Mesothelioma in Familial Mediterranean Fever With Colchicine Intolerance: A Case Report and Literature Review.

A 65-year-old Italian physician affected by Familial Mediterranean fever (FMF) was hospitalized due to progressive abdominal enlargement, which had begun 6 months before admission. Physical examination revealed ascites and bilateral leg edema. Abdominal CT scan showed ascitic fluid and extensive multiple peritoneal implants; peritoneal CT-guided biopsy revealed an epithelial-type malignant mesothelioma. The patient's past medical history revealed recurrent episodes of abdominal pain and fever from the age of 2. Clinical diagnosis of FMF was suspected at the age of 25, while genetic analysis, performed at the age of 50, confirmed homozygosity for the M694I mutation in the MEFV gene. Treatment with the first line FMF drug colchicine was started and stopped several times because of worsened leukopenia. The patient in fact had a history of asymptomatic leukopenia/lymphopenia from an early age; the intake of colchicine aggravated his pre-existing problem until the definitive suspension of the drug. As for second-line drugs, canakinumab was first prescribed, but due to prescription issues, it was not possible to be administered. When he was given anakinra, there was a worsening of leukopenia leading to septic fever. Systematic literature review indicates that, in most cases, recurrent peritoneal inflammation results in benign peritoneal fibrosis or less commonly in encapsulating peritonitis. There are only a few reported cases of recurrent peritoneal inflammation progressing from FMF to peritoneal mesothelioma (MST). In such cases, intolerance to colchicine or its erratic intake may lead to long-term recurrent inflammation, which usually precedes the development of the tumor, while pre-existing leukopenia, as in our patient, could also be a factor promoting or accelerating the tumor progression. In conclusion, we suggest that in the presence of intolerance or resistance to colchicine, interleukin (IL)-1 inhibition could suppress peritoneal inflammation and prevent MSTs.

Distress of caregivers of older adults receiving home care in European countries: results from the AgeD in HOme Care Study.

OBJECTIVE: To identify factors associated with distress of caregivers of home care patients in Europe and to assess whether caregivers response to distress varies among countries. DESIGN AND SETTING: Cross-sectional study among older adults receiving home care in 11 European countries. PARTICIPANTS: A total of 3,449 older adults receiving home care in Europe. MEASUREMENT: Caregiver distress was assessed by asking whether caregiver was distressed, angry, depressed, or in conflict because of caring for the participant. RESULTS: Mean age of study participants was 82.4 years, and distress was present in 7.5% of their caregivers. In all the country sample, number of depressive symptoms (OR 1.38, 95% CI: 1.27-1.49), cognitive performance scale score (OR 1.19, 95% CI: 1.10-1.30), number of impaired Activities of Daily Living (OR 1.36, 95% CI: 1.25-1.47), and number of behavioral symptoms (OR 1.28, 95% CI: 1.04-1.58) were significantly associated with caregivers distress. These associations were consistent among caregivers in all countries. Overall, 295 caregivers (8.6%) felt that participant would be better off in another living environment, and 1,444 (41.9%) caregivers were willing to increase help. Despite an elevated rate of distress, a low proportion of caregivers in Italy (3.0%), Germany (6.1%), and France (5.5%) felt that participants would be better off in another living environment. By contrast, in countries with lower rate of distress, as Iceland and the Netherlands, this rate was more elevated (15.5% and 20.6%, respectively). CONCLUSION: Distress of caregivers is associated with patient cognitive and functional status, depressive, and behavioral symptoms, and there are national differences in the response to distress.

Patient depression and caregiver attitudes: results from The AgeD in HOme Care study.

