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B Maero

Publications and source records attributed to B Maero.

10 recordsLinked to original sources
PubMed2004

Home care for demented subjects: new models of care and home-care allowance.

This study on home care for demented patients is one of the finalized research projects sponsored by the Ministry of Health. The teams involved are: the Home Hospitalization Service (HHS) of S. Giovanni Battista Hospital of Torino, the "Azienda Sanitaria Locale n 20" (ASL 20) of Alessandria and Tortona and the "Presidio Ospedaliero Riabilitativo Fatebenefratelli" of San Maurizio Canavese (Torino). Aim of the study is to assess the feasibility and usefulness of taking care of elderly demented patients at home and to improve the quality of life of patients and their relatives, involving training experiences and economic help. The Geriatric Department of San Giovanni Battista Hospital started a randomized controlled study on 109 severely demented subjects admitted to the emergency room of the hospital. Fifty-three patients were transferred to the traditional geriatric ward and 56 to the HHS. The team of ASL 20 of Alessandria and Tortona selected and evaluated 45 elderly demented patients living at home. These subjects, stratified for their cognitive and functional impairment, were randomly allocated to two different groups: a group receiving an economic help for one year and a control group. In the first setting of research the degree of dementia was severe, mini mental state examination (MMSE) score was 10.0 +/- 5.2 for patients at home, and 10.5 +/- 6 for the second group. The majority of patients followed at home (78.6 %) were discharged, while only 47.2 % of the in-patients returned home (p < 0.001). Seventeen out of 53 patients (32.1 %) admitted to the traditional ward and only two of home-hospitalization patients had to be sent to nursing home (p <0.001). The 45 subjects evaluated by the team of ASL 20 were divided into two groups.Twenty-four subjects were allocated to receive a home care allowance. Their functional status was impaired. Their MMSE score was 12.6 +/- 5.4 and clinical dementia rating scale(CDR) score 2.7 +/- 0.9. A control group of 21 subjects (17 women and 4 men) showed similar characteristics as the previously described group.

Aged↗
PubMed2004

[The dependence medical index (DMI): validation and comparison with the activity daily living and the instrumental activity daily living].

AIM: The aim of this study was the validation of the dependence medical index (DMI), a disability medical assessment tool in the elderly. METHODS: Study sample included 1054 subjects aged 65 and over, consecutively admitted to the University Department of Geriatric Medicine of Turin, Italy. A total of 356 of these subjects was classified as dependent to activity of daily living (ADL) and instrumental activity of daily living (IADL) scales. Some conditions causing medical dependence were detected, such as strength and/or motility impairment, incontinence, pressure sores, disturbances in speech and communication, decline in sight and/or hearing, terminal illness (death expected within 6 months), need for multiple and complex therapies, episodic disorientation, dizziness with tendency to fall, use of the wheel-chair. The relationship between dependence and the DMI was studied by discriminant analysis. A scale was created using the discriminant scores of each 15 medical indications for disability. RESULTS: The discriminant model of DMI was validated by cross-validation statistical method: its application permitted to classify correctly 73.1% of the sample. The DMI permitted to classify the dependent subjects in variable percentages: from 67% (DMI score > or =1) to 90% (DMI score > or =7). The best ratio between specificity and sensibility was for score 4 to DMI. CONCLUSION: The conclusion is drawn that DMI can be used to detect and evaluate the disability for medical reasons in elderly people.

Activities of Daily Living↗
PubMed2003

Is ankle/arm pressure predictive for cardiovascular mortality in older patients living in nursing homes?

