Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people

Aims: Antiplatelet therapy is recommended for the secondary prevention of cardio- and cerebrovascular disease, but for primary prevention it is advised only in patients at very high risk. With this background, this study aims to assess the appropriateness of antiplatelet therapy in acutely hospitalized older people according to their risk profile. Methods: Data were obtained from the REPOSI register held in Italian and Spanish internal medicine and geriatric wards in 2012 and 2014. Hospitalized patients aged ≥65 assessable at discharge were selected. Appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles. Results: Of 2535 enrolled patients, 2199 were assessable at discharge. Overall 959 (43.6%, 95% CI 41.5–45.7) were prescribed an antiplatelet drug, aspirin being the most frequently chosen. Among patients prescribed for primary prevention, just over half were inappropriately prescribed (52.1%), being mainly overprescribed (155/209 patients, 74.2%). On the other hand, there was also a high rate of inappropriate underprescription in the context of secondary prevention (222/726 patients, 30.6%, 95% CI 27.3–34.0%). Conclusions: This study carried out in acutely hospitalized older people shows a high degree of inappropriate prescription among patients prescribed with antiplatelets for primary prevention, mainly due to overprescription. Further, a large proportion of patients who had had overt cardio- or cerebrovascular disease were underprescribed, in spite of the established benefits of antiplatelet drugs in the context of secondary prevention

Antibiotic use and associated factors in a large sample of hospitalised older people.

OBJECTIVES: The aims of this study were to assess (i) the prevalence of antibiotic use, (ii) factors associated with their use and (iii) the association with in-hospital mortality in a large sample of hospitalised older people in Italy. METHODS: Data were obtained from the 2010-2017 REPOSI register held in more than 100 internal medicine and geriatric wards in Italy. Patients aged ≥65 years with at least one antibiotic prescription during their hospitalisation were selected. Multivariable logistic regression models were used to determine factors associated with antibiotic use. RESULTS: A total of 5442 older patients were included in the analysis, of whom 2786 (51.2%) were prescribed antibiotics during their hospitalisation. The most frequently prescribed antibiotic class was β- lactams, accounting for 50% of the total prescriptions. Poor physical independence, corticosteroid use and being hospitalised in Northern Italy were factors associated with a higher likelihood of being prescribed antibiotics. Antibiotic use was associated with an increased risk of in-hospital mortality (odds ratio=2.52, 95% confidence interval 1.82-3.48) also when accounting for factors associated with their use. CONCLUSION: Hospitalised older people are often prescribed antibiotics. Factors related to poor physical independence and corticosteroid use are associated with increased antibiotic use. Being prescribed antibiotics is also associated with an increased risk of in-hospital death. These results demand the implementation of specific stewardship programmes to improve the correct use of antibiotics in hospital settings and to reduce the risk of antimicrobial resistance

Risk factors for three-month mortality after discharge in a cohort of non-oncologic hospitalized elderly patients: Results from the REPOSI study