BACKGROUND: The present cross-sectional study was aimed to evaluate the association between care recipient depression and caregiver attitudes. METHODS: Data were from The AgeD in HOme Care project, a study enrolling subjects aged >or=65 years receiving home care in Europe. Depression was diagnosed as a score >or=3 on the MDS Depression Rating Scale. Caregiver attitudes were assessed using two measures: 1) caregiver dissatisfaction (the caregiver was dissatisfied with the support received from family and friends); and 2) caregiver distress (the caregiver expressed feelings of distress, anger, or depression). RESULTS: Mean age of 3415 participants was 82.4 years, 2503 (73.3%) were women and 430 (12.6%) were depressed. Dissatisfaction was significantly more common among caregivers of depressed, compared with those of non depressed patients (32/430, 7.4% vs. 78/2985, 2.6%; p=<0.001). After adjusting for potential confounders, patient depression was still significantly associated with caregiver dissatisfaction (OR: 1.84; 95% CI: 1.12-3.03). Similarly, distress was significantly more common among caregivers of depressed patients, compared with those of non depressed patients (81/430, 18.8% vs. 175/2985, 5.9%; p<0.001). After adjusting for potential confounders, patient depression was still significantly associated with caregiver distress (OR: 2.41; 95% CI: 1.72-3.39). LIMITATIONS: The cross-sectional design of the study cannot provide the cause-effect relationship between depression and caregiver attitude; no data were collected on caregiver characteristics. CONCLUSIONS: Among older adults depression is associated with increased caregiver dissatisfaction and distress. Knowledge of factors influencing caregiver attitudes may be valuable to study interventions aimed to promote patient and caregiver well being.

Physical activity prevented functional decline among frail community-living elderly subjects in an international observational study.

OBJECTIVES: The aims of the study were to describe the prevalence of physical activity in a sample of older adults in home care in Europe and to examine the relationship between physical activity and incident disability. STUDY DESIGN AND SETTING: Study population consisted of a random sample of 2,005 subjects aged 65 or older admitted to home care programs in 11 European Home Health Agencies who participated in AgeD in HOme Care project. Participants who reported spending 2 or more hours of physical activities in last 3 days were defined physically active. Disability performing activities of daily living was defined as the need of assistance in one or more of the following ADL: eating, dressing, transferring, mobility in bed, personal hygiene, and toileting. RESULTS: More than 50% of participants were physically active. During a median follow-up of 12 months, 370 subjects (15%) became disabled. After adjusting for age, gender, and other possible confounding variables, active subjects were significantly less likely to become disabled compared to those reporting no or very low-intensity physical activity (OR, 0.67; 95% CI 0.53-0.84). CONCLUSIONS: These findings support the possibility that physical activity has an independent effect on functional autonomy among frail and old people.

Case management and risk of nursing home admission for older adults in home care: results of the AgeD in HOme Care Study.

OBJECTIVES: To explore the relationship between a case management approach and the risk of institutionalization in a large European population of frail, old people in home care. DESIGN: Retrospective cohort study. SETTING: Eleven European countries. PARTICIPANTS: Three thousand two hundred ninety-two older adults receiving home care (mean age 82.3+/-7.3). MEASUREMENTS: Data on nursing home admission were collected every 6 months for 1 year. RESULTS: One thousand one hundred eighty-four (36%) persons received a home care program based on case management, and 2,108 (64%) received a traditional care approach (no case manager). During the 1-year follow-up, 81 of 1,184 clients (6.8%) in the case management group and 274 of 2,108 (13%) in the traditional care group were admitted to a nursing home (P<.001). After adjusting for potential confounders, the risk of nursing home admission was significantly lower for participants in the case management group than for those in a traditional care model (adjusted odds ratio=0.56, 95% confidence interval=0.43-0.63). CONCLUSION: Home care services based on a case management approach reduce risk of institutionalization and likely lower costs.

Association between pain and depression among older adults in Europe: results from the Aged in Home Care (AdHOC) project: a cross-sectional study.

OBJECTIVE: To assess the association between pain and depression in a population of older adults. METHOD: We conducted a cross-sectional study using data from the Aged in Home Care (AdHOC) database, which contains information on older adults receiving home care services in 11 European countries from 2001 to 2003. Pain was defined as any type of pain or discomfort manifested over the 7 days preceding the assessment. Depression was defined as a score >or= 3 on the Minimum Data Set Depression Rating Scale. RESULTS: Mean age of 3976 subjects entering the study was 82.3 years, and 2948 (74.1%) were women. Of the total sample, 2380 subjects presented with pain (59.9%), but its prevalence differed substantially among countries. Depression was diagnosed in 181 (11.3%) of the 1596 participants without pain and in 464 (19.5%) of the 2380 participants with pain (p < .001). After adjusting for potential confounders, pain was significantly associated with depression (odds ratio [OR] 1.76, 95% confidence interval [CI] = 1.43 to 2.17). This association seemed to be modified by sex. Compared to male participants without pain, women with pain were significantly more likely to present with depression (OR = 1.77; 95% CI = 1.29 to 2.42), while no significant difference was observed for women without pain (OR = 0.86; 95% CI = 0.61 to 1.22) and men with pain (OR = 1.24; 95% CI = 0.86 to 1.79). Among women, the association of pain and depression became progressively more pronounced as pain severity, pain frequency, and number of painful sites increased. CONCLUSION: This study documented that in a large sample of older adults living in the community, pain is associated with depression, especially among women.

