Research Hospital of Casatenovo

Casatenovo, Italy

Research Hospital of Casatenovo

Casatenovo, Italy
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Abbatecola A.M.,Italian National Research Center on Aging | Olivieri F.,Marche Polytechnic University | Corsonello A.,Research Hospital of Cosenza | Strollo F.,Research Hospital of Rome | And 2 more authors.
Drug Safety | Year: 2012

Frailty is considered a syndrome of decreased reserve and resistance to stressors and is clinically expressed as muscle weakness, poor exercise tolerance, factors related to body composition, sarcopenia and disability. In addition, there is a close relationship between age-related metabolic changes and the occurrence of comorbidities that may in turn lead to frailty. Even though the downward spiral of frailty is activated more quickly in older persons with type 2 diabetes, it is reversible with appropriate interventions before reaching a high level of severity. The hazard for geriatric patients with type 2 diabetes is that frailty encompasses diverse complications already associated with or caused by diabetes. Frailty is also associated with cognitive impairment, reduced ability to perform activities of daily living and increased expression of inflammatory and coagulation markers that may contribute to the adverse microvascular effects of diabetes. Although glycaemic control remains the main targeting achievement in type 2 diabetes, especially in wellfunctioning older persons, this is not appropriate for those with frailty. Frail elderly people with type 2 diabetes are a specific group in need of treatment parameters for both initial and maintenance therapy with oral antidiabetic agents. Therefore, the prescription of an antidiabetic agent in such individuals must take into consideration not only the standard goal of lowering hyperglycaemic levels, but also improving the quality of life and life expectancy. The clinical management of this population is currently particularly demanding, requiring special considerations with good medical decision making. Clinical aspects complicating diabetes care in older people include cognitive decline, physical functional decline and frailty. Available oral antidiabetic drugs include insulin secretagogues (meglitinides and sulfonylureas), biguanides (metformin), a-glucosidase inhibitors, thiazolidinediones and inhibitors of glucagon-like peptide 1 (GLP-1) degrading enzyme dipeptidyl peptidase 4. In addition, we will discuss injection treatment with GLP-1 analogues. This review will underline the association between diabetes and some frailty components in old patients and how specific antidiabetic agents may play a specific role in improving outcomes. Adis © 2012 Springer International Publishing AG. All rights reserved.


Corsonello A.,Research Hospital of Cosenza | Garasto S.,Research Hospital of Cosenza | Abbatecola A.M.,Italian National Research Center on Aging | Rose G.,University of Calabria | And 6 more authors.
Biogerontology | Year: 2010

The role of inflammation in the pathophysiology of chronic age-related diseases is increasingly recognized, and inflammation could represent the common pathway linking diseases and disability. Thus, targeting inflammation could represent a useful strategy at preventing or delaying functional decline. In this paper we review recent evidence suggesting that selected drugs, such as statins, fibrates, angiotensin converting enzyme-inhibitors and angiotensin receptor blockers, and physical exercise may be able to contrast functional decline by blunting inflammation. Results from randomized trials investigating the effects of physical activity programs on inflammation and functional decline is still limited, and further investigations are warranted. © 2010 Springer Science+Business Media B.V.


Pistelli R.,Catholic University | Ferrara L.,Italian National Research Center on Aging | Misuraca C.,Research Hospital of Casatenovo | Bustacchini S.,Italian National Research Center on Aging
Current Opinion in Pulmonary Medicine | Year: 2011

