J. Gerontol. Geriatr., Volume 69, Issue 1 (March 2021) – 11 articles , Pages 1-86

Periorbital cellulitis (POC) is an acute bacterial infection of the eyelids. In the past, before the introduction of Haemophilus influenzae type B vaccination, POC was usually caused by this bacterium. Vaccination was introduced in 1985 and extended in 1990. Since then, most cases are caused by Staphylococcus aureus or Group A β-hemolytic Streptococcus. We present a case of POC caused by H. influenzae in a 95-year-old woman: to our knowledge, this is the oldest patient with POC reported in the literature. Full article

Background & aims. FRAX is used to calculate the 10-year absolute risk for hip or “any major” fracture. It can be applied with/without DXA scores, in countries like Egypt where there is no calculator available, a neighboring country calculator is used. Our aim was to determine whether FRAX without DXA scores was reliable for calculating fracture risk, and which neighboring population was closest to ours. Methods. A hospital based convenient sample study was conducted on patients referred to the outpatient radiology department for DXA over 12 months from Nov 2018 - Dec 2019. 395 patients, aging from 40-90 years, were included. Fracture risk probability was calculated using 9 calculators (Abu Dhabi, Iran, Jordan, Kuwait, Lebanon, Morocco, Palestine, Syria, Tunisia). This was done with and without BMD femoral neck obtained from DXA scan. Results. There were 71 men and 324 women. There was a considerable agreement between the calculated risk and treatment decisions using FRAX tool with or without inclusion of BMD. Regarding sensitivity and specificity for which country calculator to base treatment decisions on; the sensitivity was relatively low with the highest sensitivity (17%) using Kuwait, Lebanon and Syria and the lowest using Tunisia (0%). The specificity was much higher with the highest specificity (100%) using Jordan, Kuwait, Morocco and Palestine and the lowest specificity using Lebanon (98.6%). Conclusions. We can use FRAX without BMD scores for treatment decisions, but there is a need for population studies about hip fractures in Egypt to formulate our own FRAX. Full article

Background. Polypharmacy, or taking five or more medications daily, can lead to poor medication compliance and an increased risk for adverse drug-to-drug interactions that may eventually lead to death. The study was designed to explore the questions of how age, the relationship between the physician and patient, and television, radio, magazines and modern electronic technology, such as the Internet, affect patients’ understanding of their medical care. Two main areas addressed in this research study included the pharmaceutical industry’s influence on consumer decisions to ask a physician for a particular medication, and the prescribing practices of the physician. Methods. This qualitative phenomenological study began with prescreening volunteer residents in a nursing home to discover potential participants who met the criteria of using five or more medicines daily. We then interviewed 24 participants who met the criteria, using semi-structured interview questions. Results. Four core themes emerged from this study: professional trust, professional knowledge, communication deficit, and direct-to-consumer advertising. Participants reported trusting their doctors and taking medications without question, but most knew why they were taking the medications. Participants also reported seeing ads for medications, but only one reported asking a physician to prescribe the medication. Conclusions. The findings from this research study showed that consumers may be becoming wiser with modern technology at their fingertips. The consumers appear to be searching for a higher level of ownership regarding their health care and seeking more of a partnership-type of relationship with their physicians. Full article

Background & aims. Elderly people have different issues at the end of their lives. This study was conducted to analyze the psychometric properties of the Persian version of Attitudes of Older People to End of Life Issues (AEOLI) questionnaire. Methods. 189 elderly people participated in this descriptive study. Face, content and construct validity and reliability were assessed for determining the psychometric characteristics of the questionnaire. Construct validity was determined by exploratory factor analysis using principal component analysis with varimax rotation. Results. The results of this study indicate that the questionnaire has an appropriate face and content validity. Internal consistency (Cronbach’s alpha = 0.78, ICC = 0.729) showed a good reliability for the questionnaire. Factor analysis showed the nine items of the questionnaire can measure the attitude of the elderly toward end-of-life issues. Conclusions. The findings of this study showed that the Persian version of the 27-item questionnaire of the elderly attitude toward end-life issues has good validity and reliability. Full article

