Use of specific serotonin reuptake inhibitors (SSRIs) (Sertraline or Citalopram) in the treatment of depression reduces the cardiovascular risk in the elderly: evidence from a Sicilian population >80 years recovered in the assisted sanitary residences (RSA).

The correlation between depression and cardiovascular pathologies was studied in geriatric age. As a matter of fact, the high comorbidity of depression with the sudden cardiac deaths or other cardiovascular events requires a careful evaluation of these causalities. A total of 110 patients were analyzed, recovered in assisted sanitary residence (from the widely used Italian name: "residenza sanitaria assistita" abbreviated as RSA) during the last 12 months. All patients were above the age of 80 years at the admission (mean age was 83.2+/-2.8 years), and all of them have had a diagnosis of depression according to the DSM IV. All patients were treated with the antidepressive specific serotonin reuptake inhibitor (SSRI) (Citalopram, 20-40mg/day, or Sertraline 50-100mg/day). The patients were divided on the basis of their therapeutic response in two groups: Group A (responders) and Group B (non-responders). After 4, 6 and 12 months of treatment, we observed a reduction of the cardiovascular events (-75%, -83% and -60%, respectively). These findings confirm the existence of a correlation between the level of affectivity and the cardiac functions.

Management and treatment of decubital ulcers of an elderly population in the assisted sanitary residence of Futura-Viagrande (Catania, Sicily, Italy).

Decubital lesions indicate the gravity of the pathologies of the elderly patients, representing a serious cause of disability and of mortality. The present study was aimed at evaluating the decubital lesions during 1 year of treatment in an assisted sanitary residence (abbreviated as RSA from the Italian name), through observations of the assistential and therapeutical outcomes, aimed at improving the quality of life of the recovered elderly patients. We had 131 patients involved from a total of 308 recovered patients in the RSA. Their mean age was 83.4+/-1.3 years (74 women and 57 men). All cases were treated, considering the actual clinical stages, according to the advanced protocols on the basis of the guidelines of the National Pressure Ulcer Advisory Panel (NPUAP). All patients were evaluated by using the Braden-scale at the start and after 30 days for having a risk for the development of decubital ulcers and also for monitoring the modifications during the therapy, while the improvements were evaluated only clinically, establishing the reduction of the stage of the lesions. A precise analysis of the data revealed a higher prevalence of decubital lesions at the entrance to the RSA, particularly the advanced Grades III and IV (84 patients, 27% of all recovered subjects), compared to those with lower gravity Grades I and II (47 cases, 15% of all recovered subjects). Complete healing was observed only in a few cases (18.0%), mainly in the lower grades. Applying the therapeutic methods and protocols of NPUAP, most of the ulcers displayed an improving tendency. We had only a few mortal cases due to the ulcers (3 deaths of 131 patients), nevertheless, numerous death cases for other causes occurred among the patients, having advanced grades of ulcers (12%). Our data confirm the statement that the decubital ulcers represent the marker of severity of the polypathological state of the fragile elderly patients.

The use of bisphosphonates in palliative treatment of bone metastases in a terminally ill, oncological elderly population.

According to the guidelines of WHO [WHO, 1999. Cancer Pain and Palliative Care Program. Cancer Pain Release, vol. 13], the term terminally ill patient refers to oncological patients whose life expectancy is lower than 90 days, and the index of their physical state (defined as the Karnofsky Index) is below 50. The terminally ill oncological patients are treatable with the palliative cures, representing a treatment system aimed at improving the quality of life (QOL) of both the patient and the family members, decreasing the physical and psychical sufferance of the patient. The present study followed 35 terminally ill oncological patients with bone metastases, at their homes, for the University of Catania. These patients had previously been followed by the Local Sanitary Unit (ASL 3) of Catania, and established a life expectancy not longer than 3 months. Independently from the basic neoplastic disease resulting in the bone metastases, all the patients were treated with sodium clodronate (SC) intravenously, 300 mg every second day, in order to decrease the bone pains. The visual analogue scale (VAS) for pain relief, the autonomy (IADL) and autosufficiency (ADL, Barthel Index) were evaluated after 1, 3, and 6 months of treatment. The results indicate an overall significant improvement both in the pain symptoms and the QOL. Also the compromised autonomy and autosufficiency of this population seemed to be improved, at least as compared to the predicted and expected results at the start of this trial, and also compared to the relevant literature. One can conclude that the i.v. application of 300 mg of SC every other day produced a significant pain reduction and improved the QOL, and helped in maintaining the actual autonomy and autosufficiency. On this basis we suggest the use of this compound in the given type of terminally ill patients.