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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63 | Blood pressure profiles and autonomic dysfunction in parkinson’s disease: a retrospective analysis of 24-hour ambulatory monitoring and orthostatic responses in an elderly population
Introduction. Parkinson’s disease (PD) is frequently associated with cardiovascular autonomic failure, leading to significant blood pressure (BP) dysregulation. Patterns such as orthostatic hypotension (OH) and impaired nocturnal dipping increase the risk of falls and cardiovascular events in elderly patients. Objectives. To evaluate the 24-hour BP profile and orthostatic responses in PD patients compared to non-PD controls in a cardio-geriatric setting. Materials and Methods. This retrospective study analyzed data from 397 elderly subjects (57.7% female; mean age 74.04±10.54 years) at Baggiovara Hospital; PD patients represented 12% of the sample. Subjects underwent 24-hour Ambulatory BP Monitoring (ABPM) and orthostatic testing. Multivariate logistic regression identified independent associated factors of PD, adjusting for age, sex, BMI, and antihypertensive therapy. Results. PD patients exhibited a significantly more pronounced systolic BP drop at 1-minute orthostatism (11.46 vs 3.07 mmHg, p=0.006). A key finding was the severe impairment of circadian rhythm; an inverted dipping phenotype was significantly more frequent in the PD group (57.1% vs 28.0%, p=0.008). Consequently, PD patients showed significantly higher nocturnal mean BP compared to controls, involving both systolic (135.31 vs 128.87 mmHg, p=0.027) and diastolic values (73.80 vs 67.76 mmHg, p=0.002). Additionally, post-prandial hypotension was more frequent in PD (76.5% vs 45.6%, p=0.001). In the multivariate model, the 1-minute systolic BP drop remained significantly associated to PD (OR: 1.054; p<0.001). Conclusions. Elderly PD patients demonstrate a specific dysautonomic BP phenotype. The association between severe orthostatic drops and nocturnal hypertension—driven by an inverted dipping profile—highlights a profound failure of autonomic homeostasis independent of common geriatric confounders.
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65 | The role of the social health operator in mobilization and fall prevention in the acute geriatrics setting of the s'orsola irccs policlinico
The Acute Department of the S'Orsola Policlinico records approximately 1,438 annual admissions, with an average length of stay of 9.83 days in 2025, down compared to 2024 when it was 10.53 days. Patients mainly admitted through the Emergency Department (approximately 88% of the girdle due) had an average age of 86.39 years (85.91 in 2024), showed high comorbidity (average DRG weight 1.23) and mortality around 11%, down from 14% in 2024. The main diagnoses, in order of frequency, were: acute pulmonary edema/respiratory failure (n.444), septicemia (274), heart failure (n.190), diseases of the nervous system (n.147), urinary tract infections (n.137). Falls complicate hospitalizations with a frequency of about 1-3 falls per 1000 patient-days and are more common among geriatric patients and those with dementia. In 2023, due to an increase in falls during hospitalization in our acute care ward, a thorough assessment was carried out and an improvement action was undertaken, involving the nursing assistant staff, consisting of the daily mobilization of patients deemed suitable by the case manager nurse and the referring geriatrician. Every morning, within a specific time slot, the mobilization and walking of the patient is carried out, included in the planning of the activities of the Healthcare Support Worker. This improvement action has led to a significant reduction in the percentage of falls, from 4.1% in 2023 to 3.6% in 2024 and 2.8% in 2025. Falls occurred mainly at night, when the staff was numerically reduced. This activity represents a non-trivial best practice intervention that has clinical repercussions on fall prevention.
66 | The role of the social worker in the emergency department: the sant’orsola experience in optimizing patient care pathways
Introduction. In the Emergency Department (ED) of the Sant’Orsola University Hospital in Bologna, the patient's clinical conditions and social needs are systematically considered as closely interconnected to ensure appropriate discharge pathways through early multidimensional assessment. Objectives. To evaluate the role of the Social Worker in the ED in planning the most proper care pathway for frail older patients. Materials and Methods. Since 2024, at the ED of the Sant’Orsola University Hospital in Bologna, 10 beds have been dedicated to frail older adults. Patients aged ≥65 years with a Triage Risk Screening Tool (TRST) score ≥2 and clinical frailty and/or social needs are eligible, in the absence of indications for intensive or surgical treatment. Care is managed by the Continuity of Care Team, including a Geriatrician, a Nurse, and a Social Worker, who perform a multidimensional assessment and define the most appropriate pathway within 72 hours. Options include: supported discharge home through the Simple Multidimensional Evaluation Unit (UVMs); institutionalization pathways via the Complex Multidimensional Evaluation Unit (UVMc) for permanent admission to nursing homes, including emergency placements; short-term residential care in ED-dedicated nursing home beds; waiting list placement for respite admissions. Results. Between 01/01/2025 and 31/12/2025, 657 patients were assessed. Care pathways included: - 139 supported discharges, 111 via UVMs - 22 admissions to ED-dedicated nursing home beds - 6 respite admissions - 66 UVMc evaluations, 24 in emergency placements - 13 patients received both supported discharge and UVMc Conclusions. Given the close interplay between clinical and social frailty, the presence of a Social Worker in the ED working within a multidisciplinary team is essential in managing frail older adults. Early assessment of patient and caregiver needs allows safe discharge when clinically appropriate and reduces inappropriate hospital admissions.
64 | Delirium day: awareness campaign for the diagnosis of delirium and the use of diagnostic tools.
Delirium represents a true epidemiological emergency in hospitals. This condition leads to complications during hospitalization, affecting the length of stay and mortality. Data in the literature show that 1 in 4 elderly patients with delirium in the hospital; the main problem is that it is often underdiagnosed and, when diagnosed, not always coded in the hospital discharge records (SDO). For a couple of years now, electronic medical records have been in use, and the completion of the 4AT scale for the diagnosis of delirium can thus be recorded and extracted. Data from the 4AT forms completed in specialist, surgical, medical, and geriatric wards were collected, and subsequently, the analysis of the hospital discharge forms (SDO) completed with the diagnosis of delirium was also performed.The data highlight the high activity of the two Geriatric departments of the Policlinico (2024-2025), with approximately 4,964 emergency admissions (over two years); in 1,136 cases (22%), delirium was correctly coded in the SDO. In the other medical and surgical departments, however, delirium was recorded only 365 times in the SDOs, highlighting the critical issue of both non-coding and failure to recognize the condition. Hence the need for awareness campaigns and training courses, which, like we carry out every year during Delirium Day and the company courses that we have organized every Years since 2017 which allowed us to obtain recognition as an Alzheimer friendly hospital. Currently, the 4AT scale is not yet known or reported in CCE; in the last year (2025), of approximately 1,501 completions, 75% occurred in Geriatrics and 13% in Medicine. The data extraction carried out with colleagues from the health management regarding bed equivalents per day for delirium in Geriatrics shows that we are at 13.9 in total The role of hospital Geriatricians is to promote the correct diagnosis and subsequent coding of delirium.
