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Sweta Nariya, Ajita Pillai,
Published: 21 September 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9845

Abstract:
People above 65 years of age would amount to 10.7% of total population of India by 2021. India has acquired the label of ‘an ageing nation’ with 7.7% of its population being more than 60 years old. Geriatric patients are exposed to potentially inappropriate medications (PIMs) thus strategies to improve quality of life and safety of prescribing is needed. One such explicit criteria tool is ‘Screening Tool of Older person’s Potentially inappropriate Prescriptions’ (STOPP) criteria. For older individuals, frailty plays a decisive role. Frailty assessment is useful for identification of risk stratifications to assist in clinical decision makings. Hence, this study is aimed to assess the percentage of PIM using STOPP criteria and correlation between PIMS and Frailty Index (FI) in elderly patients in our setting. An observational study was done in 60 patients in department of medicine at tertiary care teaching hospital. Demographic details, diagnosis and current medications were recorded in Microsoft excel 2016. PIMs based on STOPP criteria version 2 and FI suggested by Searle et al. was calculated and analyzed. Spearman rank correlation test was used to check the correlation between FI and PIM. Out of 60 prescriptions, 21 prescriptions with PIM were found. Most common drugs prescribed as PIM were Aspirin, calcium, ceftriaxone, multivitamin B complex and furosemide. FI was analyzed by using 34 variables. Value of FI was between 0.03 to 0.17. Spearman Rank correlation test showed direct low degree of significant correlation between FI and PIM with correlation (r) value of 0.1602 (P value=0.02). 35% of prescriptions were having at least one PIM in our study and we found that there was direct association between FI and PIM which will help us to reduce potential medication errors, drug interactions and adverse reactions.
Published: 21 September 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.10036

Abstract:
Growing life expectancy is challenging the quality of health care for elderly. Information regarding health related quality of life (QOL) may help policy makers to design need based health programs for this population. The objectives of this study were to estimate health related QOL of the geriatric population living in rural areas of West Tripura district and to compare it between ethnic and non-ethnic populations in respect to important domains. This community based cross-sectional study was conducted during 1st February 2019 to 31st March 2020 among 225 geriatric subjects of rural West Tripura district chosen by multistage sampling. World Health Organization’s QOL-BREF scale was used for data collection. Among the study population 46.2% had overall good health related QOL. About 52.9% had good QOL in environment and 37.3% had good QOL in social relationship domains. Marginally higher proportion of the subjects from ethnic origin had better QOL than the non-ethnic but it was not significant. Higher proportion of the Muslim subjects had better QOL than the rest, but it was also not significant. Bivariate analysis showed significant associations of QOL with age, sex, literacy, financial condition, socioeconomic status and type of family. Multivariate analysis identified male sex, younger age and living with spouse as significant predictors of good QOL. Overall health related QOL of the geriatric people living in rural areas of West Tripura district is poor but younger male subjects, of ethnic origin and living with spouse may enjoy relatively better QOL.
Alberto Cella, Erica Volta, Jacopo Demurtas, Renato Zaccaria, Moira Ceci, Andrea Pilotto, Virginia Boccardi, Alberto Castagna, Carlo Custodero, Francesco Vetta, et al.
Published: 21 September 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.10301

Abstract:
E-Health technologies may potentially improve healthcare assistance for frail elderly subjects. However, despite the interest and potential benefits of the field, research highlighted that several challenges remain, such as scarce wide spreading of information and communication technology technologies among the elderly and infrastructural difficulties. The aim of this survey was to assess to what extent digital technologies are widespread and used among Italian geriatricians. We conducted an online survey addressed to geriatricians, from the SIGOT (The Italian Geriatric Society) website, collecting the 78 completed questionnaires. We then analyzed with descriptive statistics the data. Results showed a still scarce use of digital technologies in geriatric practice in Italy. However, more than 60% of the SIGOT geriatricians who participated in the survey responded that the use of digital technology had increased significantly due to COVID-19 pandemic and for 80% of the members, the priority areas for the use of technologies for the care and treatment of the elderly are the management of chronic diseases and the prevention of hospitalization.
Maria Bonvicini, Davide Crapanzano, Susanna Fenu, Marco Giordano,
Published: 21 September 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.10007

Abstract:
We present an eighty-year old man with a one year history of progressive macroglossia, dysphagia and loss of weight. He had a medical history of arterial hypertension and prostatic hypertrophy which he had under good therapeutic control. The entire tongue was swollen, had hard solidity and was slightly painful upon palpation. A tongue biopsy revealed an amyloid deposition as it coloured bright orange-red on Congo Red staining and lead us subsequently to the diagnosis of amyloidosis; then a bone marrow biopsy confirmed the diagnosis of multiple myeloma. The case was further evaluated by a multidisciplinary team who considered it appropriate to start a lowdose melphalan treatment combined with supportive care. When macroglossia in the tongue is confirmed to be amyloidosis the differential diagnosis should include systemic amyloidosis deposition and multiple myeloma.
Manish Keshwani, , Suresh Nagalikar, Deepak Kumar Biswal, Samarjit Dey
Published: 21 September 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9911

Abstract:
Hyponatremia is a common electrolyte disorder, especially in the frail elderly population. With the increasing number of surgeries in the aging population, hyponatremia is frequently encountered by anesthesiologists and surgeons. Unfortunately, management of hyponatremia is often complex in the elderly population as it is often multifactorial, and they are physiologically susceptible. While it is well known that preoperative hyponatremia is associated with increased perioperative morbidity and mortality, a lack of recommendations or guidelines adds to the dilemma in managing such cases. The most common cause of chronic hyponatremia in the elderly is the syndrome of inappropriate antidiuretic hormone (SIADH), which can be resistant to conventional treatment. On the other hand, paraneoplastic SIADH leading to hyponatremia is rare, and surgery may be the only option available for its correction. We present a case of a 78- years-gentleman to highlight such a dilemma. He was diagnosed with renal cell carcinoma and had chronic refractory severe hyponatremia despite treatment with fluid restriction, low dose hydrocortisone, tolvaptan, and 3% sodium chloride.
The COMEPA group
Published: 21 September 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9895

