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Diagnostics
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Diagnosis and Management of Diseases in Fragile and Elderly Patients
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Diagnosis and Management of Diseases in Fragile and Elderly Patients

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 20469

Special Issue Editor

Dr. Silvia Giovannini

E-Mail Website
Guest Editor
Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
Interests: aging; internal medicine; geriatrics; rehabilitation; physical medicine; personalized medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As assessed by the World Health Organization and on the basis of the World Population Prospects 2019 (United Nations, 2019), by 2050, 1 in 6 people in the world will be over the age of 65. Population aging is a global phenomenon: in 2019, there were 703 million persons aged 65 years or over in the world. COVID-19 affected the most fragile patients, not only aged, and it forced us to consider, with close attention, diagnosis and treatment of diseases that affect patients that are considerably fragile.

This Special Issue is focused on the following aims:

  • Evaluation of the evidence on the diagnostic tools of fragile patients;
  • Overview of the different pathologies that affect the most fragile patients;
  • Assessment of the effects of specific drugs on symptom reduction and quality of life;
  • Role and development of detailed rehabilitation programs for fragile patients;
  • Analysis of the proper outcome measures.

Dr. Silvia Giovannini
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Aging
  • Fragile patients
  • Diagnosis
  • Management
  • Treatment
  • Therapy
  • Rehabilitation
  • Drug
  • Outcome measures
  • Quality of life

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Published Papers (7 papers)

