J. Gerontol. Geriatr., Volume 68, Issue 1 (March 2020) – 9 articles , Pages 1-59

Nowadays older patients with acute respiratory failure (ARF) leading to a severe respiratory acidosis are frequently ventilated using a non-invasive approach in intensive care unit (ICU). Current guidelines suggest that patients with more severe acidosis should be managed in a higher dependency area. However, the use of non-invasive ventilation (NIV) is effective and safe in treating ARF in general wards in elderly. a 82 years old male patient was admitted to a long term care facility due to a severe chronic obstructive pulmonary disease (COPD). Three days after the admission, he suffered of severe acute exacerbation of COPD leading to hypercapnic coma. NIV in Bi-PAP mode and standard medical therapy was started, taking into consideration the do-not-intubate order of the patient. His state of consciousness improved after 48 hours of NIV with decreasing of PaCO2 values and the patient was progressively weaned from the ventilator. NIV should be considered a successful approach even in unusual setting of long term facility. The choice of use NIV should be taken by multidisciplinary medical staff in a setting where nurses and medical team are trained in NIV protocol, in order to reduce ICU admission, intubation rates and mortality. Full article

Atrial fibrillation (AF) is a very common in clinical practice. The prevalence of AF is high after the age of 65 years. Patients with AF have a worse quality of life than healthy controls. However, concomitant higher hemorrhagic risks, severe cognitive and functional impairment may at least partly explain under-prescription of oral anticoagulants in the elderly [...] Full article

Elderly people often have typical age-related changes that may influence their way of life, for instance; hearing loss, impaired vision, joint pain, hypertension, coronary disease, diabetes, osteoporosis, cognitive impairment and so on. Being physically active helps one with coping better in older years. This review discusses the contribution of physical activity and fitness for the optimal health and wellness of older people. The types of physical activity are discussed, the benefits of physical activities are highlighted and the role of physical activity in the prevention of falls is also reviewed. Specifications for physical activity for the elderly people are highlighted, and importantly, safety considerations for physical activity for the elderly people are provided. In conclusion, physical activities have advantages for the prevention and management of many health-related conditions faced by an elderly person; as such, even limited or moderate physical activity is better than none. Full article

The prevalence of seizures and epilepsy in the elderly is generally underestimated. Epileptic seizures are not a rare occurrence in the elderly and their prevalence increases with age. The clinical manifestations of seizures, the aetiology, the treatment and the psychosocial impact of the epilepsy diagnosis may differ in the elderly. Differential diagnosis with episodes of unconsciousness and/or fall or other non-epileptic manifestations is often difficult. The presence of comorbidities, the polypharmatherapy and the age-related pharmacokinetic changes can represent a problem for the treatment of epilepsy in the elderly, with a higher risk of adverse effects and potentially inappropriate drug interactions. Epileptic seizures in the elderly can have semiological characteristics similar to those of other age groups. On the other hand, the richness of the electroclinical syndromes of childhood and adolescence is not found in the elderly, and, in particular, idiopathic generalized epilepsies are rarely expressed at this age. Symptomatic seizures related to acute structural injury or metabolic causes are particularly frequent. Therapy management of the elderly with an epileptic seizure should concern not only neurologists, but also general practitioners, geriatricians, and cardiologists, therefore involving a wide range of clinical specialties. This review aims to summarize the management of epilepsy in the elderly, reporting also differences in epidemiology, electroclinical features, aetiology and diagnostic procedures. Full article

Delirium, defined as an acute mental status with altered level of consciousness, is a common geriatric syndrome and a typical complication in hospitalized elderly patients. We aimed to assess the occurrence of delirium and the possible relationship with renal impairment. Patients aged over 65 years admitted consecutively to a Geriatric Unit, were screened for a first diagnosis of delirium. Delirium was evaluated using the validated Assessment Test for Delirium and Cognitive Impairment (4AT). Final analysis included 311 patients (182 women,129 men). Mean eGFR was 62.44 ± 28.84 mL/min/1.73 m². Prevalence of Cognitive impairment or delirium was 5.4, 84.8 e 9.8% for 0, 1-3 and ≥ 4 4AT scores. At univariate analysis, prevalence of clear delirium was increased with the worsening of CKD, being 3.7% in stage IIIb up to 68% in stage IV-V (p < 0.001). At multivariable logistic analysis, adjusted for gender and smoking habit, higher eGFR levels were associated with a reduced risk for the presence of delirium (OR = 0.86 95% CI 0.82-0.91, p < 0.001) and for developing possible cognitive impairment (OR = 0.87 95% CI 0.83-0.90, p < 0.001). Mild to moderate delirium is a pervasive condition among geriatric patients with manifested renal function impairment. Full article

