Calcfic aortic stenosis represents the most common heart valve disease in the elderly population. Recent evidence have demonstrated that active biological events lead to a progressive degeneration of aortic valve leaflets mainly regulated by lipids and inflammation. Clinical manifestation is frequently insidious at the onset and can be highly variable among patients with similar degrees of valve stenosis. The onset of symptoms represents an indication to surgical replacement. Echocardiography has become the key tool for the diagnosis and evaluation of aortic valve disease, and is the primary non-invasive imaging method for aortic valve stenosis assessment. Despite substantial contemporary experience with successful aortic valve replacement in elderly patients, multiple series have documented that 30% to 40% of patients with severe AS do not undergo surgery owing to advanced age. In summary, a substantial percentage of patients with AS are judged to be inoperable for surgery based primarily on the physician's or surgeon's determination of operative risk and survivability. Growing evidence indicate that in unoperable patients, transcatheter aortic valve implantation may represent a valid alternative to surgery with excellent results in terms of quality of life and survival.
Background. Observational registries on elderly patients with non-valvular atrial firbillation (NVAF) in treatment with the New Oral Anticoagulants (NAO) are still very few in the literature.Materials and methods. Prospective observational study on patients >= 65years old with NVAF treated with NAO, referring to the Geriatric Clinic in Padua from September 2013 and January 2015. Demographic and clinical baseline data were collected at the time of inclusion, while side effects and suspensions were evaluated during the follow-up.Results. Of 191 enrolled patients, dabigatran was prescribed to 86 (45%), rivaroxaban to 72 (37.7%), apixaban to 33 (17.3%) patients. Mean age was 79.3 and males were more represented (57.1%). Patients treated with low dose NAO were prevalent (71.7%). Median CHA2DS2-VASc was 4 and median HAS-BLED was 3. The main reasons for switching to NAO were labile INR (38.2%) and logistic INR monitoring problems (34%). The most frequently used previous therapy were Vitamin K Antagonists (VKA) (54.7%) and heparin (21.1%). The most frequent side effects were minor bleedings (14.1%) and gastroenteric intollerance (12%). Twelve percent of patients suspended therapy during the follow-up.Discussion. From the preliminary results of a single center in the Veneto region, NAO have been prescribed to a population with high mean age, high ischemic risk and high bleeding risk. The patients' majority were previously in treatment with VKA and the most common reason for drug switch was labile INR. Of note, there was a high incidence of suspensions.
Objectives. The aim of the following study is to assess, in terms of perceived burden, anxiety and depression, the differences between two samples of family caregivers, differing in the place of care chosen for their Alzheimer relatives. In addition, we tested the moderation effects of other environmental variables, such as social support and relationship satisfaction. Methods. Our sample is composed of 110 family caregivers: 55 of them assisted their relatives at home, the remaining 55 decided to hospitalize them. The outcomes (burden, anxiety and depression) and the moderator variables (environmental variables) were evaluated by five self-report instruments. The sample was selected on the basis of the seriousness of the patient's disease (NPI (>) 25, MMSE <= 20). Results. Our results show significant differences between the two samples for the scores of some subscales of burden (total, developmental, objective and emotional), but not for depression and anxiety. Moreover, we found some moderation effects by some environmental third variables; this is indicative of the complex dynamics between caregivers and their ill relatives. Conclusions. Assistance given to caregivers must be tailored taking in account the specific type of care; the social network has a protective function from burden and anxiety in both caregiver populations.
Introduction. Delirium is a clinical syndrome characterized by altered attention state and awareness with acute cognitive dysfunction, transient floating behind an organic cause (DSM V). The specific training of nursing staff in Nursing Home (CRA) e is a necessary tool to detect and menage Delirium in a frail elderly population with consequent positive impact on clinical and functional outcomes.Methods. During one year negative outcomes were compared two Units in CRA in one of which the nursing staff was proposed specific training on recognition and non pharmacological management of Delirium.Results. In the "trained" Unit delirium episodes were detected in 27.86% of the guests instead no cases in control group. In experimental group the outcomes falls and incontinence were significantly reduced. The no-pharmacological approaches didn't correlate with duration of Delirium.Conclusion. Training of the health care team allows you to recognize and treat delirium reducing negative outcomes.
Introduction. We formed a professional team that advanced skills which can insert and manage devices for a safe and effective administration of drugs and nutrients. The midline is a peripheral venous access for medium term-therapy, with open or valved tip, designed for a continuous or a discontinuous use. Method. We analyzed patients with a midline catheter in two different care settings: patients in Nursing Home (RSA Via Gradisca 10) and patients at home (Home Care Unit of ASL TO1) from 1 January 2013 to 31 December 2013. We enrolled 101 people. Of these, 57 patients were affected by cognitive impairment. Results. We stratified the data by age (mean age 87.07 +/- 6.18 SD), durability of the device (average number of days 49.98 +/- 46.59 SD), type of infusion (hydrating therapy 61.40%; total parenteral nutrition -TPN - 38,60%), setting of care (Home Care Unit 73.68% Nursing Home 26.32%) and causes of removal (death 38,60%; fibrin sleeve 19.30%; hospitalization 12,28%; end of therapy, malfunction and thrombosis 3.51% each; location, placement of CVC or nasogastric tube 1.75% each). Our experience suggests the feasibility and safety of the positioning of midline in the home setting, but also the need to implement its use for better management of human resources and better quality of life of the patients in sanitary settings.
