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Attivitá SIGG

Giornale di Gerontologia

Numero 5, Ottobre 2009 - Volume LVII

Copertina

Sommario

Editoriale

L´insufficienza renale misconosciuta: un problema prettamente geriatrico

R. ANTONELLI INCALZI1 2, C. PEDONE1 3, A. CORSONELLO4
1 Universitá Campus BioMedico, Roma;
2 Fondazione San Raffaele, Cittadella della Caritá, Taranto;
3 Fondazione Alberto Sordi Onlus, Roma;
4 Istituto nazionale di Ricovero e Cura per Anziani V.E.II (InRCA), Cosenza

G GERONTOL 2009;57:235-239

L´insufficienza renale: un determinante prognostico maggiore
L´insufficienza renale cronica costituisce un fattore di rischio per morte e perdita dell´autonomia personale sia nella popolazione generale sia in popolazioni selezionate.
Ad esempio in pazienti con scompenso cardiaco la mortalitá aumenta in modo drammatico nel passaggio da una velocitá di filtrazione glomerulare (GFR) di 60-90 ml/min/1,73 m2 ad una di 30 ml/min/1,73 m2. Inoltre giá il valore intermedio compreso tra 30 e 59 ml/min/1,73 m2 si caratterizza per una mortalitá maggiore che nella fascia con GFR = 90 ml/min/1,73 m2. Cosí pure, dopo un infarto del miocardio il rischio di morte é inversamente correlato con la GFR. Ancora, nella popolazione generale esistono diverse evidenze che supportano il ruolo prognostico dell´insufficienza renale.

Articoli daggiornamento

Sezione clinica
Gestione del paziente anziano con diabete mellito Tipo 2: esperienza dallo studio osservazionale IMPROVE italiano


M. BOEMI
U.O. Diabetologia e Malattie Metaboliche, Istituto nazionale Ricovero e Cura per Anziani (INRCA), Ancona

G GERONTOL 2009;57:267-274

Parole chiave: Terapia insulinica - Anziani - Insulina aspart bifasica - Diabete Tipo 2
Key words: Insulin therapy - Elderly - Biphasic insulin aspart - Type 2 diabetes

Introduzione

I dati degli Annali AMD 2008 evidenziano che il 61,9% della popolazione diabetica di Tipo 2 in Italia ha un´etá superiore ai 65 anni, e che dal 2004 c´é stato un incremento del 3% dell´incidenza di diabete in questa fascia d´etá.
Gli anziani diabetici istituzionalizzati rappresentano in media in Italia il 12,7% sul totale della popolazione anziana ospitata nelle strutture, in accordo con gli studi di prevalenza presenti in letteratura. A questa percentuale andrebbe aggiunta quella relativa ai pazienti anziani diabetici istituzionalizzati non diagnosticati, i quali potrebbero rappresentare fino al 10% della popolazione istituzionalizzata.
Il diabete nell´anziano rappresenta dunque un problema di grande rilevanza dal punto di vista della gestione sanitaria, con particolare riguardo all´attuazione e ai costi della terapia.

Sezione di Biogerontologia ed Epidemiologia
Invecchiamento della popolazione, immigrazione, crescita economica


I. VISCO
Vice Direttore Generale della Banca d´Italia

G GERONTOL 2008;56:275-295

Per il testo di questo articolo consultare copia cartacea del fascicolo

Articoli originali

Sezione di Biogerontologia
Biomarcatori di rischio cardiovascolare


F. MARCHEGIANI, M. PROVINCIALI, F. LATTANZIO*
Laboratorio di Immuno-Oncologia,
*Direzione Scientifica, I.N.R.C.A., Ancona

G GERONTOL 2009;57:240-244

Despite enormous therapeutic advances, cardiovascular disease remains a global public health problem. There is substantial interest in identifying new risk factors, to improve our understanding of disease biology and to account for the cases of heart disease that cannot be explained by known risk factors (smoking, diabetes, hypertension, obesity and history of coronary heart disease). Investigation of putative risk factors frequently involves the study of circulating biomarkers. Prior to the transfer from bench to bedside, these cardiovascular risk biomarkers have to meet the following requirements: 1) Can the clinician measure the biomarker?; 2) Does the biomarker add new information?; 3) Will the biomarker help the clinician manage patients? Until now, only few biomarkers have satisfactorily fulfilled these requirements.

Key words: Biomarker - Acute coronary syndrome - Genetics

Sezione clinica
Rilevazione di tempi assistenziali in strutture residenziali e semi-residenziali per anziani


R. RAITERI, I. ARAMINI, S. MUSANTE, C. TRAVERSO, M. PERROZZI, A. MIGONE, L. ROMEO, A. TESTI*, D. MOGGIA*, A. TRAVERSO*, P. ODETTI**
A.S.P. Emanuele Brignole, Genova;
* Universitá di Genova, Facoltá di Economia, DIEM;
** Universitá di Genova, Facoltá di Medicina e Chirurgia, DIMI, U.O. di Geriatria, Genova

G GERONTOL 2009;57:245-251

Objective. The main objective of this study was the measurement of time of direct care to older people in nursing homes and day care setting and to evaluate the correlations between the scores of two Multi-Dimensional Assessment instruments used to define the complex clinical care of older people: RUG and AGED.