Purpose of review: Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and increasing health problems in the elderly on a worldwide scale. The management of COPD in older patients presents practical diagnostic and treatment issues, which are reviewed with reference to the stable stage of the disease. Recent findings: In the diagnostic approach of COPD in the elderly the use of spirometry is recommended, but both patient conditions (such as inability to correctly perform it due to fatigue, lack of coordination, and cognitive impairment) and metrics characteristics should be taken into account for the test performance. It has been demonstrated in population studies that the use of the fixed ratio determines a substantial overdiagnosis of COPD in the oldest patients. Other parameters have been suggested [such as the evaluation of Lower Limit of Normality (LLN) for the FEV1/FVC ratio], which may be useful to guide the diagnosis. Several nonpharmacologic-such as smoking cessation, vaccination, physical activity, and pulmonary rehabilitation, nutrition, and eventually invasive ventilation-and pharmacologic interventions have been shown to improve outcomes and have been reviewed. Effective management of COPD in older adults should always consider the ability of patients to properly use inhalers and the involvement of caregivers or family members as a useful support to care, especially when treating cognitively impaired patients. Especially in the older population, timely identification and treatment of comorbidities are also crucial, but evidence in this area is still lacking and clinical practice guidelines do not take comorbidities into account in their recommendations. Summary: The Global Initiative for Obstructive Lung Disease has recommended criteria for diagnosis and management of COPD in the general population. On the contrary, available evidence suggests practical limitations in diagnostic approach and intervention strategies in older patients with stable COPD that need to be further studied for a translation into clinical practice guidelines. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Abbatecola A.M.,Italian National Research Center on Aging | Fumagalli A.,Research Hospital of Casatenovo | Bonardi D.,Research Hospital of Casatenovo | Guffanti E.E.,Research Hospital of Casatenovo
Current Opinion in Pulmonary Medicine | Year: 2011

Purpose of review: Acute exacerbations of chronic obstructive pulmonary disease (ECOPDs) have numerous causes and are associated with increased mortality and hospitalization, especially in older patients. The urgent need to identify and enable timely treatment of ECOPDs is a necessity for physicians worldwide. This review will highlight the causes and optimal combinations of available treatments for such events in older populations. Recent findings: The exact definition of exacerbations is lacking; however, it is agreed that such events are considered episodes of worsening of symptoms, leading to morbidity and death. The aging process is a consistent determinant for ECOPD events and is associated with worsening of COPD stages. The incidence of ECOPD rises across the worsening stages of COPD. Studies have shown that the frequency of exacerbations increases with age and correlated clinical outcomes are poorer than in younger patients. The risk of mortality has also been shown to be significantly higher after a hospital admission following an acute exacerbation. At the moment, the need to rapidly and correctly treat acute exacerbations is crucially important in the rapidly growing elderly population. Summary: ECOPDs are extremely dangerous events for older patients with severe stages of COPD. There is an urgent need to identify risk factors, identify tolerable treatment guidelines and manage acute exacerbations in older patients with COPD. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Chiatti C.,Italian National Research Center on Aging | Bustacchini S.,Italian National Research Center on Aging | Furneri G.,Italian National Research Center on Aging | Mantovani L.,University of Naples Federico II | And 3 more authors.
Drug Safety | Year: 2012

Adverse drug events (ADEs) are an increasingly relevant issue for healthcare systems as they are associated with poorer health outcomes and avoidable misuse of resources. The rates of ADEs are higher in the elderly population, as many older patients have comorbidities, multiple drug prescriptions and deteriorated physical and cognitive functioning. The occurrence of ADEs can lead to a perceived lack of therapy efficacy and further underuse or suboptimal adherence in elderly people, with detrimental clinical outcomes. The present article systematically reviews the studies evaluating the economic impact of ADEs occurring as consequence of poor therapy adherence, inappropriate drug use, underuse of effective treatments and poor adherence, medication errors, drug-drug and drug-disease interactions. A Medline systematic literature review of studies evaluating the economic consequences of inappropriate drug prescribing, lack of adherence and compliance, ADEs in older people was performed. English-language articles were screened through a three-step approach (title review, abstract review, full article review) to select pertinent studies quantitatively evaluating costs. We systematically reviewed evidence from767 articles. After title, abstract and full text review, 21 articles were found to measure economic implications ofADEs, inappropriate drug prescribing and poor adherence in elderly patients. Studies suggested that the economic impact of these undesired effects is substantial: hospital costs were the main cost driver, with a relevant part of them being preventable (consequences of inappropriate prescribing). Healthcare costs for unused drug wastage and destruction were also surprisingly high. Although economic evidence in elderly patients is still limited, all studies seemed to confirm that the financial burden due to pharmacological treatment issues is relevant in elderly people. Including economic effects of adverse events in pharmacoeconomic analysis would be beneficial to improve the reliability of results. Preliminary evidence suggests that programmes aimed at comprehensively assessing geriatric conditions, detecting 'high-risk' prescriptions and training patients to comply with prescribed therapies could be costeffective measures to reduce the burden of ADE. Adis © 2012 Springer International Publishing AG. All rights reserved.


