Societá

Attivitá SIGG

Giornale di Gerontologia

Numero 6, Dicembre 2007 - Volume LV

Copertina

Editoriale

Cosa ci aspetta nel prossimo futuro?

G. Salvioli
Centro di valutazione e Ricerca Gerontologica, Universitá di Modena e Reggio Emilia

G Gerontol 2007;55:687-689

Parole chiave: Futuro - Medicina - Societá - Anziani
Key words: Future - Medicine - Society - Elderly

Durante il 2007 é rimasta invariata la scarsa considerazione da parte delle classi dirigenti per le modificazioni piú importanti della realtá sociale; la popolazione invecchia (la demografia é una scienza e la medicina che si occupa degli anziani é la geriatria) e la qualitá dell´ambiente in cui viviamo si deteriora progressivamente tanto che si parla sempre di piú di The challenge to change a vari livelli della societá in cui viviamo. le risposte correnti ai problemi citati sono molteplici; leggendo i giornali prevale l´idea che si possano risolvere fondando nuovi partiti politici diretti dalle solite persone; la nuova stagione sarebbe realizzabile con gli anziani ancora protagonisti, anche se governano ormai da tantissimi anni con principi spesso paralizzati dalle ideologie.

L´autopsia puó migliorare le conoscenze geriatriche e gerontologiche?

G. Salvioli
Centro di valutazione e Ricerca Gerontologica, Universitá di Modena e Reggio Emilia

G Gerontol 2007;55:690-692

Gli anziani nelle strutture residenziali: quanti sono?

G. Salvioli
Centro di valutazione e Ricerca Gerontologica, Universitá di Modena e Reggio Emilia

G Gerontol 2007;55:693-695

Parole chiave: Anziani - Strutture residenziali
Key words: Elderly - Nursing homes

Recentemente Gori e Guaita segnalano la diminuzione degli anziani ospiti di strutture: risulta dai dati dell´iSTaT relativi all´assistenza residenziale e socio- assistenziale in italia negli ultimi anni. Gli anziani non autosufficienti che vivono in struttura sarebbero 156.175 (nel 2003) di cui solo 34.216 maschi; le differenze regionali sono eccessive e fanno temere sulla validitá dei dati riferiti: per esempio in Campania e Sicilia i ″disabili″ sono molti di piú rispetto all´Emilia Romagna, la Toscana e il veneto e soprattutto sono piú giovani; il tasso di disabilitá é piú elevato al Sud che al Nord (http://www.disabilitaincifre.it/indicatori/ assistenza/presidi_residenziali.htm).

Articoli daggiornamento

Nuove prospettive terapeutiche nel diabete mellito di tipo 2: analoghi del Glucagon-Like Peptide 1 (GLP-1) ed inibitori dell´enzima Dipeptidil Peptidasi-4

C. Irace, G. Sesti
Dipartimento di Medicina Sperimentale e Clinica, Universitá ″Magna Grcia″ di Catanzaro

G Gerontol 2007;55:725-732

Parole chiave: Diabete di tipo - Analoghi del GLP-1 - Incretine - Inibitori del DPP-4
Key words: Type 2 diabetes - GLP-1 analogues - Incretin - DPP-4 inhibitors

Articoli originali

Determinanti di NT-proBNP in pazienti anziani non cardiopatici

F. Moroni, M. Pinelli*, M. Bindi*, M. Castiglioni*, F. PentiMone
Medicina generale II, azienda ospedaliera-Universitaria Pisana, Pisa;
* Medicina generale IV, azienda ospedaliera-Universitaria Pisana, Pisa

G Gerontol 2007;55:696-703

Objectives. The aim of our study was to identify potentially confounding variables for the interpretation of plasma N-terminal pro brain natriuretic peptide (NT-proBNP) in non-cardiac hospitalized patients aged = 65 years.

Methods. Seventy consecutive non-cardiac patients underwent assessments of NT-proBNP, thyroid hormones and several haemato-chemical variables and cardiac and abdominal ultrasound examination. The correlation among NT-proBNP and the other variables was assessed by Pearson coefficient (R) and multiple regression analysis.

Results. The median value of NT-proBNP exceeds recommended cut-offs for the diagnosis of heart failure: 331 (101-547) pg/ml for subjects aged < 75 years and 746 (401-1973) pg/ml for subjects aged = 75 years. In the final multivariable regression analysis NT-proBNP is positively related with age and reactive C protein (CRP) and inversely with free-triiodothyronine (FT3), heart rate, haematocrit and hepatic steatosis.

Conclusions. In elderly hospitalized patients the levels of NT-proBNP are increased independent of overt cardiovascular disease. In this study we identify several ″confounders″ involved in the interpretation of plasma NT-proBNP concentration, among which haematocrit, FT3 and CRP which should play an important role.

