Geriatric Care

A rapid weight loss caused by therapeutic cannabinoid use in an elderly individual: a case report

Elisa Salsano — 2024-12-16

The proportion of older adults using medical cannabis is rising. Most of the cannabinoid research has focused on a healthy, younger population free from frailty and major comorbidity. In this case report, we describe an 82-year-old woman who was autonomous in basic and instrumental activities of daily living and who came to our geriatric department for marked weight loss over the past 2 months (about 10 kg) and anemia. After appropriate clinical and endoscopic checks, it was concluded that the weight loss was induced by the initiation of therapy with oral cannabis for the control of rheumatic pain.

An uncommon orthogeriatric syndrome: a case of Ogilvie’s syndrome

Elisa Salsano — 2024-07-15

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is an uncommon postoperative complication of major orthopedic surgery that is characterized by massive colonic dilatation and the potential for substantial morbidity and mortality. Most patients who had Ogilvie’s syndrome had risk factors that could be identified preoperatively, such as immobility, elevated comorbidity, and polypharmacy, prefiguring the frail elderly patient. In modern terms, it is considered a typical orthogeriatric syndrome. In these kinds of patients, we need to be vigilant for its development and judicious in the use of epidural anesthesia. We present an ACPO case in an elderly frail patient with a hip fracture, and we review the available literature to outline clinical characteristics and outcomes. Our patient presented numerous risk factors for developing the syndrome in the preoperative period: nonautonomy in basic and daily living activities, polypharmacotherapy, spinal trauma, and hyposodiemia. In this patient, epidural anesthesia was an additional risk factor. The purpose of this case report is to emphasize the presence of this rare syndrome (1.5% of orthogeriatric patients) in orthogeriatric departments and to identify not only pharmacological, traumatic, and electrolytic risk factors but also those that can be identified even through geriatric evaluation to avoid the use of anesthesiologic techniques and drugs that may have an impact on the prognosis of these patients.

Hypomagnesemia, hypogammaglobulinemia, and chronic normocytic normochromic anemia: random association? An unresolved case report of an elderly patient with remitting seronegative symmetrical synovitis with pitting edema syndrome

Mauro Turrin — 2024-07-04

This is the clinical case of an elderly man suffering from stabilized polypathology, affected by remitting seronegative symmetrical synovitis with pitting edema syndrome following anti-COVID vaccines, with evidence of persistent hypomagnesemia, coexisting chronic hypogammaglobulinemia and normochromic normocytic anemia. Although we investigated potential links between these conditions, the case remains partially unresolved.

A case report of extranodal diffuse large B-cell lymphoma involving upper limb soft tissue in a patient with rheumatoid arthritis on immunosuppressive therapy

Saverio Antonio Ciampi — 2024-03-25

An 80-year-old woman affected by rheumatoid arthritis on immunosuppressive therapy was evaluated for an 11-month history of swelling of her left upper limb. The patient did not report systemic symptoms. Ultrasonographic examination showed hypoechoic masses in the upper limb soft tissue, brachial vein thrombosis, and suspected malignant axillary lymphadenopathy. The patient underwent an excisional biopsy of the lymphadenopathy for histologic examination; a diagnosis of diffuse large B-cell lymphoma was made. The patient started anticoagulation therapy and chemotherapy, with a follow-up at a hematology clinic. At a 3-month follow-up visit in our clinic, the swelling of her left upper limb decreased, and an ultrasonographic control demonstrated a reduction in the size and number of the soft tissue masses and resolution of vein thrombosis.

38° Congresso nazionale SIGOT | Roma, 22-24 maggio 2024

the Editors — 2024-05-22

Abstract Book of the 38° SIGOT National Congress | Roma, May 22-24, 2024.

