Preventing Dementia-A Cross-Sectional Study of Outpatients in a Tertiary Internal Medicine Department.

Dementia is a significant health problem worldwide, being the seventh leading cause of death (2,382,000 deaths worldwide in 2016). Recent data suggest there are several modifiable risk factors that, if addressed, can decrease dementia risk. Several national dementia screening programs exist; however, limited-income countries do not have the means to implement such measures. We performed a prospective cross-sectional study in an outpatient department to identify individuals at risk for dementia. Patients with no known cognitive dysfunction seeking a medical consult were screened for dementia risk by means of the cardiovascular risk factors, ageing, and dementia (CAIDE) and modified CAIDE tests. Additionally, we collected demographic and clinical data and assessed each participant for depression, mental state, and ability to perform daily activities. Of the 169 patients enrolled, 63.3% were identified as being in the intermediate-risk or high-risk group, scoring more than seven points on the mCAIDE test. Over 40% of the elderly individuals in the study were assessed as "somewhat depressed" or "depressed" on the geriatric depression scale. Almost 10% of the study population was diagnosed de novo with cognitive dysfunction. In conclusion, using a simple questionnaire such as the mCAIDE in a predefined high-risk population is easy and does not represent a major financial burden. At-risk individuals can subsequently benefit from personalized interventions that are more likely to be successful. Limited-resource countries can implement such screening tools in outpatient clinics.

Factors Associated with Burnout in Medical Staff: A Look Back at the Role of the COVID-19 Pandemic.

Despite the significant consequences for medical practice and public health, burnout in healthcare workers remains underestimated. Pandemic periods have increased the reactivity to stress by favoring some changes whose influence are still felt. PURPOSE: This study aims to identify opportune factors during pandemic periods that predispose medical personnel to burnout and the differences between medical staff which worked with COVID-19 patients and those who did not work with COVID-19 patients. MATERIAL AND METHODS: This is a prospective study on 199 subjects, medical staff and auxiliary staff from national health units, COVID-19 and non-COVID-19, who answered questions using the Google Forms platform about the level of stress related to the workplace and the changes produced there. All statistical analyses were conducted using IBM SPSS Statistics (Version 28). RESULTS: The limited equipment and disinfectant solutions from the lack of medical resources category, the fear of contracting or transmitting the infection from the fears in relation to the COVID-19 pandemic category and the lack of personal and system-level experience in combating the infection due to the lack of information on and experience with COVID-19 were the most predisposing factors for burnout. No significant differences were recorded between those on the front line and the other healthcare representatives. CONCLUSIONS: The results of this study identify the stressors generated in the pandemic context with prognostic value in the development of burnout among medical personnel. At the same time, our data draw attention to the cynicism or false-optimism stage of burnout, which can mask a real decline.

The Impact of Heart Rate Variability Monitoring on Preventing Severe Cardiovascular Events.

The increase in the incidence of cardiovascular diseases worldwide raises concerns about the urgent need to increase definite measures for the self-determination of different parameters, especially those defining cardiac function. Heart rate variability (HRV) is a non-invasive method used to evaluate autonomic nervous system modulation on the cardiac sinus node, thus describing the oscillations between consecutive electrocardiogram R-R intervals. These fluctuations are undetectable except when using specialized devices, with ECG Holter monitoring considered the gold standard. HRV is considered an independent biomarker for measuring cardiovascular risk and for screening the occurrence of both acute and chronic heart diseases. Also, it can be an important predictive factor of frailty or neurocognitive disorders, like anxiety and depression. An increased HRV is correlated with rest, exercise, and good recovery, while a decreased HRV is an effect of stress or illness. Until now, ECG Holter monitoring has been considered the gold standard for determining HRV, but the recent decade has led to an accelerated development of technology using numerous devices that were created specifically for the pre-hospital self-monitoring of health statuses. The new generation of devices is based on the use of photoplethysmography, which involves the determination of blood changes at the level of blood vessels. These devices provide additional information about heart rate (HR), blood pressure (BP), peripheral oxygen saturation (SpO2), step counting, physical activity, and sleep monitoring. The most common devices that have this technique are smartwatches (used on a large scale) and chest strap monitors. Therefore, the use of technology and the self-monitoring of heart rate and heart rate variability can be an important first step in screening cardiovascular pathology and reducing the pressure on medical services in a hospital. The use of telemedicine can be an alternative, especially among elderly patients who are associated with walking disorders, frailty, or neurocognitive disorders.

Factors Associated with Burnout in Healthcare Professionals.

