospital impairment in the Instrumental-Activities-of-Daily-Living (OR-1.26; CI − 1.1; − 1.10), a change in Barthel Index from pre-hospital to hospital admission (OR-1.02; CI − 1.01 to 1.04), comorbidity (OR 1.12; CI 0.94;1.29) and the number of antibiotics (OR-1.63; CI − 1.01;2.62). Conclusion: Delirium was the main factor associated with dysphagia at rehabilitation admission. The study underlines the importance of screening dysphagia in delirious patients and warrants future studies to determine the changes in dysphagia prevalence according to delirium resolution.

Published
2023

16. The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

Author

Zucchelli, A, Manzoni, F, Morandi, A, Di Santo, S, Rossi, E, Valsecchi, M, Inzitari, M, Cherubini, A, Bo, M, Mossello, E, Marengoni, A, Bellelli, G, Citerio, G, Zucchelli A., Manzoni F., Morandi A., Di Santo S., Rossi E., Valsecchi M. G., Inzitari M., Cherubini A., Bo M., Mossello E., Marengoni A., Bellelli G., Citerio G., Zucchelli, A, Manzoni, F, Morandi, A, Di Santo, S, Rossi, E, Valsecchi, M, Inzitari, M, Cherubini, A, Bo, M, Mossello, E, Marengoni, A, Bellelli, G, Citerio, G, Zucchelli A., Manzoni F., Morandi A., Di Santo S., Rossi E., Valsecchi M. G., Inzitari M., Cherubini A., Bo M., Mossello E., Marengoni A., Bellelli G., and Citerio G.

Abstract

INTRODUCTION: Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium. METHODS: The analyses were conducted employing the cross-sectional "Delirium Day" initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses. RESULTS: A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09-2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001]. DISCUSSION AND CONCLUSION: Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium.

