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1. Incidence of young‐onset dementia in Italy: The Brescia register study

Author

Barbara Borroni, Ilenia Libri, Matteo Rota, Giuliano Binetti, Luisa Benussi, Roberta Ghidoni, Maria Sofia Cotelli, Silvia Fostinelli, Fabio Guerini, Stefano Boffelli, Eugenio Magni, Marta Pengo, Michele Gennuso, Marta Bianchi, Beatrice Cossu, Vincenzo Palomba, Andrea Crucitti, Angelo Bianchetti, Giancarlo Logroscino, and Alessandro Padovani

Subjects
Alzheimer's disease, frontotemporal dementia, incidence, population‐based study, young‐onset dementia, Neurology. Diseases of the nervous system, RC346-429, Geriatrics, RC952-954.6
Abstract

Abstract INTRODUCTION The goal of the present work was to assess the incidence of dementia with onset before the age of 65 years (i.e., young‐onset dementia [YOD]) and define the frequencies of young‐onset Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD), and dementia with Lewy bodies (DLB) in the general population. METHODS The study was conducted from January 1, 2019 to December 31, 2019 in Brescia province (population: 1,268,455). During the study period, all new YOD cases (incident YOD) were counted, and all patients’ records reviewed. The incidence was standardized to the Italian general population in 2019. RESULTS A total of 29 YOD patients were diagnosed. The age‐sex standardized incidence rate was 4.58 (95% confidence interval, 3.07–6.58) per 100,000 person‐years. No difference in incidence rate between YOD due to AD or FTLD (P = 0.83) and between sexes (P = 0.81) was observed. YOD incidence increased with age, reaching its peak after 60 years. DISCUSSION Presenting neurodegenerative YOD phenotypes encompasses both AD and FTLD. Improved knowledge on YOD epidemiology is essential to adequately plan and organize health services.

Published
2024
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2. The Impact of COVID-19 Quarantine on Patients With Dementia and Family Caregivers: A Nation-Wide Survey

Author

Innocenzo Rainero, Amalia C. Bruni, Camillo Marra, Annachiara Cagnin, Laura Bonanni, Chiara Cupidi, Valentina Laganà, Elisa Rubino, Alessandro Vacca, Raffaele Di Lorenzo, Paolo Provero, Valeria Isella, Nicola Vanacore, Federica Agosta, Ildebrando Appollonio, Paolo Caffarra, Cinzia Bussè, Renato Sambati, Davide Quaranta, Valeria Guglielmi, Giancarlo Logroscino, Massimo Filippi, Gioacchino Tedeschi, Carlo Ferrarese, the SINdem COVID-19 Study Group, Erica Gallo, Alberto Grassini, Andrea Marcinnò, Fausto Roveta, Paola De Martino, Francesca Frangipane, Gianfranco Puccio, Rosanna Colao, Maria Mirabelli, Chiara Terracciano, Federica Lino, Stefano Mozzetta, Gianmarco Gazzola, Giulia Camporese, Simona Sacco, Maria Carmela Lechiara, Claudia Carrarini, Mirella Russo, Alfonsina Casa lena, Patrizia Sucapane, Pietro Tiraboschi, Paola Caroppo, Veronica Redaelli, Giuseppe Di Fede, Daniela Coppa, Lenino Peluso, Pasqualina Insarda, Matteo De Bartolo, Sabrina Esposito, Alessandro Iavarone, Carmine Fuschillo, Elena Salvatore, Chiara Criscuolo, Luisa Sambati, Rossella Santoro, Daniela Gragnaniello, Ilaria Pedriali, Livia Ludovico, Annalisa Chiari, Andrea Fabbo, Petra Bevilacqua, Chiara Galli, Silvia Magarelli, Gianfranco Spalletta, Nerisa Banaj, Giulia Caruso, Desirée Estela Porcari, Franco Giubilei, Anna Rosa Casini, Francesca Ursini, Giuseppe Bruno, Stefano Boffelli, Michela Brambilla, Giuseppe Magnani, Francesca Caso, Edoardo G. Spinelli, Elena Sinforiani, Alfredo Costa, Simona Luzzi, Gabriella Cacchiò, A.I.M.A. –sez Parma, Marta Perini, Rossano Angeloni, Cinzia Giuli, Katia Fabi, Marco Guidi, Cristina Paci, Annaelisa Castellano, Elena Carapelle, Rossella Petrucci, Miriam Accogli, Giovanna Nicoletta Trevisi, Serena Renna, Antonella Vasquez Giuliano, Fulvio Da Re, Antonio Milia, Giuseppina Pilia, Maria Giuseppina Mascia, Valeria Putzu, Tommaso Piccoli, Luca Cuffaro, Roberto Monastero, Antonella Battaglia, Valeria Blandino, Federica Lupo, Eduardo Cumbo, Antonina Luca, Giuseppe Caravaglios, Annalisa Vezzosi, Valentina Bessi, Gloria Tognoni, Valeria Calsolaro, Giulia Lucarelli, Serena Amici, Alberto Trequattrini, Salvatore Pezzuto, Patrizia Mecocci, Giulia Caironi, Barbara Boselli, Marino Formilan, Alessandra Coin, Laura De Togni, Francesca Sala, Giulia Sandri, Maurizio Gallucci, Anna Paola Mazzarolo, Cristina Bergamelli, and Serena Passoni

Subjects
quarantine, COVID-19, dementia, Alzheimer’s disease, BPSD, caregiver burden, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

IntroductionPrevious studies showed that quarantine for pandemic diseases is associated with several psychological and medical effects. The consequences of quarantine for COVID-19 pandemic in patients with dementia are unknown. We investigated the clinical changes in patients with Alzheimer’s disease and other dementias, and evaluated caregivers’ distress during COVID-19 quarantine.MethodsThe study involved 87 Italian Dementia Centers. Patients with Alzheimer’s Disease (AD), Dementia with Lewy Bodies (DLB), Frontotemporal Dementia (FTD), and Vascular Dementia (VD) were eligible for the study. Family caregivers of patients with dementia were interviewed by phone in April 2020, 45 days after quarantine declaration. Main outcomes were patients’ changes in cognitive, behavioral, and motor symptoms. Secondary outcomes were effects on caregivers’ psychological features.Results4913 patients (2934 females, 1979 males) fulfilled the inclusion criteria. Caregivers reported a worsening in cognitive functions in 55.1% of patients, mainly in subjects with DLB and AD. Aggravation of behavioral symptoms was observed in 51.9% of patients. In logistic regression analysis, previous physical independence was associated with both cognitive and behavioral worsening (odds ratio 1.85 [95% CI 1.42–2.39], 1.84 [95% CI 1.43–2.38], respectively). On the contrary, pandemic awareness was a protective factor for the worsening of cognitive and behavioral symptoms (odds ratio 0.74 [95% CI 0.65–0.85]; and 0.72 [95% CI 0.63–0.82], respectively). Approximately 25.9% of patients showed the onset of new behavioral symptoms. A worsening in motor function was reported by 36.7% of patients. Finally, caregivers reported a high increase in anxiety, depression, and distress.ConclusionOur study shows that quarantine for COVID-19 is associated with an acute worsening of clinical symptoms in patients with dementia as well as increase of caregivers’ burden. Our findings emphasize the importance to implement new strategies to mitigate the effects of quarantine in patients with dementia.

Published
2021
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3. Clinical Presentation of COVID19 in Dementia Patients

Author

Piera Ranieri, Angelo Bianchetti, Stefano Boffelli, L. Bianchetti, G. Minelli, Renzo Rozzini, M. Trabucchi, and Fabio Guerini

Subjects
Male, Pediatrics, medicine.medical_specialty, 030309 nutrition & dietetics, Pneumonia, Viral, Medicine (miscellaneous), Logistic regression, Article, Betacoronavirus, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, mental disorders, Prevalence, medicine, Humans, Dementia, 030212 general & internal medicine, Risk factor, Pandemics, Aged, Retrospective Studies, Aged, 80 and over, 0303 health sciences, Nutrition and Dietetics, COVID19 infection, SARS-CoV-2, business.industry, Mortality rate, COVID-19, Retrospective cohort study, Middle Aged, medicine.disease, Pneumonia, Logistic Models, Italy, Delirium, mortality risk, Female, Presentation (obstetrics), medicine.symptom, Geriatrics and Gerontology, Coronavirus Infections, business, dementia
Abstract

Objective No studies analyzing the role of dementia as a risk factor for mortality in patients affected by COVID-19. We assessed the prevalence, clinical presentation and outcomes of dementia among subjects hospitalized for COVID19 infection. Design Retrospective study. Setting COVID wards in Acute Hospital in Brescia province, Northern Italy. Participants We used data from 627 subjects admitted to Acute Medical wards with COVID 19 pneumonia. Measurements Clinical records of each patients admitted to the hospital with a diagnosis of COVID19 infection were retrospectively analyzed. Diagnosis of dementia, modalities of onset of the COVID-19 infection, symptoms of presentation at the hospital and outcomes were recorded. Results Dementia was diagnosed in 82 patients (13.1%). The mortality rate was 62.2% (51/82) among patients affected by dementia compared to 26.2% (143/545) in subjects without dementia (p

