Graziano Onder

• Università Cattolica del Sacro Cuore

Introduction The provision of optimal care for older adults with complex chronic conditions (CCCs) poses significant challenges due to the interplay of multiple medical, pharmacological, functional and psychosocial factors. To address these challenges, the I-CARE4OLD project, funded by the EU-Horizon 2020 programme, developed an advanced clinical d...

Introduction: Older adults receiving home care (HC) services or living in long-term care facilities (LTCF) often experience multimorbidity. Identifying subgroups of older people sharing the same types of chronic diseases and having similar levels of impairment can help organizations target interventions effectively. Decision-support tools can foste...

Effective reduction of social inequities in health requires acknowledgement of the deeply embedded intersectional nature of systemic drivers of these inequities. With increasing population cultural and ethnic diversity, it is essential to embed principles of equity, diversity, and inclusion from the outset of programs and policy development. This i...

The European Geriatric Medicine Society (EuGMS) will publish clinical guidelines grounded in evidence-based knowledge pertaining to identification, prevention, diagnosis and management of conditions that are relevant to older people. The primary goal is to produce relevant recommendations that address areas not currently covered by organ-based clin...

People with Down syndrome (DS) are prone to develop Alzheimer’s disease (AD). Behavioral and psychological symptoms of dementia (BPSD) are core features, but have not been comprehensively evaluated in DS. In a European multidisciplinary study, the novel Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) scale was developed...

Background: Few studies have evaluated long-COVID in adolescents. Methods: Cohort study. Demographics, clinical data, and the presence of 30 symptoms were collected with a modified WHO form. Mean values were compared by Student’s t test and proportions by the chi-square test or Fisher test, with trends over time analysed using the chi-square test f...

Background Few studies describe how gender‐related factors may contribute to polypharmacy and prescribing cascades. Describing these patterns using cross‐national comparisons can improve the robustness of findings and provide lessons on the importance of considering age, sex, and gender in pharmacological research. The aim of the study was to explo...

Various explicit screening tools, developed mostly in central Europe and the USA, assist clinicians in optimizing medication use for older adults. The Turkish Inappropriate Medication use in oldEr adults (TIME) criteria set, primarily based on the STOPP/START criteria set, is a current explicit tool originally developed for Eastern Europe and subse...

Background Various explicit screening tools, developed mostly in central Europe and the USA, assist clinicians in optimizing medication use for older adults. The Turkish Inappropriate Medication use in older adults (TIME) criteria set, primarily based on the STOPP/START criteria set, is a current explicit tool originally developed for Eastern Europ...

Background: Atrial fibrillation (AF) is associated with an increased fall risk, partly due to AF-related comorbid-ities. We investigated the impact of different comorbidity patterns on fall risk in older adults with AF. Methods: Using the Swedish National Patient Register, we identified 203,042 adults (45 % females) with AF and at least one comorbi...

Background Long-COVID symptoms remain incompletely defined due to a large heterogeneity in the populations studied, case definitions, and settings of care. The aim of this study was to assess, in patients accessing care for Long-COVID, the profile of symptoms reported, the possible clustering of symptoms and cases, the functional status compared to...

Issue There is increasing awareness on the importance of integration of cultural and ethnic diversity perspectives to reduce prevailing health inequities effectively and sustainably. There is, however, limited experience and practical tools for systematic integration of these perspectives in public health. Description of the problem The EU Joint A...

Issue/Problem In Italy a National Diabetes registry is planned but not yet set up at the Ministry; JACARDI is contributing to speed up the process so that critical gaps in health data availability can be filled. While some regional registries exist, the lack of cohesion and standardization hinders the tracking of prevalence, incidence, and sequelae...

Issue/problem Non-communicable diseases are the leading cause of death and disability in Europe, with 63 million people living with cardiovascular diseases (CVDs) and 32 million with diabetes (DM) in 2019. The EU-co-funded Joint Action on CVDs and diabetes (JACARDI), with 76 partners from 21 countries, aims to reduce CVDs and DM burden at European...

Issue/Problem Health inequities persist across European countries, impacting the distribution, prevention, and management of non-communicable diseases. With increasing population diversity and improved understanding of the intersectional nature of drivers of health inequities, narrowing inequities calls for systematic integration of diversity persp...

Objective The aim of this study was to determine the prevalence of potentially inappropriate medications (PIMs) in nursing home residents across eight countries and investigate differences between residents with and without cognitive impairment, as well as those with and without life expectancy of six months or less. Methods and deign The study ut...

