Societá

Attivitá SIGG

Giornale di Gerontologia

Numero 5, Ottobre 2004 - Volume LII

Copertina

Editoriale

Invecchiamento della popolazione e necessitá di una nuova formazione in medicina

U. SENIN, P. MECOCCI, A. CHERUBINI

Sezione di Gerontologia e Geriatria, Dipartimento di Medicina Clinica e Sperimentale, Universitá di
Perugia

G GERONTOL 2004;52:205-208

Atti Congresso

RIABILITAZIONE GERIATRICA

Appropriatezza e qualitá delle prestazioni riabilitative


A. SALVIA, V. REBELLA, F. PAPALIA, S. AMATO

Direzione Sanitaria Fondazione Santa Lucia IRCCS, Roma

G GERONTOL 2004;52:211-217

Italian laws from 1992 to 1999, written in order to obtain efficient and effective National Health Service, introduced the notion of quality of therapies in the contest of the same medical system.
In the rehabilitation field, we can identify a large number of quality´ aims: Patient satisfaction and his rights, equal admittance to therapies, health workers´ professionalism, organization quality and health welfare service integration.
We can instead define appropriate all those therapies based on scientific evidences; therapies that can answer to Patients´ needs and must be guaranteed by National Healt Service.
Rehabilitation service must give care continuity, therapies efficacy. Moreover, it has to offer different frequency levels of therapies, taking in to account Patients´ needs.
Beside the control of the hospital activity must guarantee the efficiency source not at damage of the appropriateness and the quality of therapy: in doing so it safeguard people´s health.
Appropriate and congruous controls to rehabilitation are those that aim to prove extended and reiterated hospitalization and unapproprieted admission.
Health Service better quality and approach, obviously supported with steady and financial resources, can be obtained only with a better use of the clinical and managerial resources.

Key words: Compliance - Quality - Rehabilitation

RIABILITAZIONE GERIATRICA

Il percorso di cura integrato dell´emiplegico
(Dal DEA al domicilio: un´esperienza di monitoraggio del percorso)


M. BEJOR, M. SARTORI*, C. CHESSA**, M. VIAGGIANO***

Fisiatra UO RRF IRCCS ″S. Matteo″, Pavia; * Internista, UO Clinica Medica II IRCCS ″S. Matteo″, Pavia;
** Fisiatra UO RRF Fond. ″Maugeri″, Pavia; *** Geriatra, UO Riabilitazione, Fond. ″Don Gnocchi″, Salice Terme, Pavia

G GERONTOL 2004;52:218-226

The Authors present the result of the clinical governance of stroke patientstrough an integrated net of acute and rehabilitation wards. Discharge to homeor to other wards, neurological status (NIHSS), functional outcome (FIM) and comorbility(CIRS) are considered.

Key words: Stroke - Functional outcome - Discharge - Clinical governace

ODONTOIATRIA GERIATRICA

Un modello di intervento multiprofessionale


B. TASSAROTTI

Clinica Odontoiatrica, Universitá di Milano

G GERONTOL 2004;52:227-229

The Italian Society of Gerodontology aims to encourage the well-being of the elderly people, providing them with an efficient Stomatognatic Apparatus.
In the Geriatric Assessement of these patients, the evaluation of their Stomatognatic Apparatus has a primary importance, due to the fact that a limited chewing activity reduces their nourishment.

Gerodontology, a new branch of Dentistry, has recently appeared following the growing longevity of the population. So a relevant number of Gerodontologists may help the elderly people to avail themselves of the excellent progress in Dentistry, providing them with a better quality of life.

Key words: Gerodontology (or Geriatric Dentistry) - Stomato-Gnatic Apparatus - Geritric Assessement - Olistic point of view - Gerodontological novelties

ODONTOIATRIA GERIATRICA

Valutazione multidimensionale in odontostomatologia geriatrica


F. ANZIVINO, P. MANSANTI, A.M. ZAGATTI, A. ZURLO

Unitá Operativa Complessa di Geriatria, Azienda Ospedaliera Universitaria di Ferrara

G GERONTOL 2004;52:231-235

The assessment of elders´ needs requires a more complex approach than in the past: it is necessary to consider not only their prior or current diseases, but also their social environment and their individual psychological qualities. This new approach to the problem is called multidimensional assessment, a term that implies a collaboration between several professionals (multiprofessional assessment). This is the only way that will allow us to have a clear picture of the diseases as well as of the possible disabilities and the social and sanitary handicaps that could stem from them. Dentists, in particular, should be strongly interested in adopting this methodology, which would grant them concrete advantages in the daily proceedings of their profession.

Key words: Gerodontology - Geriatric assessment

ODONTOIATRIA GERIATRICA

Salute orale dell´anziano: un aspetto determinante per la qualitá della vita


M.L. LUNARDELLI, S. PIZZI*

Unitá Operativa di Geriatria, Azienda Ospedaliera e Universitaria di Parma; * Unitá Operativa di Odontostomatologia, Azienda Ospedaliera e Universitaria di Parma

G GERONTOL 2004;52:236-242

Oral health is one of the most influencing condition on elderly quality of life. Particularly frail elderly, often significantly affected by poor oral hygiene levels, develop difficulties in the access to dental cares due to the physical limitation and autonomy loss. Geriatric assistance needs to improve in order to increase oral health care in elderly, considering the importance of the oral pathologies on different aspects of the quality of life, such as nutrition and social and psychological wellbeing. The strict operative collaboration between geriatrics and dentists is essential as well as the training of assistance-team and the creation of specific intervention projects on different care-settings for elderly.

Key words: Elderly - Oral health - Quality of life - Functional assessment

ODONTOIATRIA GERIATRICA

Gestione del cavo orale nel soggetto anziano: la malattia parodontale e l´osteointegrazione


M. BALDONI, R. PAPAGNA*, F. CARINI*

Clinica Odontoiatrica, Universitá di Milano-Bicocca; * Corso di Laurea per Igienista Dentale, Universitá
di Milano-Bicocca

G GERONTOL 2004;52:243-249

The necessity of treatment for the periodontal disease in the patients with advanced age to the 65 years is in constant increment, because of the demographic increase of the old population. The greater part of such patients can be cured with the same techniques and methodologies that are executed in the practical daily in the adult patient, attending a success comparable to those obtained in the young person.

Key words: Demographic aging - Periodontal disease - Osteointegration - Therapy

L´INFORMATICA AL SERVIZIO DELL´ASSISTENZA E DELLA CURA: ESPERIENZE CONDOTTE IN STRUTTURE RESIDENZIALI

″Cartella utente″: esperienza di informatizzazione


F. ASTENGO

Piccolo Cottolengo ″Don Orione″, Genova

G GERONTOL 2004;52:250-252

The computerization plan of Piccolo Cottolengo Genovese, a complex structure holding more than 1,000 beds, is briefly illustrated in the article. In this context the attention is focused on ″User Folder″, a software that is currently being customized for the management of services and sociomedical performances

Key words: Software - User folder - Assessment

SIMPOSIO
IL DOLORE DEL CORPO E LA SOFFERENZA DELLA MENTE

La gestione del dolore cronico: farmacologia degli analgesici oppiacei


P. ROMUALDI, S. CANDELETTI

Dipartimento di Farmacologia, Universitá di Bologna

G GERONTOL 2004;52:253-258

The opiate analgesic drugs currently represent the most powerful instrument in pain therapy and elicit their therapeutic action mimicking endogenous substances, the opioid peptides, natural ligands of the opioid receptors. They interact with specific receptors, physiologically present in the CNS and in periphery, where they modulate different functions. Beside the well known function related to nociceptive transmission modulation, this system is also involved in the regulation of gastrointestinal, endocrine and autonomic functions, as well as in the mechanisms underlying reward, addiction and in memory and learning processes. Opiates are more and more diffusing in pain therapy and physicians should be able to control pain before this becomes intractable. The recent discovery of new opioid endogenous systems, like the nociceptin one, the development of alternative administration routes and of new drugs with less abuse liability, will allow better scientific understanding, better targeted therapy and a safer use of opiate drugs for the pharmacological control of pain. The goals in this field of research are important and future knowledges will be able to help physicians to use therapeutic tools in the control of pain, before it becomes intractable.

Key words: Opiates - Chronic pain - Analgesia

SIMPOSIO
CURARE LA LESIONE ARTROSICA OLTRE IL CONTROLLO DEL DOLORE?