62 | Ocular and neurological sequelae in long covid: dry eye, asthenopia, sleep disorders, asthenia, and restless legs syndrome—a case report with literature review
Introduction. Coronavirus disease 2019 is a pandemic disease caused by the severe acute respiratory syndrome coronavirus 2. Gambino et al. performed an evaluation of the ocular surfaces of post-COVID-19 patients compared to a control group of healthy subjects, and a statistically significant increase in dry eye disease emerged in both subjective and objective assessments. Fatigue and sleep disturbances have also been reported as long-term manifestations after acute infection. Objectives. In this case report, the authors describe the management of a patient with a history of acute SARS-CoV-2 infection who subsequently developed persistent dry eye and systemic symptoms. Materials and Methods. A 59-year-old Caucasian male patient was evaluated for the presence of about six weeks’ ocular burning in both eyes, which was associated with foreign body sensation, and symptoms of asthenopia. The patient was started on an oral therapy with a multivitamin product including Vitamins B, Choline, Reishi, Coenzyme Q10, and SOD. He also continued the instillation of a tear substitute and oral melatonin. Results. After 6 weeks of treatment, the patient reported a significant improvement in ocular symptoms. A reduction in asthenia and insomnia was also reported. Conclusions. Given the positive response to this combination therapy (tear substitutes, choline, vitamins, melatonin), it seems that these systemic treatments can address not only ocular symptoms but also the broader manifestations of Long Covid. The near-simultaneous presentation of dry eye, asthenopia, fatigue, and sleep disturbances, as well as the positive outcome of all clinical manifestations after six weeks of treatment, suggests a correlation between the various symptoms. Therapeutic strategies that combine nutritional support for ocular surface health with neuroprotective agents such as choline and vitamin complexes may promote symptom resolution by targeting both peripheral and central nervous system alterations.
51 | Assessment of quality of life and resident satisfaction in the nursing homes of “casa di dio” foundation
Introduction. In January 2026, a survey assessed quality of life and satisfaction among residents of Nursing Homes (NHs) managed by Casa di Dio Foundation. This study is part of a quality improvement effort, to identify issues and areas of excellence. Understanding residents’ well-being is increasingly important as NH populations become older and more clinically complex. The adopted framework was a Maslow-inspired multidimensional model, covering needs from basic physiological requirements to self-actualisation and well-being. Material and Methods. Seven trained interviewers conducted 15-minute semi-structured interviews with residents cognitively able (MMSE ≥14). The questionnaire included 13 items from the “Quality_VIA” tool and 5 from the WHO-5 Well-Being Index. 127 of 460 residents (27.6%) completed interviews in four NHs in Brescia. Results. Most residents reported satisfaction with meals (82%), sleep quality (80%), and the care received (90%). Environmental comfort and cleanliness were highly rated (95–98%), and privacy during care procedures was appreciated by 94%. Relationships with staff were generally positive (87%), although only 60% were satisfied with autonomy over daily routines. Recreational activities were limited due to influenza-related restrictions, affecting satisfaction (60%). WHO-5 results indicated that 46.5% reported optimal well-being, 48.8%) experienced distress, and 4.7% exhibited possible depressive symptoms. Conclusions. Residents are increasingly older, more clinically complex, and at higher risk of psychological distress. While material and environmental aspects of care are highly rated, nearly half of residents experience mental health challenges. The findings underscore the need to promote autonomy, self-determination, and self-actualisation alongside traditional care. In response, the Foundation has implemented interventions to enhance subjective well-being, ensuring care that addresses both physical and emotional needs.
53 | “weancare”- casa di dio foundation intervention
The “Weancare” intervention, a nutritional protocol based on enriched meals and fortified nutrition, evaluated the efficacy of personalized nutritional support in 52 frail elderly subjects with dysphagia, living in four Nursing Homes managed by Casa di Dio Foundation in Brescia (Italy). A key feature of the protocol was that the introduction of Weancare meals replaced all pre-existing caloric-protein oral nutritional supplements, which were entirely discontinued upon enrolment. Dysphagia is a condition that significantly increases the risk of malnutrition, pneumonia, and pressure sores. The study monitored clinical and functional parameters at 3 and 6 months to measure the treatment's impact. At baseline, the sample had an average age of 84, high comorbidities (high CIRS), cognitive impairment (MMSE often <24), and significant nutritional risk (MUST). Results after 3 months showed significant increase in BMI (+0.59) and lymphocyte counts, indicating improved nutritional and immunological status. Concurrently, the prevalence of pressure sores dropped drastically from 21% to 5.8%. Other biochemical parameters, such as albumin and haemoglobin, remained stable, suggesting a slower response due to the chronic nature of the underlying diseases. The 6 month analysis confirmed the sustainability of the recovery, with a steady BMI increase (+0.68 total, +0,11 per month in 6 month) and a continuous reduction in the probability of sores (prevalence of 0.19%). However, the intervention's efficacy was influenced by initial frailty: patients with multiple pathologies (high CIRS) and low autonomy (low Barthel index) responded less to the treatment. "Complete responders" (those who increased weight and resolved their sores) generally displayed moderate frailty and partial autonomy. In conclusion, integrating nutritional intervention into a multidisciplinary care model improves the prognosis of dysphagic elderly patients, though success remains tied to the individual clinical profile.
58 | Impact of deprescribing on hospitalized older adults
Introduction. The high prevalence of polypharmacotherapy in the elderly is a major public health concern, associated with increased risks of adverse drug reactions, hospitalizations, and mortality. Potentially inappropriate medications (PIMs) are frequent and often preventable through structured medication review and deprescribing. The inclusion of a clinical pharmacist in a multidisciplinary team may enhance prescribing appropriateness and patient safety. Objectives. To assess the effectiveness of a structured educational intervention on deprescribing in reducing PIMs at discharge in patients aged ≥75 years on polypharmacotherapy. Secondary objectives included evaluating polypharmacy prevalence, inappropriate prescriptions, and the role of the hospital pharmacist. Materials and Methods. This prospective multicenter observational study was conducted in Geriatrics, Neurology, and Orthopedics units of Alto Vicentino Hospital. Patients aged ≥75 years taking ≥5 medications were enrolled. The intervention included a training phase and a monitoring phase. During training, 36 patients underwent multidisciplinary medication review using STOPP/START and Beers criteria, with a 30-day telephone follow-up. Results. The intervention significantly reduced the mean number of medications (up to −1.86), across sexes and age groups, with greater effects in patients >85 years. PIMs decreased significantly (p < 0.001). Polypharmacy prevalence declined (p = 0.025), with 5 patients no longer classified as polypharmacy at discharge. Moreover, 27 patients with ≥1 PIM at admission had none at discharge (p < 0.001). No significant association between polypharmacy and PIMs was found. Conclusions. A structured educational intervention involving pharmacists and clinicians effectively reduces medication burden and PIMs in elderly patients, supporting a multidisciplinary approach with sustained post-discharge benefits.
