J. Gerontol. Geriatr., Volume 69, Issue 2 (June 2021) – 9 articles , Pages 87-146

Objective. Two systematic reviews suggest that current parametric predictive models are not recommended for use in population dementia diagnostic screening. This study was to compare predictive performance between logistic regression (conventional method) and neural network (non-conventional method). Method. Neural network analysis was performed through the R package “Neuralnet” by using the same covariates as the logistic regression model. Results. Results show that neural network had a slightly apparently better predictive performance (area under curve (AUC): 0.732 neural network vs. 0.725 logistic regression). Neural network performed similarly as logistic regression. Furthermore, logistic regression confirmed that the interaction effect among covariates, which elucidated from neural network. Conclusions. Neural network performed slightly apparently better than logistic regression, and it is able to elucidate complicated relationships among covariates. Full article

Methods. Describing the complications that an older patient underwent during his hospital stay. Results. An 87-year-old man was admitted to the San Raffaele Hospital for a transient loss of consciousness (LOC). He was hospitalized for assessing the causes of the LOC. The LOC lasted 2 minutes, was associated with bilateral upper limb clonus and subsequent confusion. The patient was severely comorbid: he suffered from metabolic syndrome, chronic kidney failure, hemodynamically significant carotid atheromasia, anemia, and he had a dubious history of epilepsy. Moreover, the patient was cognitively impaired and many episodes of LOC were reported in his medical history. During the hospital stay the patient developed many complications: a fall, nosocomial pneumonia, urinary retention and deconditioning. Conclusions. Global aging poses several challenges to society and public health systems. The traditional models of care are not suitable to face the complex needs of frail older people for whom standard decisional algorithms are seldom applicable. The context of hospitalization, though necessary, may be hazardous risky for the health of older people, especially the frailer ones. Full article

Trazodone is indicated for the treatment of Major Depressive Disorder (MDD), often associated with anxiety, insomnia, agitation, nervousness, or irritability. The aim of this review was to summarise the pharmacological properties of trazodone in improving depressive symptoms in elderly patients and in patients with neurological comorbidities, for whom secondary depression is often present. Five different pharmaceutical formulations of trazodone are available: intravenous or intramuscular liquid solution, immediate-release tablets (I.R.), oral drops, prolonged-release tablets (P.R.), and extended-release Contramid^® tablets (COAD). The initial dose of trazodone should range from 75 to 100 mg/day. For COAD formulation, the starting recommended dose is 150 mg once daily. In elderly patients, trazodone may be administered at very low dosages (25-50 mg/day for I.R. formulation, and 50-100 mg for the P.R. or E.R. formulations). The maximum daily dose should not exceed 300 mg/day, split over two administrations across the day. In elderly patients, trazodone has reported excellent results, keeping high-quality standards for safety and tolerability. It can help to improve insomnia and anxiety without resorting to benzodiazepines. In patients with neurological conditions, trazodone helps to treat anxiety-depressive symptoms. In patients with Alzheimer’s disease or frontotemporal dementia, trazodone can help to handle behavioural symptoms, also acting as a putative neuroprotective agent. Trazodone is well tolerated. Somnolence/sedation, dizziness, constipation, and blurred vision are common side effects with an incidence slightly greater than 5%. Orthostatic hypotension and headache are relatively common side effects. The great availability of formulations allows to personalise trazodone administration according to patient profile characteristics. Full article

Background & aims. A large proportion of deaths from SARS-CoV-2 infections worldwide occur among nursing home residents. The aim of this research is to study the association between age and comorbidities and the likelihood of hospitalization and death in patients with SARS-CoV-2 infection in an Italian province, taking into account the residential setting. Methods. Retrospective cohort study based on multiple anonymous administrative health databases. Multinomial logistic regression was used to assess the association of sex, age, comorbidities, nursing home residency, calendar time with likelihood of hospitalization (with no death) and death, adjusting for mutual confounding. Results. Older subjects had increased likelihood of both outcomes. Congestive heart failure and hypothyroidism significantly increased the likelihood of death. Neurological diseases and hypertension increased the risk of hospitalization. Nursing home residents were over-represented in the cohort. They had reduced likelihood of hospitalization, but mortality was analogous of that of other persons of the same age and clinical conditions. Conclusions. Efforts should be done to protect elderly and frail people from SARS-CoV-2, regardless of the residential setting. Full article

Background & aims. Anemia is common in older adults and it is associated with relevant complications. Although anemia is often multifactorial in origin and iron deficiency is considered a key relevant causative factor. The first therapeutic option is oral iron supplementation, but it is frequently characterized by adverse effects and overall poor efficacy. So far, intravenous (i.v.) iron formulations may serve as alternative treatment options and, in particular, Ferric carboxymaltose (FCM), showed to be safe and effective in older patients. We aimed to assess the safety and tolerability of FCM in real world hospitalized frail oldest old patients. Methods. This is an observational prospective study on 25 old age patients with iron deficiency anemia (IDA), admitted between July 2019 and November 2019 to the Geriatric Clinical ward of the IRCCS Policlinico San Martino, Genoa, Italy and treated with i.v. FCM. The incidence, probability and severity of adverse drug reactions (ADR) were reported along with the clinical response in term of mean Haemoglobin (Hb) increase after one week from the drug administration. Results. 72% of patients were oldest old with IDA and the clinical phenotype was characterized by multimorbidity and disability. The mean dose of i.v. FCM was 1160.0 ± 313.6 mg. FCM resulted safe therapeutic option with overall good tolerability. Additionally, a significant clinical improvement in the mean Hb level was observed. Conclusions. These findings moved a step in the recommendation of i.v. iron supplementation as a preferable route in oldest old, serving as a potential platform for future randomized clinical studies. Full article