Published
2022

17. Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

Author

Sidoli, C, Zambon, A, Tassistro, E, Rossi, E, Mossello, E, Inzitari, M, Cherubini, A, Marengoni, A, Morandi, A, Bellelli, G, Tarasconi, A, Sella, M, Paterno, G, Faggian, G, Lucarelli, C, De Grazia, N, Alberto, C, Porcella, L, Nardiello, I, Chimenti, E, Zeni, M, Romairone, E, Minaglia, C, Ceccotti, C, Guerra, G, Mantovani, G, Monacelli, F, Candiani, T, Santolini, F, Rosso, M, Bono, V, Sibilla, S, Dal Santo, P, Ceci, M, Barone, P, Schirinzi, T, Formenti, A, Nastasi, G, Isaia, G, Gonella, D, Battuello, A, Casson, S, Calvani, D, Boni, F, Ciaccio, A, Rosa, R, Sanna, G, Manfredini, S, Cortese, L, Rizzo, M, Prestano, R, Greco, A, Lauriola, M, Gelosa, G, Piras, V, Arena, M, Cosenza, D, Bellomo, A, Lamontagna, M, Gabbani, L, Lambertucci, L, Perego, S, Parati, G, Basile, G, Gallina, V, Pilone, G, Giudice, C, Pietrogrande, L, Mosca, M, Corazzin, I, Rossi, P, Nunziata, V, D'Amico, F, Grippa, A, Giardini, S, Barucci, R, Cossu, A, Fiorin, L, Distefano, M, Lunardelli, M, Brunori, M, Ruffini, I, Abraham, E, Varutti, A, Fabbro, E, Catalano, A, Martino, G, Leotta, D, Marchet, A, Dell'Aquila, G, Scrimieri, A, Davoli, M, Casella, M, Cartei, A, Polidori, G, Brischetto, D, Motta, S, Saponara, R, Perrone, P, Russo, G, Del, D, Car, C, Pirina, T, Franzoni, S, Cotroneo, A, Ghiggia, F, Volpi, G, Menichetti, C, Bo, M, Panico, A, Calogero, P, Corvalli, G, Mauri, M, Lupia, E, Manfredini, R, Fabbian, F, March, A, Pedrotti, M, Veronesi, M, Strocchi, E, Borghi, C, Bianchetti, A, Crucitti, A, Difrancesco, V, Fontana, G, Geriatria, A, Bonanni, L, Barbone, F, Serrati, C, Ballardini, G, Simoncelli, M, Ceschia, G, Scarpa, C, Brugiolo, R, Fusco, S, Ciarambino, T, Biagini, C, Tonon, E, Porta, M, Venuti, D, Delsette, M, Poeta, M, Barbagallo, G, Trovato, G, Delitala, A, Arosio, P, Reggiani, F, Zuliani, G, Ortolani, B, Mussio, E, Girardi, A, Coin, A, Ruotolo, G, Castagna, A, Masina, M, Cimino, R, Pinciaroli, A, Tripodi, G, Cassadonte, F, Vatrano, M, Scaglione, L, Fogliacco, P, Muzzuilini, C, Romano, F, Padovani, A, Rozzini, L, Cagnin, A, Fragiacomo, F, Desideri, G, Liberatore, E, Bruni, A, Orsitto, G, Franco, M, Bonfrate, L, Bonetto, M, Pizio, N, Magnani, G, Cecchetti, G, Longo, A, Bubba, V, Marinan, L, Cotelli, M, Turla, M, Sessa, M, Abruzzi, L, Castoldi, G, Lovetere, D, Musacchio, C, Novello, M, Cavarape, A, Bini, A, Leonardi, A, Seneci, F, Grimaldi, W, Fimognari, F, Bambar, V, Saitta, A, Corica, F, Braga, M, Servi, Ettorre, E, Camellini Bellelli, C, Annoni, G, Crescenzo, A, Noro, G, Turco, R, Ponzetto, M, Giuseppe, L, Mazzei, B, Maiuri, G, Costaggiu, D, Damato, R, Formilan, M, Patrizia, G, Santuar, L, Gallucci, M, Paragona, M, Bini, P, Modica, D, Abati, C, Clerici, M, Barbera, I, Nigroimperiale, F, Manni, A, Votino, C, Castiglioni, C, Di, M, Degl'Innocenti, M, Moscatelli, G, Guerini, S, Casini, C, Dini, D, Denotariis, S, Bonometti, F, Paolillo, C, Riccardi, A, Tiozzo, A, Samysalamafahmy, A, Dibari, M, Vanni, S, Scarpa, A, Zara, D, Ranieri, P, Alessandro, M, Di, F, Pezzoni, D, Platto, C, D'Ambrosio, V, Ivaldi, C, Milia, P, Desalvo, F, Solaro, C, Strazzacappa, M, Cazzadori, M, Grasso, M, Troisi, E, Guerini, V, Bernardini, B, Corsini, C, Boffelli, S, Filippi, A, Delpin, K, Faraci, B, Bertoletti, E, Vannucci, M, Crippa, P, Malighetti, A, Caltagirone, C, Disant, S, Bettini, D, Maltese, F, Abruzzese, G, Cosimo, D, Azzini, M, Colombo, M, Procino, G, Fascendini, S, Barocco, F, Del, P, Mazzone, A, Cottino, M, Vezzadini, G, Avanzi, S, Brambilla, C, Orini, S, Sgrilli, F, Mello, A, Lombardi Muti, L, Dijk, B, Fenu, S, Pes, C, Gareri, P, Passamonte, M, Rigo, R, Locusta, L, Caser, L, Rosso, G, Cesarini, S, Cozzi, R, Santini, C, Carbone, P, Cazzaniga, I, Lovati, R, Cantoni, A, Ranzani, P, Barra, D, Pompilio, G, Dimori, S, Cernesi, S, Ricco, C, Piazzolla, F, Capittini, E, Rota, C, Gottardi, F, Merla, L, Barelli, A, Millul, A, De, G, Morrone, G, Bigolari, M, Macchi, M, Zambon, F, Pizzorni, C, Dicasaleto, G, Menculini, G, Marcacci, M, Catanese, G, Sprini, D, Dicasalet, T, Bocci, M, Borga, S, Caironi, P, Cat, C, Cingolani, E, Avalli, L, Greco, G, Citerio, G, Gandini, L, Cornara, G, Lerda, R, Brazzi, L, Simeone, F, Caciorgna, M, Alampi, D, Francesconi, S, Beck, E, Antonini, B, Vettoretto, K, Meggiolaro, M, Garofalo, E, Notaro, S, Varutti, R, Bassi, F, Mistraletti, G, Marino, A, Rona, R, Rondelli, E, Riva, I, Cortegiani, A, Pistidda, L, D'Andrea, R, Querci, L, Gnesin, P, Todeschini, M, Lugano, M, Castelli, G, Ortolani, M, Cotoia, A, Maggiore, S, Ditizio, L, Graziani, R, Testa, I, Ferretti, E, Castioni, C, Lombardi, F, Caserta, R, Pasqua, M, Simoncini, S, Baccarini, F, Rispoli, M, Grossi, F, Cancelliere, L, Carnelli, M, Puccini, F, Biancofiore, G, Siniscalchi, A, Laici, C, Torrini, M, Pasetti, G, Palmese, S, Oggioni, R, Mangani, V, Pini, S, Martelli, M, Rigo, E, Zuccala, F, Cherri, A, Spina, R, Calamai, I, Petrucci, N, Caicedo, A, Ferri, F, Gritti, P, Brienza, N, Fonnesu, R, Dessena, M, Fullin, G, Saggioro, D, Sidoli C., Zambon A., Tassistro E., Rossi E., Mossello E., Inzitari M., Cherubini A., Marengoni A., Morandi A., Bellelli G., Tarasconi A., Sella M., Paterno G., Faggian G., Lucarelli C., De Grazia N., Alberto C., Porcella L., Nardiello I., Chimenti E., Zeni M., Romairone E., Minaglia C., Ceccotti C., Guerra G., Mantovani G., Monacelli F., Candiani T., Santolini F., Rosso M., Bono V., Sibilla S., Dal Santo P., Ceci M., Barone P., Schirinzi T., Formenti A., Nastasi G., Isaia G., Gonella D., Battuello A., Casson S., Calvani D., Boni F., Ciaccio A., Rosa R., Sanna G., Manfredini S., Cortese L., Rizzo M., Prestano R., Greco A., Lauriola M., Gelosa G., Piras V., Arena M., Cosenza D., Bellomo A., LaMontagna M., Gabbani L., Lambertucci L., Perego S., Parati G., Basile G., Gallina V., Pilone G., Giudice C., Pietrogrande L., Mosca M., Corazzin I., Rossi P., Nunziata V., D'Amico F., Grippa A., Giardini S., Barucci R., Cossu A., Fiorin L., Distefano M., Lunardelli M., Brunori M., Ruffini I., Abraham E., Varutti A., Fabbro E., Catalano A., Martino G., Leotta D., Marchet A., Dell'Aquila G., Scrimieri A., Davoli M., Casella M., Cartei A., Polidori G., Brischetto D., Motta S., Saponara R., Perrone P., Russo G., Del D., Car C., Pirina T., Franzoni S., Cotroneo A., Ghiggia F., Volpi G., Menichetti C., Bo M., Panico A., Calogero P., Corvalli G., Mauri M., Lupia E., Manfredini R., Fabbian F., March A., Pedrotti M., Veronesi M., Strocchi E., Borghi C., Bianchetti A., Crucitti A., DiFrancesco V., Fontana G., Geriatria A., Bonanni L., Barbone F., Serrati C., Ballardini G., Simoncelli M., Ceschia G., Scarpa C., Brugiolo R., Fusco S., Ciarambino T., Biagini C., Tonon E., Porta M., Venuti D., DelSette M., Poeta M., Barbagallo G., Trovato G., Delitala A., Arosio P., Reggiani F., Zuliani G., Ortolani B., Mussio E., Girardi A., Coin A., Ruotolo G., Castagna A., Masina M., Cimino R., Pinciaroli A., Tripodi G., Cassadonte F., Vatrano M., Scaglione L., Fogliacco P., Muzzuilini C., Romano F., Padovani A., Rozzini L., Cagnin A., Fragiacomo F., Desideri G., Liberatore E., Bruni A., Orsitto G., Franco M., Bonfrate L., Bonetto M., Pizio N., Magnani G., Cecchetti G., Longo A., Bubba V., Marinan L., Cotelli M., Turla M., Sessa M., Abruzzi L., Castoldi G., LoVetere D., Musacchio C., Novello M., Cavarape A., Bini A., Leonardi A., Seneci F., Grimaldi W., Fimognari F., Bambar V., Saitta A., Corica F., Braga M., Ettorre E., Camellini Bellelli C. G., Annoni G., Crescenzo A., Noro G., Turco R., Ponzetto M., Giuseppe L., Mazzei B., Maiuri G., Costaggiu D., Damato R., Formilan M., Patrizia G., Santuar L., Gallucci M., Paragona M., Bini P., Modica D., Abati C., Clerici M., Barbera I., NigroImperiale F., Manni A., Votino C., Castiglioni C., Di M., Degl'Innocenti M., Moscatelli G., Guerini S., Casini C., Dini D., DeNotariis S., Bonometti F., Paolillo C., Riccardi A., Tiozzo A., SamySalamaFahmy A., DiBari M., Vanni S., Scarpa A., Zara D., Ranieri P., Alessandro M., Di F., Pezzoni D., Platto C., D'Ambrosio V., Ivaldi C., Milia P., DeSalvo F., Solaro C., Strazzacappa M., Cazzadori M., Grasso M., Troisi E., Guerini V., Bernardini B., Corsini C., Boffelli S., Filippi A., Delpin K., Faraci B., Bertoletti E., Vannucci M., Crippa P., Malighetti A., Caltagirone C., DiSant S., Bettini D., Maltese F., Abruzzese G., Cosimo D., Azzini M., Colombo M., Procino G., Fascendini S., Barocco F., Del P., Mazzone A., Cottino M., Vezzadini G., Avanzi S., Brambilla C., Orini S., Sgrilli F., Mello A., Lombardi Muti L. E., Dijk B., Fenu S., Pes C., Gareri P., Passamonte M., Rigo R., Locusta L., Caser L., Rosso G., Cesarini S., Cozzi R., Santini C., Carbone P., Cazzaniga I., Lovati R., Cantoni A., Ranzani P., Barra D., Pompilio G., Dimori S., Cernesi S., Ricco C., Piazzolla F., Capittini E., Rota C., Gottardi F., Merla L., Barelli A., Millul A., De G., Morrone G., Bigolari M., Macchi M., Zambon F., Pizzorni C., DiCasaleto G., Menculini G., Marcacci M., Catanese G., Sprini D., DiCasalet T., Bocci M., Borga S., Caironi P., Cat C., Cingolani E., Avalli L., Greco G., Citerio G., Gandini L., Cornara G., Lerda R., Brazzi L., Simeone F., Caciorgna M., Alampi D., Francesconi S., Beck E., Antonini B., Vettoretto K., Meggiolaro M., Garofalo E., Notaro S., Varutti R., Bassi F., Mistraletti G., Marino A., Rona R., Rondelli E., Riva I., Cortegiani A., Pistidda L., D'Andrea R., Querci L., Gnesin P., Todeschini M., Lugano M., Castelli G., Ortolani M., Cotoia A., Maggiore S., DiTizio L., Graziani R., Testa I., Ferretti E., Castioni C., Lombardi F., Caserta R., Pasqua M., Simoncini S., Baccarini F., Rispoli M., Grossi F., Cancelliere L., Carnelli M., Puccini F., Biancofiore G., Siniscalchi A., Laici C., Torrini M., Pasetti G., Palmese S., Oggioni R., Mangani V., Pini S., Martelli M., Rigo E., Zuccala F., Cherri A., Spina R., Calamai I., Petrucci N., Caicedo A., Ferri F., Gritti P., Brienza N., Fonnesu