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.
Successful opioid tapering using a non-pharmacological approach in chronic pain: a case report
Chronic pain in older adults is a major clinical challenge due to its high prevalence, complex pathophysiology, and frequent impact on function and quality of life. Polypharmacy and prolonged analgesic use, particularly opioids, often complicate management, leading to dependence and adverse effects. We report the case of a 75-year-old woman with chronic low back pain associated with significant functional impairment and opioid dependence. A multimodal, patient-centered approach was implemented, including gradual morphine tapering, transcutaneous electrical nerve stimulation, functional rehabilitation, and structured psychological support. This integrated strategy aimed to control pain while improving mobility and autonomy and addressing psychological dimensions of chronic pain. The patient showed a favorable evolution, with reduced pain intensity, improved functional capacity, and decreased reliance on opioids. Functional autonomy improved the Instrumental Activities of Daily Living score from 4/8 to 6/8; transition from Groupes Iso-Ressources 2 to 4, along with social reintegration. She also reported a subjective improvement in quality of life and increased engagement in her care. This case emphasizes the value of multimodal, non-pharmacological strategies and individualized, function-oriented management in older adults with chronic pain.
Copyright (c) 2026 the Author(s) http://creativecommons.org/licenses/by-nc/4.0
High-flow nasal cannula oxygen therapy for refractory hypoxemia in hospitalized older patients with end-stage respiratory failure
Limited data exist regarding the effectiveness of high-flow nasal cannula (HFNC) oxygen therapy in older patients with terminal acute respiratory failure (ARF). We examined the impact of HFNC on arterial oxygenation after failure of conventional oxygen therapy (COT) and non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) in a retrospective physiologic study of 37 consecutive patients admitted to a geriatric ward with end-stage ARF who received HFNC for refractory hypoxemia after failure of NIV/CPAP (n=18) or COT (n=19). Oxygenation parameters obtained during initial respiratory support were compared with those measured after the transition to HFNC. We observed that 22 patients died, 2 were transferred to the intensive care unit, and 13 were discharged alive. A “do not intubate” status was identified in 17 of the 22 deceased patients. Following HFNC application, improvements were observed in partial pressure of oxygen (PaO2, p<0.0001), oxygen saturation (SO2, p<0.0001), PaO2/fraction of inspired oxygen (FiO2) ratio (p=0.004), and peripheral SO2 (p<0.0001). Oxygenation improvements were greater after transition from NIV/CPAP despite lower FiO2 set with HFNC and in patients discharged alive despite unchanged FiO2. HFNC successfully corrected refractory hypoxemia following NIV/CPAP or COT failure in patients with terminal ARF hospitalized in a geriatric acute-care ward.
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.
Copyright (c) 2026 The Author(s) https://creativecommons.org/licenses/by-nc/4.0
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.
35 | Impact of gender on early medical complications and mortality after hip fracture in elderly patients
Introduction. Hip fractures are associated with high morbidity and mortality in older adults. While gender disparities are suggested in the literature, specific differences in early medical complications and mortality remain a subject of investigation. Objectives. To analyze gender impact on comorbidities, complications, and 3-month mortality in orthogeriatric patients. Materials and Methods. Observational study on 382 consecutive patients (mean age 84.7 ± 7.8 years; 75.4% women) admitted to the Orthogeriatric Unit of Baggiovara Civil Hospital between January 1st and December 30th, 2024. All patients underwent a Comprehensive Geriatric Assessment (CGA). Clinical, biochemical, and functional variables were analyzed. Multivariate analysis (logistic regression) was performed to identify predictors of 3-month mortality. Results. Men had a significantly higher comorbidity burden (CIRS-com: 4.35 vs 3.72; p=0.002). Women showed poorer nutritional status (MNA: 9.2 vs 10.3; p=0.001). Surprisingly, no significant gender differences were observed in terms of sarcopenia (SARC-F: 4.92 vs 5.31; p=0.223). During hospitalization, men experienced significantly higher rates of delirium (43.5% vs 27.0%; p=0.003), perioperative infections (44% vs 31.6%; p=0.031), and thromboembolic events (DVT 4.3% vs 0.4%; p=0.004). Three-month mortality was significantly higher in men (11.4% vs 2.2%; p=0.029). In the multivariate analysis, after adjusting for age, frailty, delirium, and comorbidities, male sex emerged as the best independent predictor of 3-month mortality (OR 5.27; p=0.083). Conclusions. Male sex is associated with a five-fold increased risk of medium-term mortality and higher post-operative complications, highlighting the need for early prevention and intensive follow-up in this population.
