M. Ponzetto

Post-hospitalization mortality in the elderly

The level of disability and polypathology in hospitalized elderly is usually high. Multidimensional and functional assessment allows to identify risk factors for clinical and functional failure of patients. Many studies point out that identifying predictors of high-risk patients is a necessary step in accurate targeting. We evaluated 395 subjects (175 women, 202 men, mean age 77.9 year) during their hospitalization in our Geriatric ward. Baseline data included: demographics variables, medical diagnosis, functional evaluation, and laboratory values. After a 6-month follow up 80 (20.2%) subjects died. In our study, male gender, dependence at the Dependence Medical Index (DMI), low serum albumin (< 2.8 g/dl), impaired score at the Instrumental Activities of Daily Living scale (IADL), score lower than 13.7 at the acute physiology and chronic health evaluation (APACHE II) and neoplasm were independent predictors of 6-month post-hospitalization mortality. The high mortality rate of our sample could be a marker of considerable frailty among elderly patients. Our study shows that a poor functional status is a more reliable prognostic factor than type and number of admitting diagnosis. Clinical evaluation, improved with information about functional status, is a feasible and practical way of detecting risk of short term post-hospitalization mortality of elderly subjects.

Determination of selected trace elements in patients affected by dementia

The relationship between dementia and trace elements is widely debated. Neurotoxicity of aluminium is well recognized. The purpose of the study was to evaluate serum levels of a few trace elements and a few serum proteins in demented subjects. The study was carried out on 452 women, age range 73-88 years. Thirty one of them were affected by dementia of Alzheimer type in early or middle stages. The diagnosis had been performed by history, physical and instrumental examinations, as well as by psychometric tests. The following parameters were determined: iron, zinc, copper, serum albumin, transferrin, ceruloplasmin. Iron, copper and zinc are somewhat lower in demented subjects than in controls, but the differences are statistically not significant. The slightly diminished levels of serum albumin and transferrin in the study group may be related to a mild malnutrition. The reduction of the proteins binding trace elements, particularly of transferrin, could cause a higher bioavailability of neurotoxic trace elements such as aluminium.

Health and functional status in elderly patients living in nursing homes

Socio-economic background, functional status, multiple pathology and medical conditions requiring care have been evaluated in 506 elderly subjects living in nursing homes in Turin (Italy). In the sample 78.8% are women, mean age 84.2 years, only 21.2% are men, mean age 76.3 years. Particularly in the oldest age classes women are more represented than men. Most subjects (94.3%) require help in at least one Activity of Daily Living (ADL). Part of the sample (21.2%) comes from home, 13.2% from acute wards, 9.1% from long term care wards, 6.3% from mental hospitals, 26.3% from residential homes. Education level is rather low. Before retirement, many men were workmen (38.3%), while many women were housewives (46.6%). Multiple pathology is very common: 23.7% of patients suffer from 4 pathologies, more than 5 diseases are present in 18.8%, while only 4.7% of subjects have less than two pathologies. Half of the sample (52.6%) is affected by dementia, 37.6% by cardiovascular diseases, 29.1% by chronic obstructive lung disease and 25.5% by stroke. Bone fractures are present in 22.1% of the subjects. Severe impairments in strength and/or motility in at least two limbs affect 43.7% of patients, double incontinence 49.2%, severe disturbances in speech and communication 35.4%. The prevalence of care needs is higher in women compared with men. More females than males need aid in walking, help in eating, diapers, pressure sores prevention and bedposts.

Hemodynamic, hemorheologic, and hemocoagulative changes after treatment with picotamide in patients affected by peripheral arterial disease (PAD) of the lower limbs.

Effects of picotamide on platelet activity and on some hemorheologic, coagu lative, and hemodynamic parameters were investigated in a randomized, dou ble-blind, placebo-controlled study for eighteen months. Twenty patients, average age 61.5±9.6 (SD) years, with peripheral arterial disease (PAD) at functional stage 2 of the Fontaine classification and with intermittent claudica tion for at least six months were studied. Ten patients received tablets of picotamide, 300 mg three times a day, and 10 subjects received three identical placebo tablets each day. Similar atheroscler otic disease risk factors were present in both groups. Picotamide induced a significant decrease of plasma viscosity, fibrinogen, and beta-thromboglobulin and an increase of amplitude of the photoplethysmo graphic wave.

Hemorheolocical and photoplethysmographical modifications with aging

The association of hemorheological patterns with the common risk factors for atherosclerosis is widely known. There are only few data about hemorheological modifications with aging. The objective of our study was to evaluate the relationships of blood and plasma viscosity, the whole blood and red cell filterability, and the amplitude of photoplethysmographical wave to aging and to some risk factors for atherosclerosis. The study involved 278 healthy women, mean age 55.3 +/- 11.9 (SD) years. Blood viscosity was positively correlated to body mass index (BMI), total cholesterol/HDL ratio, triglyceridemia, glycemia and hematocrit. Plasma viscosity was positively correlated to age, systolic blood pressure, glycemia, and fibrinogen contents. Whole blood filterability was negatively correlated to diastolic blood pressure, triglyceridemia, glycemia, hematocrit, and fibrinogen contents. Red cell filterability was negatively correlated to age, hematocrit, and fibrinogen. The amplitude of photoplethysmographical wave is inversely correlated to age and systolic blood pressure. Our findings show an increase of plasma viscosity, a decrease of red cell filterability and of the amplitude of photoplethysmographical wave with advancing age. These modifications may contribute to the microcirculatory troubles often evident in aging individuals.

Risk profile in women with stroke: role of plasma fibrinogen

In 96 women with ischemic stroke, (mean age 77.9 +/- 7.4, S.D., years, body mass index, BMI = 23.7 +/- 3.91, we assessed the presence of risk factors for atherosclerosis, particularly of hyperfibrinogenemia. A control group of 96 women without relevant diseases, namely neoplasms, cardiovascular and inflammatory diseases, well matched for age and BMI was also studied. Subjects with stroke show higher values of systolic and diastolic blood pressure, total serum cholesterol, fibrinogen, hematocrit and more frequent habit of cigarette smoking. Levels of HDL-cholesterol, triglyceridemia and glycemia do not differ between the 2 groups. In stroke group fibrinogen is positively correlated with systolic and diastolic blood pressure and triglyceridemia. These findings confirm the presence of a risk profile for stroke, in which hypertension plays the most relevant role. The weight of fibrinogen in pathogenesis of stroke is likely to be related to the presence of other risk factors.