Aim of the study was to create an instrument (DISCO Index) to evaluate cognitive-behavioural disturbances in elderly people. We considered n. 192 elderly people living in Torino's nursing homes, n. 76 people screened by the Geriatric Evaluation Unit (GEU) of S. Giovanni Battista Hospital in Torino and n. 136 subjects evaluated by a Torino's District GEU. Mean age was 81.8 +/- 8.3 years. By evaluating cognitive status and behavioural disturbances we obtained a list of conditions referring to three different degrees of severity depending on care needs. The three categories have been defined as: group A: absent or light cognitive and behavioural disturbances; group B: significant impairment of space-timing orientation, hallucinations and delirium, frequent verbal abuse (outrage, menace), feeding alteration; group C: total disturbance of sleep--awakeness rhythm, frequent real or threatened physical assault, wandering or escape attempts, suicidal ideas or suicidal trials, sever feeding alterations. Functional status was also considered by ADL. 41.1% of the study population belongs to group A, 50.5% to group B and 8.4% to group C. Functional status in the sample was seriously impaired in 64.4% (autonomy loss in more then three functions) while only 9.4% of the subjects was autonomous. The totally of people belonging to the group C was found to be dependent in ADLs.

Background and aims: Frailty, multiple pathologies, functional impairment and socioeconomic conditions can prolong the length of hospitalization in the elderly. The aim of our study was to analyze risk factors for prolonged hospitalization. Methods: Our sample included 1054 patients consecutively admitted to the University Department of Geriatric Medicine of Torino, Italy. We examined some demographic variables (age, sex, socioeconomic conditions), affective, cognitive and functional status, main pathologies, and blood pressure and some hematological parameters (hemoglobin, creatinine, albumin, sodium). Results: The number of functions lost to IADL and ADL, DMI (Dependent Medical Index) dependence, high levels of creatinine and low blood levels of albumin and sodium were associated with longer hospitalization, as also were the following clinical diagnoses: tumor, chronic obstructive pulmonary disease (COPD), hip fractures, peripheral arterial disease (PAD), and pressure sores. Independent predictors of prolonged hospitalization were: the number of functions lost to the ADL index, pressure sores, hip fracture, peripheral arterial disease with critical ischemia, and low levels of sodium. Conclusions: Multidimensional assessment is essential to identify medical, functional and socioeconomic problems, and can highlight risk factors for prolonged hospitalization.

Aim of this work is to assess the effects on nutritional status of appropriate care in food intake in demented patients. In a long term care in Turin, we enrolled 96 patients aged 75-103 years free from metabolic, hematologic and neoplastic diseases and not showing signs of acute illness. Seventy seven of these patients were affected by dementia. No statistically significant differences were found between demented patients and controls in nutritional status and daily nutrient intake and only need for care in food intake was independently associated with dementia. Our data demonstrate that similar caloric intakes can be obtained in demented and non demented patients with an appropriate level of care in food intake.

OBJECTIVES:To identify prognostic factors that are independently predictive of in-hospital mortality in older patients hospitalized in a medical intensive care unit (MICU). DESIGN:Prospective cohort study. SETTING:A MICU in an Italian university hospital. PARTICIPANTS:Patients aged 65 and older consecutively admitted to the MICU directly from the first-aid unit. MEASUREMENTS:Upon admission, the following variables were examined: demographics, clinical history (diabetes mellitus, active neoplasm, cognitive impairment, immobilization, pressure ulcers, use of nutritional support, home oxygen therapy), physiopathology (Acute Physiology and Chronic Health Evaluation (APACHE) II), and cognition/function (activity of daily living (ADL), instrumental activity of daily living (IADL), Short Portable Mental Status Questionnaire (SPMSQ)). The vital status of the patient at the end of hospitalization was recorded. RESULTS:Over a period of 10 months, 659 patients were recruited (mean age +/- standard deviation = 76.6 +/- 7.5; 352 men and 307 women). There were 97 deaths (14.71%). The following factors proved to be significantly associated with in-hospital mortality: old age, low body mass index (BMI) values, low values of albumin, high scores on APACHE II, functional impairment (ADL, IADL), cognitive impairment (SPMSQ), history of cognitive deterioration, history of confinement to bed, and presence of pressure ulcers. Using multivariate analysis, the following variables were independently predictive of in-hospital mortality: lack of independence in ADLs (P <.001), moderate-to-severe cognitive impairment on SPMSQ (P <.001), score on APACHE II (P =.002), and low BMI values (P =.031). CONCLUSION:The prognosis of older patients hospitalized in medical intensive care units depends not only on the acute physiological impairments, but also on a series of preexisting conditions, such as loss of functional independence, severe and moderate cognitive impairment, and low BMI.