32 | Sarcopenia and chronic kidney disease: prevalence, correlation, and prognostic impact. The SARCOKID study
Introduction. Chronic Kidney Disease (CKD) and sarcopenia are highly prevalent in elderly. Recent research underscores a potent reciprocal relationship between CKD and sarcopenia: muscle wasting is significantly more common in renal patients and tends to exacerbate as kidney function declines. Objectives. Specifically, the research focuses on Sarcopenia as a disease progression predictor in patients with CKD. Materials and Methods. Patient’s evaluation comprehended: Medical and Pharmacological History, sarcopenia screening (SARC-F questionnaire, handgrip strength, Use of AndanteFIT for the assessment of the Short Physical Performance Battery (SPPB), Appendicular ultrasound to determine muscle mass), Multidimensional Prognostic Index (MPI) and MUST (Malnutrition Universal Screening Tool) score, Routine Laboratory Analysis, including Serum creatinine, blood urea nitrogen (BUN), microalbuminuria, 24-hour proteinuria, blood glucose, complete blood count (CBC), serum iron, ferritin, and total protein, albumin, total lymphocyte count, transferrin, and total cholesterol levels. Results. Subjects were followed up for five years between 2021 and 2026. 231 participants (mean age of 67.9 years; 59.8% males) were included at the baseline. Sarcopenia was recognized in 64.5% of subjects at the beginning of the trial. Sarcopenia was independently associated with a higher risk of hospitalization for all causes (HR 2.08, CI 95% 1.01-5.39) and with a significantly higher rate of disease progression to renal replacement therapy (HR 1.93, CI 95% 1.03-6.13). Conclusions. Sarcopenia could represent an independent prognostic factor for disease progression in older patients with CKD. Further studies will be needed to better comprehend underlying possible pathophysiological mechanisms.
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.
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.
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.
37 | Oral nutritional supplementation in geriatric patients hospitalized for sepsis: a prospective randomized study
Introduction. Malnutrition frequently affects hospitalized older adults under metabolic stress, such as sepsis. Management focuses on ensuring adequate energy/protein intake, with oral nutritional supplements (ONS) recommended when dietary intake is insufficient. Objectives. This study aims to characterize the nutritional profile of geriatric patients hospitalized with sepsis and evaluate early ONS impact on clinical outcomes. Materials and Methods. We prospectively randomized 41 septic patients (≥ 65 years), enrolled per Sepsis-3 criteria, to standard care or early ONS. Assessments included Cumulative Illness Rating Scale (CIRS), Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL), Short Portable Mental State Questionnaire (SPMSQ), 4A test, Clinical Frailty Scale (CFS), and Multidimensional Prognostic Index (MPI). Nutritional status was evaluated via Mini Nutritional Assessment Short-Form (MNA-SF), Malnutrition Universal Screening Tool (MUST), and laboratory markers. Outcomes included in-hospital/post-discharge mortality (up to 90 days) and length of stay. Results. Patients showed significant frailty and functional dependence. Malnutrition (MNA-SF: 68.3%) and weight loss >10% (58.5%) were widespread. Cumulative 90-day mortality was 36.6%; risk factors included frailty, low handgrip strength, and high MUST scores. Early ONS showed superior outcomes: significantly higher 30-day (p=0.03) and overall survival (65.4% vs 27%, p=0.047). A trend toward reduced in-hospital mortality was observed (17% vs 83%, p=0.06). ONS did not significantly alter inflammation or length of stay. Conclusions. Multidimensional assessment is essential for risk stratification. Since early ONS correlates with superior survival, integrating nutritional support into routine sepsis protocols is warranted to optimize recovery and autonomy.
21 | The role of prebiotic and probiotic supplementation in the prevention of clostridioides difficile infection
Introduction. Clostridioides difficile infection (CDI) is a frequent healthcare-associated complication in older adults, particularly in patients with multimorbidity and repeated antibiotic exposure. In geriatric care, preventive strategies targeting gut microbiota are gaining increasing attention. Objectives. To evaluate the association between prebiotic and probiotic supplementation and CDI incidence in hospitalized older patients. Materials and Methods. We conducted a retrospective observational study in a geriatric ward, including patients discharged between 2023 and 2025. From early 2025, prebiotic and probiotic supplementation was routinely administered to high-risk patients, especially during antibiotic therapy. CDI cases were analyzed annually in relation to total discharges, excluding short-stay admissions. Results. A progressive reduction in CDI cases was observed: 21 (1 recurrence) in 2023, 15 in 2024, and 11 in 2025. Discharges increased from 755 (2023) to 839 (2024) and 979 (2025). CDI incidence decreased from 2.8 to 1.8 and 1.1 cases per 100 discharges, respectively. The reduction was more evident after supplementation introduction in 2025, despite higher patient volume. Overall, a relative reduction of approximately 48% was observed. Conclusions. Prebiotic and probiotic supplementation was associated with reduced CDI incidence in hospitalized older adults. Results should be interpreted cautiously due to retrospective design and absence of a control group. However, they support a potential role for microbiota-targeted, low-cost preventive strategies in geriatric practice.