Published
2020

4. The impact of COVID-19 on health status of home-dwelling elderly patients with dementia in East Lombardy, Italy: results from COVIDEM network

Author

Nives Medici, Matteo Peli Psy, Elisa Zanacchi Psy, Elena Lucchi Psy, Melania Cappuccio, Marinella Turla, Angelo Bianchetti, Alessandro Padovani, Simona Gentile, Chiara Vecchi Psy, Alessandra Marengoni, Salvatore Caratozzolo, Mara Zanni, Marco Di Cesare, Daniele Bellandi, Renzo Rozzini, Andrea Scalvini, Rosanna Turrone Psy, Giuseppe Bellelli, Ignazio Di Fazio, Lina Falanga, Eleonora Grossi Psy, Federica Gottardi Psy, Maura Cosseddu Psy, Marina Zanetti Psy, Giuliana Vezzadini, Stefano Boffelli, Claudia Caminati, Marco Trabucchi, Maria Cotelli, Sara Fascendini, Alberto Zucchelli, Nives Palamini, Silvia Pelizzari Psy, Marta Grigolo Psy, Chiara Forlani Psy, Caratozzolo, S, Zucchelli, A, Turla, M, Cotelli, M, Fascendini, S, Zanni, M, Bianchetti, A, Psy, M, Rozzini, R, Boffelli, S, Cappuccio, M, Psy, F, Psy, C, Bellandi, D, Caminati, C, Gentile, S, Psy, E, Di Fazio, I, Vezzadini, G, Psy, R, Psy, S, Scalvini, A, Di Cesare, M, Falanga, L, Medici, N, Palamini, N, Bellelli, G, Marengoni, A, Trabucchi, M, and Padovani, A

Subjects
Male, Aging, medicine.medical_specialty, Health Status, Pneumonia, Viral, 030204 cardiovascular system & hematology, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Internal medicine, Diabetes mellitus, Pandemic, Medicine, Dementia, Humans, 030212 general & internal medicine, Viral, Pandemics, Aged, COPD, business.industry, SARS-CoV-2, Mortality rate, Medical record, COVID-19, Health status, Home dwelling, Coronavirus Infections, Female, Hospitalization, Italy, Health statu, Pneumonia, medicine.disease, Vaccination, Ageing, Original Article, Geriatrics and Gerontology, business, Complication
Abstract

Background COVID-19 outbreak has led to severe health burden in the elderly. Age, morbidity and dementia have been associated with adverse outcome. Aims To evaluate the impact of COVID-19 on health status in home-dwelling patients. Methods 848 home-dwelling outpatients with dementia contacted from April 27 to 30 and evaluated by a semi-structured interview to evaluate possible health complication due to COVID-19 from February 21 to April 30. Age, sex, education, clinical characteristics (including diagnosis of dementia) and flu vaccination history were obtained from previous medical records. Items regarding change in health status and outcome since the onset of the outbreak were collected. COVID-19 was diagnosed in patients who developed symptoms according to WHO criteria or tested positive at nasal/throat swab if hospitalized. Unplanned hospitalization, institutionalization and mortality were recorded. Results Patients were 79.7 years old (SD 7.1) and 63.1% were females. Ninety-five (11.2%) patients developed COVID-19-like symptoms. Non COVID-19 and COVID-19 patients differed for frequency of diabetes (18.5% vs. 37.9%, p p p Discussion/conclusions A high proportion of adverse outcome related to COVID-19 was observed in home-dwelling elderly patients with dementia. Active monitoring though telehealth programs would be useful particularly for those at highest risk of developing COVID-19 and its adverse outcomes.

Published
2020

5. Comparison of Italian and Norwegian Postacute Care Settings for Older Patients in Need of Further Treatment and Rehabilitation After Hospitalization

Author

Marco Trabucchi, Stefano Boffelli, Anette Hylen Ranhoff, J.F. Abrahamsen, A. Cassinadri, and Renzo Rozzini

Subjects
medicine.medical_specialty, Rehabilitation, Older patients, business.industry, medicine.medical_treatment, language, Physical therapy, Settore BIO/14, Medicine, Norwegian, business, Postacute Care, language.human_language
Abstract

Background/Objectives: Little is known regarding the influence of sociodemographic and clinical factors, on the short term outcomes of different postacute care (PAC) models in different countries. Design and setting: Prospective cohort study of a 19- bed Italian hospital subacute care (SAC) unit and a 19-bed Norwegian nursing home (NH) intermediate care (IC) unit, both based on Comprehensive Geriatric Assessment and similar multidisciplinary staffing. Participants: A total of 664 Italian and 961 Norwegian community-dwelling patients ≥70 years of age, in need of postacute geriatric based treatment, rehabilitation and care. The patients were admitted from acute medical, surgical and orthopaedic hospital units. Measurements: Demographic data, clinical information, comprehensive geriatric assessment (CGA), discharge destination and length of stay were recorded in an Italian and a Norwegian database and compared. Results: The Italian patients receiving hospital SAC, were more seriously affected by the acute disease and trauma, median Barthel index (BI) at admission/discharge was 40/60, compared to 75/85 in the Norwegian patients, and fewer of them were able to return to own home as compared to the Norwegian patients ( 64% vs. 82%). Although the Italian patients had a lower BI at discharge, fewer of them were transferred to nursing homes (9%), as compared to the Norwegian patients (14%), while more of them were discharged to further rehabilitation, acute hospitalization, hospice or died (27%), as compared to the Norwegian patients (4%). Of the patients discharged to own home, only 8% of the Italian compared to 71% of the Norwegian patients received nurse assisted home care. Admission BI and improvement in BI, were highly significant predictors for the ability to return home in multivariate logistic regression analysis both in the Italian and the Norwegian patients. Conclusions: Both clinical and sociodemographic factors influenced the clinical outcome of older patients receiving PAC in Italy and Norway. Such differences should be taken into account when results from different PAC models in different countries are compared. Both the Italian hospital SAC model and the Norwegian NH IC model are feasible and good alternatives, but more firm inclusion criteria may further optimize the selection of patients suitable for different PAC options.

Published
2015

6. The Management of Adverse Clinical Events in Nursing Homes: A 1-Year Survey Study

Author

Giovanni B. Frisoni, Marco Trabucchi, Renzo Rozzini, Piera Barbisoni, Giuseppe Bellelli, Stefano Boffelli, Bellelli, G, Frisoni, G, Barbisoni, P, Boffelli, S, Rozzini, R, and Trabucchi, M

Subjects
Male, Night Care, medicine.medical_specialty, Activities of daily living, National Health Programs, Personnel Staffing and Scheduling, Psychological intervention, MEDLINE, Drug Therapy, Nursing, Intervention (counseling), Activities of Daily Living, Outcome Assessment, Health Care, Health care, Medical Staff, Prevalence, Humans, Medicine, Prospective Studies, Hospital transfer, Geriatric Assessment, Aged, Holidays, Quality of Health Care, Aged, 80 and over, Nursing home, business.industry, Health services research, Middle Aged, Drug Utilization, Nursing Homes, Hospitalization, Italy, Physician, Family medicine, Chronic Disease, Workforce, Female, Appropriatene, Health Services Research, Geriatrics and Gerontology, business
Abstract

OBJECTIVE: In Italian nursing homes (NHs), care delivery at night and during holidays is not regulated by regional laws; some facilities employ staff physicians, others employ physicians engaged from year to year (temporary physicians), and others employ publicly funded National Health System (NHS) physicians. This study was designed to determine whether the use of different kinds of physicians leads to different outcomes with regard to the rate of hospitalization and appropriateness of the management of adverse clinical events. DESIGN: Prospective, nonrandomized-survey data collection. SETTING: Ten nonprofit nursing facilities in Italy. PARTICIPANTS: Three hundred and fifty-two NH residents, staff physicians, temporary physicians, and NHS physicians. MEASUREMENTS: Medical intervention during adverse clinical events occurring at night and during holidays. RESULTS: Three hundred and fifty-two residents experienced 551 adverse clinical events; 78 were hospitalized. The hospitalization rate of NHS physicians was about two times that of the temporary physicians and six times that of the staff physicians. Staff physicians' diagnoses and management were appropriate in the majority of cases; NHS diagnosis and management were doubtful or incorrect in about one-third of all cases. CONCLUSIONS: NH residents frequently experience adverse clinical events; physician characteristics influence the rate of hospitalization and the quality of medical interventions.

Published
2001
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7. Prevalence and predictors of depressive symptoms in a nursing home

Author

Marco Trarucchi, Renzo Rozzini, Simone Franzoni, Stefano Boffelli, and Giovanni B. Frisoni

Subjects
Gerontology, medicine.medical_specialty, Activities of daily living, business.industry, Public health, Confounding, behavioral disciplines and activities, Psychiatry and Mental health, Mood, Epidemiology, medicine, Geriatrics and Gerontology, business, Nursing homes, Depression (differential diagnoses), Depressive symptoms
Abstract

The aim of the study was to identify the prevalence of depressive symptoms (GDS score) and predictors of mood changes over a 12-month period in 56 nursing home residents (13 males and 43 females; mean age 81.1 ± 8.6). At baseline, 48.2% of the residents who scores above 11 on the MMSE had a GDS score > 15. GDS score was associated with pain, disabling diseases and self-evaluation of health, and independently with dissatisfaction with the nursing home environment, low level of nursing home social activities and younger age. Five depressed residents became non-depressed, eight non-depressed became depressed and 14 residents remained persistently depressed 12 months after baseline. After controlling for potential confounders, increasing GDS score was independently associated with decreasing basic activities of daily living, increasing number of clinical problems and younger age. Our data support the hypothesis that specific emotional adjustments can be found even in the apparently static environment of the nursing home.

