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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 interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.

Summary Paget's disease is an osteopathy the incidence of which increases with aging; in the 8th decade, it occurs in 11 % of the population. Complications of this pathology often occur, and appear prevalently in form of basilar disease. We report a case of an ultracentenarian patient (aged 107) who suffered a cervical right femur fracture after falling in her own house at the age of 104 years. Radiological and laboratory findings revealed a mono-osseal Paget's disease of the right femur. Because of her good conditions, the patient underwent an operation of non-cemented endoprothesis of Moore type, with a good post-operatory course and a physiokinetic therapeutic treatment. A kinesiologic evaluation was made, by measuring articular range of motion (ROM) through the neutral zero methods and evaluating the muscular strength: it showed a constantly progressive functional recovery of the lower limbs in both subjective and objective terms.

State-of-the-art hardware-in-the-loop (HWIL) test facilities have been established and in operation at the U.S. Army's Aviation and Missile Research, Development, and Engineering Center (AMRDEC) in McMorrow Laboratories, on Redstone Arsenal Alabama for over 37 years. These facilities have been successfully developed and employed supporting numerous tactical and interceptor missile systems. The AMRDEC HWIL facilities are constantly in a state state of modification and revision supporting evolving test requirements related to increasingly complex sensor suites, guidance implementations, and employment strategies prevalent within both existing and emerging aviation and missile programs. . This paper surveys the role of the U.S. Army Aviation and Missile Research, Development, and Engineering Center (AMRDEC) in the development and operation of HWIL test facilities and the implementation of new, innovative technologies that have been integrated within facility test assets. This technology spans both the Near IR (NIR- 1.064um) and IR (3 - 12um) and RF (2 - 95 GHz) operating ranges. The AMRDEC HWIL facilities represent the highest degree of simulation fidelity, integrating all the major parts of a HWIL simulation including tactical missile and seeker hardware, executive control software, scene generation, and NIR, IR or RF scene projection systems. Successful incorporation of scene generation and projection technologies have become a key thrust of the AMRDEC HWIL development focus, with the intention to adapt and anticipate emerging test element requirements necessitated by future system sensing technologies.

To review currently available knowledge on presentation, clinical features and management of heart failure (HF) in elderly people.To review currently available evidence, we performed a thorough search of several evidence-based sources of information, including Cochrane Database of Systematic Reviews, Clinical Evidence, Evidence-based guidelines from National Guidelines Clearinghouse and a comprehensive MEDLINE search with the MeSH terms: 'heart failure', 'elderly' and 'management'.A number of features of ageing may predispose elderly people to HF, and may impair the ability to respond to injuries. Another hallmark of elderly patients is the increasing prevalence of multiple coexisting chronic conditions and geriatric syndromes that may complicate the clinical presentation and evolution of HF. Although diagnosis may be challenging, because atypical symptoms and presentations are common, and comorbid conditions may mimic or complicate the clinical picture, diagnostic criteria do not change in elderly people. Drug treatment is not significantly different from that recommended in younger patients, and largely remains empiric, because clinical trials have generally excluded elderly people and patients with comorbid conditions. Disease management programmes may have the potential to reduce morbidity and mortality for patients with HF.Heart failure is the commonest reason for hospitalisation and readmission among older adults. HF shows peculiar features in elderly people, and is usually complicated by comorbidities, presenting a significant financial burden worldwide, nevertheless elderly people have been generally excluded from clinical trials, and thus management largely remains empiric and based on evidence from younger age groups.

A number of studies has shown that during aging thyroid presents some structural changes, whilst no data agree about secretory activity. The aim of the present study was to evaluate thyroid function in a group of healthy over-80 years old people vs a group of young subjects.This study was performed on 48 old people, 33 women (68.75%) and 15 men (31.25%), mean age 86.38+/-5.20 years old and 43 young subjects, mean age 33.35+/-3.75 years old; all of them were euthyroid and were not affected with any acute or chronic diseases and did not take any drugs which could interfere with thyroid function. A blood sample was taken from each patient, for dosing TT3, TT4, FT3, FT4, TSH, TgAb, TPOAb.The results of the present study show low serum levels of TT3 in healthy over-80 year old people compared to young people, even if serum levels of TT4, FT3, FT4, TSH have no significant changes.Functional reduction in thyroid activity during aging has not to be considered responsible for senile involution; it is more appropriate to define it as the expression of a metabolic slow down in the elderly.

Falls are the main causes of accidental death and disability in elderly people, since they may especially cause hip fractures and a number of related complications. Available incidence estimates are surely in defect, because falls are often omitted both by patients, their family and caregivers. Risk factors may be classified in intrinsic and extrinsic; the former include muscular and osteoarticular diseases or other favouring conditions, whilst the latter include environmental or iatrogenic factors, such as drugs or alcohol consumption. Extrinsic factors may be rapidly modified in the elderly and thus prevented. In fact, prevention of falls is the main intervention of geriatrist, both at patient's home and if patient is hospitalized. In order to reduce the risk of falls, it is sometimes sufficient to stop a treatment or to reduce the doses of drugs causing sedation or orthostatic hypotension, to avoid if possible, the use of sedative-hypnotics, to use non-pharmacological methods for treating insomnia. The introduction of the necessary changes in the environment, the promotion of physical activity, the individuation of the subjects with a high risk of falls and the use of hip protectors are useful means for preventing falls and avoiding their harmful consequences.