Chewing problems and mortality in older adults in home care: results from the Aged in Home Care study.

OBJECTIVES: To assess the association between chewing problems and risk of mortality in an older population receiving home care in Europe. DESIGN: Retrospective cohort study. SETTING: Eleven European countries. PARTICIPANTS: Two thousand seven hundred fifty-five older adults (mean age+/-standard deviation 82.2+/-7.2) in home care. MEASUREMENTS: Data were collected using the Minimum Data Set for Home Care. Study personnel recorded chewing problems (inability to chew food easily and without pain or difficulties, regardless of cause) that presented in the last 3 days before baseline assessment. Data on mortality were collected over a 1-year period. RESULTS: Three hundred ninety-five participants (14.3%) presented with chewing problems. One-year mortality differed significantly according to presence of chewing problems; 303 of 2,361 (12.8%) without chewing problems (crude incident rate per person-year (p-y)=0.15) and 80 of 394 (20.3%) participants with chewing problems (crude incident rate per p-y=0.24) died during follow-up. After adjusting for potential confounders, the risk of death was significantly higher for participants with chewing problems (adjusted hazard ratio (HR)=1.45, 95% confidence intervals (CI)=1.05-1.99). This association remained after exclusion of participants with cognitive impairment (adjusted HR=1.50, 95% CI=1.03-2.20) and those with unintended weight loss (adjusted HR=1.62, 95% CI=1.12-2.34). CONCLUSION: In older adults in home care in Europe, chewing problems are associated with greater risk of mortality.

Non malignant daily pain and risk of disability among older adults in home care in Europe.

Aim of the present observational study was to evaluate the association between daily pain and incident disability in elderly subjects living in the community. We used data from the AgeD in HOme Care (AD-HOC) project, a 1 year longitudinal study enrolling subjects aged 65 or older receiving home care in 11 European countries. Daily pain was defined as any type of pain or discomfort in any part of the body manifested every day in the seven days before the baseline assessment. Disability performing activities of daily living (ADLs) was defined as the need of assistance in 1 or more of the following ADL: eating, dressing, transferring, mobility in bed, personal hygiene and toileting. Mean age of 1520 subjects participating the study was 82.1 (standard deviation 6.9) years, and 1178 (77.5%) were women and 695 (45.7%) reported daily pain at the baseline assessment. Overall, 123/825 participants (19.0%) with daily pain and 132/695 (14.9%) without daily pain reported incident disability during the 1 year follow up of the study. After adjustment for potential confounders, participants with daily pain had a significantly higher risk of developing disability, compared with other participants (hazard ratio 1.36; 95% CI: 1.05-1.78). The risk of disability increased with pain severity and with number of painful sites. In conclusion among old subjects living in the community, daily pain is associated with an increased risk of disability.

Cross-sectional association between behavioral symptoms and potential elder abuse among subjects in home care in Italy: results from the Silvernet Study.

OBJECTIVES: The objectives of this study were to evaluate the prevalence of potential elder abuse among older adults receiving home care and to assess the association between behavioral symptoms and potential abuse. METHODS: Data on 4,630 subjects aged 65 or older receiving home care in Italy were collected using the Minimum Data Set for Home Care assessment. Potential abuse included signs of physical or emotional abuse and neglect. Behavioral symptoms were present if the participant exhibited one or more of the following symptoms in the 3 days before the assessment: wandering, verbally abusive, physically abusive, socially inappropriate behavior, and active resistance to care. RESULTS: Mean age of participants was 80.5 years (standard deviation: 7.7) and 2,761 (60%) were female. Signs of potential abuse were identified in 336 of 3,869 (9%) participants without behavioral symptoms and 126 of 761 (17%) with behavioral symptoms. After adjustment for potential confounders, presence of behavioral symptoms was significantly associated with potential abuse (odds ratio [OR]: 1.56; 95% confidence interval [CI]: 1.21-2.00). Examining behavioral symptoms separately, wandering was negatively associated with potential abuse (OR: 0.58; 95% CI: 0.36-0.97), whereas other symptoms were positively associated with this outcome (verbally abusive behavior OR: 1.69, 95% CI: 1.24-2.31; physically abusive behavior OR: 1.42, 95% CI: 1.00-2.03; socially inappropriate behavior OR: 1.78, 95% CI: 1.26-2.53; active resistance of care OR: 1.69, 95% CI: 1.20-2.38). CONCLUSION: Signs of potential abuse are common among older adults in home care in Italy and they are associated with the presence of behavioral symptoms.

