Raffaele Incalzi | Università Campus Bio-Medico di Roma (original) (raw)

Papers by Raffaele Incalzi

Research paper thumbnail of Disentangling the Impact of Chronic Kidney Disease, Anemia, and Mobility Limitation on Mortality in Older Patients Discharged From Hospital

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2015

Chronic kidney disease (CKD), anemia, and mobility limitation are important predictors of mortali... more Chronic kidney disease (CKD), anemia, and mobility limitation are important predictors of mortality. We aimed at investigating the interactions between estimated glomerular filtration rate (eGFR), anemia, and physical performance on 1-year mortality in older patients discharged from acute care hospitals. Four hundred and eighty seven patients enrolled in a multicenter, prospective observational study were included in the analysis. eGFR was estimated by the Berlin Initiative Study 1 equation. Anemia was defined on the basis of hemoglobin values. Mobility limitation was rated by the Short Physical Performance Battery (SPPB). Covariates included demographics, nutritional status, cognitive performance, and comorbidity. The outcome of the study was mortality over 1-year follow-up. Interactions among study variables were investigated by survival tree analysis. eGFR < 30mL/min/1.73 m(2), anemia, and SPPB = 0-4 were significantly associated with mortality, as were hypoalbuminemia and cognitive impairment. Survival tree analysis showed that compared to patients with SPPB ≥ 4 and eGFR ≥ 46.7mL/min/1.73 m(2) (ie, patients with the least mortality), patients with SPPB < 4 and hemoglobin < 12.2g/dL had the highest risk of mortality [hazard ratio (HR) = 28.9, 95%CI 10.3-81.2]. Patients with SPPB ≥ 4 and eGFR < 46.7mL/min/1.73 m(2) and those with SPPB > 4, hemoglobin ≥ 12.2g/dL, and eGFR ≥ 58.6mL/min/1.73 m(2) had intermediate risk (HR = 6.58, 95%CI = 2.15-20.2, and HR = 15.11, 95%CI=4.42-51.7, respectively). Having SPPB < 4, hemoglobin ≥ 12.2g/dL, and eGFR<58.6mL/min/l.73 m(2) was not significantly associated with increased mortality (HR = 2.95, 95%CI = 0.74-11.8). Interactions among eGFR, anemia, and mobility limitation define different profiles of risk in older patients discharged from acute care hospitals, which deserve to be considered to identify patients needing special care and careful follow-up after discharge.

Research paper thumbnail of Ruffled hair and fever in an old woman with Alzheimer's disease

Aging clinical and experimental research, 2005

In patients with dementia, the clinical presentation of unrelated medical conditions may be conce... more In patients with dementia, the clinical presentation of unrelated medical conditions may be concealed or atypical, and symptoms difficult to interpret, or confounded by existing cognitive deterioration or by medications. These difficulties pose an extraordinary challenge to clinicians, and may contribute to the disturbing evidence of inadequate assessment and treatment of medical conditions in patients with dementia. Here, we report the case of an 82-year old woman diagnosed with Alzheimer's disease, whose MMSE score started to deteriorate rapidly after six years of steady decline as a result of a temporal arteritis. Temporal arteritis, a diagnosis which is often made several months after the onset of symptoms even in the general population, can be difficult to identify in patients with pre-existing dementia.

Research paper thumbnail of Physical Function and Exercise in Older Patients with Cardiovascular and Respiratory Conditions

Current Pharmaceutical Design, 2014

The increase of life expectancy together with the decline of birth rates implies a global aging o... more The increase of life expectancy together with the decline of birth rates implies a global aging of populations living in industrialized countries. Since advanced age is associated with an exponential consumption of health care resources, this phenomenon is likely to pose a substantial threat to the stability of public health systems. Prevention of physical disability represents a major public health priority. Since disability is considered an irreversible condition, every effort should be made to prevent the onset of the disabling cascade and/or delay the physical function decline. The need for strategies against disability has led researchers to look for the most relevant risk factors potentially determining or accelerating the disabling cascade. In this context, cardiovascular and respiratory conditions have been indicated as playing prominent roles in the determination of frailty. Moreover, the high prevalence of these conditions among older persons makes them particularly amenable to targeting for preventive interventions. The aim of the present review is to show the impact of cardiovascular and respiratory conditions on physical function. Moreover, we will discuss the relationship of these conditions with the disabling process, and the importance of their assessment in the design of preventive interventions against disability in older persons.

Research paper thumbnail of Discriminative and predictive properties of disease-specific and generic health status indexes in elderly COPD patients

The association between bronchial obstruction severity and mortality in Chronic Obstructive Pulmo... more The association between bronchial obstruction severity and mortality in Chronic Obstructive Pulmonary Disease (COPD) is well established, but it is unknown whether diseasespecific health status measures and multidimensional assessment (MDA) have comparable prognostic value.

Research paper thumbnail of Inadequate caloric intake: a risk factor for mortality of geriatric patients in the acute-care hospital

Age and Ageing, 1998

Istrtuto di Medicina e Geriatria dell'Universrta' Cattolica, Policlinico A. Gemelli, La... more Istrtuto di Medicina e Geriatria dell'Universrta' Cattolica, Policlinico A. Gemelli, Largo A Gemelli 8, 00168 Roma, Italy 'Teaching Nursing Home 'Cittadella della Cartta', Taranto, Italy ... Address correspondence to: R. Antonelli Incalzi. Fax: (+39) 6 3051911 ... Objectives: to compare ...

