A. Distefano

On the importance of multidimensional evaluation of elderly oncologic patients.

The role of comorbidity and the psycho-affective attitudes have been studied in 108 elderly oncological patients, in comparison with 25 elderly subjects without tumor pathologies. The results have revealed positive correlations between the activity of daily living (ADL), as well as the instrumental activity of daily living (IADL) scales and the comorbidity both in the oncological subjects and the controls. The performance status defined by the eastern cooperative oncology group (ECOG-PS) positively correlated with the parameters of ADL and IADL scales, demonstrating an increased vulnerability and fragility of the oncological patients in their everyday activities. An increased psychological fragility of the oncological patients has also been revealed by the scores of the geriatric depression scale (GDS), which might be cause and consequence at the same time of the disease itself. In addition, the polypathologies are not associated with an increased gravity of the tumor stage, although there have been 2.5 accompanying pathologies, mainly diseases of osteoarticular and cardial character. The correction of functional damages of various organs due to aging or concomitant or previous diseases is a period of fundamental importance for an adequate oncological therapy. The principal goal of any intervention in the elderly oncological patient should certainly be an improvement of the quality of life, including an alleviation of the impact of the diagnostic and therapeutic procedures on it.

Suicides and the third age

The phenomenon of suicide represents a complex problem, the specific aspects of which should be examined by a multifactorial analysis, particularly in the elderly subjects. Although the research on risk factors continues to grow, only a limited knowledge is available on the biological changes increasing the risk for suicide. Similarly, limited information is at our disposal about the contributing psychosocial processes extending beyond the demographic factors. Although the best explored population is the elderly using primary care services, no proven interventions are known for the time being, although some efforts to test certain approaches reaching these older adults are under way. Apparently even more, continued efforts are needed to change the attitudes toward the mental illnesses and their treatments in general, in order to reach the older adults who are still outside of the health care services.

Urinary albumin excretion in elderly patients with white coat hypertension

The so-called white coat effect occurs in about 42% of elderly patients. This phenomenon leads to several problems in treatment and may also cause renal disease. One of the most frequently controlled parameters is microalbuminuria, an index of renal damage. The present case-control study intended to evaluate the urinary excretion of albumin in elderly patients suffering from white coat hypertension, and comparing their data to those of normotensive subjects. In addition, the study searched for correlations between albuminuria and various clinical and ambulatory blood pressure values. A total of 258 patients were enrolled, but after screening, only 129 were considered; 13 of the latter were further excluded because of problems encountered during ambulatory monitoring of arterial blood pressure. Therefore, 116 hypertensive subjects were included in the study. This pool of hypertensive patients was compared to a normotensive group of 33 subjects. The results have shown the occurrence of white coat effect in 25% of cases, and the microalbuminuria of these patients was statistically not significantly different from that of the normotensive group of patients. The microalbuminuria correlated only with ambulatory systolic blood pressure measured during the day.

The effects of caloric restriction and controlled physical exercise on hypertension in the elderly

The overweight and sedentary life style are associated with elevated blood pressure values in the elderly patients. The first step in the therapy of arterial hypertension should be hygienic-behavioral measures in order to modify the life style of the patients. The present study evaluates the independent effects of caloric restriction and physical exercise on the blood pressure and on the anti-hypertensive treatment in elderly subjects with mild-moderate hypertension. The number of enrolled patients was 74 in the age range of 61-72 years, showing up in our Geriatric Day Hospital. The results obtained confirm that the non-pharmacological measures represent a valid alternative to the pharmacological treatment of hypertension in the elderly patients, or may be applied in combination with the latter, in order to reduce the doses of pharmaca.

Expression of cell cycle-dependent genes and proliferative state of lymphocytes in aging

The authors analyzed the expression of some genes involved in the control of T lymphocyte proliferation in a group of healthy elderly subjects. They focused their attention on genes involved in the G(0)/G(1) transition (TK, PCNA, H3, IL2-R) and showed decreased expression in the TK, H3 and IL2-R genes. Using flow cytofluorimetry, delayed transition from the G(0)/G(1) to the S stage was observed.