Burnout in healthcare professionals remains an ongoing concern. There are a number of variables associated with reactivity to stress in healthcare staff. This study wants to identify risk factors which predispose healthcare professionals to burnout. MATERIAL AND METHODS: The cross-sectional study included a group of 200 subjects, medical staff and auxiliary staff from the national health units, who gave their free consent to answer the questions regarding the level of perceived stress at work. The screening tool used was disseminated through the Google Forms platform, maintaining the anonymity of the participants. RESULTS: Resident doctors (42%) responded predominantly, reporting the highest level of burnout, with nurses (26.5%) being the least affected (χ2 = 36.73, p < 0.01). Less work experience is correlated with increased burnout (rho = 0.29, p < 0.01). Reactivity to stress was highly associated with workplace, with ambulance staff being the most vulnerable (χ2 = 6.58, p < 0.05). Participants' relationship status significantly influenced the burnout rate, the unmarried, with or without a partner, being more affected (χ2 = 16.14, p < 0.01). There are no significant differences between male and female gender, regarding the average level of burnout (U = 1.47; p > 0.05), nor between living in a house or apartment (U = 4.66; p > 0.05). Positive associations were identified between the level of burnout and variables such as: management pressure, administrative work, routine, regretting decisions regarding patients, harassment at work and sacrifice of personal time. CONCLUSIONS: The results of this study identify age, profession, workplace seniority and relationship status as factors associated with burnout in medical personnel.

Chronic Coronary Syndrome in Frail Old Population.

The demographic trend of aging is associated with an increased prevalence of comorbidities among the elderly. Physical, immunological, emotional and cognitive impairment, in the context of the advanced biological age segment, leads to the maintenance and precipitation of cardiovascular diseases. Thus, more and more data are focused on understanding the pathophysiological mechanisms underlying each fragility phenotype and how they potentiate each other. The implications of inflammation, sarcopenia, vitamin D deficiency and albumin, as dimensions inherent in fragility, in the development and setting of chronic coronary syndromes (CCSs) have proven their patent significance but are still open to research. At the same time, the literature speculates on the interdependent relationship between frailty and CCSs, revealing the role of the first one in the development of the second. In this sense, depression, disabilities, polypharmacy and even cognitive disorders in the elderly with ischemic cardiovascular disease mean a gradual and complex progression of frailty. The battery of tests necessary for the evaluation of the elderly with CCSs requires a permanent update, according to the latest guidelines, but also an individualized approach related to the degree of frailty and the conditions imposed by it. By summation, the knowledge of frailty screening methods, through the use of sensitive and individualized tools, is the foundation of secondary prevention and prognosis in the elderly with CCSs. Moreover, a comprehensive geriatric assessment remains the gold standard of the medical approach of these patients. The management of the frail elderly, with CCSs, brings new challenges, also from the perspective of the treatment particularities. Sometimes the risk-benefit balance is difficult to achieve. Therefore, the holistic, individualized and updated approach of these patients remains a desired objective, by understanding and permanently acquiring knowledge on the complexity of the frailty syndrome.

Relationship between Frailty and Depression in a Population from North-Eastern Romania.

(1) Background: In the older population, depression often affects people with chronic medical illnesses, cognitive impairment, or disability. Frailty is another important issue affecting older adults, being difficult to clinically distinguish from frailty in advanced old age. Well-designed interventional studies and clinical strategies targeting both frailty and depression are rare or nonexistent. (2) Methods: We realized a retrospective study in which we included a total of 411 patients that were admitted to the Geriatric Clinic from "Dr. C. I. Parhon" Hospital from Iasi for a period of 13 months. The aim of our study was to investigate the relationship between depression and frailty in a geriatric population due to the fact that the quality of life is negatively influenced by both frailty and depression. (3) Results: The prevalence of the depressive symptoms screened by the GDS-15 was 66.7%, with women being more depressed than men. Furthermore, an obvious relationship between depression and the dependence degree in performing daily activities has been observed. In addition, the mean MMSE score decreased with an increasing degree of depression. (4) Conclusions: Our study demonstrates the association between frailty and depression, one of them being a risk factor in the development of the other. A poor acknowledgment of the problem and an underdiagnosis of these conditions are important public health concerns due to the high healthcare costs. Thus, an active primary prevention would be imperiously needed in order to diagnose frailty and depression at an early stage, increasing the quality of life of the elderly and also their successful aging.

Evaluation of frailty and its impact on geriatric assessment.