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Research

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12 pages, 584 KiB  
Article
Multiparametric Evaluation of Geriatric Patients Admitted to Intermediate Care: Impact on Geriatric Rehabilitation
by Giuseppe Murdaca, Sara Banchero, Marco Casciaro, Francesca Paladin, Michele Tafuro, Fiammetta Monacelli, Alessio Nencioni, Roberta Bruschetta, Giovanni Pioggia, Gennaro Tartarisco and Sebastiano Gangemi
Diagnostics 2023, 13(18), 2906; https://doi.org/10.3390/diagnostics13182906 - 11 Sep 2023
Viewed by 1119
Abstract
Optimizing the functional status of patients of any age is a major global public health goal. Rehabilitation is a process in which a person with disabilities is accompanied to achieve the best possible physical, functional, social, intellectual, and relational outcomes. The Intermediate Care [...] Read more.
Optimizing the functional status of patients of any age is a major global public health goal. Rehabilitation is a process in which a person with disabilities is accompanied to achieve the best possible physical, functional, social, intellectual, and relational outcomes. The Intermediate Care Unit within the O.U. of Geriatrics and Gerontology of the San Martino Hospital in Genoa is focused on the treatment and motor reactivation of patients with geriatric pathologies. The objective of this study was to identify which factor, among the characteristics related to the patient and those identified by the geriatric evaluation, had the greatest impact on rehabilitation outcomes. Our findings revealed significant correlations between the Barthel Index delta, the 4AT Screening Test, and the number of drugs taken. This association highlights the potential benefits of medication management in enhancing the overall well-being and functional abilities of frail older adults, despite the literature suggesting that polypharmacotherapy is associated with a reduction in functional status and an increase in mortality. These findings underscore the significance of a multidimensional geriatric assessment. Refining and optimising these multidisciplinary approaches is the objective of a more effective geriatric rehabilitation strategy. Full article
(This article belongs to the Special Issue Diagnosis and Management of Diseases in Fragile and Elderly Patients)
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10 pages, 463 KiB  
Article
Diagnostic Value of Inflammatory Markers in Elderly Arab Women with Sarcopenia
by Dara Aldisi, Mahmoud M. A. Abulmeaty, Tafany A. Alsaawi, Abeer S. Alorf, Gadah Mujlli, Atheer M. Alshahrani, Rajwa M. Alahmari, Mohammed Alquraishi, Nasser M. Al-Daghri, Nawaf W. Alruwaili and Shaun Sabico
Diagnostics 2022, 12(10), 2293; https://doi.org/10.3390/diagnostics12102293 - 23 Sep 2022
Cited by 3 | Viewed by 2157
Abstract
Several studies have found a correlation between inflammatory markers and sarcopenia; however, limited research has been conducted on the Arabic population. Therefore, this study aimed to investigate the value of inflammatory parameters in Saudi elderly women with sarcopenia. In this cross-sectional study, 76 [...] Read more.
Several studies have found a correlation between inflammatory markers and sarcopenia; however, limited research has been conducted on the Arabic population. Therefore, this study aimed to investigate the value of inflammatory parameters in Saudi elderly women with sarcopenia. In this cross-sectional study, 76 elderly Saudi women (>65 years) were stratified according to the presence (n = 26) or absence (n = 50) of sarcopenia, using the operational definition of the Asian Working Group for Sarcopenia (AWGS). Demographics and clinical data were collected. Muscle mass, muscle strength, and physical performance were assessed using bioelectrical impedance, hand grip and timed-up-and-go (TUG) tests, respectively. Inflammatory markers such as interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α) and C-reactive protein (CRP) were assessed using commercially available assays. Muscle mass and strength indicators were lower in the sarcopenia group (p-value < 0.05). Moreover, interleukin 6 (IL-6) was positively correlated with TUG (r = 0.48, p-value < 0.05), while CRP showed an inverse correlation with the right leg muscle (R-Leg-M) and a positive correlation with triceps skinfold (TSF) (r = −0.41, r = 0.42, respectively, p-values < 0.05). Additionally, TSF and R-Leg-M were independent predictors of CRP variation (R2 = 0.35; p < 0.01). Lastly, participants with a TNF-α > 71.2 were five times more likely to have sarcopenia [(OR = 5.85), 95% CI: 1.07–32.08; p = 0.04]. In conclusion, elevated levels of TNF-α are significantly associated with the risk of sarcopenia, while variations perceived in circulating CRP can be explained by changes in the muscle mass indices only among individuals with sarcopenia. The present findings, while promising, need further investigations on a larger scale to determine whether inflammatory markers hold any diagnostic value in assessing sarcopenia among elderly Arab women. Full article