Abstract:
Coronavirus disease 2019 (COVID-19) has dramatically changed our lives. In the past months, hospitals were saturated of patients; therefore, it is still important to have simple and standardized prognostic factors and to evaluate the efficacy and safety of medications commonly used for COVID-19. We aimed to collect data of the patients hospitalized in Internal Medicine and Geriatrics Wards at the University Hospital (Policlinico) ‘P. Giaccone’ in Palermo, Italy (COMEPA, COVID-19 Medicina Policlinico Palermo), with the main purpose of finding prognostic tools that can be easily used in clinical practice in order to identify patients hospitalized for/with COVID-19 at higher risk of negative outcomes, such as mortality, transfer to Intensive Care Unit (ICU) and institutionalization, as well as evaluating the efficacy/safety of medications commonly used for COVID-19. For reaching these aims, the medical records of approximately 600 patients will be recorded, having data on several parameters and including as outcomes mortality, ICU placement, institutionalization. With the COMEPA study, we therefore plan to update current literature, giving new data on prognostic factors and on the efficacy/safety of some medications used for COVID-19.
Raffaele Costa, , Carlo Torchia, Carmen Ruberto, Viviana Vespertini, Lucio Cosco, Giovanni Ruotolo
Published: 18 June 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9536

Abstract:
The aim of our study was to characterize the repolarization disorders propensity induced by drug-drug interaction. In this observational retrospective study, we report our experience on all elderly patients with ascertained diagnosis of coronavirus disease 2019 through nasopharyngeal swab with real time-polymerase chain reaction at our Pugliese-Ciaccio hospital in Catanzaro, who received hydroxychloroquine (HCQ), with or without azithromycin (AZY). 33 hospitalized patients were examined. We calculated QT value, cQT, QT dispersion, and cQT dispersion and examined possible progression on the basal electrocardiogram (T0) and after the insertion of the drug (T1). The QT value is increased by T0 vs T1 (370±40.74 vs 420±36.91 ms; P=0.000), as well as the cQT value (408±25.40 vs 451.54±58.81; P=0.003), the QT dispersion (QTd: 36.36±14.53 vs 50.90±13.12 ms; P=0.000); the dispersion of cQTc (cQTd 46.27±18.72 vs 63.18±21.93 ms; P=0.001). The ΔQT was 37.44±44.09 while the ΔcQT was 32.01±56.47). The main determinant of QTc prolongation is the number of drug at risk of prolongation of the QT that could influence the ventricular repolarization phase. The use of HCQ in combination with AZY, in patients suffering from severe acute respiratory syndrome-related coronavirus-2, can favor the onset of serious side effects, even potentially fatal. Finally, the measures of QTd and cQTd confirmed additional electrocardiographic parameters useful in identifying patients being treated with drugs at risk of potential adverse arrhythmic events following drug interaction.
Franziska M. Müller, Anna M. Meyer, Lena Pickert, Annika Heeß, Ingrid Becker, Thomas Benzing,
Published: 18 June 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9723

Abstract:
Older persons often loose independence during hospitalization. This analysis aimed at retrospectively evaluating the effects of a pilot individualized multidimensional intervention (IMI) on the comprehensive geriatric assessment (CGA)-based prognosis of older multimorbid patients in an acute internal medicine setting. Records from 72 patients aged 65 years and above who received the IMI were compared to those from 403 patients who received standard of care (SOC). All patients had undergone the CGA-based Multidimensional Prognostic Index (MPI) calculation on admission and at discharge. Patients were divided into three risk groups according to MPI score: Low-risk (MPI-1, 0-0.33), medium-risk (MPI-2, 0.34-0.66) and high-risk (MPI-3, 0.67-1). From admission to discharge, IMI patients showed significant improvements in their MPI score (P=0.014) and subdomains compared to SOC. This was particularly evident in MPI-2 and MPI-3 as well as in patients with poorer functions on MPI admission subdomains. An early geriatric intervention during hospitalization for disease-specific treatments in internal medicine settings improves overall individual prognosis in older multimorbid patients. Prospective randomized studies are needed to confirm these preliminary retrospective observations.
Mirko Di Capua, Alessio Conca, Simone Testa, Maria Mascolo, Stefano Paglia
Published: 18 June 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9614

Abstract:
Severe acute respiratory syndromerelated coronavirus 2 (SARS-CoV-2) infection has spread worldwide. The most of patients presents fever, dyspnea and cough as a typical viral infection, others show peculiar clinical and laboratory signs, such as anosmia, ageusia and thrombocytopenia. We here describe a severe coronavirus disease 2019 patient (76-year old, male) that developed an immune thrombocytopenia and acquired pseudo-thrombocytopenia that were refractory to immunomodulators even after resolution of respiratory failure. The patient developed thrombocytopenia (platelets 88,000/mm3) that got worse the following day (14,000/mm3). We started 1 mg/kg of methylprednisolone i.v. daily. Platelet count increased up to 209,000/mm3, in sodium citrate, but remained about 14,000/mm3 in EDTA 10 days after the beginning of methylprednisolone. The patient showed great improvement in respiratory parameters and radiological finding. About one week after he developed a thrombocytopenia up to 70,000/mm3. We did not modify the steroids dosage. Platelet count slowly began to increase and in about 10 days returned to normal values.
, Albert Wingnang Leung, Chuanshan Xu
Published: 18 June 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9815

Abstract:
Yoga is possible for elderly care as it promotes and balance among mind–brainbody functions through mental, physical, and emotional practices. Growing evidence has shown that yoga practices strengthen muscle, body flexibility, and boost the immune system as well as improve the physical and psychological conditions.
Published: 18 June 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9764

Abstract:
The evaluation and measurement of Sustainable Development and Well-being represent a widespread emerging theme in healthcare, especially concerning, among others, the concepts of social equity and universality of health from an intergenerational perspective. To achieve such goals, Geriatrics would play a prominent role, especially considering the growing portion of the senior population in developed countries. This work intends to explore the possibility to connect Sustainable Development Goals and dimensions of Well-being to a set of performance indicators which are representative of geriatric activities in different settings of care. To this purpose, a pattern of indicators from Emilia- Romagna Region (RER) in Italy is considered. Furthermore, a range of Transitional Care interventions is discussed and proposed in order to ameliorate (or keep stable) the performance.
Alberto Pilotto
Published: 15 June 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9915

Abstract:
Book of the 35º Congresso Nazionale SIGOT - Live streaming, 16-18 giugno 2021.
Arooj Fatima, Muhammad Usman Ali Khan, Mehkaar Najeeb,
Published: 19 February 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9338

