PURPOSE:Benzodiazepine use is prevalent among older adults despite its recognised negative effects, including increased risk of falls, fractures and decline in functional status. Lifestyle interventions can preserve physical function and reduce the risk of disability. This study investigates whether benzodiazepine use reduces the effectiveness of lifestyle-based interventions on mobility disability. METHODS:We performed a secondary analysis of the 'Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies' trial. The lifestyle intervention consisted of physical exercise and nutritional counselling. Benzodiazepine use was assessed based on baseline or longitudinal exposure (defined as use at baseline plus use at two or more additional time points). Cox regression models were used to ascertain the association between benzodiazepine use and mobility disability incidence. A separate analysis was conducted among participants with a Short Physical Performance Battery (SPPB) score 3 to 7. RESULTS:Among the 1506 participants included (mean age 78.9 years; 71.5% female; 753 intervention vs. 753 control), 211 (14.0%) reported benzodiazepine use at baseline. Overall, 55.0% of baseline benzodiazepine users and 43.6% of non-users developed mobility disability during the follow-up (P = .003). When baseline benzodiazepine use was considered, no significant effect associated with multicomponent intervention (MCI) was shown among non-users (Hazard Ratio (HR) = 0.86; 95% Confidence Interval (CI) 0.72-1.03) and users (HR = 1.04; CI 0.67-1.62). In the subgroup of participants with SPPB scores 3 to 7, a significant effect of the MCI was observed only among non-users (HR = 0.80, 95% CI 0.66-0.97), while no 'association' was detected among users (HR = 1.06; 95% CI 0.65-1.71, P for interaction = .035). When longitudinal benzodiazepine exposure was considered, similar results were observed. In particular, in the SPPB score 3 to 7 subgroup, the beneficial effect of the MCI was observed only among non-users (HR = 0.79; 95% CI 0.64-0.96), while no 'association' was detected among users (HR = 1.13; 95% CI 0.60-2.13, P for interaction = .035). CONCLUSION:In frail older adults, benzodiazepine use significantly blunts the effectiveness of lifestyle interventions for preventing mobility disability. These findings support a prudent approach to benzodiazepine use in frail older patients.

Generic medicines (GMs) are bioequivalent to brand-name medicines and more cost-effective, yet their use is limited. Gender-related factors may influence attitudes toward GMs, but data on older adults are scarce. This study aimed to explore sex and gender differences in knowledge and opinions about GMs among older patients and their caregivers. SurFE is a cross-sectional multicenter survey conducted in Italy (April–May 2023) that enrolled non-institutionalized individuals aged ≥ 65 years and their caregivers. Participants completed a questionnaire assessing knowledge, attitudes, and perceptions of GMs, and sociodemographic and health-related information. We collected data on gender-specific factors and, using a validated methodology, developed a composite gender score. Among the 471 participants (312 patients and 159 caregivers), no differences related to biological sex were observed. According to the gender score, patients with male gender characteristics were less likely to believe that generic medicines are made with lower-quality substances. Additionally, both female patients and male caregivers were more likely to consider GMs equivalent to brand-name medications. As for biological sex, ordinal regression analysis adjusted for sociodemographic and educational factors showed that female caregivers were significantly more likely to believe that GMs are produced with lower-quality substances (OR 2.06, 95% CI 1.01–4.21, p = 0.047). Also, focusing on gender, male patients were more likely to believe that GMs require more time to be effective (OR 1.89, 95% CI 1.06–3.35, p = 0.030), as well as female caregivers about the belief that GMs are produced with lower-quality substances (OR 2.25, 95% CI 0.33–1.60, p = 0.037), even if not confirmed in the adjusted model. No other significant associations emerged. Attitudes toward GMs may vary by gender, but not biological sex. However, this association was not independent of socio-cultural factors and should be explored in future longitudinal research to understand and address barriers to the use of GMs.

