The concept of intermediate care is gaining increasing recognition in Italy as a critical strateg... more The concept of intermediate care is gaining increasing recognition in Italy as a critical strategy for improving quality of care and promoting the integration of healthcare services across different settings. This is driven by demographic changes and the growing prevalence of chronic conditions. One of the key challenges in delivering intermediate care in Italy is ensuring that care is person-tailored, which requires a shift towards a more holistic approach that prioritizes individual preferences and values. This requires greater collaboration and communication across different healthcare settings and a coordinated approach to the delivery of care that promotes innovation and the use of technology to support remote monitoring and care delivery. Despite these challenges, intermediate care offers significant opportunities with which to enhance the quality of care, reduce healthcare costs, and promote social cohesion as well as community engagement. Overall, a coordinated and comprehen...
Background: One of the most widely used instruments for assessing agitation in dementia patients ... more Background: One of the most widely used instruments for assessing agitation in dementia patients is the Cohen-Mansfield Agitation Inventory (CMAI), nevertheless no global score has been proposed. The aim of this study is: (a) to conduct a confirmatory (CFA) and exploratory factor analysis (EFA) of CMAI on people with dementia and Psychological and Behavioral Symptoms (BPSD), and (b) to propose an alternative structure, based on clinical criteria including all CMAI items. Methods: Confirmatory and exploratory factor analyses were carried out on the CMAI 29 items administered at baseline to 505 patients with dementia (PwD) and BPSD enrolled in the international observational RECage study. Results: The three-factor structure has not been confirmed by the CFA, whilst the EFA was carried out respectively on 25 items disregarding 4 items with a prevalence ≤5% and then on 20 items disregarding 9 items with a prevalence ≤10%. The four-factor structure explaining 56% of the variance comprise...
Abstract: This chapter illustrates how the role of a geriatrician should be included in the assig... more Abstract: This chapter illustrates how the role of a geriatrician should be included in the assignment process of assistive technology to older people as a consultant in a Centre for Technical Aid. After an introduction to the geriatrician and the effectiveness of geriatric assessment in clinical practice, the concepts of disease, disability and frailty are discussed. Emphasis is also placed on the role of assistive technology in compensating for disability and in enhancing the performance of daily activities of the older patient. The importance of bringing together a comprehensive geriatric assessment and the International Classification of Functioning, Disability and Health (ICF) is highlighted in order to guide clinical reasoning about geriatric rehabilitation and to provide optimal client-centred care when an older user is admitted to a Centre for Technical Aid. In this respect, a clinical case study from the perspective of a geriatrician in a Centre for Technical Aid is analysed.
Advanced glycation end-products (AGEs) stimulate reactive oxygen species (ROS) generation and rep... more Advanced glycation end-products (AGEs) stimulate reactive oxygen species (ROS) generation and represent a risk factor for atherosclerosis, while their formation seems to be prevented by zinc. Metallothioneins (MT), zinc-binding proteins exert an antioxidant function by regulating intracellular zinc availability and protecting cells from ROS damages. +1245 A/G MT1A polymorphism was implicated in type 2 diabetes and in cardiovascular disease development as well as in the modulation of antioxidant response. The purpose of this study was to investigate the influence of +1245 A/G MT1A polymorphism on AGEs and ROS production and to verify the effect of zinc supplementation on plasma AGEs, zinc status parameters and antioxidant enzyme activity in relation to this SNP. One hundred and ten healthy subjects (72 ± 6 years) from the ZincAge study were supplied with zinc aspartate (10 mg/day for 7 weeks) and screened for +1245 MT1A polymorphism. +1245 MT1A G+ (Arginine) genotype showed higher pl...
Metallothioneins (MT), the antioxidant zinc-binding proteins, seem to mediate cardioprotection. I... more Metallothioneins (MT), the antioxidant zinc-binding proteins, seem to mediate cardioprotection. It has been postulated that zinc homeostasis and MT function may be altered, as a consequence of oxidative stress, in cardiovascular disease (CVD), with a potential implication of MT genetic polymorphisms. The present study explores the role of +647A/C and +1245A/G MT1A polymorphisms on the susceptibility to CVD, zinc status and enzyme antioxidant activity, in the Greek and Italian populations. The country selection was based on the lower zinc status and the reduced zinc dietary intake in Greece than in Italy despite the similar Mediterranean dietary pattern. A total of 464 old, healthy control subjects and 369 old CVD patients more than 70 years of age were studied. Logistic regression model indicated that +1245 MT1A G+ genotype significantly increased the risk of CVD in Greece (34.4% vs. 23.2%; odds ratio=1.88, 95% confidence interval=1.14-3.08; P=.013) but not in Italy. Haplotype analysis showed an increment of CG haplotype frequency in CVD Greek patients (17.4% vs. 10.6%, P<.05). Differential country-related frequency distribution was also recorded. Applying a multivariate regression model, +647/+1245 MT1A haplotype was associated with a modulation of enzyme antioxidant activities in both countries. Decreased plasma zinc and reduced intracellular Zn release, as well as increased enzyme antioxidant activity, were more apparent in Greek healthy donors than in Italy. In conclusion, +1245 MT1A polymorphism and +647/+1245 MT1A haplotype are implicated in CVD in Greece but not in Italy, suggesting a role of gene-diet interaction in the disease predisposition.