AIM: Frailty has become an increasingly important topic, being directly correlated with ageing, presence of comorbidities, and also with other factors. It is a state of high vulnerability and is a consequence of ageing-related decline in whole body functioning. In order to initiate preventive and therapeutic measures, we need to identify the characteristics of current frail older adults. To identify the characteristics of frailty depending on age, area of residence and to assess the relationship between frailty and disability, cognitive impairment, malnutrition, depression and comorbidities. METHODS: Included in the study were 663 consecutively admitted patients over the age of 65. Frailty was evaluated using the Fried criteria and a comprehensive geriatric assessment. The mean age of the subjects enrolled in this study was 76.58 ± 6.5 years, most of the patients residing in rural areas (62.4%). RESULTS: A diagnosis of frailty was made in 73% of the study patients. The presence of frailty was found to be negatively correlated, statistically significant with cognitive function assessed by Mini-Mental State Examination (P = 0.039, r = -0.094) and malnutrition assessed by Mini Nutritional Assessment (P = 0.001, r = -0.151). Also, the presence of frailty was positively correlated, statistically significant with depression evaluated by Geriatric Depression Scale (P = 0.046, r = 0.093). CONCLUSIONS: Frailty is a common condition in the surveyed elderly population. It is associated with the presence of other geriatric syndromes such as malnutrition, cognitive impairment, depression, and is influenced by age.

Elder abuse and associated factors in eastern romania.

BACKGROUND: This article explores elder abuse in a hospitalised population. We wanted to identify details related to psychological and emotional abuse in the older population in our region and to determine the importance of the Elderly Abuse Suspicion Index (EASI© ) in comprehensive geriatric assessments. METHODS: This cross-sectional study conducted between March 2015 and May 2016 included 386 consecutive hospitalised patients over 65 years of age. All patients underwent a geriatric assessment, data were collected about their medical history, and the EASI© was administered to each. The main outcome was identifying the presence, the type of abuse and the factors associated with abuse. RESULTS: There were 21.5% of patients who suffered any form of abuse. Women were more frequently abused than men. Emotional abuse was the most common (60.2%) followed by neglect (53%) and physical abuse (22.91%); sexual abuse was absent in our study group. The abused patients had an impaired cognitive function (P = 0.034). They were also malnourished (P ≤ 0.001) and depressed (P = 0.001). The presence of peripheral artery disease, stroke, pneumonia, chronic kidney disease, musculoskeletal diseases and anxiety correlated with the presence of abuse. No statistically significant correlation was found between the degree of independence in instrumental activities of daily living and the presence of abuse (r = 0.105, P = 0.051). CONCLUSIONS: EASI is a tool for detecting elder abuse and should be included in the standard geriatric assessment to prevent ageism. The number of abused elderly patients is significant, and the multiple factors associated with abuse are diverse.

A New Integrated System for Assistance in Communicating with and Telemonitoring Severely Disabled Patients.

In this paper, we present a new complex electronic system for facilitating communication with severely disabled patients and telemonitoring their physiological parameters. The proposed assistive system includes three subsystems (Patient, Server, and Caretaker) connected to each other via the Internet. The two-way communication function is based on keywords technology using a WEB application implemented at the server level, and the application is accessed remotely from the patient's laptop/tablet PC. The patient's needs can be detected by using different switch-type sensors that are adapted to the patient's physical condition or by using eye-tracking interfaces. The telemonitoring function is based on a wearable wireless sensor network, organized around the Internet of Things concept, and the sensors acquire different physiological parameters of the patients according to their needs. The mobile Caretaker device is represented by a Smartphone, which uses an Android application for communicating with patients and performing real-time monitoring of their physiological parameters. The prototype of the proposed assistive system was tested in "Dr. C.I. Parhon" Clinical Hospital of Iasi, Romania, on hospitalized patients from the Clinic of Geriatrics and Gerontology. The system contributes to an increase in the level of care and treatment for disabled patients, and this ultimately lowers costs in the healthcare system.

The Psychological Abuse of the Elderly - a Silent Factor of Cardiac Decompensation.

Abuse of the elderly is a major issue debated worldwide. The most commonly identified form of abuse is the physical abuse. It is also the most frequently studied in the medical literature. However, at least six types of elder abuse are identified, and physical abuse is found in a small proportion of the cases. The consequences of abuse are frequent and, by prolonging hospitalizations, they will be associated with high costs of medical services, and patient's lack of self-confidence which, in time, may lead to social isolation, somatization, anxiety, depression, and suicide attempts. In this context, the identification and correction of psychological abuse becomes a desideratum of utmost importance for ensuring an optimal therapeutic response. This should be done by using a simple method that does not require qualified personnel, but allows the patient to be guided towards psychological consultation; this study was carried out with the help of the EASI EASI (The Elder Abuse Suspicion Index) questionnaire. We present the case of an 80-year old patient in a rural area, who has been hospitalized several times, admitted for numerous episodes of global cardiac decompensation (about four over the last year). The causes of cardiac decompensation were, systematically, non-compliance with treatment, regardless of all attempts to readjust and simplify the therapeutic schemes. The dynamic geriatric assessment showed a deterioration of the patient's mental and nutritional status and an accentuation of depression. The EASI questionnaire used during the last admission corroborated with the psychological consultation and detected several types of abuse: abandonment, negligence and financial abuse. Given that the complexity of care, the frequency of hospitalizations and the length of stay were reduced, therapeutic compliance increased and the mental and nutritional status improved after correcting the abuse.