Sarcopenia, characterized by decreased skeletal muscle mass and strength, is classified as "primary" (due to aging) or "secondary" (due to diseases). MicroRNA-22-3p (miR-22) regulates muscle differentiation and function. We assessed the diagnostic value of circulating miR-22 levels in patients with primary and secondary sarcopenia. miR-22 levels were evaluated in 61 older adults from the "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) study and in 176 heart failure (HF) patients from the "Studies Investigating Co-morbidities Aggravating HF" (SICA-HF). miR-22 expression profile was measured in serum by miR-specific TaqMan quantitative real-time PCR. In SPRINTT, 33 participants (54.1%) had primary sarcopenia. Subjects with primary sarcopenia had slower gait speed (0.7 [0.6-0.8] vs. 0.8 [0.7-1.0] m/s; p < 0.001) than those without sarcopenia. Multivariate analysis showed miR-22 as an independent predictor of sarcopenia (adjusted OR 3.087, 95% CI 1.441-6.611, p = 0.004). In SICA-HF, 28 patients (15.9%) had secondary sarcopenia. Sarcopenic HF patients were older (74.5 [68.7-80.2] vs. 68.4 [60.9-74.8] years; p = 0.001), had lower left ventricular ejection fraction (31.1 [26.2-47.5] vs. 40.0 [30.0-55.0] %; p = 0.025), lower handgrip strength (31.1 ± 6.0 vs. 37.0 ± 13.0 kg; p = 0.016) and lower absolute peak oxygen uptake (1181.3 ± 379.5 vs. 1593.0 ± 487.0 mL/min; p < 0.001) compared with those without sarcopenia. Multivariate logistic regression analysis showed miR-22 as significantly associated with sarcopenia in HF patients (adjusted OR 0.409, 95% CI 0.193-0.867, p = 0.020). miR-22 levels are significantly associated with both primary and secondary sarcopenia, suggesting its potential as a novel epigenetic biomarker of skeletal muscle dysfunction.

To assess the impact of lifestyle interventions on use of medications for treatment of common chronic conditions in older adults. In two randomized clinical trials, lifestyle interventions based on physical activity alone (LIFE trial) or in combination with nutritional counselling/dietary intervention and information and communication technology (SPRINTT trial) did not reduce the use of cardiovascular, diabetes or mood and anxiety medications. In the SPRINTT trial, lifestyle intervention was associated with increased use of pain medications. This association was not observed in the LIFE trial. Based on the results of secondary analyses from two RCTs, lifestyle interventions cannot be considered an effective strategy to reduce medication burden in older adults. Polypharmacy is a growing public health problem and implementing strategies to reduce its prevalence is considered a research and clinical priority. Healthy lifestyle impacts the onset and progression of chronic conditions. Yet, there is limited understanding of how this effect influences medication use. The aim of the study was to assess the impact of lifestyle interventions on use of medications for treatment of common chronic conditions. We performed a secondary analyses from two randomized clinical trials: the Lifestyle Interventions and Independence for Elders Study (LIFE) and the Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT) trials. LIFE study enrolled community-dwelling men and women aged 70 to 89 years old who were physically inactive and had reduced physical function recruited in eight centers in the United States. SPRINTT enrolled community-dwelling men and women aged 70 years or older with physical frailty and sarcopenia recruited in 16 clinical sites in Europe. Active intervention groups consisted of a physical activity program in LIFE and a multicomponent intervention based on physical activity with technological support and nutritional counselling/dietary intervention in SPRINTT. The main outcome measure was the change in cardiovascular, diabetes, mood and anxiety, and chronic pain medication use as measured by daily dose per day (DDD/day). A total of 1519 LIFE participants (752 intervention vs 767 control group, mean age 78.9 years; 67.3

Infectious diseases pose a significant burden on the general population, particularly older adults who are more susceptible to severe complications. Immunization plays a crucial role in preventing infections and securing a healthier aging, but actual vaccination rates among older adults and frail individuals (OAFs) remains far from recommended targets. This study aims to collect and share good practices implemented in several Italian local health districts during the SARS-CoV-2 pandemic to ease routine immunization for OAFs. A 28-items questionnaire has been developed to collect information on organization aspect of immunization services and local good practices implemented before and during the SARS-CoV-2 pandemic. Twelve Public Health managers representative of 9 Italian Regions were further interviewed between January and March 2021. Despite literature suggests several effective interventions to increase vaccine demand, improve vaccine access, and enhance healthcare providers' performance, our survey highlighted substantial heterogeneity in their implementation at local level. Seven good local practices have been identified and described: mass vaccination centers; vaccination mobile units; drive-through vaccination; co-administration; tailored pathways; cooperation among providers involved in vaccination; digitization. Our survey pointed out valuable strategies for enhancing routine immunization for OAFs. Providers should combine effective interventions adequate to their specific context and share good practices.

