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Mazzella F.,University of Naples Federico II | Cacciatore F.,Istituto Scientifico di Campoli Telese | Galizia G.,University of Naples Federico II | Della-Morte D.,University of Naples Federico II | And 10 more authors.
Archives of Gerontology and Geriatrics | Year: 2010

Several studies have demonstrated a global increase in morbidity and mortality in elderly subjects with low social support or high comorbidity. However, the relationship between social support and comorbidity on long-term mortality in elderly people is not yet known. Thus, the present study was performed to evaluate the relationship between social support and comorbidity on 12-year mortality of elderly people. A random sample of 1288 subjects aged 65-95 years interviewed in 1992 was studied. Comorbidity by Charlson Comorbidity Index (CCI) score and Social Support by a scale in which total score ranges from 0 to 17, assigning to lowest social support the highest score, were evaluated. At 12-year follow-up, mortality progressively increase with low social support and comorbidity increasing (from 41.5% to 66.7% and from 41.2% to 68.3%, respectively; p<. 0.001). Moreover, low social support progressively increases with comorbidity increasing (and 12.4 ± 2.5 to 14.3 ± 2.6; p<. 0.001). Accordingly, multivariate analysis shows an increased mortality risk of 23% for each increase of tertile of social support scale (Hazard ratio = HR = 1.23; 95% CI = 1.01-1.51; p= 0.045). Moreover, when the analysis was performed considering different degrees of comorbidity we found that social support level was predictive of mortality only in subjects with the highest comorbidity (HR = 1.39; 95% CI = 1.082-1.78; p= 0.01). Thus, low social support is predictive of long-term mortality in the elderly. Moreover, the effect of social support on mortality increases in subjects with the highest comorbidity. © 2010 Elsevier Ireland Ltd. Source


Testa G.,University of Naples Federico II | Testa G.,University of Molise | Cacciatore F.,Istituto Scientifico di Campoli Telese | Galizia G.,University of Naples Federico II | And 9 more authors.
European Journal of Clinical Investigation | Year: 2011

Background Chronic heart failure (CHF) is characterized by a high mortality in the elderly. Moreover, depression status is also related to poor prognosis in advancing age. Thus, we sought to determine whether depressive status predicts long-term mortality in subject with or without CHF. Methods and results Long-term mortality after 12-year follow-up in 125 elderly subjects with CHF and 1143 elderly subjects without CHF was studied. Depression was evaluated using the Geriatric Depression Scale (GDS), and all subjects were stratified in tertiles according to GDS score (0-10, 11-20 and 21-30). With increasing GDS score, long-term mortality at the end of follow-up increased from 43·4% to 72·0% in subjects without (P<0·001) and from 52·6% to 83·9% in subjects with (P<0·007) CHF. In multivariate analysis, GDS appeared to be predictive of long-term mortality in the absence (Hazard ratio=1·01; confidence interval 95% 1·00-1·05; P=0·04) and, even more, in the presence of CHF (Hazard ratio=1·08; confidence interval 95% 1·01-1·15; P<0·01). Conclusions Depression symptoms predict long-term mortality in elderly subjects without and, even more, with CHF. Thus, depression can be considered a strong predictor of death in CHF elderly subjects. © 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation. Source


Galizia G.,Istituto Scientifico di Veruno Novara | Langellotto A.,University of Naples Federico II | Cacciatore F.,University of Naples Federico II | Mazzella F.,University of Naples Federico II | And 8 more authors.
Journal of the American Medical Directors Association | Year: 2012

Objectives: A high falls-related mortality rate in the elderly is not exclusively related to injuries. Moreover, the risk of falls increases with urinary disorders such as nocturia. The aim of this study was to investigate the role of nocturia in falls-related long-term mortality in elderly subjects. Design: Longitudinal study. Setting and Participants: The "Osservatorio Geriatrico Regione Campania" was a cross-sectional study performed in 1992 in Campania, a region of Southern Italy. Main Measurements: Long-term mortality (12 years' follow-up) in 178 elderly subjects (mean age 74.0 ± 6.3 years) with falls and 1110 elderly subjects (mean age 75.2 ± 6.4 years) without falls at baseline was measured. Subjects were then stratified for the presence/absence of nocturia. Key Results: In our sample, the prevalence of falls was 13.8% and the prevalence of nocturia was 45.7%. Long-term mortality was 51.3% in nonfallers and 62.9% in fallers (P < .05). In the absence of nocturia, long-term mortality was similar in nonfallers and fallers (49.0% vs 46.7%; P = 514, NS). In contrast, in the presence of nocturia, long-term mortality was higher in fallers than in nonfallers (74.5% vs 53.6%; P < .05). Cox regression analysis confirmed the predictive role of falls on long-term mortality in the presence of nocturia (hazard ratio 60; 95% confidence interval 1.01-2.57; P < .05) but not in the absence of nocturia (hazard ratio = 1.27; 95% confidence interval 0.81-1.99; P = 28). Conclusions: Our data suggest that falls are related to an increased risk of long-term mortality in the elderly much more in the presence of nocturia. This phenomenon is probably related to the high comorbidity that usually affects elderly subjects with nocturia. © 2012 American Medical Directors Association. Source


