1,721,053 research outputs found
Hospital length of stay and 30-day readmissions in older people: their association in a 20-year cohort study in Italy
Full text linkBackground: There are conflicting data on whether hospital length of stay (LOS) reduction affects readmission rates in older adults. We explored 20-year trends of hospital LOS and 30-day rehospitalizations in a cohort of Italian older people, and investigated their association. Methods: Participants in the Pro.V.A. project (n = 3099) were followed-up from 1996 to 2018. LOS and 30-day rehospitalizations, i.e. new hospitalizations within 30 days from a previous discharge, were obtained from personal interviews and regional registers. Rehospitalizations in the 6 months before death were also assessed. Linear regressions evaluated the associations between LOS and the frequency of 30-day rehospitalizations, adjusting for the mean age of the cohort within each year. Results: Over 20 years, 2320 (74.9%) participants were hospitalized. Mean LOS gradually decreased from 17.3 days in 1996 to 11.3 days in 2018, while 30-day rehospitalization rates increased from 6.6% in 1996 to 13.6% in 2018. LOS was inversely associated with 30-day rehospitalizations frequency over time (β = -2.33, p = 0.01), similarly in men and women. A total of 1506 individuals was hospitalized within 6 months before death. The frequency of 30-day readmissions at the end of life increased from 1.4% in 1997 to 8.3% in 2017 and was associated with mean LOS (β = -1.17, p = 0.03). Conclusions: The gradual LOS reduction observed in the latter decades is associated with higher 30-day readmission rates in older patients in Italy. This suggests that a careful pre-discharge assessment is warranted in older people, and that community healthcare services should be improved to reduce the risk of readmission
Mapping 15-year depressive symptom transitions in late life : population-based cohort study
No full textBackground The longitudinal course of late-life depression remains understudied. Aims To describe transitions along the depression continuum in old age and to identify factors associated with specific transition patterns. Method We analysed 15-year longitudinal data on 2745 dementia-free persons aged 60+ from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression (minor and major) was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; subsyndromal depression (SSD) was operationalised as the presence of ≥2 symptoms without depression. Multistate survival models were used to map depression transitions, including death, and to examine the association of psychosocial (social network, connection and support), lifestyle (smoking, alcohol consumption and physical activity) and clinical (somatic disease count) factors with transition patterns. Results Over the follow-up, 19.1% had ≥1 transitions across depressive states, while 6.5% had ≥2. Each additional somatic disease was associated with a higher hazard of progression from no depression (No Dep) to SSD (hazard ratio 1.09; 1.07–1.10) and depression (Dep) (hazard ratio 1.06; 1.04–1.08), but also with a lower recovery (HRSSD−No Dep 0.95; 0.93–0.97 [where ‘HR’ refers to ‘hazard ratio’]; HRDep−No Dep 0.96; 0.93–0.99). Physical activity was associated with an increased hazard of recovery to no depression from SSD (hazard ratio 1.49; 1.28–1.73) and depression (hazard ratio 1.20; 1.00–1.44), while a richer social network was associated with both higher recovery from (HRSSD−No Dep 1.44; 1.26–1.66; HRDep−No Dep 1.51; 1.34–1.71) and lower progression hazards to a worse depressive state (HRNo Dep−SSD 0.81; 0.70–0.94; HRNo Dep−Dep 0.58; 0.46–0.73; HRSSD−Dep 0.66; 0.44–0.98). Conclusions Older people may present with heterogeneous depressive trajectories. Targeting the accumulation of somatic diseases and enhancing social interactions may be appropriate for both depression prevention and burden reduction, while promoting physical activity may primarily benefit recovery from depressive disorders.</p
Association of mild and complex multimorbidity with structural brain changes in older adults: A population-based study
No full textINTRODUCTIONWe quantified the association of mild (ie, involving one or two body systems) and complex (ie, involving >= 3 systems) multimorbidity with structural brain changes in older adults.METHODSWe included 390 dementia-free participants aged 60+ from the Swedish National Study on Aging and Care in Kungsholmen who underwent brain magnetic resonance imaging at baseline and after 3 and/or 6 years. Using linear mixed models, we estimated the association between multimorbidity and changes in total brain tissue, ventricular, hippocampal, and white matter hyperintensities volumes.RESULTSCompared to non-multimorbid participants, those with complex multimorbidity showed the steepest reduction in total brain (beta*time -0.03, 95% CI -0.05, -0.01) and hippocampal (beta*time -0.05, 95% CI -0.08, -0.03) volumes, the greatest ventricular enlargement (beta*time 0.03, 95% CI 0.01, 0.05), and the fastest white matter hyperintensities accumulation (beta*time 0.04, 95% CI 0.01, 0.07).DISCUSSIONMultimorbidity, particularly when involving multiple body systems, is associated with accelerated structural brain changes, involving both neurodegeneration and vascular pathology.HighlightsMultimorbidity accelerates structural brain changes in cognitively intact older adultsThese brain changes encompass both neurodegeneration and cerebrovascular pathologyThe complexity of multimorbidity is associated with the rate of brain changes' progressio
Herbal Medications in Cardiovascular Medicine
Full text linkHerbal medications are commonly used for clinical purposes, including the treatment of cardiovascular conditions. Compared with conventional medications, herbal medications do not require clinical studies before their marketing or formal approval from regulatory agencies, and for this reason their efficacy and safety are rarely proven. In this review, we summarize available evidence on herbal medications mostly used in cardiovascular medicine. We show that the use of these medications for the treatment of cardiovascular diseases is often not supported by scientific evidence. Despite most of these herbs showing an effect on biological mechanisms related to the cardiovascular system, data on their clinical effects are lacking. Potential relevant side effects, including increased risk of drug interactions, are described, and the possibility of contamination or substitution with other medications represents a concern. Physicians should always assess the use of herbal medications with patients and discuss the possible benefits and side effects with them
Association of metabolic syndrome with falls in patients with Parkinson's disease
No full textBACKGROUND & AIMS:
Falls are a major threat for patients with Parkinson's disease, as they are associated with higher risk of morbidity, loss of functional ability, institutionalization, and mortality. Metabolic syndrome (MetS) is associated with poorer physical performance in middle age, but its impact in the older and frailer subjects is unclear. The present study aimed at assessing the association of MetS with falls in patients with Parkinson's disease.