Purpose Generic medicines (GMs) are bioequivalent to brand-name drugs and more cost-effective, yet their use is limited. Gender-related factors may influence attitudes towards GMs, but data on older adults are scarce. This study aimed to explore sex and gender differences in knowledge and opinions about GMs among older patients and their caregivers. Methods SurFE is a cross-sectional multicenter survey conducted in Italy (April-May 2023) that enrolled non-institutionalized individuals aged ≥ 65 years and their caregivers. Participants completed a questionnaire assessing knowledge, attitudes, and perceptions of GMs, and sociodemographic and health-related information. We collected data on gender-specific factors and, using a validated methodology, developed a composite gender score. Results Among the 471 participants (312 patients and 159 caregivers), no differences related to biological sex were observed. According to the gender score, patients with male gender characteristics were less likely to believe that generic medicines are made with lower-quality substances. Additionally, both female patients and male caregivers were more likely to consider GMs equivalent to brand-name medications. Logistic regression analysis showed that female caregivers were significantly more likely to believe that GMs are produced with lower-quality substances (OR = 2.06, 95% CI 1.01–4.21, p = 0.047). No other significant associations between sex, gender, and beliefs about GMs were found. Conclusions Gender-related factors may have a greater impact on shaping beliefs about GMs than biological sex. Further research is required to explore the potential role of other sociodemographic or clinical factors to better understand and address barriers to the use of GMs.

In this post-hoc analysis of the AXEPT study, 855 patients were analyzed, 544 (63.6%) females. The mean (± SD) MMSE score in women vs men was 20.8 ± 2.6 vs. 21.2 ± 2.5; p = 0.0087, and women were more likely affected by psychiatric disorders (n = 76, 14.0% women vs. n = 21, 6.8% men; p = 0.0015). Men were mainly assisted by their wives (n = 207, 66.6%), women mainly by their daughters (n = 243, 44.7%) and only in a minority of cases by their husbands (n = 92, 16.9%). Women less frequently cohabited with their caregivers than men (n = 233, 43.1% vs. n = 240, 77.9%, p < 0.0001), and received less daily time of caregiving (mean (± SD): 10.0 ± 7.2 vs. 15.2 ± 8.2; p < 0.0001). No gender differences were highlighted in compliance to treatment and caregiver satisfaction, while gender differences in caregiving were found at disadvantage of women affected by more severe cognitive and psychiatric conditions.

Delirium (DEL) and depression (DEP) may impair the course and severity of acute respiratory illness. The impact of such syndromes on respiratory and outcome parameters in inpatients with COVID-19 needs clarification. To clarify the relationship between DEL and DEP and respiratory outcome measures, we enrolled 100 inpatients from COVID-19 units of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS of Rome. Participants were divided into those with DEL, DEP, or absence of either delirium or depression (CONT). Delirium severity was assessed with the Neelson and Champagne Confusion Scale (NEECHAM). Psychopathology was assessed with the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), and the Brief Psychiatric Rating Scale (BPRS). Dependent variables include: (a) respiratory parameters, i.e., partial pressure of oxygen in arterial blood (PaO2), oxygen saturation (SpO2), ratio between arterial partial pressure of oxygen (PaO2), and fraction of inspired oxygen (PaO2/FiO2); (b) outcome parameters, i.e., duration of hospitalization and number of pharmacological treatments used during the hospitalization. We investigated between-group differences and the relationships between severity of delirium/depression and the dependent variables. Duration of hospitalization was longer for DEL than for either DEP or CONT and for DEP compared to CONT. NEECHAM and HAM-D scores predicted lower PaO2 and PaO2/FiO2 levels in the DEL and DEP groups, respectively. In DEP, BPRS scores positively correlated with duration of hospitalization. Delirium impacted the course of COVID-19 more severely than depression. The mechanisms by which delirium and depression worsen respiratory parameters differ.