Background: Short-term prognosis, e.g. mortality at three months, has many important implications in planning the overall management of patients, particularly non-oncologic patients in order to avoid futile practices. The aims of this study were: i) to investigate the risk of three-month mortality after discharge from internal medicine and geriatric wards of non-oncologic patients with at least one of the following conditions: permanent bedridden status during the hospital stay; severely reduced kidney function; hypoalbuminemia; hospital admissions in the previous six months; severe dementia; ii) to establish the absolute risk difference of three-month mortality of bedridden compared to non-bedridden patients. Methods: This prospective cohort study was run in 102 Italian internal medicine and geriatric hospital wards. The sample included all patients with three-months follow-up data. Bedridden condition was defined as the inability to walk or stand upright during the whole hospital stay. The following parameters were also recorded: estimated GFR <= 29 mL/min/1.73 m(2); severe dementia; albuminemia << 2.5 g/dL; hospital admissions in the six months before the index admission. Results: Of 3915 patients eligible for the analysis, three-month follow-up were available for 2058, who were included in the study. Bedridden patients were 112 and the absolute risk difference of mortality at three months was 0.13 (CI 95% 0.08-0.19, p << 0.0001). Logistic regression analysis also adjusted for age, sex, number of drugs and comorbidity index found that bedridden condition (OR 2.10, CI 95% 1.12-3.94), severely reduced kidney function (OR 2.27, CI 95% 1.22-4.21), hospital admission in the previous six months (OR 1.96, CI 95% 1.22-3.14), severe dementia (with total or severe physical dependence) (OR 4.16, CI 95% 2.39-7.25) and hypoalbuminemia (OR 2.47, CI 95% 1.12-5.44) were significantly associated with higher risk of three-month mortality. Conclusions: Bedridden status, severely reduced kidney function, recent hospital admissions, severe dementia and hypoalbuminemia were associated with higher risk of three-month mortality in non-oncologic patients after discharge from internal medicine and geriatric hospital wards

Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study

none331noneProietti, Marco; Nobili, Alessandro; Raparelli, Valeria; Napoleone, Laura; Mannucci, Pier Mannuccio; Lip, Gregory Y. H.; Pasina, Luca; Franchi, Carlotta; Marcucci, Maura; Eldin, Tarek Kamal; Di Blanca, Maria Pia Donatella; Perticone, Francesco; Salerno, Francesco; Corrao, Salvatore; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Emmi, Giacomo; Biolo, Gianni; Guarnieri, Gianfranco; Zanetti, Michela; Fernandes, Giovanni; Vanoli, Massimo; Grignani, Giulia; Casella, Gianluca; Bernardi, Mauro; Bassi, Silvia Li; Santi, Luca; Zaccherini, Giacomo; Mannarino, Elmo; Lupattelli, Graziana; Bianconi, Vanessa; Paciullo, Francesco; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Palazzuoli, Alberto; Salvatore, Teresa; Sasso, Ferdinando Carlo; Girelli, Domenico; Olivieri, Oliviero; Matteazzi, Thomas; Barbagallo, Mario; Plances, Lidia; Alcamo, Roberta; Licata, Giuseppe; Calvo, Luigi; Valenti, Maria; Zoli, Marco; Arnò, Raffaella; Pasini, Franco Laghi; Capecchi, Pier Leopoldo; Bicchi, Maurizio; Palasciano, Giuseppe; Modeo, Maria Ester; Peragine, Maria; Pappagallo, Fabrizio; Di Gennaro, Carla; Postiglione, Alfredo; Barbella, Maria Rosaria; De Stefano, Francesco; Cappellini, Maria Domenica; Fabio, Giovanna; Seghezzi, Sonia; De Amicis, Margherita Migone; Mari, Daniela; Rossi, Paolo Dionigi; Ottolini, Barbara Brignolo; Pugliese, Stefania; Lenti, Marco Vincenzo; Padula, Donatella; Murialdo, Giovanni; Marra, Alessio; Cattaneo, Federico; Secchi, Maria Beatrice; Ghelfi, Davide; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Davì, Giovanni; Guagnano, Maria Teresa; Sestili, Simona; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Meroni, Maria Rachele; Perin, Paolo Cavallo; Lorenzati, Bartolomeo; Gruden, Gabriella; Bruno, Graziella; Amione, Cristina; Fornengo, Paolo; Tassara, Rodolfo; Melis, Deborah; Rebella, Lara; Pretti, Vincenzo; Masala, Maristella Salvatora; Bolondi, Luigi; Rasciti, Leonardo; Serio, Ilaria; Fanelli, Filippo Rossi; Amoroso, Antonio; Molfino, Alessio; Petrillo, Enrico; Zuccalà, Giuseppe; Franceschi, Francesco; De Marco, Guido; Chiara, Cordischi; Marta, Sabbatini; Romanelli, Giuseppe; Delitala, Giuseppe; Chiesa, Deborah; Picardi, Antonio; Gentilucci, Umberto Vespasiani; Gallo, Paolo; Annoni, Giorgio; Corsi, Maurizio; Zazzetta, Sara; Bellelli, Giuseppe; Arturi, Franco; Succurro, Elena; Rubino, Mariangela; Sesti, Giorgio; Loria, Paola; Becchi, Maria Angela; Martucci, Gianfranco; Fantuzzi, Alessandra; Maurantonio, Mauro; Carta, Stefano; Atzori, Sebastiana; Serra, Maria Grazia; Bleve, Maria Antonietta; Gasbarrone, Laura; Sajeva, Maria Rosaria; Brucato, Antonio; Ghidoni, Silvia; Di Corato, Paola; Agnelli, Giancarlo; Marchesini, Emanuela; Fabris, Fabrizio; Carlon, Michela; Baritusso, Aldo; Manfredini, Roberto; Molino, Christian; Pala, Marco; Fabbian, Fabio; Boari, Benedetta; De Giorgi, Alfredo; Paolisso, Giuseppe; Rizzo, Maria Rosaria; Laieta, Maria Teresa; Rini, Giovanbattista; Mansueto, Pasquale; Pepe, Ilenia; Borghi, Claudio; Strocchi, Enrico; De Sando, Valeria; Sabbà, Carlo; Vella, Francesco Saverio; Suppressa, Patrizia; Valerio, Raffaella; Capobianco, Caterina; Fenoglio, Luigi; Bracco, Christian; Giraudo, Alessia