Isolated systolic hypertension is the most common type of hypertension in the elderly. A number of trials have widely shown that it is an independent risk factor for cardiovascular morbidity and mortality. This review focuses the prevalence of isolated systolic hypertension, its pathophysiology, diagnosis and treatment. The optimal treatment strategy is to maximize reduction in systolic blood pressure and to minimize reduction in diastolic blood pressure. All classes of antihypertensive agents can be used, but calcium antagonists, ACE-inhibitors and, more recently, the angiotensin II antagonists appear to be more successful in improving large artery stiffness and therefore are especially useful in treating isolated systolic hypertension in the elderly. A careful evaluation and treatment has to be made in particular in those patients with more risk factors, in order to choose the most appropriate drug and to avoid dangerous drug-drug interactions where polypharmacy occurs.

The increase of mean lifetime has also given rise to an increase in the number of centenarians; such a circumstance finds its explanation in an improvement in hygienic conditions in addition to the progress in the medical field. The aim of this retrospective study is the attempt to identify the probable factors encouraging the achievement of an extreme longevity.The study was carried out, on a house to house basis, on a sample of 46 calabrian centenarians. In order to demonstrate the hereditary component, the frequency of the centenarians among the closest relatives was considered, through birth and death certificates. The case history questionnaire used most geriatric and gerontological centres associated to the national project Italian Multicentric Study on Centena-rians was used.The profile of our long-lived subject has allowed us to underline the importance of the environmental factor as well as the hereditary component. In most cases these subjects live with their family and have excellent relationships, receiving a great deal of attention from the persons with which they live.The authors have therefore reached the conclusion by stressing the importance of both factors (hereditary and genetic); however a type of intervention in order to lengthen the mean lifetime is hypothesized exclusively in the environment field through the elimination of certain risk factors.

The U.S. Army Aviation and Missile Command (AMCOM) Advanced Simulation Center (ASC) provides hardware-in-the-loop (HWIL) simulation support to Program Executive Officers (PEO) and Project Managers (PM) who are responsible for developing and fielding precision guided missiles and sub-munitions for the U.S. Army. The ASC is also engaged in cooperative HWIL simulation tasks supporting other Armed Service Agencies, NATO and other U.S. allies. HWIL simulation provides a means of exercising missile guidance and control hardware in simulated flight, wherein the missile sensors are stimulated with input signals which make the system behave as though it were in actual operation. Real-time computers are used to control the target and countermeasure signatures and battlefield scenarios. Missile flight dynamics, responding to the commands issued by the guidance and control system hardware/software, are simulated in real-time to determine the missile trajectory and to calculate target intercept conditions. The ASC consists of 10 HWIL simulation facilities developed over a period of 20 years. These facilities contain special purpose infrared and RF signal generation equipment, flight motion simulators, radiation chambers, optics, and computers. They provide in- band target signatures, countermeasures, and background scenarios in the microwave, millimeter wave, infrared and visible regions of the electromagnetic spectrum. The ASC HWIL simulation facilities are an important source of test and evaluation data and have a critical role in all phases of a missile system life cycle. The development of a new generation of missile systems that use multi-spectral seekers has imposed unique and difficult requirements on ASC HWIL simulation facilities. For the past three years, the U.S. Army Aviation and Missile Command (AMCOM) has been developing a HWIL simulation facility to test common aperture multi-spectral missile seekers. This paper discusses the problems encountered during the development of this facility, the solutions, and the resulting capability of this unique HWIL simulation facility.© (2000) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

We evaluated the symptomatology caused by cerebral hypoperfusion in a group of over-65 year old hospitalized and non-patients, with hyperkinetic and hypokinetic arrhythmias.2441 clinical records of hospitalized and ambulatory patients at the unit of Cardiology, "Pugliese-Ciaccio" Hospital of Catanzaro between January 1st 1991 and March 31st 1995 were examined. The clinical records of those patients who had showed anamnestic episodes of syncope, lipothymia and dizziness were selected. The selected sample was made of 36 hospitalized patients and 36 ambulatory patients. The Holter-ECGs of these patients were examined.Six episodes of syncope (16.7%) were found in the hospitalized patients and 4 in the ambulatory patients (11.1%). Ten (27.8%) and 8 (22.2%) episodes of lipothymia, were found in the hospitalized and ambulatory patients respectively. Dizziness was found in 20 (55.5%) hospitalized and in 24 (66.6%) ambulatory patients. In all the patients the symptoms appeared during the recording and were linked to hyperkinetic arrhythmias in 22 (61.1%) hospitalized patients and in 25 (69.4%) ambulatory patients and to hypokinetic arrhythmias in 14 (39.9%) and 11 (30.5%) hospitalized and ambulatory patients.The present study pointed out that patients with hyperkinetic arrhythmias (both hospitalized and ambulatory) show symptoms of cerebral hypoperfusion more frequently than those with hyperkinetic arrhythmias.

The Authors provide an update on benign edematous polysynovitis in the elderly and propose clinical and laboratory criteria for a correct diagnosis. They also propose the use of the term "polysynovitis" rather than polyarthritis, as they think it describes the histopathological findings of the disease better. Finally, they attempt to correctly distinguish RS3PE syndrome from polymyalgia rheumatica, rheumatoid arthritis and chondrocalcinosis.