METHODS:
We analyzed data of 194 elderly with Parkinson's disease attending a geriatric Day Hospital. History of falls that occurred over the last year, as well as and the number of falls, were recorded. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program's ATP-III criteria.
RESULTS:
Falls were reported by 91 participants (47%). Logistic regression analysis showed that MetS was associated with reduced occurrence of falls (OR = .26; 95% CI = .10-.69; P = .007). Also, among participants who fell, Poisson regression indicated that MetS predicted a reduced number of falls (IRR = .43; 95% CI = .20-.89; P = .024).
CONCLUSIONS:
In our population MetS was associated with reduced probability of falls; among subjects who fell, MetS was associated with a reduced number of falls. Dedicated studies are needed to better understand the subsystems involved, as well as the therapeutic implications of such an association
Dopaminergic agents and nutritional status in Parkinson's disease
No full textMalnutrition has been found in up to 24% of patients with Parkinson's disease; dopaminergic drugs might impair nutritional status. We evaluated the association of nutritional status with the use of dopaminergic agents
Multimorbidity patterns and blood biomarkers of Alzheimer's disease in community-dwelling cognitively unimpaired older adults
No full textINTRODUCTION: Alzheimer's disease (AD) blood biomarkers hold clinical potential but their concentration may vary with somatic conditions. METHODS: We investigated the concentration of six AD blood biomarkers in relation to multimorbidity as disease count and four multimorbidity patterns in 2290 cognitively unimpaired older adults. RESULTS: Levels of phosphorylated tau (p-tau)181, p-tau217, neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP) increased with increasing number of diseases. In multi-adjusted regressions, compared to individuals without multimorbidity, the anemia/sensory impairment pattern was associated with altered levels of all biomarkers except amyloid beta (Aβ)42/40, GFAP, and total tau (p-tau181: β = 0.18, 95% confidence interval [CI]: 0.08, 0.28; p-tau217: β = 0.11, 95% CI: 0.03, 0.18; NfL: β = 0.14, 95% CI: 0.06, 0.21) and the cardiometabolic/inflammatory pattern was associated with altered levels of all biomarkers except Aβ42/40 and GFAP (p-tau181: β = 0.24, 95% CI: 0.12, 0.36; p-tau217: β = 0.23, 95% CI: 0.14, 0.32; NfL: β = 0.32, 95% CI: 0.23, 0.40; total tau: β = 0.23, 95% CI: 0.07, 0.39). Results remained unchanged after excluding those who developed dementia in 15 years. DISCUSSION: More diseases and specific multimorbidity patterns altered the levels of several AD blood biomarkers, highlighting caution when using them in adults with complex health profiles. Highlights: In cognitively unimpaired older adults blood biomarkers of Alzheimer's disease varied depending on the number of chronic diseases and specific patterns of multimorbidity. Phosphorylated tau (p-tau)181, p-tau217, neurofilament light chain (NfL), and glial fibrillary acidic protein levels increased along with increasing numbers of chronic diseases. P-tau181, p-tau217, and NfL levels were significantly higher in individuals in the anemia/sensory impairment and cardiometabolic/inflammatory multimorbidity patterns compared to those without multimorbidity. Results remained unchanged after excluding participants who developed dementia during 15-year follow-up
Gender Differences in the Relationship Between Marital Status and the Development of Frailty: A Swedish Longitudinal Population-Based Study
No full textBackground: The gender-specific role of marital status for the development of frailty has not been clarified. This study evaluates the gender differences in the association between marital status and frailty development, and the possible modifying effect by age cohort in such a relationship.Methods: The sample included 2179 community-dwelling older adults involved in the Swedish National Study on Aging and Care in Kungsholmen, followed up for 6 years. Participants stable in marital status over time were categorized as partnered, widowed, single, and divorced. Changes were classified as losing one's partner and gaining a partner. Frailty was defined as the presence of three or more criteria among: weight loss, low physical activity, slow walking speed, weakness, and exhaustion. The association between marital status and frailty, with death as an alternative outcome and controlling for confounders, was estimated with multinomial logistic regressions.Results: Men who remained single (odds ratio [OR] = 2.50, 95% confidence interval [95% CI] 1.05 - 5.98) and those who lost their partner (OR = 2.59, 95% CI 1.16 - 5.77) had higher odds of frailty than those with a partner. The OR differed between younger (60-80 years) and older (>= 81 years) women (p-(interaction) = 0.04). The youngest women who remained divorced had a higher risk of frailty (OR = 2.75, 95% CI 1.24 - 6.08) than those who still had a partner. Conversely, older women who lost their partner had 80% (95% CI 0.05-0.86) lower odds of frailty than those with a partner.Conclusions: Marital status can influence frailty development differently for women and men. This gender-specific influence may vary by age cohort, perhaps in response to sociocultural factors
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