Key words: Elderly - NT-proBNP - Haematocrit - Triiodothyronine - C reactive protein

Il carico soggettivo dei caregivers di anziani
affetti da demenza: quali indicazioni di
intervento? Indagine nel territorio piacentino


L. Luchetti* ****, E. Uhunmwangho**, M. Esposito**, G. Dordoni*, E. Cavazzuti***
* Consultorio Aziendale per i Disturbi Cognitivi nell´Anziano;
** U.O. Assistenza Socio-Sanitaria Integrata;
*** Responsabile Progetto Aziendale Demenze, Direzione Generale Azienda USL di Piacenza;
**** U.O. di Geriatria, Ospedale ″Guglielmo da Saliceto″, Azienda USL di Piacenza

G Gerontol 2007;55:704-718

Objectives. The aim of this study was to learn and give a description of burden perceived by caregivers of elderly patients with dementia. The purpose was to know how caregiver burden was influenced by caregivers´ and patients´ characteristics and by social support; the intention was to use these elements in order to suggest how to optimize the interventions which may reduce caregivers´ subjective feeling of burden.

Methods. A sample of 99 caregivers was studied using a descriptive-correlational design. Caregiver burden was assessed by CBI, a multidimensional scale proposed to quantify the caregiving workload and its impact in different aspects of caregivers´ life. The subjects also filled in a questionnaire meant to survey the sociodemographic features and the social support given by social network. The influence of different elements of caregivers´ profile on various aspects of burden was estimated.

Results. The burden was due to restrictions on their personal time and to the sense of failure regarding their hopes and expectations. Caregivers were women (80.82%), patients´ sons/daughters (60.61%), mean age was 54 and 60% of them lived with the patients. Most of the caregivers didn´t receive any sort of help in looking after the patient (52.53%) and didn´t attend any kind of support group (76.77%). Furthermore some differences in variety and level of subjective feeling of burden linked to: caregivers´ gender, relationship to patient, patients´ gender, living with patient, receiving help in caregiving and attending support group.

Conclusions. These results suggest that, in order to improve the caregivers´ psychophysical well-being, it could be useful to intervene in two ways. On one hand, improving all those interventions targeted to reduce restrictions on the personal caregivers´ time, that is, making respite care and day care units more accessible to elderly with dementia. On the other hand, giving caregivers the opportunity to benefit from interventions oriented to cope the sense of failure and the physical stress, to say, individual counselling or continued informal support. Interventions should be organized so that caregivers don´t have to spend too much personal time and psychophysical resources, in order to avoid a paradoxical increase of subjective feeling of burden.

Key words: Burden - Caregiver - Dementia

Correlazioni fisiologiche degli stati depressivi nell´invecchiamento

A.M. Polyukhov, V.I. Grebelnik, N.Yu. Bachinskaya, G.M. Butenko, A.P. Saichenko, L.V. Magdich
Istituto di Gerontologia, Vyshgorodskaia, Ucraina

G Gerontol 2007;55:719-724

The aim of the present study was to investigate the functional state of the brain and of the several endocrine and immune indices in elderly patients (73 subjects of both sexes) with non endogenic depression. The control group consisted of 42 persons of the same age and with the same somatic condition but without depressive symptoms. MMPI test, Wechsler tests, electtroencephalogram with frequency- integrative analysis, immunologic (natural killers activity, lymphocyte blast transformation reaction to PHA-stimulation (RBTL)), endocrinologic (cortisol) and neuroendocrinologic (beta-endorphin, met-enkefalin, lei-enkefalin) indices were used. In depressive patients, the increase of psychological profile values (according to neurotic scales), the decrease of middle frequency ratio of EEG rhythms on the right hemisphere, the slow down of the tempo of motor performance, the decrease of mental working capacity and visual memory and the increase of blood plasma cortisol concentration and of the RBTL were found. A significant negative correlation was found between the level of depression scale and leucocytes concentration in the blood. It was concluded that non endogenic depressive conditions in advanced age reflected the state of chronic psychological stress leading to accelerated aging.

Key words: Non endogenic depression - Aging - Chronic psychological stress - Neuropsychology - Cortisol - Lymphocyte blast transformation - Killer cells

Casi clinici

Trattamento long-term del dolore cronico nel grande anziano con oppiacei

F. Fusco, E. Donelli, S. Silvestro
Cure Palliative Domiciliari, Dipartimento Assistenza Anziani, Azienda ASL 3 Genova

G Gerontol 2007;55:733-737

Chronic persistent pain is a widespread problem in older people, particularly in the group above age 75 that represent a frail, fastest growing area of the total population.
Three above-85 older people affected by severe generalised ostheoarthrosis with refractory-persistent pain and severe functional impairment, was referred to our Palliative Care & Pain Therapy Unit. Treatment with low-dose opiates by mouth allowed a marked clinical improvement, satisfactory pain control and long-term tolerability.

Key words: Chronic pain - Opioid therapy - Older people

Indici

Indice per Autori

G Gerontol 2007;55:738-745

Indice per Argomenti

G Gerontol 2007;55:746-747