Predictors of clinical events occurring during hospital stay among elderly patients admitted to medical wards in Italy.

BACKGROUND: Clinical events occurring during hospital stay are independent predictors of prolonged hospitalization, in-hospital mortality and readmission among elderly patients admitted to medical wards. PURPOSE: To identify predictors of intercurrent clinical events (ICE) during hospital stay among the main demographic, functional and clinical characteristics assessed at hospital admission in a multicenter sample of elderly inpatients in Italy. METHODS: This observational prospective cohort study was conducted in 66 internal and geriatric medicine hospital wards in 2010. It enrolled 1267 inpatients aged 65years or older living at home before hospitalization. Multivariable Poisson regression analyses were employed to identify the most common ICEs as well as their independent predictors. RESULTS: During the hospital stay 427 patients (33.7%) experienced at least one ICE. The most common ICEs were urinary tract infections, pneumonia, anemia, arrhythmias and fluid electrolyte disorders. After correction for age, sex, comorbidity, cognitive impairment and functional dependence, independent predictors of any ICE were: being a bladder catheter holder (RR [risk ratio] 1.86, 95% CI 1.52-2.27), being on treatment at home with a proton pump inhibitor (PPI) (RR 1.25, 95% CI 1.03-1.53), with immunosuppressant therapy (RR 2.10, 95% CI 1.24-3.56), and body temperature at admission (RR 1.19, 95% CI 1.06-1.33). CONCLUSION: Four clinical characteristics, easily assessable at admission, may be useful to identify elderly inpatients at a higher risk for developing ICEs during hospital stay. Furthermore three of these predictors are modifiable factors, thus interventions reducing the use of catheter, PPI and immunosuppressants may result in reduction of ICEs.

Electrocardiographic monitoring for new prescriptions of quetiapine co-prescribed with acetylcholinesterase inhibitors or memantine from 2005 to 2009. A population study on community-dwelling older people in Italy.

PURPOSE: The aims of this study are to analyse, in community-dwelling people aged 65+ living in Italy's Lombardy Region, electrocardiographic (ECG) monitoring for new users of the atypical antipsychotic quetiapine co-prescribed with acetylcholinesterase inhibitors (AChEIs) or memantine and to find independent predictors of ECG monitoring before and after the starting of this prescription. METHODS: The Lombardy Region's administrative health database was used to retrieve prescriptions of ECG exams as well as prevalence rates of subjects aged 65+ who were prescribed such psychotropic drugs from 2005 to 2009. Multivariable analyses were adjusted for age, sex, number of drugs, treatment with beta-blockers, digoxin, verapamil or diltiazem, any antiarrhythmic drug and antidepressants. RESULTS: Overall 2,623 community-dwelling older people started therapy with quetiapine, co-prescribed with AChEIs or memantine, during these 5 years. At least one ECG was performed in 714 cases (27.2 %) in the 6 months before-and in 398 cases (15.2 %) within 3 months after-the starting of this prescription. ECG monitoring was performed both before and after starting quetiapine in only 160 cases (6.1 %). At multivariable analyses, number of drugs taken, beta-blocker and antiarrhythmic drug use were found to be independent correlates of ECG monitoring whereas female sex was associated with a lower probability of receiving an ECG within 3 months after the initiation of quetiapine (odds ratio 0.78, 95 % CI 0.62-0.98). CONCLUSIONS: ECG monitoring for new prescriptions of quetiapine in older people suffering from behavioural and psychological symptoms in dementia was actually performed infrequently, independently of the age of drug users, especially in women. Our results support the need for greater awareness within the medical community of the importance of such ECG monitoring.

New prescriptions of spironolactone associated with angiotensin-converting-enzyme inhibitors and/or angiotensin receptor blockers and their laboratory monitoring from 2001 to 2008: a population study on older people living in the community in Italy.