Valentina; Testa, Elisa; Serraino, Cristina; Fargion, Silvia; Bonara, Paola; Periti, Giulia; Porzio, Marianna; Peyvandi, Flora; Tedeschi, Alberto; Rossio, Raffaella; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Magnini, Maria; Gobbo, Giulia; Balduini, Carlo L.; Bertolino, Giampiera; Provini, Stella; Quaglia, Federica; Dallegri, Franco; Ottonello, Luciano; Liberale, Luca; Chin, Wu Sheng; Carassale, Laura; Caporotundo, Silvia; Traisci, Giancarlo; De Feudis, Lucrezia; Di Carlo, Silvia; Liberato, Nicola Lucio; Buratti, Alberto; Tognin, Tiziana; Bianchi, Giovanni Battista; Giaquinto, Sabrina; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Rozzini, Renzo; Falanga, Lina; Montrucchio, Giuseppe; Greco, Elisabetta; Tizzani, Pietro; Petitti, Paolo; Perciccante, Antonio; Coralli, Alessia; Salmi, Raffaella; Gaudenzi, Piergiorgio; Gamberini, Susanna; Semplicini, Andrea; Gottardo, Lucia; Vendemiale, Gianluigi; Serviddio, Gaetano; Forlano, Roberta; Masala, Cesare; Mammarella, Antonio; Basili, Stefania; Perri, Ludovica; Landolfi, Raffaele; Montalto, Massimo; Mirijello, Antonio; Vallone, Carla; Bellusci, Martino; Setti, Donatella; Pedrazzoli, Filippo; Guasti, Luigina; Castiglioni, Luana; Maresca, Andrea; Squizzato, Alessandro; Molaro, Marta; Bertolotti, Marco; Mussi, Chiara; Libbra, Maria Vittoria; Miceli, Andrea; Pellegrini, Elisa; Carulli, Lucia; Sciacqua, Angela; Quero, Michele; Bagnato, Chiara; Corinaldesi, Roberto; De Giorgio, Roberto; Serra, Mauro; Grasso, Valentina; Ruggeri, Eugenio; Salvi, Andrea; Leonardi, Roberto; Grassini, Chiara; Mascherona, Ilenia; Minelli, Giorgio; Maltese, Francesca; Gabrielli, Armando; Mattioli, Massimo; Capeci, William; Martino, Giuseppe Pio; Messina, Silvia; Ghio, Riccardi; Favorini, Serena; Col, Anna Dal; Minisola, Salvatore; Colangelo, Luciano; Afeltra, Antonella; Alemanno, Pamela; Marigliano, Benedetta; Castellino, Pietro; Blanco, Julien; Zanoli, Luca; Cattaneo, Marco; Fracasso, Paola; Amoruso, Maria Valentina; Saracco, Valter; Fogliati, Marisa; Bussolino, Carlo; Durante, Vittorio; Eusebi, Giovanna; Tirotta, Daniela; Mete, Francesca; Gino, Miriam; Cittadini, Antonio; Arcopinto, Michele; Salzano, Andrea; Bobbio, Emanuele; Marra, Alberto Maria; Sirico, Domenico; Moreo, Guido; Scopelliti, Francesco; Gasparini, Francesca; Cocca, Melissa; Nieves, Ramirez Duque; Alberto, Muela Molinero; Pedro, Abad Requejo; Vanessa, Lopez Pelaez; Lara, Tamargo; Xavier, Corbella Viros; Francesc, Formiga; Jesus, Diez Manglano; Esperanza, Bejarano Tello; Behamonte Esther, Del Corral; Maria, Sevil Puras; Romero, Manuel; Blanca, Pinilla Llorente; Cristina, Lopez Gonzalez-Cobos; Victoria, Villalba Garcia M.; Saez, Lopez; Bosco, Juan; Susana, Sanz Baena; Marta, Arroyo Gallego; Concepcion, Gonzalez Becerra; Antonio, Fernandez Moyano; Hernandez, Mercedes Gomez; Borrego, Manuel Poyato; Raquel, Pacheco Cuadros; Florencia, Perez Rojas; Beatriz, Garcia Olid; Sara, Carrascosa Garcia; Cervellera Alfonso, Gonzalez-Cruz; Marta, Peinado Martinez; Alberto, Ruiz Cantero; Antonio, Albarracín Arraigosa; Montserrat, Godoy Guerrero; Miguel Ángel, Barón Ramos; Manuel, Machin Jose; Ignacio, Novo Veleiro; Lucía, Alvela Suarez; Alfonso, Lopez; David, Rubal Bran; Iria, Iñiguez Vazquez; Monica, Rios Prego; On