Geriatric care

e-Health technologies may potentially improve healthcare assistance for frail elderly subjects. However, despite the interest and potential benefits of the field, research highlighted that several challenges remain, such as scarce wide spreading of information and communication technology technologies among the elderly and infrastructural difficulties. The aim of this survey was to assess to what extent digital technologies are widespread and used among Italian geriatricians. We conducted an online survey addressed to geriatricians, from the SIGOT (The Italian Geriatric Society) website, collecting the 78 completed questionnaires. We then analyzed with descriptive statistics the data. Results showed a still scarce use of digital technologies in geriatric practice in Italy. However, more than 60% of the SIGOT geriatricians who participated in the survey responded that the use of digital technology had increased significantly due to COVID-19 pandemic and for 80% of the members, the pr...

Aim The aim was to understand the emerging sector of long term care (old age homes, OAHs) in India through the voices of facility administrators as they see the imminent issues of importance in this new sector and care for the elderly. Methods Sixty five administrators, representing 55 OAHs located in Chennai, India, were interviewed using a semi structured interview guide by two trained research assistants. The interview guide elicited information related to the current status of OAHs and the recommendations to improve the standards and quality of care of the elderly. The interviews informed the thematic areas highlighted in the results section. Results The emerging OAH sector is managed by individuals with diverse professional and disciplinary background without any aging-specific qualifications. The OAHs operate for profit or as a charity with often unreliable funding. The administrators felt that they were unable to provide the services they wanted at a level they felt appropriate. Staffing and training issues were common concerns impacting level of care. Lack of government leadership was cited as a reason for lack support for the OAHs. No standards of care and quality assurance mechanisms currently exist for OAHs and the elderly these institutions serve. Conclusion Existing policies and schemes pertinent to aging care must be reviewed, adjusted, and coordinated to reflect the emerging sector in India, and the government Ageing Int

The development of increasingly intelligent and autonomous technologies will eventually lead to these systems having to face morally problematic situations. This is particularly true of artificial systems that are used in geriatric care environments. The goal of this article is to describe how one can approach the design of an elder care robot which is capable of moral decision-making and moral learning. A conceptual design for the development of such a system is provided and the steps that are necessary to implement it are described.

This paper summarizes the latest data about the treatment options available for coronavirus disease 2019 (COVID-19), paying special attention to the older patients. This review explored both trials that have included older patients and some clinically relevant drug-drug interactions. The data have been updated to 31st October, 2020. In particular, details have been reported about the use of antivirals, heparin, steroid and hyperimmune plasma.

Hypoglycaemia can cause cardiac arrhythmias such as QT interval prolongation and ventricular arrhythmias. Supraventricular arrhythmias and sinus bradycardia were rarely reported. We present the clinical case of an 84- year-old man who developed a persistent bradycardia after a hypoglycaemic episode. After restoration of normoglycaemia, bradycardia persisted for almost eighteen hours, without QT prolongation or any symptoms. Hypoglycaemia is an unusual cause of bradyarrhytmias mainly mediated by neurologic and endocrine systems. Our clinical case supports recent recommendations for more relaxed inpatient glycaemic targets in frail older adults who may be particularly vulnerable to hypoglycaemia and its consequences.

Malnutrition for the elderly is a serious threat to their health. An elderly malnourished person is more exposed to illness, to disability and to institutionalization. Among the causes of malnutrition there is also the reduction of food intake for reduced hunger. With aging many factors favor the prevalence of satiety with respect to the desire to eat. This condition has been defined as anorexia of aging. Gastric motility impairment, unbalanced central and gastrointestinal hormone and peptide dynamics, together with sensory deterioration, depression, social and iatrogenic factors may be found frequently among older person and cause anorexia. Reduced appetite and exaggerated feeling of satiety are also causes of deterioration of quality of life, due to the decrease in the pleasure of eating and the presence of unpleasant, early and prolonged sense of fullness. Understanding the mechanisms that facilitate anorexia could help eliminate reversible causes and reduce the effect of para-ph...

Urinary incontinence is a common problem among older adults that is often complicated by many nuanced ethical considerations. Unfortunately, there is a lack of guidance for healthcare professionals on how to navigate such concerns. This International Continence Society white paper aims to provide healthcare professionals with an ethical framework to promote best care practices in the care of older adults with urinary incontinence.