Abstract:
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome- related coronavirus 2 (SARS-CoV- 2), is now considered as an ongoing global pandemic. Common symptoms include pyrexia, cough, dyspnea, fatigue, sore throat, and loss of sense of taste and smell. Complications that can result from more severe insult on lung tissue is pneumonia and acute respiratory distress syndrome (ARDS), which can further lead to septic shock. It is also not uncommon to find neurological symptoms in patients suffering from COVID-19. The primary treatment for COVID-19 is symptomatic treatment and supportive care. As there is no known vaccination and antiviral therapy for this disease, there is a desperate need to find an alternative to control and stop the spread of disease. Maintaining adequate micronutrient balance might enhance the immunity and protect from viral infections as well. Vitamin C and zinc helps in improving symptoms and shortening the duration of the common cold. Vitamin C (L-ascorbic acid) possesses pleiotropic physiological activity. High dose Vitamin C has shown to be effective against the common flu, rhinovirus, avian virus, chikungunya, Zika, ARDS, and influenza, and there is evidence that supports the protective effect of high dose IV vitamin C during sepsis-induced ARDS due to COVID-19. Zinc has a profound impact on the replication of viruses. Increasing intracellular zinc concentration along with pyrithione (zinc ionophore) has been shown to impair the replication of several RNA viruses efficiently, including poliovirus, influenza virus and several picornaviruses. A combination of zinc and can also inhibit the replication of SARS-coronavirus in cell culture.
Published: 19 February 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9538

Abstract:
Diagnostic strategies should always take into consideration the setting in which they are administered. The predictive value, positive or negative of a clinical sign or diagnostic test has a different weight in family medicine than in the hospital setting. Many tests have not been formally evaluated in primary care; unfortunately, very often low prevalence settings are used to conduct screening in these populations, and often result in unrealistically high prevalence estimates for chronic disease and these results are then used to conclude that General Practitioners are not good at detecting diseases. In primary care, the prevalence and incidence of disease differs from what appears in the hospital setting, and severe disease occurs less frequently in general practice than in hospital because there is no preventive selection. This requires a specific probability-based decision-making process, based by the knowledge of patients and the community. In primary care, the diagnostic strategy should begin with complaints and symptoms and address uncertainty and complexity, using step-by-step strategies, including watchful waiting, presumptive symptomatic treatment, and focusing on low-tech strategies.
, Marta Baroni, Roberta Cecchetti, Michela Scamosci, Patrizia Bastiani, Patrizia Mecocci
Published: 19 February 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9423

Abstract:
Elevated interleukin-6 (IL-6) levels have been found positively associated with markers of physical frailty as well as identified as a potential biomarker of Alzheimer’s disease (AD). Thus, we explored the levels of plasma IL-6 at baseline in a cohort of older subjects with or without cognitive impairment, which results may have also implications for coronavirus disease 2019 (COVID-19) clinical management. This is a retrospective study including a cohort of over 60 years old-age subjects, 72 healthy controls, 95 mild cognitive impairment, and 73 AD were included in the study. Plasma IL-6 was measured in all subjects. The sample population included 240 subjects, mostly women with a mean age of 78.61±6.30 (range: 60-93) years. Age significantly correlated with IL-6 plasma levels (r=0.204, P=0.002) even after controlling by gender. No difference was found in body mass index (BMI), nutritional status (assessed by mini nutritional assessment), and comorbidity indices (cumulative illness rating scaleseverity and comorbidity index) among groups. Instead, IL-6 significantly differed, having patients affected by AD higher levels compared to the other groups. Final linear regression analysis showed that independently of age, gender, BMI, nutritional status, number of clinically relevant concomitant diseases, the diagnosis of AD was associated with higher IL-6 plasma levels. These data indicate that serum IL-6 is more elevated in AD, supporting that IL-6 may have also a potential role in response to COVID-19 in old age subjects with cognitive impairment.
, Vanni Stangherlin, Paola Mantoan, Marco Chiavalin, Florina Tudor, Gianfranco Pozzobon
Published: 19 February 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9635

Abstract:
Coronavirus disease 2019 (COVID-19) is a widespread condition in nursing homes (NHs). However, no research was made regarding frailty in NH residents during COVID-19 pandemic. The aim of this study was to assess whether frailty, assessed by the multidimensional prognostic index (MPI), can predict mortality/hospitalization in COVID-19 NH residents. A Cox’s regression analysis was used, reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs). 1146 NH residents affected by COVID-19 were included (mean age: 86 years; 75.4% females). During the followup period, we observed 286 deaths and 239 hospitalizations. Taking those with MPI
, Nicola Gennaro, Giancarlo Dal Grande, Luciana Bragagnolo, Maria Rosa Carta, Davide Giavarina, Michela Pascarella, Mario Rassu, Antonio Matteazzi, Giampaolo Stopazzolo
Published: 19 February 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9654

Abstract:
The coronavirus disease 2019 (COVID-19) pandemic will leave a profound imprint in the collective memory of humanity. In Italy, Long-Term Care Facilities (LTCFs) have seen a disproportionally high number of deaths during and the COVID-19 pandemic and, certainly, they may be considered as its epicenter. Aiming to leave a symbolic mark of what the pandemic did in these care settings, we report on an outbreak in a single LTCF where, 53 out of 64 residents, resulted infected. Our narration is based on an epidemiological field investigation together with a calendar of passages through the stages of disease in the infected population. We found an age-gradient in all clinical and epidemiological variables explored such as symptoms onset, illness severity, recovery from symptoms and deaths. According to the disease staging, 26 (49%) were asymptomatic; 9 (17%) had a mild disease; 7 (13%) a moderate stage and 11 (21%) a severe illness severity of whom 10 died. For a more comprehensive description of the impact of the pandemic on LTCFs, we compared the standard mortality ratio (SMR) in the first six months of 2020 to that of 2018 and 2019 in all the 34 facilities of the Vicenza province. Overall, there was a SMR higher 60% than the equivalent period of the previous years.
, Helen Courtney-Pratt, Kathleen Doherty
Published: 19 February 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9470

Abstract:
Although the interests in participative arts for people living with a dementia has increased over the last decade, what is yet to be reviewed is how participatory community- based arts activities for this group of people are evaluated. The overall aim of the following scoping review is to understand the scope of measurement/evaluation methods/approaches used in studies that recruited participants with dementia from the community (not from health/clinical or residential aged care settings or nursing homes) and delivered community-based participatory arts activities/programs (not art therapy programs) to them. The methodological framework by Arksey and O’Malley (2005) for undertaking a scoping review article was applied to this study. Collation, summarizing and reporting the results was carried out considering the research questions. 7 articles met inclusion/exclusion criteria published from 2013 to 2020. The type of arts activities included co-designs and co-creation of various types of arts (n=1), museum visiting and art-making activities (n=4), artistic education-based program (n=1), group singing (n=1). This scoping review shed light on the paucity of research in which older people living with dementia were recruited from the community (not healthcare/clinical settings) to participate in participatory community- based art activities. Also, the results revealed that evaluation of participatory community-based arts activities for older people living with dementia in the community should include methods/techniques to get a deeper insight into the participants’ values and perspectives and the social interaction benefits of such programs.
, Danijela Budimir Mrsic, Ante Luetic, Lara Perkovic Tabak, Mate Petricevic, Kresimir Dolic
Published: 19 February 2021
Geriatric Care, Volume 7; https://doi.org/10.4081/gc.2021.9351