BackgroundCOVID-19 may result in persistent symptoms in the post-acute phase, including cognitive and neurological ones. The aim of this study is to investigate the cognitive and neurological features of patients with a confirmed diagnosis of COVID-19 evaluated in the post-acute phase through a direct neuropsychological evaluation.MethodsIndividuals recovering from COVID-19 were assessed in an out-patient practice with a complete neurological evaluation and neuropsychological tests (Mini-Mental State Examination; Rey Auditory Verbal Test, Multiple Feature Target Cancellation Test, Trial Making Test, Digit Span Forward and Backward, and Frontal Assessment Battery). Pre- and post-COVID-19 global and mental health status was assessed along with the history of the acute phase of infection. Post-COVID-19 cognitive status was modeled by combining persistent self-reported COVID-related cognitive symptoms and pathologic neuropsychological tests.ResultsA total of 406 individuals (average age 54.5 ± 15.1 years, 45.1% women) were assessed on average at 97.8 ± 48.0 days since symptom onset. Persistent self-reported neurological symptoms were found in the areas of sleep (32%), attention (31%), and memory (22%). The MMSE mean score was 28.6. In total, 84 subjects (20.7%) achieved pathologic neuropsychological test results. A high prevalence of failed tests was found in digit span backward (18.7%), trail making (26.6%), and frontal assessment battery (10.9%). Cognitive status was associated with a number of factors including cardiovascular disease history, persistent fatigue, female sex, age, anxiety, and mental health stress.ConclusionCOVID-19 is capable of eliciting persistent measurable neurocognitive alterations particularly relevant in the areas of attention and working memory. These neurocognitive disorders have been associated with some potentially treatable factors and others that may stratify risk at an early stage.

Abstract Background Ageing is accompanied by a progressive loss of skeletal muscle mass and strength, potentially determining the insurgence of sarcopenia. Evidence suggests that motoneuron and neuromuscular junction (NMJ) degeneration contribute to sarcopenia pathogenesis. Seeking for strategies able to slow down sarcopenia insurgence and progression, we investigated whether a 2‐year mixed‐model training involving aerobic, strength and balance exercises would be effective for improving or preserving motoneuronal health and NMJ stability, together with muscle mass, strength and functionality in an old, sarcopenic population. Methods Forty‐five sarcopenic elderly (34 females; 11 males) with low dual‐energy X‐ray absorptiometry (DXA) lean mass and Short Physical Performance Battery (SPPB) score <9 were randomly assigned to either a control group [Healthy Aging Lifestyle Education (HALE), n = 21] or an intervention group [MultiComponent Intervention (MCI), n = 24]. MCI trained three times per week for 2 years with a mix of aerobic, strength and balance exercises matched with nutritional advice. Before and after the intervention, ultrasound scans of the vastus lateralis (VL), SPPB and a blood sample were obtained. VL architecture [pennation angle (PA) and fascicle length (Lf)] and cross‐sectional area (CSA) were measured. As biomarkers of neuronal health and NMJ stability status, neurofilament light chain (NfL) and C‐terminal agrin fragment (CAF) concentrations were measured in serum. Differences in ultrasound parameters, NfL and CAF concentration and physical performance between baseline and follow‐up were tested with mixed ANOVA or Wilcoxon test. The relationship between changes in physical performance and NfL or CAF concentration was assessed through correlation analyses. Results At follow‐up, MCI showed preserved VL architecture (PA, Lf) despite a reduced CSA (−8.4%, P < 0.001), accompanied by maintained CAF concentration and ameliorated overall SPPB performance (P = 0.007). Conversely, HALE showed 12.7% decrease in muscle CSA (P < 0.001), together with 5.1% and 5.5% reduction in PA and Lf (P < 0.001 and P = 0.001, respectively), and a 6.2% increase in CAF (P = 0.009) but improved SPPB balance score (P = 0.007). NfL concentration did not change in either group. In the population, negative correlations between changes in CAF concentration and SPPB total score were found (P = 0.047), whereas no correlation between NfL and SPPB variations was observed. Conclusions The present findings suggest that our 2‐year mixed aerobic, strength and balance training seemed effective for preventing the age and sarcopenia‐related increases in CAF concentration, preserving NMJ stability as well as muscle structure (PA and Lf) and improving physical performance in sarcopenic older individuals.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Carpal tunnel syndrome is the most common entrapment neuropathy, affecting quality of life for many people. Although it is a well recognised condition, new insights into epidemiology, diagnosis, and treatment have emerged in the past 6 years. The availability of disease-modifying treatments for rare systemic disorders associated with carpal tunnel syndrome (eg, amyloidosis) should alert clinicians to these diagnostic possibilities. Besides clinical evaluation and electrophysiology, the role of ultrasonography as a diagnostic tool has been confirmed and new ultrasound techniques have been applied, the clinical use and feasibility of which require further investigation. Surgical and non-surgical interventions are beneficial for the treatment of carpal tunnel syndrome and several treatment options are now available, giving clinicians the possibility to choose the best approach for every patient. New diagnostic and therapeutic techniques require further validation.

