Geriatric Care is the official journal of SIGOT (Società Italiana di Geriatria Ospedale e Territorio). It is an Open Access journal that seeks to publish high-quality, peer-reviewed manuscripts dealing with Geriatric Care in different settings including hospitals, residential services, nursing homes and home-care services for the elderly. The aim of the journal is to stimulate debate and dissemination of knowledge in the geriatric field in order to ameliorate the efficacy, effectiveness and efficiency of interventions to improve the health outcomes of elderly people. Geriatric Care publishes contributions in epidemiology, pathophysiology and clinical assessment, management and treatments of the diseases of older people, as well as health education and environmental health, hospital-residential-homecare management of the elderly including ethics, social and communication sciences, e-health and health technology assessment. Contributions on innovative topics of biological and genetics research, gender and disparity issues, as well as high-technology supports, i.e., domotics and robotics for the elderly, are welcome. Geriatric Care publishes Original Articles, Review Articles, Brief Reports, Case Reports, Statement Reports and Editorials. This journal does not apply charge for publication to Authors as it is supported by institutional funds.
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PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Visual cue training for balance, gait and cognition in post-menopausal women: a randomized controlled trial
Post-menopausal women frequently exhibit balance and gait impairments associated with hormonal changes, increasing their risk of falls and reduced functional independence. This study investigated the effect of visual cue training on balance and gait in post-menopausal women. A total of 48 eligible participants were randomly allocated into two groups: group A received visual cue training combined with conventional exercises, and group B received conventional training only. Both groups underwent an 8-week intervention, and balance, gait performance, cognitive function, and depression were assessed before and after training. Significant improvements over time were observed in step length, cadence, center of pressure (COP) range, and Berg Balance Scale scores. Between-group differences favored the visual cue group for step length and COP range. Cadence demonstrated a significant time × group interaction, indicating a differential pattern of improvement between groups, without a significant overall group effect. Both groups showed significant improvements in P300 latency over time, with no significant time × group interaction (p=0.81). No significant between-group differences were found for gait speed, stride length, COP sway, or P300 amplitude. These findings suggest adding visual cues to conventional training enhances specific aspects of postural control and cognitive processing but does not provide additional benefits for all gait-related parameters. Visual cue-based training may therefore be a valuable adjunct to conventional rehabilitation programs aimed at improving functional mobility in post-menopausal women.
Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
Pasteurella canis sepsis with fatal outcome in the frail older: a case report
Pasteurella canis typically causes wound infections following dog bites, while invasive infections are uncommon. Within invasive infections, bacteremia (the presence of bacteria in the bloodstream) must be differentiated from sepsis (the organ dysfunction caused by a dysregulated immunological response to infection). Sepsis and heart failure interact in a continuum where sepsis-induced cardiomyopathy is triggered by acute systemic inflammation, whereas preexisting heart failure increases susceptibility to sepsis and mortality. We present the case of an 87-year-old frail woman admitted with heart failure. Blood cultures taken after a febrile episode resulted positive for P. canis. Response to piperacillin/tazobactam was satisfactory, although the patient died from heart failure. She did not report a history of a dog bite; therefore, we speculated that P. canis spread through respiratory secretions of a dog known to the patient, causing pneumonia (documented at a computed tomography scan) followed by sepsis.
Vitamin D supplementation enhances neuromuscular function in older adults: controlled clinical trial
Vitamin D deficiency has been associated with impaired neuromuscular performance and increased risk of falls in older adults. Supplementation may improve physical function, but evidence remains inconsistent. This study aimed to determine the impact of vitamin D supplementation on neuromuscular performance among older adults with vitamin D insufficiency. A single-blinded controlled clinical trial was conducted on 60 participants (aged 60-75 years) with serum vitamin D levels <30 nmol, recruited from the Geriatric Unit of the institution. Participants were randomized into intervention (vitamin D 60,000 IU weekly for 12 weeks, n=30) and placebo (identical capsules, n=30) groups. Baseline and post-intervention assessments included sociodemographic data, serum vitamin D, and neuromuscular function using the Short Physical Performance Battery (SPPB: balance, chair stand, gait speed). Data were analyzed using chi-square and paired t-tests, with p<0.05 considered significant. Baseline characteristics were comparable between groups except for socioeconomic status. After 12 weeks, the intervention group showed significant improvements in serum vitamin D levels and neuromuscular performance compared with placebo. Gait speed improved with a relative reduction in time of 73% (p=0.006). Chair stand test performance improved by a mean difference of 2.67 seconds, reflecting a 90% relative change (p<0.001). Balance scores also improved significantly (p<0.001). Vitamin D supplementation led to significant gains in neuromuscular performance in older adults with insufficiency. These findings suggest that regular supplementation may serve as a simple, low-cost intervention to improve functional outcomes and potentially reduce fall risk in older adults.