Abstract:
Different aspects of the coronavirus disease 2019 (COVID-19) infection have been widely investigated since the onset of a pandemic in December 2019. Several studies investigated differences in disease development and presentation compared to patient characteristics. In this paper we present an overview of the first COVID-19 pandemic wave in Dalmatia, Croatia with specifics related to patients’ age. Demographic, clinical and radiological data from hospitalized COVID-19 positive patients in the Clinical Hospital Split over a three-month period were collected and analyzed. Subgrouping and additional analysis were performed: Octogenarians vs Non-octogenarians, and senior residence vs nonsenior residence. 160 COVID-19 positive patients were enrolled. Of those, 61% were females. Median age was 78. More than a half of all patients were senior residents. No differences in final outcome were observed comparing specific medicament treatment. Among Octogenarians group, there were more asymptomatic cases, and higher mortality rate. Some differences in radiological presentation were also observed. Senior COVID-19 positive patients are more often asymptomatic but with higher mortality rates. More attention should be paid to early detection on COVID-19 infection in the senior population.
, Simone Dini, Serena Ziliani, Crocefissa Fiorella Casuccio, Francesca Mori Ubaldini
Published: 1 October 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9330

Abstract:
This paper summarizes the latest data about the treatment options available for coronavirus disease 2019 (COVID-19), paying special attention to the older patients. This review explored both trials that have included older patients and some clinically relevant drug-drug interactions. The data have been updated to 31st October, 2020. In particular, details have been reported about the use of antivirals, heparin, steroid and hyperimmune plasma.
Julia Maria Falkenreck, Mandy Roheger, Hannah Weigert, Andrea Friese, Petra Jahr, Ingrid Becker, Gereon Nelles, Elke Kalbe, Maria Cristina Polidori
Published: 1 October 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9328

Abstract:
Cognitive integrity has a multifactorial basis and is essential for quality of life and wellbeing. Several lifestyle programs including those using cognitive training have been developed in the past recent years to preserve cognitive health, but there is still debate about the most effective strategy to be used. We retrospectively analyzed data from 289 healthy participants of the BrainProtect® cognitive training program, developed by the German Association for Memory Training (Bundesverband Gedächtnistraining e.V.). Eight weekly 90- minute sessions of cognitive exercises were holistically structured to include physical exercises and nutrition counseling basing upon social interaction. The large majority (79.9%) of the participants showed improved cognitive scores after the intervention with respect to the baseline, with more than 10/69 points gained. Almost 60% felt their cognitive efficiency increased and an average increase in all cognitive domain explored could be observed. This retrospective analysis of preliminary data suggests that BrainProtect® might improve mental fitness after 8 weeks of multidomain cognition-centered training. These encouraging results need to be confirmed in further randomized studies.
, Patrizia Mecocci
Published: 1 October 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9421

Abstract:
Older persons are more susceptible to infection due to the age-related immunologic changes and the state of constitutive lowgrade inflammation. The rate of complications from the novel severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) and its related coronavirus disease 2019 (COVID-19), is significantly higher in the elderly, with men as the most affected. It is known that women, in general, are less susceptible to viral infections complications thanks to three main differences in sex chromosomes, innate immunity, and steroid hormones. COVID-19 epidemiology in Italy further support that older women, even if frailer, may experience lower mortality than men, which extends the ‘male-female health-survival paradox’ to acutely ill patient groups.
Alex Verhemel, Yalda Dahi, Selay Kakar,
Published: 1 October 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9227

Abstract:
To protect appropriate authorship, the International Committee of Medical Journal Editors (ICMJE) formulated a guideline on authorship. Researchers not fulfilling these criteria and still enlisted as author are seen as honorary authors (HA). The objective of this study is to assess authorship decision making and the proportion of HA in journals in the field of geriatrics and gerontology. Corresponding authors of six highimpact journals in geriatrics and gerontology were sent a survey. The survey consisted of three parts: i) demographics of the respondent; ii) awareness of authorship guidelines; and iii) authorship decisions made for the paper they are authors of. Respondents were also asked if one of their coauthors does not deserve authorship. This is defined as self-perceived HA. Furthermore, respondents were asked if any of their co-authors only performed tasks from a list of non-authorship tasks. This is defined as ICMJE-defined HA. Of the 1592 contacted authors, 528 filled in a survey (response rate 33.2%). 84.4% was aware of the ICMJE-guidelines, but 44.2% was unaware of the issue of HA. The proportion of self-perceived HA was 12.7%. Independent factors associated with more self-perceived HA were having a senior member automatically enlisted as coauthor [odds ratio (OR) 3.4, 95%confidence interval (CI) 1.8 to 6.4] and have gotten the suggestion to include an HA (OR 11.1, 95% CI 4.4 to 27.9). The proportion of ICMJE defined HA was 39.3%. The journal surveyed (OR 1.2, 1.0 to 1.3) was associated with more, and awareness of the ICMJE-guidelines (OR 0.5, 95% CI 0.3 to 0.9) was associated with less ICMJE-defined HA respectively. Having a senior member automatically enlisted as co-author (OR 2.1 95% CI 1.3 to 3.4) and having anyone suggest to include an HA (OR 4.8 95% CI 1.8 to 12.8) were also associated with more ICMJE-defined HA. More than one out of ten of the corresponding authors thinks that based on the ICMJE-guidelines, one or more of their coauthors did not deserve authorship. A stricter journal policy and more awareness of the ICMJE-guidelines could help reduce the proportion of HA.
, Francesco Vetta, Giuseppe Attisani, Raffaele Costa, Carmen Ruberto, Viviana Vespertini, Lucio Cosco, Giovanni Ruotolo
Published: 1 October 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9064

Abstract:
Hydroxychloroquine is an antimalarial drug also known for its anti-inflammatory and antiviral effects, which have raised the interest of many researchers for its potential use in COVID-19 patients. It is known that this drug, being able to influence the cardiac repolarization phase with QTc interval prolongation, can be potentially harmful, chiefly in elderly subjects with frailty syndrome, several comorbidities and polypharmacotherapy. Therefore, although electrocardiogram monitoring of QTc prolongation is the focal point for reducing the arrhythmic risk of these patients, in order to identify the most exposed patients, the traditional Comprehensive Geriatric Assessment should be combined with a multiparametric risk score for QTc prolongation.
Ming Cheh Ou, Dennis Ou, Chung Chu Pang
Published: 1 October 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9171