PURPOSE: To analyse, in older community-dwelling people living in Italy's Lombardy region, 8-year trends in new users of spironolactone co-prescribed with angiotensin-converting-enzyme inhibitors (ACE-Is) and/or angiotensin receptor blockers (ARBs); blood test monitoring; and independent predictors of appropriate blood test monitoring. METHODS: The region's administrative health database from 2001 to 2008 was used to retrieve yearly frequencies of subjects aged 65+ who started this co-prescription. Multivariate analyses were adjusted for age, sex, local health unit, treatment with beta-blockers, drugs for diabetes, and polypharmacy (i.e., exposure to five or more different drugs). RESULTS: Only new users of spironolactone co-prescribed with ARBs increased from 2001 to 2008 (P < 0.001). In the 6 months before starting the co-prescriptions 96 to 100% of patients measured serum creatinine (mean 99.3%), sodium (97.3%) and potassium (98.6%). Within 3 months of starting the co-prescriptions 96 to 99% of patients measured serum sodium (mean 97.3%) and potassium (98.6%), but on average only 48% of them (range 43 to 53%) measured serum creatinine, with an increase over time (odds ratio [change in regression per year] = 1.03, 95% CI 1.02-1.05, P < 0.001). At multivariate analysis polypharmacy was found to be the only independent predictor of such creatinine monitoring (P < 0.001). CONCLUSIONS: Our results support the need for greater awareness within the medical community of the potential renal toxicity of the association of spironolactone with ACE-Is and/or ARBs. Adequate short-term monitoring of serum creatinine in all older community-dwelling people who receive such co-prescription is necessary in order to ensure safe usage of these medications.

A short measure of quality of life in older age: the performance of the brief Older People's Quality of Life questionnaire (OPQOL-brief).

Promoting quality of life in older age is an internationally recognized priority, requiring valid measurement. We present a short version of the established Older People's Quality of Life questionnaire (OPQOL-brief). The full OPQOL-35 was original in being developed from the perspectives of older people, assessed conceptually, and validated with a population sample using gold-standard psychometric assessment. The OPQOL-brief was also developed by asking older people to prioritize the most important items from the OPQOL-35, next assessed psychometrically with a population sample, and also statistically against the discarded 22 items. The aim was to assess the psychometric properties of the short, 13-item version of the OPQOL (OPQOL-brief), and to compare the performance of included and discarded items. The method was a national population survey of people aged 65+ living at home. The measures were OPQOL-brief, WHOQOL-QOL and CASP-19. The OPQOL-brief was found to be a highly reliable and valid, short measure of quality of life in older age. The OPQOL-brief is of value in assessment of interventions where a rigorously tested, short measure is required. The grounded development of the instrument is consistent with international policy emphasis on user involvement in shaping policy and research.

Frailty syndrome diagnosed according to the Study of Osteoporotic Fractures criteria and mortality in older outpatients suffering from Alzheimer's disease: a one-year prospective cohort study.

OBJECTIVE: The frailty syndrome is associated with adverse clinical outcomes independently of cognitive impairment. The recent easy-to-apply Study of Osteoporotic Fractures (SOF) criteria for frailty could be useful to diagnose such syndrome also in Alzheimer's disease (AD) patients. The aim of this study was to apply these criteria among AD outpatients in order to determine: (i) the prevalence and correlates of frailty and (ii) the one-year predictors of death in this population. METHOD: This prospective cohort study enrolled 109 community-dwelling outpatients aged 65+ (median age 84 years) consecutively diagnosed with AD at a geriatric outpatient service in Italy in 2009. At baseline, participants underwent a comprehensive geriatric assessment including the evaluation of frailty status by means of the SOF criteria. Multiple logistic regression analysis was performed to find correlates of frailty. At a one-year follow-up, data on mortality were available for 95 participants and predictors of death were evaluated by means of multiple logistic regression analysis. RESULTS: Most participants had mild (52%) or moderate (29%) dementia. Frailty status was defined for all subjects at baseline: 25 (22%) were robust, 30 (28%) pre-frail and 54 (50%) frail. Independent correlates of frailty were age and dependence in the basic activities of daily living, and in particular in dressing. One year after enrolment, frailty was an independent predictor of death (odds ratio 11.27, 95% confidence interval 1.64-77.72, p = 0.014) after correction for age, sex, dependence in the basic activities of daily living, severity of cognitive impairment and comorbidity. CONCLUSION: Frailty status was diagnosed according to the SOF criteria in all AD outpatients and it was an independent one-year predictor of death. In order to provide them with appropriate prognostic evaluation and therapeutic advice all AD outpatients, especially those with specific disabilities, could be screened by means of the SOF criteria for frailty.

