Gloria Pina

University of Milan, Milano, Lombardy, Italy

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Publications (3)5.31 Total impact

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    ABSTRACT: The frailty syndrome is associated with adverse clinical outcomes independently of cognitive impairment. The recent easy-to-apply Study of Osteoporotic Fractures (SOF) criteria for frailty could be useful to diagnose such syndrome also in Alzheimer's disease (AD) patients. The aim of this study was to apply these criteria among AD outpatients in order to determine: (i) the prevalence and correlates of frailty and (ii) the one-year predictors of death in this population. This prospective cohort study enrolled 109 community-dwelling outpatients aged 65+ (median age 84 years) consecutively diagnosed with AD at a geriatric outpatient service in Italy in 2009. At baseline, participants underwent a comprehensive geriatric assessment including the evaluation of frailty status by means of the SOF criteria. Multiple logistic regression analysis was performed to find correlates of frailty. At a one-year follow-up, data on mortality were available for 95 participants and predictors of death were evaluated by means of multiple logistic regression analysis. Most participants had mild (52%) or moderate (29%) dementia. Frailty status was defined for all subjects at baseline: 25 (22%) were robust, 30 (28%) pre-frail and 54 (50%) frail. Independent correlates of frailty were age and dependence in the basic activities of daily living, and in particular in dressing. One year after enrolment, frailty was an independent predictor of death (odds ratio 11.27, 95% confidence interval 1.64-77.72, p = 0.014) after correction for age, sex, dependence in the basic activities of daily living, severity of cognitive impairment and comorbidity. Frailty status was diagnosed according to the SOF criteria in all AD outpatients and it was an independent one-year predictor of death. In order to provide them with appropriate prognostic evaluation and therapeutic advice all AD outpatients, especially those with specific disabilities, could be screened by means of the SOF criteria for frailty.
    Aging and Mental Health 10/2011; 16(3):273-80. · 1.68 Impact Factor
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    ABSTRACT: There is limited knowledge on the ability of a poor quality of life (QOL) and health-related QOL (HRQOL) to predict mortality and other adverse health events, independently of the frailty syndrome and other confounders, in older people living in the community and not selected on the basis of specific chronic conditions. Aim of this study was to evaluate the ability of the overall QOL and of the HRQOL to predict several adverse health outcomes at a one-year follow-up in an older outpatient population living in the community. We carried out a prospective cohort study on 210 community-dwelling outpatients aged 65+ (mean age 81.2 yrs) consecutively referred to a geriatric clinic in Milan, Italy. At baseline participants underwent a comprehensive geriatric assessment including evaluation of overall QOL and HRQOL by means of the Older People's Quality of Life (OPQOL) questionnaire. At a one-year follow-up, between June and December 2010, we investigated nursing home placement and death in all 210 participants as well as any fall, any admission to the emergency department (ED), any hospitalisation and greater functional dependence among the subset of subjects still living at home. One year after the visit 187 subjects were still living at home (89%) while 7 had been placed in a nursing home (3.3%) and 16 had died (7.7%). At multiple logistic regression analyses the lowest score-based quartile of the OPQOL total score at baseline was independently associated with a greater risk of any fall and any ED admission. Also, the lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (odds ratio [OR] 10.03, 95% confidence interval [CI] 1.25-80.54, P = 0.030) and death (OR 4.23, 95% CI 1.06-16.81, P = 0.041). The correlation with the latter two health outcomes was found after correction for age, sex, education, income, living conditions, comorbidity, disability and the frailty syndrome. In an older outpatient population in Italy the OPQOL total score and its health-related sub-score were independent predictors of several adverse health outcomes at one year. Notably, poor HRQOL predicted both nursing home placement and death even after correction for the frailty syndrome. These findings support and enhance the prognostic relevance of QOL measures.
    Health and Quality of Life Outcomes 09/2011; 9:72. · 2.27 Impact Factor
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    ABSTRACT: The easy-to-apply SOF criteria for frailty were recently validated in studies conducted in the U.S. only. In order to determine the ability of the SOF criteria to predict adverse health outcomes at a one-year follow-up in a sample of older outpatients in Italy we carried out a prospective cohort study on 265 community-dwelling outpatients aged 65+ (mean age 81.5 years) consecutively referred to a geriatric clinic. At baseline participants underwent a comprehensive geriatric assessment (CGA) including evaluation of their frailty status according to the SOF criteria. At a one-year follow-up, between June and December 2010, we investigated nursing home placement and death in all participants as well as any fall, any admission to the emergency department (ED), any hospitalization and a greater disability among the subset of subjects still living at home. One year after the visit 231 subjects were still living at home (87.2%), 9 had been placed in a nursing home (3.4%) and 25 had died (9.4%). Frailty was associated with a greater risk of falls (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.05-3.83, p=0.035), hospitalization (OR 2.08, 95% CI 1.02-4.24, p=0.045) and death (OR 3.07, 95% 1.02-4.24, p=0.045) after correction for demographic characteristics, comorbidity including dementia and depression, socioeconomic position and severe disability. Thus, in an older outpatient population in Italy the frailty syndrome diagnosed according to the SOF criteria was an independent predictor of several adverse health outcomes.
    Archives of gerontology and geriatrics 08/2011; 54(2):e23-8. · 1.36 Impact Factor