Clinical outcomes and complication rates of peritoneal dialysis in elderly patients: an 18-year retrospective analysis
Peritoneal dialysis (PD) is a gentle, self-managed modality that offers significant benefits for elderly patients with end-stage kidney disease (ESKD), particularly in preserving residual kidney function (RKF). Despite its advantages, PD remains underutilized in this population. This retrospective study evaluated clinical, nutritional, and metabolic outcomes, as well as quality of life, in 164 patients initiating PD, comparing elderly patients (≥65 years, n=22; mean age 71.1±5.5 years) to younger counterparts (<65 years, n=142; mean age 42.8±13.2 years). Parameters were assessed at baseline and after 24 months. Initially, the elderly group had a higher Charlson comorbidity index and lower RKF. Serum creatinine was the only significantly lower marker in older patients, with other metabolic and clearance parameters showing no notable differences. After 24 months, both groups exhibited improved clearance of urea, potassium, and alkaline reserves. In the elderly, serum albumin decreased and triglycerides increased significantly. Complication rates were similar across groups. While not statistically significant, elderly patients showed better technique survival but higher mortality, primarily from cardiovascular causes. These findings suggest that PD is a viable and safe treatment option for elderly ESKD patients, yielding comparable outcomes to younger individuals. However, ongoing monitoring of comorbidities and nutritional status remains crucial to optimize care in this population.
Heart failure patients: what does it change in the elderly?
Heart failure (HF) represents a growing public health challenge, particularly among older adults. Its prevalence increases with age and is frequently complicated by frailty, multimorbidity, and functional decline, all of which worsen prognosis and complicate management. The relationship between HF and frailty is bidirectional: HF promotes sarcopenia, cachexia, and inflammation, while frailty reduces resilience and tolerance to therapy. The objective of the paper is to summarize current evidence on the management of HF in frail older adults, highlighting recent pharmacological advances, geriatric considerations, and emerging multidisciplinary strategies. A narrative synthesis has been performed, including the most recent European Society of Cardiology and American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines, position papers, and randomized controlled trials focusing on drug therapy, non-pharmacological interventions, and comprehensive geriatric care in older adults with HF. Guideline-directed medical therapy for HF with reduced ejection fraction—comprising sodium-glucose co-transporter 2 (SGLT2) inhibitors, angiotensin receptor-neprilysin inhibitors, β-blockers, and mineralocorticoid receptor antagonists—remains the cornerstone of treatment. Evidence for HF with mildly reduced ejection fraction and HF with preserved ejection fraction supports SGLT2 inhibitors and individualized management of comorbidities. Multidimensional interventions, including nutritional support, tailored physical rehabilitation, cognitive and psychological care, and telemonitoring, significantly improve outcomes. Structured transitional care and early palliative integration reduce readmissions and enhance quality of life. Effective management of HF in frail older adults requires combining evidence-based pharmacological therapy with a holistic, geriatric, and multidisciplinary approach spanning hospital, transitional, and community settings. Strengthening randomized evidence and integrating comprehensive care models are essential to improving prognosis and functional independence in this vulnerable population.