Research paper thumbnail of Severe Hypoglycemia Is Associated With Antidiabetic Oral Treatment Compared With Insulin Analogs in Nursing Home Patients With Type 2 Diabetes and Dementia: Results From the DIMORA Study

Journal of the American Medical Directors Association, 2015

Severe hypoglycemia is associated with cognitive decline and dementia in older persons with type ... more Severe hypoglycemia is associated with cognitive decline and dementia in older persons with type 2 diabetes. The role of antidiabetic treatments on severe hypoglycemia is unknown in dementia. The aims were to determine the prevalence of severe hypoglycemic events and investigate associations among severe hypoglycemic and specific antidiabetic treatments (classes of oral agents and types of insulin analogs) in a large sample of nursing home patients with diabetes according to dementia status. Cross-sectional observational study. A total of 150 nursing homes across Italy. A total of 2258 patients with type 2 diabetes (dementia = 1138, no dementia = 1120). Diagnosis of dementia before nursing home admission. Data were collected regarding functional status, glycemic control, antidiabetic treatments, comorbidities, and biochemical and clinical measurements. Logistic regression models with severe hypoglycemia as the dependent variable were used to test associations with antidiabetic agents. Patients had a mean age (SD) of 82 (8) years, body mass index (BMI) of 25.4 (4.8), fasting plasma glucose (FPG) of 7.5 (3.0) mmol/L, postprandial glucose (PPG) of 10.3 (3.6) mmol/L, HbA1c of 7.1% (54 mmol/L), and impairments in activities of daily living (ADLs) of 3.7 (2.1). Severe hypoglycemia was more prevalent in patients with dementia (18%) compared with patients without dementia (8%). Patients with dementia were older, showed greater ADL impairments, greater number of comorbidities, lower FPG, and higher PPG compared with those without dementia. Adjusted logistic regression models in patients with dementia showed that rapid- and long-acting insulin analogs were associated with reduced odds ratio (OR) (OR 0.333; 95% confidence interval [CI] 0.184-0.602; OR 0.248, 95% CI 0.070-0.882, respectively), whereas sulphonylureas and combined metformin + sulphonylurea were associated with increased ORs (OR 8.805, 95% CI 4.260-18.201; OR 6.639; 95% CI 3.273-14.710, respectively) of experiencing severe hypoglycemia. No correlations were found in patients without dementia. In older nursing home patients with type 2 diabetes, severe hypoglycemia was significantly higher in dementia. Our findings suggest that sulphonylureas should be used with caution, whereas rapid- and long-acting insulin analogs seem safer.

Research paper thumbnail of Identifying older diabetic patients at risk of poor glycemic control

BMC geriatrics, Jan 23, 2002

Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patie... more Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patients at risk of poor glycemic control could help promoting dedicated interventions. The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients. A total of 1354 older diabetic in-patients consecutively enrolled in a multicenter study formed the training population (retrospective arm); 264 patients consecutively admitted to a ward of general medicine formed the testing population (prospective arm). Glycated hemoglobin (HbA1c) was measured on admission and one year after the discharge in the testing population. Independent correlates of a discharge glycemia > or = 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed. The ability of the prediction rule and that of admission HbA1c to predict discharge glycemia > or = 140 mg/dl and HbA1c >...

Research paper thumbnail of Outcomes of pharmacological trials are not for the elderly respiratory patient

American journal of respiratory and critical care medicine, Jan 15, 2014

Research paper thumbnail of Treating COPD in Older and Oldest Old Patients

Current pharmaceutical design, Jan 30, 2015

The treatment of older and oldest old patients with COPD poses several problems and should be tai... more The treatment of older and oldest old patients with COPD poses several problems and should be tailored to specific outcomes, such as physical functioning. Indeed, impaired homeostatic mechanisms, deteriorated physiological systems, and limited functional reserve mainly contribute to this complex scenario. Therefore, we reviewed the main difficulties in managing therapy for these patients and possible remedies. Inhaled long acting beta-agonists (LABA) and anticholinergics (LAMA) are the mainstay of therapy in stable COPD, but it should be considered that pharmacological response and safety profile may vary significantly in older patients with multimorbidity. Their association with inhaled corticosteroids is recommended only for patients with severe or very severe airflow limitation or with frequent exacerbations despite bronchodilator treatment. In hypoxemic patients, long-term oxygen therapy (LTOT) may improve not only general comfort and exercise tolerance, but also cognitive funct...

Research paper thumbnail of Longitudinal Association between Serum Leptin Concentration and Glomerular Filtration Rate in Humans

PloS one, 2015

Obesity is a risk factor for decline in glomerular filtration rate (GFR). One proposed mechanism ... more Obesity is a risk factor for decline in glomerular filtration rate (GFR). One proposed mechanism leading to glomerulopathy is an increase in leptin levels. However, the association between leptin and GFR has never been demonstrated. The aim of this study is to verify whether higher levels of leptin are associated with longitudinal changes of estimated GFR (eGFR). We selected 744 participants in the InCHIANTI study (416 women). The association between eGFR and leptin changes over a 6-years follow-up was assessed using random effect models including leptin as a time-varying covariate and adjusted for potential confounders. We also compared the proportion of patients with rapid decline of renal function across tertiles of change in serum leptin between baseline and 6-years follow-up. Mean baseline eGFR was 82.2 ml/min/1.73 m, 78.7 ml/min/1.73 m, and 75.4 ml/min/1.73 m in the first, second and third tertile of baseline serum leptin concentration, respectively. After adjustment for poten...

