J. Gerontol. Geriatr., Volume 72, Issue 2 (June 2024) – 9 articles , Pages 51-113

The paper reports the second case described in the literature of spondylodiscitis caused by Clostridium ramosum in an elderly immunocompetent patient affected by cellulitis of the left lower limb treated with triple antibiotic therapy (vancomycin, metronidazole and meropenem). The patient has shown a clinical and bio-humoral improvement after the treatment, even if he died after 16 days of hospitalization for severe sepsis of unknown origin. Full article

The aging process intricately intersects with oral health, necessitating a meticulous focus on the preservation and augmentation of well-being in the elderly. This demographic frequently contends with dental issues such as dental caries, periodontal problems, tooth loss, and an escalated susceptibility to severe oral conditions, notably oral cancer. The compounding factors of cognitive impairments and chronic illnesses exacerbate oral health challenges, further complicated by the pharmacological interventions they undergo. The ongoing global demographic transition towards an aging populace engenders apprehensions, particularly in densely populated regions and emerging economies, where healthcare infrastructures may confront limitations. The advent of the COVID-19 pandemic has exerted a profound impact on healthcare systems, permeating into oral health services. The elderly, disproportionately susceptible to severe manifestations of the virus, grapple with heightened apprehension and reluctance to pursue healthcare, encompassing oral care. Prolonged social isolation imposed by lockdown measures contributes to mental health ramifications, discouraging their engagement with oral healthcare services. This discourse underscores the pivotal significance of oral health in the elderly, propounding the necessity for targeted interventions and meticulously recalibrated strategies tailored to their distinctive needs. In the trajectory of this imperative undertaking, collaborative alliances among healthcare practitioners, policymakers, and communities assume paramount importance. Sustained research endeavors, coupled with synergistic partnerships with academic institutions, are imperative for the continual refinement of oral health interventions for the aging demographic, thereby fostering enhancements in their holistic well-being. Full article

Objective.The global elderly population is anticipated to surpass 1.5 billion by the year 2050. Within the population covered by the Iran Health Insurance Organization (IHIO), approximately 8% consists of individuals aged 65 and above, amounting to over 3.5 million people. A critical concern in the elderly is the prevalent use of potentially inappropriate medications (PIM), leading to adverse drug reactions and hospitalizations. This study aimed to assess the prevalence of PIM prescriptions and polypharmacy among outpatient geriatrics in Tehran. Methods. In this cross-sectional study, electronic medical records of geriatric patients (≥ 65 years), covered by IHIO were collected from outpatient clinics over one year in Tehran. The evaluation of PIM was conducted with the Beers Criteria 2023, and analysis was performed utilizing the CRISP data mining methodology. Results. This study analyzed 1,273,622 prescription medications from 327,295 patients. Approximately 57.14% of prescriptions were for female patients, and 60.27% of prescriptions were for the age group of 65 to 74 years. Polypharmacy was found in 36.95% of prescriptions. 21.04% (267,954 prescriptions) had at least one PIM. Ketorolac was the most often prescribed PIM. Psychiatrists exhibited a high PIM-prescribed prevalence. Linear regression analysis showed there was no association between patient age (β = -0.021) or gender (β = -0.038) and the prevalence of PIM prescriptions. Conclusions. The notable prevalence of PIM and polypharmacy in Tehran’s geriatric population raises the imperative for healthcare professionals, policymakers, and the IHIO to collaborate closely to enhance the prescription safety of the elderly population. Full article

Backgrounds and purpose. In-hospital older patients have a high mortality and a higher risk of severe COVID-19 outcomes. However, it is unclear whether COVID-19 infection further increases the already-high mortality risk. This study aimed to assess whether COVID-19 could impact in-hospital and post-discharge mortality in older individuals. Methods. We compared in-hospital and up to 240 days after hospital discharge all-cause mortality in hospitalized 75 years and older patients with and without COVID-19. One-to-one propensity score allocated study participants into two balanced groups (n = 69 for both). Notably, this study was carried out in 2020, when COVID-19 vaccination was not available yet. Results. COVID-19 patients died more frequently within 30 days of hospital admission than non-COVID patients (36.2 vs 18.8%, respectively; p = 0.018). In contrast, the 240-day post-discharge mortality rate did not differ between groups (42.0 vs 47.8%, respectively; p = 0.304). After controlling for clinical covariates, we found that 30-day all cause-mortality was significantly and independently associated with COVID-19 infection (HR = 2.284, 95% CI = 1.068-4.883, p = 0.033) whereas 240-day all-cause mortality was not significantly associated with the infection (HR = 1.525, 95% CI = 0.869-2.678, p = 0.141). Conclusions. Our results confirm that COVID-19 significantly increases the mortality risk of patients aged 75 or older during hospitalization. However, we found no substantial difference in post-discharge mortality risk between COVID-19 and non-COVID-19 patients. We suggest that continued monitoring of COVID-19 patients after discharge remains crucial to understand the breadth and severity of the long-term effects of SARS-CoV-2 infection, particularly as currently the number of COVID-19 unvaccinated individuals is still high. Full article