Increase of the Prostatic Specific Antigen (PSA) is a non-invasive, sensitive and specific markers for prostatic diseases, including prostatic cancer. However, age-related Benign Prostatic Hyperplasia (BPH), as well as prostatitis, may at the same time alter PSA values. The aim of this study was to evaluate the relationship between ageing and PSA, and whether age-specific upper normal limits of PSA should be considered for elderly patients. We evaluated 569 consecutive subjects aged 60 years or more (mean age 74.2 years) who were free from malignant prostatic disease, without clinical evidence of prostatic phlogosis and who were not receiving PSA levels affecting drugs. All patients underwent Digital Rectal Examination (DRE) and Trans-Rectal Ultrasonography (TRU), with determination of the three prostatic diameters, the Maximum Adenoma Diameter (MAD) and calculation of the prostatic volume (PV) by the ellipsoid formula. PSA was determined in all patients before DRE and TRU, and the PSA free ratio was determined in those with total PSA values >4 ng/ml. The PSA density was calculated according to the formula PSA/PV. One hundred and seventy-nine subjects (31.6%) were found to have PSA values >4 ng/ml: among them, 26 (14.5%) had values exceeding 10 ng/ml. Age was slightly correlated with PV (P<0.05), but not with PSA values. On the contrary, PSA values were strongly related with PV and MAD (P<0.01 both). Mean PSA-free ratio was 16.3±6.0% and most of patients had values in the so-called ‘grey zone’ of discrimination between benignity and malignity.

Chronic pain is a common problem for the aged. Aim of the study was to evaluate prevalence, characteristics and influence on functional parameters of chronic pain in the elderly. Our study included 105 patients (mean age 82.2 +/- 9 yr). Chronic pain, tested by using the McGill Pain Questionnaire, was present in 87 patients (82.9%); it lasted more than 2 years and it was continuous in half of them (49.4%). Our study shows that chronic pain in the elderly has a strong affective component. Its intensity, evaluated by specific tests such as analogical visual and verbal scales, influences old patient's quality of life.

BACKGROUND AND AIM This study compares the cholesterol-lowering efficacy of atorvastatin and simvastatin in attainment of the National Cholesterol Education Program (NCEP) guidelines LDL-cholesterol (LDL-C) goal in patients with heterozygous familial hypercholesterolemia (HFH). The association of atorvastatin with significant changes of blood fibrinogen and other coagulative variables was also compared with that of simvastatin. METHODS AND RESULTS In a 24-week study, 26 HFH patients (16 men, 10 women, mean age 55.1 +/- 11.3) were randomly assigned to receive atorvastatin or simvastatin. The initial daily dose of 10 mg was progressively raised to 20, 40 and 80 mg in patients who had not reached the NCEP LDL-C goal. Significant reductions of total and LDL-C (p < 0.001), triglycerides (p < 0.005) and apoB100 (p < 0.001) were observed in both groups. Atorvastatin caused greater reductions in total cholesterol (-42% vs -30%) (p < 0.001) and LDL-C (-50% vs -37%) (p < 0.01). Three patients treated with Atorvastatin (23%) and none of those treated with simvastatin reached the NCEP LDL-C goal at the end of the study. No significant departures from the fibrinogen and coagulative variable baselines were observed. CONCLUSIONS Atorvastatin has greater cholesterol-lowering efficacy than simvastatin in HFH.