59 | Service charter - local palliative care network asl roma 3
The Service Charter of the Local Palliative Care Network (RLCP) of the ASL Roma 3, updated to Revision 1 of October 2025, represents the official guidance tool for citizens and healthcare professionals. The document, drafted in accordance with Law 38/2010 and regional guidelines (DCA) No. U00311/2014, outlines the care offered to patients suffering from advanced cancer or chronic-degenerative diseases. The Network's primary objective is to ensure the best possible quality of life through relief from physical, psychological, and spiritual suffering, while protecting the dignity of the vulnerable. The organizational model is headed by the Casal Bernocchi Palliative Care Network UOSD, which coordinates the care pathways in synergy with the Local Operations Centers (COT) and the Hospital Operations Team (TOH). Its key principles include universal accessibility, multi-professional integration, continuity of care between hospital and community, and respect for patient self-determination. Care is provided in multiple settings, starting with residential hospices (Fondazione Sanità e Ricerca, Villa Maria Immacolata, and Merry House), designed as home environments for 24-hour specialized care. The network also provides home-based palliative care through accredited institutions and outpatient services in the districts of Ostia, Fiumicino, Municipio XI, and XII, where Individualized Care Plans are developed. A specific chapter focuses on pediatric palliative care, coordinated by the regional referral center at Bambino Gesù Hospital in Passoscuro. Access to services is based on the referral of a general practitioner or specialist, by submitting the Single Care Form to the COT-A. Finally, the document emphasizes the role of the multiprofessional team and volunteers, ensuring transparency and protection of rights through the Public Relations Office (URP) and the Patients' Rights Tribunal.
57 | Isolated delirium as a presenting sign of abdominal sepsis: a case of acute perforated diverticulitis in an elderly patient
Introduction. With increasing life expectancy, emergency department visits among elderly patients are rising, requiring greater awareness of atypical presentations. Delirium may be the sole manifestation of severe, time-dependent conditions, with high risk of diagnostic delay in the absence of focal signs. Case presentation. A 79-year-old woman with arterial hypertension presented with acute confusion and fever (38.7°C), without other symptoms. She was previously independent and in good health until the day prior to admission. Material and Materials and Methods. Vital signs were stable (BP 170/80 mmHg, HR 95 bpm, SpO₂ 95%, GCS 15), and physical examination, including abdominal and neurological assessment, was unremarkable. Laboratory tests showed normal WBC (8.29×10³/µL), mildly elevated procalcitonin (0.3 ng/mL), and high C-reactive protein (100 mg/L). Chest X-ray, abdominal ultrasound, and brain CT were negative. Bladder catheterization showed clear urine, reducing suspicion of urinary infection. Persistent fever and delirium despite negative first-line tests prompted further investigation. Results. Contrast-enhanced CT revealed sigmoid diverticulitis with contained perforation. The patient was admitted to emergency surgery and treated conservatively with intravenous fluids and antibiotics (metronidazole and ciprofloxacin). She was discharged after one week in fair condition, with planned follow-up. Conclusions. Delirium may be the sole sign of severe intra-abdominal pathology in elderly patients, even without pain or focal findings. Biomarker discrepancies may complicate diagnosis, highlighting their limitations in the geriatric population. Such atypical presentations are increasingly frequent and require heightened clinical awareness. Delirium should be considered a red flag, prompting a proactive approach with early advanced imaging to avoid delays and improve outcomes.
55 | Description of the functional characteristics of patients attending a geriatric outpatient clinic: cross-sectional study 2021–2025 at the geriatric outpatient clinic of the ospedale israelitico of rome.
Introduction. Aging is one of the main healthcare challenges of the 21st century. The high prevalence of frailty, multimorbidity, and disability requires an integrated clinical approach based on Comprehensive Geriatric Assessment (CGA). Aim of this study is to describe clinical and functional characteristics of an elderly population attending a geriatric outpatient clinic and to identify the main factors associated with health-related dependency, defined by the Medical Dependency Index (D.M.I.). Materials and Methods. We studied 271 patients evaluated from 2021 to 2025. Data were collected on age, sex, MMSE, ADL, IADL, Tinetti scale, and number of comorbidities. The D.M.I. was calculated based on the presence of absolute and/or relative criteria of dependency. Statistical analysis was conducted with, Spearman correlations, and multivariate logistic regression to identify independent predictors of dependency (p<0.05). Results. Mean age of the sample was 79.3±7.2 years: females (62.4%). A total of 54.6% of subjects were classified as dependent. Mean ADL, IADL, Tinetti, and MMSE scores were significantly lower in the dependent group compared with the independent group (p<0.001). The D.M.I. showed a strong negative correlation with ADL (r =–0.68) and Tinetti (r =–0.71), and a moderate correlation with MMSE (r =–0.48). Logistic regression analysis indicated that advanced age, multimorbidity ≥3, and reduced functional performance were independent predictors of dependency (OR=2.46; 95% CI 1.41–4.29; p=0.002). Conclusions. Dependency emerges as a multifactorial condition, determined by the interaction between functional decline, cognitive impairment, and comorbidities. The D.M.I. is confirmed to be a useful tool for risk stratification and can be integrated into community-based care models aligned with the WHO ICOPE framework (2025). Early adoption of multidimensional care pathways represents a priority objective to preserve functionality, autonomy, and quality of life in older adults.
