Changes of psychical and physical conditions in the elderly after a four-year follow-up.

The elderly show a loss of both the intellectual functions and of motion ability. This happens also without particular pathologies; possible tests to highlight this loss are the Mini Mental State Examination (MMSE), and the Functional Reach (FR)-test. During 2004-2005 winter 50 healthy subjects were analyzed; the subjects were divided into three age-groups: from 55 to 64 years; from 65 to 74 years; over 75 years of age. The test results showed a significant decline of MMSE and FR from the first group to the other two groups, a same behavior of male and female subjects, a greater decline of physical characteristics compared to psychic characteristics. During 2008-2009 winter several subjects (34 of 50) were again analyzed, and a more accurate facility was used to measure the FR. The aim of the new test has been the exam of the cognitive conditions and of the physical performances after the 4 year follow-up. The results of the new tests confirm the previous results, both with regard to the decline of the psychophysical characteristics from the first age-group to the others but the decrease is not as significant as the previous, and with regard to the greater physical decline. What is surprising is that the decline of both the psychic and the physical characteristics concerns only the first age-group, not the other two. Maybe healthy subjects, without particular pathologies reach a stabilization of the above-mentioned characteristics; some hypothesis is given to explain what happens.

Prevalence of pain in elderly hospitalized patients.

Several studies indicate that pain, although very common in the elderly, is under-treated, because it is considered as a concomitant effect of aging. This study aimed to evaluate the prevalence of pain among patients in eight Italian geriatric hospital departments, correlated to prescribed therapy. We enrolled 387 patients in the study, 367 of whom were evaluated. Each patient's recovery, co-morbidity, pain intensity, prescribed therapy, side effects, duration of pain, and efficacy of therapy were monitored during two 15-day periods from 15 July to end of August 2008, and from 1 October to 15 November 2008. The results of this study confirmed that hypertension, cardiopathic disease, diabetes, and chronic obstructive pulmonary disease (COPD) are common pathologies, and that pain is present in 67.3% of those recovered in geriatric departments. In general, however, pain is not treated. Indeed only 49% of those with pain had any type of treatment, which was adequate for the pain intensity. In fact 74.5% of patients considered the therapy to be of low or no efficacy. These data demonstrate the presence of pain in a high percentage of elderly patients, which is either not treated, or treated inadequately. Controlling pain is essential in elderly patients in order to allow a normal life and an active role in family and society. The main conclusion is that pain is often poorly considered in the elderly, thus leading to a dangerous under-treatment. We want to underline the crucial clinical impact of such under-treatment in elderly patients.

Recurrent syncope in elderly patients and tilt test table outcome: the role of comorbidities.

Syncope is a common disorder that can lead to serious consequences in the elderly. Tilt-test is a safe, useful specific tool to investigate recurrent syncope also in the elderly. Comorbidities and medication use, widely present in elderly patients, affecting the hemodynamic response, can influence the tilt-test outcome. The aim of this study was to evaluate the influence of these confounding factors on tilt-test results in elderly patients with recurrent syncope. We included in this study a consecutive group of 87 patients>75 years (82.1+/-4.3 years) with unexplained syncope. They underwent passive upright tilt-test. Heart rate an blood pressure were recorded using non-invasive devices. The patients were classified according to the modified Vasovagal Syncope International Study (VASIS). Comorbidities were measured with the geriatric index of comorbidities (GIC), which is a composite score taking into account both the number of diseases and their severity as measured by Greenfield's IDS. The tilt-test was positive in 22 patients. There were no significant differences in clinical characteristics, and medication use between the tilt-test negative and positive patients, except for the GIC score (1.12+/-0.5 vs. 2.42+/-0.48; p=0.001) and for a reduced number of medications in the former group (5.7+/-3.1 vs. 8.2+/-2.4; p=0.001). This study suggests that comorbidities and the number of medications could influence tilt test outcome.

Home care prevents cognitive and functional decline in frail elderly.

Today home health care (HHC) programs have been developed in numerous Western countries, in order to answer the questions regarding the care of frail elderly suffering from polypathologies and, therefore, being at high risk of disability. The HHC program of the Israelite Hospital of Rome has been planned as a complementary model, and not as a substitute of hospitalization, being able to offer flexible services, suitable for each elderly patient. The present study has established that taking care of old patients in their home allows us to prevent the deterioration of cognitive performance and functional impairments,as measured by the mini mental state examination (MMSE), the scales of activity of daily living (ADL), and the instrumental activity of daily living (IADL), respectively. We found considerable improvements also in the mood disorders during HHC, as measured by the geriatric depression scale (GDS). All psychometric tests were administered at the beginning of home care and after almost 1 year. Moreover, we formulated some questions regarding the quality of the offered services, and the answers revealed great satisfaction of both the patients and their caregivers.