The aim of the study was to evaluate the direct influence of cholesterol and triglycerides on the rheologic-coagulative pattern. Blood rheologic properties (blood plasmatic and seric viscosity, whole blood and red cell filterability), some coagulative factors (fibrinogen, levels of clotting factors VII and VIII activity), and beta-thromboglobulin and platelet factor 4 were studied in 156 men aged 40–54 years, 87 with type II hyperlipoproteinemia (46 type IIa and 41 type IIb) and 69 normolipemic controls. Smokers and patients with arterial hypertension, diabetes mellitus, or cardiovascular clinical manifestations were excluded. Increased blood viscosity (shear rate 225 sec-1,p<0.01) and higher value of beta-thromboglobulin and platelet factor 4 (p<0.001 both) were observed in type IIb hyperlipoproteinemic patients. Levels of fibrinogen and factor VII and VIII activity did not differ in hyperlipemic patients and controls. After multiple regression analysis, levels of platelet factor 4, plasma viscosity, and fibrinogenemia were positively related with triglycerides concentration; total cholesterol concentration was positively related to fVII activity and inversely with red cell filterability. We conclude that the rheologic-coagulative pattern is more severely altered in type IIb than in type IIa hyperlipoproteinemia, and that these alterations are strictly related to the severity of the increase in trigly cerides and cholesterol levels.

The experience of the home hospitalization service (HHS) started with a decision of the Turin Health Authority having charged the Department of Gerontology of the University with the HHS experimental project. The nursing staff works on a day and evening shift system providing regular and emergency interventions. Medical care is provided by seven geriatricians of the Department who perform this activity as a part of their duties. In four years, 519 patients were treated at home. The service has proved to be effective and of benefit for the patients. From the phsychological point of view, the results were considered excellent both by the patients and the relatives. In terms of cost, as compared to a stay in a medical hospital ward, the HHS is less expensive.

Presence and severity of asymptomatic carotid atherosclerosis in 'relation to age, lipoprotein pattern and smoking habit have been evaluated in 232 of 315 patients (average age 57.3 +/- 2.7 years) who were exposed to carotid echodoppler examination. Patients with hypertension and/or diabetes were excluded. The extension of the atherosclerotic process and the severity of the vascular narrowing were explored. Both parameters proved to increase with advancing age, in part independently from the presence of the risk factors. Hypercholesterolemia was found to be associated with higher prevalence, earlier appearance and greater severity of carotid plaques in patients below 60 years; in this group, the presence, extension and severity of carotid atherosclerosis were found to be positively correlated with total and LDL-cholesterol and negatively with HDL/LDL ratio. Smokers showed greater extension and severity of carotid atherosclerosis than non smokers and the difference tends to increase with age.

The effects of two plasma-lipid lowering drugs, bezafibrate and simvastatin on the coagulative and rheologic pattern have been studied. Thirty-six hypercholesterolemic patients were randomly divided in two groups (18 subjects each) and received 400 mg/day bezafibrate R or 10-40 mg/day simvastatin over a period of 12 weeks. Apart from a decrease in plasma fibrinogen and fibrinopeptide A, bezafibrate induced a reduction of factor VIIc and VIIIc activity, while anti-thrombin 3 activity was increased; the hemorheologic pattern was greatly improved. Simvastatin treatment caused a slight decrease in factor VIIIc activity and a moderate reduction of beta-thromboglobulin.

Some considerations were made following a study on the family conditions of 500 elderly patients cared for under the home hospitalization service (HHS) from 1985 to 1989 in Turin, Italy. Most patients were over 70 years of age, not selfsufficient and affected by various concomitant pathologies. Most of them lived with their elderly spouse: these family units had important problems in solution of which a decisive role was played by the direct intervention of the HHS team. A randomized study on a sub-group of patients showed an improved quality of life during HHS care even in cases of pathologies with unfavorable prognoses. It is postulated that this result was obtained as a consequence of an improvement of the family role.