Purpose Generic medicines (GMs) are bioequivalent to brand-name drugs and more cost-effective, yet their use is limited. Gender-related factors may influence attitudes towards GMs, but data on older adults are scarce. This study aimed to explore sex and gender differences in knowledge and opinions about GMs among older patients and their caregivers...

INTRODUCTION: SARS-CoV-2 vaccination can bring an important benefit for older people in reducing mortality and hospitalization. However, rare adverse effects following SARS-CoV-2 vaccination, such as altered consciousness and delirium, have been reported in the older population, raising concerns. This study aims to evaluate delirium incidence follo...

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4834020

The growing complexity of geriatric pharmacotherapy necessitates effective tools for mitigating the risks associated with polypharmacy. The Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) criteria have been instrumental in optimizing medication management am...

Introduction Cardiovascular disease (CVD) and diabetes and their complications are leading causes of death worldwide. They are major causes of hospitalisation, acquired disability and lost productivity. The rising of the legal retirement age suggests that this emerging issue will soon become a major challenge for companies. Materials and Methods J...

Introduction SARS-CoV-2 infection has been associated with the onset or persistence of symptoms in the long-term after the acute infection is resolved. This condition known as Post-COVID, might be particularly severe and potentially life-threatening. However, little is known on the impact of post-COVID condition on mortality. Aim of the present stu...

Introduction Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolyph...

Background Individuals with Down syndrome (DS) experience premature aging. Whether accelerated aging involves changes in body composition parameters and is associated with early development of sarcopenia is unclear. Aims To compare parameters of body composition and the prevalence of sarcopenia between adults with DS and the general population. M...

Purpose Delirium has been recognized as an atypical presenting feature of COVID-19 in older adults and is independently associated with mortality. We aimed to perform an updated systematic review of the literature and proportional meta-analysis to assess prevalence and incidence of delirium in older adults with COVID-19, addressing differences acco...

Recent medical advancements have increased life expectancy, leading to a surge in patients affected by multiple chronic diseases and consequent polypharmacy, especially among older adults. This scenario increases the risk of drug interactions and adverse drug reactions, highlighting the need for medication review and deprescribing to reduce inappro...

Background The use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults’ clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European...

Objectives: As little is known about the burden of type 1 (T1DM) and type 2 diabetes (T2DM) in adolescents in Western Europe (WE), we aimed to explore their epidemiology among 10–24 year-olds. Methods: Estimates were retrieved from the Global Burden of Diseases Study (GBD) 2019. We reported counts, rates per 100,000 population, and percentage chang...

Objectives: As little is known about the burden of type 1 (T1DM) and type 2 diabetes (T2DM) in adolescents in Western Europe (WE), we aimed to explore their epidemiology among 10-24 year-olds. Methods: Estimates were retrieved from the Global Burden of Diseases Study (GBD) 2019. We reported counts, rates per 100,000 population, and percentage chang...

Background A significant proportion of individuals reports persistent clinical manifestations following SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) acute infection. Nevertheless, knowledge of the burden of this condition—often referred to as ‘Long COVID’—on the health care system remains limited. This study aimed to evaluate health...

Background: In western countries, the increasing life expectancy and the growing number of individuals with advanced chronic conditions have resulted in a greater demand for palliative care. Specifically, Italy has witnessed substantial growth in the palliative care field, marked by the establishment of Palliative Care Networks and an academic fel...

Cardiovascular diseases (CVD) and diabetes pose significant health challenges in Europe, affecting millions and burdening healthcare systems. The recent EU4Health Programme places reducing the burden of non-communicable diseases (NCD) at the forefront, through a Joint Action focused on CVD and diabetes (JACARDI, Joint Action on CARdiovascular disea...

Considering the multidimensionality of chronic pain, it is crucial to develop comprehensive strategies for its effective management. However, establishing well-defined, evidence-based guidelines for such approaches remains challenging. To overcome this, we present the finding from a 4-month intervention to enhance the management of non-cancer chron...

Polypharmacy is common in older adults, particularly among those living in long-term care facilities. This condition represents a marker of clinical complexity and might directly affect the immunological response. However, there are limited data on the association of polypharmacy with vaccine immunogenicity. This study evaluated the immune response...