54 | Differential diagnosis in older age bipolar disorder: the role of neuropsychological assessment in differentiating psychiatric neuroprogression from neurocognitive disorders
Introduction. Older Age Bipolar Disorder (OABD) represents a significant diagnostic challenge. The clinical overlap between affective symptoms and cognitive decline makes identifying the etiology of these deficits difficult. Discriminating between psychiatric neuroprogression and the onset of a Neurocognitive Disorder (NCD) requires the integration of clinical, metabolic and instrumental data. Objectives. To describe the case of a 78-year-old woman affected by bipolar disorder, hypertension, cardiopathy, hyperglycemia, hypercholesterolemia, and hypothyroidism, referred to our clinic for suspected cognitive impairment. Materials and Methods. The diagnostic process included monitoring of blood parameters, electrocardiogram, electroencephalogram, carotid artery ultrasound, Computed Tomography (CT) of the brain, and neuropsychological assessment. A comparison was performed between the baseline CT and a one-year follow-up scan. Results. The CT comparison showed unchanged cortical-subcortical atrophy in the absence of acute ischemic lesions. Neuropsychological evaluation evidenced a clear dissociation between preserved cognitive functioning on the Mini-Mental State Examination and episodic memory tests, contrasted by marked executive impairment. This was associated with a reduction in autonomy in activities of daily living. Consistent neuroimaging findings, the integrity of episodic memory, and the selective executive impairment—along with the relative functional decline—appear consistent with Older Age Bipolar Disorder and the influence of metabolic burden (hypothyroidism), rather than a primary Neurocognitive Disorder. Conclusions. A multidisciplinary approach and the preserved memory profile allowed for the correct classification of the patient, directing clinical management toward the appropriate therapeutic path and avoiding the misdiagnosis of a Neurocognitive Disorder.
56 | Utility of necpal tool in identifying palliative care needs in an acute geriatric ward: a 2-year survival analysis
Introduction. Acute geriatric patients often present with advanced chronic conditions and complex needs requiring a proactive palliative approach. The Necesidades Paliativas (NECPAL) tool, centered on the "Surprise Question" (SQ), identifies patients at risk of death who may benefit from palliative care planning. Objectives. To evaluate the NECPAL-SQ in predicting long-term prognosis and guiding clinical decisions, such as pharmacological optimization and palliative care activation, in hospitalized older adults. Materials and Methods. A prospective observational study was conducted on 150 consecutive patients (mean age 84.7± 6.4 years, 49% women) admitted to the Acute Geriatric Ward of Baggiovara Civil Hospital (Modena, Italy) between January 1 and March 31, 2023. The NECPAL tool and Comprehensive Geriatric Assessment (CGA) was completed for all patients. 24-month survival was analyzed using Kaplan-Meier curves and multivariate Cox model. Results. The Surprise Question (SQ-NO: "I would not be surprised if the patient died") identified 49.3% (74/150) of the sample as high-risk. This group showed significantly higher frailty (p<0,001): ADL (1.8 vs 3.8), Multi Prognostic Index (2.7 vs 2.0), and Clinical Frailty Scale (7.3 vs 5.5). SQ-NO patients received higher doses of morphine (90% vs 37%, p<0.001) and showed 100% sensitivity for in-hospital mortality. Kaplan-Meier analysis revealed a median survival of 4 months for SQ-NO vs. median survival not reached for SQ-YES (Log-Rank p<0.001). In the multivariate Cox model, the Clinical Frailty Scale was the strongest independent predictor of mortality (HR 1.95; 95% CI 1.37-2.77; p<0.001). Significant deprescribing of preventive drugs (statins, ACE-inhibitors) occurred in palliative patients. Conclusions. The NECPAL Surprise Question is a reliable prognostic tool in acute care geriatrics. It effectively identifies high-risk patients, facilitating timely palliative care and appropriate deprescribing.
61 | Real-world data on clinical, functional, and cognitive characteristics of nursing home residents in a large italian network (anni azzurri): a multicenter observational study
Introduction. Population ageing is associated with increasing clinical complexity, multimorbidity, and cognitive impairment in nursing home residents. Real-world data are essential to better characterize this population and optimize care models. Objectives. To describe the clinical, functional, cognitive, and care profile of residents in a large Italian nursing home network (Anni Azzurri) using real-world data from electronic health records, to outline care complexity. Materials and Methods. Observational study conducted in 59 nursing homes across Italy. All residents present on the index date (Nov 1, 2025) were included. Data collected: demographics (age, sex, length of stay), functional status (Barthel Index, dependency levels), cognitive status (dementia diagnosis, MMSE), comorbidities, and drug therapy. Results. A total of 6,431 residents were included (68% female), mostly oldest-old (>85 years: n=3,545), with mean stay of 1 year 10 months. Functional dependency was high: total 50%, severe 19%, moderate 15%, mild 11%, minimal 7%. Cognitive impairment was prevalent: MMSE not assessable 20%, severe 12%, moderate 32%, mild 10%, preserved 25%. Clinical complexity was high (mean 6 diagnoses/resident), with dementia in 56%. Common conditions included cardiovascular diseases (hypertension, atrial fibrillation), neurological disorders, and geriatric syndromes (urinary and fecal incontinence). Polypharmacy was frequent (mean 6 drugs/resident), including 1.6 neuropsychiatric drugs. Most prescribed classes were psycholeptics (11.9%), antithrombotics, and gastrointestinal drugs; most used agents included pantoprazole (30.9%), cholecalciferol (30.8%), furosemide (28.3%), and quetiapine (24.9%). Conclusions. These findings highlight high care complexity in nursing homes, requiring multidisciplinary care models. Real-world data are essential to monitor prescribing appropriateness (e.g., deprescribing) and support personalized care
50 | Gut dysbiosis, microbiome and heart failure. the gut-heart axis and eating habits in frail elderly with polipathology. a clinical case report.
Introduction. Gut and heart connection involves gut microbiota, immune system, and autonomic nervous system. Alterated gut microbiota (dysbiosis) and an inappropiate diet can promote cardiac diseases as heart failure. Normally shortchain fatty acids (SCFAs) have antinflammatory effects. During dysbiosis TMAO (trimethylamine N-oxide)increases endothelium permeability so bacteria and toxins pass into the blood. This relationship is more evident in frail patients usually elderly with multiple diseases, polypharmacy, reduction in functional reserve. Frailty is frequent in heart failure. Objectives. Show how a good dietary approach, modifying microbiota composition, in a frail elderly subject with heart disease and frequent episodes of intestinal dysbiosis, can improve cardiac function, frailty and prognosis. Materials and Methods. Woman 88 years old, affected by atrial fibrillation, hypertension, heart failure (NYHA II), mitral valve stenosis, episodes of intestinal dysbiosis associated with worsening cardiac function. We revealed a poor dietary intake of food with fiber. She was followed for two years making changes in the diet components introducing or increasing fibers and fermented foods. We performed the Multidimensional Prognostic Index (MPI) and the Rockwood Frailty Clinical Index. Results. Without dysbiosis NYHA class was II; Rockwood Frailty Index score of 4 (vulnerable), one-year mortality risk: 0.22(low). During dysbiosis NYHA class was III-IV; Rockwood Frailty Index was from 6 to 8 (moderately to very severely frail), one-year mortality risk moderate (0.66) or severe (0.80). Changing diet led to a reduction of dysbiosis and improvement of prognostic and frailty indices. At the end prognostic and frailty indices were similar to the data recorded without episodes of dysbiosis. Conclusions. A fiber-rich diet has a positive impact on gut microbiota, reduces inflammation, prevents cardiovascular disease and in the elderly improves prognostic and frailty indicators.