Artrosi e disabilitá


A. BARONI, A. MANNONI*

Polo Geriatrico Montedomini, Firenze; * UO Reumatologia - ASL 10, Firenze

G GERONTOL 2004;52:259-261

LUNCH SESSION
LA GESTIONE DELLA COMPLESSITÁ CLINICA DELL´ANZIANO OSPEDALIZZATO TRA COSTI E PRESTAZIONI

All Patient Refined (APR) DRG in Geriatria: un nuovo sistema per valutare i costi dell´anziano ospedalizzato


A. PILOTTO, A. GRECO*, M. FRANCESCHI, F. SIENA**, C. SCARCELLI, L. MISCIO**, G. VENDEMIALE*, P. D´AMBROSIO

″Casa Sollievo della Sofferenza″, IRCCS, San Giovanni Rotondo: * UO Geriatria, UO Medicina Generale
e ** Direzione Sanitaria

G GERONTOL 2004;52:262-266

APR-DRG is a patient classification system that is an enhancement of HCFA-DRG because of it takes into account of age and comorbidity risk adjustment. APRDRG adds four subclasses to each DRG. These four subclasses are expressed as APR-Severity Index (SI) or Mortality Risk Index (MR): mild, moderate, severe, extreme. The overall care consumption of geriatric patients is related not only to the severity of clinical impairment, but also to the functional, cognitive and socio- economic impairment of an individual, as properly assessed by the Comprehensive Geriatric Assessment (CGA). The APR-DRG system was found to be able to identify three groups of patients with a significant different multidimensional impairment, as assessed by the CGA criteria. Dividing the patients according to the APR-SI, a significant different functional, cognitive and comorbidity status were found. APR-DRG is an administrative tool that was found to be able to evaluate the clinical and functional impairment in elderly inpatients. A top down costing method (Yale Costing Model) has been validated in USA and linked to APR-DRG system in order to calculate costs for each severity level. APRDRG classification system seems to properly evaluate severity, co-morbidity, disability and costs in elderly acute inpatients and may identify frailty as a high risk of great health resource consumption.

Key words: APR-DRG - Frail elderly - Costs - Multidimensional evaluation

SIMPOSIO
ANZIANO, FARMACI E COMORBILITÁ

La comorbilitá nell´anziano: epidemiologia e caratteristiche cliniche


P. ABETE1, G. TESTA1, D. DELLA MORTE1, F. MAZZELLA1, G. GALIZIA1, D. D´AMBROSIO1, C. VISCONTI1, G. GARGIULO1, F. CACCIATORE2, F. RENGO1 2

1 Dipartimento di Medicina Clinica e Scienze Cardiovascolari ed Immunologiche, Cattedra di Geriatria,
Universitá ″Federico II″ di Napoli; 2 Fondazione ″Salvatore Maugeri″ Clinica del Lavoro e della Riabilitazione, IRCCS, Istituto Scientifico di Campoli/Telese

G GERONTOL 2004;52:267-272

Comorbidity has been defined as the presence of two or more diseases in the same subject and it represents a peculiar clinical characteristic of elderly patients. Advanced age is characterized by the presence in the same subject of multiple diseases due to an age-related increased of chronic diseases. Several indexes has been proposed to evaluate the comorbidity in the elderly: CIRS (Cumulative Illness Rating Scale), Kaplan-Feinstein index, Charlson index, lndex of coexistent diseases (ICED) and Geriatric Index of comorbidity (GIC). These methods show some difficulties especially in the cognitive impaired elderly patients. In a study from ″Osservatorio Geriatrico Campano″, a region of Southern Italy, it has been demonstrated that comorbidity is strictly correlated to mortality by studying the prevalence of single disease and comorbidity. In the mean time, the interaction among disease determines a large increase of the mortality risk at 12 years follow-up. Thus, comorbidity should be always taken into account especially in age-related epidemiological studies.

Key words: Comorbility - Chronic diseases - Mortality

SIMPOSIO
ANZIANO, FARMACI E COMORBILITÁ

Il progetto S.O.F.I.A.: studio osservazionale sul consumo di farmaci in anziani ambulatoriali in Italia


A. PILOTTO, D.F. VITALE*, M. FRANCESCHI, A. ZANINELLI**, G. MASOTTI***, F. RENGO****
ON BEHALF OF THE FIRI (FONDAZIONE ITALIANA PER LA RICERCA SULL´INVECCHIAMENTO)
E SIGG (SOCIETÁ ITALIANA DI GERONTOLOGIA E GERIATRIA)

Unitá Operativa Geriatria, IRCCS ″Casa Sollievo della Sofferenza″, S. Giovanni Rotondo; * Servizio
di Epidemiologia Clinica, Fondazione ″Salvatore Maugeri″ IRCCS, Istituto Scientifico di Telese Terme;
** Medico di Medicina Generale, Universitá Firenze; *** Cattedra di Geriatria, Universitá di Firenze;
**** Cattedra Geriatria, Universitá ″Federico II″, Napoli

G GERONTOL 2004;52:273-279

Background. The prevalence of Adverse Drug Reactions increases with advancing age. Few studies have evaluated the association between NSAID or Coxib use and gastrointestinal (GI) symptoms and prescriptions in ambulatory care elderly patients. Methods. The study was carried out by 133 GPs referring to 24 Geriatric Units in Italy. By using a structured interview, the following parameters were recorded from all elderly subjects who referred to their GPs: sex, age, ADL, IADL, current medications and new drug prescriptions (according to the ATC classification), GI symptoms (according to the Gastrointestinal Symptom Rating Scale, GSRS) and diagnostic procedures occurred during the last 6-month period. Results. The prevalence of drug use was 91.6%. The mean number of drugs was 2.86/person. Either the prevalences and the mean number of drugs significantly increased with advancing age. A significantly higher prevalence of upper GI symptoms was observed in elderly NSAID users compared to Coxib users and non-users of musculo-skeletal drugs (43.7% vs. 32.7% vs. 32.1%, p = 0.0001). A significant association between GI drug prescriptions and upper GI symptoms (OR = 1.7, 95 %CI = 1.6-1.9), previous GI disorders (OR = 1.1, 95 %CI = 1.0-1.3) and NSAID use (OR = 1.5, 95 %CI = 1.0-2.2) was observed. Conclusion. In this elderly population, drug use is very high; NSAID use was associated with higher upper GI symptoms and the prescriptions of GI drugs than Coxib use.

Key words: Adverse drug reaction - Coxib - NSAID - Gastrointestinal

LETTURA

The Evolution of the Myofibroblast Concept: a Key Cell for Wound Healing and fibrotic diseases

I processi di riparazione e fibrosi


G. GABBIANI

Department of Pathology, Centre Médical Universitaire, Geneva, Switzerland

G GERONTOL 2004;52:280-282

Wound healing and fibrocontractive diseases are characterized by the presence of a cell called myofibroblast that is responsible for pathological tissue remodeling. TGF-beta is the main stimulus for the fibrolast/myofibroblast modulation. Alpha-smooth muscle (SM) actin, the actin isoform typical of vascular smooth muscle cells, is the main marker of the myofibroblastic differentiation and in addition is responsible for the high retractile activity of this cell. The Nterminal sequence of alpha-SM actin inhibits myofibroblast contraction in vitro and in vivo and could represent a therapeutic tool in fibrotic diseases.

Key words: TGF-beta, cellular fibronectin, granulation tissue, actin isoforms

LETTURA

Anemia e declino funzionale nell´anziano


M. BARBAGALLO, G. BELLAVIA, L.J. DOMINGUEZ, A. GALIOTO, A. FERLISI, E. PUTIGNANO, M. BELVEDERE, G. COSTANZA, A. DI SCIACCA

Cattedra di Geriatria, Universitá di Palermo

G GERONTOL 2004;52:283-289

Age-related disability and limitations in physical function are growing public priorities. Physical function limitation is a threat to the independence and quality of life of older adults, and has substantial social and economic effect. Consequently awareness of common and potentially treatable condition that affect physical function is needed. Recent findings have shown that anaemia leads to disability, poorer physical performance and lower muscle strength. The prevalence of anaemia, defined by the World Health Organization (WHO) as a haemoglobin concentration below 12 g/dl in women and below 13 g/dl in men, increase with age. A majority of the anaemia in the elderly is assumed due to underlying diseases such as cancer and infectious disease or due to malnutrition or iron deficiency, however in at least 20% of cases it is not possible to attribute anaemia to these factors. It has been suggested that the aging process itself might be an intrinsic factor in the development of anaemia, possibly through the age-related dysregulation of certain proinflammatory cytokines such as interleukin-6 (IL-6). Although the mechanism underlying the association between increased IL-6 and anaemia has not been fully elucidated, it has been suggested that, like with other cytokines, it involves direct inhibition of erythropoietin production or interaction with the erythropoietin receptor.