Abstract:
Ou MC decrescendo phenomenon treatment (OuDPt) is a self-administered practice in which the interactions of the anatomical axes result in a physiological response and produce a zone under the contralateral hand with decreased pain or inflammation. OuDPt has shown an effect to alleviate cough, rhinorrhea, headache, acute edematous swellings, dysmenorrhea, endometriosis and joint pain that are related to inflammatory reaction. Most symptoms with coronavirus infection disease 2019 (COVID-19) as fever, cough, myalgia or diarrhea are also associated with inflammation. If the inflammation by severe acute respiratory syndrome coronavirus 2 is suppressed, mild COVID-19 disease may not develop into severe or critical stage. Further investigations are warranted.
, Jacopo Demurtas, Stefania Maggi, Antonio Cherubini, Vincenzo Solfrizzi, Alberto Cella, Filippo Luca Fimognari, Alberto Ferrari, Alberto Pilotto
Published: 1 October 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9339

Abstract:
The need for major information in meta-research (i.e. the part of medicine interested in systematic reviews [SRs] and meta-analyses [MAs]) is increasing. In the last years we are observing an exponential rate of publications as SRs/MAs in geriatric medicine. In order to better assess the interest in meta-research, we proposed a survey to know the knowledge and the needs in meta-research in geriatrics. A short survey (about 5 minutes) was freely available in the Italian Society of Hospital and Community Geriatrics (SIGOT) website and diffused in social networks. The survey was available during the entire 2019. The survey regards demographic information, previous research activities and the knowledge of the participant on meta-research. Altogether, 148 participants mainly men (=65.5%) and mainly aged 36 to 44 years and working in hospital from all Italian regions completed the survey. Responders read more than 20 articles in the previous year (=58.1%), including 10-20 SRs/MAs (25%). Many respondents (41.9%) had published >20 articles during their life. At the same time, a consistent part of the respondents recognized the importance of metaresearch for clinical practice and almost all the participants recognized that metaresearch has changed their daily clinical approach to the patient. Almost all the participants would like to have more training in meta-research suggesting that SIGOT should organize training courses for metaresearch in geriatric medicine. In conclusion, our survey showed that the interest in SRs/MAs is high, whilst the knowledge is still limited suggesting that education is needed to fill the gap in this field.
, Marília Fernandes, Inês Figueiredo, Diogo Drummond Borges, Filipa Louenço
Published: 1 October 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9106

Abstract:
Heart failure is a major cause of morbidity and mortality worldwide. The prevalence increases with age and usually progresses, leading to repeated hospital admissions and significant symptom burden for patients. The correct management of these patients may decrease readmissions and increase quality of life. Our aim is to compare elderly patients with and without 1-year readmissions in an internal medicine ward, particularly in terms of mortality. Retrospective study, consulting patient’s clinical records, with a diagnosis of heart failure. The patients were characterized and divided in groups: with (wR) and without readmission (woR) within 1 year. Mortality was the primary outcome. Eighty-nine patients were included; 60 woR and 29 wR. There was no gender difference between groups, the wR group had older patients. The most frequent comorbidities included atrial fibrillation, hypertension and chronic renal failure stage 3 or higher. The most frequent cause of hospitalization was heart failure due to insufficient therapy or natural progression of the disease. The etiology of heart failure was mainly hypertensive and ischemic. The wR group had more patients classified as NYHA >III. In relation to the primary outcome; mortality at 12 months was higher in the group with repeated admissions. The characterization of this population allows us to highlight the causes of decompensation and to review medication in order to increase the quality of life.
Melahat Kizil, Kamile Nazan Turhan, Ramazan Kizil, Nursun Ustunkarli
Published: 1 October 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.8920

Abstract:
This study aimed to determine the relationship between chronic diseases and nutrition in the older adults in a nursing home. In 2014 and 2019, we investigated older people aged 60 years and over living in a nursing home in Izmir and who agreed to participate and could perform self-care. A 26-item questionnaire that focuses on sociodemographic, socioeconomic and chronic disease characteristics, and the Turkish version of Mini Nutritional Assessment Test-Short Form were applied using the face-to-face method. In 2014, 68.9% of the older had no malnutrition risk, 23% had malnutrition risk, and 8.1% had malnutrition. The women had a higher malnutrition risk and actual malnutrition than men (P0.05). At both times, malnutrition risk increased in those with chronic disease (P
Alberto Pilotto
Published: 18 September 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9363

Abstract:
Book of the 34° Congresso Nazionale SIGOT - Live streaming, 22-23 settembre 2020.
, Ligia J. Dominguez, Laura Vernuccio, Mario Barbagallo
Published: 1 July 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9137

Abstract:
Although presbyphagia is a clinically relevant problem among elderly population, possibly leading to dysphagia in old age, it remains a still underestimated health condition. The present review analyzes swallowing related anatomical and functional changes during aging, both in healthy people and in those affected by dysphagia. First of all, dysphagia in old people must not be confused with presbyphagia. To distinguish these two different conditions, a correct definition of both should be considered. Subsequently, a comprehensive evaluation including instrumental analysis should be carried out. The aim of this narrative review is to analyze the current knowledge of this clinical condition and to provide the state of art to clinicians. A systematic PubMed research on dysphagia in the elderly was conducted and most relevant and most recent references were manually screened and selected. The aim of a correct diagnosis is to enable the choice of a correct intervention in order to prevent and treat complications of dysphagia, such as ab ingestis pneumonia and malnutrition. Moreover, the assessment, diagnosis and therapy of dysphagia/ presbyphagia should include the intervention of different specialists.
, Muhammad Usman Khan, Ayesha Muazzam, Hajrah Farooq, Javeria Iqbal, Muhammad Imran, Rabia Bashir, Sania Ahmad, Sara Arif
Published: 1 July 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9093

Abstract:
In December 2019, an increasing number of cases of novel coronavirus (2019-nCoV) that were linked to seafood wholesale market have identified in Wuhan, China. Taxonomist declared 2019-nCoV as severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) and the disease termed as COVID-19. Importantly, there is no approved drugs or vaccine against SARS-CoV-2. Current review is related to address treatment option for COVID-19. Interferon-β have shown significant activity against previous outbreak of SARS-CoV and MERS-CoV. Faced with an ongoing pandemic of SARS-CoV-2 and lack of effective treatment options, identifying compounds with antiviral activity has become a high priority. Efficacy of these treatments is still unclear. Therefore, final analysis is important to develop better treatment strategies for ongoing pandemic.
, Giovanni Granata, Chiara Pelliccia, Raffaele La Porta,
Published: 1 July 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9079