Recent works highlight the influence of different aspects of lifestyle on cognitive decline and the risk of dementia. Some data suggest that exercise could improve cognitive performance, especially executive functions and reduce the risk of cognitive decline and dementia in the elder. There is controversial data regarding the role of physical exercise on cognitive performance in older patients with dementia, which may be due to diverse study designs. Innovative interventional trials need to adapt their aims toward physical and cognitive changes in patients suffering from Alzheimer’s disease (AD) in association with physical activity (PA). Future goals should include specific Adapted Physical Activity (APA) intervention programs on maintaining cognitive, emotional, and physical function in older persons with dementia at risk of rapid decline. In this commentary, we will provide novel insights on the use of potential physical activity programs in Alzheimer’s Disease Day Centers. Full article

Background & aims. Frailty syndrome, characterized by loss of functional reserves and vulnerability to acute stressors, conditionate a higher risk of adverse outcomes and mortality. Its prevalence is mainly high (65%) in patients with End Stage Kidney Disease, receiving renal replacement therapy. Methods. Cross-sectional study with a non-probabilistic sampling of adult patients with chronic kidney disease stage 5 that initiated renal replacement therapy at a dialysis centre from Santander, Colombia. The main objective was to estimate the prevalence of frailty syndrome and to describe the clinical and functional characteristics of the studied population. The frailty syndrome was defined through the FRAIL Questionnaire. Results. Sixty-six subjects were included. The median age was 65 years (IQR 58-69). 54.55% were frail. The median age in frail patients was higher than the one in non-frail (p = 0.019). The prevalence of frailty syndrome was higher in women than in men (p = 0.045). Frail patients had a higher Charlson comorbidity index (p =< 0.01). The mean serum creatinine, parathyroid hormone (PTH), and albumin were lower in frail patients, with statistically significant differences. Conclusions. The prevalence of frailty in patients that initiate renal replacement therapy in Santander, Colombia, is similar to that reported in other latitudes. Although the FRAIL Scale is based on the self-report, it counts with studies that endorse its reproductivity. Albumin and creatinine serum levels are decreased in subjects with frailty syndrome, behaving as frailty biomarkers in our research. Full article

Background & aims. Multiple studies have shown associations between low testosterone, declining physical function and cognition, metabolic syndrome, depression, falls, and even mortality, and the benefits of reestablishing the level of testosterone in elderly men with deficiency. The purpose of the study was to decide who of such men might benefit from further geriatric assessment, intervention by training, testosterone injections, and how to get in touch with these gentlemen. Method. Testosterone was measured in men above 70 years old who experienced a decline in safety of mobility. Participants were recruited through advertisements in local newspapers. Men who walk unsteadily, are about to fall or have been falling, who experience that they are getting weaker or have deteriorated physical health, were questioned about symptoms and diseases, supplied with total testosterone measurements and a 30 seconds chair stand test. Results. 177 men were screened. Mean age 77.7 (70-95). Total testosterone mean value = 12.1 (4.3-17.0 nmol/l). Chair stand tests did not correlate with testosterone levels, p = 0.98, neither did testosterone levels correlate with age, p = 0.65, (Spearman). Conclusions. The important fact is that the gentlemen themselves experience a physical decline confirmed through a thorough conversation. We still do not know for sure how to identify men who might profit from further examination but a testosterone blood test and a chair stand test in men above 70 years old who experience increasing frailty will be a start. Full article

Objectives. Acute heart failure is major cause of hospitalisation in Western countries. As patients with acute heart failure cannot be admitted directly to the wards, they stay in emergency rooms, causing access block. Brief Intensive Observation areas are holding units dedicated to the stabilisation of patients requiring close monitoring. However, these units have been associated with acute exacerbation of heart failure. This study aimed to evaluate the impact of Brief Intensive Observation areas on the management of acute heart failure in elderly patients. Methods. This retrospective, single-centred observational study analysed patients who presented in the emergency room with acute heart failure in 2017 and divided them into two cohorts: those treated in the Brief Intensive Observation and those who were not. The reduction of colour codes at discharge, mortality rate within the emergency rooms, hospitalisation rate, rate of transfer to less intensive facilities and readmission rate at 7, 14 and 30 days after discharge were compared. Results. Of the 694 patients, 62% were transferred to the Brief Intensive Observation for stabilisation. Age and sex between the cohorts were not significantly different. However, compared to non-Brief Intensive Observation patients, the Brief Intensive Observation patients had worse clinical conditions on arrival and longer stabilisation period. The stabilisation rate was higher in Brief Intensive Observation patients than in non-Brief Intensive Observation patients. Conclusions. Brief Intensive Observation areas allows effective stabilisation of elderly patients, better management of beds, reduced admission rates and reduced use of high intensity care unit beds. Full article