Key words: Anaemia - Erythropoietin - Interleukins - Disability - Elderly

SIMPOSIO
PARKINSON-DEMENZA: DALLA DIAGNOSI ALLA GESTIONE CLINICA

Aspetti psichiatrici


G. GORI, M. CADELO, S. GIARDINI, G.L. SERRA

Ospedale ″I Fraticini″, U.O. Geriatria, ASL 10, Firenze

G GERONTOL 2004;52:290-298

Psychiatric and behavioral disturbances associated to Parkinson-Dementia complex (PD) are reviewed, along with their impact on the patient´s and caregiver´s Quality of Life. Psychiatric disorders are very common in PD, including a variety of depressive patterns as well as a cluster of psychotic symptoms, from hallucinations to delusional states and delirium. Primary disorders are differentiated from symptoms derived from a long term levodopa therapy. The therapeutical approach, comprehensive of levodopa dosage reduction, use of antipsychotic agents and cholinomimetic therapy, is discussed.

Key words: Parkinson-Dementia - Psychiatric symptoms

SIMPOSIO
PARKINSON-DEMENZA: DALLA DIAGNOSI ALLA GESTIONE CLINICA

Il trattamento farmacologico della malattia di Parkinson con demenza: implicazioni nella pratica clinica dello studio ″Express″


U. BONUCCELLI, C. BERTI, D. CANEPARO

Dipartimento di Neuroscienze, Universitá di Pisa, U.O.C. Neurologia, Ospedale Versilia

G GERONTOL 2004;52:299-302

Cognitive impairement is a prominent feature of idiopathic Parkinson´s disease (PD) and the risk of dementia in PD is nearly five times higher than in the general population. The observation that patients with PD and dementia have extensive cholinergic deficits led to the hypothesis that cholinesterase inhibitors may provide benefit for patients with this condition. ″Express″ study, an international, multicentric, double blind, randomised and placebo controlled study, suggests that rivastigmina is effective in the treatment of PD and dementia, without worsening of Parkinsonism. 541 patients with PD and dementia were recruited and treated with rivastigmina or placebo with a relation of randomisation 2:1. The rivastigmina dose ranged between 3-12 mg/die; the duration of treatment was of 24 week. 72.2% of patients under rivastigmina treatment and the 82.1% of placebo treated patients completated the study. At the end of the study a significative improvement of cognitive test battery, without worsening of Parkinsonism. This is the first large-scale study that demonstrates significant benefits of rivastigmina in dementia associated with PD.

Key words: Parkinson´s disease - Dementia - Rivastigmine

SIMPOSIO
PARKINSON-DEMENZA: DALLA DIAGNOSI ALLA GESTIONE CLINICA

Il ruolo degli inibitori delle colinesterasi


P.F. PUTZU, V. PUTZU

Centro Alzheimer, Divisione Geriatria, Ospedale ″S.S. Trinitá″, ASL 8, Cagliari

G GERONTOL 2004;52:303-308

The Parkinson-Dementia syndrome represents a field of great interest for researchers as well as for clinicians. Marked neuronal loss of cholinergic nuclei, reduced cholinergic markers in the neocortex, hippocampo and selected thalamic nuclei, and receptor changes have been reported in Parkinson´s disease and dementia and dementia with Lewy bodies. Pharmacologic therapy meets difficulties due to the worsening of the parkinsonian symptoms induced by neuroleptic drugs and to the onset or worsening of psychotic diseases induced by dopaminergic drugs. Cholinesterase Inhibitors showed a certain efficacy just in one single double-blind placebo-controlled randomised trial and in two small placebo-controlled studies, but there are at least 18 more reports confirming their utility. The best efficacy has been found concerning attention and some psychotic symptoms (hallucinations).Two more multicentric wide-range studies are in progress.

Key words: Cholinesterase inhibitors - Dementia with Lewy bodies - Parkinson dementia

LETTURA

Studio VALUE e continuum cardiovascolare


E. MALACCO

Divisione di Medicina Interna, Ospedale ″L. Sacco″, Polo Universitario, Milano

G GERONTOL 2004;52:309-312

The adverse effects of angiotensin II on blood pressure and vascular function have been well established in both experimental and clinical investigations. Ang II play a pivotal role in the pathophysiology of vascular disease through is ability to cause abnormal vasoconstriction, activation of the sympathetic nervous system, impairment of endothelial function, induction of vascular hypertrophy, increased potential for thrombosis, and increase in superoxide formation. The treatment of hypertension with agents that block the deleterious effects of Ang II offer a compelling strategy for not only blood pressure but also improving vascular function and health. While the control of blood pressure is of paramount importance in reducing the rate cardiovascular disease, agents that positively impact hypertension, oxidative stress, and endothelial function confer the potential improve vascular structure and function. Both inhibiting the production of Ang II and blocking its action at the receptor expand therapeutic opportunities for treating hypertension, heart failure, nephropathy, and reducing incident diabetes. VALUE trial compared cardiovascular outcomes in 15,313 hypertensive patients randomized to regimens based on the angiotensin receptor blocker valsartan or the 3rd generation calcium channel blocker amlodipine. VALUE provides three important messages for the way we treat hypertension: blood pressure control should be rigorous and also prompt, therapy based on an angiotensin receptor blocker delays the onset of diabetes and its adverse consequences, for optimal cardiovascular risk protection, tight blood pressure control include AT1 receptor blockade.

Key words: Treatment of hypertension - Ang II receptor antagonist - Trials

SIMPOSIO
L´ASSISTENZA ALL´ANZIANO DIABETICO

Diabete e qualitá della vita nel soggetto anziano


D. CUCINOTTA

Dipartimento di Medicina Interna, Universitá di Messina

G GERONTOL 2004;52:313-315

Together with physical problems, diabetic subjects often have a worsened quality of life, that could be especially evident in the elderly. Actually there are different methods for quantifying this impairment, as the SF36 and the Well Being Questionnaire. These instruments have been used in a large survey of Italian diabetic subjects (> 3,000 patients) and have showed that the well being sensation, both at physical and at psychic levels, is impaired in these subjects in comparison with the general population, especially in the female sex and when other diseases or chronic complications of diabetes are present. In patients older than 65 years these data are even more significant, thus demonstrating that these subjects have a greatly impaired quality of life and should be carefully managed, also in this regard.

Key words: Diabetes mellitus - Quality of life - Elderly subjects

SIMPOSIO
L´ASSISTENZA ALL´ANZIANO DIABETICO

Il target metabolico e la compliance nel diabetico anziano


M.R. RIZZO, D. MANZELLA, M. BARBIERI, A. ABBATECOLA, R. GRELLA, S. ATTANASIO, C. BOLOGNA, E. QUARANTA, M. PAPA, F. DI PASQUALE, G. PAOLISSO

Dipartimento di Geriatria e Malattie del Metabolismo, Seconda Universitá di Napoli, Napoli

G GERONTOL 2004;52:316-321

The metabolic target in elderly diabetic patients is very difficult to assess due tothe lack of specific indication in this specific population. Most recently, theAmerican Society of Geriatrics has suggested that the following parametersshould be taken into account: a) individualized pharmacological and educationaltherapy; b) prevention of cardiovascular diseases; c) evaluation of glico-metaboliccontrol for preventing micro-angiopathy; d) screening and treatment ofmajor geriatric syndrome such as depression, cognitive impairment, falls andpain. It should be pointed out that only once all such a problems have been detailed,one can really evaluate the "metabolic profile" of very old diabetics.

Key words: Diabetes mellitus - Elderly - Metabolic target - Guidelines

SIMPOSIO
L´ASSISTENZA ALL´ANZIANO DIABETICO

Quale terapia ipoglicemizzante?