AIM: To identify whether Ankle/Arm Index (AAI) is a predictive factor for cardiovascular mortality in institutionalised elderly. METHODS DESIGN: longitudinal descriptive study. SETTING: 2 large nursing homes in Turin, Italy. SUBJECTS: 418 dependent elderly (83 males, 335 females, mean age 83.7+/-8.5 y, range 55-102) living in the nursing homes. MEASUREMENTS: the prevalence of peripheral arterial disease (PAD) was evaluated using a Doppler Ultrasound measurement of AAI (Ankle/Arm blood pressure Index). Death causes according to ICD-9-CM were ascertained on patient's clinical records. RESULTS: Diagnosis of PAD was made in 122 subjects (29.2%) with AAI <0.90. After a 3 year follow-up 203 patients (48.6%) died. The presence of PAD was not related to total mortality or to mortality for ischemic heart disease (IHD), cerebrovascular disease or other causes. IHD mortality was significantly and independently related to low haemoglobin values, previous cerebrovascular disease, polypharmacy and poor mobility conditions. CONCLUSION: The prevalence of PAD is high in nursing home residents. AAI is not predictive for IHD mortality in this population. In very frail elderly traditional risk factors and PAD are less important predictors of death compared to poor functional status, nutritional factors and previous cardiovascular disease.

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PubMed2002

[Factors predicting a prolonged hospital stay in elderly patients].

BACKGROUND: Aim of our prospective study was to evaluate risk factors for prolonged hospitalization in elderly patients. METHODS: The study sample included 1054 patients admitted to University Department of Geriatric Medicine in Turin, Italy. We analysed: demographic variables (age, sex, marital status, economic status and living condition), affective status (GDS), cognitive status (SPMSQ), functional status (ADL-IADL), medical dependence (DMI), medical diagnosis, systolic and diastolic blood pressure, some haematological parameters (haemoglobin, creatinine, albumin, sodium, potassium). RESULTS: Average length of stays was 18+/-20.6 days; 178 patients died during hospitalization and their length of stay significantly longer (21.8+/-25.59) than survivors (17.4+/-19.3). We find that DMI dependence, impaired IADL and ADL score were associated with longer hospital stays. Medical diagnosis related to a prolonged hospitalization were: neoplasm, chronic bronchitis, hip fracture and peripheral arterial disease (PAD) with critical ischemia. Longer hospitalisation was associated also with high level of creatinine and low level of albumin and sodium. Indipendent predictors variables of prolonged hospital stay were: ADL impairment, pressure sores, hip fractures, PAD with critical ischemia, low sodium value. CONCLUSIONS: Multidimensional assessment among hospitalized elderly allows to identify risk factors for prolonged hospital stay.

Activities of Daily Living↗
PubMed2001

[Predictive variables of mortality in elderly patients after hospitalization. Significance of multidimensional evaluation].

Functional status evaluation in the elderly is stronger predictor of hospital outcomes than type and number of pathology. Multidimensional and functional assessment among hospitalized elderly allows to identify, as well as acute and chronic illness, disabilities of sanitary problems and socio-economical aspects that in the elderly can complicate illness. Our study has identified six-month mortality post hospitalization of 20.2%. The high mortality observed in our follow-up agrees with the literature and it is a marker of considerable frailty among elderly patients. The independent predictor variables of six month post hospital mortality in the study were: male gender, dependence DMI score, low serum albumin (2.8 g/dl), impaired IADL score, cancer illness and APACHE score < 13.7. These measures represent distinct domains: demographic, functional and clinical. Identifying predictors of high-risk patients is an important way in accurate targeting.

Age Factors↗
PubMed2001

[Assessment of cognitive and functional status in hospitalized elderly].

In 1745 elderly patients (971 men and 774 women), consecutively admitted to University Geriatric Ward in San Giovanni Battista Hospital of Torino, cognitive status (SPMSQ) was evaluated. Moderate-severe and mild cognitive impairment were respectively present in 26.8% and 15.8% of the sample. Subjects affected by moderate-severe cognitive impairment were older (80.7 +/- 8.0 yrs) than patients with mild deterioration (79.5 +/- 7.8 yrs) and patients without cognitive problems (75.3 +/- 8.3 yrs). The number of pathologies and the length of hospital stay were not related to severe cognitive impairment. Lower schooling was associated with cognitive alteration. Among subjects affected by moderate-severe cognitive deterioration 15.6% was living with assistance before hospitalization. The prevalence of functional impairment (ADL) was higher (70.9%) among patients with moderate-severe cognitive impairment. In-hospital mortality was higher (21.2%) among patients with moderate-severe cognitive deterioration.

Activities of Daily Living↗
PubMed2001

[Deep venous thrombosis and cancer in the elderly].