Abstract:
Glyphozines also called SGLT2 inhibitors, are a new class of agents that inhibit reabsorption of glucose in the kidney, in proximal tubules, and therefore lower blood sugar. They act by inhibiting sodiumglucose transport protein 2 (SGLT2). Glyphozines are used in the treatment of type II diabetes mellitus. In studies with canagliflozin, a member of this class, the medication was found to enhance blood sugar control as well as reduce body weight and systolic and diastolic blood pressure. In addition to regulate blood glucose, recent studies have shown that glyphozines have important positive cardiovascular benefits, such as weight loss, decreased volaemia and PA, reduced triglycerides, natriuresis and improved endothelial wall dysfunction. Clinical studies have shown reduction in deaths from cardiovascular events among diabetic patients treated with glyphozines. At the moment these drugs are being studied for an extension of the therapeutic indication also for cardiovascular diseases such as heart failure. In this review, we discuss the class of SGLT2 inhibitors in the treatment of diabetes, and studies focused on their possible role in the treatment of cardiac disease.
Israel Oluwasegun Ayenigbara, Olawale Akanbi Moronkola
Published: 1 July 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9045

Abstract:
As every nation battles the coronavirus disease 2019 (COVID-19) pandemic comprehensively, older adults are by far the most affected group in terms of morbidity and mortality rates. Particularly individuals in the age range of >60 years and with comorbidities and other geriatric conditions are at heightened risk of complications from COVID-19 compared to any other age groups in the world. The time between the infection of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV- 2) and the manifestation of the symptoms is between two to twelve days. Typical symptoms of COVID-19 are high temperature, dry cough, and breathing difficulties in complicated cases, while new evidence shows atypical presentations of COVID-19 symptoms in older adults, and are highlighted in this review. From this synopsis, we deduced that firstly, the severity of COVID-19 among older adults is because of biological (dwindling immunity with old age), socio-economic (poverty and over-stretched health system) and physical reasons (frailty and comorbidities). Secondly, there is an upsurge in the rates of transmission and COVID-19 fatalities in nursing homes globally. Lastly, to abate the spread of SARS-CoV-2 among older adults, strict adherence to physical distancing, frequent hand hygiene and respiratory hygiene, frequent disinfection of surfaces, stoppage to unnecessary travel and nonessential hospital’s visitations, appropriate use of face masks, healthy life style choices, proper identification and isolation of infected older adults, assistance and support for older adults in the community, and prevention of infections in nursing homes should all essentially be implemented globally. It is recommended that maximum compliance to measures provided in this review should be ensured and implemented. Governments, civil societies and general public should provide supports for older adults during this COVID-19 pandemic period, and new researches should look more into the global severity of COVID-19 on nursing homes and the geriatric populations generally to get progressively feasible exact information that will enable informed preventive choices.
Nicola Forni, Valentina Boasi, Katiuscia Sciole, Silvia Borile, Nicoletta Pingelli, Domenico Marra, Sara Tita Farinella, , Federico Ariel Sanchez
Published: 1 July 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9128

Abstract:
The recent outbreak exposed doctors to a new challenge: treating people without any scientific evidence. All molecules combined in treatment schedules were merged on the basis of weak and anecdotal data so, the recommendations are constantly changing. In this context it is either mandatory for clinicians focusing on the different treatment options and on probable side effects of each molecules. It is well acquired that among elderly within same age group and strain, the outcome will differ according to each patient’s frailty. Moreover, old and frail people are particularly exposed to a double risk: the first one is the age-related mortality and the second one the susceptibility (also age related too) to side effects. Aim of our paper is reporting our experience in reducing toxicity with a constant action of scientific update and subsequent modification in clinical management protocols. Main focus was on frail patients and cardiologic risk-related to hydroxychloroquine.
, Mohammad Abdolrahmani
Published: 15 June 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9056

Abstract:
Kinesiophobia is one of the pain complications which eventually might cause disability. Several studies showed correlation between age-related problems with kinsiophobia. The objective was to investigate clinical trials about managing kinesiophobia among older adults aged +65 years until March 2020. PubMed, CINAHL, Google Scholar, and PsycINFO databases were electronically searched until March 2020. All studies about kinesiophobia, with clinical trials, and randomized trials study design among older adults aged +65 years were included in the review. Two set of searching terms including ‘kinesiophobia AND intervention’ and ‘fear of movement AND intervention’ were used. From a total of 2669 articles, after excluding for different reasons, only three articles with total of 87 participants, mean age 68.5, all from Turkey related to the objectives of this study remained. Two of them were evaluated using two different physiotherapy approaches to manage neck pain and low back pain and one of them was regarding falls. Kinesiophobia was used as measure for the effectiveness of treatments. Older adults with routine and properly designed exercise and activity are healthier, with a lower probability for disability and therefore higher quality of life and longer healthy life. But to reach those goals, agerelated diseases and barriers should be investigated.
Rosa Paola Cerra, , Carlo Torchia, Raffaele Costa, Luigi Scalise, Edoardo Suraci, Giovanni Ruotolo
Published: 15 June 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.8934

Abstract:
Purple urine bag syndrome is a rare condition that occurs predominantly in the elderly, immobilized and bearer of chronic bladder catheter. It is a phenomenon usually associated with urinary tract infection, particularly in the presence of high bacterial load. The presence of alkaline urine, constipation, high-protein diet and dehydration are predisposing factors. In most cases it is an asymptomatic condition. We described the case of an elderly patient admitted to the geriatric Department in which purple urine was found in the urine collection bag. The culture of urine showed the presence of infection with Klebsiella pneumoniae. Targeted antibiotic treatment and proper hydration determined the resolution of the phenomenon and the resolution of the infection. Although it is an alarming phenomenon due to the particularity of the color of the urine, it is a treatable and solvable condition with an adequate specific antibiotic treatment. Prevention measures are equally effective and consist in eliminating the risk factors for this condition.
Raffaele Costa, , Carlo Torchia, Carmen Ruberto, Giovanni Ruotolo
Published: 15 June 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9121