Anticholinergic and sedative medication burden in older adults: an observational analysis
The cumulative effects of multiple medications with anticholinergic and sedative properties, referred to as anticholinergic and sedative burdens, can result in adverse effects in older adults. This study aimed to evaluate the exposure of older adult patients to anticholinergic and sedative medications. This cross-sectional study included older adult patients (aged ≥60 years) admitted to the geriatric inpatient wards. The anticholinergic burden was assessed using the CRIDECO scale, and the Drug Burden Index (DBI) quantified the cumulative anticholinergic and sedative burden. The data obtained were categorically assessed and are represented as [n (%)]. The associations between medication burden and health outcomes were analyzed using appropriate tests. The mean age of the participants in the study cohort was 72.80±7.41 years. Among the participants, 29.17% were administered at least one anticholinergic medication, with a mean cumulative Anticholinergic Cognitive Burden (ACB) score of 2.49±2.00. The majority (94.34%) had a cumulative DBI score of ≥1, with a mean DBI score of 3.14±1.55. Linear regression analysis demonstrated that both ACB and DBI were significant predictors of the length of hospitalization (ACB: p=0.002; DBI: p=0.001), whereas only DBI was associated with the Charlson Comorbidity Index (p=0.001). Logistic regression revealed that ACB scores significantly predicted cognitive decline (p=0.047). This study highlights the high prevalence of anticholinergic and sedative medication use among hospitalized older adult patients and its association with adverse health outcomes. Regular medication reviews and targeted deprescribing strategies are essential to reduce the medication burden in this vulnerable population.
Copyright (c) 2025 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
Palliative geriatrics and dementia: key issues and challenges
Palliative care enhances the quality of life for patients and families facing life-threatening illnesses by addressing physical, psychosocial, and spiritual needs. Dementia, characterized by its progressive and terminal trajectory, presents unique challenges due to its unpredictable course and the difficulty of identifying the terminal phase. This manuscript aims to explore the integration of palliative care into the management of advanced dementia, emphasizing patient-centered approaches and timely, appropriate interventions. We discuss early intervention strategies and tailored approaches for managing nutrition, infections, symptoms, pain, and medication in advanced dementia. Key issues include ethical considerations surrounding artificial nutrition, the role of assisted feeding, cautious opioid use, and deprescribing of non-essential medications. The manuscript also addresses systemic barriers, including limited awareness, ageism, and inadequate professional training. Emphasis is placed on shared care planning, caregiver support, and continuity of care. Future directions underscore the importance of telemedicine, community-based services, and enhanced professional education to address the growing needs of an aging population. Integrating palliative care into dementia management promotes dignity, improves quality of life, and supports individuals and families throughout the course of the disease.
Glioblastoma cancer: comparing the effectiveness of 3D conformal radiation therapy and volumetric modulated radiotherapy - an artificial intelligence-based survival prediction
This study aimed to evaluate the survival efficacy of different radiotherapy strategies in patients with glioblastoma (GBM). Furthermore, by utilizing various artificial intelligence algorithms and machine learning models, including neural networks, logistic regression, and decision trees, among others, the possibility of obtaining outcome predictions for a specific point in time was explored. The study considered data from radiotherapy treatments for patients affected by GBM. Eligible data included patients treated with 3D conformal radiotherapy or intensity-modulated radiotherapy, who reported overall survival and progression-free survival. The impact of different radiotherapy modalities on survival was evaluated through direct comparisons of the available data. In the second part of the study, the possibility of using artificial intelligence to predict the survival status of patients after a specific period following the end of radiation treatment was explored. To test our hypothesis, we used data from new patients and asked the machine learning models with the best fit to our data to predict survival for these new patients. A total of 30 elderly GBM patients treated with modern radiotherapy strategies were examined, showing a better overall survival when volumetric modulated radiotherapy (VMAT) was used compared to the 3D conformal radiation therapy technique. The artificial intelligence algorithm was asked to predict the survival status of three new patients. The neural network method, compared to the others used, is the one that responded correctly in 100% of the cases submitted. In second place was the decision tree method, which responded correctly in 67% of the cases. Our results suggested VMAT as a standard radiotherapy modality with potentially superior survival outcomes for selected patients with GBM.
A survey among hospital members of the Italian Hospital and Territory Society
To describe hospital activities distributed across the national territory, we conducted an online survey, addressed to all hospital members of the Italian Hospital and Territory Society (SIGOT) by email, and disseminated using SIGOT social channels. The questionnaire was available from June to September 2024. The survey addressed general and demographic characteristics of 126 respondents from different Italian geriatric hospital wards and the peculiarities of the activities inherent to comprehensive multidimensional assessment or specific techniques (non-invasive ventilation, high-flow oxygen therapy), type of organizations, and connection with intermediate care. Results of this survey show the importance of geriatricians in the acute-care setting, as well as point out some critical issues, such as the difficulty of clinicians to balance the objectives of economic efficiency (assigned yearly to the hospital unit) with those regarding quality of care and improved patients’ clinical outcomes.