Research paper thumbnail of I limiti della farmacologia tradizionale

Research paper thumbnail of COPD, restrictive syndrome and inflammation

Research paper thumbnail of Comorbidity modulates non invasive ventilation-induced changes in breath print of obstructive sleep apnea syndrome patients

Sleep and Breathing, 2014

After online publication, subscribers (personal/institutional) to this journal will have access t... more After online publication, subscribers (personal/institutional) to this journal will have access to the complete article via the DOI using the URL:

Research paper thumbnail of A thrombotic snake in the thoracic aorta

Internal and Emergency Medicine, 2009

A 52-year-old woman was admitted to the surgery unit because of abdominal pain. She had a history... more A 52-year-old woman was admitted to the surgery unit because of abdominal pain. She had a history of smoking (10 cigarettes/day), high blood pressure, and hypothyroidism. Her current drug regimen included L-thyroxine 100 lg/day, ramipril 10 mg/day, and atenolol 50 mg/day. Routine blood examination revealed the presence of anemia (Hb 8.3 g/dl, serum iron 10 lg/dl, ferritin 5.46 ng/ml), high ESR (49 mm) with normal PCR values (0.36 mg/dl) and coagulation tests, and negative occult fecal blood. Chest X-ray study revealed the presence of dilated aortic arch, and gastroscopic examination showed a hiatus hernia. Electrocardiogram and transthoracic echocardiography were normal, while transesophageal echocardiography disclosed a thrombotic formation in the first tract of the descending aorta, which appeared as a ''thrombotic snake'' fluctuating in the lumen in the longitudinal projection . A CT scan confirmed the diagnosis of aortic thrombosis with an extension of about 7 cm. Lower limb echo-color Doppler revealed occlusion of the popliteal artery and collateral revascularization of the tibial arteries. Abdominal pain was interpreted as ischemic in origin due to celiac-mesenteric hypoperfusion

Research paper thumbnail of Associations of Heart Rate With Inflammatory Markers Are Modulated by Gender and Obesity in Older Adults

The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 26, 2014

Faster resting heart rate (HR), which is associated with inflammation and elevated cortisol level... more Faster resting heart rate (HR), which is associated with inflammation and elevated cortisol levels, is a risk factor for excess cardiovascular morbidity and mortality. Obesity is associated with increased cardiovascular morbidity and mortality, inflammation, and elevated cortisol levels. The aim of the present study was to evaluate the interaction of Body Mass Index (BMI) with inflammation and cortisol in modulating HR in older subjects. We analyzed data of 895 participants aged 65+ enrolled in the "InCHIANTI" study, in sinus rhythm, and not taking beta blockers or digoxin. Linear regression was performed to assess the adjusted association between HR, IL-6, and cortisol levels. The model was also analyzed stratifying for BMI tertiles. Logistic regression was adopted for evaluating the association of HR exceeding the mean value with Il-6 and serum cortisol. According to multivariable linear regression, IL-6 and cortisol levels were associated with HR (B = 1.42, 95% CI = 0.4...

Research paper thumbnail of Exhaled Breath Analysis for the Monitoring of Elderly COPD Patients Health-state

This pilot study assesses how effectively a gas sensors array can follow the evolution of elderly... more This pilot study assesses how effectively a gas sensors array can follow the evolution of elderly patients with COPD, the most common chronic respiratory disease. In particular, reproducibility of breath analysis (calculated for each subject along three weekly measurements) resulted comparable to spirometry, except for a larger spread for breath analysis, whose patterns was significantly correlated with other heath status

Research paper thumbnail of Polypharmacy in elderly patients at discharge from the acute care hospital

Therapeutics and Clinical Risk Management, 2007

Objective: To investigate correlates of polypharmacy at discharge from wards of general medicine ... more Objective: To investigate correlates of polypharmacy at discharge from wards of general medicine and geriatrics. Population: 2465 patients enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) study. Main outcome measure: Polypharmacy, ie having more than 6 drugs prescribed at discharge. Methods: Data on drugs prescribed at home, during hospital stay, and at discharge were collected according to a validated procedure. Logistic regression analysis was used to identify independent correlates of polypharmacy at discharge. The adherence to current therapeutic guidelines was assessed for selected drugs (digitalis, diuretics, antithrombotics, bronchodilators) Results: The median number of prescribed drugs was 3.0 before admission and 4.0 at discharge (p < 0.001). Polypharmacy prior to admission (Odds Ratio [OR] 4.32, 95% Confidence Interval [CI] 3.13-5.96), cumulative comorbidity (OR 1.81, 95% CI 1.40-2.32) and selected chronic conditions (diabetes, heart failure, chronic obstructive pulmonary disease, renal insufficiency, and depression) were significant correlates of polypharmacy at discharge. Negative correlate of the outcome was the occurrence of adverse drug reactions prior to admission (OR 0.22, 95% CI 0.09-0.51). The rate of appropriate prescription reached 80% only for antithrombotics either at home or in hospital and at discharge. Conclusions: Hospitalization increases drug prescription at discharge in elderly patients. Efforts are needed to identify the determinants and to assess the quality of this prescription practice, with the final aim of contrasting polypharmacy.