Abstract:
On 11 March 2020, the World Health Organization declared a pandemic state, in relation to the spread of the severe acute respiratory syndrome-coronavirus disease- 2, responsible for the coronavirus disease- 2019 (COVID-19). The pandemical blast of COVID-19 uncovered well known weakness of financial chain and put our economic organizations facing off dramatic consequences if new strategies will not be developed to adapt health-care on detailed sub-groups of patients. Frail individual aged >65 years affected by cardiovascular disease are an aged population that showed a particular attitude to contract infection and a higher mortality rate compared to general population. In this brief article, we will focus on the management of issues related to cardiovascular patients facing coronavirus infection, in particular in the most fragile groups of the population such as the elderly, increasingly numerous and affected by multimorbidity. Protecting aged populations will be a central question, probably primary in everyone’s interest.
, Veronica Maria Lanni, Valerio Massimo Magro
Published: 15 April 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9016

Abstract:
In 2019, a new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), aroused the attention of the entire world. It causes an acute respiratory disease, by involving the same receptor, i.e. the angiotensin-converting enzyme 2, as that for severe acute respiratory syndrome coronavirus (SARS-CoV), mainly spreads through the respiratory tract. The clinical symptoms in patients with of SARS-CoV-2 include fever, cough, dyspnea, fatigue and in a small percentage of patients also gastrointestinal symptoms have been reported...
Giuseppe Coppolino, Pierangela Presta, Ramona Nicotera, Giordano Placida, Caterina Vita, Nazzareno Carullo, Michele Andreucci, Davide Bolignano, , Giovanni Ruotolo
Published: 15 April 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9029

Abstract:
The pandemic blast of COVID-19 uncovered well known weakness of financial chain and put our economic organizations facing off dramatic consequences if new strategies will not be developed to adapt health-care on detailed sub-groups of patients. The exponential number of older and frail subjects aged >65 years represents a challenge for public health. Patients affected by renal disease are an aged population that showed a particular attitude to contract infection and a higher mortality rate respect to general population. In this brief article, we would point out the focus on the management of issues related to renal patients facing off with coronavirus infection, in particular in a geriatric population particularly exposed to contagion like hemodialysis patients and precautions decided to slow the spread of contamination.
Carlo Custodero, Alberto Cella, Nicola Veronese, Margherita Azzini, Filippo Fimognari, Francesco Mattace-Raso, Maria Cristina Polidori, Carlo Sabbà, Alberto Pilotto
Published: 15 April 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9038

Abstract:
The emergent coronavirus-19 disease (COVID-19) pandemic posed and still poses serious issues in the management of the inpatients and in the resource allocation, in particular for those patients requiring Intensive Care Unit (ICU) management. Epidemiological data clearly suggest that multimorbid older patients have the poorest prognosis. However, it is conceivable that age and number of comorbidities alone do not reflect the real condition and the expected prognosis of the patients affected by COVID-19. A different approach based on comprehensive geriatric assessment (CGA) could help to better identify older patients more at risk of dismal outcomes and who, at some point of their clinical course, will need the ICU admission. The Multidimensional Prognostic Index (MPI) is a well-accepted tool derived from a standard CGA which allows to measure prognosis of older patients in different clinical settings including hospital. Therefore, we designed a multicenter, prospective, observational study to evaluate the role of MPI in predicting risk of ICU admission and in-hospital mortality among 500 COVID-19-positive older subjects admitted to geriatric and internal medicine wards. In addition, risk of re-hospitalization, institutionalization and death after 3 months from discharge will be assessed. The MPI yields a straightforward value from 0 to 1 and might be able to adequately stratify complex, vulnerable COVID-19 patients for best possible decision-making and treatment allocation.
Juliana Verdini De Carvalho Pinheiro, Mariana Fonseca Vaz, Ana Paula Novello, Leonardo Fonseca, Tiago Batista Da Costa Xavier, Luciana Moisés Camilo, Marco Orsini, Marco Antonio Alves Azizi, Cristiane Sousa Nascimento Baez Garcia,
Published: 15 April 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.8784

Abstract:
The objective of the present study was to describe the physical and functioning profile of Brazilian older adults admitted to avascular surgery wards (VSW). This is an observational and cross-sectional study using patients admitted to VSW. The study included subjects considered able to (group 1, G1) or restricted to physical and functional assessment (group 2, G2). Barthel index (BI) was evaluated in G1 and G2 groups, while hand grip strength (HGS), Timed up and Go (TUG), maximal inspiratory and expiratory pressures (MIP and MEP respectively) were assessed only in G1. The data of a total of 104 older adults (G1=56 and G2=48) were analyzed. Most patients had good bed mobility (83.9% in G1 and 75% in G2). There were significant difference between the predicted values and the recorded values obtained for MIP, MEP and HGS (P
Published: 15 April 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9025

Abstract:
The coronavirus disease-19 (COVID-19) pandemic is imposing an extraordinary threat to global health. Consequently, fear has been raised in that the COVID-19 pandemic could disproportionately affect lowincome countries. Low-income countries are mainly concentrated in the Global South of the tropics with a high diversity of pathogens, and a considerable proportion of people living under chronic poverty. All these risks might have made Southern people develop a sort of herd immunity and resilience against a broad range of infections. The analysis of the COVID-19 Worldometers data by using country-, territory-, or conveyance-wise summarized in Global North (64 countries) and Global South (147 countries) suggested the high incidence of COVID-19 infection in the North world countries. However, this should be treated with caution given the low testing and contact tracing, and presumably reporting capacity, by the South World countries. Nevertheless, Southern people are living under minimal healthcare, consequently, their relative wellness amidst the COVID-19 crisis could not be overlooked. The observed differences in infectivity, however, might not be ethnically-biased but most likely they could be due to the differences in the living standard, healthcare systems as well as the lifestyle of Global North versus Global South countries.
, Daniela Pinto, Pietro Calogero
Published: 15 April 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9043

Abstract:
Since the outbreak of coronavirus disease- 19 (COVID-19) pandemic, geriatric population has been the most affected due to the peculiarities of the disease in terms of contagiousness and severity. Major changes have been implemented in healthcare structures and facilities worldwide in order to accomplish the necessity to host and isolate infected patients. Simultaneously, many critical issues have emerged concerning medical and nursing assistance to elderly patients, due to the new arrangement of wards and innovative work tools. Acute Geriatric Units dedicated to COVID-19 have been asked to put giant efforts in adapting to new care models in mobility, communication, feeding, basic assistance and caregivers’ involvement. The purpose of this dissertation is to highlight the role of Geriatricians as proactive contributors of new approaches to elderly patients in times of COVID-19, in order to develop a further-thinking working methodology.
, Carmen Ruberto, Rosa Paola Cerra, Laura Greco, Giovanni Ruotolo
Published: 15 April 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.8670