R., Dessena M., Fullin G., Saggioro D., Sidoli, C, Zambon, A, Tassistro, E, Rossi, E, Mossello, E, Inzitari, M, Cherubini, A, Marengoni, A, Morandi, A, Bellelli, G, Tarasconi, A, Sella, M, Paterno, G, Faggian, G, Lucarelli, C, De Grazia, N, Alberto, C, Porcella, L, Nardiello, I, Chimenti, E, Zeni, M, Romairone, E, Minaglia, C, Ceccotti, C, Guerra, G, Mantovani, G, Monacelli, F, Candiani, T, Santolini, F, Rosso, M, Bono, V, Sibilla, S, Dal Santo, P, Ceci, M, Barone, P, Schirinzi, T, Formenti, A, Nastasi, G, Isaia, G, Gonella, D, Battuello, A, Casson, S, Calvani, D, Boni, F, Ciaccio, A, Rosa, R, Sanna, G, Manfredini, S, Cortese, L, Rizzo, M, Prestano, R, Greco, A, Lauriola, M, Gelosa, G, Piras, V, Arena, M, Cosenza, D, Bellomo, A, Lamontagna, M, Gabbani, L, Lambertucci, L, Perego, S, Parati, G, Basile, G, Gallina, V, Pilone, G, Giudice, C, Pietrogrande, L, Mosca, M, Corazzin, I, Rossi, P, Nunziata, V, D'Amico, F, Grippa, A, Giardini, S, Barucci, R, Cossu, A, Fiorin, L, Distefano, M, Lunardelli, M, Brunori, M, Ruffini, I, Abraham, E, Varutti, A, Fabbro, E, Catalano, A, Martino, G, Leotta, D, Marchet, A, Dell'Aquila, G, Scrimieri, A, Davoli, M, Casella, M, Cartei, A, Polidori, G, Brischetto, D, Motta, S, Saponara, R, Perrone, P, Russo, G, Del, D, Car, C, Pirina, T, Franzoni, S, Cotroneo, A, Ghiggia, F, Volpi, G, Menichetti, C, Bo, M, Panico, A, Calogero, P, Corvalli, G, Mauri, M, Lupia, E, Manfredini, R, Fabbian, F, March, A, Pedrotti, M, Veronesi, M, Strocchi, E, Borghi, C, Bianchetti, A, Crucitti, A, Difrancesco, V, Fontana, G, Geriatria, A, Bonanni, L, Barbone, F, Serrati, C, Ballardini, G, Simoncelli, M, Ceschia, G, Scarpa, C, Brugiolo, R, Fusco, S, Ciarambino, T, Biagini, C, Tonon, E, Porta, M, Venuti, D, Delsette, M, Poeta, M, Barbagallo, G, Trovato, G, Delitala, A, Arosio, P, Reggiani, F, Zuliani, G, Ortolani, B, Mussio, E, Girardi, A, Coin, A, Ruotolo, G, Castagna, A, Masina, M, Cimino, R, Pinciaroli, A, Tripodi, G, Cassadonte, F, Vatrano, M, Scaglione, L, Fogliacco, P, Muzzuilini, C, Romano, F, Padovani, A, Rozzini, L, Cagnin, A, Fragiacomo, F, Desideri, G, Liberatore, E, Bruni, A, Orsitto, G, Franco, M, Bonfrate, L, Bonetto, M, Pizio, N, Magnani, G, Cecchetti, G, Longo, A, Bubba, V, Marinan, L, Cotelli, M, Turla, M, Sessa, M, Abruzzi, L, Castoldi, G, Lovetere, D, Musacchio, C, Novello, M, Cavarape, A, Bini, A, Leonardi, A, Seneci, F, Grimaldi, W, Fimognari, F, Bambar, V, Saitta, A, Corica, F, Braga, M, Servi, Ettorre, E, Camellini Bellelli, C, Annoni, G, Crescenzo, A, Noro, G, Turco, R, Ponzetto, M, Giuseppe, L, Mazzei, B, Maiuri, G, Costaggiu, D, Damato, R, Formilan, M, Patrizia, G, Santuar, L, Gallucci, M, Paragona, M, Bini, P, Modica, D, Abati, C, Clerici, M, Barbera, I, Nigroimperiale, F, Manni, A, Votino, C, Castiglioni, C, Di, M, Degl'Innocenti, M, Moscatelli, G, Guerini, S, Casini, C, Dini, D, Denotariis, S, Bonometti, F, Paolillo, C, Riccardi, A, Tiozzo, A, Samysalamafahmy, A, Dibari, M, Vanni, S, Scarpa, A, Zara, D, Ranieri, P, Alessandro, M, Di, F, Pezzoni, D, Platto, C, D'Ambrosio, V, Ivaldi, C, Milia, P, Desalvo, F, Solaro, C, Strazzacappa, M, Cazzadori, M, Grasso, M, Troisi, E, Guerini, V, Bernardini, B, Corsini, C, Boffelli, S, Filippi, A, Delpin, K, Faraci, B, Bertoletti, E, Vannucci, M, Crippa, P, Malighetti, A, Caltagirone, C, Disant, S, Bettini, D, Maltese, F, Abruzzese, G, Cosimo, D, Azzini, M, Colombo, M, Procino, G, Fascendini, S, Barocco, F, Del, P, Mazzone, A, Cottino, M, Vezzadini, G, Avanzi, S, Brambilla, C, Orini, S, Sgrilli, F, Mello, A, Lombardi Muti, L, Dijk, B, Fenu, S, Pes, C, Gareri, P, Passamonte, M, Rigo, R, Locusta, L, Caser, L, Rosso, G, Cesarini, S, Cozzi, R, Santini, C, Carbone, P, Cazzaniga, I, Lovati, R, Cantoni, A, Ranzani, P, Barra, D, Pompilio, G, Dimori, S, Cernesi, S, Ricco, C, Piazzolla, F, Capittini, E, Rota, C, Gottardi, F, Merla, L, Barelli, A, Millul, A, De, G, Morrone, G, Bigolari, M, Macchi, M, Zambon, F, Pizzorni, C, Dicasaleto, G, Menculini, G, Marcacci, M, Catanese, G, Sprini, D, Dicasalet, T, Bocci, M, Borga, S, Caironi, P, Cat, C, Cingolani, E, Avalli, L, Greco, G, Citerio, G, Gandini, L, Cornara, G, Lerda, R, Brazzi, L, Simeone, F, Caciorgna, M, Alampi, D, Francesconi, S, Beck, E, Antonini, B, Vettoretto, K, Meggiolaro, M, Garofalo, E, Notaro, S, Varutti, R, Bassi, F, Mistraletti, G, Marino, A, Rona, R, Rondelli, E, Riva, I, Cortegiani, A, Pistidda, L, D'Andrea, R, Querci, L, Gnesin, P, Todeschini, M, Lugano, M, Castelli, G, Ortolani, M, Cotoia, A, Maggiore, S, Ditizio, L, Graziani, R, Testa, I, Ferretti, E, Castioni, C, Lombardi, F, Caserta, R, Pasqua, M, Simoncini, S, Baccarini, F, Rispoli, M, Grossi, F, Cancelliere, L, Carnelli, M, Puccini, F, Biancofiore, G, Siniscalchi, A, Laici, C, Torrini, M, Pasetti, G, Palmese, S, Oggioni, R, Mangani, V, Pini, S, Martelli, M, Rigo, E, Zuccala, F, Cherri, A, Spina, R, Calamai, I, Petrucci, N, Caicedo, A, Ferri, F, Gritti, P, Brienza, N, Fonnesu, R, Dessena, M, Fullin, G, Saggioro, D, Sidoli C., Zambon A., Tassistro E., Rossi E., Mossello E., Inzitari M., Cherubini A., Marengoni A., Morandi A., Bellelli G., Tarasconi A., Sella M., Paterno G., Faggian G., Lucarelli C., De Grazia N., Alberto C., Porcella L., Nardiello I., Chimenti E., Zeni M., Romairone E., Minaglia C., Ceccotti C., Guerra G., Mantovani G., Monacelli F., Candiani T., Santolini F., Rosso M., Bono V., Sibilla S., Dal Santo P., Ceci M., Barone P., Schirinzi T., Formenti A., Nastasi G., Isaia G., Gonella D., Battuello A., Casson S., Calvani D., Boni F., Ciaccio A., Rosa R., Sanna G., Manfredini S., Cortese L., Rizzo M., Prestano R., Greco A., Lauriola M., Gelosa G., Piras V., Arena M., Cosenza D., Bellomo A., LaMontagna M., Gabbani L., Lambertucci L., Perego S., Parati G., Basile G., Gallina V., Pilone G., Giudice C., Pietrogrande L., Mosca M., Corazzin I., Rossi P., Nunziata V., D'Amico F., Grippa A., Giardini S., Barucci R., Cossu A., Fiorin L., Distefano M., Lunardelli M., Brunori M., Ruffini I., Abraham E., Varutti A., Fabbro E., Catalano A., Martino G., Leotta D., Marchet A., Dell'Aquila G., Scrimieri A., Davoli M., Casella M., Cartei A., Polidori G., Brischetto D., Motta S., Saponara R., Perrone P., Russo G., Del D., Car C., Pirina T., Franzoni S., Cotroneo A., Ghiggia F., Volpi G., Menichetti C., Bo M., Panico A., Calogero P., Corvalli G., Mauri M., Lupia E., Manfredini R., Fabbian F., March A., Pedrotti M., Veronesi M., Strocchi E., Borghi C., Bianchetti A., Crucitti A., DiFrancesco V., Fontana G., Geriatria A., Bonanni L., Barbone F., Serrati C., Ballardini G., Simoncelli M., Ceschia G., Scarpa C., Brugiolo R., Fusco S., Ciarambino T., Biagini C., Tonon E., Porta M., Venuti D., DelSette M., Poeta M., Barbagallo G., Trovato G., Delitala A., Arosio P., Reggiani F., Zuliani G., Ortolani B., Mussio E., Girardi A., Coin A., Ruotolo G., Castagna A., Masina M., Cimino R., Pinciaroli A., Tripodi G., Cassadonte F., Vatrano M., Scaglione L., Fogliacco P., Muzzuilini C., Romano F., Padovani A., Rozzini L., Cagnin A., Fragiacomo F., Desideri G., Liberatore E., Bruni A., Orsitto G., Franco M., Bonfrate L., Bonetto M., Pizio N., Magnani G., Cecchetti G., Longo A., Bubba V., Marinan L., Cotelli M., Turla M., Sessa M., Abruzzi L., Castoldi G., LoVetere D., Musacchio C., Novello M., Cavarape A., Bini A., Leonardi A., Seneci F., Grimaldi W., Fimognari F., Bambar V., Saitta A., Corica F., Braga M., Ettorre E., Camellini Bellelli C. G., Annoni G., Crescenzo A., Noro G., Turco R., Ponzetto M., Giuseppe L., Mazzei B., Maiuri G., Costaggiu D., Damato R., Formilan M., Patrizia G., Santuar L., Gallucci M., Paragona M., Bini P., Modica D., Abati C., Clerici M., Barbera I., NigroImperiale F., Manni A., Votino C., Castiglioni C., Di M., Degl'Innocenti M., Moscatelli G., Guerini S., Casini C., Dini D., DeNotariis S., Bonometti F., Paolillo C., Riccardi A., Tiozzo A., SamySalamaFahmy A., DiBari M., Vanni S., Scarpa A., Zara D., Ranieri P., Alessandro M., Di F., Pezzoni D., Platto C., D'Ambrosio V., Ivaldi C., Milia P., DeSalvo F., Solaro C., Strazzacappa M., Cazzadori M., Grasso M., Troisi E., Guerini V., Bernardini B., Corsini C., Boffelli S., Filippi A., Delpin K., Faraci B., Bertoletti E., Vannucci M., Crippa P., Malighetti A., Caltagirone C., DiSant S., Bettini D., Maltese F., Abruzzese G., Cosimo D., Azzini M., Colombo M., Procino G., Fascendini S., Barocco F., Del P., Mazzone A., Cottino M., Vezzadini G., Avanzi S., Brambilla C., Orini S., Sgrilli F., Mello A., Lombardi Muti L. E., Dijk B., Fenu S., Pes C., Gareri P., Passamonte M., Rigo R., Locusta L., Caser L., Rosso G., Cesarini S., Cozzi R., Santini C., Carbone P., Cazzaniga I., Lovati R., Cantoni A., Ranzani P., Barra D., Pompilio G., Dimori S., Cernesi S., Ricco C., Piazzolla F., Capittini E., Rota C., Gottardi F., Merla L., Barelli A., Millul A., De G., Morrone G., Bigolari M., Macchi M., Zambon F., Pizzorni C., DiCasaleto G., Menculini G., Marcacci M., Catanese G., Sprini D., DiCasalet T., Bocci M., Borga S., Caironi P., Cat C., Cingolani E., Avalli L., Greco G., Citerio G., Gandini L., Cornara G., Lerda R., Brazzi L., Simeone F., Caciorgna M., Alampi D., Francesconi S., Beck E., Antonini B., Vettoretto K., Meggiolaro M., Garofalo E., Notaro S., Varutti R., Bassi F., Mistraletti G., Marino A., Rona R., Rondelli E., Riva I., Cortegiani A., Pistidda L., D'Andrea R., Querci L., Gnesin P., Todeschini M., Lugano M., Castelli G., Ortolani M., Cotoia A., Maggiore S., DiTizio L., Graziani R., Testa I., Ferretti E., Castioni C., Lombardi F., Caserta R., Pasqua M., Simoncini S., Baccarini F., Rispoli M., Grossi F., Cancelliere L., Carnelli M., Puccini F., Biancofiore G., Siniscalchi A., Laici C., Torrini M., Pasetti G., Palmese S., Oggioni R., Mangani V., Pini S., Martelli M., Rigo E., Zuccala F., Cherri A., Spina R., Calamai I., Petrucci N., Caicedo A., Ferri F., Gritti P., Brienza N., Fonnesu R., Dessena M., Fullin G., and Saggioro D.