behalf of REPOSI investigators, nullProietti, Marco; Nobili, Alessandro; Raparelli, Valeria; Napoleone, Laura; Mannucci, Pier Mannuccio; Lip, Gregory Y. H.; Pasina, Luca; Franchi, Carlotta; Marcucci, Maura; Eldin, Tarek Kamal; Di Blanca, Maria Pia Donatella; Perticone, Francesco; Salerno, Francesco; Corrao, Salvatore; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Emmi, Giacomo; Biolo, Gianni; Guarnieri, Gianfranco; Zanetti, Michela; Fernandes, Giovanni; Vanoli, Massimo; Grignani, Giulia; Casella, Gianluca; Bernardi, Mauro; Bassi, Silvia Li; Santi, Luca; Zaccherini, Giacomo; Mannarino, Elmo; Lupattelli, Graziana; Bianconi, Vanessa; Paciullo, Francesco; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Palazzuoli, Alberto; Salvatore, Teresa; Sasso, Ferdinando Carlo; Girelli, Domenico; Olivieri, Oliviero; Matteazzi, Thomas; Barbagallo, Mario; Plances, Lidia; Alcamo, Roberta; Licata, Giuseppe; Calvo, Luigi; Valenti, Maria; Zoli, Marco; Arnò, Raffaella; Pasini, Franco Laghi; Capecchi, Pier Leopoldo; Bicchi, Maurizio; Palasciano, Giuseppe; Modeo, Maria Ester; Peragine, Maria; Pappagallo, Fabrizio; Di Gennaro, Carla; Postiglione, Alfredo; Barbella, Maria Rosaria; De Stefano, Francesco; Cappellini, Maria Domenica; Fabio, Giovanna; Seghezzi, Sonia; De Amicis, Margherita Migone; Mari, Daniela; Rossi, Paolo Dionigi; Ottolini, Barbara Brignolo; Pugliese, Stefania; Lenti, Marco Vincenzo; Padula, Donatella; Murialdo, Giovanni; Marra, Alessio; Cattaneo, Federico; Secchi, Maria Beatrice; Ghelfi, Davide; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Davì, Giovanni; Guagnano, Maria Teresa; Sestili, Simona; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Meroni, Maria Rachele; Perin, Paolo Cavallo; Lorenzati, Bartolomeo; Gruden, Gabriella; Bruno, Graziella; Amione, Cristina; Fornengo, Paolo; Tassara, Rodolfo; Melis, Deborah; Rebella, Lara; Pretti, Vincenzo; Masala, Maristella Salvatora; Bolondi, Luigi; Rasciti, Leonardo; Serio, Ilaria; Fanelli, Filippo Rossi; Amoroso, Antonio; Molfino, Alessio; Petrillo, Enrico; Zuccalà, Giuseppe; Franceschi, Francesco; De Marco, Guido; Chiara, Cordischi; Marta, Sabbatini; Romanelli, Giuseppe; Delitala, Giuseppe; Chiesa, Deborah; Picardi, Antonio; Gentilucci, Umberto Vespasiani; Gallo, Paolo; Annoni, Giorgio; Corsi, Maurizio; Zazzetta, Sara; Bellelli, Giuseppe; Arturi, Franco; Succurro, Elena; Rubino, Mariangela; Sesti, Giorgio; Loria, Paola; Becchi, Maria Angela; Martucci, Gianfranco; Fantuzzi, Alessandra; Maurantonio, Mauro; Carta, Stefano; Atzori, Sebastiana; Serra, Maria Grazia; Bleve, Maria Antonietta; Gasbarrone, Laura; Sajeva, Maria Rosaria; Brucato, Antonio; Ghidoni, Silvia; Di Corato, Paola; Agnelli, Giancarlo; Marchesini, Emanuela; Fabris, Fabrizio; Carlon, Michela; Baritusso, Aldo; Manfredini, Roberto; Molino, Christian; Pala, Marco; Fabbian, Fabio; Boari, Benedetta; De Giorgi, Alfredo; Paolisso, Giuseppe; Rizzo, Maria Rosaria; Laieta, Maria Teresa; Rini, Giovanbattista; Mansueto, Pasquale; Pepe, Ilenia; Borghi, Claudio; Strocchi, Enrico; De Sando, Valeria; Sabbà, Carlo; Vella, Francesco Saverio; Suppressa, Patrizia; Valerio, Raffaella; Capobianco, Caterina; Fenoglio, Luigi; Bracco, Christian; Giraudo, Alessia