Published
1996
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8. Changes in characteristics of Alzheimer patients at first visit to centers for dementia: a 10-year follow-up study

Author

Luca, Rozzini, Barbara, Vicini Chilovi, Maddalena, Riva, Renzo, Rozzini, Stefano, Boffelli, Marco, Trabucchi, and Alessandro, Padovani

Subjects
Aged, 80 and over, Male, Time Factors, Italy, Alzheimer Disease, Humans, Female, Middle Aged, Mental Status Schedule, Aged, Follow-Up Studies, Retrospective Studies
Abstract

The Cronos Project is an observational study on Alzheimer's disease (AD), created by Italy's Ministry of Public Health in 2000. The aim of our study was to evaluate whether the clinical characteristics of patients at their first visit to the Alzheimer Evaluation Unit (UVA) changed from September 2000 to December 2009, and to examine possible reasons for changes noted.1532 consecutive patients were enrolled in two UVAs (September 2000 to December 2009) in a retrospective, descriptive study, with medical records as the primary source of data.Patients' age at the first visit was not different throughout the period of observation. No differences were observed with regard to education or functional characteristics. However, a reduction in the severity of cognitive impairment was found during the period of evaluation: patients consecutively recruited in the first years were more cognitively, functionally, and psycho- behaviorally compromised than patients recruited in the following years.Data show changes in characteristics at the first visit in patients affected by cognitive deterioration during the years of observation. This finding indicates new clinical needs of patients, requiring changes in pharmacological treatment and in general of the clinical approach.

Published
2011

9. Delirium in a sub-intensive care unit for the elderly: occurrence and risk factors

Author

Renzo Rozzini, Marco Trabucchi, Tony Sabatini, Anette Hylen Ranhoff, Angela Cassinadri, and Stefano Boffelli

Subjects
Male, Aging, medicine.medical_specialty, Alcohol Drinking, Urinary Catheterization, Humans, Aged, Geriatric Assessment, Subacute Care, Prospective Studies, Psychoses, Substance-Induced, Aged, 80 and over, Risk Factors, Cohort Studies, Intensive Care Units, Incidence, Middle Aged, Dementia, Disabled Persons, Female, Delirium, Substance-Induced, behavioral disciplines and activities, law.invention, law, Intensive care, Acute care, mental disorders, medicine, 80 and over, Intensive care medicine, Prospective cohort study, business.industry, Incidence (epidemiology), Settore BIO/14, Psychoses, medicine.disease, Intensive care unit, nervous system diseases, Emergency medicine, Geriatrics and Gerontology, medicine.symptom, business, Cohort study
Abstract

Background and aims: The objective was to study occurrence and risk factors of delirium in a new model of care, the Sub-Intensive Care Unit for the elderly (SICU), which is a level of care between that offered by ordinary wards and intensive care. Methods: A prospective observational study of 401 consecutively admitted patients, 60+ years, in a four-bed SICU in the geriatric ward of a general hospital. Delirium was detected by the Confusion Assessment Method (CAM) at admission (prevalent) and during SICU stay (incident). Impaired function (Barthel Index) and/or IADL two weeks prior to admission identified disability, and additional Mini-Mental State Examination (MMSE)

Published
2006

10. Subintensive care unit for the elderly: a new model of care for critically ill frail elderly medical patients

Author

Anette Hylen Ranhoff, Alessandro Morandi, Marco Ferri, Tony Sabatini, Renzo Rozzini, Stefano Boffelli, Antonella Ricci, Nicola Travaglini, Angela Cassinadri, and Marco Trabucchi

Subjects
Male, medicine.medical_specialty, Critical Care, APACHE, Critical Illness, Aged, 80 and over, Humans, Frail Elderly, Practice Guidelines as Topic, Intensive Care Units, Aged, Intensive Care, Female, Models, Theoretical, MEDLINE, Unit (housing), Ambulatory care, Theoretical, Models, Critical care nursing, Acute care, Intensive care, Internal Medicine, 80 and over, Medicine, Frail elderly, Intensive care medicine, Critically ill, business.industry, Settore BIO/14, medicine.disease, Emergency Medicine, Medical emergency, business
Abstract

An increasing number of elderly patients are admitted to the hospital for critical diseases and the gap between supply and demand of intensive care resources is a growing problem. To meet this challenge, 4 beds in a 24-bed acute care for the elderly (ACE) medical unit were dedicated to a subintensive care unit (SICU). Severely ill elderly medical patients, requiring a higher level of care than provided in ordinary wards, are admitted. The aim of the study was to describe the characteristics of the setting and to discuss its usefulness based on data obtained after the first period of implementation.This article describes the development, management, economics and patient characteristics of the SICU. Patient care combines the ACE model with a highly specialised medical care. Patients admitted to the SICU are compared with patients treated in the ordinary ACE unit before the SICU opened. All patients received a multidimensional evaluation, including demographics, main diagnosis, number of chronic somatic diseases, Charlson index, APACHE II score, APACHE-APS subscore, number of currently administered drugs, serum albumin, cognitive status (Mini-Mental State Examination), depression (Geriatric Depression Scale) and functional status (basic and instrumental activities of daily living). Ward physicians performed assessment and collection of data.During the first 16 months, 489 patients were admitted, 401 according to the selection criteria (60 +/- years and APACHE II scoreor =5 and/or APACHE-APS scoreor =3). Mean age was 78.1 years, mean APACHE II score 14.5 (moderate severity) and non-invasive mechanical ventilation was received by 87 (21.7%). The most common diagnoses were respiratory failure, cardiac disease and stroke. Mean length of stay in the SICU was 61.8 h, and 6.0 days in the hospital. Compared with ACE-unit patients admitted during 2002 (n=1380), SICU patients were obviously more seriously ill (APACHE II score 14.5 vs 6.7). When comparing patients of same illness severity (APACHE-APS scoreor =3) (n=125), patients treated in the SICU had lower in-hospital mortality than those treated in the ordinary ACE ward (12.5 vs 19.2%). Only a few patients (3.5%) were transferred to the intensive care unit as a consequence of increased severity of illness.The SICU is an innovative method to treat frail elderly patients with more severe conditions. Low hospital mortality compared with that of severe patients in the ACE unit supports the usefulness of this model. It could be implemented in medical units of large hospitals in order to give optimal care and advanced interventions to the frail elderly and to avoid intensive care unit overcrowding.

Published
2006

11. Relationship between functional loss before hospital admission and mortality in elderly persons with medical illness

Author

Marco Ferri, Giovanni B. Frisoni, Tony Sabatini, Marco Trabucchi, Piera Barbisoni, Stefano Boffelli, Angela Cassinadri, and Renzo Rozzini

Subjects
Male, Aging, medicine.medical_specialty, Activities of daily living, Anemia, Frail Elderly, Disability Evaluation, Patient Admission, Risk Factors, Internal medicine, Activities of Daily Living, 80 and over, Medicine, Dementia, Humans, Hospital Mortality, Prospective cohort study, Retrospective Studies, Aged, Aged, 80 and over, business.industry, Survival Rate, Middle Aged, Female, Settore BIO/14, Retrospective cohort study, medicine.disease, Confidence interval, Relative risk, Physical therapy, Geriatric Depression Scale, Geriatrics and Gerontology, business
Abstract

Objective. This hospital-based prospective study tests the hypothesis that, in a large group of hospitalized elderly patients, those who report functional decline between pre-illness baseline and hospital admission have a higher risk of death. Methods. Nine hundred fifty elderly ambulant patients (F ¼ 69.3%; mean age 78.3 6 8.5 years) were consecutively admitted to a geriatric ward (Poliambulanza Hospital, Brescia, Italy) during a 15-month period. Number and severity of somatic diseases, Charlson Index score, APACHE II score, level of serum albumin, cognitive status (by Mini-Mental State Examination), and depression score (by Geriatric Depression Scale), were assessed on admission and evaluated as potential prognostic factors. Functional status (by Barthel Index) was assessed by self-report on admission. Preadmission function was also assessed by self-report at the time of admission. Impairment of function due to an acute event is measured as the difference between performances on admission and 2 weeks before the acute event. Six-month survival was the main outcome variable. Results. Factors related to mortality in bivariate analysis were: male sex, age over 80, cancer, congestive heart failure, pulmonary diseases, elevated Charlson Index score, and (independently) dementia (Mini-Mental State Examination , 18), APACHE–Acute Physiology Score , albumin level ,3.5 g/dL, and anemia. After controlling for these variables and for Barthel Index score 2 weeks before the acute event, change in function due to the acute disease is independently related to 6-month mortality (minor functional change [,30 Barthel Index Point] relative risk: 1.3, 95% confidence interval, 0.6–3.0 and major functional change [major functional decrement] relative risk: 2.8, 95% confidence interval, 1.3–5.7). Conclusions. Disease-induced disability may reflect a condition of biological inability to react to acute diseases (i.e., frailty), and should be assessed as a relevant prognostic indicator.

