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Ageing with HIV: newly diagnosed older adults in Italy
- Authors:
- ORCHI N., et al
- Journal article citation:
- AIDS Care, 20(4), April 2008, pp.419-425.
- Publisher:
- Taylor and Francis
The prevalence of HIV/AIDS among people in midlife and late adulthood has been increasing in Western countries over the last decade. This study analyzed data from a prospective, observational multi-centre study on individuals newly diagnosed with HIV between January 2004 and March 2007 in 10 public counselling and testing sites in Latium, Italy. To analyze the association of individual characteristics with age, the study compared older adults (≥50 years) with their younger counterpart (18-49 years). To adjust for potential confounding effect of the epidemiological, clinical and behavioural characteristics, to identify factors associated with older age at HIV diagnosis, multivariate logistic regression analysis was performed. Overall, 1,073 individuals were identified, 125 of whom (11.6%) were aged 50 years or above. The questionnaire was completed by 41%. Compared with their younger counterparts, a higher proportion of older patients were males, born in Italy, reported heterosexual or unknown HIV risk exposure, were never tested for HIV before and were in a more advanced stage of HIV infection at diagnosis. In addition, older adults had a lower educational level and were more frequently living with their partners or children. With respect to psycho-behavioural characteristics, older patients were more likely to have paid money for sex and have never used recreational drugs. No differences were found regarding condom use, which was poor in both age groups. These findings may have important implications for the management of older adults with HIV, who should be targeted by appropriate public health actions, such as opportunistic screening and easier access to healthcare. Moreover, strategies including information on HIV and prevention of risk behaviours are needed.
Discharge diagnosis and comorbidity profile in hospitalized older patients with dementia
- Authors:
- ZULIANI Giovanni, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(3), March 2012, pp.313-320.
- Publisher:
- Wiley
Dementia is known to be present in a significant proportion of hospitalised older patients, and may be associated with different pathologies and longer stays in hospital. The aim of this study was to investigate the prevalence of dementia in a large sample of hospitalised older individuals, and to analyse principal discharge diagnosis and related comorbidity in the patients affected by dementia. Data from 51,838 consecutive computerised discharge records of individuals aged 60 years and over from a hospital in Ferrara, Italy were analysed. The number of admissions, length of stay in hospital, primary and secondary discharge diagnosis, number of procedures, and possible death were evaluated. The findings showed that demented patients represented 8.6% of the sample and were older and more likely to be female patients. They were characterised by higher number of admissions to hospital, instrumental clinical investigations, secondary diagnoses, and mortality rate. Among the primary diagnoses, a higher prevalence of cerebrovascular disease, pneumonia, and hip fracture was observed in demented patients. Furthermore, pulmonary embolism, renal failure, septicaemia, and urinary infections were frequently reported in demented patients, but not in controls. As regards secondary diagnoses, dementia was associated with an increased risk of delirium, muscular atrophy and immobilisation, dehydration, cystitis, and pressure ulcers, whereas the risk for other conditions, including cancer, was reduced.
Poor mental and physical health differentially contributes to disability in hospitalized geriatric patients of different ages
- Authors:
- MARENGONI Alessandra, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(1), January 2004, pp.27-34.
- Publisher:
- Wiley
This article seeks to evaluate the relationship between depressive symptoms, cognition and somatic diseases on functional status of geriatric patients at hospital discharge. Patients 65+ years consecutively admitted to the acute care geriatric ward of the Internal Medicine Department I, Civil Hospital of Brescia, Italy, from February 1998 to December 2000 (n = 830) were examined. Functional disability was defined as need of physical assistance in at least one of the basic Activities of Daily Living (ADL). The Greenfield Index of Disease Severity (IDS) and the Geriatric Index of Comorbidity (GIC) were used to measure number and severity of diseases. The Mini-Mental State Examination (MMSE) assessed cognitive status and the Geriatric Depression Scale (GDS) measured depressive symptoms. Prevalence of functional disability at discharge was 29.3% in the younger age group (65-74 years) and 55.2% in the older age group (75+ years). Using logistic regression models, older age, poorer cognitive status, and depressive symptoms were independently associated with functional disability in the younger and older age group, respectively. Additionally cognitive impairment and depressive symptoms showed an additive association with disability, especially in younger patients, while comorbidity was correlated with functional status only in the oldest old, in particular among those who were cognitively impaired. Functional disability after acute hospitalization is highly prevalent in geriatric patients. Depressive symptoms, comorbidity, and cognitive impairment often coexist, interact and are differentially associated with function depending on age. Considering that depressive symptoms are a modifiable problem, their detection in hospital settings may help clinicians in targeting subjects at high risk of functional disability.