"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Genomic DNA fingerprints as a tool for identifying cultivated types of radicchio (Cichorium intybus L.) from Veneto, Italy

Red or variegated chicory (Cichorium intybus L., 2n = 2x = 18) native to, and very extensively cultivated in north-eastern Italy as a leafy vegetable, locally called 'radicchio', includes different types which represent valuable high-quality crops. The five major types of radicchio cultivated in the Veneto region were investigated by polymerase chain reaction (PCR)-derived markers. The experimental material was represented by two outbred populations (one of 'Variegato di Castelfranco' (CF) and one of 'Rosso di Verona' (VR)) and by eight inbred lines (three of early 'Rosso di Treviso' (TVP), three of late 'Rosso di Treviso' (TVT) and two of 'Rosso di Chioggia' (CH)). A total of 96 individual plant DNAs and 16 bulked DNAs of six plants each were assayed. The different types were well distinguished from one another if analysed by means of bulks using amplified fragment length polymorphism markers at the population level, while they were not if analysed at the individual level using random amplified polymorphic DNA, inter-simple sequence repeat and Arbitrarily Primed (AP)-PCR markers. The genetic variation was shown to be much higher within types than between types. This result suggests that, in each radicchio type, populations produced by breeders through controlled intercrossing (VR and CF) or repeated selfing (TVP, TVT and CH) conserved their well-separated gene pools over the years. The setting up of a molecular reference system seems to be feasible and suitable both for the precise identification of the single types of radicchio and for the evaluation of the extent of natural hybridization that can occur between different types

Low levels of high-density lipoprotein cholesterol are a marker of disability in the elderly

none6BACKGROUND: In the elderly, high-density lipoprotein cholesterol (HDL-C) seems to have further clinical meanings besides the inverse relationship with coronary heart disease (CHD); indeed, low values have been found in elderly subjects with functional disability, chronic illness, and in severe clinical conditions. OBJECTIVE: To verify the hypothesis that low HDL-C might be a 'marker' for disability, we evaluated the relationship between lipoprotein parameters and functional status, over a period of 2 years, in a large sample of institutionalized elderly. METHODS: 344 institutionalized subjects aged over 65 years were studied. They were divided into two groups according to basal disability level: 'low-mild': class A-E, and 'high': class F-G of the Katz index. 124 survivors, independent in at least two basic activities of daily living (BADL) at enrollment, were divided into two groups on the basis of 2 years' modifications in functional status: stable/improved or worsened (lost >/=2 BADL). RESULTS: Total cholesterol, LDL-C, HDL-C, and apo A-I levels were lower in the high disability group, while no differences in triglycerides and apo B levels emerged. Multiple logistic regression analysis showed that severe disability was associated with HDL-C (II vs. III tertile: OR 2.01; CI 95% 1.04-3.91; I vs. III tertile: OR 2.52; CI 95% 1.23-5. 15), total cholesterol (I vs. III tertile: OR 2.35; CI 95% 1.14-4. 81), blood glucose (OR 0.98), and body mass index (OR 0.91), independently from uric acid, number of pathologies, number of drugs, body cell mass, vitamin B(12) and folic acid plasma levels, waist/hip ratio, age, and gender. Subjects who lost >/=2 BADL in the 2-year follow-up consistently showed lower basal HDL-C levels compared to subjects with stable/improved functional status, and this difference was significant after adjustment for basal Katz class, age, gender, number of pathologies, blood glucose, body mass index, and waist/hip ratio. CONCLUSIONS: The results of this study suggest that in the elderly severe disability is strongly associated with low HDL-C levels. Longitudinal data support the hypothesis that low HDL-C might be considered as a marker for 'ongoing' disability in BADL. Copyright 1999 S. Karger AG, BaselnoneG. ZULIANI; ROMAGNONI F; BOLLINI C; LEOCI V; SOATTIN L; FELLIN RZuliani, Giovanni; Romagnoni, F; Bollini, C; Leoci, V; Soattin, L; Fellin, Renat