Echocardiographic studies on elderly patients with white coat hypertension to evaluate cardiac organ damages.

This case-control study was aimed at evaluating the distribution of some echocardiographic signs of cardiac organ damages in elderly patients with white coat hypertension (WCH), as compared with a normotensive group of elderly. Correlations between the signs of cardiac organ damages and the clinical and ambulatory blood pressure parameters (obtained by means of a 24-h monitoring) have also been evaluated. The first screening covered 258 elderly subjects of both sexes, aged from 65 to 82 years, with clinical diagnosis of hypertension (systolic and diastolic blood pressures being higher than 160 and 95 mmHg, respectively). Of this group, 116 subjects remained in the final pool, and their echocardiographic parameters were compared with 33 normotensive (N) subjects. Out of the 116 clinically hypertensive patients, 29 (25%) displayed WCH, according to the established criteria. Variance analyses on the ranks followed by Dunns test revealed no statistically significant differences between the N and WCH groups, while the hypertensive group (H) proved to be significantly different from both the N and the WCH groups. In addition to the descriptive statistics, an analysis of correlations between the pressure variables and the echocardiographic parameters has also been performed by means of a forward-stepwise multiple linear regression method. The models generated by this regression analysis covered only the ambulatory diurnal systolic pressure, and the clinical diastolic pressure in most of the cases of the echocardiographic parameters, taken as independent variables. In all these cases, the standardizecl correlation coefficient of the diurnal systolic pressure was always higher than that of the clinical diastolic pressure, indicating that the echocardiographic parameters depend more strongly on the first than on the second pressure value.

Nutritional and behavioral measures in the non-pharmacological treatment of elderly hypertensive subjects

The antihypertensive treatments have resulted in favorable effects in terms of cardiovascular morbidity and mortality in the elderly, but the therapeutic approaches raise problems linked to the pathophysiological aspects of hypertensives and to the reduced homoeostatic capacity of the senile organism. The antihypertensive treatment in elderly must be aimed at achieving a maximal improvement in the cardiovascular risk profile with possibly minimal side effects. The first step is the non-pharmacological therapy which is a hygienic-behavioral program aimed at changing the patients life style (physical exercise, reduced salt intake, body weight control, etc.). Non-pharmacological therapy in the elderly patients requires a preliminary evaluating protocol and a close monitoring of the individual responses. The diet, restriction of sodium intake (4-6 g/day), and aerobic physical exercise are important for decrease the development and persistence of hypertension. The non-pharmacological therapy has a low antihypertensive action, however, once established, it should not be abandoned, as its association with pharmacological treatment allows the use of fewer and lower doses of drugs, with a consequent reduction of the risks due to side effects.

Comparison of ambulatory and clinical blood pressures, and their correlation with organic heart damage, in the elderly

Casual blood pressure (BP) measurements may sometimes indicate the presence of cardiovascular morbidity and mortality, but the correlations between BP values and the subsequent occurrence of such complications are low. This may depend on the known inability of casual BP measurements to reflect accurately the 24-hour mean and overall profile of the BP. In this study, electrocardiography (ECG) of left ventricular muscle mass was related to various measures of BP during circadian ambulatory BP monitoring in 156 hypertensive and non-hypertensive elderly patients. Multiple regression analysis performed to establish the presence of left ventricular hypertrophy (LVH) revealed that the product of ambulatory systolic BP x diastolic BP (p = 0.027) and ambulatory diastolic BP were significant variables. Clinical pressure variables were not significant. Multiple linear regression analysis to establish the degree of LVH in function of the pressure variables generated a model where the variables included are the product of ambulatory systolic BP x diastolic BP (p = 2.7 x 10(-8)), ambulatory systolic BP (p = 7.8 x 10(-6)) and ambulatory diastolic BP (p = 2.4 x 10(-6)). Results obtained agree with the literature and revealed that LVH evaluated using ECG-Romhilt-Estes score was correlated in terms of presence/absence of organ damage and in terms of score to ambulatory monitoring values.