Association between decreased walking speed and higher-level functional capacity in community-dwelling older women

Suguru Ando — 2024-09-24

This study aimed to investigate the relationship between walking speed and higher-level functional capacity in community-dwelling older women. Data were collected from 91 healthy Japanese women aged ≥65 years (mean age, 78.7 years) in Ibaraki City, Osaka Prefecture. Participants’ higher-level functional capacity was assessed using the Japan Science and Technology Agency Index of Competence (JST-IC). Participants were categorized into two groups based on walking speed (faster or slower than 1.0 m/s). Logistic regression analysis revealed that grip strength [odds ratio (OR): 0.84; 95% confidence interval (CI): 0.713-0.992], the total JST-IC score (OR: 0.82; 95% CI: 0.675-0.997), and the JST-IC subscale for use of technology (OR: 0.54, 95% CI: 0.309-0.958) were significant factors associated with decreased walking speed. The decreased walking speed observed among community-dwelling older women was related to cognitive aspects such as processing and spatial perception, as well as the use of technology. Maintaining physical and cognitive functions, particularly hand function, is crucial for preserving or improving walking speed, a barometer of health.

Prevalence, pattern, and potential predictors of microvascular complications in aging Nigerians with type 2 diabetes

William Balogun — 2024-06-13

In low-resource settings like Nigeria, the rising prevalence of diabetes is accompanied by an excessive burden of microvascular complications from diabetes. This study aimed to determine the prevalence and predictors of microvascular complications among older patients with diabetes mellitus. Therefore, a 2-year retrospective cross-sectional study was carried out among elderly diabetes patients at the Chief Tony Anenih Geriatric Center outpatient diabetes clinic. A total of 148 diabetic patients were included in the study; the mean (± standard deviation) age was 70.89 (±6.99) years, with 71.6% of the studied population being female. Logistic regression analysis was employed to determine the prevalence and predictors of microvascular complications. Results show that the prevalence of microvascular complications in older diabetes patients was 73.9% [95% confidence interval (CI)=66.7-81.6] with peripheral neuropathy (77.1% prevalence, 95% CI=67.9-84.8) being the most common and retinopathy being the least prevalent (95% CI=4.7-16.8). The significant predictors of developing microvascular complications were intake of oral agents only [p=0.013, odds ratio (OR)=2.35, 95% CI=1.15-16.81], number of comorbidities (p=0.041, adjusted OR=5.28, 95% CI=1.09-27.93) and systolic blood pressure (p=0.042, OR=1.02, 95% CI=1.00-1.04). Considering the high prevalence of microvascular complications among aging patients with diabetes mellitus, older patients should comply with oral medications and undergo regular check-ups, and more advocacy should be undertaken to strengthen geriatric healthcare systems to mitigate comorbidities and reduce complications.

The medical treatment needs and in-home care service utilization of the elderly: a population-based data analysis of long-term care insurance payments in Tokyo, Japan

Hiromi Watanabe — 2024-03-25

How can we improve in-home care for the elderly with medical treatment needs? The purpose of this study is to investigate medical treatment and examine the use of home care services. We analyzed the long-term care insurance service payments data in City A (n=18,882) as of January 2019 and checked 12 medical treatment care needs items. The results showed that 10.1% (1913 of a total of 18,882) of people required medical treatment. The analysis was carried out by using a filter, “living in home” (n=15,320). We focused on urinary catheter and tube feeding. The study subjects are categorized into three groups: group 1 [both tubes (n=61)], group 2 [either tube (n=564)], and group 3 [no tube (n=14,698)]. The home help utilization rate was 27.9% in group 1, 29.9% in group 2, and 20.5% in group 3 (p<0.01). The home visit nursing utilization rate was 11.5% in group 1, 23.7% in group 2, and 8.1% in group 3 (p<0.01).