E. MANNUCCI

Unitá di Geriatria, Dipartimento di Area Critica Medico-Chirurgica, Universitá di Firenze

G GERONTOL 2004;52:322-325

Non-pharmacological treatments represent the first-line approach to the treatment of type 2 diabetes. When those measures are not sufficient, hypoglycaemic drugs should be added. Presently available agents include sulphonylureas (glimepiride, gliclazide, glibenclamide), glinides (repaglinide), biguanides (metformin), thiazolidinediones (rosiglitazone, pioglitazone), alpha-glucosidase inhibitors (acarbose), and insulin. All hypoglycaemic drugs show a similar longterm efficacy in the reduction of glycaemia and HbA1c. Available data on the efficacy of different agents in the reduction of micro- and macrovascular complications of diabetes are scarce. The prevention of microvascular complications (nephropathy, retinopathy) can be obtained thorugh the reduction of blood glucose; at present, there is no evidence of superiority of any individual hypoglycaemic agents in this respect. On the other hand, only metformin has shown a significant efficacy in the prevention of cardiovascular diseases, while insulin and sulphonylureas, with a similar effect on glycaemia, did not induce any relevant reduction of incidence of macrovascular complications. The claims of a possible specific reduction of cardiovascular risk with acarbose or with thiazolidinediones is presently based only on preliminary or controversial data. At present, metformin should then be considered the drug of choice for the prevention of cardiovascular disease in type 2 diabetic patients. When metformin monotherapy is insufficient, a second drug should be added; it should be considered that some doubts have been raised on the safety of the most widely used combination, that of metformin with sulphonylureas.

Key words: Diabetes mellitus - Cardiovascular risk - Hypoglycaemic treatment

SIMPOSIO
APPROFONDIMENTI E ACQUISIZIONI RECENTI SULL´ATEROSCLEROSI

Stress ossidativo, alterazioni dell´HMGCoA reduttasi e del metabolismo degli isoprenoidi, e patogenesi dell´ipercolesterolemia dell´anziano


E. BERGAMINI, G. CAVALLINI, A. DONATI, Z. GORI, S. INCERPI*, A. MANFRINI, V. PALLOTTINI*, I. PARENTINI, A. PASCOLINI*, A. TRENTALANCE*

Centro di Ricerca Interdipartimentale di Biologia e Patologia dell´Invecchiamento dell´Universitá di Pisa; * Dipartimento di Biologia, Universitá di Roma III

G GERONTOL 2004;52:326-328

The aging process enhances oxidative stress and causes an alteration in membrane lipid and an increase in dolichol tissue levels and rate of synthesis and an increase in cholesterol synthesis and plasma levels. Recent observations show that changes in dolichol and cholesterol synthesis are secondary to a constitutive activation of HMGCoA activity, which may be caused by the ageing-dependent increase in oxidative stress in membranes.

Key words: Ageing - Polyprenols - Dolichol - Hypecholesterolemia - HMGCoA reductase - Statins - PUFA - Vitamin E

SIMPOSIO
APPROFONDIMENTI E ACQUISIZIONI RECENTI SULL´ATEROSCLEROSI

Ruolo delle acetiltransferasi e deacetilasi istoniche nell´aterosclerosi


B. ILLI**, C. CIRIELLI*, F. SERINO*, S. DAMIA*, G. BANDIERA*, M. CAPOGROSSI, C. GAETANO

Laboratorio di Patologia Vascolare e * Dipartimento di Chirurgia e Patologia Vascolare, Istituto Dermopatico ″dell´Immacolata″, Roma; ** Laboratorio di Biologia Vascolare e Terapia Genica, Centro
Cardiologico Fondazione ″I. Monzino″, Milano

G GERONTOL 2004;52:329-330

Atherosclerosis is one of the principal reason of death in the industrialized world. Laminar blood flow alterations seem to contribute to the physio-pathological environment that leads to atherogenesis. We have already described how laminar blood flow regulates chromatin remodeling in human endothelial cells, modifying specific histone residues 1. Recent observations suggest that laminar flow-dependent nitric oxide (NO) production could have a role in these phenomena stimulating the nuclear localization of class II HDACs in vascular cells, while inhibitors of nitric oxide production block this process. Western blot experiments performed on smooth muscle cells extracts, exposed to laminar flow and treated with NO inhibitors, show an enhancement in histone H3 acetylation when compared to control cells. These results indicate that NO plays an important role in chromatin remodeling. It is well known that alterations in NO production as well as blood flow turbulence are particularly relevant in atherogenic prone regions 2. For this reason, the chromatin state of the cells that contribute to atherosclerotic plaques formation has been analyzed by immunohistochemistry. Our results show a significant enhancement in histone H3 acetylation and phosphorylation in smooth muscle cells in atherosclerotic regions compared to normal arteries. In conclusion, these data suggest that chromatin remodeling, mediated by blood flow alterations and NO production, may provide the molecular basis for the cellular activation associated to atherosclerosis.

Key words: Chromatin remodelling - Blood flow - Atherosclerosis

SIMPOSIO
IPERTENSIONE E RISCHIO CARDIOVASCOLARE GLOBALE

Aspetti epidemiologici dell´ipertensione arteriosa nell´anziano


M. DI BARI, L. LAMBERTUCCI, C. POZZI, A. VIRGILLO, A. UNGAR, G. MASOTTI, N. MARCHIONNI

Dipartimento di Area Critica Medico Chirurgica, Unitá Funzionale di Gerontologia e Geriatria, Universitá
di Firenze e Azienda Ospedaliero-Universitaria Careggi, Firenze

G GERONTOL 2004;52:331-337

Blood pressure increases with aging, yet hypertension is powerful risk factor for cardiovascular disease also at an advanced age and not a benign condition of normal aging. At the same time, intervention studies have shown that treatment can reduce this excess risk also at an advanced age. This review summarizes the most recent advances on epidemiology of hypertension in the elderly. Emphasis will be given to new acquisitions in the field of epidemiology of ambulatory blood pressure monitoring in the diagnostic and prognostic evaluation of older persons with high blood pressure.

Key words: Hypertension - Elderly - Epidemiology - Cardiovascular risk

SIMPOSIO
IPERTENSIONE E RISCHIO CARDIOVASCOLARE GLOBALE

Compliance al trattamento e obiettivi pressori


D. CUCINOTTA, G. ARNONE, G. PANTIERI, G.M. PUDDU, M. MARTORELLI

Dipartimento di Medicina Interna e dell´Invecchiamento, Azienda Ospedaliero-Universitaria ″S. Orsola-
Malpighi″, Scuola di Specializzazione in Geriatria, Bologna

G GERONTOL 2004;52:338-342

Hypertension is a very common disease in the elderly, when comorbidity is the rule. Many studies have shown that heart failure in the elderly is mostly caused by chronic hypertension followed by coronary heart disease. Blood pressure (BP) variability in the elderly must be considered before starting with any therapy. Systolic hypertension is much more common in the elderly and is a risk factor of cardiovascular morbidity and mortality. In spite of these considerations, updated guidelines for the treatment of hypertension do not take into account the oldest old. There is no difference between the desired therapeutic BP levels in elderly and younger patients, but the recommended BP levels should be obtained very cautiously in the very old frail people. Compliance to treatment depends on side effects interfering with physical function, or mental function, or quality of life and/or bothersomeness of side effects. Ability to prevent and reduce symptoms, the convenience of administration, the difficulty of a scheduled therapy could have an important effect on the compliance. The patient´s characteristics, factors related to the patient-doctor relationship, and ecologic factors influence the success of treatment in the elderly, who require help from caregivers. Treatment must be based not only on drug administration, but also on sodium restriction, that rapidly improves arterial compliance, and on life style modifications. Clinicians and researchers who rely on reports about BP of elderly hypertensive patients under treatment should be aware of these limits and should take steps to enhance the accuracy and control of treatment.

Key words: Hypertension - Compliance - Elderly

SIMPOSIO
IPERTENSIONE E RISCHIO CARDIOVASCOLARE GLOBALE

Ipertensione sistolica isolata


A. UNGAR, L. LAMBERTUCCI, M. DI BARI, A. FEDELI, N. MARCHIONNI, G. MASOTTI

Dipartimento di Area Critica Medico-Chirurgica, Unitá Funzionale di Gerontologia e Geriatria, Universitá
di Firenze e Azienda Ospedaliero-Universitaria, Careggi

G GERONTOL 2004;52:343-352

The prevalence of essential hypertension is very high in Western Countries and isolated systolic hypertension (ISH) is the peculiar form of older patients. ISH was considered a physiological condition until the ´80s and it was recognised as a real disease only in the ´90s, when the efficacy of pharmacological treatments in terms of cardiovascular morbidity and mortality in older patients was finally demonstrated. However, until now the cut off value for treatment as well as the efficacy and opportunity of treating the oldest old affected by significant comorbidity and disability, were controversial. In this paper the main epidemiological, physiopathological and therapeutic aspects of ISH will be reviewed.