Labial angioedema in an elderly woman with hypogammaglobulinemia, grass allergy and urticaria: a case report
This is the clinical case of an elderly woman with stabilized polypathology, suffering from a grass allergy, multiple intolerances, episodes of urticaria, and recurrent labial angioedema. The diagnostic work-up, carried out over many years, failed to yield definitive conclusions, as increases in eosinophils, elevated immunoglobulin (Ig) E, and autoimmune phenomena were all ruled out. Only in later life was a mild hypogammaglobulinemia discovered, specifically an IgG2 subclass deficiency. According to the recent DANCE classification, the labial angioedema was interpreted as idiopathic histaminergic angioedema, which was also suggested by the fact that, after initiating long-term therapy with a second-generation antihistamine, the clinical manifestations did not recur. Although we investigated possible links between chronic urticaria, angioedema, and hypogammaglobulinemia, the case remains partially unresolved, as reports of IgG subclass deficiency associated with angioedema are extremely rare. Only targeted genetic analyses could better define this inborn error of immunity, especially considering that hypogammaglobulinemia was also found in a family member.
Unraveling Parkinson’s disease: from dopaminergic dysfunction to novel therapeutic targets
Parkinson’s disease (PD) is a neurodegenerative disorder influenced by multiple factors and primarily defined by the gradual loss of dopaminergic neurons within the substantia nigra pars compacta. This pathological process fundamentally reduces available dopamine levels and produces core motor symptoms that include bradykinesia, resting tremor, rigidity, postural instability, and a generalized loss of balance. However, the pathology of PD appears to include far more than nigrostriatal function, as it is increasingly recognized that PD extends across the central and peripheral nervous systems through many different neurotransmitter systems/neurotransmitters, neuroinflammation, mitochondrial dysfunction, genetic mutations, abnormal protein aggregation (particularly of α-synuclein), and other factors. Thus, the complexities of PD are suggestive of more of a syndromic process rather than a single disease process with varied pathogenetic pathways that also result in varied clinical presentations. Traditionally, treatment options for PD have primarily focused on dopaminergic treatment strategies to manage the progressive symptoms, which include the lifestyle impact of diminished dopamine levels. This regimen primarily includes levodopa in addition to dopamine agonist options and an array of adjunctive therapies. While these early treatments are completely life-altering and provide considerable improvement for the first several years, their benefit eventually wanes, and they fundamentally simply do not alter disease progression. Recently, there has been a concerted effort to identify treatment options that are not simply a dopaminergic replacement treatment but can alter some aspects of the disease, including several novel approaches investigating mitochondrial health, neuroinflammation, autophagy, α-synuclein aggregation, and genetic regulation in both preclinical and early clinical studies. This review takes a critical look at the classic view of PD occurring as a result of dopaminergic dysfunction, extends into modern concepts that include abnormalities at the cellular and molecular levels, and describes new treatment strategies that fundamentally reflect the multifactorial nature of PD. However, its central aim is to direct the audience to interventions that not only relieve symptoms but also hold the promise to stop or reverse the disease, ultimately offering renewed hope to patients and physicians alike.
A network meta-analysis of anorexia treatments in disease and old age: pharmacogenomics, the gut-brain axis and artificial neural nets. Where are we?
