Geriatric Care <p><strong>Geriatric Care</strong> is the official journal of <a href="" target="_blank" rel="noopener">SIGOT</a> (<em>Società Italiana di Geriatria Ospedale e Territorio</em>), it is a recently-launched Open Access journal that seeks to publish high quality, peer-reviewed manuscripts dealing with the Geriatric Care in the different settings including the hospitals, residential services, nursing homes and home-care services for the elderly. The aim of the journal is to stimulate debate and dissemination of knowledge in the geriatric field in order to ameliorate efficacy, effectiveness and efficiency of interventions to improve health outcomes of the elderly people. <strong>Geriatric Care</strong> publishes contributions of epidemiology, pathophysiology and clinical assessment, management and treatments of the diseases of the older people, as well as health education and environmental health, hospital-residential-homecare management of the elderly including ethics, social and communication sciences, e-health and health technology assessment. Contributions on innovative topics of biological and genetics research, gender and disparity issues, as well as high-technology supports, i.e. domotics and robotics for the elderly, are welcome. <strong>Geriatric Care</strong> publishes <em>Original Articles</em>, <em>Review Articles</em>, <em>Brief Reports</em>, <em>Case Reports</em>, <em>Statement Reports</em> and <em>Editorials</em>.</p> <p>This journal does not apply charge for publication to Authors as it is supported by institutional funds.</p> PAGEPress Scientific Publications, Pavia, Italy en-US Geriatric Care 2465-1109 <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li class="show">the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li class="show">a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> The unavoidable costs of frailty: a geriatric perspective in the time of COVID-19 <p>The world is facing speechless one of the most feared, greatest catastrophes for human beings. Despite better healthcare systems, despite warnings through similar situations and even documented threats, as the COVID-19 pandemic hit, it found us largely unprepared. It offered to us on a silver tray the fragility of mankind. And once again, but this time in a particularly overwhelming way, the most vulnerable part of the world population is mowed down: older persons. Indeed, recent data from the Italian Istituto Superiore di Sanità showed that COVID-19 is more lethal in older subjects: in Italy, at the date of March 17, 2020, the overall case-fatality rate was 7.2% and 96.4% of died patients had more than 60 years. When data were stratified by age groups, individuals aged 70 years or older represent 35.5% of cases, while subjects aged ≥80 years were 52.3%. These data confirm once again that the older generation payed the highest price in time of crisis...</p> Maria Cristina Polidori Stefania Maggi Francesco Mattace-Raso Alberto Pilotto ##submission.copyrightStatement## 2020-03-30 2020-03-30 6 1 10.4081/gc.2020.8989 General practitioner attitudes and confidence to deprescribing for elderly patients <p>Deprescribing is a patient-centered process of medication withdrawal intended to achieve improved health outcomes through discontinuation of one or more medications that are either potentially harmful or no longer required. The objective of this study was to assess the perceptions of primary care physicians on deprescribing and potential barriers to deprescribing in the Local Health Authority (LHA) of Turin, Piedmont, Italy. Secondary objective was to evaluate educational needs of primary care physician. Cross sectional survey of primary care physicians working in the LHA of Turin, Piedmont, Italy. 439 GPs (71.3% of the total number of primary care physicians) attended an educational session related to deprescribing and were asked to anonymously answer a paper survey. Participants were asked to complete a previously published questionnaire about deprescribing and potential factors affecting the deprescribing process. A correlation coefficient was calculated to assess the association between physicians’ confidence in deprescribing and attitudes or barriers associated with deprescribing. Many GPs (71%) reported general confidence in their ability to deprescribe. Most respondents (83%) reported they were comfortable deprescribing preventive medications, however almost half expressed doubts regarding deprescribing when medication was initially prescribed by a colleague (45%) or when patient and/or caregiver supported the opportunity to continue the assumption (49%). Around a third of doctors maintain that the absence of strong evidence supporting deprescribing prevents them from considering it (38%), that they do not have the necessary time to effectively go through the process of deprescribing (29%), and that fear of possible effects due on withdrawal prevents them from deprescribing (31%). There was no strong correlation between physicians’ confidence and attitudes or barriers associated with deprescribing. The present study confirms that general practitioners sense the importance of deprescribing and feel prepared to face it managing communication with patients and caregivers, but find barriers when enacting the practice in a real-life context.