Published
2005

12. Nutritional intervention in special care units for dementia

Author

Stefano, Boffelli, Renzo, Rozzini, and Marco, Trabucchi

Subjects
Aged, 80 and over, Male, Time Factors, Body Weight, Malnutrition, Nutritional Status, Long-Term Care, Survival Rate, Italy, Outcome Assessment, Health Care, Weight Loss, Humans, Dementia, Female, Comprehensive Health Care, Prospective Studies, Dietary Services, Aged
Published
2004

13. Special care units for demented patients: a multicenter study

Author

Angelo Gasparotti, Alfredo Gheza, Giovanni B. Guerrini, GianCarlo Raggi, Angelo Bianchetti, Giuseppe Ritondale, Marco Trabucchi, Stefano Boffelli, Luisa Guglielmi, Giuseppe Bellelli, Piera Ranieri, GianLuigi Nobili, Antonio Fusari, Giovanni B. Frisoni, AnnaMaria Scotuzzi, Bellelli, G, Frisoni, G, Bianchetti, A, Boffelli, S, Guerrini, G, Scotuzzi, A, Ranieri, P, Ritondale, G, Guglielmi, L, Fusari, A, Raggi, G, Gasparotti, A, Gheza, A, Nobili, G, and Trabucchi, M

Subjects
Male, medicine.medical_specialty, Mental Status Schedule, Hospitals, Special, Alzheimer Disease, medicine, Dementia, Humans, Psychiatry, Geriatric Assessment, Aged, Aged, 80 and over, Patient Care Team, business.industry, Physical restraints, Social Behavior Disorders, Cognition, General Medicine, Middle Aged, medicine.disease, Social Behavior Disorder, Combined Modality Therapy, Treatment Outcome, Multicenter study, Italy, Female, Special care, Geriatrics and Gerontology, Alzheimer's disease, Care program, business, Gerontology, Human
Abstract

The local government of Regione Lombardia, Italy, recently (1994) funded a clinical and research project specifically devoted to dementia (Piano Alzheimer). A central role in this project has been reserved for the special care units (SCUs) for demented patients with behavioural disturbances. In order to evaluate their effectiveness, eight SCUs took part in this study. A specifically designed care program, focusing on environment and staff, was implemented in each SCU. Cognitive, functional, and somatic health status, and use of psychotropic drugs and of physical restraints were assessed at baseline, and after 3 and 6 months in 55 consecutively admitted patients. The data show an overall reduction in behavioral disturbances and a decreased use of psychotropic drugs and physical restraints.

Published
1998

14. Assessment of functional ability with the bed rise difficulty scale in a group of elderly patients

Author

Marco Trabucchi, Piera Barbisoni, Stefano Boffelli, Renzo Rozzini, Bruno Bertozzi, and Simone Franzoni

Subjects
Gerontology, Male, Aging, medicine.medical_specialty, Scale (ratio), Tinetti balance score, media_common.quotation_subject, Aptitude, Logistic regression, medicine, Humans, Functional ability, Longitudinal Studies, Geriatric Assessment, media_common, Aged, Aged, 80 and over, Tinetti test, Body movement, Regression analysis, Physical therapy, Physical Endurance, Regression Analysis, Female, Geriatrics and Gerontology, Psychology
Abstract

The aim of the study (part of the Progetto Longitudinale Gussago) was to evaluate the variables related to the difficulty in rising from a bed in 2 groups of elderly patients: nursing home residents, and patients admitted to a geriatric evaluation and management unit. Functional ability was tested through the bed rise difficulty scale (BRD). The version used in this study considered only those 7 items (out of 12) found to be of value. Only those patients who were able to rise from bed without help were selected in order to achieve the aim of the study (33 males, 113 females; mean age 79.6 +/- 7.3 years). Although the 146 patients assessed were considered as having a good functional level (Tinetti score 18.8 +/- 6.9, ADL Katz score 1.6 +/- 1.4), most of them had high scores on the BRD scale, indicating the ability of this scale to detect early, mild disability. The total score of the BRD scale was significantly related to the ADL Katz (r = 0.29, p = 0.000), Tinetti scale (r = -0.39, p = 0.000) and physical performance test (PTT; r = -0.47, p = 0.000). Similar results were obtained for the correlation between BRD time and ADL Katz (r = 0.033, p = 0.000), Tinetti scale (r = -0.30, p = 0.000) and PPT-(r = -0.46, p = 0.000). In a logistic regression analysis the items of the PPT scale considering upper extremity function and Tinetti balance score were significantly associated with the total bed rise time and score.

Published
1996

15. Nutritional Intervention in Special Care Units for Dementia

Author

Marco Trabucchi, Stefano Boffelli, and Renzo Rozzini

Subjects
Gerontology, business.industry, MEDLINE, Nutritional status, Outcome assessment, medicine.disease, Long-term care, Intervention (counseling), Health care, medicine, Dementia, Special care, Geriatrics and Gerontology, business
Published
2004
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16. P4-018 Delirium in a sub-intensive care unit (SICU) for elderly patients

Author

Stefano Boffelli, Renzo Rozzini, Marco Trabucchi, Angela Cassinadri, and Tony Sabatini

Subjects
Aging, medicine.medical_specialty, business.industry, General Neuroscience, Intensive care unit, law.invention, law, Emergency medicine, medicine, Delirium, Neurology (clinical), Geriatrics and Gerontology, medicine.symptom, business, Developmental Biology
Published
2004
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17. Food intake and mortality in the frail elderly

Author

Luigi Ferrucci, Renzo Rozzini, Simone Franzoni, Giovanni B. Frisoni, Marco Trabucchi, and Stefano Boffelli

Subjects
Gerontology, Male, Aging, Food intake, Frail Elderly, Psychological intervention, Nutritional Status, Eating, Risk Factors, Environmental health, Medicine, Homes for the Aged, Humans, Frail elderly, Mortality, Survival analysis, Aged, Aged, 80 and over, Proportional hazards model, business.industry, Mortality rate, Confounding, Age Factors, Middle Aged, Survival Analysis, Nursing Homes, Relative risk, Female, Geriatrics and Gerontology, business, Energy Intake
Abstract

Background Adequate qualitative and quantitative food intake is a major determinant of health. However, nutritional requirements in the elderly are unknown, and even more so in the frail elderly. The aim of the study was to evaluate the influence of energy and macro-nutrients on health in the frail nursing home elderly. Methods Food intake of 72 not severely diseased elderly patients was assessed with direct weighing method. Outcome measure was survival over 28-month follow-up period. Confounders of the association of food intake with survival were: age, gender, body-mass index, daily function, somatic health, anergy, and nutritional status. Crude association of food intake with survival was assessed with Kaplan-Meyer method, and adjusted association with multiple Cox regression models. Results Patients of the study had good average food intake. Mortality rate was relatively low (.20 per year). Low levels of energy, protein, lipid, and carbohydrate intake were negatively associated with survival even after adjustment for confounders. When compared to high intake, adjusted relative risks for mortality of low intake were 4.74, 3.75, 4.71, and 2.04, respectively. Medium levels of energy, protein, and lipid, but not carbohydrate, intake yielded intermediate mortality risk. Conclusions Food intake is a strong predictor of survival even in moderately diseased elderly patients, suggesting possible low-cost interventions.

Published
1995

18. A nutritional index predicting mortality in the nursing home

Author

Giovanni B. Frisoni, Simone Franzoni, Stefano Boffelli, Luigi Ferrucci, M. Trabucchi, and Renzo Rozzini

Subjects
Gerontology, Male, Index (economics), Nutritional Status, Sensitivity and Specificity, Risk Factors, Medicine, Health Status Indicators, Homes for the Aged, Humans, Prospective Studies, Mortality, Prospective cohort study, Geriatric Assessment, Aged, Aged, 80 and over, business.industry, Discriminant Analysis, Nutritional status, Anthropometry, Middle Aged, Prognosis, Nursing Homes, Nutrition Assessment, Mortality data, Female, Geriatrics and Gerontology, Nursing homes, business, Demography, Follow-Up Studies
Abstract

OBJECTIVE: To define a sensitive and specific index, based on nutritional indicators, predicting mortality in nursing home patients. DESIGN: A prospective cohort study. SETTING: A nursing home. MEASUREMENTS: Anthropometric and laboratory nutritional indicators were assessed in 104 nursing home elderly residents (20 males, 84 females). Patients were aged 60 years and older and had relatively good somatic health and nutritional status. Mortality data were collected over an 18-month follow-up period. Discriminant analysis was used to compute an adimensional measure (index) that could predict mortality with the highest sensitivity and specificity. RESULTS: Mortality was 0.20/year. A nonlinear, “U-shaped” relationship of cholesterol levels with mortality was found. A prognostic index based on cholesterol, lymphocyte count, mid-arm circumference, hemoglobin, age, and gender was obtained. Higher values of this index were associated with progressively higher risks at 12 months and 18 months. Sensitivity and specificity calculated on 18-month mortality were 80% and 78.4%, respectively. CONCLUSIONS: This index, based on simple measures, can be a useful tool in the evaluation of health status of the elderly living in nursing homes.