(This article belongs to the Special Issue Diagnosis and Management of Diseases in Fragile and Elderly Patients)
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10 pages, 1700 KiB  
Article
Effects of Social Distancing on Quality of Life and Emotional-Affective Sphere of Caregivers and Older Patients Hospitalized in Rehabilitation Departments during COVID-19 Quarantine: An Observational Study
by Irene Aprile, Francesca Falchini, Emiliano Mili, Alessia Mastrorosa, Emanuele Langone, Rita Mosca, Stefano Larocca, Michele Lategana, Loredana Aiello, Angela Lorusso, Mariacristina Siotto, Daniele Giansanti and Marco Germanotta
Diagnostics 2022, 12(6), 1299; https://doi.org/10.3390/diagnostics12061299 - 24 May 2022
Cited by 2 | Viewed by 1974
Abstract
During the COVID-19 emergency, institutional social distancing conditions were established, preventing family and caregivers’ access to rehabilitation departments. Our study goal was to assess inpatients’ and caregivers’ anxiety, depression, and Quality of Life (QoL) during the Italian lockdown due to the pandemic. We [...] Read more.
During the COVID-19 emergency, institutional social distancing conditions were established, preventing family and caregivers’ access to rehabilitation departments. Our study goal was to assess inpatients’ and caregivers’ anxiety, depression, and Quality of Life (QoL) during the Italian lockdown due to the pandemic. We investigated anxiety, depression, and QoL in 53 patients and 51 caregivers, using the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II), and the Short Form 36 Health Survey (SF36). These questionnaires were given to patients after one (T0) and two months (T1) since the hospitalization. The BAI showed that anxiety was moderate for 7.5% of patients and 23.5% of caregivers, and severe for 35.8% of patients and 17.6% of caregivers. The BDI found moderate depression in 11.3% of patients and 15.7% of caregivers, and severe depression in 34.0% of patients and 9.8% of caregivers. Depression was higher in patients than caregivers, while no differences were detected in anxiety. Compared to normative data, patients’ QoL declined in all eight SF36 dimensions, while caregivers’ QoL declined only in social, emotional, and mental components. Unexpectedly, patients still hospitalized at T1 showed significant improvements in both anxiety and three QoL subscores. These findings emphasize the importance of psychological support for patients and their families. Full article
(This article belongs to the Special Issue Diagnosis and Management of Diseases in Fragile and Elderly Patients)
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10 pages, 1067 KiB  
Article
Frailty Network in an Acute Care Setting: The New Perspective for Frail Older People
by Sara Salini, Silvia Giovannini, Marcello Covino, Christian Barillaro, Nicola Acampora, Ester Manes Gravina, Claudia Loreti, Francesco Paolo Damiano, Francesco Franceschi and Andrea Russo
Diagnostics 2022, 12(5), 1228; https://doi.org/10.3390/diagnostics12051228 - 13 May 2022
Cited by 8 | Viewed by 2346
Abstract
The incidence of elderly patients who come to the emergency room is progressively increasing. The specialization of the physician units might not be adequate for the evaluation of this complexity. The present study aimed to present a standard procedure, called ‘The Geriatric Frailty [...] Read more.
The incidence of elderly patients who come to the emergency room is progressively increasing. The specialization of the physician units might not be adequate for the evaluation of this complexity. The present study aimed to present a standard procedure, called ‘The Geriatric Frailty Network’, operating at the Policlinico Gemelli IRCCS Foundation, which is configured specifically for the level II assessment of frail elderly patients. This was a retrospective study in 1191 patients aged over 65, who were evaluated by the Geriatric Frailty Unit directly after emergency department admission for one year. All patients underwent multidimensional geriatric evaluation. Data were collected on demographics, co-morbidity, disease severity, and Clinical Frailty Scale. Among all patients, 723 were discharged directly from the emergency room with early identification of continuity of care path. Globally, 468 patients were hospitalized with an early assessment of frailty that facilitated the discharge process. The geriatric frailty network model aims to assist the emergency room and ward doctor in the prevention of the most common geriatric syndromes and reduce the number of incongruous hospitalizations. Full article
(This article belongs to the Special Issue Diagnosis and Management of Diseases in Fragile and Elderly Patients)
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Review