</p> Pier Riccardo Rossi Sarah E. Hegarty Vittorio Maio Marco Lombardi Andrea Pizzini Aldo Mozzone Marzio Uberti Simonetta Miozzo ##submission.copyrightStatement## 2020-03-12 2020-03-12 6 1 10.4081/gc.2020.8703 The predictive efficacy of multidimensional prognostic index in the elderly with heart failure and reduced ejection fraction in a real world sample: the Post-Acute Long-Term Care setting <p>The multidimensional prognostic index (MPI) is an accurate predictor of mortality validated in hospitalized older patients. Aim of this study was to evaluate the reliability of the MPI in predicting shortand long-term mortality in patients with heart failure (HF), particularly in those with reduced left ventricular ejection fraction (HFrEF). The study population included all patients older than 65 years admitted in a Post-Acute Long-Care Unit from 2013 to 2018. Patients were divided into two groups: patients with HF (N=143) and patients without HF as controls (N=1254). Furthermore, patients affected by HF were subdivided according to echocardiographic left ventricular ejection fraction (LVEF), i.e. reduced, mid-range and preserved LVEF (respectively HFrEF, HFmrEF, HFpEF). All patients underwent a comprehensive geriatric assessment (CGA) to calculate the MPI based on information on functional, cognitive, nutritional and mobility status, comorbidity, poli-pharmacy and co-habitation. Mortality rates in the HF group was 46% in patients MPI-1 or MPI-2 groups versus 59% in patients included in the MPI- 3 group. In particular, of 32 HF patients with HFrEF 67.7% were in the MPI-3 class compared to 43% of 14 patients with HFmrEF group and to 41% of 63 patients with HFpEF. These findings suggest that MPI is a reliable predictor of mortality in HF patients and that it was particularly useful in the subgroup of patients with HFrEF.</p> Eleonora Pittui Caterina Dore Irene Mameli Angelo Scuteri Marco Dettori Antonio Uneddu ##submission.copyrightStatement## 2020-03-27 2020-03-27 6 1 10.4081/gc.2020.8407 Polymyalgia rheumatica following intravesical bacillus Calmette-Guerin instillation: coincidence or true association? A case report and literature review <p>We report the case of a 73-year-old male patient suffering from non muscle invasive bladder cancer (NMIBC) who had violent pains in his neck and shoulders associated with general discomfort and fever, following the second intravesical instillation of bacillus Calmette-Guerin (BCG), with further worsening after the third instillation. During his hospitalization, laboratory tests showed a significant raise of inflammatory markers. An ultrasound (US) examination of his shoulders showed bilateral longhead-biceps exudative tenosynovitis and subdeltoid bursitis. An 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) associated with total body computed tomography (CT) showed pathological inflammatory findings in neck and shoulders, with exclusion of pathological findings in other sites. Cystoscopy was negative for NMIBC recurrence. Polymyalgia rheumatica (PMR) was diagnosed and BCG instillations was stopped. The patient had fast improvement of clinical manifestations and laboratory tests, but when he resumed them a few weeks later, the same manifestations recurred.</p> Ciro Manzo ##submission.copyrightStatement## 2020-03-30 2020-03-30 6 1 10.4081/gc.2020.8868 Brief report on cognitive function and corticosteroid therapy in elderly <p>Glucocorticoids (GCs) are drugs commonly used for the treatment of a great number of acute or chronic pathological conditions. In a cross-sectional study we analyze a cohort of elderly patients treated for at least four weeks with a glucocorticoid (GC), exactly prednisone therapy, for a renal or rheumatological condition pointing out on functional, mental and clinical status. The main purpose was to assess change in cognitive performances. Corticosteroids administration also at low dosage in older subjects could enhance cognitive function. This observation should be proved in larger population and underlying mechanisms studied in deep.</p> Alberto Castagna Giuseppe Coppolino Carmen Ruberto Giovanni Ruotolo Ciro Manzo ##submission.copyrightStatement## 2020-04-02 2020-04-02 6 1 10.4081/gc.2020.8785