Research paper thumbnail of Depression and drug utilization in an elderly population

Therapeutics and Clinical Risk Management, 2005

Objective: To verify whether depression, defined as a 15-item Geriatric Depression Scale (GDS) > ... more Objective: To verify whether depression, defined as a 15-item Geriatric Depression Scale (GDS) > 6, is associated with greater drug utilization by elderly patients. Population: 2568 patients enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) study. Main outcome measure: Polypharmacy, ie, the daily use of at least 3 drugs, excluding antidepressant and anxiolytic agents, in the month prior to admission. Method: Home therapy data were collected according to a validated procedure. Correlates of polypharmacy were assessed by logistic regression analysis in the whole population and in subgroups for which indexes of disease severity were available. Results: GDS > 6 was found to be positively correlated with polypharmacy (odds ratio 1.22; 95% confidence interval 1.01-1.48) as were older age, comorbidity, hypertension, diabetes mellitus, congestive heart failure, and renal failure. Negative correlates of polypharmacy were smoking habit and alcohol consumption, and GDS > 6 was negatively associated with the use of analgesic (11.8% vs 15.6%, p = 0.012). In the subgroups with congestive heart failure and chronic renal failure, GDS > 6 was strictly associated with greater disease severity, but did not correlate with polypharmacy in multivariable models including indexes of disease severity. Conclusions: Depressed mood is associated with polypharmacy in the broad elderly population. However, when indexes of disease severity were considered, the association was lost, indicating that depression is a marker of the burden of disease and does not increase drug consumption per se.

Research paper thumbnail of Restrictive pulmonary dysfunction at spirometry and mortality in the elderly

Respiratory Medicine, 2008

Objectives: To evaluate the association between pulmonary restriction and mortality in the elderl... more Objectives: To evaluate the association between pulmonary restriction and mortality in the elderly, taking into account potential confounders not considered in the past (disability, cognitive dysfunction, diabetes, and visceral obesity). Design: Longitudinal study. Setting: Community-based. Participants: Twelve hundred sixty-five patients (51.9% men) aged 65e97 years old from the Salute Respiratoria nell'Anziano (SaRA) Italian multicentric study. Measurements: Participants were divided in 4 groups: normal spirometry (NS): FEV1/ FVC 70%, FVC 80% of predicted; restrictive ventilatory pattern (RVP): FEV1/FVC 70%, FVC < 80%; obstructive ventilatory pattern (OVP): FEV1/FVC < 70%, FVC 80%, and mixed ventilatory pattern (MVP): FEV1/FVC < 70%, FVC < 80%. We calculated the association between restriction and mortality corrected for potential confounders using a multivariable Cox regression model. Results: We found a prevalence of RVP, OVP and MVP of 10.9%, 25.4%, and 17.3%, respectively. Compared to people with normal spirometric pattern, disability (19.6% vs. 10.1%), poor physical performance (35.4% vs. 22.3%), cognitive impairment (21.0% vs. 11.5%), increased waist circumference (62.1% and 26.8%), and kyphoscoliosis (56.8 and 13.5%) were more prevalent in the RVP group. After correction for potential confounders, RVP was associated with increased mortality (HR: 1.89; 95% CI: 1.15e3.11), as well as OVP (HR: 2.33; 95% CI: 1.58e 3.11) and MVP (HR: 2.60; 95% CI: 1.74e3.93). Other factors associated with mortality were disability (HR: 1.92; 95% CI: 1.35e2.72), poor physical performance (HR: 1.37; 95% CI: 1.01e1.85), a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r m e d Respiratory Medicine (2008) 102, 1349e1354

Research paper thumbnail of Cognitive Training Is Ineffective in Hypoxemic COPD: A Six-Month Randomized Controlled Trial

Rejuvenation Research, 2008

Cognitive impairment is highly prevalent in chronic obstructive pulmonary disease (COPD) complica... more Cognitive impairment is highly prevalent in chronic obstructive pulmonary disease (COPD) complicated by chronic hypoxemia, but the effect of cognitive training in patients with COPD has not been studied. The aim of the present study was to verify whether cognitive training can preserve cognitive abilities of patients with hypoxemic COPD. Our series consisted of 105 COPD patients with at rest (n = 36) or effort (n = 69) hypoxemia and free from concurrent dementing diseases. Neuropsychologic assessment included a screening test, the Mini Mental State Examination (MMSE), and a standardized confirmatory battery of neuropsychological tests, the Mental Deterioration Battery (MDB). After baseline assessment, patients were randomized to receive standardized multidimensional care (standardization of pharmacological therapy, health education, selection of inhalers according to patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s ability, respiratory rehabilitation, nutritional counseling, oxygen therapy, and control visits) with (n = 53) or without (n = 52) cognitive training aimed at stimulating attention, learning, and logical-deductive thinking. Cognitive performance was reassessed after 1.5, 4, and 6 months. The analysis of variance for repeated measures (ANOVA) having the group membership (study vs. control) as grouping factor was used to assess changes in cognitive performance. Both intervention and control groups showed no significant changes in cognitive performance except for a trend toward improvement in verbal fluency and verbal memory, but cognitive intervention had no significant effect. In conclusion, cognitive training seems ineffective in COPD. However, a multidimensional standardized therapeutic approach, as it was indistinctly provided to all patients, could help to slow or prevent cognitive decline.