Predictors of two-year mortality in older nursing home residents. The IRA study

Besides functional impairment, several factors have been associated with mortality in institutionalized older subjects, including advanced age, gender, comorbidity, and malnutrition. We investigated the possible association of a large number of factors, including functional, anthropometric, nutritional, metabolic, clinical, and demographic variables, with two-year all-cause mortality in a sample of 344 institutionalized older subjects (> or = 65 years) without evidence of acute illness at the time of observation. Although a number of factors were associated with mortality risk, multivariate analysis showed that only severe disability (6 vs 0-1 lost ADL, O.R.: 3.37, C.I. 95%: 1.76-7.3) and low albumin levels (lowest vs highest tertile: O.R.: 3.0, C.I. 95%: 1.65-5.43) were independent predictors of outcome. Moreover, in the analysis stratified for degree of disability and albumin tertiles, we found a strong gradient in mortality risk with increasing disability and decreasing albumin levels. These results further support the value of these two simple parameters in identifying frail institutionalized older individuals

Combined measurement of serum albumin and high-density lipoprotein cholesterol strongly predicts mortality in frail older nursing-home residents

BACKGROUND AND AIMS: The aim of this study was to verify the hypothesis that a combined measurement of albumin and HDL-C might predict total mortality in institutionalized frail older residents. METHODS: Participants were 344 older subjects (272 F, 72 M), living in the "Istituto Riposo Anziani" (I.R.A.), a nursing-home located in Padova, North-east Italy. Functional status, comorbidity, and clinical chemistry parameters were evaluated at entry. All-cause mortality was evaluated after 2 and 4 years. The sample was divided into 4 groups by using the 50 degrees percentile of albumin and HDL-C as cut-off value. The mortality odds ratio (OR) was estimated by multivariate logistic regression analysis. RESULTS: Total mortality was 36.8% after 2 years and 51.8% after four years. A trend toward an increase in mortality from group 1 to 4 was observed (p for trend: 0.01). The OR for 2 and 4 years mortality was 3.83 (95% CI 1.86-7.58) and 2.66 (95% CI 1.37-5.17), respectively, in group 4 compared with group 1, after adjustment for age, gender, number of chronic diseases, functional status, BMI, diabetes, dementia, stroke, CHD, CHF, hypertension, depression, COPD, and total cholesterol levels. CONCLUSIONS: Among frail older nursing-home residents, simple measurement of serum albumin and HDL-C levels may be useful in identifying varying degrees of frailty

Stato di salute e disabilità: risultati di una esperienza di valutazione geriatrica in una RSA

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Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home residents

OBJECTIVES: To investigate the relationship between body composition (assessed using body mass index (BMI) and body cell mass (BCM)) and all-cause mortality in a sample of older nursing home residents. DESIGN: Prospective study with a median follow-up period of 3.5 years. SETTING: Istituto di Riposo per Anziani, Padua, Italy. PARTICIPANTS: A total of 344 participants (79.1% women) aged 65 and older at baseline. MEASUREMENTS: Anthropometric, nutritional, and metabolic parameters were measured at baseline. BCM was measured using tetrapolar bioelectric impedance analysis. Up to 4 years of follow-up data for vital status were available. Survival analysis was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models. RESULTS: During the follow-up period, there were 179 deaths. After adjustment for age and sex, subjects with low BMI and low BCM (lowest sex-specific tertiles) had significantly higher mortality than those with higher BMI or BCM levels. In a fully adjusted regression model, there was no association between BMI levels and risk of mortality, with subjects in the top tertile having the same likelihood of mortality as subjects in the lowest tertile (relative risk (RR)=0.94, 95% confidence interval (CI)=0.61-1.43). Conversely, there was a strong and significant inverse association between BCM levels and mortality (RR for tertile III=0.55, 95% CI=0.35-0.87; P<.01). Furthermore, participants who had high BCM had comparable survival rates in all BMI tertiles. CONCLUSION: In this sample of older nursing home residents, BCM was a strong and independent risk factor for mortality. BCM assessment might provide more useful prognostic information for clinicians than BMI

Stato di salute e disabilità: risultati di una esperienza di valutazione geriatrica in una RSA

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