Testa G.,University of Naples Federico II | Testa G.,University of Molise | Cacciatore F.,Istituto Scientifico di Campoli Telese | Galizia G.,University of Naples Federico II | And 11 more authors.
Journal of the American Geriatrics Society | Year: 2010

Objectives: To examine whether waist circumference (WC) and body-mass index (BMI) can predict long-term mortality in elderly subjects with and without chronic heart failure (CHF). Design: Longitudinal evaluation with a 12-year follow-up. Setting: Campania, a region of southern Italy. Participants: One thousand three hundred thirty-two subjects aged 65 and older selected from the electoral rolls of Campania. Measurements: The relationship between WC or BMI and mortality during a 12-year follow-up in 125 subjects with and 1,143 subjects without CHF. Results: Mortality increased as WC increased in elderly subjects without CHF (from 47.8% to 56.7%, P=.01), and the increase was even greater in patients with CHF (from 58.1% to 82.0%, P=.01). In contrast, mortality decreased as BMI increased in elderly subjects without CHF (from 53.8% to 46.1%, P0 =.046) but not in those with CHF. According to Cox regression analysis, BMI protected against long-term mortality in the absence but not in the presence of CHF. In the absence of CHF, WC was associated with a 2% increased risk of long-term mortality for each 1-cm greater WC (Hazard Ratio (HR)=1.02, 95% confidence interval (CI)=1.01-1.03; P<.001), versus 5% increased in the presence of CHF (HR=1.06, 95% CI=1.02-1.10; P<.001). Conclusion: WC, but not BMI, is predictive of long-term mortality in elderly individuals with CHF and to a lesser extent in those without CHF. © 2010 The American Geriatrics Society. Source


Galizia G.,University of Naples Federico II | Cacciatore F.,Istituto Scientifico di Campoli Telese | Testa G.,University of Naples Federico II | Testa G.,University of Molise | And 10 more authors.
Aging Clinical and Experimental Research | Year: 2011

Background and aims: Elderly subjects are characterized by a high prevalence of chronic obstructive pulmonary disease (COPD) and frailty. This study examined the predictive role of frailty on long-term mortality in elderly subjects with and without COPD. Methods: The study assessed mortality after a 12-year follow-up in 489 subjects with COPD and 799 subjects without COPD, selected in 1992. Frailty was assessed according to the Frailty Staging System scores ranging from 1 to 7. Results: After 12 years' follow-up, mortality was 48.1% in subjects without and 60.7% in subjects with COPD (p<0.001). With increasing frailty, mortality increased from 41.7% to 75.1% (p for trend <0.01) in subjects without and from 54.3% to 97.0% in subjects with COPD (p for trend <0.001). Multivariate analysis showed that both COPD [hazard ratio (HR)=1.34; 95% confidence interval (95% CI)=1.02-1.81; p=0.042] and frailty score (HR=1.69 for each unit of increase; 95% CI=1.42-2.00; p<0.001) were predictive of long-term mortality. The frailty score also increased the risk of long-term mortality by 34% in the absence of COPD (HR=1.34 for each unit of increase; 95% CI=1.02-1.81; p<0.05) and by 80% in its presence (HR=1.80 for each unit of increase; 95% CI=1.28-2.53; p<0.001). Conclusions: Long-term mortality was higher in elderly subjects with than in those without COPD. The clinical frailty score also significantly predicted mortality in subjects without and, even more, in those with COPD. Thus, clinical frailty may be considered a new prognostic factor to identify COPD subjects at high risk of mortality. ©2011, Editrice Kurtis. Source

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