Metods. The survey lasted one week in the Nursing Homes and six days in Day Care centers; the whole survey was completed in five weeks. Data were collected during working hours by the team project. Information as about 42,500 cards and 500,000 items have been collected.

Results and conclusions. A database has been built containing the amount of time of formal care delivered to 663 guests (552 for Nursing Homes and 111 for Day-Care), classified by types of hospitalization, and clinical complexity of care through the scores AGED and RUG. On average, the clinical complexity of care was quite high. The total time of care showed a higher correlation with AGED than with case-mix of the RUG. AGED has been built around the timing of care, therefore the result agrees quite well. It is conceivable an integration of the two scoring systems: AGED for a quick estimate in the community, RUG-CMI for the assessment of the patient in residences for older people. RUG-CMI should be reviewed at intervals of time, assuming that the case-mix could be the basis for the reimbusement by the National Health Service. Moreover, the presence of cognitive and behavioural disorders are underestimated by both the AGED that RUG-CMI, thus the AGED test should be integrated with some variabiles that take into greater account the clinical complexity and the severity of cognitive impairment.

Key words: Nursing homes - Geriatric assessment - RUG - AGED

Sezione clinica
Analisi dello strain e strain rate sistolico longitudinale del ventricolo sinistro in pazienti adulti ed anziani


E. SANTILLO*, G. VENTURA*, S. CASSANO*, A. RITACCO*, R. RAGO*, T. LAMPRINOUDI*, A. FERRARO*, I. CORSINI*, F. ROSSELLI*, G. GROSSO*, M. VASILE*, M. MIGALE**, F.P. CARIELLO*.
* Istituto ″Ninetta Rosano″ - Casa di Cura Polispecialistica Tricarico. Divisione Cardiovascolare, Belvedere Marittimo (CS);
** DEA U.O. Pronto Soccorso - Presidio Ospedaliero, Praia a Mare (CS)

G GERONTOL 2009;57:252-261

Objective. Strain and strain rate imaging have emerged as modern echocardiographic technique to estimate myocardial deformation and rate of deformation. Evidences about changes in strain and strain rate occurring with senescence are poor. Aim of our study was to verify the existence of age-related modifications of systolic strain and strain rate in adults and elderly without ischemic heart disease and with normal ejection fraction.

Methods. We studied 50 patients: 25 elderly and 25 adults, admitted at our Institute. All patients had complete clinical examination, electrocardiogram and laboratory tests. In every subject we performed standard echocardiographic examination with longitudinal 2D strain and strain rate analysis of the 6 myocardial segments detectable in apical four-chamber view.

Results
. Old patients have lower values of longitudinal systolic strain and strain rate for almost all examined myocardial segments. Mean strain was significantly lower in elderly compared with adults (-19,70 3,46 vs. -21,64 2,48; p: 0,027), as it was the case for mean strain rate (-1,20 0,22 vs. -1,34 0,19; p: 0,023). Linear regression identified age as the only predictor of mean strain, explaining about 22% of variability; indexed left ventricular mass was the only predictor of mean strain rate accounting for 19% of variability.

Conclusions
. Lower strain and strain rate values in elderly appear congruent with age-related structural and functional changes reducing myocardial contractility. Strain and strain rate imaging is a technique of significant value enabling assessment of segmental myocardial function and completing information derived from global function indexes.

Key words
: Strain - Strain rate - Aging heart

Sezione clinica
Il dolore cronico nel paziente anziano


L. BAGNARA, E. COLOMBO, C. BILOTTA, C. VERGANI, L. BERGAMASCHINI
Dipartimento di Medicina Interna, Unitá di Geriatria, Fondazione Ospedale Maggiore-Policlinico IRCCS, Universitá di Milano

G GERONTOL 2009;57:262-266

Objective. To analyze the prevalence of persistent pain in the elderly and estimate its impact on patients´ usual daily activities and depression symptoms.

Methods
. 227 patients at the Geriatric Unit, Ospedale Maggiore Policlinico di Milano, or their caregivers filled up a questionnaire about presence of pain and its impact on functional autonomy. Further information was gathered from the charts and, 3 months later, patients and caregivers underwent a follow-up evaluation by phone interview.

Results
. 75% of patients reported persistent pain, occurring daily in 70% of subjects. Average intensity was 6.5 (on a 0-10 range) and it affected patients´ common daily activities and was associated with depressive symptoms. 52% of patients did not use analgesics, NSAIDs were the most common class of analgesics (16%). The lower prevalence of pain among patients with dementia is likely associated with undervaluation by caregivers. Pain and depression do not correlate, whilst a greater use of antidepressants (SSRI) was observed among patients without pain.

Conclusions
. Persistent pain in the elderly seems to be poorly diagnosed and treated despite its influence on patients´ mood and daily activities. Common acceptance of pain and scepticism towards analgesics, especially for patients that already assume several drugs, may contribute to the under-treatment of persistent pain. Lack of communication might further complicate the assessment in patients with dementia. In depressed patients, antidepressant treatment seems to avoid the risk of developing pain.

Key words
: Persistent pain - Elderly - Analgesics - Quality of life