Background & aims. It is generally accepted that there arises a decrease in sensory integrity with aging. Despite so much emphasis on the lower extremity, studies have not focused sufficiently on agerelated sensory changes in the hands and wrists. The aim of our study is to evaluate the hand and wrist sensory parameters of young and geriatric people and to reveal the sensorial differences in young and geriatric hands. Methods. 60 elderly and 60 young individuals were included in our study. The 3D Motion Sensor mOOver® was used to assess joint position sense. Baseline Pneumatic Bulb Dynamometer® device was used to assess the grip sensitivity. The hand pressure sensitivities was evaluated with Stabilizer Pressure Biofeedback®. The vibration senses, sensory threshold and two-point discrimination were evaluated. Results. Joint position sense error rates of all movements of dominant and nondominant wrists and errors of grip and pressure sensitivity, sensory threshold and two points discrimination distance were found lower in youths (p = 0.000). Sense of vibration’s duration was found higher in youths (p = 0.000). Conclusions. Our results are of great importance in terms of demonstrating how aging affects sensory changes in the hand and wrist. Adequate and accurate assessment of the sensory parameters in the hand and wrist will be able to enable the accurate detection of pathologies that may be encountered in this region. This data will help professionals working in the fields of geriatric rehabilitation and hand rehabilitation to predict changes in sensory parameters and to design protective rehabilitation and treatment programs. Full article

Background & aims. Clostridium difficile infection (CDI) is a leading cause of nosocomial diarrhoea in elderly people. This study aimed to describe the main clinical features and prognosis at 6 months of patients affected by CDI in a Geriatric Unit. Retrospective observational study based on clinical records conducted among elderly patients admitted to a Geriatric Care Unit. Methods. Inclusion criteria were: 1) patients discharged with diagnosis of CDI, confirmed by positive fast enzyme immunoassay for detection of C. Difficile toxin B on stool sample; 2) availability of Multidimensional Prognostic Index (MPI) score, assessed during the first 48 hours after admission. Secondary analysis was performed to investigate potential risk factors for worse outcomes during hospitalization, and on the incidence of recurrences and survival in a subgroup at 6 months of follow-up. Results. Thirty-three patients enrolled (23 F, 10 M), mean age 89 years. CDI was the reason for hospital admission in 39.6% of cases, while 60.4% developed the infection during hospitalization. All patients had undergone recent antibiotic treatment and 97% had recently been hospitalized or were nursing home residents. Ninety percent of subjects had more than two comorbidities and in 85% of cases, MPI predicted a high risk of mortality. In-hospital mortality was 21% and, in the subgroup of 16 patients who completed the 6-month follow-up, 31% had at least one recurrence and 75% died. Conclusions. CDI affects oldest-old and vary frail patients, with high comorbidity and high risk of mortality, and most of them have a poor prognosis, suggesting that CDI might be considered as a frailty marker itself. Full article

Background and aims. The COVID-19 outbreak is a far-reaching health crisis and a significant psychological stressor. COVID-19 patients experience an unknown and life-threatening condition that exposes them to strict social distancing, physical discomfort, medication side effects, long hospitalization, stigmatization and fear of death. Older people seem to be particularly vulnerable to the current pandemic from both a physical and a psychological point of view. The present article aims to describe different psychological reactions in older hospitalized COVID-19 patients encountered by the clinical psychology Unit of one of northern Italy most hit hospitals. Three prototypical clinical cases will be described and discussed. Insights about different attitudes towards the illness will be offered. Conclusions. Auto-biographical narration among older hospitalized COVID-19 patients has positive effect. Hospital psychologist can support patients in the process of disease acceptance. Full article