Research paper thumbnail of Disentangling the Impact of Chronic Kidney Disease, Anemia, and Mobility Limitation on Mortality in Older Patients Discharged From Hospital

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2015

Chronic kidney disease (CKD), anemia, and mobility limitation are important predictors of mortali... more Chronic kidney disease (CKD), anemia, and mobility limitation are important predictors of mortality. We aimed at investigating the interactions between estimated glomerular filtration rate (eGFR), anemia, and physical performance on 1-year mortality in older patients discharged from acute care hospitals. Four hundred and eighty seven patients enrolled in a multicenter, prospective observational study were included in the analysis. eGFR was estimated by the Berlin Initiative Study 1 equation. Anemia was defined on the basis of hemoglobin values. Mobility limitation was rated by the Short Physical Performance Battery (SPPB). Covariates included demographics, nutritional status, cognitive performance, and comorbidity. The outcome of the study was mortality over 1-year follow-up. Interactions among study variables were investigated by survival tree analysis. eGFR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 30mL/min/1.73 m(2), anemia, and SPPB = 0-4 were significantly associated with mortality, as were hypoalbuminemia and cognitive impairment. Survival tree analysis showed that compared to patients with SPPB ≥ 4 and eGFR ≥ 46.7mL/min/1.73 m(2) (ie, patients with the least mortality), patients with SPPB &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 4 and hemoglobin &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 12.2g/dL had the highest risk of mortality [hazard ratio (HR) = 28.9, 95%CI 10.3-81.2]. Patients with SPPB ≥ 4 and eGFR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 46.7mL/min/1.73 m(2) and those with SPPB &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 4, hemoglobin ≥ 12.2g/dL, and eGFR ≥ 58.6mL/min/1.73 m(2) had intermediate risk (HR = 6.58, 95%CI = 2.15-20.2, and HR = 15.11, 95%CI=4.42-51.7, respectively). Having SPPB &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 4, hemoglobin ≥ 12.2g/dL, and eGFR&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;58.6mL/min/l.73 m(2) was not significantly associated with increased mortality (HR = 2.95, 95%CI = 0.74-11.8). Interactions among eGFR, anemia, and mobility limitation define different profiles of risk in older patients discharged from acute care hospitals, which deserve to be considered to identify patients needing special care and careful follow-up after discharge.

Research paper thumbnail of Ruffled hair and fever in an old woman with Alzheimer's disease

Aging clinical and experimental research, 2005

In patients with dementia, the clinical presentation of unrelated medical conditions may be conce... more In patients with dementia, the clinical presentation of unrelated medical conditions may be concealed or atypical, and symptoms difficult to interpret, or confounded by existing cognitive deterioration or by medications. These difficulties pose an extraordinary challenge to clinicians, and may contribute to the disturbing evidence of inadequate assessment and treatment of medical conditions in patients with dementia. Here, we report the case of an 82-year old woman diagnosed with Alzheimer's disease, whose MMSE score started to deteriorate rapidly after six years of steady decline as a result of a temporal arteritis. Temporal arteritis, a diagnosis which is often made several months after the onset of symptoms even in the general population, can be difficult to identify in patients with pre-existing dementia.

Research paper thumbnail of Physical Function and Exercise in Older Patients with Cardiovascular and Respiratory Conditions

Current Pharmaceutical Design, 2014

The increase of life expectancy together with the decline of birth rates implies a global aging o... more The increase of life expectancy together with the decline of birth rates implies a global aging of populations living in industrialized countries. Since advanced age is associated with an exponential consumption of health care resources, this phenomenon is likely to pose a substantial threat to the stability of public health systems. Prevention of physical disability represents a major public health priority. Since disability is considered an irreversible condition, every effort should be made to prevent the onset of the disabling cascade and/or delay the physical function decline. The need for strategies against disability has led researchers to look for the most relevant risk factors potentially determining or accelerating the disabling cascade. In this context, cardiovascular and respiratory conditions have been indicated as playing prominent roles in the determination of frailty. Moreover, the high prevalence of these conditions among older persons makes them particularly amenable to targeting for preventive interventions. The aim of the present review is to show the impact of cardiovascular and respiratory conditions on physical function. Moreover, we will discuss the relationship of these conditions with the disabling process, and the importance of their assessment in the design of preventive interventions against disability in older persons.

Research paper thumbnail of Discriminative and predictive properties of disease-specific and generic health status indexes in elderly COPD patients

The association between bronchial obstruction severity and mortality in Chronic Obstructive Pulmo... more The association between bronchial obstruction severity and mortality in Chronic Obstructive Pulmonary Disease (COPD) is well established, but it is unknown whether diseasespecific health status measures and multidimensional assessment (MDA) have comparable prognostic value.

Research paper thumbnail of Inadequate caloric intake: a risk factor for mortality of geriatric patients in the acute-care hospital

Age and Ageing, 1998

Istrtuto di Medicina e Geriatria dell'Universrta' Cattolica, Policlinico A. Gemelli, La... more Istrtuto di Medicina e Geriatria dell'Universrta' Cattolica, Policlinico A. Gemelli, Largo A Gemelli 8, 00168 Roma, Italy 'Teaching Nursing Home 'Cittadella della Cartta', Taranto, Italy ... Address correspondence to: R. Antonelli Incalzi. Fax: (+39) 6 3051911 ... Objectives: to compare ...