Published
1994

19. Fear of falling in nursing home patients

Author

Marco Trabucchi, Giovanni B. Frisoni, Stefano Boffelli, Simone Franzoni, and Renzo Rozzini

Subjects
Gerontology, Male, Aging, medicine.medical_specialty, Poison control, Fear of falling, Suicide prevention, Occupational safety and health, Disability Evaluation, Risk Factors, Injury prevention, Activities of Daily Living, medicine, Homes for the Aged, Humans, Longitudinal Studies, Aged, Aged, 80 and over, business.industry, Human factors and ergonomics, Fear, Nursing Homes, Physical therapy, Anxiety, Accidental Falls, Female, Geriatrics and Gerontology, medicine.symptom, business, Nursing homes, Attitude to Health
Abstract

The study analyzes the characteristics of 54 nursing home patients (12 male, 42 female; mean age 81.9 +/- 7.9 years) with and without the complaint of the fear of falling, and the association of this fear with falling and functional status. Patients who had a fear of falling at baseline (n = 25) had a lower functional status (Barthel Index) score (69.8 +/- 22.3 vs. 79.3 +/- 15.4), lower scores for balance (8.4 +/- 4.4 vs. 10.6 +/- 3.7) and gait (Tinetti; 6.7 +/- 3.3 vs. 8.3 +/- 2.6) and were taking a higher number of psychotropic drugs (0.8 +/- 1.1 vs. 0.2 +/- 0.5) than those with no fear (n = 29). At 24 months' follow-up, 25 subjects were still available for evaluation. Fear of falling at baseline was predictive of a decline in activities of daily living, as measured by the Barthel Index, in a multiple regression model, after controlling for baseline cognitive function and change in cognitive function, age, gender, balance and gait, frequency of psychotropic drug usage, and number of chronic symptoms. The findings of this study suggests that, in mobile patients, the fear of falling can be a clinically important predictor of functional decline.