Introduction/Aims In traumatic nerve lesions (TNLs), motor unit potentials (MUPs) may be difficult to detect in early injury. Ultrasound-guided electromyography (US-EMG) can aid in identifying areas of muscle activation, but its sensitivity can be improved. In this study we compare the sensitivity of US-EMG alone with US-EMG after peripheral nerve stimulation (NC-US-EMG) to better identify active muscle regions. Methods In this prospective study, 32 patients with severe TNLs were evaluated with standard EMG (ST-EMG), US-EMG, and NC-US-EMG at baseline (T0), after 2 to 3 months (T1), and after 5 to 6 months (T2). Results NC-US-EMG was more sensitive in detecting MUPs compared with US-EMG and ST-EMG at T0 (19 patients vs 14 and 5 patients, respectively). In addition, both US-guided techniques were more sensitive than ST-EMG in detecting MUPs (ST-EMG vs US-EMG: P = .014; ST-EMG vs NC-US-EMG: P = .003). At T1, ST-EMG remained less sensitive NC-US-EMG (P = .019). No significant differences were observed among the three techniques at T2. Discussion In the evaluation of severe TNLs, the combination of peripheral nerve stimulation and US increases the sensitivity of EMG for MUP detection at baseline and 2 to 3 months postinjury.

The prompt identification of frailty in primary care is the first step to offer personalized care to older individuals. We aimed to detect and quantify frailty among primary care older patients, by developing and validating a primary care frailty index (PC-FI) based on routinely collected health records and providing sex-specific frailty charts. The PC-FI was developed using data from 308,280 primary care patients ≥ 60 years old part of the Health Search Database (HSD) in Italy (baseline 2013–2019) and validated in the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; baseline 2001–2004), a well-characterized population-based cohort including 3363 individuals ≥ 60 years old. Potential health deficits part of the PC-FI were identified through ICD-9, ATC, and exemption codes and selected through an optimization algorithm (i.e., genetic algorithm), using all-cause mortality as the main outcome for the PC-FI development. The PC-FI association at 1, 3 and 5 years, and discriminative ability for mortality and hospitalization were tested in Cox models. The convergent validity with frailty-related measures was verified in SNAC-K. The following cut-offs were used to define absent, mild, moderate and severe frailty: < 0.07, 0.07–0.14, 0.14–0.21, and ≥ 0.21. Mean age of HSD and SNAC-K participants was 71.0 years (55.4% females). The PC-FI included 25 health deficits and showed an independent association with mortality (hazard ratio range 2.03–2.27; p < 0.05) and hospitalization (hazard ratio range 1.25–1.64; p < 0.05) and a fair-to-good discriminative ability (c-statistics range 0.74–0.84 for mortality and 0.59–0.69 for hospitalization). In HSD 34.2%, 10.9% and 3.8% were deemed mildly, moderately, and severely frail, respectively. In the SNAC-K cohort, the associations between PC-FI and mortality and hospitalization were stronger than in the HSD and PC-FI scores were associated with physical frailty (odds ratio 4.25 for each 0.1 increase; p < 0.05; area under the curve 0.84), poor physical performance, disability, injurious falls, and dementia. Almost 15% of primary care patients ≥ 60 years old are affected by moderate or severe frailty in Italy. We propose a reliable, automated, and easily implementable frailty index that can be used to screen the primary care population for frailty.

