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.
Lancioni L.,Marche Polytechnic University |
SpazzaFuMo L.,Statistic and Biometry Center |
Polonara S.,Azienda Ospedali Riuniti |
Abbatecola A.M.,National Health Research Institute |
And 2 more authors.
Journal of Nutrition, Health and Aging | Year: 2012
Objectives: Frail older adults are at an increased risk for adverse outcomes after an emergency Department (eD) visit. comprehensive geriatric assessment (cGa) has been proposed to screen for frailty in the eD, but it is difficult to carry out. We tested whether a cGa-based approach using the identification of Seniors at risk (iSar) screening tool was associated with the brief deficit accumulation index (Dai) of frailty. Design: prospective observational study. Setting: two urban eDs in italy. Participants: a cohort of 200 elderly (≥65 years) eD patients. Measurements: identifiers, triage, clinical and social data along with the administration of iSar. cGa was performed using: charlson index, Short portable Mental Status Questionnaire and Katz's aDl. Follow-up data at 30 and 180 days included: mortality, eD revisit, hospital admission, and functional decline. Frailty was defined according to a brief Dai. logistic regression evaluated the consistency of the frailty definition; roc curves evaluated iSar ability in identifying frailty. Results: Frailty was present in 117 (58.5%) subjects and predicted eD revisit and frequent eD return, hospitalization and 6-month mortality. iSar had an auc of 0.92 (95%ci 0.88-0.96, p<0.0001) in identifying frail elders in the eD and using a cut-off of 2 showed 94% sensitivity and 63% specificity. Conclusion: iSar is a useful screening tool for frailty and identifies elderly patients at risk of adverse outcomes after an eD visit. iSar can also be used to select high-risk patients more likely to benefit from a geriatric approach or intervention, independently of admission or discharge.
Achilli A.,University of Perugia |
Olivieri A.,University of Pavia |
Pala M.,University of Pavia |
Kashani B.H.,University of Pavia |
And 20 more authors.
PLoS ONE | Year: 2011
Mitochondrial dysfunction has been implicated in rare and common forms of type 2 diabetes (T2DM). Additionally, rare mitochondrial DNA (mtDNA) mutations have been shown to be causal for T2DM pathogenesis. So far, many studies have investigated the possibility that mtDNA variation might affect the risk of T2DM, however, when found, haplogroup association has been rarely replicated, even in related populations, possibly due to an inadequate level of haplogroup resolution. Effects of mtDNA variation on diabetes complications have also been proposed. However, additional studies evaluating the mitochondrial role on both T2DM and related complications are badly needed. To test the hypothesis of a mitochondrial genome effect on diabetes and its complications, we genotyped the mtDNAs of 466 T2DM patients and 438 controls from a regional population of central Italy (Marche). Based on the most updated mtDNA phylogeny, all 904 samples were classified into 57 different mitochondrial sub-haplogroups, thus reaching an unprecedented level of resolution. We then evaluated whether the susceptibility of developing T2DM or its complications differed among the identified haplogroups, considering also the potential effects of phenotypical and clinical variables. MtDNA backgrounds, even when based on a refined haplogroup classification, do not appear to play a role in developing T2DM despite a possible protective effect for the common European haplogroup H1, which harbors the G3010A transition in the MTRNR2 gene. In contrast, our data indicate that different mitochondrial haplogroups are significantly associated with an increased risk of specific diabetes complications: H (the most frequent European haplogroup) with retinopathy, H3 with neuropathy, U3 with nephropathy, and V with renal failure. © 2011 Achilli et al.