In recent years, many research groups are trying to quantify the physiological signals of an individual, proposing new models to assess the complex dynamics of biological control systems. Indeed, life coincides with the good handling of the structures in the organism and of physiological control mechanisms, while disease and death coincide with the loss of structure and of coordinated functions. The homeodynamic systems which normally govern health are the same that cause pathological events when activated inadequately, or rather, when the balance between order and chaos of the elementary physiological processes is no longer effectively controlled in relation to any type of stress, both external and internal to the body. In a complex system, loss or alteration of communication between physiological signals means pathology. In this paper a signal analysis method based on Entropy (E), Lyapunov exponent (1), Median Absolute Deviation (MAD), Multiscale Entropy (MSE), is proposed to esti...

Since the outbreak of coronavirus disease- 19 (COVID-19) pandemic, geriatric population has been the most affected due to the peculiarities of the disease in terms of contagiousness and severity. Major changes have been implemented in healthcare structures and facilities worldwide in order to accomplish the necessity to host and isolate infected patients. Simultaneously, many critical issues have emerged concerning medical and nursing assistance to elderly patients, due to the new arrangement of wards and innovative work tools. Acute Geriatric Units dedicated to COVID-19 have been asked to put giant efforts in adapting to new care models in mobility, communication, feeding, basic assistance and caregivers’ involvement. The purpose of this dissertation is to highlight the role of Geriatricians as proactive contributors of new approaches to elderly patients in times of COVID-19, in order to develop a further-thinking working methodology.

Prevalence of non-valvular atrial fibrillation is increasing over time. Particularly in elderly population, treatment strategies to reduce the rate of stroke are challenging and still represent an unsolved cultural question. Indeed, the risk of thromboembolism increases in the elderly in parallel with the risk of bleeding. The frequent coexistence of several morbidities, frailty syndrome, polypharmacy, chronic kidney disease and dementia strengthens the perception that risk-benefit ratio of anticoagulant therapy could be unfavorable, and explains why such treatment is underused in the elderly. Recently, the introduction of non-vitamin K oral anticoagulants (NOACs) has allowed us to overcome the large number of limitations imposed by the use of vitamin K antagonists. In this manuscript, the benefits of individual NOACs in comparison with warfarin in elderly patients are reviewed. Targeted studies on complex elderly patients are needed to test usefulness of a geriatric comprehensive a...

As every nation battles the coronavirus disease 2019 (COVID-19) pandemic comprehensively, older adults are by far the most affected group in terms of morbidity and mortality rates. Particularly individuals in the age range of >60 years and with comorbidities and other geriatric conditions are at heightened risk of complications from COVID-19 compared to any other age groups in the world. The time between the infection of severe acute respiratory syndrome-coronavirus 2 (SARSCoV-2) and the manifestation of the symptoms is between two to twelve days. Typical symptoms of COVID-19 are high temperature, dry cough, and breathing difficulties in complicated cases, while new evidence shows atypical presentations of COVID-19 symptoms in older adults, and are highlighted in this review. From this synopsis, we deduced that firstly, the severity of COVID-19 among older adults is because of biological (dwindling immunity with old age), socio-economic (poverty and over-stretched health system) ...

This study aimed to determine the relationship between chronic diseases and nutrition in the older adults in a nursing home. In 2014 and 2019, we investigated older people aged 60 years and over living in a nursing home in Izmir and who agreed to participate and could perform self-care. A 26-item questionnaire that focuses on sociodemographic, socioeconomic and chronic disease characteristics, and the Turkish version of Mini Nutritional Assessment Test-Short Form were applied using the face-to-face method. In 2014, 68.9% of the older had no malnutrition risk, 23% had malnutrition risk, and 8.1% had malnutrition. The women had a higher malnutrition risk and actual malnutrition than men (P<0.05). Malnutrition was most common in 75-84 years of age. In 2019, 41.6% of the older had malnutrition risk, whereas 7.8% had actual malnutrition. No difference was found between malnutrition and malnutrition risk, between women and men and between age and sex (P>0.05). At both times, malnutr...