Frailty syndrome diagnosed according to the Study of Osteoporotic Fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study.

The easy-to-apply SOF criteria for frailty were recently validated in studies conducted in the U.S. only. In order to determine the ability of the SOF criteria to predict adverse health outcomes at a one-year follow-up in a sample of older outpatients in Italy we carried out a prospective cohort study on 265 community-dwelling outpatients aged 65+ (mean age 81.5 years) consecutively referred to a geriatric clinic. At baseline participants underwent a comprehensive geriatric assessment (CGA) including evaluation of their frailty status according to the SOF criteria. At a one-year follow-up, between June and December 2010, we investigated nursing home placement and death in all participants as well as any fall, any admission to the emergency department (ED), any hospitalization and a greater disability among the subset of subjects still living at home. One year after the visit 231 subjects were still living at home (87.2%), 9 had been placed in a nursing home (3.4%) and 25 had died (9.4%). Frailty was associated with a greater risk of falls (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.05-3.83, p=0.035), hospitalization (OR 2.08, 95% CI 1.02-4.24, p=0.045) and death (OR 3.07, 95% 1.02-4.24, p=0.045) after correction for demographic characteristics, comorbidity including dementia and depression, socioeconomic position and severe disability. Thus, in an older outpatient population in Italy the frailty syndrome diagnosed according to the SOF criteria was an independent predictor of several adverse health outcomes.

Quality of life in older outpatients living alone in the community in Italy.

There is limited knowledge on the relationship between the living conditions of community-dwelling older people and their quality of life (QOL) considered in all its specific domains. The purpose of this study was to determine (1) which dimensions of QOL were independently associated with living alone and (2) the independent correlates of these dimensions of QOL amongst older outpatients. We conducted a cross-sectional survey of 239 community-dwelling outpatients aged 65+ (mean age 81.5 years) consecutively referred to a geriatric medicine clinic in Italy between June and November 2009 (response rate 93%). Subjects underwent a comprehensive geriatric assessment including QOL, which was evaluated by using the Older People's QOL questionnaire. In multivariate logistic regression analyses, living alone was associated with the lowest score-based tertile of two specific dimensions of QOL out of seven, namely 'social relationships and participation' [odds ratio (OR) 2.73, 95% confidence interval (CI) 1.08-6.91] and 'home and neighbourhood' (OR 4.96, 95% CI 1.75-14.07), independently of the main demographic, social, functional and clinical characteristics of the subjects. Amongst the 107 subjects living alone, independent correlates of these dimensions of QOL were depression, having no caregiver and having never been married. Depression, having no caregiver and having never been married could provide a valuable means of identifying older people living alone who are at greater risk of a poor QOL and who would most benefit from effective social and medical interventions.

Older People's Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up. A prospective cohort study on older outpatients living in the community in Italy.

BACKGROUND: There is limited knowledge on the ability of a poor quality of life (QOL) and health-related QOL (HRQOL) to predict mortality and other adverse health events, independently of the frailty syndrome and other confounders, in older people living in the community and not selected on the basis of specific chronic conditions. Aim of this study was to evaluate the ability of the overall QOL and of the HRQOL to predict several adverse health outcomes at a one-year follow-up in an older outpatient population living in the community. METHODS: We carried out a prospective cohort study on 210 community-dwelling outpatients aged 65+ (mean age 81.2 yrs) consecutively referred to a geriatric clinic in Milan, Italy. At baseline participants underwent a comprehensive geriatric assessment including evaluation of overall QOL and HRQOL by means of the Older People's Quality of Life (OPQOL) questionnaire. At a one-year follow-up, between June and December 2010, we investigated nursing home placement and death in all 210 participants as well as any fall, any admission to the emergency department (ED), any hospitalisation and greater functional dependence among the subset of subjects still living at home. RESULTS: One year after the visit 187 subjects were still living at home (89%) while 7 had been placed in a nursing home (3.3%) and 16 had died (7.7%). At multiple logistic regression analyses the lowest score-based quartile of the OPQOL total score at baseline was independently associated with a greater risk of any fall and any ED admission. Also, the lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (odds ratio [OR] 10.03, 95% confidence interval [CI] 1.25-80.54, P = 0.030) and death (OR 4.23, 95% CI 1.06-16.81, P = 0.041). The correlation with the latter two health outcomes was found after correction for age, sex, education, income, living conditions, comorbidity, disability and the frailty syndrome. CONCLUSIONS: In an older outpatient population in Italy the OPQOL total score and its health-related sub-score were independent predictors of several adverse health outcomes at one year. Notably, poor HRQOL predicted both nursing home placement and death even after correction for the frailty syndrome. These findings support and enhance the prognostic relevance of QOL measures.

An easy intervention to improve short-term adherence to medications in community-dwelling older outpatients. A pilot non-randomised controlled trial.

BACKGROUND: Complex interventions to improve compliance to pharmacological treatment in older people have given mixed results and are not easily applicable in clinical practice. The aim of this study was to test the short-term efficacy on self-reported medication adherence of an easy intervention in which the patient or caregiver was asked to transcribe the pharmacological treatment while it was dictated to him/her by the doctor. METHODS: Pilot non-randomised controlled trial involving 108 community-dwelling outpatients aged 65+ (54 in the intervention arm, 54 controls) referred to a geriatric service from May to July 2009 and prescribed by the geriatrician a change in therapy. The intervention was applied at the end of the visit to the person managing the medications, be it the elder or his/her caregiver. Outcome of the study was the occurrence of any adherence error, assessed at a one-month follow-up by means of a semi-structured interview. RESULTS: The socio-demographic, functional and clinical characteristics of the two compared groups were similar at baseline. At a one-month follow-up 43 subjects (40%) had made at least one adherence error, whether unintentional or intentional. In the intervention group the prevalence of adherence errors was lower than in controls (20% vs 59%; adjusted odds ratio 0.16, 95% confidence interval 0.07 - 0.39; p < 0.001) after adjusting for the person managing the medications, the adherence errors at baseline and for the number of prescribed drugs. CONCLUSIONS: In an older outpatient population the intervention considered was effective in reducing the prevalence of adherence errors in the month following the visit. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000347965.

Social vulnerability, mental health and correlates of frailty in older outpatients living alone in the community in Italy.

OBJECTIVE: To determine the main social, functional and clinical characteristics of community-dwelling older outpatients living alone and to find correlates of frailty in this population. METHOD: Cross-sectional survey of 302 community-dwelling outpatients aged 65+ (median age 82 years) consecutively referred to a geriatric medicine clinic in Italy from June to November 2009. Participants underwent a comprehensive geriatric assessment including frailty status evaluated by means of the study of osteoporotic fractures (SOF) criteria. Student's t-test and the chi-squared test were used to compare subjects 'living alone' and 'not living alone' as well as 'frail' and 'not frail' subjects among the participants living alone. Multiple logistic regression analyses were performed to find independent correlates of frailty among participants living alone. RESULTS: Participants 'living alone' were 124 (41%). Compared to subjects 'not living alone' (n = 178), they were older, received less assistance from informal and formal caregivers, had poorer living and financial conditions, a better cognitive status and functional self-sufficiency but a worse emotional status. One-third of them (n = 41) were frail. Among frail elders (n = 116), subjects living alone also showed a higher prevalence of unexpected new diagnoses of dementia than those not living alone. Independent correlates of frailty among participants living alone were: having experienced a severe acute disease in the past year (odds ratio [OR] 303.9; 95% confidence interval [CI] 13-7091; p < 0.001), dependence in the bathing BADL ability (OR 62.74; 95% CI 12.17-323.32; p < 0.001), depression (OR 10.43; 95% CI 2.31-47.13; p = 0.002) and incontinence (OR 3.98; 95% CI 1.01-15.66; p = 0.048). CONCLUSION: In older outpatients living alone, including those who were frail, we found a lower availability of personal assistance, significantly more social and financial vulnerability and a higher risk of depression. In frail elders there was also a higher prevalence of underdiagnosed dementia. In order to better recognise frail subjects in this specific population, four independent correlates of frailty were identified.

Dimensions and correlates of quality of life according to frailty status: a cross-sectional study on community-dwelling older adults referred to an outpatient geriatric service in Italy.

BACKGROUND: There is a lack of knowledge concerning the relationship between two closely-linked multidimensional variables: frailty and quality of life (QOL). The aim of this study was to investigate dimensions and correlates of QOL associated with frailty status among community-dwelling older outpatients. METHODS: We conducted a cross-sectional survey of 239 community-dwelling outpatients aged 65+ (mean age 81.5 years) consecutively referred to a geriatric medicine clinic in Italy between June and November 2009. Participants underwent a comprehensive geriatric assessment, including assessment of their frailty status according to the Study of Osteoporotic Fractures (SOF) criteria, and QOL, which was evaluated by using the Older People's QOL (OPQOL) questionnaire. One-way ANOVA and chi-squared tests were used to find correlates of frailty, including QOL dimensions, after stratification of participants in the "robust" (n = 72), "pre-frail" (n = 89) and "frail" (n = 78) groups. Multiple linear regression analyses were performed to find correlates of QOL in the overall sample and among "frail" and "robust" participants. RESULTS: A negative trend of QOL with frailty status was found for almost all dimensions of QOL (health, independence, home and neighbourhood, psychological and emotional well-being, and leisure, activities and religion) except for social relationships and participation and financial circumstances. Independent correlates of a poor QOL in the total sample were "reduced energy level" (SOF criterion for frailty), depressive status, dependence in transferring and bathing abilities and money management (adjusted R squared 0.39); among "frail" participants the associations were with depressive status and younger age, and among "robust" participants the association was with lower body mass index. CONCLUSIONS: Five out of seven dimensions of QOL were negatively affected by frailty, but only one SOF criterion for frailty was independently related to QOL, after correction for age, functional status and depression. A more advanced age as well as a better affective status were correlates of a better QOL among frail elders. Interventions targeting the QOL in frail community-dwelling older outpatients should consider as outcomes, not only health-related QOL, but also other domains of the QOL.

Caregiver burden as a short-term predictor of weight loss in older outpatients suffering from mild to moderate Alzheimer's disease: a three months follow-up study.

OBJECTIVE: To determine if caregiver burden (CB) can be an independent predictive factor of weight loss at three months in older outpatients suffering from mild to moderate Alzheimer's disease (AD) and living at home. METHOD: Prospective cohort study involving 105 subjects aged 70 years or more, affected by mild to moderate AD and living at home with the assistance of at least one informal caregiver, who consecutively underwent a multidimensional geriatric assessment. Body weight was re-evaluated at a three month follow-up, from December 2008 to April 2009. Those who experienced a weight loss greater than 3% of the baseline weight constituted the 'weight loss' group. RESULTS: Out of the 97 older participants attending follow-up, 22 (23%) had experienced a weight loss > 3%. At a multivariate logistic regression analysis, a greater CB at baseline, defined by a score of the caregiver burden inventory scale in the highest tertile (i.e. 36+ out of 96), turned out to predict weight loss at three months (odds ratio (OR) 13.93, 95% confidence interval (CI) 1.91-101.33, p = 0.009), independently of other factors associated with the 'weight loss' group such as age, functional dependence and the risk of malnutrition estimated by means of the Mini Nutritional Assessment Short Form (MNA-SF). CONCLUSION: For older outpatients affected by mild to moderate AD and living at home, CB constitutes a risk factor for weight loss even in the short-term, independently of other factors such as the risk of malnutrition assessed by means of the MNA-SF.

Adenosine A2A receptor expression in peripheral blood mononuclear cells of patients with mild cognitive impairment.

Adenosine suppresses immune responses through the adenosine A2A receptors (A2AR). We evaluated the expression of A2AR in blood mononuclear cells (PBMCs) of patients with mild cognitive impairment (MCI), Alzheimer's disease (AD), and controls in order to verify if it may help distinguish different forms of cognitive decline. There was a significant linear increase in both mRNA levels and receptor density from multiple cognitive domain MCI (mcd-MCI) to amnestic MCI (a-MCI), spanning through AD and controls, without any significant difference between the latter two groups of subjects. These data, which need to be confirmed in a larger number of patients, suggest that expression of A2AR in PBMCs may be a valuable means of differentiating a-MCI and mcd-MCI.

Day care centre attendance and quality of life in depressed older adults living in the community.

Late-life depression is associated with disabled functioning and a poor quality of life (QOL). The aim of this cross-sectional study was to find out whether the attendance of a day care centre (DC) was associated with QOL in community-dwelling older adults suffering from a depressive disorder without dementia. The study enrolled 149 depressed older adults aged 70 or older, who consecutively underwent a comprehensive geriatric assessment from April to July 2008 at the Geriatric Medicine Unit of the Fondazione Ospedale Maggiore Policlinico in Milan, Italy. QOL was evaluated by means of the European Quality of Life Visual Analogue Scale (EuroQol VAS). DC attendance was quantified as number of days of attendance per week in the past month. Participants attending a DC at least once a week (n = 17) had a higher mean EuroQol VAS score than non-attendants (n = 132) (mean ± SD 58.8 ± 19 vs. 45.3 ± 22.5; P = 0.019). In multiple linear regression analysis a higher weekly attendance of DCs was related to a better quality of life according to the EuroQol VAS score (unstandardized coefficient 3.048, 95% CI 0.063-6.033, P = 0.045) after correction for age, sex, balance and gait abilities, comorbidity, pharmacotherapy, living alone, and severity of depression. Therefore, in older outpatients suffering from a depressive disorder without dementia the attendance of a DC was an independent correlate of the QOL. A randomized controlled longitudinal study will be necessary to determine whether attending a DC is really effective on the QOL in the management of late-life depression.

Quality of private personal care for elderly people in Italy living at home with disabilities: risk of nursing home placement at a 1-year follow-up.

The aim of this prospective study was to evaluate the correlation between the self-perceived quality of private personal care for elderly people living at home and the 1-year risk of hospital admission, nursing home placement and death. We enrolled 100 community-dwelling elderly outpatients (mean age 85 years), who had been receiving private personal care for any kind of disability for at least 1 month. Quality of care was described by both the elderly person without overt cognitive impairment and their informal caregivers, and this was categorised for analysis as 'poor or fair' or 'optimal or intermediate'. Rates of hospital admission, long-term care placement and death were assessed at a 1-year follow-up, between May 2006 and January 2008. One year after enrollment, 67 elderly people were still living at home, 10 had been institutionalised and 23 had died. Forty-six had experienced at least one hospital admission. The elderly people belonging to the 'poor or fair care' group (n = 16) showed a higher risk of nursing home placement when compared to the people belonging to the 'optimal or intermediate care' group (n = 84) (relative risk = 5.25, 95% confidence interval 1.72-16.06), without there being any significant difference between the two groups in terms of baseline assessment and basic functional status at follow-up. The quality of personal care was not a predictor of either hospital admission or death. Therefore, a poor or fair quality of personal care turned out to be a 1-year predictor of placement in a long-term care facility for community-dwelling older adults with a disability.

Quality of private personal care for elderly people with a disability living at home: correlates and potential outcomes.

