Ricostruzione e valutazione dello stato anteriore

Il 22% della popolazione anziana in Italia ha pi\uf9 di 65 anni, con un costo complessivo per le assicurazioni nel 2017 per i sinistri per macroinvalidit\ue0 e morte pari a 4,6 miliardi di euro. Si pone pertanto per il sistema sanitario nazionale e per i medici legali il problema di come valutare il danno biologico nella persona anziana. Infatti, le tabelle per la valutazione del danno a persona prendono in considerazione l\u2019entit\ue0 della lesione, ma non l\u2019et\ue0 del paziente. Si \ue8 deciso quindi di applicare per la prima volta alla medicina legale la metodologia della Consensus Conference, utilizzata generalmente per dirimere questioni controverse in ambito clinico, al fine di affrontare un tema di fondamentale interesse scientifico e produrre un unico documento contenente indicazioni per valutare in maniera metodologicamente corretta e condivisa il danno biologico nella persona anziana. Ad oggi la mancanza di una condivisione di opinioni su questo tema produce una forte disomogeneit\ue0 di comportamenti sul piano clinico e valutativo e il documento comporter\ue0 grandi ripercussioni sull\u2019attivit\ue0 quotidiana stante il costante invecchiamento della popolazione generale e le grandi problematiche che la fragilit\ue0 dell\u2019anziano crea nella valutazione del danno alla persona

Integrated care for the management of ageing-related non-communicable diseases: current gaps and future directions

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An International Perspective on Chronic Multimorbidity: Approaching the Elephant in the Room

Multimorbidity is a common and burdensome condition that may affect quality of life, increase medical needs, and make people live more years of life with disability. Negative outcomes related to multimorbidity occur beyond what we would expect from the summed effect of single conditions, as chronic diseases interact with each other, mutually enhancing their negative effects, and eventually leading to new clinical phenotypes. Moreover, multimorbidity mirrors an accelerated global susceptibility and a loss of resilience, which are both hallmarks of aging. Due to the complexity of its assessment and definition, and the lack of clear evidence steering its management, multimorbidity represents one of the main current challenges for clinicians, researchers, and policymakers. The authors of this article recently reflected on these issues during two twin international symposia at the 2016 European Union Geriatric Medicine Society (EUGMS) meeting in Lisbon, Portugal, and the 2016 Gerontological Society of America (GSA) meeting in New Orleans, USA. The present work summarizes the most relevant aspects related to multimorbidity, with the ultimate goal to identify knowledge gaps and suggest future directions to approach this condition

Rapidly developing multimorbidity and disability in older adults: does social background matter?

Background Multimorbidity is among the most disabling geriatric conditions. In this study we explored whether a rapid development of multimorbidity potentiates its impact on the functional independence of older adults, and whether different sociodemographic factors play a role beyond the rate of chronic disease accumulation. Methods A random sample of persons aged ≥60 years (n = 2387) from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) was followed over 6 years. The speed of multimorbidity development was estimated as the rate of chronic disease accumulation (linear mixed models) and further dichotomized into the upper versus the three lower rate quartiles. Binomial negative mixed models were used to analyse the association between speed of multimorbidity development and disability (impaired basic and instrumental activities of daily living), expressed as the incidence rate ratio (IRR). The effect of sociodemographic factors, including sex, education, occupation and social network, was investigated. Results The risk of new activity impairment was higher among participants who developed multimorbidity faster (IRR 2.4, 95% CI 1.9–3.1) compared with those who accumulated diseases more slowly over time, even after considering the baseline number of chronic conditions. Only female sex (IRR for women vs. men 1.6, 95% CI 1.2–2.0) and social network (IRR for poor vs. rich social network 1.7, 95% CI 1.3–2.2) showed an effect on disability beyond the rate of chronic disease accumulation. Conclusions Rapidly developing multimorbidity is a negative prognostic factor for disability. However, sociodemographic factors such as sex and social network may determine older adults' reserves of functional ability, helping them to live independently despite rapid accumulation of chronic conditions. This article is protected by copyright. All rights reserved

Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly.

BACKGROUND: Proton pump inhibitors (PPI) are among the most commonly prescribed medicines and their overuse is widespread in both primary and secondary care. Inappropriate prescription is of particular concern among elderly patients, who have often multiple comorbidities and need many drugs. METHODS: We evaluate the appropriateness of drugs for peptic ulcer or gastro-esophageal reflux disease (GERD) in a sample of elderly patients (65 years old or older) at admission and discharge in 38 internal medicine wards between January 2008 and December 2008, according to the presence of specific conditions or gastro-toxic drug combinations. RESULTS: Among 1155 patients eligible for the analysis, 466 (40.3%) were treated with drugs for GERD or peptic ulcer were at hospital admission and 647 (56.0%) at discharge; 62.4% of patients receiving a drug for peptic ulcer or GERD at admission and 63.2% at discharge were inappropriately treated. Among these, the number of other drugs prescribed was associated with greater use of drugs for peptic ulcer or GERD, even after adjustment for age, sex and number of diagnoses at admission (OR 95% CI=1.26 (1.18-1.34), p=.0001) or discharge (OR 95% CI=1.11 (1.05-1.18), p=0.0003). CONCLUSIONS: Prevalence of inappropriate prescription of drugs for peptic ulcer or GERD remained almost the same at admission and discharge. Inappropriate use of these drugs is related to the concomitant use of other drugs. Careful assessment of clinical conditions and stricter adherence to evidence-based guidelines are essential for a rational and cost-effective use of drugs for peptic ulcer or GERD

Avaliação sensorial de pescado empanado produzido com carne mecanicamente separada de pacu cultivados em tanques-rede.