A case of severe hypoalbuminemia associated with chronic congestive heart failure: the role of the tricuspid regurgitation.

Hypoalbuminemia is considered an independent predictor of mortality, especially in elderly patients. It is common in patients with congestive heart failure, when is due to several mechanisms: increased volume of distribution, significant stasis in the mesenteric circulation and altered protein metabolism in the liver. These alterations are even more pregnant when tricuspid regurgitation is associated or aggravated by different risk factors (recent infections, anemia, hyperthyroidism). We present the case of an elderly patient with severe hypoproteinemia and important hypoalbuminemia associated with congestive heart failure and aggravation of tricuspid regurgitation. The differential diagnosis concluded that hypoalbuminemia was influenced by tricuspid regurgitation as it enhanced liver dysfunction and enteral protein absorption due to increased stasis in mesenteric system. On the other hand, hypoalbuminemia contributed to the progression of heart failure by favoring myocardial edema, volume overload, and diuretic resistance. This is why correct management of this situation should include removal of subclinical excess of fluid and renutrition. A multidisciplinary approach is needed in order to achieve a good control of the symptoms and a significant improvement of quality of life.

Approaching frailty as the new geriatric syndrome.

Ageing is inevitably associated with a decline in physiologic reserves. Frailty results from reaching a threshold of decline across multiple organ systems. By consequence, it is associated with a high vulnerability and reduced ability to maintain homeostasis. This vulnerability is not only age-related, but also related to disability and comorbidity, as illustrated by three clinical cases. Sarcopenia, which is defined as age-related loss of muscle mass, is considered to be a central manifestation of frailty. In addition to being highly prevalent in elderly population, frailty also exerts a substantial impact on quality of life. As it is extremely challenging by defying conventional medication and involving new therapeutically approaches, frailty fully qualifies as a new geriatric syndrome.

Self-neglect in the case of the elderly. Where are we now?

UNLABELLED: Self-neglect in an elderly person is a behavior that threatens his/her own health and safety. It is present when a person refuses to adequately feed, water, shelter, or clothe himself, refuses medication or medical care, and personal safety measures. MATERIAL AND METHOD: This is a multicentric study of self-neglect in three geriatric units from Finland, Greece and Romania The medical, social, psychological and behavioral profile analysis was based on a questionnaire; this questionnaire relied on existing studies and social, economic and medical facts in the three countries. The cognitive function, nutritional status, and the presence or absence of depression have also been assessed. RESULTS AND DISCUSSIONS: The data obtained until now support the importance of self-neglect among the elderly. The social-medical network should not only identify, diagnose, prevent, and treat the elderly affected by the phenomenon of self-neglect, but also educate the society to help them and, moreover, to prevent their marginalization.

[Correlation between cognitive impairment and cardiovascular risk factors in dialysis vs. non-dialysis elderly patients]. / Corelatia între deficitul cognitiv si factorii de risc cardiovascular la pacientul vârstnic dializat vs. nedializat.

UNLABELLED: The emergence or worsening of cognitive impairment is a consequence of the aging process. Geriatric depression occurs due to cognitive impairment associated with aging, and as it develops, it also affects the cognitive function. AIM: To analyze retrospectively over a period of 6 months the clinical parameters and biological differences of the depression and cognitive impairment in dialyzed and non-dialyzed elderly patients. MATERIAL AND METHODS: There were 63 patients over 65 years included in the study (29 patients admitted to the Geriatric Department of the "C. I. Parhon" Hospital, Iasi, and 34 patients that were in the renal dialysis program into the Transplant Centre Iasi) that were evaluated in terms of cognitive status and level of depression through the following tests: MMSE (the cognitive impairment severity assessment), the Geriatric Depression Score, the modified Hachinski Ischemic Score (for vascular dementia). The resulting data were interpreted statistically by SPSS 12.0 software and the results were evaluated by t- Student test (p <0.05). RESULTS: The average age was 73.2 + / -6.1 for non-dialyzed patients group and 69.8 +/- 4.6 for dialyzed group. Body mass index (BMI), hemoglobin, glucose and lipids were similar for both categories of patients. In the dialyzed group, depression is correlated with an elevated blood triglycerides, and the vascular dementia is correlated with glucose levels (p=0.04). Cognitive impairment is more accentuated in the dialyzed group compared to the non dialyzed one. CONCLUSIONS: Elderly dialyzed people are likely to develop more frequently and more severely vascular dementia than non-dialyzed old people, probably in the context of the factors that are related with dialysis itself.