BACKGROUND: The aim of this study was the assessment of Deep Venous Thrombosis (DVT), and its relationship with malignant neoplasm in elderly. METHODS: The study sample included six-hundred patients admitted to the University Department of Geriatric Medicine in Turin in 1997 (332 male and 268 female, mean age 77.7+/-8 year). Not-neoplastic subjects affected with DVT were followed up for two years. We analysed incidence of malignant cancer in this group and then it was compared with incidence of new neoplasm in subjects without DVT at baseline. RESULTS: Prevalence of deep venous thrombosis at hospital admission and during the hospitalization was 4.8%. About 50% of patients with DVT had a related neoplastic disease. Patients with DVT were affected with malignant disease four times more than subjects without DVT. The risk of a neoplasm, during the two-years follow-up, was 6.8 times higher for patients with DVT at baseline in comparison with elderly without DVT. We didn't find significative differences between subjects with primary DVT and elderly with DVT due to neoplasm. CONCLUSIONS: There is a wide association between DVT and malignant disease. For this reason a careful follow-up of people with DVT is recommended.

Age Factors↗
PubMed1999

[Polypharmacy in the ambulatory care of aged patients].

The aim of this study was to assess the prevalence and possible predictors of polypharmacy in a sample of the general population. The sample consisted of 638 subjects (267 males, mean age 54.7, and 371 females, mean age 55) taken from the records of three general practitioners in the city of Turin, Italy. The prevalence of polypharmacy, for prescription drugs, was 12.5% (80 subjects). The prevalence of polypharmacy, for non prescription drugs, was 17.4% (111 subjects). The number of prescription drugs per patient rises progressively with age, averaging 2.28 and 2.5 respectively in males and in female aged older than 80 years. The number of non prescription drugs was observed to decrease with age: in women, subjects that used two or more non prescription drugs were 35% in those aged under 50 years, 20% in subjects aged from 65 to 80 years and 12.5% in those aged older than 80 years. Subjects aged older than 65 years, an IADL score < 10, more than 20 physical exams performed by practitioner in the last year, a recent hospitalisation, presence of cardiovascular disease, and presence of genito-urinary disease, were significantly and independently associated to polypharmacy for prescription drugs. Only female sex was significantly associated to polypharmacy for non prescription drugs. Our conclusion is that although age should not be involved in polypharmacy as a variable, several phenomena that influence medical treatment goals become more prevalent with increasing age and explain the high drugs consumption in the elderly. A rational, essential therapy, helped by guidelines could reduce potential problems associated with polypharmacy in the elderly.

Activities of Daily Living↗
PubMedDate not supplied

[Sleep disorders in the aged].

OBJECTIVES: The aim of the study was the assessment of prevalence and risk factors of sleep disorders in the elderly. METHODS: The study sample consisted of a group of institutionalized elderly, from two university affiliated community nursing homes in Turin. The following subjects were excluded: a) those aged less than 65 years; b) had length of stay less than thirty days; c) were not able to communicate because of severe aphasia or severe hearing loss and d) had cognitive impairment based on the Short Portable Mental Status Questionnaire (SPMSQ ) > 5. A total of 88 subjects (65-102 ys; 24 male and 64 female) have been studied. Comorbidity was measured using the Acute Physiology and Chronic Health Evaluation scale (APACHE), disability using the index of Activity Daily Living (ADL), depressive symptoms using the Geriatric Depression Scale (GDS); sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI) and the subjective health by the Self-Rated Health (SRH) was also evaluated. RESULTS: Using the PSQI questionnaire, 70 subjects (79.5%) were identified as "poor sleepers" (PSQI > 5). They complained of difficulties in getting sleep (85.7%) and frequent awakening (75.7%). The most common causes of sleep disturbances were nycturia (51.4%), cough (38.6%) and pain (32.9%). Insomnia correlated with depressive symptoms, poor physical activity, number of medications and bad self-rated health. CONCLUSION: Sleep disorders probably are due to physical, psychological or ambient factors. The identification and correction of treatable causes of insomnia are relevant for improving the quality of sleep and health in the elderly.

APACHE↗