Introduction. The spread of infections caused by multidrug-resistant microorganisms is a major global health priority, with over 670,000 infections and approximately 33,000 deaths annually in Europe; Italy is among the most affected countries. In geriatric patients, the burden is greater, as more than half of cases occur in older adults, driven by frailty, multimorbidity, and immunosenescence, which increase exposure to hospitalizations and antibiotic treatments. Moreover, infections are increasingly developing in community and intermediate care settings beyond the traditional hospital context. Despite this, significant challenges persist, including limited knowledge of newly introduced antibiotics, partly due to excessive reliance on infectious disease consultation, and a lack of geriatric-specific data. The high cost of some new agents and the need for antimicrobial stewardship strategies further emphasize the importance of a more informed, context-based approach. Materials and Methods. A pre-congress course promoted by the SIGOT Young Group aims to provide practical tools for managing infections in older adults. The program covers basic microbiology, interpretation of antimicrobial susceptibility testing beyond simple categorization, and a rational approach to antibiotic selection across care settings. Conclusions. The course targets geriatricians, particularly early-career professionals, aiming to improve clinical competencies, promote exchange of real-world experiences, and foster collaboration, ultimately enhancing quality of care and supporting research in geriatric infectious diseases.
04 | Prevalence of dementia in a geriatric ward through the years
Introduction. In 2015, an estimated 46.8 million people worldwide were living with dementia; this number continues to grow. A significant percentage of hospitalized dementia patients will die in hospital. Objectives. The aim of this study was to evaluate the prevalence of dementia in a cohort of hospitalized patients aged 65 years and older and to analyse its association with other conditions. Materials and Methods. This is a retrospective study. Discharge letters and hospital discharge forms (SDO) were analyzed for patients admitted to the Geriatrics Department of the Sassari University Hospital between September 2018 and November 2018; between September and November 2020; and between September and November 2024. Statistical analysis was conducted with GraphPad Prism version 10.5.0. Results. A total of 699 discharge letters and hospital discharge forms were analysed. The mean age of the patients was 82.18 in 2024, 83.70 in 2020, and 85.52 in 2018. Female gender was found to be the predominant gender in the number of hospitalizations over the years. The average number of medications taken was 6.15 in 2018, 5.65 in 2020, and 6.95 in 2024. The number of patients with dementia showed a significant increase from 2018 (45.45% of hospitalized patients) to 2024 (56.17%) of the total hospitalized patients. The most frequently associated pathologies were cardiovascular diseases such as chronic heart failure and atrial fibrillation, chronic renal failure, diabetes mellitus, and chronic obstructive bronchitis. Deaths in hospital increased from 2018 to 2020 and subsequently in 2014: 22.55% in 2024, 16.66% in 2018, and 23% in 2020. Conclusions. In our study, we observed an increase over the years in the number of patients hospitalized with dementia who died during their hospital stay. Therefore, a careful assessment of care needs, a multidisciplinary approach, and communication with the patient and their family regarding their end-of-life preferences and wishes are important.
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.
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.