Key words: Systolic hypertension - Elderly - Cardiovascular disease - Therapy

SIMPOSIO
IPERTENSIONE E RISCHIO CARDIOVASCOLARE GLOBALE

Ruolo dell´ipertensione nella sindrome metabolica


N. FERRARA* **, G. CORBI**, D. SCARPA***, F. GIULIANO**, M. SCIOLI**, G. LONGOBARDI**,
G. FURGI**, F. RENGO** ****

* Dipartimento di Scienze per la Salute, Universitá del Molise, Campobasso; ** Fondazione ″S. Maugeri″,
Istituto Scientifico di Telese, Benevento, IRCCS; *** Dipartimento di Medicina Sperimentale,
Seconda Universitá di Napoli; **** Dipartimento di Medicina Clinica e Scienze Cardiovascolari ed Immunologiche, Cattedra di Geriatria, Universitá ″Federico II″ di Napoli

G GERONTOL 2004;52:353-359

The metabolic syndrome term is generally used to define the co-presence of risk factors responsible for an important increase of cardiovascular diseases incidence in patients with overweight, obesity, hypertension and type II diabetes mellitus. Long the history of such syndrome, if it is considered that already in the 50´s the Framingham study´s first observations concluded that the presence of more factors was increasing the relative risk of cardiovascular events (Ictus, myocardial infarct, death, etc.) in an exponential way. In 1988 Reaven coined the X syndrome term, recognizing this entity like a multiple and independent risk factor for cardiovascular disease. A recent report of the National Cholesterol Education Programme Adult Treatment Panel (NCEPT-ATP III) has identified the metabolic syndrome as an independent risk factor for cardiovascular disease and considers it like tightening indication for an intense modification of the life style. Currently there are three definitions more commonly recognized, as the one suggested by the World Health Organisation (WHO), by the European Group For The Study Of Insulin Resistance (EGIR) and the National Cholesterol Education Programme Adult Treatment Panel (ATP III). In all cases a central role has the hypertension. In fact, beyond the differences in the definition and the emergency of the so-called new risk factors, all of metabolic, proinflammatory and prothrombotic nature, it has to point out that the hypertension is a constant in all the definition, reaching the prevalence of 100% in the metabolic syndrome of the elderly. The prevalence of the syndrome increases with the age and is present in almost half of the over 60 population. In particular, it increases from 6.7% in patients with 20-29 years to 43% in the over 70. In both sexes the prevalence quickly increases after the third decade of life, reaching a peak between the 50 and 70 years in the men and the 60-80 years in the women. Regarding to the pathogenesis of the hypertension in subjects with metabolic syndrome: the hyperinsulinemia secondary to insulin-resistance seems to play an important role determining both the stimulation of the sympathetic nervous system, with consequent vasoconstriction, and the retention of sodium, responsible of increase in arterial blood pressure values, such to antagonize the vasodilator effects of the insulin. In particular, the chronic hyperinsulinemia associated to the metabolic syndrome could modulate the renal sodium excretion, since it has been shown that such hormone is able to regulate the reabsorption of the sodium at tubular level or to increase the Sodium/Hydrogen pump by renal tubuli. As regards the management of this disease, the necessity of a treatment to 360° of the metabolic syndrome in its entirety and of its single aspects, included the hypertension, seems not questionable. However, we have to point out the necessity of a particular attention both of the doctor and the patient in the management of the polipharmacotherapy that, in the elderly, is a clear risk factor for the iatrogenic damage. Probably, the engagement of the doctors to choose drugs with pharmacocinetic and pharmacodinamic profiles more appropriates to the total treatment of the syndrome and their ability to induce a stable modification of the life style will make surer and more effective the management of such syndrome also in the elderly subject.

Key words: Risk factors - Obesity - Hypertension - Hyperinsulinaemia

SIMPOSIO
IPERTENSIONE E RISCHIO CARDIOVASCOLARE GLOBALE

Ipertensione arteriosa e decadimento cognitivo


G. BELLELLI, M. TRABUCCHI*

Gruppo di Ricerca Geriatrica Brescia, Clinica Ancelle della Caritá Cremona; * Universitá Tor Vergata,
Roma e SIGG Firenze

G GERONTOL 2004;52:360-367

The prevalence and incidence of dementia is expected to exponentially increase in the future 30 years. Accordingly, the identification of the causes of dementia and of the possible risk factors become very important for researchers and clinicians. A growing body of evidence suggests that hypertension may be a risk factor for vascular and neurodegenerative dementias. Recently, it has been shown that hypertension is associated not only with cerebrovascular disease, which is in turn associated with dementia, but it could also affect the course of Alzheimer disease. A strong relationship between long-standing hypertension and cognitive impairment or dementia has been demonstrated by several large observational studies, especially with untreated hypertension. The risk increases with increasing blood pressure. However, the relationship between blood pressure and dementia is not linear. Blood pressure may decrease to normal or low levels before dementia (and especially Alzheimer´s disease) becomes clinically manifest. There may also be an association between blood pressure variability in hypertensive patients and impaired cognition. In an extension of the Systolic Hypertension in Europe (Syst-Eur) study in older people and in other studies using the 24-hour non-invasive monitoring of the blood pressure values, an increased blood pressure variability at baseline has been shown to positively correlate with worse cognitive performances. This variability may reflect central nervous system dysregulation or occult injury to the prefrontal autonomic centers, occurring just before the clinical manifestation of dementia. Randomized therapeutic hypertension trials focusing on cognitive function and the occurrence of dementia have shown that an active treatment may be beneficial, although the optimal levels of blood pressure have not yet defined. Future studies, comparing the effect of different classes of antihypertensive drugs on the absolute blood pressure levels and of the 24 hour blood pressure variability, are expected to further clarify this topic.

Key words: Hypertension - Blood pressure - Cognitive impairment - Dementia

LUNCH SESSION
IL DELIRIUM NELL´ANZIANO

Come si diagnostica


C. MUSSI

Centro di Valutazione e Ricerca Gerontologica, Modena

G GERONTOL 2004;52:368-375

Delirium is a common and serious syndrome for the older patient, but it is frequently not diagnosed; in fact, it is rarely present in the discharge diagnosis after hospitalization. The prevalence of delirium is 11-42%; it causes a longer hospital stay, a higher risk of hospitalization, and a higher mortality. The DSM-IV definition is still the diagnostic gold standard, but many screening test have been proposed, since this syndrome is important, but not diagnosed; the Confusion Assessment Method, the Delirium Rating Scale, the Delirium Index, and the Neecham Confusion Scale allow easily and quickly the recognition of delirium, also by the nurse staff. It is desirable that this topic will be adeguately teached, and that the diagnostic guidelines will be costantly implemented. Key words: Delirium - Older - Diagnosis

LETTURA

La valutazione di outcome in geriatria


T. VECCHIATO

Fondazione ″E. Zancan″, ONLUS

G GERONTOL 2004;52:376-386

Questions related to outcome evaluation in the geriatric field are investigated starting from some main issues: nature of the outcomes, methodologies to recognise them and criteria for evaluating them. Different approaches have been considered for this purpose, and documented by recent publications on this topic (Higgins, et al. 2004; Pitkala, et al. 2004; Tambe, et al. 2004; Tanaka, et al. 2004; Demers, et al. 2004). Recent works on outcome evaluation focus on the prospective evaluation of the pharmacological impact through SPECT analysis, the concordance therapy and its effects, the treatment of older people with by Weber B fractures, the Conceptual Framework for the Assessment of Geriatric Rehabilitation Outcomes (FAGRO) and the predictive values of positive life orientation, in terms of gain in life terms. The analysis highlights the importance to distinguish between absolute and relative outcome, sectoral and global outcome, prospective - namely prior to the intervention - and ex-post obtained outcome. The article analyses the approaches proposed by International Classification of Functioning, disabilities and health (ICF), HoNOS and Polar Scheme and highlights the possibility of developing new methodologies in order to give a more systematic framework to the outcome-based evaluation approach. It will be important to bear in mind how different kind of outcomes - ex-ante/ex-post outcome, and global outcome - can be detected considering different variables, by nature and context and their potentialities.