Research paper thumbnail of Severe Hypoglycemia Is Associated With Antidiabetic Oral Treatment Compared With Insulin Analogs in Nursing Home Patients With Type 2 Diabetes and Dementia: Results From the DIMORA Study

Journal of the American Medical Directors Association, 2015

Severe hypoglycemia is associated with cognitive decline and dementia in older persons with type ... more Severe hypoglycemia is associated with cognitive decline and dementia in older persons with type 2 diabetes. The role of antidiabetic treatments on severe hypoglycemia is unknown in dementia. The aims were to determine the prevalence of severe hypoglycemic events and investigate associations among severe hypoglycemic and specific antidiabetic treatments (classes of oral agents and types of insulin analogs) in a large sample of nursing home patients with diabetes according to dementia status. Cross-sectional observational study. A total of 150 nursing homes across Italy. A total of 2258 patients with type 2 diabetes (dementia = 1138, no dementia = 1120). Diagnosis of dementia before nursing home admission. Data were collected regarding functional status, glycemic control, antidiabetic treatments, comorbidities, and biochemical and clinical measurements. Logistic regression models with severe hypoglycemia as the dependent variable were used to test associations with antidiabetic agents. Patients had a mean age (SD) of 82 (8) years, body mass index (BMI) of 25.4 (4.8), fasting plasma glucose (FPG) of 7.5 (3.0) mmol/L, postprandial glucose (PPG) of 10.3 (3.6) mmol/L, HbA1c of 7.1% (54 mmol/L), and impairments in activities of daily living (ADLs) of 3.7 (2.1). Severe hypoglycemia was more prevalent in patients with dementia (18%) compared with patients without dementia (8%). Patients with dementia were older, showed greater ADL impairments, greater number of comorbidities, lower FPG, and higher PPG compared with those without dementia. Adjusted logistic regression models in patients with dementia showed that rapid- and long-acting insulin analogs were associated with reduced odds ratio (OR) (OR 0.333; 95% confidence interval [CI] 0.184-0.602; OR 0.248, 95% CI 0.070-0.882, respectively), whereas sulphonylureas and combined metformin + sulphonylurea were associated with increased ORs (OR 8.805, 95% CI 4.260-18.201; OR 6.639; 95% CI 3.273-14.710, respectively) of experiencing severe hypoglycemia. No correlations were found in patients without dementia. In older nursing home patients with type 2 diabetes, severe hypoglycemia was significantly higher in dementia. Our findings suggest that sulphonylureas should be used with caution, whereas rapid- and long-acting insulin analogs seem safer.

Research paper thumbnail of Identifying older diabetic patients at risk of poor glycemic control

BMC geriatrics, Jan 23, 2002

Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patie... more Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patients at risk of poor glycemic control could help promoting dedicated interventions. The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients. A total of 1354 older diabetic in-patients consecutively enrolled in a multicenter study formed the training population (retrospective arm); 264 patients consecutively admitted to a ward of general medicine formed the testing population (prospective arm). Glycated hemoglobin (HbA1c) was measured on admission and one year after the discharge in the testing population. Independent correlates of a discharge glycemia > or = 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed. The ability of the prediction rule and that of admission HbA1c to predict discharge glycemia > or = 140 mg/dl and HbA1c >...

Research paper thumbnail of Outcomes of pharmacological trials are not for the elderly respiratory patient

American journal of respiratory and critical care medicine, Jan 15, 2014

Research paper thumbnail of Treating COPD in Older and Oldest Old Patients

Current pharmaceutical design, Jan 30, 2015

The treatment of older and oldest old patients with COPD poses several problems and should be tai... more The treatment of older and oldest old patients with COPD poses several problems and should be tailored to specific outcomes, such as physical functioning. Indeed, impaired homeostatic mechanisms, deteriorated physiological systems, and limited functional reserve mainly contribute to this complex scenario. Therefore, we reviewed the main difficulties in managing therapy for these patients and possible remedies. Inhaled long acting beta-agonists (LABA) and anticholinergics (LAMA) are the mainstay of therapy in stable COPD, but it should be considered that pharmacological response and safety profile may vary significantly in older patients with multimorbidity. Their association with inhaled corticosteroids is recommended only for patients with severe or very severe airflow limitation or with frequent exacerbations despite bronchodilator treatment. In hypoxemic patients, long-term oxygen therapy (LTOT) may improve not only general comfort and exercise tolerance, but also cognitive funct...

Research paper thumbnail of Longitudinal Association between Serum Leptin Concentration and Glomerular Filtration Rate in Humans

PloS one, 2015

Obesity is a risk factor for decline in glomerular filtration rate (GFR). One proposed mechanism ... more Obesity is a risk factor for decline in glomerular filtration rate (GFR). One proposed mechanism leading to glomerulopathy is an increase in leptin levels. However, the association between leptin and GFR has never been demonstrated. The aim of this study is to verify whether higher levels of leptin are associated with longitudinal changes of estimated GFR (eGFR). We selected 744 participants in the InCHIANTI study (416 women). The association between eGFR and leptin changes over a 6-years follow-up was assessed using random effect models including leptin as a time-varying covariate and adjusted for potential confounders. We also compared the proportion of patients with rapid decline of renal function across tertiles of change in serum leptin between baseline and 6-years follow-up. Mean baseline eGFR was 82.2 ml/min/1.73 m, 78.7 ml/min/1.73 m, and 75.4 ml/min/1.73 m in the first, second and third tertile of baseline serum leptin concentration, respectively. After adjustment for poten...