Elevated interleukin-6 (IL-6) levels have been found positively associated with markers of physical frailty as well as identified as a potential biomarker of Alzheimer’s disease (AD). Thus, we explored the levels of plasma IL-6 at baseline in a cohort of older subjects with or without cognitive impairment, which results may have also implications for coronavirus disease 2019 (COVID-19) clinical management. This is a retrospective study including a cohort of over 60 years old-age subjects, 72 healthy controls, 95 mild cognitive impairment, and 73 AD were included in the study. Plasma IL-6 was measured in all subjects. The sample population included 240 subjects, mostly women with a mean age of 78.61±6.30 (range: 60-93) years. Age significantly correlated with IL-6 plasma levels (r=0.204, P=0.002) even after controlling by gender. No difference was found in body mass index (BMI), nutritional status (assessed by mini nutritional assessment), and comorbidity indices (cumulative illness ...

People above 65 years of age would amount to 10.7% of total population of India by 2021. India has acquired the label of ‘an ageing nation’ with 7.7% of its population being more than 60 years old. Geriatric patients are exposed to potentially inappropriate medications (PIMs) thus strategies to improve quality of life and safety of prescribing is needed. One such explicit criteria tool is ‘Screening Tool of Older person’s Potentially inappropriate Prescriptions’ (STOPP) criteria. For older individuals, frailty plays a decisive role. Frailty assessment is useful for identification of risk stratifications to assist in clinical decision makings. Hence, this study is aimed to assess the percentage of PIM using STOPP criteria and correlation between PIMS and Frailty Index (FI) in elderly patients in our setting. An observational study was done in 60 patients in department of medicine at tertiary care teaching hospital. Demographic details, diagnosis and current medications were recorded ...

It is essential for welfare systems to predict the health and care needs of people with chronic diseases. The Multidimensional Prognostic Index (MPI) proved excellent accuracy in predicting negative health outcomes. Recently, a selfadministered version of MPI (SELFY-MPI) was developed and validated in community- dwelling subjects showing an excellent agreement between the two instruments regardless of age. This is a feasibility study concerns the implementation of SELFYMPI in five European countries. The SELFY-MPI includes the self-administration of Barthel Index, Instrumental Activities of daily Living (IADL), Test Your Memory (TYM) Test, Mini Nutritional Assessment-Short Form (MNA-SF), comorbidity, number of medications, and the Gijon’s Socio-Familial Evaluation Scale (SFES). A descriptive analysis was performed on the data collected. 300 subjects (mean age 62 years, range 19-88 years; male/female ratio 0.81) completed the SELFY-MPI. The mean value of the SELFY-MPI was 0.131 (rang...

Prevalence of non-valvular atrial fibrillation is increasing over time. Particularly in elderly population, treatment strategies to reduce the rate of stroke are challenging and still represent an unsolved cultural question. Indeed, the risk of thromboembolism increases in the elderly in parallel with the risk of bleeding. The frequent coexistence of several morbidities, frailty syndrome, polypharmacy, chronic kidney disease and dementia strengthens the perception that risk-benefit ratio of anticoagulant therapy could be unfavorable, and explains why such treatment is underused in the elderly. Recently, the introduction of non-vitamin K oral anticoagulants (NOACs) has allowed us to overcome the large number of limitations imposed by the use of vitamin K antagonists. In this manuscript, the benefits of individual NOACs in comparison with warfarin in elderly patients are reviewed. Targeted studies on complex elderly patients are needed to test usefulness of a geriatric comprehensive a...

The pandemic blast of COVID-19 uncovered well known weakness of financial chain and put our economic organizations facing off dramatic consequences if new strategies will not be developed to adapt health-care on detailed sub-groups of patients. The exponential number of older and frail subjects aged >65 years represents a challenge for public health. Patients affected by renal disease are an aged population that showed a particular attitude to contract infection and a higher mortality rate respect to general population. In this brief article, we would point out the focus on the management of issues related to renal patients facing off with coronavirus infection, in particular in a geriatric population particularly exposed to contagion like hemodialysis patients and precautions decided to slow the spread of contamination.