Introduction In 2021 the Italian Ministry of Health, recognizing the need to improve knowledge and standardise the approach to Long-COVID nationwide, funded a project, led by the Italian National Institute of Health, with the following objectives: 1) to define the magnitude and impact of Long-COVID; 2) to identify and assess Long-COVID services nat...

Background Type 1 (T1DM) and type 2 diabetes mellitus (T2DM) are major causes of global morbidity and mortality. As little is known about the burden of DM in adolescents in Western Europe (WE), we aimed to explore the epidemiology of T1DM and T2DM among 10-24-year-olds, including temporal trends. Methods Estimates were retrieved from the Global Bu...

Inappropriate polypharmacy is highly prevalent among older adults and presents a significant healthcare concern. Conducting medication reviews and implementing deprescribing strategies in multimorbid older adults with polypharmacy are an inherently complex and challenging task. Recognizing this, the Special Interest Group on Pharmacology of the Eur...

Purpose Non-pharmacological interventions (NPIs) play an important role in the management of older people receiving homecare. However, little is known about how often specific NPIs are being used and to what extent usage varies between countries. The aim of the current study was to investigate the prevalence of NPIs in older homecare recipients in...

Background Multimorbidity, the coexistence of multiple chronic diseases in an individual, is highly prevalent and challenging for healthcare systems. However, its risk factors remain poorly understood. Objective To systematically review studies reporting multimorbidity risk factors. Methods A PRISMA-compliant systematic review was conducted, sear...

The progressive ageing of the population has led to a new health scenario, where frailty and multimorbidity are extremely common. Multimorbidity, usually described as the coexistence of two or more chronic diseases in the same individual, is a heterogeneous and complex entity characterized by the intricate relationship between chronic conditions an...

A supplementary file was missing from this article and has now been uploaded and the order of the supplementary files has been changed. In the second supplementary file, the title “Appendix 2” has been added. In addition, the reference to the supplementary files in the text has been amended to: ‘The final total number of validated STOPP/START crite...

Introduction Geriatric co-management is known to improve treatment of older adults in various clinical settings, however, widespread application of the concept is limited due to restricted resources. Digitalization may offer options to overcome these shortages by providing structured, relevant information and decision support tools for medical prof...

Introduction In ageing societies, the number of older adults with complex chronic conditions (CCCs) is rapidly increasing. Care for older persons with CCCs is challenging, due to interactions between multiple conditions and their treatments. In home care and nursing homes, where most older persons with CCCs receive care, professionals often lack ap...

Background Numerous individual and organizational factors can influence the spread of SARS-CoV-2 infection in Long Term Care Facilities (LTCFs). A range of outbreak control measures are still implemented in most facilities involving administrations, staff, residents and their families. This study aims to evaluate which measure could influence the t...

Purpose: STOPP/START is a physiological systems-based explicit set of criteria that attempts to define the clinically important prescribing problems relating to potentially inappropriate medications (PIMs-STOPP criteria) and potential prescribing omissions (PPOs-START criteria). The previous two versions of STOPP/START criteria were published in 2...

Background: The aging population has increased concerns about the affordability, quality, and nature of long-term care for older people, emphasizing the role of nursing homes. Unlike acute hospital and primary care, there is a lack of drug consumption data in long-term care to understand regional or national healthcare policies. Objectives: This st...

Aim Long-term-care facility residents are a vulnerable population who experienced reduced healthcare access during the pandemic. This study aimed to assess the indirect impact of the COVID-19 pandemic, in terms of hospitalisation and mortality rates, among this population in two Italian Regions, Tuscany and Apulia, during 2020 in comparison with th...

Background Older adults living in long-term care facilities (LTCF) have been severely affected by COVID-19. Hospice care (HC) facilities and palliative care are essential in treating patients dying from COVID-19. In Italy, little is known about the impact of COVID-19 on deaths in LTCF and the care provided in HC to COVID-19 patients. Aim To assess...

Background: The aging of our societies leads to a higher prevalence of multimorbidity and therefore polypharmacy, which often results in inappropriate drug treatment. To address this issue, numerous listing approaches, such as the Fit fOR The Aged (FORTA) list have been developed. FORTA's positive impact on the quality of medications and relevant...

Despite the reported sex-related variations in the immune response to vaccination, whether the effects of SARS-CoV-2 vaccination differ by sex is still under debate, especially considering old vulnerable individuals, such as long-term care facilities (LTCFs) residents. This study aimed to evaluate COVID-19 infections, adverse events, and humoral re...

