Objectives. The aim of this study is to identify among caregivers of patients affected by Alzheimer's disease the emerging needs while they care for these patients. Methods. Between July 2008 and February 2009 we administered an anonymous questionnaire to 100 caregivers of patients affected by Alzheimer's disease attending the Memory Clinic of the Geriatrics section of the San Giovanni Battista hospital of Turin. Questions were asked to evaluate the knowledge that caregivers have about the disease. Caregiver's stress was evaluated by using the CBI scale and behavioural disease was evaluated by CMAI score. Results. Knowledge of district services was good about ADI, UVA, Day Care Centers and RSA, but it was insufficient about hospitalization at home and Respite care. The mean CBI score shows a mild-moderate caregiver's stress that is significantly associated with cognitive impairment, and with the care time. Conclusions. The study shows that healthcare professionals need to provide more information to guarantee a better management of the patient.

Introduction. Malnutrition is a frequent condition among the elderly. The present study aims to evaluate the risk of malnutrition in a sample of elderly patients affected by cognitive impairment but still living at home. Methods. From April to September 2005, all patients affected by cognitive disorders and consecutively admitted to the Memory Clinic of the Geriatric Section of the San Giovanni Battista Hospital of Torino, were asked to participate to the present observational study. At baseline, demographic data, past and recent clinical data and socio-economic status were collected. Cognitive, behaviour, and nutritional status were evaluated using the Mini Mental State Examination (MMSE), the Neuropsychiatric Inventory (NPI) and the Mini Nutritional Assessment (MNA). Results. The MNA total score was significantly related with age (p = 0.01), mean duration of dementia (p = 0.001), severity of cognitive (p = 0.001) and behaviour (p = 0.001) status. In particular, risk of malnutrition was related with delusions (p = 0.001), depression/dysphoria (p = 0.001), appetite/eating (p = 0.001), wandering (p = 0.001), agitation/aggression (p = 0.01). Discussion. The present study confirms that elderly patients with dementia present a risk of malnutrition that seems to be strictly related with patients' age and duration of disease. Moreover, malnutrition is related with severity of cognitive impairment and behavioural problems. The evaluation of nutritional status in elderly demented subjects could prevent and diagnose nutrition related problems.

In 2000, Alzheimer's disease (AD) and other dementias were the third most expensive health conditions in the USA and in 2005 their annual costs amounted to more than $148 billion. An observational, non-randomized study aimed to evaluate direct costs of demented patients in their homes. Two hundred thirty-six informal caregivers have been enrolled. A financial support, represented by a disability living allowance (15.3%) or attendance allowance (3.4%), was presented in just 19.7% of the cases. Patients receiving assistance from an employed carer were 39% with a mean cost of 800 €/month. Receiving assistance from an employed carer is not correlated with cognitive and functional impairment, with the age of the caregiver and with the duration of the disease (t=1.03; t=−0.86; t=1.41; t=−0.16, respectively). The informal caregivers declared that they thoughts about the possibility of institutionalize the patient were 20.9%. The present study underlines the discrepancy between subjects having assistance from an employed caregiver and subjects receiving financial supports. It often happens that patients not reaching the minimum requisites for social assistant or financial support, need at least a supervision.

Aim of the study was to evaluate mortality and functional, cognitive, affective status in elderly patients (>or=75 years) with exacerbation of chronic obstructive pulmonary disease (COPD) or acute congestive heart failure (CHF) admitted to the emergency department (ED) of S. Giovanni Battista Hospital of Torino and randomly assigned to the geriatric home hospitalization service (GHHS) or to a general medical ward (GMW). All patients were evaluated on admission, on discharge and at 6 months, using a standardized study protocol. We excluded patients with unstable medical conditions. The total sample included 73 patients: 35 with COPD exacerbation (19 GHHS, 16 GMW) and 38 with CHF (19 GHHS, 19 GMW). Mean age was 81.7+/-8.0 years. At baseline, no significant differences in demographic, social and clinical conditions were found between the two groups of patients. 56.7% of COPD patients had a severe exacerbation, according to Anthonisen criteria; 65% of CHF patients were NYHA-III and 35% NYHA-IV (according to the criteria of the New York Heart Association) (FE<35% in 40% of patients). On admission all patients were partially dependent in ADLs and IADLs, with a moderate impairment of depression score and a fairly good quality of life. On discharge depression score and quality of life were significantly better only in GHHS patients. Mortality was similar in the two setting of care. Patients managed at home had a significantly longer length of treatment. At 6-month follow-up we did not observe a difference in mortality, but we observed a higher readmission rate in patients previously treated in hospital. In conclusion, our study indicates that home-treated patients with COPD or CHF have better depressive scores and quality of life and a lower rate of hospital readmission after six months.