One hundred and sixty-nine severely demented patients were tested in a multicenter study with the... more One hundred and sixty-nine severely demented patients were tested in a multicenter study with the short version of the Severe Impairment Battery which was translated into Italian with the purpose of adapting and validating it for an Italian population. Patients were enrolled in Italian geriatric centers participating in the Study Group on Aging Brain of the Italian Society of Gerontology and Geriatrics. Following thorough clinical and instrumental examinations, they were evaluated with the Mini Mental State Examination, the Clinical Dementia Rating, the Severe Impairment Battery (SIB), the Gottfries-Bråne-Steen Rating Scale for Dementia, the Activity of Daily Living index, and the Bedford Alzheimer Nursing Severity scale (BANS.s). The inter-rater reliability of the SIB was highly significant for the total score and its subtests; test-retest reliability showed the same significance in all items. Also concurrent validity, performed comparing the total SIB score with the total BANS.s score, was significant. The short Italian version of the SIB proved to be a very reliable tool for the evaluation of severely demented patients; it has the advantage of being easy to administer, it evaluates more cognitive domains that, are typically assessed in dementia, and has a wide enough range of scores to detect even small differences in the examined abilities.
The increasing life expectancy of populations worldwide represents the most evident success of th... more The increasing life expectancy of populations worldwide represents the most evident success of the last century thanks to varying interacting social and medical achievements [...]
P158 Experimental research suggests the association between ischemic stroke and increased oxidati... more P158 Experimental research suggests the association between ischemic stroke and increased oxidative stress. Carotenoids are lipid-soluble molecules with antioxidant activity, but changes of their plasma concentrations during stroke have been never evaluated. Twenty-eight consecutive patients (19M, 9F, mean age 77 y) with acute ischemic stroke (onset < 24 hrs) were divided in subgroups according to the functional outcome at one week as assessed by Barthel Index: group 1 - pts who died or experienced functional decline; group 2 - pts who remained functionally stable. Plasma levels of carotenoids including lutein, zeaxanthin, b-cryptoxanthin, lycopene, α- and β-carotene, and of malondialdehyde (MDA), a marker of lipid peroxidation, were measured on admission, after 6 and 24 hrs, and then on days 3, 5 and 7, by HPLC. Levels on admission were compared to those of age- and sex-matched controls (ctrls). On admission, plasma carotenoid levels were significantly lower (lutein, p
The concept of intermediate care is gaining increasing recognition in Italy as a critical strateg... more The concept of intermediate care is gaining increasing recognition in Italy as a critical strategy for improving quality of care and promoting the integration of healthcare services across different settings. This is driven by demographic changes and the growing prevalence of chronic conditions. One of the key challenges in delivering intermediate care in Italy is ensuring that care is person-tailored, which requires a shift towards a more holistic approach that prioritizes individual preferences and values. This requires greater collaboration and communication across different healthcare settings and a coordinated approach to the delivery of care that promotes innovation and the use of technology to support remote monitoring and care delivery. Despite these challenges, intermediate care offers significant opportunities with which to enhance the quality of care, reduce healthcare costs, and promote social cohesion as well as community engagement. Overall, a coordinated and comprehen...
Background: One of the most widely used instruments for assessing agitation in dementia patients ... more Background: One of the most widely used instruments for assessing agitation in dementia patients is the Cohen-Mansfield Agitation Inventory (CMAI), nevertheless no global score has been proposed. The aim of this study is: (a) to conduct a confirmatory (CFA) and exploratory factor analysis (EFA) of CMAI on people with dementia and Psychological and Behavioral Symptoms (BPSD), and (b) to propose an alternative structure, based on clinical criteria including all CMAI items. Methods: Confirmatory and exploratory factor analyses were carried out on the CMAI 29 items administered at baseline to 505 patients with dementia (PwD) and BPSD enrolled in the international observational RECage study. Results: The three-factor structure has not been confirmed by the CFA, whilst the EFA was carried out respectively on 25 items disregarding 4 items with a prevalence ≤5% and then on 20 items disregarding 9 items with a prevalence ≤10%. The four-factor structure explaining 56% of the variance comprise...
Abstract: This chapter illustrates how the role of a geriatrician should be included in the assig... more Abstract: This chapter illustrates how the role of a geriatrician should be included in the assignment process of assistive technology to older people as a consultant in a Centre for Technical Aid. After an introduction to the geriatrician and the effectiveness of geriatric assessment in clinical practice, the concepts of disease, disability and frailty are discussed. Emphasis is also placed on the role of assistive technology in compensating for disability and in enhancing the performance of daily activities of the older patient. The importance of bringing together a comprehensive geriatric assessment and the International Classification of Functioning, Disability and Health (ICF) is highlighted in order to guide clinical reasoning about geriatric rehabilitation and to provide optimal client-centred care when an older user is admitted to a Centre for Technical Aid. In this respect, a clinical case study from the perspective of a geriatrician in a Centre for Technical Aid is analysed.