A fall is an event where a person unintentionally and traumatically finds themselves on the floor or a lower level. Falls are very common, especially in the older adult population. One in four people falls at least once a year after age 65. Because of falls, there can be injuries, whereby there can be an impairment of health status. Fractures, reduced mobility, disability, and the need for institutionalization are potential consequences after falls. In older adult patients, especially frail ones, these types of complications are more common. There are several risk factors for falls. Falls generally result from a combination of factors operating simultaneously. Sarcopenia, cognitive impairment, or poly-pharmacotherapy are just a few examples of risk factors that are common in the older people. Through careful clinical evaluation, it is possible to identify risk factors and conditions predisposing to falls. In some cases, it is possible to correct these factors. Several types of treatment are available to restore the health status before the fall and prevent subsequent falls. Using multi-component interventions, the risk of falls can be effectively reduced. Aware that this review will not be exhaustive of such a broad topic, the purpose of this narrative review is to summarize relevant and recent evidence in the current literature to encapsulate fall-related risk factors, risk identification, fall prevention, and management, including various rehabilitation techniques. This article conforms to the Scale for Assessment of Narrative Review Articles (SANRA) guidelines.

OBJECTIVETo show the importance of geriatricians in the assessment and treatment of patients with terminal illnesses requiring palliative care.METHODSThis was a retrospective epidemiological study, in which the authors used data relating to 229 patients with terminal stage cancer/advanced chronic diseases, which were evaluated by a palliative care team and collected from January to December 2018.RESULTSThe average age of the sample was 72 years. The sample was divided into two groups, called 'advanced cancer' (N=161, 70.3%) and 'advanced chronic diseases' (N=68, 29.6%). The authors found that patients with advanced chronic diseases had the highest age, highest number of comorbidities and higher indicators of complex care. The authors also showed that, in advanced chronic diseases, the factors that are associated with increased hospital death are: bedridden (OR=3,778; 95% CI=1,371-10,409), dysphagia (OR=2,038; 95% CI=1,005-4,133) and a higher number of diseases (OR=1,446; 95% CI=1,179-1,774).DISCUSSIONGiven these findings, there is a high prevalence of elderly hospitalised patients with advanced chronic end-stage disease, a classic geriatric condition, who need access to palliative care services.CONCLUSIONThe authors believe that an increase in geriatricians dedicated to palliative care services is needed to ensure that these patients have equal access to continuity of care services and optimal treatment.

Abstract Background Stroke, the incidence of which increases with age, has a negative impact on motor and cognitive performance, quality of life, and the independence of the person and his or her family, leading to a number of direct and indirect costs. Motor recovery is essential, especially in elderly patients, to enable the patient to be independent in activities of daily living and to prevent falls. Several studies have shown how robotic training associated with physical therapy influenced functional and motor outcomes of walking after stroke by improving endurance and walking strategies. Considering data from previous studies and patients’ needs in gait and balance control, we hypothesized that robot-assisted balance treatment associated with physical therapy may be more effective than usual therapy performed by a physical therapist in terms of improving static, dynamic balance and gait, on fatigue and cognitive performance. Methods This is an interventional, single-blinded, preliminary randomized control trial. Twenty-four patients of both sexes will be recruited, evaluated, and treated at the UOC Rehabilitation and Physical Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome from January to December 2022. Patients will be randomized into two groups: the experimental group will perform specific rehabilitation for balance disorder using the Hunova® robotic platform (Movendo Technology srl, Genoa, IT) for 3 times a week, for 4 weeks (12 total sessions), and for 45 min of treatment, in addition to conventional treatment, while the conventional group (GC) will perform only conventional treatment as per daily routine. All patients will undergo clinical and instrumental evaluation at the beginning and end of the 4 weeks of treatment. Conclusions The study aims to evaluate the improvement in balance, fatigue, quality of life, and motor and cognitive performance after combined conventional and robotic balance treatment with Hunova® (Movendo Technology srl, Genoa, IT) compared with conventional therapy alone. Robotic assessment to identify the most appropriate and individualized rehabilitation treatment may allow reducing disability and improving quality of life in the frail population. This would reduce direct and indirect social costs of care and treatment for the National Health Service and caregivers. Trial registration ClinicalTrials.gov NCT05280587. Registered on March 15, 2022.