Abstract

Background: Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. Aim: We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the “Delirium Day project”. Methods: We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the “Delirium Day project” (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. Results: Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17–1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08–2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62–2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10–1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02–1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68–3.36, p value < 0.0001). Conclusion: This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

Published
2022

18. Sustained improvement of intrinsic capacity in community-dwelling older adults: The +AGIL Barcelona multidomain program

Author

Ferrara, M, Pérez, L, Sole, A, Villa-García, L, Ars, J, Soto-Bagaria, L, Bellelli, G, Cesari, M, Enfedaque, M, Inzitari, M, Ferrara, Maria Cristina, Pérez, Laura Mónica, Sole, Aida Ribera, Villa-García, Lorena, Ars, Joan, Soto-Bagaria, Luis, Bellelli, Giuseppe, Cesari, Matteo, Enfedaque, María Belén, Inzitari, Marco, Ferrara, M, Pérez, L, Sole, A, Villa-García, L, Ars, J, Soto-Bagaria, L, Bellelli, G, Cesari, M, Enfedaque, M, Inzitari, M, Ferrara, Maria Cristina, Pérez, Laura Mónica, Sole, Aida Ribera, Villa-García, Lorena, Ars, Joan, Soto-Bagaria, Luis, Bellelli, Giuseppe, Cesari, Matteo, Enfedaque, María Belén, and Inzitari, Marco

Abstract

Background: Different programs promote healthy ageing through the optimization of intrinsic capacity. However, a major challenge is to assess their sustained effects over time. +AGIL Barcelona, a consolidated multidomain program, aims to optimize older adults’ intrinsic capacity through a coordinated approach among primary care, geriatrics and community resources, in agreement with the integrated care for older people (ICOPE) guidelines. We aimed to evaluate the +AGIL Barcelona longitudinal effect on older adults’ physical performance. Methods: All +AGIL Barcelona consecutive participants since 2016 were enrolled. After a comprehensive geriatric assessment, a tailored, multidisciplinary intervention aligned with the ICOPE guidelines is offered. It includes a 10-week boost multicomponent exercise program, nutritional and sleep-hygiene counselling, revision and optimization of pharmacological treatments and screening for cognitive impairment, depression and loneliness. Changes in physical performance after 3 and 6 months were assessed using mixed models including baseline frailty degree, time and all potential significant confounders. Results: We included 194 participants in the analysis (mean age = 81.6 [standard deviation = 5.8], 68% women). An independent, clinically and statistically significant improvement in physical performance (Short Physical Performance Battery [SPPB] test, combining gait speed, strength and balance) was found at 3 months (SPPB mean change: 1.4; 95% CI: 1.1–1.6) and 6 months (SPPB mean change: 1.1; 95% CI 0.8–1.5). Equivalent results were observed for all the SPPB sub-tests. Conclusions: A coordinated, multidisciplinary and integrated program can benefit older adults’ intrinsic capacity. The participants’ empowerment and the connection with the available community resources are critical points for a successful intervention.

Published
2023

19. Geriatric syndromes and functions in older adults with COVID-19 hospitalized in sub-acute care: a multicenter study

Author

Morandi, A, Gual, N, Cesari, M, Mota, M, Buttò, V, Gentile, S, Balestreri, G, Camussi, A, Platto, C, Roig, T, de Andrés, A, Bellelli, G, Inzitari, M, de Andrés, AM, Morandi, A, Gual, N, Cesari, M, Mota, M, Buttò, V, Gentile, S, Balestreri, G, Camussi, A, Platto, C, Roig, T, de Andrés, A, Bellelli, G, Inzitari, M, and de Andrés, AM

Abstract

Objective: Alternatives to conventional acute hospitalizations have been particularly useful during the COVID-19 pandemic. However, little is known on the management and outcomes of COVID-19 in older patient admitted to non-acute settings. The main aim of this study was to determine the effect of geriatrics syndromes on functional outcomes in older COVID-19 patients cared in sub-acute units. Methods: Prospective multicenter observational cohort study of patients aged 65 years and older with COVID-19, admitted to sub-acute units in Italy and Spain. Multivariable logistic regression models were used to test the association between geriatric syndromes and other clinical variables, and the functional status at discharge, defined by a Barthel Index > = 80. Results: A total of 158 patients were included in the study with a median age of 82 [Interquartile Range 81, 83]; of these 102 (65%) patients had a Barthel Index ≥ 80 at discharge. In the main multivariable logistic regression model a higher severity of frailty-measured with the Clinical Frailty Scale—(OR 0.30; CI 0.18–0.47), and the presence of delirium (OR 0.04; CI 0.00–0.35) at admission were associated with lower odds of a higher functional status at discharge. Other variables associated with lower functional status were female gender (OR 0.36; CI 0.13–0.96), and a higher number of comorbidities (OR 0.48; CI 0.26–0.82). Conclusion: The study reports a relatively high prevalence of functional recovery for older COVID-19 patients admitted to sub-acute units. Additionally, it underlines the importance of targeting geriatrics syndromes, in particular frailty and delirium, for their possible effects on functional recovery.