Rivolta M.W.,University of Milan | Aktaruzzaman M.,University of Milan | Rizzo G.,CNR Institute of Molecular Bioimaging and Physiology | Lafortuna C.L.,CNR Institute of Molecular Bioimaging and Physiology | And 4 more authors.
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS | Year: 2015

Falling in elderly is a worldwide major problem because it can lead to severe injuries, and even sudden death. Fall risk prediction would provide rapid intervention, as well as reducing the over burden of healthcare systems. Such prediction is currently performed by means of clinical scales. Among them, the Tinetti Scale is one of the better established and mostly used in clinical practice. In this work, we proposed an automatic method to assess the Tinetti scores using a wearable accelerometer. The balance and gait characteristics of 13 elderly subjects have been scored by an expert clinician while performing 8 different motor tasks according to the Tinetti Scale protocol. Two statistical analysis were selected. First, a linear regression study was performed between the Tinetti scores and 8 features (one feature for each task). Second, the generalization quality of the regression model was assessed using a Leave-One Subject-Out approach. The multiple linear regression provided a high correlation between the Tinetti scores and the features proposed (adj. R2 = 0:948; p = 0:003). Moreover, six of the eight features added statistically significantly to the prediction of the scores (p < 0:05). When testing the generalization capability of the model, a moderate linear correlation was obtained (R2 = 0:67; p < 0:05). The results suggested that the automatic method might be a promising tool to assess the falling risk of older individuals. © 2015 IEEE.


Abbatecola A.M.,Italian National Research Center on Aging | Spazzafumo L.,Statistic and Biometry Center | Corsonello A.,Research Hospital of Cosenza | Sirolla C.,Statistic and Biometry Center | And 2 more authors.
Rejuvenation Research | Year: 2011

Background: A fast and simple tool is needed to test for the risk of mortality and rehospitalization in older patients. Objective: The aim of this study was to construct and validate a prognostic index using specific items from the Comprehensive Geriatric Assessment (CGA) in a large population of older hospitalized adults. Method: This was a prospective study of a 24-month follow-up period, between 2005 to 2008 in 3,043 elderly patients (mean age, 81±6) discharged from three acute geriatric wards in the Marche region of Italy. Baseline predictors of demographics and 25 items from the CGA regarding functional and cognitive status, depression, co-morbidity, social isolation, and quality of life were used to build a summary score, the Hospitalized Older Patient Examination (HOPE) Index. The HOPE index was developed in 1,533 patients and validated in 1,510 consecutively hospitalized patients. Outcome measures were 24-month mortality and rehospitalization. Results: Three risk categories of HOPE based on the best sensitivity and specificity for mortality and rehospitalization were: Low (≤4), moderate (4-8), and high (≥8). Categorizing data across the HOPE index, mortality ranged from 7.9% to 14.5% in the development cohort and 6.2% to 14.0% in the validation cohort, whereas rehospitalization ranged from 68.3% to 79.4% and 69.8% to 79.8%, respectively. Kaplan-Meier survival curves demonstrated that risk for mortality increased with a worsening across the HOPE index (p<0.001). In the development and validation cohorts, a close agreement was found for HOPE on mortality and rehospitalization with a receiver operating characteristic (ROC) of 0.69 (95% confidence interval [CI] 0.61-0.74) vs. 0.67 (95% CI 0.57-0.70) and rehospitalization of 0.62 (95% CI 0.58-0.66) vs. 0.60 (95% CI 0.56-0.63), respectively. In the development and validation cohorts, Cox proportional hazard models showed that a high HOPE index predicted risks of 2.38 (1.34-4.23) and 2.86 (1.24-6.61) on mortality and 1.27 (1.09-1.44) and 1.37 (1.10-1.64) on rehospitalization, respectively. Conclusions: HOPE may be useful for long-term clinical planning, discharge, and follow-up. © Copyright 2011, Mary Ann Liebert, Inc. 2011.