The COVID-19 pandemic has forced us to define new care models in order to ensure continuity of care, facing new individual and public health needs. Medicalized Hotel Facility for self-sufficient COVID patients (COVID Hotel) is a new care model introduced in many countries to face the spread of contagions and the consequent need to implement effective isolation strategies. In our experience the Hotel has given hospitality to people from the most disparate territorial settings and with a great variety of health care needs (physical, psychological, social and spiritual). Although COVID is in most cases a self-limiting acute viral disease, in a pandemic context, comprehensive geriatric assessment has proven to be particularly appropriate for the management of the COVID Hotel, also in the approach to younger patients.

AIM:To analyse the presence and treatment of infections in hospitalised terminal patients by identifying potential risk factors.METHODS:We conducted a retrospective study using health data from 229 terminally ill patients (evaluated by our hospital palliative care team (HPCT) hospitalised from January to December 2018.RESULTS:A total of two types of infections were identified: blood flow infection (through blood cultures) and pneumonia (through radiological examinations), while the other cases of infection remained unknown. The most frequently identified microorganism was Staphylococcus spp. The prevalence of infections was higher in patients with non-oncological diseases (n=47, 36.7%; p value 0.009). The potential risk factors identified for infections were the presence of: Parkinson's disease (n=15, 11.7%; p value 0.005), dysphagia (n=49, 38.3%; p value 0.007), bedding (n=15, 11.7%; p value 0.048), pressure ulcers (n=31, 24. 2%); p value 0.018), oxygen therapy (n=60, 46.9%; p value 0.050), urinary catheters (n=95, 74.2%; p value 0.038) and polypathology (2.3 vs 1.7; p value 0.022). Parkinson's disease (OR=5.973; 95% CI=1.292-27.608), dysphagia (OR=2.090; 95% CI=1.080-4.046) and polypathology (OR=1.220; 95% CI=1.015-1.466) were confirmed by a corrected logistic regression analysis.CONCLUSIONS:Infections and, consequently, antibiotic therapies, have a high prevalence in hospitalised patients with terminal disease. Potential risk factors for infections in these patients could be polypathology, dysphagia and Parkinson's disease. Patients with these conditions could benefit from prevention programmes.

OBJECTIVE: Frailty is a common condition in older adults, characterized by multimorbidity, physical weakness and nutritional deficit. Frailty can be detected early and a prehabilitation treatment could reduce the incidence of disability. PATIENTS AND METHODS: Two-hundred-fifteen elderly patients were admitted to the Rehabilitation and Physical Medicine Unit of Policlinico Gemelli for one year. Patients were clinically assessed by Charlson Comorbidity Index (CCI) and blood sample values. Numerical Pain Rating Scale (NRS) and Hand Grip Test were assessed before (T0) and after (T1) hospitalization. Number of drugs and number of infections were recorded. RESULTS: Patients were originally hospitalized in orthopaedic, neurology and medical ward. Most patients (68%) after discharge return home. Negative correlations between albumin and CCI and between total protein and CCI were recorded. Positive correlation between CCI cognitive subscore and number of drugs and a negative correlation between that subscore and Vitamin D were detected. An improvement in NRS and in the handgrip strength was recorded. At discharge an increase in the number of drugs and the number of infections was noted. CONCLUSIONS: The handgrip strength improvement increases quality of life. Pain management and NRS indicate a better recovery of activities of daily living. Malnutrition is a real problem; albumin is the principal negative acute-phase reactant and is related to a worse clinical condition and low vitamin D levels are associated with worse cognitive function. The goal of a Rehabilitation Unit is to create an effective multidisciplinary transitional care plan, involving the patient and caregivers, creating a continuity of care after discharge and a sustainable project.