Published
2023

23. Impact of supplementation with vitamins B6, B12, and/or folic acid on the reduction of homocysteine levels in patients with mild cognitive impairment: A systematic review

Author

Olaso‐gonzalez, G, Inzitari, M, Bellelli, G, Morandi, A, Barcons, N, Viña, J, Olaso‐Gonzalez, Gloria, Inzitari, Marco, Bellelli, Giuseppe, Morandi, Alessandro, Barcons, Núria, Viña, José, Olaso‐gonzalez, G, Inzitari, M, Bellelli, G, Morandi, A, Barcons, N, Viña, J, Olaso‐Gonzalez, Gloria, Inzitari, Marco, Bellelli, Giuseppe, Morandi, Alessandro, Barcons, Núria, and Viña, José

Abstract

Hyperhomocysteinemia is an independent predictor of the risk for cognitive decline and may be a result of low levels of vitamins B12, B6, and folate. Previous findings suggest that adequate intake of these vitamins may reduce homocysteine levels. This review aimed to assess the effects of treatment with vitamins B6, B12, and/or folic acid in the homocysteine levels in patients with mild cognitive impairment (MCI). A systematic literature review was conducted in EMBASE, MEDLINE®, PsycINFO, and Cochrane Central Register of Controlled Trials. The research question was formulated using the Population, Intervention, Comparison, and Outcome (PICO) framework: in patients with MCI (P); what is the efficacy of vitamins B6, B12, and/or folic acid intake (I); compared with baseline values, and/or compared with controls (C); in reducing homocysteine levels from baseline (O). A total of eight primary studies with a total of 1,140 participants were included in the review. Four were randomized controlled trials, one was a quasi-controlled trial, and three were observational studies. All studies included folic acid in their intervention, seven vitamin B12, and four vitamin B6. Mean (SD) length of the intervention period was 18.8 (19.3) months, ranging from 1 to 60 months. All studies showed a statistically significant decrease in homocysteine levels in groups treated with vitamins B6, B12, and/or folic acid compared to controls, with a mean decline of homocysteine concentration of 31.9% in the intervention arms whereas it increased by 0.7% in the control arm. This review identified evidence of a reduction of plasma homocysteine levels in MCI patients taking vitamins B6, B12, and/or folic acid supplements, with statistically significant declines being observed after 1 month of supplementation. Findings support that supplementation with these vitamins might be an option to reduce homocysteine levels in people with MCI and elevated plasma homocysteine.

Published
2022

24. A retrospective multicentre cohort study of the performances on attention tests in outpatients with cognitive dysfunctions without delirium

Author

Grossi, E, Lucchi, E, Kreisel, S, Toepper, M, Boedecker, S, Inzitari, M, Bellelli, G, Gentile, S, Morandi, A, Grossi, Eleonora, Lucchi, Elena, Kreisel, Stefan H, Toepper, Max, Boedecker, Sebastian, Inzitari, Marco, Bellelli, Giuseppe, Gentile, Simona, Morandi, Alessandro, Grossi, E, Lucchi, E, Kreisel, S, Toepper, M, Boedecker, S, Inzitari, M, Bellelli, G, Gentile, S, Morandi, A, Grossi, Eleonora, Lucchi, Elena, Kreisel, Stefan H, Toepper, Max, Boedecker, Sebastian, Inzitari, Marco, Bellelli, Giuseppe, Gentile, Simona, and Morandi, Alessandro

Abstract

Objective: Attention is the cardinal feature of delirium, but attentional domains may also be affected by dementia and its severity. It is, therefore, of interest to study the correlation between the severity of cognitive impairment in non-delirious patients and different measurements of attentional performance, to identify attention subdomains less affected by severity of cognitive impairment. Methods: Neuropsychological data from non-delirious outpatients (age ≥ 65 years), presenting at two memory clinics were analysed retrospectively. Scores for selective, divided, and sustained attention were correlated with cognitive impairment as defined by the score of the Mini-Mental State Examination. Results: A total of 1658 outpatients were included. The mean age was 77.15 (± 8.17) years, with a mean MMSE score of 22.67 (± 4.91). Compared to the type of attention, the tests that are less influenced by the severity of cognitive impairment are those of selective attention, in particular the Digit Span Forward (DSF). Conclusions: This is the first study to correlate deficits in attention subdomains with the degree of cognitive impairment in non-delirious patients. The results suggest that measurements of selective attention (i.e. DSF) might be better suited to discriminate delirium from dementia. Indeed, a lower score on these tests might be indicative of an acute change and worsening of the baseline inattention and a longitudinal monitoring of these changes might be used to determine the delirium resolution.

Published
2022

26. Impact of supplementation with vitamins B-6, B-12, and/or folic acid on the reduction of homocysteine levels in patients with mild cognitive impairment: A systematic review

Author

Olaso-Gonzalez G, Inzitari M, Bellelli G, Morandi A, Barcons N, and Vina J

Subjects
folic acid, mild cognitive impairment, vitamin B-6, homocysteine, vitamin B-12
Abstract

Hyperhomocysteinemia is an independent predictor of the risk for cognitive decline and may be a result of low levels of vitamins B-12, B-6, and folate. Previous findings suggest that adequate intake of these vitamins may reduce homocysteine levels. This review aimed to assess the effects of treatment with vitamins B-6,B- B-12, and/or folic acid in the homocysteine levels in patients with mild cognitive impairment (MCI). A systematic literature review was conducted in EMBASE, MEDLINE (R), PsycINFO, and Cochrane Central Register of Controlled Trials. The research question was formulated using the Population, Intervention, Comparison, and Outcome (PICO) framework: in patients with MCI (P); what is the efficacy of vitamins B-6, B-12, and/or folic acid intake (I); compared with baseline values, and/or compared with controls (C); in reducing homocysteine levels from baseline (O). A total of eight primary studies with a total of 1,140 participants were included in the review. Four were randomized controlled trials, one was a quasi-controlled trial, and three were observational studies. All studies included folic acid in their intervention, seven vitamin B-12, and four vitamin B-6. Mean (SD) length of the intervention period was 18.8 (19.3) months, ranging from 1 to 60 months. All studies showed a statistically significant decrease in homocysteine levels in groups treated with vitamins B-6,B- B-12, and/or folic acid compared to controls, with a mean decline of homocysteine concentration of 31.9% in the intervention arms whereas it increased by 0.7% in the control arm. This review identified evidence of a reduction of plasma homocysteine levels in MCI patients taking vitamins B-6,B- B-12, and/or folic acid supplements, with statistically significant declines being observed after 1 month of supplementation. Findings support that supplementation with these vitamins might be an option to reduce homocysteine levels in people with MCI and elevated plasma homocysteine.

Published
2022

27. Team, occupational therapist and geriatrician

Author

Pozzi, C, Lanzoni, A, Graff, MJL, Morandi, A, Bellelli, G, Inzitari, M, Segura, J, Morel-Bracq, M, Bertholom, Y, Bellelli G., Inzitari M., Segura J. A. L., Morel-Bracq M. C., Bertholom Y. M., Pozzi, C, Lanzoni, A, Graff, MJL, Morandi, A, Bellelli, G, Inzitari, M, Segura, J, Morel-Bracq, M, Bertholom, Y, Bellelli G., Inzitari M., Segura J. A. L., Morel-Bracq M. C., and Bertholom Y. M.

Abstract

Older adults have multi-factorial problems and needs, which require an interdisciplinary teamwork. Comprehensive geriatric assessment (CGA) is an effective multidimensional, interdisciplinary, and coordinated approach to evaluate the bio-psycho-social domains. The role of the occupational therapist within the team is critical, because this figure adds specific information about the person and the environment, as well as a participatory approach to patient care.

