Cristina Gagliardi

Impact of telemonitoring at home on the management of elderly patients with congestive heart failure

We studied the effects of home telemonitoring in elderly patients with congestive heart failure (CHF) on mortality and rate of hospitalization, compliance with treatment, quality of life and costs of CHF management, by comparison with a group receiving usual care. Fifty-seven elderly CHF patients were randomized to standard care or to home telemonitoring-based care and followed for 12 months. In the subjects who were monitored, weekly reports on their clinical status were obtained and their management was modified accordingly. Home telemonitoring was associated with improvements in the composite endpoint of mortality and rate of hospitalizations (P = 0.006), a better compliance with therapy, more frequent use of beta-blockers and statins, lower total cholesterol level and a better reported health perception score. The improved results with home telemonitoring in CHF were probably due to better compliance and to closer monitoring of the patients.

The outdoor mobility and leisure activities of older people in five European countries.

ABSTRACT Many gerontological studies have dealt with the leisure activities of older people and they have generated many important theories. Although outdoor activities and mobility promote good health in old age, both decrease with increasing age as people lose physical and mental functions. This paper examines the outdoor and indoor leisure activities of 3,950 older adults and their variations by personal and environmental characteristics in Germany, Finland, Hungary, The Netherlands and Italy. The main dimensions of activity were established by factor analysis, and in all countries four factors were found: home activities, hobbies, social activities, and sports activities. Both similar and distinctive pursuits characterised each dimension among the five countries. ‘Home activities’ mainly comprised indoor activities, but the other three dimensions involved more physical mobility. The scores of various socio-environmental characteristics on the factors enabled the attributes of the participants to be profiled. Sports activities and hobbies were performed more often by younger men, by those with good physical functioning and by those who drove cars. Social activities were performed more by women and those who used public transport. Home activities were more frequently performed by those with low physical function and women.

Associations of personal and mobility resources with subjective well-being among older adults in Italy and Germany.

The purpose of this study was to investigate the patterns of associations of personal and mobility resources with positive well-being in two sample populations of older adults from Germany (n=1518) and Italy (n=600). A correlation study showed which variables correlated the closest with the well-being components, then four logistic regression analyses were performed, one for each well-being component such as the positive and negative affect schedule (PANAS) positive scale, mobility satisfaction, health satisfaction and life satisfaction. High positive scores of PANAS and satisfaction scales were found both for Germany and Italy. As expected and in accordance with previous studies, components utilized as a measure of subjective well-being correlated significantly with each other in both countries, confirming their validity as instruments of evaluation for several different life domains. A considerable result of this study was that the driving car is an important predictor of well-being in both countries. The findings underlined a variety of associations among the mobility resources and the subjective perception of well-being. Our work supports the importance of being aware of the main variables influencing the positive dimension of well-being for creating a better understanding the needs and goals of older people. Moreover, the present study shows that individual-environment interaction should be considered in evaluating personal well-being, especially in older people.

Zinc in Elderly People: Effects of Zinc Supplementation on Psychological Dimensions in Dependence of IL-6 -174 Polymorphism: A Zincage Study

Zinc is relevant for psychological dimensions, which are altered in zinc deficiency, as in aging. Since zinc deficiency and the beneficial effect of zinc supplementation may be related to genotypes of IL-6 -174 polymorphism, the main goal was to examine psychological dimensions in relationship to plasma zinc and genetic background of IL-6 in healthy elderly subjects, recruited in Italy, Greece, and Poland, before and after zinc supplementation. On the basis of IL-6 -174 polymorphism, significant restoration occurs for PSS, especially in Greece and Poland, less for MMSE and GDS, after zinc supplementation, suggesting zinc is important in reducing stress in elderly people.

Social Support Networks and Depression of Women Suffering from Early-Stage Breast Cancer: A Case Control Study

The aim of this study was to investigate the areas of depression, anxiety, and social support using the structural model of the social network. By comparing the networks of two samples of breast cancer sufferers and healthy control participants, it was possible to identify differences in their relationships, in the shape of the networks themselves, and in the levels of depression and anxiety. Women with breast cancer described smaller and denser networks, including mainly kins whereas the healthy women included more friends, coworkers, and leisure companions. The levels of anxiety and depression were higher in women with breast cancer. Social network and social support measure correlated differently with depression and anxiety in the two groups.

Association between Cognitive Status and Physical Activity: Study Profile on Baseline Survey of the My Mind Project.