Sepsis and septic shock in geriatrics

Aurora Vitali — 2024-11-28

Sepsis is a potentially life-threatening condition that poses diagnostic challenges, particularly in the older population. Clinical manifestations of sepsis in these individuals can be blurred and atypical, making detection and diagnosis difficult. Common symptoms such as fever may be absent; conversely, older patients may present with atypical signs such as delirium, altered mental status, falls, weakness, and urinary incontinence. This can lead to delayed diagnosis, which increases the risk of rapid progression to septic shock. To improve diagnostic accuracy, various laboratory biomarkers and clinical scores have been developed, such as the Sequential (Sepsis-related) Organ Failure Assessment Score (SOFA-score), quick SOFA (qSOFA), and geriatric-qSOFA. These tools aid in identifying sepsis and predicting mortality risk promptly. In terms of treatment, early intervention is crucial. Maintaining adequate tissue perfusion (“fluid resuscitation”), appropriate antibiotic therapy, and eventually vasopressor support are key components of sepsis management in older adults. Additionally, in frail and comorbid patients, priority must be given to supportive care aimed at enhancing quality of life. Tailored therapeutic interventions are crucial to improving outcomes in this vulnerable population.

The comprehensive geriatric assessment in emergency and intensive unit settings

Mariagiovanna Cozza — 2024-10-01

This review discusses the challenges that hospitals face when caring for older patients in emergency departments and intensive care units. Beyond chronic diseases, the older person is often affected by acute events, which require, in addition to the typical knowledge of emergency medicine and anesthesia, the holistic and targeted approach of the comprehensive geriatric assessment in the emergency room and intensive care setting. With Italy’s health centers struggling to manage the increasing pressure of patients, the COVID-19 pandemic has highlighted the need for a geriatric approach to address this challenge. This review outlines the Geriatric 5Ms Model of Care, which addresses five domains, and the Domain Management Model, which provides acute medical management.

Enteral nutrition for elderly patients in intensive care unit settings

Simone Dini — 2024-05-09

Nutrition plays a fundamental role in the management of frail elderly patients. Indeed, effective management can reduce common pathological situations, such as malnutrition, refeeding syndrome, and aspiration pneumonia, which can increase morbidity and mortality in intensive care unit settings. To optimize this management, it is essential to have knowledge of basic aspects such as timing, route, and composition of nutrition, as well as the prevention and management of the most common adverse events.

Hyponatremia: practical considerations in the acute geriatric setting

Aurora Vitali — 2024-03-25

In older adults, hyponatremia often represents a medical emergency and is frequently associated with neurological manifestations or symptomatic pictures that the clinician mistakes for other pathologies. This paper deals with some practical considerations in the assessment and management of hyponatremia in older adults in the acute care setting, following the clinical discussion that took place at the Soave (Italy) meeting convened by the scientific committee of the Italian Society of Geriatrics Hospital and Territory.

Position paper on essential strategies for healthy aging: focus on preventing sarcopenia and cardiovascular diseases from the 38^th National Congress of the Italian Society of Geriatrics Hospital and Territory (SIGOT)

Virginia Boccardi — 2024-07-22

Italy’s demographic setting is rapidly evolving and is characterized by a substantial increase in the older population segment. This trend, driven by prolonged life expectancy and declining birth rates, positions Italy as a leader in global aging patterns. The 38^th National Congress of the Società Italiana di Geriatria Ospedale e Territorio (SIGOT), held in Rome, underlined the importance of addressing the health needs of this aging population, particularly focusing on preventing sarcopenia and cardiovascular diseases. Recent data challenge the notion of functional decline as an inevitable consequence of aging, highlighting the interplay of genetic, environmental, and lifestyle factors in modulating health outcomes. Sarcopenia, a prevalent condition and biological substrate of frailty, significantly impacts physical function and mortality rates, necessitating behavioral interventions to mitigate its effects. Physical exercise emerges as a key strategy for maintaining cardiovascular health and reducing the risk of arrhythmias, prevalent in older age groups. However, the complex relationship between physical activity intensity, age, and cardiovascular risk underlines the importance of tailored interventions and preliminary screenings. Looking ahead, proactive measures such as enhanced screening, promoting lifelong healthy habits, research and innovation, robust community support systems, and adaptable policies are essential to address the multifaceted challenges posed by an aging population. With this consensus paper, we aimed to summarize the key messages from the three intensive days of the SIGOT National Congress.