60 | Not just delirium: post-infectious autoimmune encephalitis in an older adult—acute illness unveiling hidden frailty and the value of multidisciplinary care
Introduction. In older adults, preserved functional reserve may conceal underlying frailty that becomes evident during acute illness. Neuropsychiatric symptoms are often attributed solely to delirium secondary to systemic infection, which may delay recognition of primary or para-infectious inflammatory brain disorders. Case description. A 77-year-old man with mild cognitive impairment (MCI), otherwise independent in activities of daily living and instrumental activities of daily living, was admitted for acute agitation, hallucinations, delusions and fever. A nasal swab was positive for Influenza A and chest imaging showed pneumonia, initially supporting infection-associated delirium. Persistent triphasic slow waves on EEG and CT evidence of normal-pressure hydrocephalus prompted further work-up. Brain MRI demonstrated post-contrast meningeal enhancement consistent with an inflammatory process. Lumbar puncture was performed and was negative for common pathogens, viruses and paraneoplastic/onconeural antibodies. Failure of antiviral therapy with acyclovir and further neurological deterioration, including dysphagia and aphasia, raised suspicion of post-infectious autoimmune encephalitis; high-dose intravenous corticosteroids led to clinical improvement. The course was complicated by acyclovir-associated acute kidney injury and multidrug-resistant bacterial infections, successfully managed through a multidisciplinary and nutritional approach. The patient was discharged to a neurorehabilitation program aimed at restoring functional autonomy. Conclusions. Delirium may be the only clinical clue to pre-existing but compensated frailty. Moving beyond diagnostic anchoring on infection alone is essential to identify treatable neurological conditions and to enable timely rehabilitation.
52 | Need for palliative care in nursing homes
Introduction. Nursing Homes (NHs) are shifting from primarily caring for frail and socially isolated older adults to increasingly serving people in the final phase of life, making it essential to develop end-of-life care competencies. Materials and Methods. We analysed deaths between July 2023 and December 2025 in four NHs in Brescia (460 beds). Data are presented as absolute numbers, means ± SD, and percentages. Comorbidity was assessed using CIRS-G; cognitive function with MMSE; functional autonomy with Barthel Index; and gait performance with Tinetti Scale. Results. A total of 387 deaths were recorded: 93 men (23.9%) and 294 women (76.1%). The mean age was 89.1 ± 4.56 years, with a mean comorbidity index of 4.1 ± 1.6. Mean MMSE was 7.84 ± 8.24, mean Barthel Index 12.0 ± 19.3, and mean Tinetti score 3.32 ± 6.14. Mean length of stay was 30 ± 29 months (2 days–15 years). The main causes of death were neurodegenerative diseases (41.6%), infections (pneumonia 12.1%, sepsis 6.2%), cardiovascular diseases (11.8%), cancer (8.7%), cerebrovascular diseases (3.4%), malnutrition (3.1%), and trauma (5.3%). Death occurred in the NHs in 88.4% of cases and in hospital in 11.6%. Terminal status was recognised in 72.4% of residents, and comfort therapy was provided in advance of death in 59.3%. Conclusions. Deaths involved very old residents with severe cognitive and functional impairments and high comorbidity. Of 44 hospitalisations, only 12 were for conditions not manageable within the NHs; in the remaining cases, family pressure contributed to potentially inappropriate transfers, with death occurring within 72 hours. Multidimensional assessment enabled recognition of the terminal phase in most cases, supporting shared decision-making with families and adequate symptom control. As NHs increasingly care for very old individuals, often in the final year of life, the main goal of care becomes optimising the quality of remaining life through an early, structured palliative approach.
39 | Analgesic efficacy of peng block versus femoral nerve block in elderly patients with hip fracture: a comparative study based on surgical procedure
Introduction. Optimizing postoperative pain management in geriatric patients with hip fractures is crucial to reduce the side effects associated with opioid-based analgesic therapy. Objectives. This study compared the analgesic efficacy of Pericapsular Nerve Group (PENG) block, Femoral Nerve Block (FNB), and a control group (no block) regarding pain intensity, opioid consumption, and Post Operative Delirium (POD) incidence, stratified by surgical procedure. Materials and Methods. Patients were consecutively recruited in the Orthogeriatric Ward at Ospedale Civile Baggiovara (Jan 1–Sep 30, 2024; N=214; 72.4% female; mean age 84.9±7.7). Cohorts included hemiarthroplasty (HA, n=82) and gamma nail (GN, n=132). Outcomes were Pain measured with the Numerical Rating Scale (NRS), Delirium measured with 4AT, and morphine equivalent consumption on postoperative days (DAY) 1-3. Results. In the HA group, the PENG group showed significantly lower morphine consumption on DAY 3 compared to FNB (1.14 vs 4.22 mg; p=0.045). In the GN group, both blocks significantly reduced NRS and morphine consumption on DAY 2 and 3, compared to the control (p<0.05). In DAY 1, FNB showed lower NRS than PENG (2.24 vs 3.41; p=0.022). Delirium Incidence didn't show significant differences between groups. Multivariate analysis confirmed that "Block Type" was a significant independent predictor of reduced morphine consumption on DAY 3 (p=0.006), regardless of surgery type, age, and sex. Conclusions. Regional anesthesia efficacy varies by surgery type. For gamma nail, both blocks provide superior pain control and opioid sparing, though FNB appears more effective in the immediate postoperative period (DAY 1). For hemiarthroplasty, the PENG block demonstrates a significant late opioid-sparing effect compared to FNB. The independent role of the block in reducing late opioid requirements supports its systematic use in multimodal geriatric analgesia.
42 | Use of the brief-multidimensional prognostic index for medication reconciliation and deprescribing in frail elderly patients
Introduction. Polypharmacy in frail elderly patients increases the risk of adverse events. Using the Brief-Multidimensional Prognostic Index (B-MPI) allows for risk-based stratification in General Practice, effectively identifying candidates for medication reconciliation and targeted deprescribing within a person-centered care model. Materials and Methods. A project for General Practitioners (GPs) was conducted in two phases. The first phase consisted of training sessions aimed at introducing prescribing appropriateness and defining criteria for patients eligible for reconciliation and subsequent deprescribing. The second phase actively involved GPs in the practical application of these concepts by identifying patients aged over 80 taking more than eight medications. The standardized B-MPI questionnaire was administered to these patients to provide a score for stratifying global prognostic risk (mortality and adverse events), supporting the identification of those suitable for therapeutic intervention. Results. Descriptive analysis of the database included interventions from 28 physicians, covering a total of 140 patients. When stratified using the B-MPI, the sample showed a predominantly moderate global risk (57%), while 26% showed high risk and 17% mild risk. The most frequently deprescribed pharmacological classes were proton pump inhibitors (18%), allopurinol (15%), and statins (14%), followed by acetylsalicylic acid (5%), cholecalciferol/calcifediol (5%), and ezetimibe (4%). Conclusions. This project validates a care model centered on prescribing appropriateness through active GPs engagement. Preliminary analyses confirm the high prevalence of complex and often partially inappropriate polypharmacy in frail elderly patients. These data support the necessity of a structured pathway for case selection, standardized data collection, and systematic medication review.