Research paper thumbnail of I limiti della farmacologia tradizionale

Research paper thumbnail of COPD, restrictive syndrome and inflammation

Research paper thumbnail of Comorbidity modulates non invasive ventilation-induced changes in breath print of obstructive sleep apnea syndrome patients

Sleep and Breathing, 2014

After online publication, subscribers (personal/institutional) to this journal will have access t... more After online publication, subscribers (personal/institutional) to this journal will have access to the complete article via the DOI using the URL:

Research paper thumbnail of A thrombotic snake in the thoracic aorta

Internal and Emergency Medicine, 2009

A 52-year-old woman was admitted to the surgery unit because of abdominal pain. She had a history... more A 52-year-old woman was admitted to the surgery unit because of abdominal pain. She had a history of smoking (10 cigarettes/day), high blood pressure, and hypothyroidism. Her current drug regimen included L-thyroxine 100 lg/day, ramipril 10 mg/day, and atenolol 50 mg/day. Routine blood examination revealed the presence of anemia (Hb 8.3 g/dl, serum iron 10 lg/dl, ferritin 5.46 ng/ml), high ESR (49 mm) with normal PCR values (0.36 mg/dl) and coagulation tests, and negative occult fecal blood. Chest X-ray study revealed the presence of dilated aortic arch, and gastroscopic examination showed a hiatus hernia. Electrocardiogram and transthoracic echocardiography were normal, while transesophageal echocardiography disclosed a thrombotic formation in the first tract of the descending aorta, which appeared as a ''thrombotic snake'' fluctuating in the lumen in the longitudinal projection . A CT scan confirmed the diagnosis of aortic thrombosis with an extension of about 7 cm. Lower limb echo-color Doppler revealed occlusion of the popliteal artery and collateral revascularization of the tibial arteries. Abdominal pain was interpreted as ischemic in origin due to celiac-mesenteric hypoperfusion

Research paper thumbnail of Associations of Heart Rate With Inflammatory Markers Are Modulated by Gender and Obesity in Older Adults

The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 26, 2014

Faster resting heart rate (HR), which is associated with inflammation and elevated cortisol level... more Faster resting heart rate (HR), which is associated with inflammation and elevated cortisol levels, is a risk factor for excess cardiovascular morbidity and mortality. Obesity is associated with increased cardiovascular morbidity and mortality, inflammation, and elevated cortisol levels. The aim of the present study was to evaluate the interaction of Body Mass Index (BMI) with inflammation and cortisol in modulating HR in older subjects. We analyzed data of 895 participants aged 65+ enrolled in the "InCHIANTI" study, in sinus rhythm, and not taking beta blockers or digoxin. Linear regression was performed to assess the adjusted association between HR, IL-6, and cortisol levels. The model was also analyzed stratifying for BMI tertiles. Logistic regression was adopted for evaluating the association of HR exceeding the mean value with Il-6 and serum cortisol. According to multivariable linear regression, IL-6 and cortisol levels were associated with HR (B = 1.42, 95% CI = 0.4...

Research paper thumbnail of Exhaled Breath Analysis for the Monitoring of Elderly COPD Patients Health-state

This pilot study assesses how effectively a gas sensors array can follow the evolution of elderly... more This pilot study assesses how effectively a gas sensors array can follow the evolution of elderly patients with COPD, the most common chronic respiratory disease. In particular, reproducibility of breath analysis (calculated for each subject along three weekly measurements) resulted comparable to spirometry, except for a larger spread for breath analysis, whose patterns was significantly correlated with other heath status

Research paper thumbnail of Polypharmacy in elderly patients at discharge from the acute care hospital

Therapeutics and Clinical Risk Management, 2007

Objective: To investigate correlates of polypharmacy at discharge from wards of general medicine ... more Objective: To investigate correlates of polypharmacy at discharge from wards of general medicine and geriatrics. Population: 2465 patients enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) study. Main outcome measure: Polypharmacy, ie having more than 6 drugs prescribed at discharge. Methods: Data on drugs prescribed at home, during hospital stay, and at discharge were collected according to a validated procedure. Logistic regression analysis was used to identify independent correlates of polypharmacy at discharge. The adherence to current therapeutic guidelines was assessed for selected drugs (digitalis, diuretics, antithrombotics, bronchodilators) Results: The median number of prescribed drugs was 3.0 before admission and 4.0 at discharge (p < 0.001). Polypharmacy prior to admission (Odds Ratio [OR] 4.32, 95% Confidence Interval [CI] 3.13-5.96), cumulative comorbidity (OR 1.81, 95% CI 1.40-2.32) and selected chronic conditions (diabetes, heart failure, chronic obstructive pulmonary disease, renal insufficiency, and depression) were significant correlates of polypharmacy at discharge. Negative correlate of the outcome was the occurrence of adverse drug reactions prior to admission (OR 0.22, 95% CI 0.09-0.51). The rate of appropriate prescription reached 80% only for antithrombotics either at home or in hospital and at discharge. Conclusions: Hospitalization increases drug prescription at discharge in elderly patients. Efforts are needed to identify the determinants and to assess the quality of this prescription practice, with the final aim of contrasting polypharmacy.