25 | Analytics in effectiveness of therapeutical compliance in elderly patients affected by bone frailty
Introduction. Effectiveness of therapy applied to elderly patients affected by Osteoporosis is strictly connected to therapeutic compliance. Objectives. The study evaluated the efficacy of the therapeutic compliance in brittle bone disease applied to frail elderly people affected by osteoporosis and in treatment with Denosumab. Materials and Methods. We studied people > 75; 43 women (mean age 83 + 3) and 14 men (mean age 85 + 3).In 34 women and 6 men we discovered 1-2 vertebral fractures.They have been treated with Denosumab 60 mg in a 6 –month span of time.The study design included at T0-T48:1) DEXA Bone Densitometry;2) X rays of the spine;3) Geriatric Depression State (GDS);4) Numerical Rating Scale (NRS);5) Tinetti balance and gait Scale (TBGS);6) Short Physical Performance Battery (SPPB). Results. At T0 patients showed 1) GDS: 40.5% mild depression (p<0.05), 53.6% severe depression (p<0.05);2) NRS: 25.6% moderate pain (p<0.01), 74.4% severe pain (p<0.01);3) TBGS: 83.8% mean score 10 (high risk of fall) (p<0.5), 16.2% mean score 1(non walking) (p<0.5);4) SPPB score 7 (p 0.05).At T 48 we detected: 1) GDS: 69.3% mild depression (p<0.05), 24.7% severe depression (p<0.05); 2) NRS: 37.3% mild pain (p<0.01), 28.1% moderate pain (p<0.01), 9.5% severe pain (p<0.01); 3) TBGS: 86.5% mean score 21 (low risk of fall) (p<0.5), 7.6% mean score 10.7 (high risk of fall) (p<0.5).; 4) SPPB score 10 (p 0.05) showing improvement in balance and gait rates.At T0 we detected: MMSE mean score 19.5;mean comorbidity index 3;mean severity index of comorbidity 2.23.AT T48,through X rays of the spine in the dorsal,lumbar and sacral regions,we checked that no new fractures had occurred.At T48 the DEXA Bone Densitometry showed a mean femoral T- score -2.9. Conclusion:We evaluated the frailty markers (depression,pain,fall,) and,after the Denosumab treatment,we studied analyticals regarding the efficiency in therapeutic compliance compared to the changes of frailty scores and physical ability empowerment.
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.
16 | Empowerment and vaccine prevention among diabetic patients over 65 in charge of the integrated management clinics
Introduction. The prevalence of diabetes (5.9%) reaches 21% in those over 75 years of age. People affected by diabetes are characterized by an increased infectious risk (1:2 in 5th year) and mortality compared to the general population. The National-Vaccine-Plan’23-25 include this risk category to develop vaccination supply strategies. The aim of this study is to evaluate the empowerment of diabetic patients in charge of the AGI both in the prevention of diabetes complications and infectious risk. Materials and Methods. An observational pilot study was conducted from February 2024 to May 2025. A total of 173 patients were recruited showing a mean age of 70, 52% male. An ad-hoc questionnaire was administered during the follow-up to evaluate HbA1c, vaccines history (anti-flu, anti-SARSCoV2, anti-pneumococcal, anti-HZV), Vaccine-Confidence-Index (VCI) adding "vaccines protect myself and others”, EQ-5D-3L+VAS for quality of life (QoL). Results. The patients showed a mean HbA1c of 7.2% (max11.4; min5; mode7.2); 74% received the anti-flu, 20% anti-pneumococcal, 16% anti-HZV, 90% antiSARS-CoV2 until 2022, 8% weren’t vaccinated. The VCI was 70% indicating moderate confidence in vaccines. Specifically, 22 patients didn’t answer the VaxRel question considering it unrelated; 68.2% agreed with "vaccines protect myself and others"; 16% didn’t trust in vaccines. More than 65% declared physical/mental well-being for the 5Ds; most frequent EQ-VAS value was 70/100 (22%). Conclusions. Data showed a low vaccination coverage, especially for the anti-HZV and anti-pneumococcal vaccine, which indicate a low propensity to vaccination, despite that the VCI was 70%. Otherwise, the QoL, compared to HbA1c values, gives an acceptable estimate of the empowerment of diabetic patients even if it can be improved. Therefore, it’s essential to elaborate more suitable strategies involving different healthcare professionals to increase diabetes' health literacy and vaccine confidence for patient-centred management.
08 | Role of ultrasonography in elderly patients with gallbladder diseases
Introduction. Gallbladder diseases in elderly patients without pain and relevant symptoms often are detected with ultrasonography (US) performed in patients with metabolic syndrome. Objective of our study is to evaluate with US 300 elderly patients with diabetes. Materials and methods. Abdominal US was performed in 300 diabetic elderly patients (300 women and 200 men, age from 75 to 95 years). Results. Gallstones were detected in 150 patients (95 women and 55 men); acute colecystitis with gallstones were detected in 17 patients (10 women and 10 men); Gallbladder cancer was detected in patients (4 women, 3 men); jaundice was detected in 12 asymptomatic patients. Conclusions. The US in elderly patients with diabetes is very useful if there are clinical symptoms. When the symptoms are few or absent US is the only diagnostic tecnique that can detect gallstones, cancer and cholecystitis.
65 | The role of the social health operator in mobilization and fall prevention in the acute geriatrics setting of the Sant'Orsola IRCCS Policlinico, Bologna
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.
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.
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.
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.
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.
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.
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.
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.
55 | Description of the functional characteristics of patients attending a geriatric outpatient clinic: cross-sectional study 2021–2025 at the geriatric outpatient clinics 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.