Although oral anticoagulant therapy (OAT) is recommended for patients with atrial fibrillation (AF), it is widely underused among older patients, who are frequently prescribed antiplatelet therapy (APT) instead. We assessed mortality and incidence of ischemic and hemorrhagic events according to prescription of OAT or APT in older medical in-patients with AF discharged from hospital. Stroke and bleeding risk were evaluated using the CHA<sub>2</sub>DS<sub>2</sub>-VASC (<em>Congestive heart failure/ left ventricular dysfunction, Hypertension, Aged ≥75 years, Diabetes Mellitus, Stroke/transient ischemic attack/systemic embolism, Vascular Disease, Aged 65-74 years, Sex Category</em>) and HAS-BLED…

Severe acute respiratory syndromerelated coronavirus 2 (SARS-CoV-2) infection has spread worldwide. The most of patients presents fever, dyspnea and cough as a typical viral infection, others show peculiar clinical and laboratory signs, such as anosmia, ageusia and thrombocytopenia. We here describe a severe coronavirus disease 2019 patient (76-year old, male) that developed an immune thrombocytopenia and acquired pseudo-thrombocytopenia that were refractory to immunomodulators even after resolution of respiratory failure. The patient developed thrombocytopenia (platelets 88,000/mm3) that got worse the following day (14,000/mm3). We started 1 mg/kg of methylprednisolone i.v. daily. Platelet count increased up to 209,000/mm3, in sodium citrate, but remained about 14,000/mm3 in EDTA 10 days after the beginning of methylprednisolone. The patient showed great improvement in respiratory parameters and radiological finding. About one week after he developed a thrombocytopenia up to 70,000...

The recent outbreak exposed doctors to a new challenge: treating people without any scientific evidence. All molecules combined in treatment schedules were merged on the basis of weak and anecdotal data so, the recommendations are constantly changing. In this context it is either mandatory for clinicians focusing on the different treatment options and on probable side effects of each molecules. It is well acquired that among elderly within same age group and strain, the outcome will differ according to each patient’s frailty. Moreover, old and frail people are particularly exposed to a double risk: the first one is the age-related mortality and the second one the susceptibility (also age related too) to side effects. Aim of our paper is reporting our experience in reducing toxicity with a constant action of scientific update and subsequent modification in clinical management protocols. Main focus was on frail patients and cardiologic risk-related to hydroxychloroquine.

In patients with dementia and Alzheimer’s disease (AD), treatment of neuropsychiatric symptoms (NPS) is a major concern in the management of these devastating diseases. Among NPS in AD, agitation and aggression are common with earlier institutionalization, increased morbidity and mortality, and greater caregiver burden. Pharmacological treatments for AD-related agitation, specifically off-label use of atypical antipsychotics, showed only modest improvements, with increased side-effect burden and risk of mortality. Non-pharmacological treatment approaches have become the preferred firstline option. However, when such treatments fail, pharmacological options are often used. Therefore, there is an urgent need to identify effective and safe pharmacological treatments for agitation/aggression in AD and dementia. Unfortunately, progresses have been slow, with a small number of methodologically heterogeneous randomized controlled trials (RCTs), with disappointing results. However, evidence...

In December 2019, an increasing number of cases of novel coronavirus (2019-nCoV) that were linked to seafood wholesale market have identified in Wuhan, China. Taxonomist declared 2019-nCoV as severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) and the disease termed as COVID-19. Importantly, there is no approved drugs or vaccine against SARS-CoV-2. Current review is related to address treatment option for COVID-19. Interferon-β have shown significant activity against previous outbreak of SARS-CoV and MERS-CoV. Faced with an ongoing pandemic of SARS-CoV-2 and lack of effective treatment options, identifying compounds with antiviral activity has become a high priority. Efficacy of these treatments is still unclear. Therefore, final analysis is important to develop better treatment strategies for ongoing pandemic.

As every nation battles the coronavirus disease 2019 (COVID-19) pandemic comprehensively, older adults are by far the most affected group in terms of morbidity and mortality rates. Particularly individuals in the age range of >60 years and with comorbidities and other geriatric conditions are at heightened risk of complications from COVID-19 compared to any other age groups in the world. The time between the infection of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV- 2) and the manifestation of the symptoms is between two to twelve days. Typical symptoms of COVID-19 are high temperature, dry cough, and breathing difficulties in complicated cases, while new evidence shows atypical presentations of COVID-19 symptoms in older adults, and are highlighted in this review. From this synopsis, we deduced that firstly, the severity of COVID-19 among older adults is because of biological (dwindling immunity with old age), socio-economic (poverty and over-stretched health system...