Background and aims. This study investigated the effect of Lee Silverman Voice Treatment^® BIG (LSVT^® BIG) on four major motor symptoms (tremor, rigidity, bradykinesia, and postural instability/gait disorder) in patients with Parkinson’s disease classified as Hoehn and Yahr (HY) stages II-III. Methods. This retrospective, observational, single-center study included 17 patients with Parkinson’s disease classified as HY stages II-III. To examine the effect of the LSVT^® BIG, the total scores of the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III and each score of the major motor symptoms (tremor, rigidity, bradykinesia, and postural instability/gait disorder) extracted from the MDS-UPDRS Part III were assessed pre- and post-LSVT^® BIG. The Wilcoxon signed-rank test was used for statistical analysis. Results. The total scores of MDS-UPDRS Part III, bradykinesia, and postural instability/gait disorder improved when comparing pre- and post-LSVT^® BIG (median [interquartile range]: 24 [16-36] to 18 [13-22], 8 [6-11] to 6 [5-8], and 5 [3-8] to 3 [1-5], respectively). The tremor and rigidity scores showed a trend toward improvement but did not achieve statistical significance (median [interquartile range]: 4 [0-6] to 3 [0-5], and 4 [2-10] to 4 [2-6], respectively). Conclusions. These results suggest that LSVT^® BIG for patients with Parkinson’s disease classified as HY stages II-III is effective for improving bradykinesia and postural instability/gait disorder. The findings have important clinical implications for preliminarily estimating the effect of LSVT® BIG on each major motor symptom. Full article

West Nile Virus (WNV) infection in humans ranges from asymptomatic infection or mild febrile illness to severe neurological manifestations causing West Nile Neuroinvasive Disease (WNND) that, in some cases, may lead to death. Elderly and immunocompromised patients have a higher risk of developing WNND. We reported a case of very difficult diagnosis of WNND in an elderly patient hospitalized for fever and pollakiuria secondary to prostatitis and orchiepididymitis. Full article

Objective. Falls among older adults can significantly worsen their physical health. While it is important to prevent their falls, there is also a great need to reduce their fear of falling. In this study, we focus on confidence in their own physical strength as one of the variables associated with the fear of falling. We explored whether older adults with more confidence in their own physical strength have a lower fear of falling (Hypothesis 1). We also examined whether interactions between confidence in physical strength and subjective health/positive images of older adults affect the fear of falling (Hypotheses 2 and 3). Methods. In this study, we surveyed 274 Japanese older adults. Multiple regression analysis was conducted with fear of falling as the dependent variable, confidence in physical strength, subjective health, positive images of older adults, their interactions, and the demographics as independent variables. Results. The results showed that participants with more confidence in their physical strength had a lower fear of falling, supporting Hypothesis 1. No interaction was observed between confidence in one’s physical strength and subjective health, rejecting Hypothesis 2. For those with more positive images of older adults, more confidence in one’s physical strength was associated with a lower fear of falling, supporting Hypothesis 3. Conclusions. We found that older participants with more confidence in their own physical strength had a lower fear of falling. Although this study has some limitations, it has implications for intervention research to reduce older adults’ fear of falling. Full article

Background and aims. The aging of the world population has inevitably led to an increase in the number of multi-morbid patients seeking healthcare assistance. The transition from hospital to territory is a particularly delicate moment. New treatment paradigms are required to optimize the continuity of care and to satisfy patients and caregivers’ needs. The San Raffaele hospital signed an agreement with the VIDAS association for providing an integrated home care for chronic, complex and frail (CCF) patients, after hospital discharge. We aim at evaluating the effectiveness and satisfaction of an experimental transitional care program between hospital and territory, CCF patients. Methods. CCF patients discharged from an Internal Medicine Ward, and based on the geographical area of residence (covered or not by VIDAS assistance) will be divided into two groups: 1) receiving standard care 2) involved in the transition care program. The administration of PACIC questionnaire, to assess the eventual organizational improvement in the study group, will be performed at hospital discharge and at 6- and 12-month follow-ups. Conclusions. If this innovative intervention proves to be effective, it will be able to improve the management of chronic, complex and frail patients, reducing the risk of negative health outcomes and diminishing the related healthcare expenditure. Full article

Objective. Changes in voice in older people impact their ability to use their voice to communicate in all situations and can lead to decreased quality of life. The purpose of our study was to investigate through acoustic voice analysis the vocal parameters, according to sex, of older people who came to observation for dysphonia and subsequent diagnosis of presbyphonia. Methods. The study was carried out on a group of 15 dysphonic patients (5 men and 10 women, mean age 69 years, range 62-75). The control group consisted of 20 euphonic patients (10 men and 10 women, mean age 68,55, range 62-75). Acoustic analyses were performed with the Multidimensional Voice Program (MDVP). Results. After the calculation of the Fisher test (with p < 0.05) the differences in the vocal acoustic parameters dependent on sex, in the male dysphonic group were: Jitter, Shimmer, and VTI; in the female dysphonic group were FFtr, Fatr, vFo, Shimmer, VTI, FTRI. Conclusions. Our study provided acoustic data of voice for the dysphonic older patients, which has been scarcely reported in the literature. Voice analysis programs such as MDVP require established norms for both older and younger/middle-aged individuals. This is crucial because the acoustic outputs of older speakers may differ significantly from those of younger and middle-aged speakers due to the natural aging process. Full article