Anorexia affects millions of people worldwide, and treatments vary widely, with no definitive treatment guidelines. A network meta-analysis compared and contrasted existing treatments for chronically ill and elderly patients. EMBASE, MEDLINE, PubMed, Cochrane, and clinicaltrials.gov were searched for articles reporting weight/body mass index changes pre- and post-treatment in the last 65 years. The target population was anorectic adults with chronic long-term illness (cancer, HIV, cystic fibrosis) or the elderly (ages over 65). Outcomes using pooled-weighted-standard-mean effect sizes were analyzed using a random effects model with Bayesian and frequentist methods. Meta-regressions with artificial neural nets were used to validate results and predict response to treatments. A total of 74 studies were included in the network meta-analysis out of the retrieved 340 articles, and 16,390 patients were analyzed in total. The random effects model calculated a pooled-weighted-effect size (p<0.0001) for olanzapine [0.87, confidence interval (CI) 95% (0.66-0.97)], for megestrol acetate high-dose [0.72, CI 95% (0.53-0.91)], for anamorelin [0.56, CI 95% (0.36-0.77)], for megestrol acetate low-dose [0.47, CI 95% (0.25-0.69)], for mirtazapine [0.42, CI 95% (0.13-0.72)], and for nutritional supplementation [0.45, CI 95% (0.29-0.61)]. Cannabinoids, cyproheptadine, other antidepressants, and steroids did not perform well. Between-study heterogeneity was tau-squared (τ2)=0.03. Subgroup analysis indicates that olanzapine is most effective for cancer patients, followed by megestrol acetate in high doses and anamorelin. Results were inconclusive for other patient groups. Olanzapine-induced weight gain is an adverse drug reaction that can be explained by pharmacogenomics affecting gut-microbiota dysbiosis. Compared to megestrol acetate and anamorelin, it has fewer side effects, improves sleep and mood, and has proven anti-nausea/anti-vomiting effects in chemotherapy. Furthermore, it inhibits some types of cancer cells and can be cytotoxic. Drug repositioning of olanzapine and anamorelin for cancer, elderly, HIV, and cystic fibrosis patients as orexigenic agents should be explored further. Appropriate nutritional supplementation should augment anorexia treatments.
39° Congresso nazionale SIGOT | Modena, 21-23 maggio 2025
Abstract Book of the 39° SIGOT National Congress | Modena, May 21-23, 2025
The impact of glomerular filtration rate on short-term outcome in elderly patients with heart failure with preserved ejection fraction
Heart failure with preserved ejection fraction is a frequent condition among the elderly. The prevalence of chronic kidney disease is also very high, accounting for 5-10% of the population. The aim of this study was to investigate whether the decrease in renal function, assessed by estimated glomerular filtration rate (eGFR), was an independent predictor of adverse events such as death and new hospitalizations in elderly patients hospitalized with heart failure with preserved ejection fraction. This study included hospitalized patients diagnosed with heart failure with preserved ejection fraction. Renal function was estimated by calculating glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration formula. Patients were stratified into two cohorts using the median eGFR value of 45.45 mL/min/1.73 m2 as the cutoff. During a 3-month follow-up, a total of 30 events were recorded. Multivariate logistic analysis adjusted for confounding factors such as age, gender, anemia, and therapy revealed that eGFR was an independent predictive factor in various models: odds ratio (OR): 0.96, 95% confidence interval (CI) 0.93-0.99, p=0.016; OR: 0.95, 95% CI 0.93-0.98, p=0.003. GFR is an independent predictive factor of short-term events in a population of elderly patients with heart failure with preserved ejection fraction.
Clinical activities of out-of-hospital Italian public geriatrics: a survey of members of the Italian Society of Geriatrics Hospital and Territory
The out-of-hospital public geriatrician is a key professional figure to address the challenges of the complexity of old patients and to act as a bridge between general and local medical services and increasingly crowded hospitals. This is a distinctive geriatrician in Italy who works mostly in the territory and intermediate care, capable of mediating the transition of the setting and following the patient in their home care. To have an overview of the current state of activities outside the hospital, distributed across the national territory, we conducted an online survey addressed to all Italian Society of Geriatrics Hospital and Territory (SIGOT) out-of-hospital members by email and disseminated it using SIGOT social channels. The questionnaire, available from June to September 2024, specifically addressed general characteristics/demographics of the members and the peculiarities of the activities inherent to home visits, multidimensional assessment, telemedicine, contact and collaboration with the general practitioner, and personal opinions (free field). A total of 67 out-of-hospital geriatricians responded to the survey. The results emphasize the specificity of the out-of-hospital geriatrician’s role and underline the collaboration between geriatricians and general practitioners, the importance of the Comprehensive Geriatric Assessment, and the relevance of domiciliary care. At the same time, this survey points out some critical issues, such as the lack of development of telemedicine in clinical practice and a long waiting time for a programmable (P-priority) first geriatric visit.