Valentina; Testa, Elisa; Serraino, Cristina; Fargion, Silvia; Bonara, Paola; Periti, Giulia; Porzio, Marianna; Peyvandi, Flora; Tedeschi, Alberto; Rossio, Raffaella; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Magnini, Maria; Gobbo, Giulia; Balduini, Carlo L.; Bertolino, Giampiera; Provini, Stella; Quaglia, Federica; Dallegri, Franco; Ottonello, Luciano; Liberale, Luca; Chin, Wu Sheng; Carassale, Laura; Caporotundo, Silvia; Traisci, Giancarlo; De Feudis, Lucrezia; Di Carlo, Silvia; Liberato, Nicola Lucio; Buratti, Alberto; Tognin, Tiziana; Bianchi, Giovanni Battista; Giaquinto, Sabrina; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Rozzini, Renzo; Falanga, Lina; Montrucchio, Giuseppe; Greco, Elisabetta; Tizzani, Pietro; Petitti, Paolo; Perciccante, Antonio; Coralli, Alessia; Salmi, Raffaella; Gaudenzi, Piergiorgio; Gamberini, Susanna; Semplicini, Andrea; Gottardo, Lucia; Vendemiale, Gianluigi; Serviddio, Gaetano; Forlano, Roberta; Masala, Cesare; Mammarella, Antonio; Basili, Stefania; Perri, Ludovica; Landolfi, Raffaele; Montalto, Massimo; Mirijello, Antonio; Vallone, Carla; Bellusci, Martino; Setti, Donatella; Pedrazzoli, Filippo; Guasti, Luigina; Castiglioni, Luana; Maresca, Andrea; Squizzato, Alessandro; Molaro, Marta; Bertolotti, Marco; Mussi, Chiara; Libbra, Maria Vittoria; Miceli, Andrea; Pellegrini, Elisa; Carulli, Lucia; Sciacqua, Angela; Quero, Michele; Bagnato, Chiara; Corinaldesi, Roberto; De Giorgio, Roberto; Serra, Mauro; Grasso, Valentina; Ruggeri, Eugenio; Salvi, Andrea; Leonardi, Roberto; Grassini, Chiara; Mascherona, Ilenia; Minelli, Giorgio; Maltese, Francesca; Gabrielli, Armando; Mattioli, Massimo; Capeci, William; Martino, Giuseppe Pio; Messina, Silvia; Ghio, Riccardi; Favorini, Serena; Col, Anna Dal; Minisola, Salvatore; Colangelo, Luciano; Afeltra, Antonella; Alemanno, Pamela; Marigliano, Benedetta; Castellino, Pietro; Blanco, Julien; Zanoli, Luca; Cattaneo, Marco; Fracasso, Paola; Amoruso, Maria Valentina; Saracco, Valter; Fogliati, Marisa; Bussolino, Carlo; Durante, Vittorio; Eusebi, Giovanna; Tirotta, Daniela; Mete, Francesca; Gino, Miriam; Cittadini, Antonio; Arcopinto, Michele; Salzano, Andrea; Bobbio, Emanuele; Marra, Alberto Maria; Sirico, Domenico; Moreo, Guido; Scopelliti, Francesco; Gasparini, Francesca; Cocca, Melissa; Nieves, Ramirez Duque; Alberto, Muela Molinero; Pedro, Abad Requejo; Vanessa, Lopez Pelaez; Lara, Tamargo; Xavier, Corbella Viros; Francesc, Formiga; Jesus, Diez Manglano; Esperanza, Bejarano Tello; Behamonte Esther, Del Corral; Maria, Sevil Puras; Romero, Manuel; Blanca, Pinilla Llorente; Cristina, Lopez Gonzalez-Cobos; Victoria, Villalba Garcia M.; Saez, Lopez; Bosco, Juan; Susana, Sanz Baena; Marta, Arroyo Gallego; Concepcion, Gonzalez Becerra; Antonio, Fernandez Moyano; Hernandez, Mercedes Gomez; Borrego, Manuel Poyato; Raquel, Pacheco Cuadros; Florencia, Perez Rojas; Beatriz, Garcia Olid; Sara, Carrascosa Garcia; Cervellera Alfonso, Gonzalez-Cruz; Marta, Peinado Martinez; Alberto, Ruiz Cantero; Antonio, Albarracín Arraigosa; Montserrat, Godoy Guerrero; Miguel Ángel, Barón Ramos; Manuel, Machin Jose; Ignacio, Novo Veleiro; Lucía, Alvela Suarez; Alfonso, Lopez; David, Rubal Bran; Iria, Iñiguez Vazquez; Monica, Rios Prego; On behalf of REPOSI investigators, Nul