43 | Acute ischemic stroke in a tachy-brady syndrome patient: a case of multidisciplinary team approach to diagnosis.
Introduction. Ischemic stroke and atrial fibrillation are two highly prevalent conditions in the elderly population. Up to 30% of ischemic strokes have a cardioembolic etiology, which leads to a worse prognosis and a higher complication rate. Case Report. C.K., a 69-year-old woman, was admitted to our hospital for sudden speech impairment and right-sided hemiparesis. Pre-admission Rankin Scale 0. At neurological examination, complete aphasia, positive Babinski sign, and forced leftward gaze deviation were reported (National Institutes of Health Stroke Scale [NIHSS] was 20). Upon admission, new-onset atrial fibrillation was detected, and Multimodal Computed Tomography (CT) revealed an acute occlusion of the left internal carotid artery with an extensive area of hypoperfusion consistent with an ischemic penumbra (Alberta Stroke Program Early CT Score [ASPECTS] 10). Two and a half hours after symptom onset, systemic thrombolysis with tenecteplase followed by mechanical thrombectomy were performed, achieving complete reperfusion. An early post-procedural brain CT scan showed no signs of hemorrhagic transformation; however, a 24-hour follow-up detected a deep subacute ischemic area in the left hemisphere. The patient achieved complete neurological recovery (NIHSS 0). Due to the cardioembolic stroke etiology, anticoagulant therapy and beta-blockers were introduced; statin therapy was tailored to achieve lipid targets. However, 24-hour Holter monitoring revealed post-extrasystolic pauses, prompting beta-blocker discontinuation. After hospital discharge and a beta-blocker wash-out, a 7-day Holter assessment was repeated, which confirmed recurrent diurnal asystolic pauses (maximum 6 seconds), consistent with tachy-brady syndrome, leading to permanent pacemaker implantation. Conclusions. This case highlights that a multidisciplinary team approach is essential in stroke management. Our findings underline the importance of continuous care and of post-discharge follow-up.
45 | Bridging the gap: a collaborative model for the follow-up of older intensive care unit survivors
Introduction. In Europe, patients aged ≥80 years account for 10-20% of adult Intensive Care Unit (ICU) admissions, with 30-day mortality rates around 37% and 1-year mortality reaching 50% for the oldest old. Locally, over the last 5 years, our ICU admitted more than 3700 patients with nearly 30% aged ≥75. ICU mortality was only slightly higher than the 55-65 age group, leaving a large population at risk of Post-Intensive Care Syndrome (PICS). Assessing residual autonomy and sustainable follow-up is urgent to improve long-term outcomes. Objectives. We aim to implement multidisciplinary follow up clinic for ICU survivors aged ≥75. Key goals include: assessing current cognitive and functional status vs. pre-admission baseline; identifying unmet clinical or social needs and ensuring continuity of care through hospital-territory integration; monitoring clinical trajectories over time. Materials and Methods. The project targets patients ≥75 surviving at least 3 months post-ICU discharge. Its core consists of a multidisciplinary joint-visit model, where Intensivist, Geriatrician and Psychologist perform a simultaneous and collaborative assessment of the patient. A systematic clinical follow-up is scheduled at 6 months to monitor long-term outcomes. Results. We expect to intercept PICS early and reduce the care gap often seen after discharge. Identifying specific geriatric syndromes (sarcopenia, cognitive decline, depression) will allow for targeted interventions, potentially reducing hospital readmissions and improving the perceived quality of life for both patients and caregivers. Conclusions. The high survival rate of older patients in our ICU justifies a shift in focus from short-term survival to long-term functional recovery. A multidisciplinary approach is essential to ensuring functional recovery and sustainable care for the expanding cohort of very old ICU survivors.
40 | Predictive accuracy of anticholinergic burden scales for ecg abnormalities in older adults
Introduction. Polypharmacy and anticholinergic burden (AB) are common in older adults, but their impact on cardiac electrophysiology remains unclear. Objectives. To compare seven validated scales in predicting electrocardiogram (ECG) abnormalities and identify the tool with the highest accuracy in geriatric patients. Materials and Methods. This multicenter prospective study included 292 patients (mean age 80.7±6.2 years). We used Anticholinergic Activity Scale (AAS), Anticholinergic Burden Classification (ABC), Anticholinergic Cognitive Burden (ACB), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), Clinician-Rated Anticholinergic Score (CRAS), and Anticholinergic Loading Scale (ACL) to assess AB. Pathological 12-lead ECG findings included Atrial Fibrillation (AF) and conduction blocks. Accuracy was assessed using ROC curves and multivariate logistic regression. Results. Pathological EKGs were found in 12.1% of patients. ABC, ACB, and ADS were significantly associated with ECG abnormalities and AF. ROC analysis identified the ABC scale as the best predictor for overall ECG abnormalities (Area Under the Curve [AUC] 0.666; p=0.001) and AF (AUC 0.715; p<0.001). In multivariate models, ABC remained an independent predictor (Odds Ratio [OR] 1.531; 95% Confidence Interval [CI] 1.198-1.956; p=0.001), alongside age and cardiological symptoms. Conclusions. The Anticholinergic Burden Classification scale most effectively identifies patients at risk of cardiac instability. A high ABC score is a clinical 'red flag' for arrhythmic risk and warrants proactive monitoring, periodic ECGs, and AF screening. Early identification prevents serious thromboembolic or hemodynamic complications. Targeted deprescribing is needed to restore vagal control, mitigate cardiotoxicity, and preserve autonomy in elderly patients.