Advanced glycation end-products (AGEs) stimulate reactive oxygen species (ROS) generation and rep... more Advanced glycation end-products (AGEs) stimulate reactive oxygen species (ROS) generation and represent a risk factor for atherosclerosis, while their formation seems to be prevented by zinc. Metallothioneins (MT), zinc-binding proteins exert an antioxidant function by regulating intracellular zinc availability and protecting cells from ROS damages. +1245 A/G MT1A polymorphism was implicated in type 2 diabetes and in cardiovascular disease development as well as in the modulation of antioxidant response. The purpose of this study was to investigate the influence of +1245 A/G MT1A polymorphism on AGEs and ROS production and to verify the effect of zinc supplementation on plasma AGEs, zinc status parameters and antioxidant enzyme activity in relation to this SNP. One hundred and ten healthy subjects (72 ± 6 years) from the ZincAge study were supplied with zinc aspartate (10 mg/day for 7 weeks) and screened for +1245 MT1A polymorphism. +1245 MT1A G+ (Arginine) genotype showed higher pl...
Metallothioneins (MT), the antioxidant zinc-binding proteins, seem to mediate cardioprotection. I... more Metallothioneins (MT), the antioxidant zinc-binding proteins, seem to mediate cardioprotection. It has been postulated that zinc homeostasis and MT function may be altered, as a consequence of oxidative stress, in cardiovascular disease (CVD), with a potential implication of MT genetic polymorphisms. The present study explores the role of +647A/C and +1245A/G MT1A polymorphisms on the susceptibility to CVD, zinc status and enzyme antioxidant activity, in the Greek and Italian populations. The country selection was based on the lower zinc status and the reduced zinc dietary intake in Greece than in Italy despite the similar Mediterranean dietary pattern. A total of 464 old, healthy control subjects and 369 old CVD patients more than 70 years of age were studied. Logistic regression model indicated that +1245 MT1A G+ genotype significantly increased the risk of CVD in Greece (34.4% vs. 23.2%; odds ratio=1.88, 95% confidence interval=1.14-3.08; P=.013) but not in Italy. Haplotype analysis showed an increment of CG haplotype frequency in CVD Greek patients (17.4% vs. 10.6%, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). Differential country-related frequency distribution was also recorded. Applying a multivariate regression model, +647/+1245 MT1A haplotype was associated with a modulation of enzyme antioxidant activities in both countries. Decreased plasma zinc and reduced intracellular Zn release, as well as increased enzyme antioxidant activity, were more apparent in Greek healthy donors than in Italy. In conclusion, +1245 MT1A polymorphism and +647/+1245 MT1A haplotype are implicated in CVD in Greece but not in Italy, suggesting a role of gene-diet interaction in the disease predisposition.
One hundred and sixty-nine severely demented patients were tested in a multicenter study with the... more One hundred and sixty-nine severely demented patients were tested in a multicenter study with the short version of the Severe Impairment Battery which was translated into Italian with the purpose of adapting and validating it for an Italian population. Patients were enrolled in Italian geriatric centers participating in the Study Group on Aging Brain of the Italian Society of Gerontology and Geriatrics. Following thorough clinical and instrumental examinations, they were evaluated with the Mini Mental State Examination, the Clinical Dementia Rating, the Severe Impairment Battery (SIB), the Gottfries-Bråne-Steen Rating Scale for Dementia, the Activity of Daily Living index, and the Bedford Alzheimer Nursing Severity scale (BANS.s). The inter-rater reliability of the SIB was highly significant for the total score and its subtests; test-retest reliability showed the same significance in all items. Also concurrent validity, performed comparing the total SIB score with the total BANS.s score, was significant. The short Italian version of the SIB proved to be a very reliable tool for the evaluation of severely demented patients; it has the advantage of being easy to administer, it evaluates more cognitive domains that, are typically assessed in dementia, and has a wide enough range of scores to detect even small differences in the examined abilities.
The increasing life expectancy of populations worldwide represents the most evident success of th... more The increasing life expectancy of populations worldwide represents the most evident success of the last century thanks to varying interacting social and medical achievements [...]
P158 Experimental research suggests the association between ischemic stroke and increased oxidati... more P158 Experimental research suggests the association between ischemic stroke and increased oxidative stress. Carotenoids are lipid-soluble molecules with antioxidant activity, but changes of their plasma concentrations during stroke have been never evaluated. Twenty-eight consecutive patients (19M, 9F, mean age 77 y) with acute ischemic stroke (onset < 24 hrs) were divided in subgroups according to the functional outcome at one week as assessed by Barthel Index: group 1 - pts who died or experienced functional decline; group 2 - pts who remained functionally stable. Plasma levels of carotenoids including lutein, zeaxanthin, b-cryptoxanthin, lycopene, α- and β-carotene, and of malondialdehyde (MDA), a marker of lipid peroxidation, were measured on admission, after 6 and 24 hrs, and then on days 3, 5 and 7, by HPLC. Levels on admission were compared to those of age- and sex-matched controls (ctrls). On admission, plasma carotenoid levels were significantly lower (lutein, p
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