Pattern of in-hospital changes in drug use in the older people from 2010 to 2016

Purpose: To assess the pattern of in-hospital changes in drug use in older patients from 2010 to 2016. Methods: People aged 65 years or more acutely hospitalized in those internal medicine and geriatric wards that did continuously participate to the REgistro POliterapie Società Italiana di Medicina Interna register from 2010 to 2016 were selected. Drugs use were categorized as 0 to 1 drug (very low drug use), 2 to 4 drugs (low drug use), 5 to 9 drugs (polypharmacy), and 10 or more drugs (excessive polypharmacy). To assess whether or not prevalence of patients in relation to drug use distribution changed overtime, adjusted prevalence ratios (PRs) was estimated with log-binomial regression models. Results: Among 2120 patients recruited in 27 wards continuously participating to data collection, 1882 were discharged alive and included in this analysis. The proportion of patients with very low drug use (0-1 drug) at hospital discharge increased overtime, from 2.7% in 2010 to 9.2% in 2016. Results from a log-logistic adjusted model confirmed the increasing PR of these very low drug users overtime (particularly in 2014 vs 2012, PR 1.83 95% CI 1.14-2.95). Moreover, from 2010 to 2016, there was an increasing number of patients who, on polypharmacy at hospital admission, abandoned it at hospital discharge, switching to the very low drug use group. Conclusion: This study shows that in internal medicine and geriatric wards continuously participating to the REgistro POliterapie Società Italiana di Medicina Interna register, the proportion of patients with a very low drug use at hospital discharge increased overtime, thus reducing the therapeutic burden in this at risk population

Prognostic value of degree and types of anaemia on clinical outcomes for hospitalised older patients

Study objective This study investigated in a large sample of in-patients the impact of mild-moderate-severe anaemia on clinical outcomes such as in-hospital mortality, re-admission, and death within three months after discharge. Methods A prospective multicentre observational study, involving older people admitted to 87 internal medicine and geriatric wards, was done in Italy between 2010 and 2012. The main clinical/laboratory data were obtained on admission and discharge. Based on haemoglobin (Hb), subjects were classified in three groups: group 1 with normal Hb, (reference group), group 2 with mildly reduced Hb (10.0–11.9 g/dL in women; 10.0–12.9 g/dL in men) and group 3 with moderately-severely reduced Hb (<10 g/dL in women and men). Results Patients (2678; mean age 79.2 ± 7.4 y) with anaemia (54.7%) were older, with greater functional impairment and more comorbidity. Multivariable analysis showed that mild but not moderate-severe anaemia was associated with a higher risk of hospital re-admission within three months (group 2: OR = 1.62; 95%CI 1.21–2.17). Anaemia failed to predict in-hospital mortality, while a higher risk of dying within three months was associated with the degree of Hb reduction on admission (group 2: OR = 1.82;95%CI 1.25–2.67; group 3: OR = 2.78;95%CI 1.82–4.26) and discharge (group 2: OR = 2.37;95%CI 1.48–3.93; group 3: OR = 3.70;95%CI 2.14–6.52). Normocytic and macrocytic, but not microcytic anaemia, were associated with adverse clinical outcomes. Conclusions Mild anaemia predicted hospital re-admission of older in-patients, while three-month mortality risk increased proportionally with anaemia severity. Type and severity of anaemia affected hospital re-admission and mortality, the worst prognosis being associated with normocytic and macrocytic anaemia

Living alone as an independent predictor of prolonged length of hospital stay and non-home discharge in older patients.