Published
1994

20. 'Delirium Day': a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Author

Bellelli, Giuseppe, Morandi, Alessandro, Di Santo, Simona G., Mazzone, Andrea, Cherubini, Antonio, Mossello, Enrico, Mario, Bo, Bianchetti, Angelo, Rozzini, Renzo, Zanetti, Ermellina, Musicco, Massimo, Ferrari, Alberto, Ferrara, Nicola, Trabucchi, Marco, Boffelli, Stefano, Stefano, Fabio Di, Filippi, Francesco De, Guerini, Fabio, Bertoletti, Erik, March, Albert, Margiotta, Alessandro, Mecocci, Patrizia, Addesi, Desireè, Fantò, Fausto, Dijik, Babette, Porrino, Paola, Cotroneo, Antonino Maria, Galli, Giovanni, Bruni, Amalia Cecilia, Bernardini, Bruno, Corsini, Carla, Cagnin, Annachiara, Zurlo, Amedeo, Barbagallo, Giuseppe, Lunardelli, Maria Lia, Martini, Emilio, Battaglia, Giuseppe, Latella, Raffaele, Petritola, Donatella, Sinforiani, Elena, Cester, Alberto, Formilan, Marino, Carbone, Pasqualina, Appollonio, Ildebrando, Cereda, Diletta, Tremolizzo, Lucio, Bottacchi, Edo, Lucchetti, Lucio, Mariani, Claudio, Rapazzini, Piero, Romanelli, Giuseppe, Marengoni, Alessandra, Zuliani, Giovanni, Bianchi, Lara, Suardi, Teresa, Muti, Ettore, Bottura, Renato, Sgrò, Giovanni, Mandas, Antonella, Serchisu, Luca, Crippa, Patrizia, Ivaldi, Claudio, Ungar, Andrea, Villani, Daniele, Raimondi, Clara, Mussi, Chiara, Isaia, Giancarlo, Provenzano, Giuseppe, Mari, Daniela, Odetti, Patrizio, Monacelli, Fiammetta, Incalzi, Raffaele Antonelli, Pluderi, Alice, Bellamoli, Claudio, Terranova, Luciano, Scarpini, Elio, D'Amico, Ferdinando, Cavallini, Maria Chiara, Guerrini, Gianbattista, Scotuzzi, Anna Maria, Chiarello, Antonino, Pilotto, Alberto, Tognini, Sara, Dell'Aquila, Giuseppina, Toigo, Gabriele, Ceschia, Giuliano, Piccinini, Maristella, Fabbo, Andrea, Zoli, Marco, Forti, Paola, Wenter, Christian, Basile, Giorgio, Lasagni, Anna, Padovani, Alessandro, Rozzini, Luca, Cottino, Maria, Vitali, Silvia, Tripi, Gabriele, Avanzi, Stefano, Annoni, Giorgio, Ruotolo, Giovanni, Boschi, Federica, Bonino, Paolo, Marchionni, Niccolo, Fascendini, Sara, Noro, Gabriele, Turco, Renato, Ubezio, Maria C., Serrati, Carlo, Infante, Maria, Gentile, Simona, Pernigotti, Luigi M., Biagini, Carlo A., Canonico, Enzo, Bonati, Pietro, Gareri, Pietro, Caffarra, Paolo, Ceretti, Arcangelo, Castiglia, Rosanna, Gabelli, Carlo, Storto, Mario Lo, Putzu, Paolo, Santo, Simona Di, Malara, Alba, Spadea, Fausto, Di Cello, Serena, Ceravolo, Francesco, Fabiano, Francesco, Rispoli, Vincenzo, Chiaradia, Giuseppe, Gabriele, Amedeo, Settembrini, Vincenzo, Capomolla, Domenico, Citrino, Antonella, Scriva, Antonietta, Bruno, Irene, Secchi, Roberto, De Martino, Eugenio, Muccinelli, Roberto, Lupi, Gerardo, Paonessa, Patrizio, Fabbri, Andrea, Castellari, Sofia, Andrea, Po, Gaggioli, Guido, Varesi, Massimo, Moneti, Paolo, Capurso, Sebastiano, Latini, Vincenzo, Ghidotti, Stefano, Riccardelli, Francesco, Macchi, Maurizio, Cassinadri, Angela, Tonini, Gabriele, Andreani, Laura, Coralli, Mirco, Balotta, Antonio, Cancelliere, Roberto, Strazzacapa, Mara, Cavallino, Pierangela, Fabio, Stefano, De Filippi, Francesco, Giudice, Chiara, Floris, Patrizia, Dentizzi, Cosimo, D’Elia, Katia, Azzini, Margherita, Cazzadori, Marco, Benati, Claudia, Tobaldini, Chiara, Antonioli, Angela, Mombelloni, Paolo, Fontanini, Fulvio, Oliverio, Martina, Del Grosso, Luciano, Giavedoni, Cristina, Bidoli, Giuliano, Mazzei, Bruno, Corsonello, Andrea, Fusco, Sergio, Vena, Silvio, De Vuono, Tommaso, Maiuri, Giorgio, Castegnaro, Eugenio, De Rosa, Salvatore, Sechi, Rossella Bazzano, Benvenuti, Enrico, Del Lungo, Ilaria, Giardini, Sante, Giulietti, Chiara, D’Amico, Ferdinando, Caronzolo, Francesco, Grippa, Alessandro, Lombardo, Giuseppina, Pipicella, Tiziana, Nitti, Maria Teresa, Felici, Alessandro, Pavan, Silvia, Piazzani, Fabrizio, Lunelli, Alessandra, Dimori, Sergio, Magnani, Angelo, Soglia, Tiziano, Postacchini, Demetrio, Brunelli, Roberto, Santini, Silvia, Francavilla, Monia, Macchiati, Ilenia, Sorvillo, Francesca, Giuli, Cinzia, Perticone, Francesco, Rosa, Paola Cerra, Bencardino, Giuseppe, Falbo, Tania, Grillo, Nadia, Isaia, Gianluca, Pezzilli, Stella, Bergamo, Daniele, Furno, Elisabetta, Rrodhe, Sokol, Lucarini, Simonetta, Dall’Acqua, Francesca, Cappelletto, Francesco, Calvani, Donatella, Becheri, Dimitri, Gambardella, Lucia, Valente, Carlo, Ceci, Giacomo, Ettorre, Evaristo, Tironi, Sara, Grassi, Maria Grazia, Troisi, Elio, Gabutto, Anna, Baglietto, Nino, Quazzo, Loredana, Rosatello, Annalisa, Suraci, Domenico, Tagliabue, Benedetta, Perrone, Chiara, Ferrara, Lucia, Castagna, Alberto, Tremolada, Maria Luisa, Piano, Simonetta, Serviddio, Gaetano, Lo Buglio, Aurelio, Gurrera, Tiziana, Merlo, Valeria, Rovai, Carla, Carlucci, Rosaria, Abbaldo, Anna, Monzani, Fabio, Qasem, Ahmad Amedeo, Bini, Giacomo, Tafuto, Silvia, Mancuso, Giovanna, Fragiacomo, Federica, Pompanin, Sara, Guerra, Gianluca, Pala, Marco, Menozzi, Luca, Gatti, Chiara Delli, Magon, Stefania, Di Francesco, Vincenzo, Faccioli, Silvia, Pellizzari, Luca, Lia Lunardelli, Maria, Macchiarulo, Maria, Corneli, Maria, Bacci, Monica, Lo Storto, Mario, Seresin, Chiara, Simonato, Matteo, Loreggian, Michele, Cestonaro, Fausta, Durando, Mario, Mazzoleni, Marta, Russo, Giuseppe, Ponte, Martino, Valchera, Alessandro, Salustri, Giuseppe, Costa, Alfredo, Cotta, Matteo Ramusino, Pizio, Renato Nicola, Perego, Germana, Bucciantini, Elisabetta, Di Giovanni, Marco, Franchi, Fabrizio, Claudio Mariani, Sara Barbieri, Grande, Giulia, Fugazza, Luciano, Guerrini, Chiara, De Paduanis, Giovanna, Iallonardo, Lucia, Palumbo, Pasquale, Ortolani, Beatrice, Capatti, Eleonora, Soavi, Cecilia, Francesconi, Daniela, Miselli, Agata, Zaccarini, Cinzia, Mirra, Gianluca, Secreto, Piero, Bisio, Erika, Cecchettani, Marco, Naldi, Tamara, Pallavicino, Alessandra, Pugliese, Michela, Iozzo, Rosaria Cosima, Guido Grassi, Giovanni Sgrò, Dell’Oro, Raffaella, Mannironi, Antonio, Giorli, Elisa, Oberti, Sara, Fierro, Brigida, Piccoli, Tommaso, Giacalone, Fabio, Costaggiu, Diego, Pinna, Elisa, Orrù, Francesca, Mannai, Martina, Cordioli, Zeno, Pelizzari, Luca, Chiloiro, Roberta, Cimino, Rosella, Ruberto, Carmen, Dal Santo, Pierluigi, Andriolli, Antonino, Burattin, Giuseppe, Rossi, Laura, Tezza, Fabiana, Aloisio, Paola, Di Monda, Tiziana, Galbassini, Gloria, Russo, Anna Maria, Pesci, Alberto, Suigo, Giulia, Zanasi, Massimo, Moniello, Giovanni, Rostagno, Carlo, Cartei, Alessandro, Polidori, Gianluca, Melis, Maria Ramona, Martellini, Eleonora, Battiston, Bruno, Berardino, Maurizio, Cavallo, Simona, Lombardi, Bruna, D’Ippolito, Pierpaolo, Furini, Angela, Guarneri, Massimo, Paolucci, Stefano, Bassi, Andrea, Coiro, Paola, De Angelis, Domenico, Morone, Giovanni, Venturiero, Vincenzo, Palleschi, Lorenzo, Raganato, Paolo, Di Niro, Giuseppina, Imoscopi, Alessandra, Tibaldi, Vittoria, Bottignole, Giuliana, Calvi, Elisa, Clementi, Carlotta, Zanocchi, Mauro, Agosta, Luca, Criasia, Antonio, Spertino, Elena, Nortarelli, Antonella, Principato, Pietro, Rizzo, Anita, Cellura, Eleonora, Zanghierato, Angelo, Romano, Federica Y., Rosini, Francesca, Mansi, Marta, Rossi, Silvia, Riccardelli, Alex, Potena, Alfredo, Lichii, Mihaela, Candiani, Tiziana, Grimaldi, William, Bertani, Emiliano, Calogero, Pietro, Pinto, Daniela, Bernardi, Roberto, Nicolino, Francesco, Galetti, Caterina, Gianstefani, Alice, Prefumo, Matteo, Paolisso, Giuseppe, Rizzo, Maria Rosaria, Prestano, Raffaele, Dalise, Anna Maria, Barra, Davide, Dal Bosco, Livio, Asprinio, Vincenzo, Dallape, Luciana, Perina, Elisa, Bartoli, Isaura Rossi, Maina, Antonella, Pecoraro, Elisabetta, Sciarra, Michela, Prudente, Angela, Benini, Lucia, Levato, Francesco, Mhiuta, Victor, Alius, Florin, Davidoaia, Diana, Giardini, Vittorio, Garancini, Mattia, Bozzini, Claudia, Tosoni, Paolo, Provoli, Emma, Cascone, Luisa, Dioli, Andrea, Ferrarin, Gianfranco, Bucci, Adelmo, Bua, Guido, Fenu, Sara, Bianchi, Giovanna, Casella, Silvia, Romano, Valentina, Belotti, Gloria, Cavaliere, Sabina, Cuni, Estella, Merciuc, Nina, Oberti, Rosella, Colombo, Katia, D’Arcangelo, Paolo, Montenegro, Nicola, Montanari, Roberto, Lamanna, Pierpaolo, Gasperini, Beatrice, Arighi, Andrea, Granata, Antonino, Ranalli, Claudia, Cammilli, Alessandra, Tricca, Manola, Natella, Daniela, Sozzi, Ferdinando, Valenti, Luigi, Monia, Monella, Prete, Camilla, Senesi, Barbara, Meta, Anna Cristina, Pendenza, Enrico, Pasqualetti, Giuseppe, Polini, Antonio, Ballino, Elena, Dell’Aquila, Giuseppina, Gasparrini, Pina Maria, Marotti, Elisabetta, Migale, Monica, Scrimieri, Antonia, Rosso, Alessia, Tongiorgi, Chiara, Scarpa, Cristina, Pacchioni, Maurizio, De Dominicis, Luigino, Pucci, Eugenio, Renzi, Sara, Cartechini, Elisabetta, Barilaro, Giuseppe, Ugenti, Francesca, Romeo, Pasquale, Nardelli, Anna, Lauretani, Fulvio, Visioli, Sandra, Montanari, Ilaria, Ermini, Francesca, Giordano, Antonio, Pigato, Giorgio, Simeone, Emilio, Colameco, Franco, Cecamore, Antonella, Scurti, Rosa, Lupinetti, Maria Cristina, Barbujani, Mario, Perazzi, Beatrice, Giampieri, Marina, Amoruso, Raffaele, Ferrari, Camilla, Gambetti, Claudio, Sfrappini, Mario, Semeraro, Letizia, Striuli, Rinaldo, Mariani, Claudia, Pelliccioni, Giuseppe, Marinelli, Donatella, Rossi, Tommaso, Pesallaccia, Martina, Sabbatini, Debora, Gobbi, Beatrice, Cerqua, Raffaella, Tagliani, Giancarla, Schlauser, Elena, Caser, Luciano, Caramello, Elisa, Sandigliano, Franca, Rosso, Giorgio, Bendini, Chiara, Scevola, Moreno, Vitale, Enrico, Maugeri, Domenico, Sorace, Rosaria, Anzaldi, Massimiliano, De Gesu, Roberto, Morrone, Giuseppe, Davolio, Federica, Pirazzoli, Luca, Fabbri, Elisa, Ruffini, Ingrid, Insam, Miriam, Abraham, Elisabeth, Kirchlechner, Christine, Cucinotta, Domenico, Parise, Pasquale, Boccali, Andrea, Amici, Serena, Gambacorta, Maurizia, Lovati, Roberto, Giovinazzo, Francesca, Kimak, Elzbieta, Lo Castro, Marika, Mauro, Flavia, De Luca, Alessandro, Sancesario, Giuseppe, Martorana, Alessandro, Scaricamazza, Beatrice, Toniolo, Sofia, Di Lorenzo, Francesco, Liguori, Claudio, Lasco, Antonino, Vita, Natale, Giomi, Mirna, Forte, Floriana, Ceraso, Anna, Marelli, Eleonora, Miceli, Salvatore, Urso, Giovanni, Grioni, Giuseppe, Vezzadini, Giuliana, Misaggi, Giulia, Forlani, Chiara, Iemolo, Francesco, Giordano, Antonello, Sanzaro, Enzo, D’Asta, Gabriele, Proietto, Maria, Carnemolla, Anna, Razza, Grazia, Spadaro, Daniela, Bertolotti, Marco, Neviani, Francesca, Balestri, Francesca, Torrini, Monica, Mannarino, Giulio, Tesi, Francesca, Bigolari, Michela, Natale, Alessia, Grassi, Simona, Bottaro, Cinzia, Stefanelli, Sara, Bovone, Ugo, Tortorolo, Umberto, Quadri, Roberto, Leone, Giuseppe, Ponzetto, Maria, Frasson, Paola, Bruni, Adriana, Confalonieri, Roberto, Corsi, Maurizio, Moretti, Daniela, Teruzzi, Fabiola, Umidi, Simona, Barocco, Federica, Spallazzi, Marco, Chioatto, Paolo, Bortolamei, Sandra, Soattin, Lucia, Bertazzoli, Marco, Rota, Elisabetta, Adobati, Annamaria, Scarpa, Alberto, Granziera, Serena, Zuccher, Paola, Dal Fabbro, Angela, Zara, Daniela, Lo Nigro, Ambra, Franchetti, Lorena, Toniolo, Marika, Marcuzzo, Cinzia, Rollone, Marco, Guerriero, Fabio, Sgarlata, Carmelo, Massè, Alessandro, Zatti, Giovanni, Piatti, Massimiliano, Graci, Jole, Benati, Giuseppe, Biondi, Mario, Fiumi, Nicoletta, Locatelli, Sergio M., Mauri, Sabrina, Beretta, Mauro, Margheritis, Laura, Desideri, Giovanbattista, Liberatore, Ester, Carucci, Anna Cecilia, Caput, Margherita, Antonietti, Maria Paola, Polistena, Giuseppe, De la Pierre, Franz, Mari, Marcello, Massignani, Paola, Tombesi, Fabio, Selvaggio, Fabio, Verbo, Brunella, Bodoni, Paolo, Marchionni, Niccolò, Sabatini, Tony, Mussio, Eleonora, Titoldini, Giulia, Cossu, Beatrice, Licini, Cristina, Tomasoni, Angela, Calderazzo, Massimo, Prampolini, Raffaella, Melotti, Rita