Published
2020

28. The relationship between frailty and delirium: insights from the 2017 Delirium Day study

Author

Mazzola, P, Tassistro, E, Di Santo, S, Rossi, E, Andreano, A, Valsecchi, Mg, Cherubini, A, Marengoni, A, Mossello, E, Bo, M, Inzitari, M, Di Bari, M, Udina, C, Latronico, N, Paolillo, C, Morandi, A, Bellelli, G, Tarasconi, A, Sella, M, Auriemma, S, Paternò, G, Faggian, G, Lucarelli, C, De Grazia, N, Alberto, C, Margola, A, Porcella, L, Nardiello, I, Chimenti, E, Zeni, M, Giani, A, Famularo, S, Romairone, E, Minaglia, C, Ceccotti, C, Guerra, G, Mantovani, G, Monacelli, F, Candiani, T, Ballestrero, A, Santolini, F, Rosso, M, Bono, V, Sibilla, S, Dal Santo, P, Ceci, M, Barone, P, Schirinzi, T, Formenti, A, Nastasi, G, Isaia, G, Gonella, D, Battuello, A, Casson, S, Calvani, D, Boni, F, Ciaccio, A, Rosa, R, Sanna, G, Manfredini, S, Cortese, L, Rizzo, M, Prestano, R, Greco, A, Lauriola, M, Gelosa, G, Piras, V, Arena, M, Cosenza, D, Bellomo, A, Lamontagna, M, Gabbani, L, Lambertucci, L, Perego, S, Parati, G, Basile, G, Gallina, V, Pilone, G, Giudice, C, Pietrogrande, L, Mosca, M, Corazzin, I, Rossi, P, Nunziata, V, D'Amico, F, Grippa, A, Giardini, S, Barucci, R, Cossu, A, Fiorin, L, Distefano, M, Lunardelli, M, Brunori, M, Ruffini, I, Abraham, E, Varutti, A, Fabbro, E, Catalano, A, Martino, G, Leotta, D, Marchet, A, Scrimieri, A, Davoli, M, Casella, M, Cartei, A, Polidori, G, Brischetto, D, Motta, S, Saponara, R, Perrone, P, Russo, G, Pirina, T, Franzoni, S, Cotroneo, A, Ghiggia, F, Volpi, G, Menichetti, C, Panico, A, Calogero, P, Corvalli, G, Mauri, M, Lupia, E, Manfredini, R, Fabbian, F, March, A, Pedrotti, M, Veronesi, M, Strocchi, E, Bianchetti, A, Crucitti, A, Difrancesco, V, Fontana, G, Bonanni, L, Barbone, F, Serrati, C, Ballardini, G, Simoncelli, M, Ceschia, G, Scarpa, C, Brugiolo, R, Fusco, S, Ciarambino, T, Biagini, C, Tonon, E, Porta, M, Venuti, D, Del Sette, M, Poeta, M, Barbagallo, G, Trovato, G, Delitala, A, Arosio, P, Reggiani, F, Zuliani, G, Ortolani, B, Mussio, E, Girardi, A, Coin, A, Ruotolo, G, Castagna, A, Masina, M, Cimino, R, Pinciaroli, A, Tripodi, G, Cannistrà, U, Cassadonte, F, Vatrano, M, Scaglione, L, Fogliacco, P, Muzzuilini, C, Romano, F, Padovani, A, Rozzini, L, Cagnin, A, Fragiacomo, F, Desideri, G, Liberatore, E, Bruni, A, Orsitto, G, Franco, M, Bonfrate, L, Bonetto, M, Pizio, N, Magnani, G, Cecchetti, G, Longo, A, Bubba, V, Marinan, L, Cotelli, M, Turla, M, Sessa, M, Abruzzi, L, Castoldi, G, Lovetere, D, Musacchio, C, Novello, M, Cavarape, A, Bini, A, Leonardi, A, Seneci, F, Grimaldi, W, Fimognari, F, Bambara, V, Saitta, A, Corica, F, Braga, M, Ettorre, E, Camellini, C, Annoni, G, Crescenzo, A, Noro, G, Turco, R, Ponzetto, M, Giuseppe, L, Mazzei, B, Maiuri, G, Costaggiu, D, Damato, R, Formilan, M, Patrizia, G, Gallucci, M, Paragona, M, Bini, P, Modica, D, Abati, C, Clerici, M, Barbera, I, Nigroimperiale, F, Manni, A, Votino, C, Castiglioni, C, Degl'Innocenti, M, Moscatelli, G, Guerini, S, Casini, C, Dini, D, D'Imporzano, E, Denotariis, S, Bonometti, F, Riccardi, A, Tiozzo, A, Samy Salama Fahmy, A, Dibari, M, Vanni, S, Scarpa, A, Zara, D, Ranieri, P, Alessandro, M, Pezzoni, D, Platto, C, D'Ambrosio, V, Ivaldi, C, Milia, P, Desalvo, F, Solaro, C, Strazzacappa, M, Cazzadori, M, Confente, S, Grasso, M, Troisi, E, Guerini, V, Bernardini, B, Corsini, C, Boffelli, S, Filippi, A, Delpin, K, Faraci, B, Bertoletti, E, Vannucci, M, Tesi, F, Crippa, P, Malighetti, A, Caltagirone, C, Disant, S, Bettini, D, Maltese, F, Abruzzese, G, Cosimo, D, Azzini, M, Colombo, M, Procino, G, Fascendini, S, Barocco, F, Mazzone, A, Riva, E, Dell'Acqua, D, Cottino, M, Vezzadini, G, Avanzi, S, Brambilla, C, Orini, S, Sgrilli, F, Mello, A, Lombardi, L, Muti, E, Dijk, B, Fenu, S, Gareri, P, Passamonte, M, Rigo, R, Locusta, L, Caser, L, Rosso, G, Cesarini, S, Cozzi, R, Santini, C, Carbone, P, Cazzaniga, I, Lovati, R, Cantoni, A, Ranzani, P, Barra, D, Pompilio, G, Dimori, S, Cernesi, S, Riccò, C, Piazzolla, F, Capittini, E, Rota, C, Gottardi, F, Merla, L, Barelli, A, Millul, A, Morrone, G, Bigolari, M, Macchi, M, Zambon, F, Pizzorni, C, Dicasaleto, G, Menculini, G, Marcacci, M, Catanese, G, Sprini, D, Dicasalet, T, Bocci, M, Borga, S, Caironi, P, Cingolani, E, Avalli, L, Greco, G, Citerio, G, Gandini, L, Cornara, G, Lerda, R, Brazzi, L, Simeone, F, Caciorgna, M, Alampi, D, Francesconi, S, Beck, E, Antonini, B, Vettoretto, K, Meggiolaro, M, Garofalo, E, Notaro, S, Varutti, R, Bassi, F, Mistraletti, G, Marino, A, Rona, R, Rondelli, E, Riva, I, Scapigliati, A, Vitale, F, Pistidda, L, D'Andrea, R, Querci, L, Gnesin, P, Todeschini, M, Lugano, M, Castelli, G, Ortolani, M, Cotoia, A, Maggiore, S, Ditizio, L, Graziani, R, Testa, I, Ferretti, E, Castioni, C, Lombardi, F, Caserta, R, Pasqua, M, Simoncini, S, Baccarini, F, Rispoli, M, Grossi, F, Cancelliere, L, Carnelli, M, Puccini, F, Biancofiore, G, Siniscalchi, A, Laici, C, Torrini, M, Pasetti, G, Palmese, S, Oggioni, R, Mangani, V, Pini, S, Martelli, M, Rigo, E, Zuccalà, F, Cherri, A, Spina, R, Calamai, I, Petrucci, N, Caicedo, A, Ferri, F, Gritti, P, Brienza, N, Fonnesu, R, Dessena, M, Fullin, G, Saggioro, D., Mazzola, P, Tassistro, E, Di Santo, S, Rossi, E, Andreano, A, Valsecchi, M, Cherubini, A, Marengoni, A, Mossello, E, Bo, M, Inzitari, M, Di Bari, M, Udina, C, Latronico, N, Paolillo, C, Morandi, A, and Bellelli, G

Subjects
Aging, medicine.medical_specialty, medicine.medical_treatment, Population, Socio-culturale, frailty, Odds, older people, delirium, Risk Factors, Internal medicine, 80 and over, Medicine, Humans, Prospective Studies, LS4_4, education, Prospective cohort study, Geriatric Assessment, Aged, Aged, 80 and over, education.field_of_study, Rehabilitation, business.industry, Confounding, Delirium Day, Delirium Day, delirium, frailty, mortality, older people, General Medicine, Odds ratio, mortality, Delirium, Observational study, Geriatrics and Gerontology, medicine.symptom, business
Abstract

Background although frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality. Objective to examine, in hospitalized older persons, whether frailty is associated with delirium, and whether these two conditions, alone or in combination, affect these patients’ 30-day survival. Design observational study nested in the Delirium Day project, with 30-day follow-up. Setting acute medical wards (n = 118) and rehabilitation wards (n = 46) in Italy. Subjects a total of 2,065 individuals aged 65+ years hospitalized in acute medical (1,484 patients, 71.9%) or rehabilitation (581 patients, 28.1%) wards. Methods a 25-item Frailty Index (FI) was created. Delirium was assessed using the 4AT test. Vital status was ascertained at 30 days. Results overall, 469 (22.7%) patients experienced delirium on the index day and 82 (4.0%) died during follow-up. After adjustment for potential confounders, each FI score increase of 0.1 significantly increased the odds of delirium (odds ratio, OR: 1.66 [95% CI: 1.45–1.90]), with no difference between the acute (OR: 1.65 [95% CI: 1.41–1.93]) and rehabilitation ward patients (OR: 1.71 [95% CI: 1.27–2.30]). The risk of dying during follow-up also increased significantly for every FI increase of 0.1 in the overall population (OR: 1.65 [95% CI: 1.33–2.05]) and in the acute medical ward patients (OR: 1.61 [95% CI: 1.28–2.04]), but not in the rehabilitation patients. Delirium was not significantly associated with 30-day mortality in either hospital setting. Conclusions in hospitalized older patients, frailty is associated with delirium and with an increased risk of short-term mortality.