Abstract:
Fahr’s disease (FD), also known as familial idiopathic basal ganglia calcification, is a neurodegenerative disease affecting cerebral micro vessels, mainly in the basal ganglia. It mostly presents with movement disorders, dementia and behavioral abnormalities. It is considered hereditary with an autosomal dominant transmission. Fahr’s disease is often underestimated and under diagnosed. We reported the clinical differences found in two patients with Fahr’s Disease. In particular, we described a case of Fahr’s disease with behavioral alteration with extrapyramidal movement disorders, and a rare case of Fahr’s disease with cognitive and behavioral alterations in absence of extrapyramidal movement disorders.
Published: 15 April 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.9015

Abstract:
The role of hydroxychroloquine (HCQ) sulfate as therapeutic option in coronavirus disease 2019 (COVID-19) patients aroused great interest and hope, so much so as to authorize several studies in the world. Despite the beneficial effects demonstrated in vitro and in some case-series, doubts remain about its clinical use, so that at present more than 20 different therapeutic study protocols have been proposed. Very recently, a protocol has been authorized by the Italian Medicines Agency (AIFA), in order to evaluate the efficacy of out-of-hospital treatment with HCQ in the reducing viral loads and need for hospitalization in symptomatic COVID-19 infected patients who are confined at home. The article describes lights and shadows of HCQ therapy in the elderly and geriatric patients affected by COVID-19, and suggests that the geriatrician should use HCQ only after careful patient selection and be aware of its pharmacokinetic properties and adverse effects, before better-designed studies determine their benefit, if any, in treating COVID-19.
, Giuseppe Coppolino, Carmen Ruberto, Giovanni Ruotolo, Ciro Manzo
Published: 12 March 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.8785

Abstract:
Glucocorticoids (GCs) are drugs commonly used for the treatment of a great number of acute or chronic pathological conditions. In a cross-sectional study we analyze a cohort of elderly patients treated for at least four weeks with a glucocorticoid (GC), exactly prednisone therapy, for a renal or rheumatological condition pointing out on functional, mental and clinical status. The main purpose was to assess change in cognitive performances. Corticosteroids administration also at low dosage in older subjects could enhance cognitive function. This observation should be proved in larger population and underlying mechanisms studied in deep.
, Sarah E. Hegarty, Vittorio Maio, Marco Lombardi, Andrea Pizzini, Aldo Mozzone, Marzio Uberti, Simonetta Miozzo
Published: 12 March 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.8703

Abstract:
Deprescribing is a patient-centered process of medication withdrawal intended to achieve improved health outcomes through discontinuation of one or more medications that are either potentially harmful or no longer required. The objective of this study was to assess the perceptions of primary care physicians on deprescribing and potential barriers to deprescribing in the Local Health Authority (LHA) of Turin, Piedmont, Italy. Secondary objective was to evaluate educational needs of primary care physician. Cross sectional survey of primary care physicians working in the LHA of Turin, Piedmont, Italy. 439 GPs (71.3% of the total number of primary care physicians) attended an educational session related to deprescribing and were asked to anonymously answer a paper survey. Participants were asked to complete a previously published questionnaire about deprescribing and potential factors affecting the deprescribing process. A correlation coefficient was calculated to assess the association between physicians’ confidence in deprescribing and attitudes or barriers associated with deprescribing. Many GPs (71%) reported general confidence in their ability to deprescribe. Most respondents (83%) reported they were comfortable deprescribing preventive medications, however almost half expressed doubts regarding deprescribing when medication was initially prescribed by a colleague (45%) or when patient and/or caregiver supported the opportunity to continue the assumption (49%). Around a third of doctors maintain that the absence of strong evidence supporting deprescribing prevents them from considering it (38%), that they do not have the necessary time to effectively go through the process of deprescribing (29%), and that fear of possible effects due on withdrawal prevents them from deprescribing (31%). There was no strong correlation between physicians’ confidence and attitudes or barriers associated with deprescribing. The present study confirms that general practitioners sense the importance of deprescribing and feel prepared to face it managing communication with patients and caregivers, but find barriers when enacting the practice in a real-life context.
, Caterina Dore, Irene Mameli, Angelo Scuteri, Marco Dettori, Antonio Uneddu
Published: 12 March 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.8407

Abstract:
The multidimensional prognostic index (MPI) is an accurate predictor of mortality validated in hospitalized older patients. Aim of this study was to evaluate the reliability of the MPI in predicting shortand long-term mortality in patients with heart failure (HF), particularly in those with reduced left ventricular ejection fraction (HFrEF). The study population included all patients older than 65 years admitted in a Post-Acute Long-Care Unit from 2013 to 2018. Patients were divided into two groups: patients with HF (N=143) and patients without HF as controls (N=1254). Furthermore, patients affected by HF were subdivided according to echocardiographic left ventricular ejection fraction (LVEF), i.e. reduced, mid-range and preserved LVEF (respectively HFrEF, HFmrEF, HFpEF). All patients underwent a comprehensive geriatric assessment (CGA) to calculate the MPI based on information on functional, cognitive, nutritional and mobility status, comorbidity, poli-pharmacy and co-habitation. Mortality rates in the HF group was 46% in patients MPI-1 or MPI-2 groups versus 59% in patients included in the MPI- 3 group. In particular, of 32 HF patients with HFrEF 67.7% were in the MPI-3 class compared to 43% of 14 patients with HFmrEF group and to 41% of 63 patients with HFpEF. These findings suggest that MPI is a reliable predictor of mortality in HF patients and that it was particularly useful in the subgroup of patients with HFrEF.
Published: 12 March 2020
Geriatric Care, Volume 6; https://doi.org/10.4081/gc.2020.8868

Abstract:
We report the case of a 73-year-old male patient suffering from non muscle invasive bladder cancer (NMIBC) who had violent pains in his neck and shoulders associated with general discomfort and fever, following the second intravesical instillation of bacillus Calmette-Guerin (BCG), with further worsening after the third instillation. During his hospitalization, laboratory tests showed a significant raise of inflammatory markers. An ultrasound (US) examination of his shoulders showed bilateral longhead-biceps exudative tenosynovitis and subdeltoid bursitis. An 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) associated with total body computed tomography (CT) showed pathological inflammatory findings in neck and shoulders, with exclusion of pathological findings in other sites. Cystoscopy was negative for NMIBC recurrence. Polymyalgia rheumatica (PMR) was diagnosed and BCG instillations was stopped. The patient had fast improvement of clinical manifestations and laboratory tests, but when he resumed them a few weeks later, the same manifestations recurred.
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