Background and Objective: Health Literacy (HL), defined as the ability to access/obtain, understand, appraise/judge/evaluate, apply/use health-related information, has a direct impact on the capacity of managing three main domains of health-relevant information: Health Care (HC), Disease Prevention (DP), and Health Promotion (HP), which are fundame...

A significant number of people, following acute SARS-CoV-2 infection, report persistent symptoms or new symptoms that are sustained over time, often affecting different body systems. This condition, commonly referred to as Long-COVID, requires a complex clinical management. In Italy new health facilities specifically dedicated to the diagnosis and...

Abstract The prompt identification of frailty in primary care is the first step to offer personalized care to older individuals. We aimed to detect and quantify frailty among primary care older patients, by developing and validating a primary care frailty index (PC-FI) based on routinely collected health records and providing sex-specific frailty c...

Background Frailty, disability, and polypharmacy are prevalent in nursing home (NH) residents, often co-occurring with multimorbidity. There may be a complex interplay among them in terms of outcomes such as mortality. Aims of the study were to (i) assess whether nursing home residents with polypharmacy (5–9 medications) or hyperpolypharmacy (≥10 d...

Introduction: We presented a four-case series of COVID-19 related deaths occurred in patients with Guillain-Barré syndrome (GBS) between February 2020 and January 2022 in Italy. Methods: They were extracted from 8,436 medical charts of COVID-19 patients dying. All cases, ranged 48-73 years, showed classical GBS clinical onset - limb weakness, se...

Objective This study aims to analyse the impact of the pandemic on the amount of use and new medication dispensation for chronic diseases in the Italian population aged 65 years and older (almost 14 million inhabitants).Methods The “Pharmaceutical Prescriptions database”, which gathers data on medications, reimbursed by the National Health Service...

Objectives Nursing home (NH) residents have been significantly affected by the COVID-19 pandemic. Studies addressing the immune responses induced by COVID-19 vaccines in NH residents have documented a good post-vaccination antibody response and the beneficial effect of a third booster vaccine dose. Less is known about vaccine-induced activation of...

The ageing process is associated with an increased probability of accumulating health deficits, chronic conditions and geriatric syndromes, leading to a growing prevalence of multimorbidity, defined as the co-occurrence of two or more chronic conditions (of which, at least one physical condition). One of the most frequent and direct consequences of...

Introduction In hospitalized patients with COVID-19, bloodstream infections (BSI) are associated with high mortality and high antibiotic resistance rates. The aim of this study was to describe BSI etiology, antimicrobial resistance profile and risk factors in a sample of patients deceased with COVID-19 from the Italian National COVID-19 surveillanc...

Objectives To assess in the Italian general adult population the trends of blood pressure (BP) and prevalence of raised BP (RBP), hypertension and its control in order to evaluate population health and care, and the achievement of an RBP 25% relative reduction as recommended by the WHO at population level. Design Results comparison of health exami...

Purpose: To provide an overview of the current deprescribing attitudes, practices, and approaches of geriatricians and geriatricians-in-training across Europe. Methods: An online survey was disseminated among European geriatricians and geriatricians-in-training. The survey comprised Likert scale and multiple-choice questions on deprescribing appro...

Background The COVID-19 pandemic caused an overabundance of valid and invalid information rapidly spread via traditional media, by internet and digital communication. Health Literacy (HL), as the ability to access, understand, appraise, apply health information, is fundamental for finding, interpreting, correctly using COVID-19 information. Method...

Background In monitoring population health and the effectiveness of public health strategies, the body mass index (BMI) is often assessed within national surveys from self-reported height and weight rather than measured values. Using data collected within a recent health examination survey (HES), the discrepancies between self-reported and measured...

Background Little is known on how frailty influences clinical outcomes in persons with specific multimorbidity patterns. Aims To investigate the interplay between multimorbidity and frailty in the association with mortality in older individuals living in nursing homes (NH). Methods We considered 4,131 NH residents aged 60 years and over, assessed...

Objective: Type 2 diabetes may affect the humoral immune response after vaccination, but data concerning coronavirus disease 19 (COVID-19) vaccines are scarce. We evaluated the impact of diabetes on antibody response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in older residents of long-term care facilities (LTC...

Although vaccines represent a primary public health achievement of the last century, vaccine awareness and uptake still face significant challenges, as evidenced by the COVID-19 pandemic. Vaccine Literacy (VL) is the ability to find, understand, judge immunisation-related information to make appropriate immunisation decisions. In 2021, participating...