Published
2021

30. La vitesse de marche comme critère de fragilité chez la personne âgée vivant au domicile

Author

Houles, M., Abellan van Kan, G., Rolland, Y., Andrieu, S., Anthony, P., Bauer, J., Beauchet, O., Bonnefoy, M., Cesari, M., Donini, L. -M., Gillette-Guyonnet, S., Inzitari, M., Jurk, I., Nourhashemi, F., Offord-Cavin, E., Onder, G., Ritz, P., Salva, A., Visser, M., Vellas, B., and Un groupe de travail de l’International Academy on Nutrition and Aging (IANA)

Published
2010
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31. On Schrödinger’s Cat and Evaluation of Trials Disrupted by the Covid19 Pandemic: A Critical Appraisal

Author

Cesari, M., Calvani, Riccardo, Canevelli, M., Aprahamian, I., de Souto Barreto, P., Azzolino, D., Fielding, R. A., Vanacore, N., Inzitari, M., Marzetti, Emanuele, Calvani R. (ORCID:0000-0001-5472-2365), Marzetti E. (ORCID:0000-0001-9567-6983), Cesari, M., Calvani, Riccardo, Canevelli, M., Aprahamian, I., de Souto Barreto, P., Azzolino, D., Fielding, R. A., Vanacore, N., Inzitari, M., Marzetti, Emanuele, Calvani R. (ORCID:0000-0001-5472-2365), and Marzetti E. (ORCID:0000-0001-9567-6983)

Abstract

From the beginning of 2020, the world has been fighting the SARS-Cov-2 outbreak. The life of each one of us has profoundly hanged. Unavoidably, our clinical routine has drastically modified in its priorities and methodologies (1). The COVID-19 pandemic has also raised significant issues in the field of research. The investigators’ responsibility has increased with the need to thoughtfully weigh the risk-benefit ratio for each protocol in an emergency and evolving scenario (2).

Published
2021

32. Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study

Author

Morandi, A, Inzitari, M, Udina, C, Gual, N, Mota, M, Tassistro, E, Andreano, A, Cherubini, A, Gentile, S, Mossello, E, Marengoni, A, Olivé, A, Riba, F, Ruiz, D, de Jaime, E, Bellelli, G, Morandi, Alessandro, Inzitari, Marco, Udina, Cristina, Gual, Neus, Mota, Miriam, Tassistro, Elena, Andreano, Anita, Cherubini, Antonio, Gentile, Simona, Mossello, Enrico, Marengoni, Alessandra, Olivé, Anna, Riba, Francesc, Ruiz, Domingo, de Jaime, Elisabet, Bellelli, Giuseppe, Morandi, A, Inzitari, M, Udina, C, Gual, N, Mota, M, Tassistro, E, Andreano, A, Cherubini, A, Gentile, S, Mossello, E, Marengoni, A, Olivé, A, Riba, F, Ruiz, D, de Jaime, E, Bellelli, G, Morandi, Alessandro, Inzitari, Marco, Udina, Cristina, Gual, Neus, Mota, Miriam, Tassistro, Elena, Andreano, Anita, Cherubini, Antonio, Gentile, Simona, Mossello, Enrico, Marengoni, Alessandra, Olivé, Anna, Riba, Francesc, Ruiz, Domingo, de Jaime, Elisabet, and Bellelli, Giuseppe

Abstract

Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 “Delirium Day” project. Setting and Participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P <.001), visual impairment (24.2% vs 15.7%; P <.01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2–2.1; P =.00] and in Model 2 (OR 1.4; CI 1.1–1.9; P =.02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6–1.2, P =.36; OR 1.1; CI 0.8–1.4; P =.42) or in Model 2 (OR 0.8, CI 0.6–1.2, P =.27; OR 1.1, CI 0.8–1.4, P =.63). Conclusions and implications: Our findings support the importance of routine screening and specific interv

Published
2021

34. Frailty related factors as predictors of functional recovery in geriatric rehabilitation: The sarcopenia and function in aging rehabilitation (safari) multi-centric study

Author

Calle, A, Onder, G, Morandi, A, Bellelli, G, Ortolani, E, Perez, L, Mesas, M, Sanniti, A, Mazzanti, P, Platto, C, Gentile, S, Martinez, N, Roque, M, Inzitari, M, Calle A., Onder G., Morandi A., Bellelli G., Ortolani E., Perez L. M., Mesas M., Sanniti A., Mazzanti P., Platto C. N., Gentile S., Martinez N., Roque M., Inzitari M., Calle, A, Onder, G, Morandi, A, Bellelli, G, Ortolani, E, Perez, L, Mesas, M, Sanniti, A, Mazzanti, P, Platto, C, Gentile, S, Martinez, N, Roque, M, Inzitari, M, Calle A., Onder G., Morandi A., Bellelli G., Ortolani E., Perez L. M., Mesas M., Sanniti A., Mazzanti P., Platto C. N., Gentile S., Martinez N., Roque M., and Inzitari M.

Abstract

Background: Frailty-related characteristics, such as sarcopenia, malnutrition and cognitive impairment, are often overlooked, both in clinical practice and research, as potential contributors to functional recovery during geriatric rehabilitation. Objective: The aim of the study was to identify frailty-related characteristics associated with functional recovery in a cohort of post-orthopedic surgery and post-stroke older adults. Design: Multi-centric cohort study. Participanst and Settings: Patients over 65 years, admitted to three geriatric rehabilitation units, in Spain and Italy, after an orthopedic event or a stroke, from December 2014 to May 2016. Measurements: The Absolute Functional Gain (AFG) defined as the difference between Barthel Index score at discharge and at admission, and the Relative Functional Gain (RFG) that represents the percentage of recovery of the function lost due to the event, were selected as outcomes. Both outcomes were analyzed as continuous and dichotomous variables. Analyses were also stratified as diagnostic at admission. Results: We enrolled 459 patients (mean age±SD=80.75±8.21 years), 66.2% women, 69.5% with orthopedic conditions and with a length of stay of 28.8±9.1 days. Admission after a stroke (Odds Ratio=0.36, 95% Confidence Interval=0.22-0.59]) and a better functional status at admission (OR=0.96, 95% CI=0.94-0.97), were associated with a lower likelihood of AFG, while a better pre-event Barthel index (OR=1.03 for each point in score, 95% CI=1.01-1.04), being able to walk (OR=2.07, 95% CI=1.16-3.70), and a better cognitive status at admission (OR=1.05, 95% CI=1.01-1.09), were associated with a higher chance of AFG. Post-stroke patients with delirium at admission had a re-duced chance of AFG (OR=0.25, 95% CI=0.07-0.91]). Patients admitted after an orthopedic event with better pre-event functional status (OR=1.04, 95% CI=1.02-1.06) and able to walk at admission (OR=2.79, 95% CI=1.29-6.03]) had an increased chance of AFG. Additio

Published
2018

36. IMAGINE study protocol of a clinical trial: A multi-center, investigator-blinded, randomized, 36-month, parallel-group to compare the effectiveness of motivational interview in rehabilitation of older stroke survivors

Author

Gual N., Pérez L.M., Castellano-Tejedor C., Lusilla-Palacios P., Castro J., Soto-Bagaria L., Coll-Planas L., Roqué M., Vena A.B., Fontecha B., Santiago J.M., Lexell E.M., Chiatti C., Iwarsson S., and Inzitari M.

Subjects
Stroke Rehabilitation, clinical trial, Motivational Interviewing, Stroke, aged, multicenter study, Treatment Outcome, quality of life, Spain, survivor, randomized controlled trial, Humans, controlled study, epidemiology, human, Survivors, cerebrovascular accident
Abstract

Background: Rehabilitation pathways are crucial to reduce stroke-related disability. Motivational Interviewing (MI), as a person-centered complex intervention, aimed to empower and motivate, and could be a resource to improve rehabilitation outcomes for older stroke survivors. The IMAGINE project aims to assess the impact of MI, as a complement to standard geriatric rehabilitation, on functional improvement at 30 days after admission, compared to standard geriatric rehabilitation alone, in persons admitted to geriatric rehabilitation after a stroke. Secondary objectives include assessing the impact of MI on physical activity and performance, self-efficacy, safety, cost-utility, participants' experiences and functional status at 3 months. Methods: We will conduct a multicenter randomized clinical trial in three geriatric rehabilitation hospitals in Spain. Older adults after mild-moderate stroke without previous severe cognitive impairment or disability will be randomized into the control or intervention group (136 per group, total N = 272). The intervention group will receive 4 sessions of MI by trained nurses, including the design of a personalized rehabilitation plan agreed between stroke survivors and nurses based on stroke survivors goals, needs, preferences and capabilities. Main outcome will be the Functional Independence Measure (FIM). In-hospital physical activity will be measured through accelerometers and secondary outcomes using validated scales. The study includes a process evaluation and cost-utility analysis. Discussion: Final results are expected by end of 2020. This study will provide relevant information on the implementation of MI as a rehabilitation reinforcement tool in older stroke survivors. A potential reduction in post-stroke disability and dependence would increase person's health-related quality of life and well-being and reduce health and social care costs. IMAGINE has the potential to inform practice and policymakers on how to move forward towards shared decision-making and shared responsibilities in the vulnerable population of older stroke survivors. Trial registration: ClinicalTrials.gov: NCT03434938, registered on January 2018. © 2020 The Author(s).

Published
2020

38. Sleep disturbances and the speed of multimorbidity development in old age : results from a longitudinal population-based study

Author

Sindi, S., Pérez, L. M., Vetrano, D. L., Triolo, F., Kåreholt, Ingemar, Sjöberg, L., Darin-Mattsson, A., Kivipelto, M., Inzitari, M., Calderón-Larrañaga, A., Sindi, S., Pérez, L. M., Vetrano, D. L., Triolo, F., Kåreholt, Ingemar, Sjöberg, L., Darin-Mattsson, A., Kivipelto, M., Inzitari, M., and Calderón-Larrañaga, A.