Abbatecola A.M.,Scientific Direction Italian National Research Center on Aging | Fumagalli A.,Research Hospital of Casatenovo | Spazzafumo L.,Statistic and Biometry Center | Betti V.,Scientific Direction Italian National Research Center on Aging | And 5 more authors.
Age and Ageing | Year: 2014

Background: Body composition has been shown to be correlated with physical performance, but data in older persons with diverse chronic diseases are lacking. Objective: We aimed at investigating the associations of body composition to gait speed and nutritional status of older people in different stages of chronic obstructive pulmonary disease (COPD). Design, setting and subjects: Cross-sectional analysis of data from Pulmonary Rehabilitation Geriatric Unit at INRCA in Casatenovo, Italy including 132 consecutively admitted COPD patients (mean age: 75 years) with data on body composition, walking speed and respiratory parameters. Methods: Body mass parameters were assessed using bioelectrical impedance analysis. Pulmonary function tests included spirometry and arterial blood gases. Differences among body composition markers were compared according to gender. Separate multivariate linear regression models with gait speed as the dependent variable were used to test for independent associations with body composition markers after adjusting for multiple confounders. Results: Walking speed deteriorated with increasing severity of COPD. Men were heavier and had more lean mass than women. Participants in the fastest gait tertile were younger, had lower body mass index and fat mass (FM); higher lean-to-fat ratio and albumin levels and better respiratory function (FEV1, FVC) compared with those in the slower tertiles. Total body FM was an independent determinant of walking speed, while fat-free mass and lean-to-fat ratio were not. Conclusions: Excess body fat may be harmful for physical functioning among elders with COPD. © The Author 2013. Published by Oxford University Press on behalf of the British Geriatrics Society.


PubMed | Research Hospital of Casatenovo, Research Hospital of Cosenza, Statistic and Biometry Center, Scientific Direction Italian National Research Center on Aging and Geriatric Hospital
Type: Journal Article | Journal: Age and ageing | Year: 2014

Body composition has been shown to be correlated with physical performance, but data in older persons with diverse chronic diseases are lacking.We aimed at investigating the associations of body composition to gait speed and nutritional status of older people in different stages of chronic obstructive pulmonary disease (COPD).Cross-sectional analysis of data from Pulmonary Rehabilitation Geriatric Unit at INRCA in Casatenovo, Italy including 132 consecutively admitted COPD patients (mean age: 75 years) with data on body composition, walking speed and respiratory parameters.Body mass parameters were assessed using bioelectrical impedance analysis. Pulmonary function tests included spirometry and arterial blood gases. Differences among body composition markers were compared according to gender. Separate multivariate linear regression models with gait speed as the dependent variable were used to test for independent associations with body composition markers after adjusting for multiple confounders.Walking speed deteriorated with increasing severity of COPD. Men were heavier and had more lean mass than women. Participants in the fastest gait tertile were younger, had lower body mass index and fat mass (FM); higher lean-to-fat ratio and albumin levels and better respiratory function (FEV1, FVC) compared with those in the slower tertiles. Total body FM was an independent determinant of walking speed, while fat-free mass and lean-to-fat ratio were not.Excess body fat may be harmful for physical functioning among elders with COPD.


PubMed | Research Hospital of Casatenovo, Research Hospital of Cosenza, Italian National Research Center on Aging, Biostatistical Center and Advanced Technology Center for Aging Research
Type: Clinical Trial | Journal: Aging clinical and experimental research | Year: 2015

Italy is expected to experience the largest growth in persons 65 years (>20% by 2020). This demographic shift allows for geriatric research on predictive clinical and biological markers of outcomes related to frailty, re-hospitalization and mortality.To describe rationale and methods of the Report-AGE study project of acute care patients in Italian National Research Center on Aging (INRCA) research hospitals.Report-AGE study is a large observational study on health conditions and outcomes of hospitalized elderly patients (65 years). The primary objective of the study is to create a high-level data resource of demographics, comprehensive geriatric assessments, clinical and diagnostic information, as well as biological and molecular markers in all older patients admitted to INRCA Hospitals. Assessments in physical and nutritional parameters, co-morbid health conditions, and associations with frailty parameters are ongoing in older hospitalized adults following an acute event. Study collection began in September 2011.Up to date, there are 3479 patients 65 years (mean age: 85 7years) with 1543 men and 1936 women enrolled. Data have been recorded regarding functional and clinical parameters before, during hospital admission and at discharge. Data collection for primary outcome analyses related to re-hospitalization and mortality is estimated for September 2016.This study aims at collecting precise clinical data, comprehensive geriatric assessment, risk factors, and biological data from acute care patients. Data will also be used to identify mechanisms underlying frailty in this specific population.This study provides a descriptive epidemiological collection of the health conditions of older in-patients.

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