Key words: Outcome - Evaluation

SIMPOSIO CONGIUNTO SIGG-SIPREC
SINDROME METABOLICA E SUE COMPLICANZE NELL´ANZIANO

Fisiopatologia, diagnosi e terapia


E. MANZATO, G. ROMANATO, S. ZAMBON, F. TEZZA, S. MAGGI, G. CREPALDI

Clinica Medica I, Dipartimento di Scienze Mediche e Chirurgiche, Universitá di Padova

G GERONTOL 2004;52:387-391

The importance of the metabolic syndrome is increasingly recognized due to its increasing prevalence and to its role as cardiovascular risk factor. The prevalence of this syndrome is directly related to age. The age related increase of the metabolic syndrome is due to the age related increase in insulin resistance, obesity, diabetes, hypertension, and dyslipidaemia. Also in the elderly the metabolic syndrome is associated to an increased frequency of cardiovascular diseases. Several treatments aimed to treat the specific alterations present in the metabolic syndrome are useful to reduce the cardiovascular disease incidence in these patients.

Key words: Metabolic syndrome - Atherosclerosis - Elderly

Riabilitazione e training cognitivo nella malattia di Alzheimer: fatti e fantasie

A. GUAITA, S.F. VITALI*

Fondazione ″Cenci Gallingani″, Cesano Boscone (MI); * Istituto Geriatrico ″C. Golgi″, Abbiategrasso (MI)

G GERONTOL 2004;52:395-400

Carrying out cognitive rehabilitation for the aging people with dementia requires a new definition of the terms in use, i.e. ″cognitive″ as well as ″rehabilitation″. On the basis of these concepts a review was made of the published studies about the cognitive rehabilitation issue, mainly about the results of the ROT, the memory training, the multi sensory stimulation in the Alzheimer´s disease.

Key words: Dementia - Rehabilitation - Non-pharmacological treatment

IL MODELLO RIABILITATIVO

″Use or Lose″ (usalo o lo perdi): le basi biologiche dell´intervento riabilitativo


S.F. CAPPA

Universitá Vita Salute ″San Raffaele″, Milano

G GERONTOL 2004;52:401-403

The investigation of the biological foundations of rehabilitation is a central aspect of the study of brain plasticity. Functional neuroimaging allows the in vivo investigation of plasticity phenomena, such as the modifications in the pattern of brain activity associated to learning in both normal and diseased brains. The available studies in this area have usually dealt with the correlates of functional recovery of impairments due to localized brain damage. The extension of this approach to progressive pathological conditions, such as those associated with dementia, is not straightforward. The idea of ″dementia rehabilitation″ is closely linked to the decline of the concept of ″global″ cognitive dysfunction, and to the adoption of a modular approach. Specific examples of this line of investigation can be found in the area of language, in which a distinction can be drawn between aspects compromised early, such as lexical-semantics, and resilient components, such as syntax; and memory, in which the presence of relatively spared implicit abilities has been already exploited in rehabilitation. Recent areas of research development are related to the mechanisms of relearning, and on the neurobiological correlates of intensive training (constraint-induced and errorless learning techniques).

Key words: Learning - Neuroimaging - Plasticity

IL MODELLO RIABILITATIVO

La riabilitazione cognitiva nelle fasi iniziali della malattia di Alzheimer


M. COTELLI, M. CALABRIA, O. ZANETTI

U.O. Alzheimer, Centro per la Memoria, IRCCS Centro ″S. Giovanni di Dio - Fatebenefratelli″, Brescia

G GERONTOL 2004;52:404-407

The application of cognitive rehabilitation in early stage of dementia is based on theoretical evidence regarding the neuropsychology of memory impairments in Alzheimer´s disease (AD). While short-term forgetting is impaired, long-term forgetting appears to be relatively spared. The memory problems in AD does not appears to be of impaired of storage but the deficits to lie in encoding and acquisition of new memories. Indeed the anatomical areas most affected in the early stage of AD are the medial temporal lobe structures; these areas are critical in the consolidation of new memories. The aim of the cognitive rehabilitation is to promote maximal adaptive cognitive functioning in patient with neurologically induced cognitive deficits.

Key words: Cognitive Rehabilitation - Alzheimer´s disease

IL MODELLO RIABILITATIVO

L´efficacia dell´associazione tra farmaci e Reality Orientation Therapy


O. ZANETTI, M. CALABRIA, M. COTELLI

U.O. Alzheimer, Centro per la Memoria, IRCCS Centro ″S. Giovanni di Dio - Fatebenefratelli″, Brescia, Italy

G GERONTOL 2004;52:408-411

Cholinesterase inhibitors are indicated for the symptomatic treatment of mildto- moderate Alzheimer´s Disease because they slow the progression of the disease. Its efficacy and safety have been demonstrated in placebo-controlled trials for ut to one year. By now, non-pharmachological interventions are also available; Reality Orientation Therapy (ROT) is the only one clearly effective as a Cochrane Library review has shown. A recent meta-analysis concluded that the ROT could improve both the cognitive performances and the behavioural disturbances. So, the ROT is the best candidate to be included in the therapy of Alzheimer´s Disease. Recent studies have shown that the association of ROT to drug therapy can benefit more cognition than colinesterase inhibitor alone.

Key words: Donepezil - ROT

IL MODELLO PROTESICO

La metodologia Gentle Care


S.F. VITALI

Centro Regionale Alzheimer, Istituto Geriatrico ″C. Golgi″, Amministrazione delle II.PP.A.B, Abbiategrasso, Milano

G GERONTOL 2004;52:412-417

Gentle Care is a prosthetic model of dementia care developed by Moyra Jones, based on the premise of accurately defining the deficit the person is experiencing, and organizing the macro-environment, people, programs and physical space, into a prosthesis to compensate for the deficts in functioning, to support existing or residual function and to maximize the quality of life. Gentle Care derives from the belief that the person with dementia is experiencing devasting problems and deserves support with life challanges. Gentle Care is more than attitude, it is a comprehensive program designed to prepare professional carers and families for caring the person with dementia. A patnership between formal and informal carers is encouraged. Carers are assisted to evaluate the functional deficits and strenghts of the client, they are provided as well with problem solving and sterss reducing startegies, they are taught to integrate daily activities with helpuful programs that use the client´s existing performance abilities to develop effective supportive care. Gentle Care is a system of care that gives the oppurtunity to re-conceptualize the way we see the dementing process, and to pursue reasonable gols in the care of person suffering with dementia.

Key words: Dementia - Models of care - Prosthetic model

IL MODELLO PROTESICO

L´ambiente fisico e relazionale


F. TOSI

Dipartimento INDACO, Politecnico di Milano

G GERONTOL 2004;52:418-422

The paper presents some User-Centered Design evaluation methods addressed to old people products and domestic environments, and applied by PUL, Product Usability Lab in Politecnico of Milano. Contents are: - the relationship between users autonomy and usability and safety requirements; - the design guide lines.

Key words: Ergonomics - Design - Old people

IL MODELLO PROTESICO

Musicoterapia e demenza


D. VILLANI, A. RAGLIO

Istituto Ospedaliero di Sospiro (CR)

G GERONTOL 2004;52:423-428

Music can be used as a healer in many diseases, although with different techniques, methods and theoretical issues. Recently, particularly in the last decade, even dementias have been an object of concern for musicotherapy and other healing practices involving sound and music. The increasing number of Alzheimer´s diseases and dementias affected people, together with the limited therapeutical chances, has stimulated a growing interest for rehabilitation techniques, among which musicotherapy can be placed. About all these techniques there are still unsolved problems mainly related to the assessment instruments, to the effectiveness of the action, to the lasting of the positive effect after the treatment and, eventually, to the cost/efficacy relationship. After a brief introduction on musicotherapy, the Authors describe the theoretical and methodological concerns of the therapy they used, as well as its applicative practices.

Key words: Musictherapy - Dementia - Rehabilitation

COMUNICAZIONI E POSTER - CORSO RIABILITAZIONE

LETTURA

Infermieri in Universitá: cosa cambia?


E. CARLI

Universitá di Brescia, Facoltá di Medicina e Chirurgia, Brescia

G GERONTOL 2004;52:433-437

The relation examines, for its elements the synergies that they have concurred the evolution of the nursing is in reference to the definition area of competence, is for how much concerns the formation. With respect to this last one, they are intentional to examine the levels (of base and post base) to propose as an opportunity for the professionals beyond that for the sanitary organizations that can therefore, be taken advantage of qualified staff. In front of the question ″what changes?″, the answer is: the capacity/possibility to assume charitable responsibilities, a diffuse one use of the critical thought, sharing the interdipendence like value and instrument in order to face the charitable problems. The attitude of search. The status recognized from the society.