49 | A case of peritoneal sclerosis in a general medicine department
Encapsulating peritoneal sclerosis (EPS) is a rare and life-threatening complication of peritoneal dialysis (PD). Its incidence and prevalence are still not clearly defined, but they increase with the duration of PD treatment;mortality rate is always high. Etiology is unclear, meaby due to the chronic exposure to bioincompatible PD solutions, which cause peritoneal inflammation and long-term modifications of the peritoneum. A 91-year-old-lady was admitted to our department for abdominal pain and constipation. She was treated with PD by 7 years and switched to hemodialysis (HD) about 5 mounths before because of heart failure exacerbation requiring hospitalization. An abdominal ultrasound examination showed ascitic effusione, confirmed by abdominal TC scan, which excluded radiological signs of mechanical or paralytic intestinal obstruction. No laboratory signs of infection or hemodynamic decompensation could be traced. During the days of hospitalization bowel quickly re-channeled thanks to enema;however, the persistence of abdominal tensione required execution of evacuative paracentesis. After that, abdominal TC scan was programmed. The ascitic fluid was an exudate with no evidence of microbiological infection;the cytological test recited:“sample including red blood cells, a few small lymphocytes and some reactive mesothelial cells;no evidence of epithelial neoplasia”. Abdominal TC showed peritoneal effusion extending into the abdominal-pelvic cavity cranio-caudally, surrounding the abdominal organs and displacing intestinal loops posteriorly like a thickened sack of 2 mm that takes contrast medium. Althouth rare, physicians should always suspect EPS in patients with a suggestive history and clinical symptoms indicative of occlusive condition in absence of an alternative diagnosis. The presence of ascites and its analysis can help in the diagnosis, even if radiology plays a crucial role since the tomographic appearance of peritoneum is pathognomonic and allows early diagnosis.
47 | Dual etiology of chronic hypercobalaminemia: macro-vitamin b12 interference and inflammatory protein overexpression in a patient with sjögren’s syndrome
Persistent hypercobalaminemia often triggers extensive investigations to rule out malignancies. However, elevated levels can result from analytical interference or increased cobalamin-binding proteins. We report a 73-year-old female with vitamin B12 levels exceeding 2000 nanograms per liter for over a decade. Her history included Sjögren syndrome with antinuclear antibodies and lupus anticoagulant positivity, fibromyalgia, and hypertension treated with olmesartan medoxomil. Laboratory showed diluted vitamin B12 of 4911 nanograms per liter, normal homocysteine (11.4 micromoles per liter), and normal methylmalonic acid (16.0 micrograms per liter). Normal functional markers confirmed absence of true deficiency and supported pseudohypercobalaminemia. To investigate the suspected presence of macro-vitamin B12, polyethylene glycol precipitation was performed. Post-polyethylene glycol vitamin B12 was 1672 nanograms per liter, showing 66% reduction. A reduction exceeding 50% is diagnostic for macro-vitamin B12, an artifact caused by immunocomplexes between vitamin B12 and immunoglobulins. However, residual value remained elevated compared to reference range (165 to 695 nanograms per liter). This suggests dual etiology: interferential component from macro-vitamin B12 and true increase in cobalamin-binding proteins specifically haptocorrin or transcobalamin. The chronic inflammatory state in Sjögren syndrome, with B-cell hyperactivity and interferon pathway activation, likely stimulates production of these transport proteins. This case highlights the importance of polyethylene glycol precipitation to identify artifacts, while recognizing that residual elevated values may reflect underlying inflammatory processes. In autoimmune diseases with persistent hypercobalaminemia, clinicians should consider both analytical interference and inflammation-driven increases in binding proteins.
44 | Radiofrequency echographic multi spectrometry (rems) for bone assessment in geriatric patients
Introduction. Osteoporosis is a silent, multifactorial disease typically assessed through bone mineral density (BMD), expressed as a T-score (number of standard deviations from the young-adult mean). Diagnosis often occurs only after a fragility fracture, making osteoporosis largely underdiagnosed and underestimated. Early identification is therefore crucial, particularly in geriatric and bedridden populations. Standard techniques such as dual-energy X-ray absorptiometry (DXA) present limitations, including exposure to ionizing radiation and limited portability. Radiofrequency Echographic Multi Spectrometry (REMS) is a portable, operator-independent, radiation-free technology that evaluates both bone quantity and quality at reference skeletal sites (lumbar spine and proximal femur), providing a comprehensive assessment of bone health. Objectives. To evaluate the suitability of REMS for bone assessment in geriatric populations. Materials and Methods. A structured literature review was conducted on REMS performance in bone health and fracture risk assessment. Studies were independently reviewed by two authors and validated by a third reviewer. Results. REMS demonstrated high sensitivity and specificity (>90%) in geriatric populations at axial sites. It also provides a BMD-independent parameter, the Fragility Score (FS), which reflects bone quality and skeletal fragility. By integrating T-score and FS, REMS enables automatic fracture risk stratification into seven classes (R1–R7), with corresponding 5-year fracture risk probabilities. REMS has also been included in Italian Ministry of Health guidelines on fragility fractures. Conclusions. REMS represents a valuable tool for bone monitoring in geriatric patients. Its use in clinical practice may enhance early identification and support personalized management of osteoporosis and skeletal fragility.
48 | Predictors of functional recovery after hip fracture in frail older adults: insights from a post-acute care cohort
Introduction. Femoral fractures in older adults represent a significant cause of morbidity and mortality. To address this issue, multidisciplinary care models integrating geriatric, orthopedic, and rehabilitative expertise have been developed at the S. Orsola Polyclinic in Bologna. Objectives. To evaluate, within the Post-Acute Care and Continuity of Care setting (PACA)—where patients with the highest clinical and social frailty are concentrated—the possibility of identifying clinical characteristics predictive of failure to recover functional autonomy. Materials and Methods. This retrospective observational study included patients aged over 75 years who underwent surgery for femoral fracture and were admitted to PACA between August 2022 and September 2025. Frailty was assessed using the Clinical Frailty Scale (CFS), and comorbidities were evaluated using the Charlson Comorbidity Index (CCI). Rehabilitation outcomes were analyzed in comparison with pre-fracture functional status, along with complications and discharge setting. Results. Out of 71 patients, 71% did not recover their pre-fracture functional autonomy. Patients with poor outcomes had higher mean CFS (5.87 vs 5.33; p=0.52) and CCI (7.33 vs 6; p=0.15) scores, although these differences were not statistically significant. Among patients with dementia (n=27), 88% failed to achieve rehabilitation goals. The most frequent complications hindering rehabilitation were infections (9 cases) and delirium (19 cases). Conclusions. High levels of frailty, comorbidity, and the presence of dementia are associated with an increased risk of rehabilitation failure, despite geriatric care and early initiation of rehabilitation. Early planning of the post-discharge pathway is therefore essential, taking into account the likelihood of returning home with increased disability and care needs. Furthermore, a cut-off value of 6 for both CCI and CFS may help identify patients at higher risk of functional decline.
