Objectives: To develop and validate a Multidimensional Prognostic Index (MPI) for mortality based on information collected by the Multidimensional Assessment Schedule (SVaMA), the recommended standard tool for multidimensional assessment of community-dwelling older subjects in seven Italian regions. Design: Prospective cohort study. Participants: Community-dwelling subjects older than 65 years who underwent an SVaMA evaluation from 2004 to 2010 in Padova Health District, Veneto, Italy. Measurements: The MPI-SVaMA was calculated as a weighted (weights were derived from multivariate Cox regressions) linear combination of the following nine domains: age, sex, main diagnosis, and six scores, ie, the Short Portable Mental Status Questionnaire, the Barthel index (contains two domains: activities of daily living and mobility), the Exton-Smith scale, the Nursing Care Needs, and the Social Network Support by a structured interview. Subjects were followed for a median of 2 years; those who had not died were followed for at least 1 year. The MPI-SVaMA score ranged from 0 to 1 and 3 grades of severity of the MPI-SVaMA were calculated on the basis of estimated cutoffs. Discriminatory power and calibration were further assessed. Results: A total of 12,020 subjects (mean age 81.84 ± 7.97 years) were included. Two random cohorts were selected: (1) a development cohort, ie, 7876 subjects (mean age 81.79 ± 8.05, %females: 63.1) and (2) a validation cohort, ie, 4144 subjects (mean age: 81.95 ± 7.83, %females: 63.7). The discriminatory power for mortality of MPI-SVaMA was 0.828 (95% CI 0.817–0.838) and 0.832 (95% CI 0.818–0.845) at 1 month and 0.791 (95% CI 0.784–0.798) and 0.792 (95% CI 0.783–0.802) at 1 year in development and validation cohorts, respectively. MPI-SVaMA results were well calibrated showing lower than 10% differences between predicted and observed mortality, both in development and validation cohorts. Conclusions: The MPI-SVaMA is an accurate and well-calibrated prognostic tool for mortality in community-dwelling older subjects, and can be used in clinical decision making.

In older acute care inpatients, MPI score assessed at hospital admission is an independent predictor of in-hospital mortality and the length of hospital stay.

Background Cognitive and functional measures are often measured and interpreted separately during the clinical evaluation of patients with cognitive impairment. This can sometimes lead to a challenging interpretation when measures do not show concordance, especially after a clinical intervention. In this study, the development and evaluation of a new approach, using the Rasch model, that combines cognitive and functional measures in one single and more powerful measure (compared to stand-alone tests) to assess global functioning in older adults with cognitive impairment (including dementia) was presented. Methods Clinical data from 265 older adults’ subjects diagnosed with mild cognitive impairment, or dementia, included: The Mini-mental state examination (MMSE), the Esame Neuropsicologico Breve (ENB) – a neuropsychological battery used in Italy–, the Activities of Daily Living (ADL), and the Instrumental Activities of Daily Living (IADL) questionnaires. Results Patients with severe cognitive impairment showed lower global functioning score compared to patients with moderate impairment. Receiver Operating Characteristic (ROC) curve analyses were performed to determine sensitivity and specificity of the global functioning score resulting from the combined measure. Results showed that the global functioning score discriminates better between patients with severe and moderate cognitive impairment compared to the ENB, ADL, and IADL when considered separately. Conclusions The Rasch model was able to combine cognitive and functional measures into a single score (global functioning score). All together, these results suggest that the diverse cognitive and functional measures can be considered part of one single dimension (global functioning) and that this dimension can be measured as a single construct and score. This study offers an alternative perspective for future development of instruments that would help clinicians in measuring global functioning in older adults’ patients at different stages of cognitive impairments and different baseline level of performance.

In this research the representations of feminine and masculine roles in the mafia thought have been studied using a qualitative analysis of the texts collected during clinical interviews with five collaborators of justice. The relation between the intimate and the social relationships is addressed as well as the problem of amoral familism that is at the roof of the mafia sub-culture. Data show that the mesosystem and macrosystem levels are not present at all, while the microsystem includes totally the mesosystem.

Key summary points Aim To comparatively assess the clinical profiles of older patients treated with trazodone or other antidepressants in a large dataset from the GeroCovid Observational multiscope and multisetting study. Findings 10.8% out of 3396 persons included used trazodone and the 8.5% other antidepressants; the use of trazodone was highly prevalent in functionally dependent and comorbid older adults admitted to long-term care facilities or living at home. Conditions associated with trazodone use included depression, dementia and behavioral and psychological symptoms of dementia. Message The present data suggest an off-label use of trazodone as a possible therapeutic option in the challenging field of behavioral and psychological disturbances in older adults with dementia.