Research paper thumbnail of Depression and drug utilization in an elderly population

Therapeutics and Clinical Risk Management, 2005

Objective: To verify whether depression, defined as a 15-item Geriatric Depression Scale (GDS) > ... more Objective: To verify whether depression, defined as a 15-item Geriatric Depression Scale (GDS) > 6, is associated with greater drug utilization by elderly patients. Population: 2568 patients enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) study. Main outcome measure: Polypharmacy, ie, the daily use of at least 3 drugs, excluding antidepressant and anxiolytic agents, in the month prior to admission. Method: Home therapy data were collected according to a validated procedure. Correlates of polypharmacy were assessed by logistic regression analysis in the whole population and in subgroups for which indexes of disease severity were available. Results: GDS > 6 was found to be positively correlated with polypharmacy (odds ratio 1.22; 95% confidence interval 1.01-1.48) as were older age, comorbidity, hypertension, diabetes mellitus, congestive heart failure, and renal failure. Negative correlates of polypharmacy were smoking habit and alcohol consumption, and GDS > 6 was negatively associated with the use of analgesic (11.8% vs 15.6%, p = 0.012). In the subgroups with congestive heart failure and chronic renal failure, GDS > 6 was strictly associated with greater disease severity, but did not correlate with polypharmacy in multivariable models including indexes of disease severity. Conclusions: Depressed mood is associated with polypharmacy in the broad elderly population. However, when indexes of disease severity were considered, the association was lost, indicating that depression is a marker of the burden of disease and does not increase drug consumption per se.

Research paper thumbnail of Restrictive pulmonary dysfunction at spirometry and mortality in the elderly

Respiratory Medicine, 2008

Objectives: To evaluate the association between pulmonary restriction and mortality in the elderl... more Objectives: To evaluate the association between pulmonary restriction and mortality in the elderly, taking into account potential confounders not considered in the past (disability, cognitive dysfunction, diabetes, and visceral obesity). Design: Longitudinal study. Setting: Community-based. Participants: Twelve hundred sixty-five patients (51.9% men) aged 65e97 years old from the Salute Respiratoria nell'Anziano (SaRA) Italian multicentric study. Measurements: Participants were divided in 4 groups: normal spirometry (NS): FEV1/ FVC 70%, FVC 80% of predicted; restrictive ventilatory pattern (RVP): FEV1/FVC 70%, FVC < 80%; obstructive ventilatory pattern (OVP): FEV1/FVC < 70%, FVC 80%, and mixed ventilatory pattern (MVP): FEV1/FVC < 70%, FVC < 80%. We calculated the association between restriction and mortality corrected for potential confounders using a multivariable Cox regression model. Results: We found a prevalence of RVP, OVP and MVP of 10.9%, 25.4%, and 17.3%, respectively. Compared to people with normal spirometric pattern, disability (19.6% vs. 10.1%), poor physical performance (35.4% vs. 22.3%), cognitive impairment (21.0% vs. 11.5%), increased waist circumference (62.1% and 26.8%), and kyphoscoliosis (56.8 and 13.5%) were more prevalent in the RVP group. After correction for potential confounders, RVP was associated with increased mortality (HR: 1.89; 95% CI: 1.15e3.11), as well as OVP (HR: 2.33; 95% CI: 1.58e 3.11) and MVP (HR: 2.60; 95% CI: 1.74e3.93). Other factors associated with mortality were disability (HR: 1.92; 95% CI: 1.35e2.72), poor physical performance (HR: 1.37; 95% CI: 1.01e1.85), a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r m e d Respiratory Medicine (2008) 102, 1349e1354

Research paper thumbnail of Cognitive Training Is Ineffective in Hypoxemic COPD: A Six-Month Randomized Controlled Trial

Rejuvenation Research, 2008

Cognitive impairment is highly prevalent in chronic obstructive pulmonary disease (COPD) complica... more Cognitive impairment is highly prevalent in chronic obstructive pulmonary disease (COPD) complicated by chronic hypoxemia, but the effect of cognitive training in patients with COPD has not been studied. The aim of the present study was to verify whether cognitive training can preserve cognitive abilities of patients with hypoxemic COPD. Our series consisted of 105 COPD patients with at rest (n = 36) or effort (n = 69) hypoxemia and free from concurrent dementing diseases. Neuropsychologic assessment included a screening test, the Mini Mental State Examination (MMSE), and a standardized confirmatory battery of neuropsychological tests, the Mental Deterioration Battery (MDB). After baseline assessment, patients were randomized to receive standardized multidimensional care (standardization of pharmacological therapy, health education, selection of inhalers according to patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s ability, respiratory rehabilitation, nutritional counseling, oxygen therapy, and control visits) with (n = 53) or without (n = 52) cognitive training aimed at stimulating attention, learning, and logical-deductive thinking. Cognitive performance was reassessed after 1.5, 4, and 6 months. The analysis of variance for repeated measures (ANOVA) having the group membership (study vs. control) as grouping factor was used to assess changes in cognitive performance. Both intervention and control groups showed no significant changes in cognitive performance except for a trend toward improvement in verbal fluency and verbal memory, but cognitive intervention had no significant effect. In conclusion, cognitive training seems ineffective in COPD. However, a multidimensional standardized therapeutic approach, as it was indistinctly provided to all patients, could help to slow or prevent cognitive decline.