Maria, Lilli, Albina, Buda, Simona, Adversi, Marco, Mantovani, Anna Roberta, Viola, Maria C., D’Ambrosio, Viviana, Mazzanti, Paolo, Brambilla, Cristina, Sportelli, Silvia, Quattrocchi, Daniela, Pisu, Cristina, Sicuro, Francesca, Zagnoni, Piergiuseppe, Ghiglia, Stefania, Mosca, Massimiliano, Corazzin, Ileana, Deola, Mariangela, Biagini, Carlo Adriano, Bencini, Francesca, Cantini, Claudia, Tonon, Elisabetta, Pierinelli, Silvia, Onofrj, Marco, Thomas, Astrid, Bonanni, Laura, Cacchiò, Gabriella, Comi, Giancarlo, Magnani, Giuseppe, Santangelo, Roberto, Mazzeo, Salvatore, Barbieri, Cristina, Giroldi, Liviana, Bandini, Fabio, Masina, Marco, Malservisi, Simona, Cicognani, Annalena, Ricca, Laura, Tassinari, Tiziana, Brogi, Davide, Sugo, Annalisa, Bellelli G., Morandi A., Di Santo S.G., Mazzone A., Cherubini A., Mossello E., Bo M., Bianchetti A., Rozzini R., Zanetti E., Musicco M., Ferrari A., Ferrara N., Trabucchi M., Boffelli S., Stefano F.D., Filippi F.D., Guerini F., Bertoletti E., March A., Margiotta A., Mecocci P., Addesi D., Fanto F., Dijik B., Porrino P., Cotroneo A.M., Galli G., Bruni A.C., Bernardini B., Corsini C., Cagnin A., Zurlo A., Barbagallo G., Lunardelli M.L., Martini E., Battaglia G., Latella R., Petritola D., Sinforiani E., Cester A., Formilan M., Carbone P., Appollonio I., Cereda D., Tremolizzo L., Bottacchi E., Lucchetti L., Mariani C., Rapazzini P., Romanelli G., Marengoni A., Zuliani G., Bianchi L., Suardi T., Muti E., Bottura R., Sgro G., Mandas A., Serchisu L., Crippa P., Ivaldi C., Ungar A., Villani D., Raimondi C., Mussi C., Isaia G., Provenzano G., Mari D., Odetti P., Monacelli F., Incalzi R.A., Pluderi A., Bellamoli C., Terranova L., Scarpini E., D'Amico G., Cavallini M.C., Guerrini G., Scotuzzi A.M., Chiarello A., Pilotto A., Tognini S., Dell'Aquila G., Toigo G., Ceschia G., Piccinini M., Fabbo A., Zoli M., Forti P., Wenter C., Basile G., Lasagni A., Padovani A., Rozzini L., Cottino M., Vitali S., Tripi G., Avanzi S., Annoni G., Ruotolo G., Boschi F., Bonino P., Marchionni N., Fascendini S., Noro G., Turco R., Ubezio M.C., Serrati C., Infante M., Gentile S., Pernigotti L.M., Biagini C.A., Canonico E., Bonati P., Gareri P., Caffarra P., Ceretti A., Castiglia R., Gabelli C., Storto M.L., Putzu P., Santo S.D., Malara A., Spadea F., Di Cello S., Ceravolo F., Fabiano F., Rispoli V., Chiaradia G., Gabriele A., Settembrini V., Capomolla D., Citrino A., Scriva A., Bruno I., Secchi R., De Martino E., Muccinelli R., Lupi G., Paonessa P., Fabbri A., Castellari S., Po A., Gaggioli G., Varesi M., Moneti P., Capurso S., Latini V., Ghidotti S., Riccardelli F., Macchi M., Cassinadri A., Tonini G., Andreani L., Coralli M., Balotta A., Cancelliere R., Strazzacapa M., Cavallino P., Fabio S., De Filippi F., Giudice C., Floris P., Dentizzi C., D'Elia K., Azzini M., Cazzadori M., Benati C., Tobaldini C., Antonioli A., Mombelloni P., Fontanini F., Oliverio M., Del Grosso L., Giavedoni C., Bidoli G., Mazzei B., Corsonello A., Fusco S., Vena S., De Vuono T., Maiuri G., Castegnaro E., De Rosa S., Sechi R.B., Benvenuti E., Del Lungo I., Giardini S., Giulietti C., D'Amico F., Caronzolo F., Grippa A., Lombardo G., Pipicella T., Nitti M.T., Felici A., Pavan S., Lunelli A., Dimori S., Magnani A., Soglia T., Postacchini D., Brunelli R., Santini S., Francavilla M., Macchiati I., Sorvillo F., Giuli C., Perticone F., Rosa P.C., Bencardino G., Falbo T., Grillo N., Pezzilli S., Bergamo D., Furno E., Rrodhe S., Lucarini S., Dall'Acqua F., Cappelletto F., Calvani D., Becheri D., Gambardella L., Valente C., Ceci G., Ettorre E., Tironi S., Grassi M.G., Troisi E., Gabutto A., Baglietto N., Quazzo L., Rosatello A., Suraci D., Tagliabue B., Perrone C., Ferrara L., Castagna A., Tremolada M., Piano S., Serviddio G., Lo Buglio A., Gurrera T., Merlo V., Rovai C., Carlucci R., Abbaldo A., Monzani F., Qasem A., Bini G., Tafuto S., Mancuso G., Fragiacomo F., Pompanin S., Guerra G., Pala M., Menozzi L., Gatti C.D., Magon S., Di Francesco V., Faccioli S., Pellizzari L., Lia Lunardelli M., Macchiarulo M., Corneli M., Bacci M., Lo Storto M., Seresin C., Simonato M., Loreggian M., Cestonaro F., Durando M., Mazzoleni M., Russo G., Ponte M., Valchera A., Salustri G., Costa A., Cotta M.R., Pizio R.N., Perego G., Bucciantini E., Di Giovanni M., Franchi F., Claudio Mariani S.B., Grande G., Fugazza L., Guerrini C., De Paduanis G., Iallonardo L., Palumbo P., Ortolani B., Capatti E., Soavi C., Francesconi D., Miselli A., Zaccarini C., Mirra G., Secreto P., Bisio E., Cecchettani M., Naldi T., Pallavicino A., Pugliese M., Iozzo R., Guido Grassi G.S., Dell'Oro R., Mannironi A., Giorli E., Oberti S., Fierro B., Piccoli T., Giacalone F., Costaggiu D., Pinna E., Orru F., Mannai M., Cordioli Z., Pelizzari L., Chiloiro R., Cimino R., Ruberto C., Dal Santo P., Andriolli A., Burattin G., Rossi L., Tezza F., Aloisio P., Di Monda T., Galbassini G., Russo A., Pesci A., Suigo G., Zanasi M., Moniello G., Rostagno C., Cartei A., Polidori G., Melis M., Martellini E., Battiston B., Berardino M., Cavallo S., Lombardi B., D'Ippolito P., Furini A., Guarneri M., Paolucci S., Bassi A., Coiro P., De Angelis D., Morone G., Venturiero V., Palleschi L., Raganato P., Di Niro G., Imoscopi A., Tibaldi V., Bottignole G., Calvi E., Clementi C., Zanocchi M., Agosta L., Criasia A., Spertino E., Nortarelli A., Principato P., Rizzo A., Cellura E., Zanghierato A., Romano F.Y., Rosini F., Mansi M., Rossi S., Riccardelli A., Potena A., Lichii M., Candiani T., Grimaldi W., Bertani E., Calogero P., Pinto D., Bernardi R., Nicolino F., Galetti C., Gianstefani A., Prefumo M., Paolisso G., Rizzo M.R., Prestano R., Dalise A.M., Barra D., Dal Bosco L., Asprinio V., Dallape L., Perina E., Bartoli I.R., Maina A., Pecoraro E., Sciarra M., Prudente A., Benini L., Levato F., Mhiuta V., Alius F., Davidoaia D., Giardini V., Garancini M., Bozzini C., Tosoni P., Provoli E., Cascone L., Dioli A., Ferrarin G., Bucci A., Bua G., Fenu S., Bianchi G., Casella S., Romano V., Belotti G., Cavaliere S., Cuni E., Merciuc N., Oberti R., Colombo K., D'Arcangelo P., Montenegro N., Montanari R., Lamanna P., Gasperini B., Arighi A., Granata A., Ranalli C., Cammilli A., Tricca M., Natella D., Sozzi F., Valenti L., Monia M., Prete C., Senesi B., Meta A.C., Pendenza E., Pasqualetti G., Polini A., Ballino E., Gasparrini P., Marotti E., Migale M., Scrimieri A., Rosso A., Tongiorgi C., Scarpa C., Pacchioni M., De Dominicis L., Pucci E., Renzi S., Cartechini E., Barilaro G., Ugenti F., Romeo P., Nardelli A., Lauretani F., Visioli S., Montanari I., Ermini F., Giordano A., Pigato G., Simeone E., Colameco F., Cecamore A., Scurti R., Lupinetti M.C., Barbujani M., Perazzi B., Giampieri M., Amoruso R., Ferrari C., Gambetti C., Sfrappini M., Semeraro L., Striuli R., Pelliccioni G., Marinelli D., Rossi T., Pesallaccia M., Sabbatini D., Gobbi B., Cerqua R., Tagliani G., Schlauser E., Caser L., Caramello E., Sandigliano F., Rosso G., Bendini C., Scevola M., Vitale E., Maugeri D., Sorace R., Anzaldi M., De Gesu R., Morrone G., Davolio F., Pirazzoli L., Fabbri E., Ruffini I., Insam M., Abraham E., Kirchlechner C., Cucinotta D., Parise P., Boccali A., Amici S., Gambacorta M., Lovati R., Giovinazzo F., Kimak E., Lo Castro M., Mauro F., De Luca A., Sancesario G., Martorana A., Scaricamazza B., Toniolo S., Di Lorenzo F., Liguori C., Lasco A., Vita N., Giomi M., Forte F., Ceraso A., Marelli E., Miceli S., Urso G., Grioni G., Vezzadini G., Misaggi G., Forlani C., Iemolo F., Sanzaro E., D'Asta G., Proietto M., Carnemolla A., Razza G., Spadaro D., Bertolotti M., Neviani F., Balestri F., Torrini M., Mannarino G., Tesi F., Bigolari M., Natale A., Grassi S., Bottaro C., Stefanelli S., Bovone U., Tortorolo U., Quadri R., Leone G., Ponzetto M., Frasson P., Bruni A., Confalonieri R., Corsi M., Moretti D., Teruzzi F., Umidi S., Barocco F., Spallazzi M., Chioatto P., Bortolamei S., Soattin L., Bertazzoli M., Rota E., Adobati A., Scarpa A., Granziera S., Zuccher P., Dal Fabbro A., Zara D., Lo Nigro A., Franchetti L., Toniolo M., Marcuzzo C., Rollone M., Guerriero F., Sgarlata C., Masse A., Zatti G., Piatti M., Graci J., Benati G., Biondi M., Fiumi N., Locatelli S.M., Mauri S., Beretta M., Margheritis L., Desideri G., Liberatore E., Carucci A.C., Caput M., Antonietti M.P., Polistena G., De la Pierre F., Mari M., Massignani P., Tombesi F., Selvaggio F., Verbo B., Bodoni P., Sabatini T., Mussio E., Titoldini G., Cossu B., Licini C., Tomasoni A., Calderazzo M., Prampolini R., Melotti R.M., Lilli A., Buda S., Adversi M., Mantovani A.R., Viola M.C., D'Ambrosio V.V., Mazzanti P., Brambilla C., Sportelli S., Quattrocchi D., Pisu C., Sicuro F., Zagnoni P., Ghiglia S., Mosca M., Corazzin I., Deola M., Bencini F., Cantini C., Tonon E., Pierinelli S., Onofrj M., Thomas A., Bonanni L., Cacchio G., Comi G., Magnani G., Santangelo R., Mazzeo S., Barbieri C., Giroldi L., Bandini F., Masina M., Malservisi S., Cicognani A., Ricca L., Tassinari T., Brogi D., Sugo A., Bellelli, G, Morandi, A, Di Santo, S, Mazzone, A, Cherubini, A, Mossello, E, Bo, M, Bianchetti, A, Rozzini, R, Zanetti, E, Musicco, M, Ferrari, A, Ferrara, N, Trabucchi, M, Appollonio, I, Cereda, D, Tremolizzo, L, Annoni, G, Zatti, G, Bellelli, Giuseppe, Morandi, Alessandro, Di Santo, Simona G, Mazzone, Andrea, Cherubini, Antonio, Mossello, Enrico, Bo, Mario, Bianchetti, Angelo, Rozzini, Renzo, Zanetti, Ermellina, Musicco, Massimo, Ferrari, Alberto, Ferrara, Nicola, Trabucchi, Marco, Giuseppe Bellelli, Alessandro Morandi, Simona G. Di Santo, Andrea Mazzone, Antonio Cherubini, Enrico Mossello, Mario Bo, Angelo Bianchetti, Renzo Rozzini, Ermellina Zanetti, Massimo Musicco, Alberto Ferrari, Nicola Ferrara, Marco Trabucchi, and on behalf of the Italian Study Group on Delirium (ISGoD), Stefano Boffelli, Fabio Di Stefano, Francesco De Filippi, Fabio Guerini, Erik Bertoletti, Albert March, Alessandro Margiotta, Patrizia Mecocci, Desireè Addesi, Fausto Fantò, Gianluca Isaia, Babette Dijik, Paola Porrino, Antonino Maria Cotroneo, Giovanni Galli, Amalia Cecilia Bruni, Bruno Bernardini, Carla Corsini, Annachiara Cagnin, Amedeo Zurlo, Giuseppe Barbagallo, Maria Lia Lunardelli, Emilio Martini, Giuseppe Battaglia, Raffaele Latella, Donatella Petritola, Elena Sinforiani, Alberto Cester, Marino Formilan, Pasqualina Carbone, Ildebrando Appollonio, Diletta Cereda, Lucio Tremolizzo, Edo Bottacchi, Lucio Lucchetti, Claudio Mariani, Piero Rapazzini, Giuseppe Romanelli, Alessandra Marengoni, Giovanni Zuliani, Lara Bianchi, Teresa Suardi, Ettore Muti, Renato Bottura, Giovanni Sgrò, Antonella Manda, Luca Serchisu, Patrizia Crippa, Claudio Ivaldi, Andrea Ungar, Daniele Villani, Clara Raimondi, Chiara Mussi, Giancarlo Isaia, Giuseppe Provenzano, Daniela Mari, Patrizio Odetti, Fiammetta Monacelli, Raffaele Antonelli Incalzi, Alice Pluderi, Claudio Bellamoli, Luciano Terranova, Elio Scarpini, Ferdinando D'Amico, Maria Chiara Cavallini, Gianbattista Guerrini, Anna Maria Scotuzzi, Antonino Chiarello, Alberto Pilotto, Sara Tognini, Giuseppina Dell’Aquila, Gabriele Toigo, Giuliano Ceschia, Maristella Piccinini, Andrea Fabbo, Marco Zoli, Paola Forti, Christian Wenter, Giorgio Basile, Anna Lasagni, Alessandro Padovani, Luca Rozzini, Maria Cottino, Silvia Vitali, Gabriele Tripi, Stefano Avanzi, Giorgio Annoni, Giovanni Ruotolo, Federica Boschi, Paolo Bonino, Niccolò Marchionni, Maria C. Cavallini, Sara Fascendini, Gabriele Noro, Renato Turco, Maria C. Ubezio, Carlo Serrati, Maria Infante, Simona Gentile, Luigi M. Pernigotti, Carlo A. Biagini, Enzo Canonico, Pietro Bonati, Pietro Gareri, Paolo Caffarra, Arcangelo Ceretti, Rosanna Castiglia, Carlo Gabelli, Mario Lo Storto, Paolo Putzu, Simona Di Santo, Andrea, Mazzone, and Rita Maria Melotti