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Implementation of the Frailty Index in hospitalized older patients: Results from the REPOSI register

Background: Frailty is a state of increased vulnerability to stressors, associated to poor health outcomes. The aim of this study was to design and introduce a Frailty Index (FI; according to the age-related accumulation of deficit model) in a large cohort of hospitalized older persons, in order to benefit from its capacity to comprehensively weight the risk profile of the individual. Methods: Patients aged 65 and older enrolled in the REPOSI register from 2010 to 2016 were considered in the present analyses. Variables recorded at the hospital admission (including socio-demographic, physical, cognitive, functional and clinical factors) were used to compute the FI. The prognostic impact of the FI on in-hospital and 12-month mortality was assessed. Results: Among the 4488 patients of the REPOSI register, 3847 were considered eligible for a 34-item FI computation. The median FI in the sample was 0.27 (interquartile range 0.21\u20130.37). The FI was significantly predictive of both in-hospital (OR 1.61, 95%CI 1.38\u20131.87) and overall (HR 1.46, 95%CI 1.32\u20131.62) mortality, also after adjustment for age and sex. Conclusions: The FI confirms its strong predictive value for negative outcomes. Its implementation in cohort studies (including those conducted in the hospital setting) may provide useful information for better weighting the complexity of the older person and accordingly design personalized interventions

Prognostic relevance of glomerular filtration rate estimation obtained through different equations in hospitalized elderly patients

The estimated glomerular filtration rate (eGFR) is a predictor of important outcomes and its reduction has been associated with the risk of all-cause mortality in both general population and elderly patients. However while reduced renal function is common in older people, the best method for estimating GFR remains unclear, especially in an acute care setting. Most studies analyzing the accuracy of eGFR in the elderly were carried out in different heterogeneous settings. In this study, we compare the prognostic value of different formulas estimating GFR in predicting the risk of in-hospital morbidity and mortality within 3 months from discharge in elderly hospitalized patients. Data were extracted from \u201cRegistro Politerapia Societ\ue0 Italiana di Medicina Interna (REPOSI)\u201d. Patients with available creatinine values at hospital admission were selected and eGFR was calculated according to the different formulas: Cockcroft-Gault, Modification of Diet in Renal Disease equation, Chronic Kidney Disease Epidemiology Collaboration, Berlin Initiative Study and Full Age Spectrum. 4621 patients were included in the analysis. Among these, 4.2% and 14.2% died during hospitalization and within 3 months from discharge, respectively. eGFR &gt; 60 ml/min/1.73 m2 at admission was associated with a very low risk of mortality during the hospital stay and within 90 days from discharge, while an eGFR &lt; 60 ml/min/1.73 m2 was associated with unfavorable outcomes, although with a poor level of accuracy (AUC 0.60\u20130.66). No difference in predictive power between different equations was found. Physicians should be aware of the prognostic role of eGFR in a comprehensive assessment of elderly in-patients

Prevalence, characteristics and treatment of chronic pain in elderly patients hospitalized in internal medicine wards

Background: Chronic pain is a frequent characteristic of elderly people and represents an actual and still poorly debated topic. Objective: We investigated pain prevalence and intensity, and its pharmacological therapy in elderly patients hospitalized in 101 internal medicine wards. Methods: Taking advantage of the “REgistro POliterapie Società Italiana Medicina Interna” (REPOSI), we collected 2535 patients of whom almost a quarter was older than 85 years old. Among them, 582 patients were affected by pain (either chronic or acute) and 296 were diagnosed with chronic pain. Results: Patients with pain showed worse cognitive status, higher depression and comorbidities, and a longer duration of hospital stay compared to those without pain (all p &lt;.0366). Patients with chronic pain revealed lower level of independency in their daily life, worse cognitive status and higher level of depression compared to acute pain patients (all p &lt;.0156). Moreover, most of them were not treated for pain at admission (73.4%) and half of them was not treated with any analgesic drug at discharge (50.5%). This difference affected also the reported levels of pain intensity. Patients who received analgesics at both admission and discharge remained stable (p =.172). Conversely, those not treated at admission who received an analgesic treatment during the hospital stay decreased their perceived pain (p &lt;.0001). Conclusions: Our results show the need to focus more attention on the pharmacological treatment of chronic pain, especially in hospitalized elderly patients, in order to support them and facilitate their daily life after hospital discharge