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Laudisio A.,Biomedical University of Rome | Marzetti E.,Catholic University of Medicine | Franceschi F.,Catholic University of Medicine | Bernabei R.,Catholic University of Medicine | Zuccala G.,Catholic University of Medicine
Aging Clinical and Experimental Research | Year: 2015

Background: Emergency room (ER) visits and hospitalizations of elderly subjects with chronic comorbidities, often disabled, are increasing. Aims: The aim of the present study was to assess whether among older subjects functional disability is associated with increased ER visits and hospitalization rates. Methods: We assessed the association of functional ability with 1-year ER visits and hospitalization rates in all 342 subjects aged 75+ living in Tuscania (Italy) in 2004. Functional ability was estimated using the Katz’ activities of daily living (ADLs), and the Lawton and Brody scale for the instrumental activities of daily living (IADLs). Functional disability was defined as the dependence for two or more ADLs or IADLs. Results: According to Cox regression, disability in ADLs was associated with increased risk of ER visits (RR 2.12; 95 % CI 1.11–4.08; P = .023) but not of hospital admission (RR 1.50; 95 % CI.80–2.80; P = .208). Also, in Poisson regression, ADLs disability predicted the number of ER visits (IRR 2.56; 95 % CI 1.48–4.40; P = .001). Discussion: Disability is associated with increased risk of ER visits, but not of subsequent hospitalization in community-dwelling elderly, independent of clinical conditions. Dedicated studies are needed to evaluate the impact of social interventions for disabled elderly on ER access rates. Conclusions: Emergency Departments should implement innovative triage procedures to identify older patients with disability who gain access to ER, to recognize and classify any unmet social needs. © 2015, Springer International Publishing Switzerland. Source


Laudisio A.,Biomedical University of Rome | Vetrano D.L.,Catholic University of Medicine | Meloni E.,Catholic University of Medicine | Ricciardi D.,Catholic University of Medicine | And 4 more authors.
Movement Disorders | Year: 2014

Background: Malnutrition has been found in up to 24% of patients with Parkinson's disease; dopaminergic drugs might impair nutritional status. We evaluated the association of nutritional status with the use of dopaminergic agents. Methods: We analyzed data from 75 elderly patients with Parkinson's disease attending a geriatric day hospital. Nutritional status was assessed by the Mini Nutritional Assessment (MNA). Dopaminergic drugs were normalized for weight. Results: In linear regression, total levodopa (l-dopa) equivalent daily dose (LEDD) was associated with worse MNA (B=-0.14, 95% CI=-0.26--0.02; P=0.019). This association remained significant only for l-dopa (B=-0.19, 95% CI=-0.32--0.52; P=0.007), but not dopaminergic agent dosages. Increasing l-dopa dosages were associated with increasing probability of risk of malnutrition (P for trend=0.049). Conclusions: In our population, LEDD was associated with worse nutritional status and risk of malnutrition; this association was limited to use of l-dopa. © 2014 International Parkinson and Movement Disorder Society. Source


Laudisio A.,Biomedical University of Rome | Lo Monaco M.R.,Catholic University of Medicine | Vetrano D.L.,Catholic University of Medicine | Pisciotta M.S.,Catholic University of Medicine | And 3 more authors.
Clinical Nutrition | Year: 2016

Background & aims: Falls are a major threat for patients with Parkinson's disease, as they are associated with higher risk of morbidity, loss of functional ability, institutionalization, and mortality. Metabolic syndrome (MetS) is associated with poorer physical performance in middle age, but its impact in the older and frailer subjects is unclear. The present study aimed at assessing the association of MetS with falls in patients with Parkinson's disease. Methods: We analyzed data of 194 elderly with Parkinson's disease attending a geriatric Day Hospital. History of falls that occurred over the last year, as well as and the number of falls, were recorded. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program's ATP-III criteria. Results: Falls were reported by 91 participants (47%). Logistic regression analysis showed that MetS was associated with reduced occurrence of falls (OR = .26; 95% CI = .10-.69; P = .007). Also, among participants who fell, Poisson regression indicated that MetS predicted a reduced number of falls (IRR = .43; 95% CI = .20-.89; P = .024). Conclusions: In our population MetS was associated with reduced probability of falls; among subjects who fell, MetS was associated with a reduced number of falls. Dedicated studies are needed to better understand the subsystems involved, as well as the therapeutic implications of such an association. © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Source


Laudisio A.,Catholic University of Medicine | Marzetti E.,University of Florida | Pagano F.,Catholic University of Medicine | Pozzi G.,Catholic University of Medicine | And 2 more authors.
Aging and Mental Health | Year: 2010

Objectives: Subjects with depression might request more healthcare services. The aim of this study was to evaluate the association of depressive symptoms with hospitalization and mortality rates in a general unselected older population. Methods: We assessed the association of the 30-items Geriatric Depression Scale (GDS) score with one-year hospitalization and mortality in all 344 subjects aged 75+ living in Tuscania (Italy). This population had been enrolled in a national study of the genetic determinants of health status. Analyses were conducted using continuous, as well as categorical GDS score levels. Results: After adjusting for potential confounders, depressive symptoms were associated in Cox regression modelling with hospitalization (relative risk, RR = 1.05; 95% confidence interval, CI = 1.01-1.09; p = 0.016), but not with mortality (RR = 1.06; 95% CI = 0.96-1.16; p = 0.246). Increasing GDS score levels were associated with increasing risk of hospitalization (p for trend = 0.033). Up to 39% of hospitalizations might be attributed to depression. Conclusion: Depressive symptoms are not associated with increased mortality rates in general older populations. However, depressive symptoms represent a potentially reversible determinant of increased hospitalization rates in these subjects, independent of the presence and severity of other medical conditions. © 2010 Taylor & Francis. Source


Laudisio A.,Catholic University of Medicine | Marzetti E.,Catholic University of Medicine | Pagano F.,Catholic University of Medicine | Bernabei R.,Catholic University of Medicine | Zuccala G.,Catholic University of Medicine
Aging Clinical and Experimental Research | Year: 2012

Background and aims: Although the use of angiotensin-converting enzyme-inhibitors (ACE-I) is a cornerstone of treatment for heart failure (HF), these agents have been associated with decreasing hemoglobin levels in several settings. The aim of this study was to assess whether ACE-I are associated with decreasing hemoglobin in older subjects, and whether this effect is enhanced among patients with HF. Methods: The association between starting use of ACE-I and variations in hemoglobin levels was investigated in 10,354 hospitalized elderly, 1217 of whom had a verified diagnosis of HF, enrolled in a multicenter pharmacoepidemiology survey. Results: According to Cox regression analysis, the relative risk of a decrease in hemoglobin levels >0.5 g/dL associated with starting treatment with ACE-I was 1.12 (95% CI 0.98-1.26, p=0.081) among participants without HF, and 1.98 (95% CI 1.54-2.53, p>0.0001) among patients with HF, after adjusting for potential confounders. Analysis of the interaction term in Cox regression confirmed that the association between use of ACE-I and hemoglobin decrease varied according to diagnosis of HF (p=0.003) and older age (p=0.029). Conclusions: Starting treatment with ACE-I is independently associated with increased risk of hemoglobin decrease among older hospitalized patients with HF. Hemoglobin levels should be monitored in older subjects who start ACE-I. ©2012, Editrice Kurtis. Source

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