Cracking geriatric complexity: key messages from the Italian Society of Geriatrics Hospital and Territory Young Masterclass
The population is aging worldwide, and multimorbidity, polypharmacy, atypical symptoms, and geriatric syndromes are highly prevalent in older adults. Therefore, a personalized approach to care is essential. Adequate training for geriatricians is mandatory to guarantee homogeneity of care for complex patients. The Italian Society of Geriatrics Hospital and Territory (Società Italiana Geriatria Ospedale e Territorio, SIGOT) is committed to providing appropriate geriatric education through various projects and initiatives. Notably, the masterclass “Taking charge of the complexity between different care settings”, which was held in Bertinoro (Emilia-Romagna, Italy), addressed key geriatric topics in geriatrics such as antimicrobial stewardship, malnutrition, sarcopenia, psychogeriatrics, cardiogeriatrics, and transitional care. The event brought together young specialists and residents with experienced experts for 3 days of intensive learning, knowledge sharing, and professional networking. This consensus statement article summarizes the most important concepts discussed during this impactful event.
The role of geriatric multidimensional assessment in elderly patients with severe aortic stenosis and candidates for transcatheter aortic valve implantation
Severe aortic stenosis (AS) is a prevalent valvular condition among older adults, primarily resulting from the calcification and fibrosis of the aortic valve. Surgical aortic valve replacement and transcatheter aortic valve implantation (TAVI) are the main therapeutic options. TAVI has emerged as the preferred approach for elderly and frail patients deemed unsuitable for conventional surgery. This study highlights the critical role of Comprehensive Geriatric Assessment, including frailty evaluation, in identifying elderly patients best suited for TAVI. Tools such as the Essential Frailty Toolset, Clinical Frailty Scale, and the Multidimensional Prognostic Index have demonstrated efficacy in predicting postoperative mortality and disability. Multidimensional assessments, encompassing functional tests such as the 6-Minute Walking Test, enable enhanced risk stratification and personalized care planning. The findings emphasize the importance of a multidisciplinary approach in optimizing outcomes for geriatric patients with severe AS, focusing on improving clinical results and quality of life.
Analysis of predictive factors for hospitalization outcomes in older patients: the Geriatric Risk Assessment and Care Evaluation (GRACE) study protocol by the Azienda Ospedaliera San Giovanni-Addolorata (AOSGA) and the Italian Society of Hospital and Community Geriatrics (SIGOT)
Acute care hospitalization for older people is a major issue in terms of mortality, loss of functional independence, and reduced quality of life. The Geriatric Comprehensive Assessment may be crucial in promoting predictive models of hospitalization outcomes, including clinical, functional, and socio-demographic factors. The Geriatric Risk Assessment and Care Evaluation (GRACE) Study, a collaborative effort between the Azienda Ospedaliera San Giovanni Addolorata (AOSGA) and the Italian Society of Hospital and Community Geriatrics, is an observational, retrospective cohort study. It focuses on patients consecutively admitted to the acute geriatric care unit of AOSGA. The primary objective of the GRACE study is to identify factors that may predict in-hospital mortality. Secondary objectives include analyzing factors influencing the length of hospital stay and discharge setting. This paper details the study’s rationale and methodology and provides a brief overview of existing evidence regarding hospitalization outcomes in older adults. On behalf of the GRACE-AOSGA/SIGOT Study Group Investigators
Why should the Italian geriatrician be interested in elderly-onset inflammatory rheumatic diseases?
Inflammatory rheumatic diseases (IRDs) may onset in patients over 65 years old, and some of them are absent in younger subjects. As the over-65-year-old population is growing, IRD prevalence is consequently increasing. As for today, incorporating a comprehensive assessment in IRD management is rare, contrary to what happens in other areas of medicine. This brief communication stresses the main reasons why the Italian geriatrician should grow their interest in IRDs.