Key words: Formation - Change - Profession

SIMPOSIO
LA CURA DELL´ANZIANO NEL PAESE PIÚ VECCHIO DEL MONDO

Invecchiamento nel mondo: compressione della mortalitá, della morbilitá, della disabilitá


M. DI BARI, M. INZITARI, B. CROVETTI, A. LUMINI, A. COLOMBINI, G. MASOTTI, N. MARCHIONNI

Dipartimento di Area Critica Medico Chirurgica, Unitá Funzionale di Gerontologia e Geriatria, Universitá di Firenze e Azienda Ospedaliero-Universitaria Careggi, Firenze

G GERONTOL 2004;52:438-445

Increase in life expectancy and declining fertility, started in Europe at the end of XIX century, since the second half of the last century began to spread out to low- and middle-income countries throughout the world. This ″demographic transition″ is strictly connected with economic and technologic growth, and it is associated with an ″epidemiologic transition″, characterized by an increased prevalence of chronic degenerative diseases, such as atherosclerosis and cancer. In developed countries, these conditions have overcome transmissible diseases as causes of death and disability, whereas in less developed countries they are rapidly adding up to transmissible diseases. In the early 1980s, it was hypothesized that an increased life expectancy (compression of mortality) could be associated with a delay in the onset of chronic disease, therefore leading to compression of morbidity and disability as well. Recent data support this hypothesis in developed countries, demonstrating declining estimates in the prevalence of disability in older persons, especially among those who adopted healthy-oriented lifestyles to prevent chronic diseases. The reality of less developed countries is more complex and worrisome, because their demographic transition is faster and associated with the risk of an epidemics of chronic morbidity and disability. In fact, behavioural risk factors for degenerative diseases are escalating in these countries which, at the same time, are overall poorly prepared to the impact of chronic diseases and still dramatically overloaded by infective diseases and by poverty.
Key words: Demographic transition - Compression of mortality - Active life expectancy

SIMPOSIO
LA CURA DELL´ANZIANO NEL PAESE PIÚ VECCHIO DEL MONDO

Declino funzionale ed invecchiamento


C. BASSO

Centro Regionale Invecchiamento Cerebrale (C.R.I.C.), Azienda Ospedale Universitá di Padova, Consorzio di Ricerca ″Luigi Amaducci″, Padova

G GERONTOL 2004;52:446-449

Aging is associated with alterations in body composition and decline in functional status. The muscle strength at 70 years of age is almost one half as compared with younger adults. Healthy older persons have decreased muscle mass and increased fat mass, changes that are associated with progressive impairment in muscle strength, contributing thereby to an increased risk of frailty (falls, fractures, and chronic disease). In addition, it has been shown a temporal association with reduction in basal and stimulated plasma concentrations of growth hormone (GH) and Insulin like Growth Factor I (IGF-I) that have led to postulate that somatic changes partly reflect GH deficiency. This observation is supported by the fact that after the age of 30 years the secretion of GH by the pituitary gland tends to decline and by the evidence that diminished secretion of GH is accompanied by a fall in plasma IGF-I concentration, atrophy of lean body mass and expansion of adipose tissue. Reduction in physical capacity means disuse, leading to inactivity and loss of independence. In this perspective, it will describe potential mechanisms underlying the decline in physical functional performance observed in aged population.

Key words: Physical functional performance - Frailty - Disability

SIMPOSIO
LA CURA DELL´ANZIANO NEL PAESE PIÚ VECCHIO DEL MONDO

L´importanza della valutazione funzionale diretta del soggetto anziano sia per la prevenzione del declino funzionale che per la formulazione di programmi di trattamento mirato


J.M. MCILWRATH, C. BASSO, D. GOLLIN, C. GABELLI

Centro Regionale Invecchiamento Cerebrale (C.R.I.C.) Azienda Ospedale, Universitá di Padova, Consorzio di Ricerca ″Luigi Amaducci″, Padova

G GERONTOL 2004;52:450-453

The prevention of functional decline among frail elderly patients depends largely on the ability of the qualified staff (generally the occupational therapist) to perform rehabilitation programs. It is well known how difficult gathering information is about these patients, in particular the caregiver´s indirect judgement can be misleading (built-in bias). A direct way to evaluate physical functional performance in a controlled, ecological, and standardized environment should be considered. According to our perspective a direct assessment scale should take into account the following criteria: 1.Sensibility; 2. Test-retest and inter-relater competence; 3. Internal consistency; 4. Linguistic efficacy; 5. Capacity to predict outcome and goals of treatment. The aim is to provide practical advice within a holistic approach to both patient and caregiver. The direct functional assessment scale allows the therapist to become aware of both residual abilities and functional disabilities. Functional performance is investigated on basic skills (bathing, dressing, eating etc.) and more complex tasks (cooking, laundry, transportation, cleaning). Results of this evaluation should be used to plan rehabilitation programs promoting autonomy and favouring independent living to enhance well-being of the frail elderly person.

Key words: Ecological observation - Holistic approach - Direct functional assessment

TAVOLA ROTONDA
MODELLI ASSISTENZIALI: DALLA CURA PER ACUTI ALLA CRONICITÁ

Modelli organizzativi


L. D´ADDIO

Professore a contratto di Scienze Infermieristiche, Universitá di Firenze

G GERONTOL 2004;52:454-458

This paper describes an analysis concerning the nursing job organization, starting from a consideration of the services which our society demands in view of the ageing of the population. The hospital, which goes on playing a central role in the organization of the services nowadays, should be supported by other health facilities which should tend to the needs of the elderly, in order to assure a continuity of assistance to those who are chronically ill or suffer for degenerative diseases. The organising competence of the Italian nursing profession is analysed through the assessment of the reasons which could hamper a change, with a focus on the gap between the expectations of the society, clearly marked by the regulations of the past decade, and the organization of health care and welfare services. Finally, an operational model is suggested for the management of a change in the direction of services which should define health care and nursing care on the basis of the target population.

Key words: Nursing reengineering - Personal care - Nursing care

TAVOLA ROTONDA
MODELLI ASSISTENZIALI: DALLA CURA PER ACUTI ALLA CRONICITÁ

Strumenti per l´organizzazione del luogo di cura


A. BANDINI, D. ACCORSI, P. CHIARI, S. FONTANA, P. TADDIA

DDSI, Servizio Infermieristico e Tecnico, Azienda Ospedaliera di Bologna, Policlinico ″S. Orsola
Malpighi″

G GERONTOL 2004;52:459-464

Aim of this lecture is to analyse nursing organization: in particular Authors suggest how to document the nursing process.
Authors analyze three instruments (guide line, nursing records, protocols) using problem solving process steps

Key words: Guideline - Nursing records - Protocols

SIMPOSIO
I RISVOLTI ASSISTENZIALI DELLA PATOLOGIA ONCOLOGICA NELL´ANZIANO

La cura nella fase terminale della vita: processi di comunicazione e di accompagnamento nel percorso del morire


M. PETRINI, F. CARETTA, R. BERNABEI

CEPSAG - Centro di Promozione e Sviluppo dell´Assistenza Geriatrica, Universitá Cattolica del Sacro
Cuore, Facoltá di Medicina e Chirurgia ″A. Gemelli″

G GERONTOL 2004;52:465-471

The peculiar characteristic of death today is that the dying process is notable ″prolonged″ due to the increase of chronic and degenerative diseases and the progress made in medicine´s therapeutic means. It is a question, then, of accompanying an old person towards the end of life, with the conviction that the value of human life remains integrally the same in all its aspects and stages even when physical conditions continue to deteriorate. Assistance, therefore, takes on the significance of accompanying a person by sharing his or her pain and suffering. These are prospects which may not taken into consideration in a purely technological concept of assistance. Many of the elderly speak much more readily and freely of their death than expected; generally, they seem not to express a pathological fear of death which, in fact, is mitigated by the frequent thought of seeing their dead loved ones again. It is indispensable to form all professional workers accordingly, making them start from a correct vision of the elderly and the process of ageing.

Key words: Terminal care - Accompanying the dying

SIMPOSIO
I RISVOLTI ASSISTENZIALI DELLA PATOLOGIA ONCOLOGICA NELL´ANZIANO

La valutazione della qualitá di vita nella fase terminale


F. PAOLI

U.O. di Ematologia (Sezione Trapianti Midollo Osseo), Azienda Ospedaliero Universitaria Careggi, Firenze

G GERONTOL 2004;52:472-474

Many instruments in the literature of the last years give evidence of the great interest regarding the quality of life in oncology. The Hospice Quality of Life Index (HQLI), used in many hospices of Forida, is a 28 items questionnaire; each item is a numeric rating scale (0-10). The HQLI is a multidimensional test that includes physical well being, functional well being, social and spiritual well being. Twenty-nine patients of Unitá di Cure Continue Azienda Sanitaria of Florence, sud-est area, completed the Italian version of HQLI. This descriptive research, although many problems can be solved, showed aspects of patients quality of life that nurses have not identified; nurses can play an important role to improve quality of life at the end of life.