The incidence of thrombotic cardiovascular disease increases with age. Several potential reasons can explain the association between thrombosis risk and age, such as the high prevalence of predisposing illnesses among older people and age-related changes in hemostasis pathways, including endothelial dysfunction, alterations in platelet function, coagulation and fibrinolytic factors, that contribute to create a hypercoagulability of the blood. Furthermore, some components of this procoagulant status may also support the inflammatory processes that characterize advancing age, promoting an increased risk of a thrombo-inflammatory disease. However, despite the increased thrombotic risk make the older patient a theoretical target for anticoagulant therapy, the concomitant risk of major bleeding make the use of this drugs problematic, with consequent underuse. This review summarizes the physiological changes of hemostasis pathways in older people in the context of thromboembolic disease as a geriatric syndrome. The balance between thrombotic and hemorrhagic risk and therefore the therapeutic efficacy of anticoagulant medications are also discussed. Full article

The multifactorial process of ageing is one of the biggest biological and medical challenges of the 21^st century with age-related conditions such as cardiovascular diseases, neurodegeneration and cancer being among the leading causes of death among industrialized countries. Rather than one single causative factor, a range of environmental, demographic, biological, behavioral and social factors determine the development and onset of age-related diseases (ARDs). While it remains a challenge to assess the cumulative effect of environmental influences on human ageing, growing evidence indicates that both ARDs and non-pathological ageing processes are driven by environmental influences. The present review takes a closer look at the different environmental factors including air, climate, water, soil, urban green, social and individual environments and their influence on common ARDs and other life-limiting pathologies. It is of major public health relevance, to understand the interactions between these factors to develop preventive strategies both at individual and societal level to support healthy ageing. Full article

Introduction. Sarcopenia has been demonstrated to affect the quality of life (QoL) of hospitalised elderly. However, no convincing evidence for the best method for measuring sarcopenia in hospitalised elderly is available. The current review aims to investigate the common outcome measures used to measure QoL and sarcopenia in hospitalised elderly. Method. A systematic search of the literature was conducted manually and by using databases, such as Scopus, Web of Science, and PubMed, with various search terms, such as “quality of life,” “health-related quality of life”, “elderly”, “older persons”, “sarcopenia”, and “sarcopenic”. Two researchers independently assessed the studies for eligibility. Studies included in the review were written in the English language and indexed journals published between 2015 and 2019. Results. A total of 400 studies were retrieved; among which, 5 articles were included in the review. The review found that various sarcopenia measures were applied as follows: two studies, skeletal muscle index; one study, muscle cross-sectional area; one study, SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls) questionnaire; and one study, the algorithm of the European Working Group for Sarcopenia in Older People. The outcome measures for QoL that were used in the studies included the 36-item short-form survey, EuroQoL-5 dimension, Kidney Disease Quality of Life-Short Form, and CASP-12 (control, autonomy, self-realization, pleasure) scale. Mixed results were found in the relationship of QoL with hospitalisation and sarcopenia. Conclusions. Inconsistent findings were found for the relationship between QoL and sarcopenia probably because of the different measures used to assess sarcopenia and QoL of the elderly. The results highlight the importance of conducting a further study on QoL among the elderly with sarcopenia, particularly those who were hospitalised using the currently recommended tool for assessing sarcopenia. Such research may promote patient-centered care and improve QoL by incorporating the concept of QoL into geriatric rehabilitation. Full article

Chronic obstructive pulmonary disease (COPD) represents a complex respiratory disorder characterized by persistent respiratory symptoms due to chronic airflow limitation caused by exposure to noxious particles/gases with an increased inflammatory response of the airways. COPD is common in older people, with an estimated prevalence of 10% in the US population aged > 75 years and is often accompanied by other concomitant chronic conditions that negatively impact prognosis and health status. The aim of this paper is to highlight the relationship between COPD and other comorbidities in elderly population. We focus our attention on the relationship existing between COPD and cardiovascular diseases, lung cancer, obstructive sleep apnoea syndrome, malnutrition/sarcopenia and osteoporosis with particular attention to adipokines, considering that adipose tissue plays a relevant role in the cross-talk between organs. Full article