Despite diabetes mellitus is highly prevalent among older persons (>= 65 years), yet optimal glucose management in this population remains ill-defined. For younger adults, the American Diabetes Association (ADA) recommends glycemic control to achieve a HbA(1c) level of less than 7% to reduce the risk of microvascular complications. Recent large studies have shown lack of benefit and sometimes higher risk of morbidity and mortality with tight glycemic control, especially in older adults, particularly those with complex medical problems or comorbidities, compared with younger, healthier persons. Hypoglycemia in elderly patients with diabetes mellitus increases the risk of cardiovascular and cerebrovascular events, progression of dementia, injurious falls, emergency department visits and hospitalization. Hypoglycemic episodes are difficult to diagnose in this population also because of frequent unawareness of hypoglycemia. Insulin therapy in older adults is complicated by psychosocial and physiological changes of aging. Several new insulin analogue preparations are now available for clinical use. Used as prandial (e.g. insulin lispro, insulin aspart or insulin glulisine) and basal insulin (e.g. insulin glargine, insulin detemir and the new insulin degludec), these analogues simulate physiological insulin profiles more closely than the older conventional insulins. The availability of multiple insulin products provides new opportunities to achieve control of diabetes mellitus in older population with less risk of hypoglycemia.
This work through the classical sources to research the processes of resemanticization of ancient fabulae when they enjoy literary and figurative associations, often difficult to explain. This occurs in the connection between the myth of the Danaids, condemned to unnecessarily fill jars with holes, the story of a man bitten by snake "thirst" (dipsade) and the disease of diabetes, also indicated by the name of this snake. This connection arises from pertusum dolium of the Danaids: it recalls the image of the siphon/ us the body of the patient with , unable to retain fluids ingested, as well as afflicted by a relentless thirst.
Falls in older adults are a major healthcare issue worldwide, being associated with significant mortality, disability, costs and reduction of quality of life, mainly due to fractures. Gait speed has been demonstrated to be particularly useful to predict falls and to identify individuals at high risk of falling. We previously demonstrated that a single 10-minute PEMF exposition was found to improve gait parameters in older adults. In this study, PEMF (TEPS) was administered to 266 older adults (91% female, mean age 77) every two months for 1 year. Gait speed increased significantly after each treatment with respect to baseline (P<.00.1). Subjects with a baseline gait speed less than 80 cm/s had a mean percentage increase (60.1%) significantly greater than that of those with a baseline value greater than 80 cm/s (8.1%) (P<.001). These results suggest that continuous exposure to PEMF improves self-selected gait speed in older adults at risk of falling.
Aim.To evaluate, through a literature systematic review, the efficacy of non-pharmacological interventions for the treatment of delirium hospitalized elderly patient. Method. For the systematic review have been consulted Cochrane, DARE, MEDLINE, EMBASE and CINAHL databases, including only experimental studies. Results. Non-pharmacological strategies determine conflicting results. Only mortality is decreased among patients, but these results should be considered with caution. Conclusions. So far there is lack of evidence regarding the effectiveness of non-pharmacological strategies for hospitalized patients with delirium. This demonstrates the need for primary studies and research.
The present paper is due to a recently exposed analysis on local differences in terms of social and sanitary assistance to the over seventy-five people. These observations have been exposed to the recent SIGG meeting of Bologna in the SIGG-AGE session.
The number of nursing home residents being admitted to hospital has been increasing. Residents in nursing homes (NH) are an increasingly vulnerable group with complex medical and care needs. Access to acute care will always be an important component of quality care for nursing homes residents. Nevertheless, reducing preventable hospitalization is fundamental in terms of better quality of care, improved health and cost savings. Evidence indicates that many hospitalizations of NH residents could be avoided, but it is not so clear what specific interventions or combination of interventions effectively decrease potentially avoidable hospital admissions. The objective of this work is a revision of more recent literature on problems and possibile solutions to manage the difficult reationship between hospital and nursing homes.
The author reflects on the issue of personal identity. It examines the theoretical perspectives of philosophy and social sciences and discusses the implications of bio-ethics. Ask a critical paradigm autonomy that prevails today under the care emphasizing the weakness of his starting as personal identity, in the post-secular, it lost in compactness and stability. Discusses the problem of personal identity in diseases dementigene and proposes its own key to reading based on the self and the ability to take care of anyway.
Background. Music therapy is a safe and effective non-pharmacological intervention for the treatment of agitation and aggression in people with Alzheimer's disease. Several recommendations suggest that health workers can use music to bring physical benefits, psychological and social. The literature supports the fact that music should be included in the plans of nursing care. Methods. The review of the literature shows that the music leads to a significant reduction of agitation during and after listening in patients with Alzheimer's disease. A musical approach effectively coordinated by nurses is the best strategy of non-pharmacological treatment to be applied, even for very low costs and for the low risk of the patients. In France a new validated instrument called Voix d'Or proved to be particularly effective to fight the agitation and aggression. Voix d'Or procures welfare, increases self-esteem of the patient and facilitates the exchange and communication between patients and health workers. Results. The results of research conducted with Voix d'Or on French patients it was successful with a significant reduction of anxiety and agitation. Discussion. The music is a low cost alternative compared to traditional pharmacological management; it's easy to manage and recommended in nursing practice. Voix d'Or is an innovation in the sector of non-pharmacological interventions that use music to people with Alzheimer's disease. Future research would be desirable to disseminate and validate the system in other countries besides France.
Devic's disease is an inflammatory disease of central nervous system but with lesions that have different characteristics from the ones seen in multiple sclerosis. It is classically characterized by acute, severe episodes of optic neuritis and longitudinally extensive transverse myelitis, usually with a relapsing course. The identification of an autoantibody exclusively detected in these patients against aquaporin-4 has allowed identification of cases of this neurological disease, not very frequence in the elderly patient.
