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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.

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.

Bustacchini S.,Italian National Research Center on Aging | Abbatecola A.M.,Italian National Research Center on Aging | Bonfigli A.R.,Italian National Research Center on Aging | Chiatti C.,Italian National Research Center on Aging | And 8 more authors.
Aging Clinical and Experimental Research | Year: 2015

Background: 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. Aims: 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. Methods: 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. Results: 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. Discussion: 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. Conclusion: This study provides a descriptive epidemiological collection of the health conditions of older in-patients. © 2015, Springer International Publishing Switzerland.

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.

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