Lupin poisoning in a geriatric patient: a case report
Lupin seeds can contain toxicologically significant bitter quinolizidine alkaloids, which may induce symptoms of poisoning in humans by affecting the nervous, circulatory, and digestive systems. Typical manifestations of lupin alkaloid poisoning include dizziness, confusion, tachycardia, nausea, dry mouth, loss of motor coordination, and, in severe cases, cardiac arrest and respiratory paralysis. This case report describes accidental poisoning following the ingestion of food contaminated by water previously used to boil dry lupin seeds. An 85-year-old woman consumed meals prepared with this water and subsequently exhibited classic symptoms of gastrointestinal poisoning, requiring urgent admission to the emergency department.
Italian out-of-hospital Centers for Cognitive Disorders and Dementias: a survey of members of the Italian Society of Geriatrics Hospital and Territory
The Italian Society of Geriatrics Hospital and Territory conducted a survey regarding the Centers for Cognitive Disorders and Dementias in which territorial geriatricians work. The main characteristics of these centers were considered. Particular attention was given to the composition of the work teams and the integration between the various professional figures. Critical issues concerning mainly the scarcity of resources were also exposed. Finally, special emphasis was given to the major challenges of the immediate future, especially concerning the recent approval for the use of lecanemab to treat patients with early-stage Alzheimer’s disease.
Older patients with pulmonary embolism: a state-of-the-art review
Pulmonary embolism (PE) represents one of the main causes of acute respiratory failure in geriatric patients. In the older population, critical issues in PE management are multiple: reduced specificity of clinical signs and symptoms (with symptoms common to other pathologies, such as chest pain, dyspnea, and tachypnea), frequent late diagnosis (delay in diagnosis or misdiagnosis), the difficulty in the diagnostic algorithm, the need for a rapid prognostic assessment, and consequent timely treatment. Optimal PE management is patient-centered, includes all treatment options available, and aims at optimizing clinical outcomes in the short, medium, and long term with a multidisciplinary approach.
Cost of care among older people with chronic medical conditions in a healthcare facility in southwestern Nigeria
The global population of older individuals is rapidly increasing, a trend attributed to medical advances and increased life expectancy. This demographic shift has led to a higher prevalence of chronic conditions, placing significant pressure on healthcare systems and escalating costs. Our research aims to shed light on this pressing issue, providing crucial insights into the economic implications of geriatric care. Specifically, this study aimed to determine the cost of care and its factors among older adults with chronic diseases in a secondary health facility in southwestern Nigeria, providing crucial insights into the economic implications of geriatric care. A rigorous, simple random sampling technique was employed to recruit 300 older people diagnosed with chronic disease who have been on follow-up care for more than 6 months. A structured questionnaire was meticulously administered to the participants between July and December 2020. SPSS version 26 was used for data analysis, ensuring the robustness of our findings. To determine the difference in the average cost, t-tests and analysis of variance were employed, and p<0.05 was considered to indicate statistical significance. The mean age (standard deviation) in this study was 68.26 (7.01) years; 58.3% of participants were female. The total cost of care ranges from 2296 Nigerian Naira (₦) [6.4 U.S. dollars ($)] to 100,651 ₦ (280 $), with an average of 22,589.06 ₦ (63 $). Participants receiving pensions and those receiving very low income had higher costs. Compared with those without diabetes and those with one condition, diabetic participants and those with multimorbidity had twice as high a cost of care. Our findings underscore the importance of economic support, such as pensions and stipends, for older people in improving access to timely care, preventing complications, and ultimately lowering healthcare costs. The recommendation for regular screening for diabetes and other chronic conditions provides a practical strategy for improving diagnosis and timely interventions, empowering healthcare professionals and policymakers to make a tangible difference in geriatric care.
Pneumonia is a very frequent problem for old frail patients due to diffusion, mortality, and other negative outcomes. The most complex aspects consist of the formulation of a diagnosis and the choice of an adequate treatment. In this context, optimal management requires the correct definition of the category and the most probable etiology involved in choosing the empiric treatment. Following this, it is crucial to conduct accurate examinations and, whenever feasible, switch to targeted treatments, ensuring timely adoption of oral administration.