Subjects
Male, Cross-sectional study, Hospitalized patients, Prevalence, 0302 clinical medicine, Surveys and Questionnaires, 80 and over, Odds Ratio, Medicine, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Multicenter, Acute hospital, 2. Zero hunger, Aged, 80 and over, Medicine(all), Medicine (all), Settore BIO/14, General Medicine, 3. Good health, 4AT, Delirium, Hospital, Aged, Cross-Sectional Studies, Female, Humans, Inpatients, Italy, Logistic Models, medicine.symptom, Research Article, Rehabilitation hospital, medicine.medical_specialty, NO, 03 medical and health sciences, 4AT, Delirium, Hospital, Multicenter, Prevalence, Aged, Aged, 80 and over, Cross-Sectional Studies, Delirium, Female, Humans, Inpatients, Italy, Logistic Models, Male, Odds Ratio, Prevalence, Prospective Studies, Surveys and Questionnaires, mental disorders, Psychiatry, business.industry, Odds ratio, Emergency medicine, business, 030217 neurology & neurosurgery
Abstract

Background To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods This is a point prevalence study (called “Delirium Day”) including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01–1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12–1.27), dementia (OR 3.25, 95 % CI 2.41–4.38), malnutrition (OR 2.01, 95 % CI 1.29–3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45–2.82), feeding tubes (OR 2.51, 95 % CI 1.11–5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06–1.87), urinary catheters (OR 1.73, 95 % CI 1.30–2.29), and physical restraints (OR 1.84, 95 % CI 1.40–2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29–3.14), while admission to other settings was not. Conclusions Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The “Delirium Day” project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys. Electronic supplementary material The online version of this article (doi:10.1186/s12916-016-0649-8) contains supplementary material, which is available to authorized users.

Published
2016
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