Background Nursing home (NH) residents suffered the greatest impact of the COVID-19 pandemic. Limited data are available on vaccine-induced immunity and on the protection ensured by a prior infection in this population. Aims The present study aims to monitor antibody levels and their persistence over a 6-month period in NH residents according to t...

Background and objective: Prescribing cascades occur when a drug is prescribed to manage side effects of another drug, typically when a side effect is misinterpreted as a new condition. A consensus list of clinically important prescribing cascades that adversely affect older persons' health (i.e., where risks of the prescribing cascade usually exc...

Background: Italy has witnessed high levels of COVID-19 deaths, mainly at the elderly age. We assessed the comorbidity and the biochemical profiles of consecutive patients ≤65 years of age to identify a potential risk profile for death. Methods: We retrospectively analyzed clinical data from consecutive hospitalized-for-COVID-19 patients ≤65 yea...

Background Dysphagia is a frequent condition in older nursing home residents (NHRs) which may cause malnutrition and death. Nevertheless, its prevalence is still underestimated and there is still debate about the appropriateness and efficacy of artificial nutrition (AN) in subjects with severe dysphagia. The aim is to assess the prevalence of dysph...

Background Despite the growing clinical relevance of Long-COVID, there is minimal information available on the organizational response of health services to this condition. Methods A national online survey of centers providing assistance for Long-COVID was implemented. Information collected included date of start of activity, target population, mo...

Introduction: Data on frailty frequency are heterogeneous and mostly based on cross-sectional studies. Little is known about frailty development and progression over time. Our aim was to conduct a systematic analysis of frailty prevalence and incidence in a large cohort of older adults and to evaluate the association with incident disability, in o...

Background Chronic cough (CC) is a burdensome health problem in adult and older people, with a major impact on quality of life. Its management is often troublesome, and many guidelines have been released. Notwithstanding, a proportion of cases still do not reach a definite diagnosis and resolutive treatment. A coordinated approach between different...

Down Syndrome (DS) is a neurodevelopmental disorder that is characterized by an accelerated aging process, frequently associated with the development of Alzheimer’s disease (AD). Previous studies evidenced that DS patients have various metabolic anomalies, easily measurable in their serum samples, although values that were found in DS patients were...

Introduction: Dementia is common in nursing homes (NH) residents. Defining dementia comorbidities is instrumental to identify groups of persons with dementia that differ in terms of health trajectories and resources consumption. We performed a cross-sectional study to identify comorbidity patterns and their associated clinical, behavioral, and fun...

Background Patients hospitalised for COVID-19 may present with or acquire bacterial or fungal infections that can affect the course of the disease. The aim of this study was to describe the microbiological characteristics of laboratory-confirmed infections in hospitalised patients with severe COVID-19. Methods We reviewed the hospital charts of a...

Multimorbidity and polypharmacy are emerging health priorities and the care of persons with these conditions is complex and challenging. The aim of the present guidelines is to develop recommendations for the clinical management of persons with multimorbidity and/or polypharmacy and to provide evidence-based guidance to improve their quality of car...

A third dose of mRNA COVID-19 vaccine dose restores high levels of anti-Spike IgG in nursing home residents. A longer interval between first and third dose does not impair immunogenicity.

Background Dysphagia is a frequent condition in older nursing home residents (NHRs) which may cause malnutrition and death. Nevertheless, its prevalence is still underestimated and there is still debate about the appropriateness and efficacy of artificial nutrition in subjects with severe dysphagia. The objective assesses the prevalence of dysphagi...

Objective People with Down syndrome (DS) are particularly vulnerable to Covid-19 and show altered immune response to vaccination. We aimed to evaluate the immune response of a group of adults with DS treated with standard regimens of SARS-CoV-2 vaccine as compared with an aged- and sex-matched group of persons without DS. Methods We compared antib...

Objective: To systematically review the evidence from randomized controlled trials comparing the effects of goal-oriented care against standard care for multimorbid adults. Data sources/study setting: The literature presenting the results of randomized trials assessing the outcomes of goal-oriented care compared with usual care for adults with m...

Older adults are often affected by multiple chronic conditions and experience geriatric syndromes that may affect the risk/benefit profile of medications. Little is known about the use of such medications in the older population. This article describes medication use and costs in Italian adults aged ≥90 years. Data from the 2019 Pharmaceutical Pres...