Hepatocellular carcinoma management in older adults and its relation with frailty
Frailty, defined as a condition of extreme clinical vulnerability, is a crucial predictor of survival in elderly cancer patients. Frailty is not a specific disease but rather a combination of physical, cognitive, and social factors that compromise the patient’s ability to effectively respond to stressful situations. The majority of patients diagnosed with hepatocellular carcinoma (HCC) are over 65 years old, making it essential to also assess comorbidities and conditions that may predispose to frailty, as these can influence prognosis. Therefore, identifying a clinical tool to standardize the concept of the “frail elderly patient” is essential to ensure an appropriate medical approach for this population. In this review, we examine various frailty assessment tools and evaluate their application in different therapeutic and management settings for elderly patients with HCC. Understanding the impact of frailty in elderly patients with HCC can help optimize clinical management, thereby reducing resource waste for the healthcare system and minimizing stress factors for the patient.
Assessing the health implications of anticholinergic drugs in older people
In this narrative review, we analyzed the existing literature on the pros and cons of anticholinergic medications, focusing on their prevalence, underlying mechanisms, and methods of assessment. Our review underscores the significant adverse effects of anticholinergic drugs, particularly on cognition and functional abilities in older adults. These effects include the exacerbation of various cognitive states, increased psychiatric symptoms, heightened risk of delirium, functional decline, elevated hospitalization rates, greater likelihood of institutionalization, and increased mortality. While anticholinergic medications provide therapeutic benefits, their use in older adults requires careful evaluation due to these considerable risks. Discontinuation of anticholinergic therapy offers both benefits and challenges. We propose practical guidelines for their use in clinical contexts such as dementia, schizophrenia, depression, anxiety, Parkinson’s disease, cardiovascular conditions, and urinary incontinence.
Education and training in geriatrics: guiding the generational change of health professionals
The increased volume of the aged population, the complexity of patients, and the updates in the legislative aspects linked to older people constitute various challenges for geriatrics. Education and training of young geriatricians appear crucial to forming conscious medical professionals. This short communication highlights the role of the Italian Society of Geriatrics Hospital and Territory in promoting good clinical practices for the care of older people.
A rapid weight loss caused by therapeutic cannabinoid use in an elderly individual: a case report
The proportion of older adults using medical cannabis is rising. Most of the cannabinoid research has focused on a healthy, younger population free from frailty and major comorbidity. In this case report, we describe an 82-year-old woman who was autonomous in basic and instrumental activities of daily living and who came to our geriatric department for marked weight loss over the past 2 months (about 10 kg) and anemia. After appropriate clinical and endoscopic checks, it was concluded that the weight loss was induced by the initiation of therapy with oral cannabis for the control of rheumatic pain.
Copyright (c) 2024 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
Sepsis is a potentially life-threatening condition that poses diagnostic challenges, particularly in the older population. Clinical manifestations of sepsis in these individuals can be blurred and atypical, making detection and diagnosis difficult. Common symptoms such as fever may be absent; conversely, older patients may present with atypical signs such as delirium, altered mental status, falls, weakness, and urinary incontinence. This can lead to delayed diagnosis, which increases the risk of rapid progression to septic shock. To improve diagnostic accuracy, various laboratory biomarkers and clinical scores have been developed, such as the Sequential (Sepsis-related) Organ Failure Assessment Score (SOFA-score), quick SOFA (qSOFA), and geriatric-qSOFA. These tools aid in identifying sepsis and predicting mortality risk promptly. In terms of treatment, early intervention is crucial. Maintaining adequate tissue perfusion (“fluid resuscitation”), appropriate antibiotic therapy, and eventually vasopressor support are key components of sepsis management in older adults. Additionally, in frail and comorbid patients, priority must be given to supportive care aimed at enhancing quality of life. Tailored therapeutic interventions are crucial to improving outcomes in this vulnerable population.
The comprehensive geriatric assessment in emergency and intensive unit settings
This review discusses the challenges that hospitals face when caring for older patients in emergency departments and intensive care units. Beyond chronic diseases, the older person is often affected by acute events, which require, in addition to the typical knowledge of emergency medicine and anesthesia, the holistic and targeted approach of the comprehensive geriatric assessment in the emergency room and intensive care setting. With Italy’s health centers struggling to manage the increasing pressure of patients, the COVID-19 pandemic has highlighted the need for a geriatric approach to address this challenge. This review outlines the Geriatric 5Ms Model of Care, which addresses five domains, and the Domain Management Model, which provides acute medical management.