A análise sensorial pode ser aplicada para determinar a aceitação de um produto por parte dos consumidores, no desenvolvimento de novos produtos, no melhoramento de produtos, ou ainda em estudos para redução de custos, controle de qualidade e, entre outras aplicações, estudos de vida útil. O objetivo deste trabalho foi realizar a avaliação sensorial do empanado elaborado com carne mecanicamente separada de pacu. Os empanados foram analisados por cem provadores não treinados de várias faixas etárias. Para a caracterização da análise sensorial os empanados foram assados em forno elétrico durante 20 minutos, e em seguida, encaminhado para a avaliação sensorial, onde os provadores expressaram o grau de aceitação global em relação ao sabor, cor, aroma, aparência e textura. As variáveis apresentaram correlações positivas e significativas entre elas, exceto entre textura e cor. Outra correlação significativa que houve, mas negativa, foi o teste de intenção de compra (comprar ou não comprar o produto) com a variável sabor. A carne mecanicamente separada de pacus cultivados no Pantanal mostrou-se tecnologicamente viável para produção de empanado

Medication Use and Costs Among Older Adults Aged 90 Years and Older in Italy

Older adults are often affected by multiple chronic conditions and experience geriatric syndromes that may affect the risk/benefit profile of medications. Little is known about the use of such medications in the older population. This article describes medication use and costs in Italian adults aged ≥90 years. Data from the 2019 Pharmaceutical Prescriptions database, concerning data on medications reimbursed by the Italian National Health Service, were analyzed in terms of prevalence and amount of use expressed as defined daily dose/1,000 users (DDD/1,000 users/day), accounting for different age-groups and sex. All individuals aged ≥90 years used at least one medication, with a mean number of 3128 DDD/1,000 users/day corresponding to an annual cost of 683 euros per user. Both use and costs linearly decreased with increasing age, with men accounting for a higher amount of DDD/1,000 users and costs than women across all age-groups. Antihypertensives (1330 DDD/1,000 inhabitants), antiplatelet agents (337 DDD/1,000 inhabitants), medications for peptic ulcer and gastroesophageal reflux (328 DDD/1,000 inhabitants), and lipid-lowering agents (166 DDD/1,000 inhabitants) were the most frequently used medications. We observed a progressive decrease in the usage of the majority of medications with increasing age, with the exception of antibiotics and antipsychotics. Individuals aged ≥90 years used a lower DDD/1,000 users, with an associated decrease in annual costs. The persistent use of preventive medications highlights the potential lack of awareness regarding medication rationalization and guidance for optimizing prescriptions. Our findings highlight the need for further initiatives to improve medications’ appropriateness in these older age-groups

Association between clusters of diseases and polypharmacy in hospitalized elderly patients: results from the REPOSI study.

BACKGROUND: Although the association between multimorbidity and polypharmacy has been clearly documented, no study has analyzed whether or not specific combinations of diseases influence the prescription of polypharmacy in older persons. We assessed which clusters of diseases are associated with polypharmacy in acute-care elderly in-patients. METHODS: This cross-sectional study was held in 38 Italian internal medicine and geriatric wards participating in the Registro Politerapie SIMI (REPOSI) study during 2008. The study sample included 1155 in-patients aged 65 years or older. Clusters of diseases, defined as two or more co-occurring specific chronic diseases, were identified using the odds ratio (OR) for the associations between pairs of diseases followed by cluster analysis. Polypharmacy was defined as the prescription of five or more different medications at hospital discharge. Logistic regression models were run to analyze the association between clusters of diseases and polypharmacy. RESULTS: Among clusters of diseases, the highest mean number of drugs (>8) was found in patients affected by heart failure (HF) plus chronic obstructive pulmonary disease (COPD), HF plus chronic renal failure (CRF), COPD plus coronary heart disease (CHD), diabetes mellitus plus CRF, and diabetes mellitus plus CHD plus cerebrovascular disease (CVD). The strongest association between clusters of diseases and polypharmacy was found for diabetes mellitus plus CHD plus CVD, diabetes plus CHD, and HF plus atrial fibrillation (AF). CONCLUSIONS: The observed knowledge of the relationship among co-occurring diseases and polypharmacy should help to identify and monitor older in-patients at risk of polypharmacy. Copyright © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved