Moderate to severe depressive symptoms and rehabilitation outcome in older adults with hip fracture.

OBJECTIVE: To evaluate if depressive symptoms affect recovery of walking ability and 1-year institutionalization or mortality in older adults who underwent post-hip fracture (HF) surgery rehabilitation. METHODS: Depressive symptoms were assessed on admission using the 15-item Geriatric Depression Scale (GDS), with scores ≥10/15 indicating moderate to severe depressive symptoms. Multidimensional assessment included Mini Mental State Examination, Charlson Comorbidity Index, Body Mass Index, albumin serum levels, number of drugs, antidepressants and Barthel Index (BI) on admission and at discharge. Walking ability was evaluated using the BI walking sub-item referred to 1 month before HF, on admission, and at discharge. Patients scoring ≤3/15 BI walking sub-item on admission (i.e. those fully dependent or requiring major supervision in walking) were included. Walking independence at discharge was defined as a score ≥12/15 at the BI walking sub-item. RESULTS: In multivariate analyses, after adjustment for covariates and potential confounders, patients with moderate to severe depressive symptoms were more likely to fail walking independence at discharge (odds ratio, OR = 3.2; 95% CI = 1.3 to 7.8; p = 0.010) and to be institutionalized or died at 1 year (OR = 3.6, 95% CI = 1.4 to 9.1, p = 0.007). In further analyses, the failure to recover walking independence at discharge partly mediates the relationship between moderate to severe depressive symptoms and 1-year adverse events. CONCLUSIONS: Moderate to severe depressive symptoms affect the recovery of walking independence after HF rehabilitation and are associated with severe adverse outcomes at 1 year.

Changes of the quality-of-life under the treatment of severe senile osteoporosis with teriparatide.

Despite being treated with antiresorptive drugs, the severe osteoporosis (SO) is being considered as a condition in which patients are still subject to one or more vertebral or femoral fractures, or non-vertebral or non-femoral fractures, i.e., of other parts of the body such as the wrist, shoulder, tibia, ribs or hip. These patients are defined as non-responders (NRs) to the antiresorptive therapy, and recent research has shown that they represent 10-25% of all SO patients. During the last almost 3 years a new drug has become available in Italy, called teriparatide (rh-PTH-1-34), produced in Escherichia coli using the recombinant-DNA technique. It shows remarkable trophic and anabolic actions on the bones, and proved to be very useful for treating the osteoporosis in general. This study describes our experience in using teriparatide for the treatment of SO in a sample of 141 elderly women of mean age 73.4+/-5.8 years, with a mean number of fractures of 3.0+/-0.85, with a spine deformity index (SDI) of 5.92+/-1.27 and a mean vertebral T-Score (L1-L4) of -3.15+/-0.39, and a mean femoral T-Score of -2.50+/-0.28. All these patients had been treated with antiresorptive drugs for at least 1 year: specifically 70 of them with Alendronate, 42 of them with Risedronate and 29 of them with Raloxifene. For 18 months, all these patients were injected subcutaneously with 20 microg of teriparatide, with the daily addition of 1 g of calcium and 880 IU of vitamin D. The study was continued for 24 months, at the end of which the patients continued to take only calcium and vitamin D. The patients underwent a CBM-DEXA control of vertebral column and femur every 6 months, and they were also administered a Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). The QUALEFFO (41 items) questionnaire to evaluate the changes in the quality-of-life (QoL) and the consumption of non-steroidal anti-inflammatory drugs (NSAIDs) was also recorded. The results showed that teriparatide protected 96.5% against new fractures (only five new fractures occurred), bone mineral density (BMD) increased approximately by 12% in the vertebral column and by 11% in the femur, consumption of NSAIDs was reduced at the early stage approximately 80%, the QoL improved considerably and remained so during the 18 months of teriparatide treatment, with only a slight decrease during the 6 subsequent months.

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.

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.