Key words: Quality of life - Palliative care - Terminal illness

SIMPOSIO
I RISVOLTI ASSISTENZIALI DELLA PATOLOGIA ONCOLOGICA NELL´ANZIANO

Affari di famiglia


G. BRAIDI

Ambulatorio di Neuroscienze ″Villa Matilde″, Parma

G GERONTOL 2004;52:475-478

The author indicates in the good operation of the whole treating staff, of the working climate and in a well done work with the patients and their family members, the possibility to prevent burnout.

Key words: Emotions - Burnout - Prevention

TAVOLA ROTONDA
L´ASSISTENZA INFERMIERISTICA BASATA SU PROVE DI EFFICACIA

Evidence Based Nursing nell´ospedale ″S. Orsola-Malpighi″: i progetti applicativi


P. CHIARI

Centro studi EBN, Direzione Servizio Infermieristico e Tecnico, Policlinico ″S. Orsola-Malpighi″, Azienda Ospedaliera di Bologna

G GERONTOL 2004;52:479-482

Ebn is the process by which nurses make clinical decisions using the best available research, their clinical expertice and the patient´s preferences. EBN Study Centre was created at ″S. Orsola Malpighi″ in 1998. Its mission is to educate nurses, midwives, physiotherapists to use EBN methodology. Besides the improvement of the single practitioner, since 1999 many activities have been undertaken within the Clinical Governance. They are modifing the hospital care in many fields as pressure ulcers, accidental patients falls, swallowing disorders, heart attack clinical care pathway. You can see EBN Study Centre at the internet web site: www.evidencebasednursing.it.

Key word: Nursing - Self-learning - Evidence based nursing - Internet&nursing - Research

TAVOLA ROTONDA
L´ASSISTENZA INFERMIERISTICA BASATA SU PROVE DI EFFICACIA

La formazione infermieristica avanzata in geriatria: l´esperienza del Master dell´Universitá di Verona in Trento


M. DELLAI

Scuola Superiore Formazione Sanitaria, Polo didattico, Trento

G GERONTOL 2004;52:483-489

The progressive aging of the elderly and the growth of the health and social needs require a consideration about the nursing education, through specific curricula who will develop advanced competencies in gerontological areas. The purpose of this work is to present the outcomes of several trials which show the positive outcomes of the advanced nursing education on elderly and their caregivers. The article will also report the 2003/2004 master´s program in gerontological care by the University of Verona. The reasons which have brought to the realization of this education program are strictly related with the consciousness that diffusion of advanced nursing competencies in gerontological areas will contribute to a better quality of care, trough effective responses to prior health problems and most frequent needs of elderly in the different care settings.

Key words: Advanced practice nursing - Outcome - Elderly

SIMPOSIO
ASSISTENZA AL DEMENTE ANZIANO

La gestione integrata clinico ambientale: lo spazio come risorsa terapeutica


D. GOLLIN, C. BASSO, J. MCILWRATH, C. GABELLI

Centro Regionale Invecchiamento Cerebrale (C.R.I.C.), Azienda Ospedale, Universitá di Padova, Consorzio di Ricerca ″Luigi Amaducci″, Padova

G GERONTOL 2004;52:490-499

Dementia and Alzheimer´s disease in particular, due to their characteristics of duration, complexity and irreversibility, provoke our interest to reflect on how to effectively approach the question of its management. Dealing the natural course of the illness, the aim is to establish care and assistance priorities, reducing symptoms and improving relational and emotional exchange between patient and environment. Studies have demonstrated how dangerous can be an inadequate management of the patient´s surroundings exacerbating inappropriate behavioural patterns such as agitation and confusion. On the contrary, a well-organized environment offers a valuable therapeutic resource, contributing significantly to patient quality of life, whether at home or residential setting. Nurses have an important role in developing links between patients, families and rehabilitation team, offering professional skills in the management of patient suffering from dementia.

Key words: Life Quality - Independence - Safety

SIMPOSIO
ASSISTENZA AL DEMENTE ANZIANO

Il ruolo del sociale


C. VERA

Coordinatrice Servizi Socio-Assistenziali IPAB, Opere Pie d´Onigo di Pederobba, Treviso

G GERONTOL 2004;52:500-502

The radical transformation of the population in recent years must inevitably urge social worker to carefully survey the needs of the older people and to put into practice new quality services which are on-target, immediate, integrated and well-organized. Social workers must also make a radical transformation from being simply centres for the care and assistance of the older people to being vital centres for development of the personality, the dignity and the autonomy of the older person, while all the time working in close collaboration with all the other services available in the area. Services will therefore have to, on the one hand qualify for intensive, health and rehabilitation care required by the elderly with serious disabilities, and on the other hand they will have to initiate suitable innovative services to support home care programmes, such temporary accommodation for respite and rehabilitation care, support for partially autonomous persons, day-care centers, ecc. Legal support is necessary.

Key words: Dementia - Family - Social and health service

SIMPOSIO
ASSISTENZA AL DEMENTE ANZIANO

La rete dei servizi


M. CALABRÓ

U.O. Geriatria, Lungodegenza, Servizio Assistenza Domiciliare, Presidio Ospedaliero Montebelluna, Treviso

G GERONTOL 2004;52:503-504

Managing a long term disease, that is primarily supported by patient´s family
members, requires several related strategies.
The Service´s Network provides a therapy for both the patient and the caregive
as it fulfils their needs and the goal of this successful long tem care plan is to
improve the quality of care delivered to patients through a multitask direction.

Key words: Therapeutic alliance - Therapeutic strategy global - Direction

SIMPOSIO
LO STRESS DEL CAREGIVER

Le problematiche del caregiver


A. TOGNETTI

Geriatria, Ospedale ″S. Eugenio″, ASL Roma C

G GERONTOL 2004;52:505-510

It is very hard to take care of a patient with dementia. It challenges the psychophysical equilibrium of the single and the family. The goal of this work is to explain the problems the caregiver is facing, focusing on the different emotional and relational involvment during the different phases of the illness.

Key words: Dementia - Caregiver - Family - Emotional involvement

SIMPOSIO
LO STRESS DEL CAREGIVER

Pianificazione del supporto familiare: informazione, educazione e sostegno


L. SILVANO

Studio METIS, Modena

G GERONTOL 2004;52:511-514

Information, Education and Support are three important and indispensable approaches towards managing the relationship with the families of dementia sufferers and managing the illness itself. This report explains the peculiarities of each one and describes the possibility of help and mutual integration. Common aspects to the three are the use of a clear language, interpersonal relationship as an operative instrument and the adjustment to the family´s receptive abilities. The planning of the family support requires the carers to have the capacity to see from the family point of view, without prejudices and fears in order to optimise the efforts invested in the relationship and to obtain results consistent with the psychological energies invested and time spent.

Key words: Information - Education - Support

SIMPOSIO
LO STRESS DEL CAREGIVER

Il demente ed i suoi familiari: i negletti dell´assistenza


M. MATERA, E. CIULLI*

Vicepresidente A.I.M.A.; * Infermiera presso ASL 10 di Firenze

G GERONTOL 2004;52:515-518

In these last years, dementia presents an increasing prevalence in advanced industrial countries, due to population ageing. Chronicity, the gravity of effects, high social, economical and family costs make it a social disease. In most cases, a main caregiver provides full nursing to the patient from hygiene, to mobilizing, and assistance to his needs. Although the social and health services network is trying to match the needs of Alzheimer patients, more than 50% of involved families still attend public services with not yet satisfactory results. Among the available services, home nursing service appears to be the most required, even though it should be reorganized to completely satisfy the needs of patients and caregivers. Quality improvement of social and health system should include - besides an increasing reliability and standard services - the development of the ability to manage complex and multidimensional needs of patients and families. We present a research performed on caregivers and nurses. The research explores the caregivers needs, compared with needs as perceveid by home nurses. The results provide guidelines explaining how global and flexible nursery might match the evolution of needs of the patients and their families.

Key words: Alzheimer - Caregiver - Services

COMUNICAZIONI E POSTER - CORSO NURSING