To investigate correlates of the quality of private personal care for community-dwelling elderly people, this cross-sectional study enrolled 100 elderly outpatients living at home, along with their private aides and 88 informal caregivers, from May 2005 to January 2007. Cases were stratified according to the quality of private care as was described by both elderly participants and informal caregivers. In cases where the elderly person was suffering from overt cognitive impairment, only the opinions of the informal caregivers were taken into account. A comparison was made between the 'poor or fair care' group (n = 16), the 'intermediate care' group (n = 39) and the 'optimal care' group (n = 45). Considering the characteristics of private aides, there was a significant trend across the three groups in terms of language skills (P = 0.002) and level of distress with life conditions (P = 0.020). A statistical analysis performed on elderly participants without an overt cognitive impairment (n = 59) and informal caregivers showed an increase in the European Quality of Life Visual Analogue Scale score in the elderly group [mean +/- standard deviation (SD) were, respectively, 45 +/- 23.2, 63.7 +/- 19.7 and 68.8 +/- 21.6; P = 0.007], and a decrease in the Caregiver Burden Inventory score (mean +/- SD were, respectively, 34.9 +/- 25.3, 26 +/- 17.7 and 17.6 +/- 14.6; P = 0.020) across the three groups. We found no significant difference between elderly people in the three groups in terms of social variables, functional and cognitive status, prevalence of depressive disorders and morbidity. Therefore, good language skills and non-distressing life conditions of private aides appeared to be correlates of an optimal quality of care for community-dwelling elderly people with a disability, and also a better quality of life for them and less distress for their informal caregivers appeared to be potential outcomes of the quality of personal care.

A comprehensive evaluation of elderly people discharged from an Emergency Department.

Elderly people make extensive use of the Emergency Department (ED). After discharge from the ED, these patients are at high risk of short-term adverse outcomes such as functional decline, readmission to the ED, hospitalization and death. We investigated whether a comprehensive geriatric evaluation (CGE) and follow-up of the elderly discharged from the ED can provide them with better diagnosis and treatment, and thus reduce adverse outcomes. Out of 423 elderly patients over 75 years of age discharged from an ED we evaluated 222 of them. The patients were evaluated and treated, based on testing for physical, functional, cognitive and emotional status. A comparison was made between scale scores at baseline and 3 months later. We observed a significant improvement in physical and emotional status in all the studied patients, a significant improvement in behavioural status in the elderly patients with cognitive dysfunction, and a reduction of distress in the caregivers of the elderly patients with cognitive dysfunction and behavioural disturbances. We also found that the rate of ED readmission or hospitalization was lower than in the 3 months preceding the CGE. The experience of older patients with the ED system can be greatly improved if their complex needs are given due attention by developing interdisciplinary programs between emergency physicians, geriatricians, and primary care physicians.

Quality of spirometric performance in older people.

OBJECTIVES: chronic obstructive pulmonary disease and asthma are major causes of hospitalisation and mortality among older patients but respiratory diseases are often under- or misdiagnosed because spirometry is not extensively used at this age. DESIGN: we examined 715 elderly subjects with respiratory symptoms; all underwent a spirometric test and were administered the Mini Mental State Examination, Activities of Daily Living, Instrumental Activities of Daily Living and Geriatric Depression Scale questionnaires for cognitive, functional and effective evaluation. Their educational level and Body Mass Index were also taken into consideration. RESULTS: a total of 585 patients (81.8%) were able to perform spirometry according to ATS'94 criteria while 130 (18.2%) were unable to do it. As regards educational level, Mini Mental State Examination, Activities of Daily Living and Instrumental Activities of Daily Living scores showed a significant difference (P<0.001) between the groups of patients with high-quality spirometries and those with inadequate ones. There was no difference between the two groups in terms of age, Body Mass Index or Geriatric Depression Scale score. CONCLUSIONS: the majority of elderly subjects can perform spirometry according to international guidelines; age itself cannot be considered a risk factor for a bad spirometric performance, but it becomes influential if it is associated with cognitive and functional impairment.