46 | Enhancing the comprehensive geriatric assessment through national well-being indicators: a multidimensional framework for older people
Introduction. In the current demographic context, identifying frailty and the needs of older people requires specific tools. The Comprehensive Geriatric Assessment (CGA) is a key resource for defining personalized care plans, serving as a driver of healthcare reorganization and the development of community-based services, in line with recent policy reforms. Objectives. This study aims to build a multidimensional national system by classifying existing well-being indicators into the four CGA domains (clinical, functional, cognitive, socio-environmental), in order to support national and regional health policies in the geriatric field. Materials and Methods. Starting from the Italian Equitable and Sustainable Well-being (BES) framework, 22 indicators referring to the population aged 75+ and one of healthy life expectancy at age 65 were selected, covering the period 2016–2024. For each indicator, the desired direction (polarity) was defined. Indicators were allocated across the four domains (6, 3, 3, 11), normalized through a base-100 index (2016=100), and aggregated via arithmetic mean. Results. The least favorable results concern the clinical domain, which in 2024 remains at 2016 levels after a temporary improvement in 2021–2023, mainly due to negative trends in smoking and diet. The cognitive domain shows a gradual recovery after the pandemic (+5 in 2024 vs 2016), as does the functional domain (+8), both previously affected by increased limitations and sedentary behavior. Despite rising inequalities and poverty risk, the socio-environmental domain constantly remains above the baseline, reaching +11 in 2024. Conclusions. The study supports the development of a dashboard to inform national health policies for older people. Future research will involve healthcare professionals in refining indicator selection and classification, as well as defining weighting systems for the aggregation phase.
38 | Delayed surgical management in proximal femoral fractures: implications in a frail older patient.
Introduction. Proximal femoral fractures in older adults are associated with high morbidity and mortality. Current evidence strongly supports surgical treatment within 48 hours from the fall, to help reducing complications and improving survival; however, delays frequently occur in frail patients with multiple comorbidities. Case Presentation. We report the case of an 89-year-old woman with dementia, hypertensive heart disease and moderate aortic stenosis, who sustained an unwitnessed fall while at home. On Emergency Department admission, she presented with respiratory failure due to acute decompensated heart failure, requiring antibiotic therapy, intravenous diuretics, and oxygen support. Initial brain computed tomography scan was negative for acute findings. Due to bed unavailability, she was admitted to the Orthogeriatric ward two days later. Cardiology evaluation showed worsening aortic stenosis. Given the high perioperative risk, intensive care monitoring was recommended, delaying surgery until day 6 post-injury. Surgery was completed without immediate complications. On postoperative day one, early mobilization revealed left upper limb weakness. Brain CT initially showed a right parietal hygroma; a follow-up CT scan at 48 hours revealed a Ponto mesencephalic hemorrhage, leading to withdrawal of antithrombotic prophylaxis. The subsequent CT scan documented progressive resolution of both the brain hemorrhage and the parietal hygroma, so it was possible to reintroduce prophylaxis. Afterwards, the patient continued rehabilitation and is currently awaiting transfer to a hospital-based rehabilitation unit. Conclusions. Surgical delay in frail older patients with femur fractures may increase the risk of severe, preventable complications, even when clinically justified. Early surgery remains the standard of care to improve outcomes and preventing morbidity and even mortality.
41 | Multimodal intervention for active ageing: the muovi-mente community-based project based on 10 sequential sessions of physical activity and cognitive stimulation
Longevity is associated a higher prevalence of cognitive decline and frailty, making sustainable prevention interventions a priority. Evidence suggest that multimodal approaches help maintaining cognitive function and overall well-being. The MuoviMente project, aligns with prevention strateges promoted by the NationalDementiaPlan(code2026012VIN). This study aims to describe baseline characteristics of the sample and early adherence to the program, pending post-intervention outcome evaluation. MethodsSample:65 participants enrolled at the UniversityThirdAge. Upon enrollment, they were administered a questionnaire covering the 14 risk factors identified by the LancetCommission on Dementia, along with the MMSE, Barthel Index and Hand Grip Test. MuoviMente, currently underway, consists of 10 structured sessions(including low-intensity walking, cognitive stimulation exercises, group relational activities). During this phase, participant characteristics and adherence were analyzed; a post-intervention clinical-functional reassessment will be performed at the end of the program to assess its potential impact. ResultsThe sample was predominantly female (74%), mean age 71years (58–94), with good baseline functional status (Barthel Index 100 in 75%; MMSE ≥27; mean HandGripStrength 22. 8 kg). Regular physical activity was reported by 69% and 72% had an adequate social network. The prevalent comorbidities were hypertension 41% and dyslipidemia 57%. Mean education was 8 years. Early adherence analysis showed a decline followed by stabilization at around 65%. ConclusionsPreliminary data indicate that the program is reaching a relatively active population. At this stage adherence appears to be a key aspect. Since the project is ongoing, it is not yet possible to draw conclusions about its effectiveness. This is expected at the end of the project, with the aim of evaluating its impact on cognitive and functional outcomes. MuoviMente appears to be a potentially sustainable and replicable regional model
29 | Factors associated with 30-day mortality and vasopressor use in a cohort of elderly patients with sepsis: a retrospective analysis at the multidisciplinary internal medicine unit of correggio hospital
Introduction. Sepsis is a major cause of morbidity and mortality in the elderly. Immunosenescence increases susceptibility to infection and risk of severe disease. Diagnosis is difficult due to atypical presentations, requiring an integrated approach considering severity, frailty and function. Objectives. To describe clinical and laboratory features of elderly patients with sepsis and assess associations between baseline variables and 30-day mortality and vasopressor use. Materials and Methods. This retrospective single-center study included 41 elderly patients with sepsis admitted between March and August 2025 to a geriatric internal medicine unit. Clinical data, functional status, and geriatric assessment (cognition, nutrition, comorbidities, frailty, Multidimensional Prognostic Index) were collected. At admission, clinical and laboratory data and severity scores (quick Sequential Organ Failure Assessment, Sequential Organ Failure Assessment, National Early Warning Score 2) were recorded. Outcomes were 30-day mortality and vasopressor use, reflecting decision-making in a geriatric context. Results. Malnutrition (p=0.020), frailty (p=0.012), anemia (p=0.027), hypoalbuminemia (p=0.037), and hypotension (p=0.048) were associated with mortality. Vasopressor use was associated with comorbidity burden (p=0.022), chronic kidney disease (p=0.031), chronic obstructive pulmonary disease (p = 0.048), lower leukocytes (p < 0.001), lower C-reactive protein (p=0.023), lower procalcitonin at day 1 and 3 (p=0.007), and higher Sequential Organ Failure Assessment scores (p=0.007). Dementia was associated with lower vasopressor use, reflecting a conservative approach. Mortality related to frailty and nutrition; vasopressor use to severity. Conclusions. In elderly sepsis, prognosis depends on infection severity and patient vulnerability. Vasopressor use reflects clinical decision-making. Geriatric assessment may improve prognostic stratification and support personalized care.