Abstract

Background: Sleep disturbances are prevalent among older adults and are associated with various individual diseases. The aim of this study was to investigate whether sleep disturbances are associated with the speed of multimorbidity development among older adults. Methods: Data were gathered from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), an ongoing population-based study of subjects aged 60+ (N = 3363). The study included a subsample (n = 1189) without multimorbidity at baseline (< 2 chronic diseases). Baseline sleep disturbances were derived from the Comprehensive Psychiatric Rating Scale and categorized as none, mild, and moderate–severe. The number of chronic conditions throughout the 9-year follow-up was obtained from clinical examinations. Linear mixed models were used to study the association between sleep disturbances and the speed of chronic disease accumulation, adjusting for sex, age, education, physical activity, smoking, alcohol consumption, depression, pain, and psychotropic drug use. We repeated the analyses including only cardiovascular, neuropsychiatric, or musculoskeletal diseases as the outcome. Results: Moderate–severe sleep disturbances were associated with a higher speed of chronic disease accumulation (ß/year = 0.142, p = 0.008), regardless of potential confounders. Significant positive associations were also found between moderate–severe sleep disturbances and neuropsychiatric (ß/year = 0.041, p = 0.016) and musculoskeletal (ß/year = 0.038, p = 0.025) disease accumulation, but not with cardiovascular diseases. Results remained stable when participants with baseline dementia, cognitive impairment, or depression were excluded. Conclusion: The finding that sleep disturbances are associated with faster chronic disease accumulation points towards the importance of early detection and treatment of sleep disturbances as a possible strategy to reduce chronic multimorbidity among older adults.

Published
2020
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39. Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Author

Sansano-Nadal, O, Gine-Garriga, M, Brach, JS, Wert, DM, Jerez-Roig, J, Guerra-Balic, M, Oviedo, G, Fortuno, J, Gomara-Toldra, N, Soto-Bagaria, L, Perez, LM, Inzitari, M, Sola, I, Martin-Borras, C, and Roque, M

Subjects
meta-analysis, systematic review, Older adults, physical activity, adherence, sustainability
Abstract

Exercise is a form of physical activity ( PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis ( PROSPERO: CRD42017070892) of randomized clinical trials ( RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active ( e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active ( e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian-Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up ( standardized mean difference ( SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I-2 0%), but not at the one-or two-years follow-ups. No data were available on the mid-and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.

Published
2019

40. The relationship between frailty and polypharmacy in older people: A systematic review

Author

Gutiérrez‐Valencia, M., Izquierdo, M., Cesari, M., Casas‐Herrero, Á., Inzitari, M., and Martínez‐Velilla, N.

Subjects
Aged, 80 and over, Observational Studies as Topic, Frailty, Frail Elderly, Polypharmacy, Humans, Systematic Review and Meta–Analysis, Aged
Abstract

AIMS: Frailty is a complex geriatric syndrome resulting in decreased physiological reserves. Frailty and polypharmacy are common in older adults and the focus of extensive studies, although little is known about the impact they may have on each other. This is the first systematic review analysing the available evidence on the relationship between frailty and polypharmacy in older adults. METHODS: Systematic review of quantitative studies. A comprehensive literature search for publications in English or Spanish was performed on MEDLINE, CINAHL, the Cochrane Database and PsycINFO in September 2017 without applying restrictions on the date of publication. Studies reporting any relationship between frailty and polypharmacy in older adults were considered. RESULTS: A total of 25 publications were included, all of them observational studies. Evaluation of Fried's frailty criteria was the most common approach, followed by the Edmonton Frail Scale and FRAIL scale. Sixteen of 18 cross‐sectional analyses and five of seven longitudinal analyses demonstrated a significant association between an increased number of medications and frailty. The causal relationship is unclear and appears to be bidirectional. Our analysis of published data suggests that polypharmacy could be a major contributor to the development of frailty. CONCLUSIONS: A reduction of polypharmacy could be a cautious strategy to prevent and manage frailty. Further research is needed to confirm the possible benefits of reducing polypharmacy in the development, reversion or delay of frailty.

Published
2018

42. Impairments in balance and mobility identify delirium in patients with comorbid dementia

Author

Gual, N, Richardson, S, Davis, D, Bellelli, G, Hasemann, W, Meagher, D, Kreisel, S, Maclullich, A, Cerejeira, J, Inzitari, M, Morandi, A, Gual, Neus, Richardson, Sarah J., Davis, Daniel H. J., Bellelli, Giuseppe, Hasemann, Wolfgang, Meagher, David, Kreisel, Stefan H., Maclullich, Alasdair M. J., Cerejeira, Joaquim, Inzitari, Marco, Morandi, Alessandro, Gual, N, Richardson, S, Davis, D, Bellelli, G, Hasemann, W, Meagher, D, Kreisel, S, Maclullich, A, Cerejeira, J, Inzitari, M, Morandi, A, Gual, Neus, Richardson, Sarah J., Davis, Daniel H. J., Bellelli, Giuseppe, Hasemann, Wolfgang, Meagher, David, Kreisel, Stefan H., Maclullich, Alasdair M. J., Cerejeira, Joaquim, Inzitari, Marco, and Morandi, Alessandro

Abstract

Diagnosing delirium superimposed on dementia (DSD) remains challenging because of a lack of specific tools, though motor dysfunction in delirium has been relatively under-explored. This study aimed to use dysfunction in balance and mobility (with the Hierarchical Assessment of Balance And Mobility: HABAM) to identify DSD. This is a cross-sectional multicenter study, recruiting consecutive patients ≥70 years admitted to five acute or rehabilitation hospitals in Ireland, Italy, Portugal, and Switzerland. Delirium was diagnosed using DSM-5 criteria; dementia was determined by the Mini-Mental State Examination and the Questionnaire of Cognitive Decline in the Elderly. HABAM score was recorded at admission. Out of 114 patients (mean age ± SD = 82 ± 7; 54% female), dementia alone was present in 24.6% (n = 28), delirium alone in 18.4% (n = 21) and DSD in 27.2% (n = 31). Patients with DSD had a mean HABAM score 7 points greater than those with dementia alone (19.8 ± 8.7 vs 12.5 ± 9.5; p < 0.001); 70% of participants with DSD were correctly identified using the HABAM at a cut off of 22 (sensitivity 61%, specificity 79%, AUC = 0.76). Individuals with delirium have worse motor function than those without delirium, even in the context of comorbid dementia. Measuring motor function using the HABAM in older people at admission may help to diagnose DSD.

Published
2019

43. Effectiveness of a Hospital-at-Home Integrated Care Program as Alternative Resource for Medical Crises Care in Older Adults With Complex Chronic Conditions

Author

Mas MÀ, Santaeugènia SJ, Tarazona-Santabalbina FJ, Gámez S, and Inzitari M

Subjects
multimorbidity, medical crises, Hospital-at-home, integrated care
Abstract

Objectives: To compare clinical outcomes in older patients with acute medical crises attended by a geriatrician-led home hospitalization unit (HHU) vs an inpatient intermediate-care geriatric unit (ICGU) in a post-acute care setting. Design: Quasi-experimental longitudinal study, with 30-day follow-up. Participants: Older patients with chronic conditions attended at the emergency department or day hospital for an acute medical crisis. Interventions: Patients were referred to geriatrician-led HHU or ICGU wards. Setting: An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. Measurements: We compared health crisis outcomes (recovery from the acute health crisis, referral to an acute hospital, or death), length of stay, relative functional gain (RFG) at discharge, readmission to an acute care unit within 30 days of discharge, and mortality within 30 days of discharge. Results: We included 171 older adults (57 in the HHU and 114 in the ICGU) with complex conditions at risk of negative outcomes. At baseline, HHU patients were significantly younger and less likely to be cognitively impaired and referred from an emergency department. Most patients in both groups recovered from their health crises (91.2% in the HHU group vs 88.6% in the ICGU group, P = .79). No differences were found between the 2 groups in 30-day mortality (8.6% vs 9.6%, P = >. 99). There was a trend toward lower 30-day readmission to an acute care unit in the HHU group (10.5% vs 19.3% in the ICGU group, P = .19). HHU patients had higher RFG (mean 0.75 days vs 0.51 in the ICGU group, P = .01), and a longer stay in the unit (9.7 vs 8.2 days in the ICGU group, P < .01). Conclusions: These preliminary results suggest that the geriatrician-led HHU seems effective in resolving acute medical crises in older patients with chronic disease. Patients attended by the HHU obtained better functional outcomes compared to those from the ICGU, although the groups did have some baseline differences. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Published
2018

44. Frailty and Sarcopenia

Author

Pérez, L, primary, Luis, S, additional, Gual, N, additional, Diaz, F, additional, Sitjá, M, additional, Enfedaque, B, additional, and Inzitari, M, additional

Published
2018
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