There is a controversy about the association between Hepatocyte growth factor (HGF) and cognition. Increased serum level of HGF has been reported in patients with hypertension, peripheral arteriosclerosis and carotid atherosclerosis. Ankle-brachial index (ABI) is considered as a marker of atherosclerosis. we hypothesized that hypertension or atherosclerosis with hypertension could alter the relation between HGF serum level and cognitive function. To study HGF and cognitive function in hypertensives with and without atherosclerosis versus healthy controls. This case-control study included ninety elderly subjects attending outpatient primary care geriatric clinics. They were subdivided into 3 groups; Group A (30 normotensives with normal Ankle-brachial index (ABI) as controls, group B (30 hypertensives with normal ABI) and group C (30 hypertensives with abnormal ABI) as cases. Cognitive function was assessed by Rowland Universal Dementia Assessment Scale (RUDAS). Group C had worse score in RUDAS than controls (P = 0.01). HGF was negatively correlated with ABI in group C (p = 0.007). HGF was positively associated with RUDAS score, in group A (p < 0.001), in group B; after further adjustment for systolic blood pressure (SBP) (p = 0.024) and in group C; after adjustment for ABI (p = 0.031) or ABI and SBP (p = 0.05). The potential beneficial link between HGF serum concentration and cognition was met in normotensive subjects with normal ABI. However, this link is halted in the presence of hypertension or atherosclerosis as assessed by ABI. Alternatively, the raised HGF serum level may be an epiphenomenon of atherosclerosis. Full article

Background and aims. Bedside chest ultrasound has emerged as a versatile and accurate diagnostic tool for the management of respiratory conditions in several clinical settings, integrating traditional imaging. The current utilization of this technique in geriatric hospital wards is still unknown. Our aim was to assess availability, uses and applications of chest ultrasonography in a convenience sample of 25 Italian geriatric wards. Methods. A questionnaire, based on the current literature state-of-theart, was e-mailed to head doctors of geriatric wards of Italian hospitals. The questionnaire explored ultrasound equipment availability, practice of chest ultrasound, expertise of ward physicians, clinical indications, and perceived impact on patient care. Results. Ultrasound equipment was available in 92% of wards, and chest ultrasound was performed in 82% of cases. Among the wards where chest ultrasound was performed, it was considered as routine assessment in only 52% of cases, mainly for diagnosis of pleural effusions (95%) and acute heart failure (89%), assessment of volemic state (79%), and assistance to invasive procedures (79%). It was used in emergency/ urgency assessment of acute dyspnea in only 53% of cases. In most wards, only three or less physicians were able to perform chest ultrasound. In 53% of cases, head doctors declared that they perceived benefits of chest ultrasound in patient care in only selected cases. Conclusions. Chest ultrasound utilization in Italian geriatric wards is inhomogeneous, and the number of trained physicians is still limited. Geriatricians’ attitude towards chest ultrasound is generally cautious. Research and training programs are needed to spread the correct use of this technique in geriatric practice. Full article

Background & aims. Several studies report that a low number of teeth is strictly associated with a higher risk of cognitive impairment. Aim of this study is to evaluate the oral condition of a nursing home population, in order to clarify the possible association between tooth loss and cognitive decline. Methods. 444 patients were selected; clinical information were excerpted from their hospital records. Subjects were visited in their nursing home unit, paying particular attention to number of teeth, prosthesis and soft tissues. Results. 378 subjects were visited, 277 with formal diagnosis of dementia and 101 with mild or no impairment in cognition. Age was similar in both group, while education level, MMSE and number of teeth were significantly lower among people with dementia. There was an inverse correlation between age and number of remaining teeth, while MMSE did not seem to be associated with tooth loss. School level was positively associated with number of teeth. Conclusions. There is a significant difference in number of teeth, school level and MMSE between patients with and without dementia. Maybe due to the high prevalence of people with severe cognitive impairment, a significant association between MMSE and number of teeth was not found. The presence of compromise oral conditions is relevant. Full article