Depression and risk of nursing home admission among older adults in home care in Europe: results from the Aged in Home Care (AdHOC) study.

OBJECTIVE: Depression is a frequent condition observed among nursing home residents. However, so far, limited data are available on the impact of depression on nursing home admission. The aim of the present study was to assess the effect of depression on the risk of nursing home admission in a group of older adults receiving home care in Europe. METHOD: We conducted a longitudinal analysis using data from the Aged in Home Care (AdHOC) database, which contains information on older adults receiving home care services in 11 European countries. Subjects had been admitted to the home care programs between 2001 and 2003. Depression was diagnosed as a score >or=3 on the Minimum Data Set (MDS) Depression Rating Scale. Information on nursing home admission was collected semiannually for 1 year by trained research personnel. RESULTS: The mean age of 2718 older adults entering the study was 82.4 (SD = 7.3) years, 2047 (75.3%) were women, and 331 (12.2%) were depressed. Overall, 49/331 depressed participants (14.8%) and 252/2387 nondepressed participants (10.6%) were admitted to a nursing home (p = .02). After adjusting for potential confounders, the risk of nursing home admission was significantly higher for depressed participants (hazard ratio = 1.43, 95% CI = 1.02 to 2.02). The risk of nursing home admission progressively and significantly increased as MDS Depression Rating Scale score increased (signifying more severe depression) (p = .001 for linear trend). CONCLUSIONS: In older adults receiving home care in Europe, depression is associated with an increased risk for nursing home admission. This association increases with severity of depression.

Body mass index, free insulin-like growth factor I, and physical function among older adults: results from the ilSIRENTE study.

The aim of the present study was to evaluate the mediating role played by obesity on the relationship of free insulin-like growth factor I (IGF-I) and IGF-binding protein-3 (IGFBP-3) with muscle strength and physical performance. Data were from baseline evaluation of the ilSIRENTE Study. Muscle strength was measured by hand grip strength. Physical performance was assessed using the walking speed and the 0-3 Short Physical Performance Battery (SPPB) score. Based on its median value, free IGF-I was categorized in the following two groups: low IGF-I (IGF-I <0.65 ng/ml; n = 174) and high IGF-I (IGF-I > or =0.65 ng/ml; n = 175). Similarly, IGFBP-3 was categorized in the following two groups: low IGFBP-3 (IGFBP-3 <4,319.9 ng/ml; n = 174) and high IGFBP-3 (IGFBP-3 > or =4,319.9 ng/ml; n = 175). Body mass index (BMI) was categorized as follows: <25 kg/m(2) (n = 160), 25-29.9 kg/m(2) (n = 133), > or =30 kg/m(2) (n = 56). Mean age of the 349 participants was 85.8 yr, and 234 (67%) were women. After adjusting for potential confounders, no significant association of IGF-I and IGFBP-3 with study outcomes was observed. After the study sample was stratified by BMI groups, compared with participants with low IGF-I level, those with high IGF-I level had a significantly better grip strength [35.2 +/- 1.6 vs. 29.2 +/- 2.0 (SE) kg, P = 0.03], walking speed (0.55 +/- 0.04 vs. 0.40 +/- 0.04 m/s, P = 0.01), and SPPB score (1.9 +/- 0.1 vs. 1.5 +/- 0.1 m/s, P = 0.01) but only in the group with BMI > or =30 kg/m(2) and not in other BMI groups. A statistically significant interaction between BMI and IGF-I level was observed on all study outcomes. By contrast, no association was observed between IGFBP-3 and study outcomes, independently of BMI. In conclusion, high IGF-I level is associated with better physical function in older persons with obesity, but not in nonobese subjects.