Background: The incidence of people with dementia is expected to increase significantly in the coming years, but it seems that there is a relationship between an active lifestyle and cognitive decline. The present study aimed to compare the characteristics and engagement in the physical activity (PA) of three groups of Italian elderly with different cognitive statuses at baseline phase. Methods: Data were examined using the results from the “My Mind Project” on 305 community-dwelling Italians. The sample was comprised of 93 subjects with Alzheimer’s disease (AD), 109 with mild cognitive impairment (MCI) and 103 healthy elderly (HE). Results: Classification of subjects on the basis of Physical Activity Scale for the Elderly (PASE) score showed that 47% of HE performed the highest level of physical activity while 40% of AD performed the lowest level. MCI subjects were distributed quite homogeneously across the levels (p < 0.001). Physical activity such as walking and light sports was carried out mainly and more frequently by HE as compared to the others (p < 0.05). As regards functional status, AD presented worse conditions in basic and instrumental activities of daily living than the other groups (p < 0.001). Conclusions: Our results evidenced that subjects with cognitive decline had the tendency to engage in PA less than HE. In particular, age and education negatively affected engagement in PA.

Pre-admission functional decline predicts functional improvement among older patients admitted to acute care hospital

Background Functional decline from preadmission to admission may represent an important predictor of functional trajectories during hospitalization among older patients. Therefore, we aimed at describing the impact of preadmission decline on functional trajectories among older hospitalized patients. Methods Our series consisted of 2,011 patients aged 65 years or more consecutively admitted to four acute care wards of Geriatric Medicine participating to a multicenter observational study. Enrolled patients underwent comprehensive geriatric assessment (CGA) by Inter-RAI Minimum Data Set. Main outcomes were functional decline or improvement from hospital admission to discharge based on Activities of Daily Living (ADL) scale. The main exposure variable was ADL decline during the preadmission period (ie, 3 days before the onset of acute illness), and its impact on functional trajectories during stay was investigated by Cox regression models after adjusting for potential confounders. Results After adjusting for potential confounders, preadmission functional decline was significantly associated with functional improvement during stay (hazard ratio [HR] = 6.65; 95% confidence interval [CI] = 5.01-8.84), but not with functional decline. Severe cognitive impairment (HR = 0.28, 95% CI = 0.13-0.60), visual impairment (HR = 0.60, 95% CI = 0.41-0.89), and weight loss (HR = 0.67, 95% CI = 0.47-0.94) were associated with functional improvement during stay. Hearing impairment (HR = 1.94, 95% CI = 1.17-3.23) and mild (HR = 2.54, 95% CI = 1.41-4.58) or severe cognitive impairment (HR = 2.72, 95% CI = 1.13-6.56) were associated with functional decline during stay. Conclusions Patients experiencing recent preadmission functional decline should be considered as those for which the geriatric approach may lead to the better functional result in the acute care setting. CGA allows to individuate risk factors to be addressed in the acute care setting.

A pilot programme evaluation of social farming horticultural and occupational activities for older people in Italy

The aim of this study was to evaluate a 1-year social farming programme conducted between 2014 and 2015, including horticultural and occupational activities on six agricultural farms for older people in good general health. Social farming is a practice that uses agricultural resources to provide health, social or educational services to vulnerable groups of people. Activity participation, social relationships, physical activity, and the quality of life of the participants were assessed using a pretest, posttest design. A total of 112 subjects were interviewed at baseline, though only 73 participants were retained through the end of the follow-up, resulting in a dropout rate of 34%. Data analysis revealed significant improvements in both social relationships and overall occupational engagement at the end of the programme, with significant increases in the frequency of contact with friends or relatives as well as the number of activities performed by the participants. This work adds to the literature on the effects of social farming and indicates that farming may provide opportunities for older people to engage in activities that stimulate social behaviours.

Further research and applications in the field of ozone therapy: Much more than a "Therapeutic Unconventional Hypothesis".

Ozone therapy is widely used in many countries since many years. Recently, the increasing widespread of this complementary therapy has been accomplished by an increased number of basic and clinic papers published on international journals. Many of the basic mechanisms of the ozone action are now well outlined. In addition, the modulation of interleukins and of some biochemical pathways related to inflammation and pain, indicates the rationale for its use in many pathological conditions related to pain, inflammation and age disorders. We will discuss on the mode of action of ozone that, with a hormetic mechanism, appear to be more similar to xenobiotic stress model than a pure pharmacological action. Indeed, our recent work in vivo on patients treated with major autohemo therapy (MAH) demonstrated the increase of Nrf2 level (P<0.01) in peripheral blood mononuclear cells (PBMC) immediately after exposition of blood to ozone and prior reinfusion. The activities of superoxide dismutase and catalase were increased (P<0.05) following the cycle of MAH’s. These data demonstrate by the first time in vivo the activation of the Nrf2 pathway by a low dose of ozone and the activation of the feedback mechanism that induces the synthesis of proteins which finally favours the cell survival. Following the above research on Nrf2, it is now in progress a new scientific approach in the aim to study the transcriptional profile by qRT-PCR of transcripts in both Nrf2- and NFkB-dependent genes to further define the profile of the positive effect induced by low ozone doses in many ailments in patients in vivo.