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18 pages, 290 KiB  
Review
Comprehensive Peri-Operative Risk Assessment and Management of Geriatric Patients
by Nikolaos Theodorakis, Maria Nikolaou, Christos Hitas, Dimitrios Anagnostou, Magdalini Kreouzi, Sofia Kalantzi, Aikaterini Spyridaki, Gesthimani Triantafylli, Panagiota Metheniti and Ioannis Papaconstantinou
Diagnostics 2024, 14(19), 2153; https://doi.org/10.3390/diagnostics14192153 - 27 Sep 2024
Cited by 2 | Viewed by 1044
Abstract
Background: As the population ages, the prevalence of surgical interventions in individuals aged 65+ continues to increase. This poses unique challenges due to the higher incidence of comorbidities, polypharmacy, and frailty in the elderly population, which result in high peri-operative risks. Traditional preoperative [...] Read more.
Background: As the population ages, the prevalence of surgical interventions in individuals aged 65+ continues to increase. This poses unique challenges due to the higher incidence of comorbidities, polypharmacy, and frailty in the elderly population, which result in high peri-operative risks. Traditional preoperative risk assessment tools often fail to accurately predict post-operative outcomes in the elderly, overlooking the complex interplay of factors that contribute to risk in the elderly. Methods: A literature review was conducted, focusing on the predictive value of CGA for postoperative prognosis and the implementation of perioperative interventions. Results: Evidence shows that CGA is a superior predictive tool compared to traditional models, as it more accurately identifies elderly patients at higher risk of complications such as postoperative delirium, infections, and prolonged hospital stays. CGA includes assessments of frailty, sarcopenia, nutritional status, cognitive function, mental health, and functional status, which are crucial in predicting post-operative outcomes. Studies demonstrate that CGA can also guide personalized perioperative care, including nutritional support, physical training, and mental health interventions, leading to improved surgical outcomes and reduced functional decline. Conclusions: The CGA provides a more holistic approach to perioperative risk assessment in elderly patients, addressing the limitations of traditional tools. CGA can help guide surgical decisions (e.g., curative or palliative) and select the profiles of patients that will benefit from perioperative interventions to improve their prognosis and prevent functional decline. Full article
(This article belongs to the Special Issue Diagnosis and Management of Diseases in Fragile and Elderly Patients)
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15 pages, 582 KiB  
Review
Vascular Aging and Damage in Patients with Iron Metabolism Disorders
by Krzysztof Młodziński, Michał Świątczak, Justyna Rohun, Jacek Wolf, Krzysztof Narkiewicz, Marcin Hellmann and Ludmiła Daniłowicz-Szymanowicz
Diagnostics 2022, 12(11), 2817; https://doi.org/10.3390/diagnostics12112817 - 16 Nov 2022
Cited by 3 | Viewed by 2153
Abstract
Vascular aging is a physiological, multifactorial process that involves every type of vessel, from large arteries to microcirculation. This manifests itself as impaired vasomotor function, altered secretory phenotype, deteriorated intercellular transport function, structural remodeling, and aggravated barrier function between the blood and the [...] Read more.
Vascular aging is a physiological, multifactorial process that involves every type of vessel, from large arteries to microcirculation. This manifests itself as impaired vasomotor function, altered secretory phenotype, deteriorated intercellular transport function, structural remodeling, and aggravated barrier function between the blood and the vascular smooth muscle layer. Iron disorders, particularly iron overload, may lead to oxidative stress and, among other effects, vascular aging. The elevated transferrin saturation and serum iron levels observed in iron overload lead to the formation of a non-transferrin-bound iron (NTBI) fraction with high pro-oxidant activity. NTBI can induce the production of reactive oxygen species (ROS), which induce lipid peroxidation and mediate iron-related damage as the elements of oxidative stress in many tissues, including heart and vessels’ mitochondria. However, the available data make it difficult to precisely determine the impact of iron metabolism disorders on vascular aging; therefore, the relationship requires further investigation. Our study aims to present the current state of knowledge on vascular aging in patients with deteriorated iron metabolism. Full article
(This article belongs to the Special Issue Diagnosis and Management of Diseases in Fragile and Elderly Patients)
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18 pages, 804 KiB  
Review
Chronic Fatigue Syndrome in Patients with Deteriorated Iron Metabolism
by Michał Świątczak, Krzysztof Młodziński, Katarzyna Sikorska, Alicja Raczak, Paweł Lipiński and Ludmiła Daniłowicz-Szymanowicz
Diagnostics 2022, 12(9), 2057; https://doi.org/10.3390/diagnostics12092057 - 25 Aug 2022
Cited by 5 | Viewed by 8374
Abstract
Fatigue is a common, non-specific symptom that often impairs patients’ quality of life. Even though fatigue may be the first symptom of many serious diseases, it is often underestimated due to its non-specific nature. Iron metabolism disorders are a prominent example of conditions [...] Read more.
Fatigue is a common, non-specific symptom that often impairs patients’ quality of life. Even though fatigue may be the first symptom of many serious diseases, it is often underestimated due to its non-specific nature. Iron metabolism disorders are a prominent example of conditions where fatigue is a leading symptom. Whether it is an iron deficiency or overload, tiredness is one of the most common features. Despite significant progress in diagnosing and treating iron pathologies, the approach to chronic fatigue syndrome in such patients is not precisely determined. Our study aims to present the current state of knowledge on fatigue in patients with deteriorated iron metabolism. Full article
(This article belongs to the Special Issue Diagnosis and Management of Diseases in Fragile and Elderly Patients)
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