4th International Conference on Geriatrics & Gerontological Nursing October 3-4, 2016 London, UK

Stephen Gethin-Jones has completed his Doctorate at the Unviersity of Cardiff in 2012 with a focus on Homecare delivery to older housebound adults, and he continued to develop a specialist interest in home care and support services for older adults, with a particular focus on outcome focused care. He has been involved in the development of services for community care in both the statutory and private sectors. He currently works as a Teacher, teaching a variety of health and social care degrees at both undergraduate and postgraduate level.

Social isolation is perceived to be a growing issue for older housebound adults and has a significant impact upon both the individuals physical and mental well-being. This presentation aims to discuss whether the level of social isolation and loneliness as assessed by care managers corresponds to the level of social isolation and loneliness as perceived by the older persons whose care needs are being assessed. This mixed methods study followed up the assessment of 40 older people by 20 care managers with a focus on the accuracy of the care manager’s assessment on the level of social isolation experienced by the service user. In order for this to be achieved, structured interviews were conducted with both the older person and the care manager assessing their needs, with a specific focus on the assessment of loneliness and social isolation. Following these initial interviews two focus groups were then undertaken by the care manager to discuss the findings and unpack the assessment pros. The key issues were that the true level of social isolation and loneliness was under assessed by the care manager completing the assessment. The care manager’s assessment was predominantly focused on the physical well-being of the older person and heavily influenced by the assessment paperwork. This provides lessons for professionals about the lack of effectiveness of their assessment of social isolation and loneliness in older people, and the potential impact this has on the older person’s quality of life.

Lena Sandin Wranker has been Graduated from Lund University, Sweden as Medical Doctor, with the specialties including General Medicine, Rehabilitation

Medicine and Diploma in Persistent Pain from the The National Board of Health and Welfare. Later on she obtained her PhD from University of Lund with the Gender perspectives on pain among older adults, and then started working at The Lund University where she has continued her research. Presently she is joining the research team at the Clinical Research Centre (CRC) i Malmö.

Background and Aims: Pain is a multidimensional, unpleasant sensory and emotional experience. Its relationship with ageing is unclear. The aim was to investigate pain from a gender perspective, the influence of biological, social, psychological and existential factors on the relationship between pain and quality of life, associations between pain and personality traits, and

changes in pain over time.

 

Methods: The studies employed data from the longitudinal Swedish National Study on Aging and Care – Blekinge (SNAC-B). A total of 1,402 randomly selected individuals were included.

 

Results: Almost 55% of the participants reported pain, predominantly women, p<0.01. The intensity was rated as moderate or severe (VAS >4) and women scored higher than men, p<0.023. Pain intensity declined with age among men, p<0.013. The strongest OR for low QoL among elderly women was found for pain (OR 2.27, CI 1.36-3.78), which is in contrast to elderly men who suffered from insomnia (OR 1.86, CI 1.04-3.33). Personality traits and pain were related among the older adults but gender differences were observed. The prevalence of pain declines with increasing age, but is still higher among women. The

pain relief rate is higher for older men compared to older women. Low external locus of control scores may contribute to pain relief among men (Study IV).

 

Conclusions: Pain is common, especially among women, but declines with increasing age and the intensity also decreases. There are gender differences in how pain influences quality of life. Low external locus of control scores may contribute to pain relief among men.

Minde is a sociologist, Associate professor at University of Tromso, campus Harstad Norway, Department of Health and Social services. Minde has published books, reports and articles in national and international journals. She has presented papers at many national and international conferences. She also makes documentary about older people in recovery.

This presentation takes a culturally sensitive approach to elderly care. The elderly here are ethnic Norwegians, the Sami Indigenous people and the Kven minorities in the Arctic region in Northern Norway. How can an older person rediscover his or her dignity when they arrive in nursing homes? Cultural values, beliefs and worldviews are anchored in “the living body.” This means that the human’s biological conditions are woven together with life experiences and interpretations thereof. The method in this article is based on case studies i.e material collected by the students during their second year of their bachelor

studies. The most important motivator in rediscovering the older person`s dignity in nursing homes lies in the interaction between the older person and service workers who have a culturally–sensitive approach. This means that the social and health providers see the older person as a complete person, not just his or her body and cognitively impairment. By using a person-centered

care in milieu therapy in the nursing homes, the students were preserving health and continuity in the lives of elderly patients.

Catharina Gillsjo earned her PhD in a Joint PhD Program in Nursing between the University of Rhode Island, USA and University of Skövde, Sweden. The focus of her research is on the health and well-being of older adults in various contexts,especially that of home. It also encompasses common health problems associated with aging, such as long-term musculoskeletal pain. Furthermore, it includes interventions that support older adults in daily living and their ability to remain at home. Catharina is a senior lecturer at the University of Skovde. She is interested in national and international collaboration in research and education.

Long-term musculoskeletal pain is a major health problem among older adults. Many lack professional guidance and feel forced to learn to live with pain on their own. The method Reflective STRENGTH-giving dialogue (STRENGTH) is developed to holistically meet older adults’ needs in a way that promotes health, well-being, meaning and strength in life. An intervention study was conducted in which education and continuous supervision were given to 10 health care professionals that carried out dialogues with 20 community dwelling older adults living with long-term musculoskeletal pain at home.

Interview data were obtained before and after the intervention from a reflective lifeworld research approach. Phenomenology (before intervention) and hermeneutics (after intervention) were methods used to analyze data. Suffering in silence was essential in the older adults’ lives before the intervention. They endured and tried to distract from the disabling pain, but felt not being taken seriously and avoided thoughts of the future. The intervention led to the development of a continuous and trustful relationship, alleviation of pain and diminished loneliness. The dialogue was experienced as a new way of talking

about life with pain. There was a transfer in orientation towards present and future time and from obstacles to opportunities. The older adult showed an increased joy, engagement and motion in life. The dialogues created a deepened caring relationship that contributed to an increased sense of security, courage, strength and meaning in life, which implies that the Reflective

STRENGTH-giving dialogues have the potential to enhance older adult’s sense of health and wellbeing if acknowledged in nursing practice.

Anne Cooney is the Health Promotion Officer at AIT. Her background lies in health care both as a practitioner and in promoting health through information, creating opportunities and programmes enabling people to take control over, and improve their health. (RGN, CM, Higher diploma Oncology, Post graduate certificate in Health Promotion). She has recently completed an MSc by research.

Societies are ageing at an unprecedented rate (OECD, 2015). There is a rapid demographic transformation with the older person happening nationally and internationally. By 2041, there will be 1.4 million people in Ireland aged 65 and over, three times more than the present older population (CSO, 2007, 2012). Social capital is strongly associated with social participation, mutual trust and reciprocity (Ahnquist et al., 2012). While the theory of social capital is now well developed and investigated, its relationship and relevance to older people is less clear (Smith et al. 2002). This study investigates the relationship between the variables of age, gender, education, quality of life, self-reported physical and mental health, and their association with social capital in a group of people aged over 65 years in the Midlands Region of Ireland. The study used a quantitative method of survey design. Data was collected from a representative sample (n= 195), using a self-administered survey via a General

Practitioner in a primary health care environment. The survey measured the frequency of the older peron’s participation in civic engagement, volunteering, reciprocity, trust, social networks, religion, levels of loneliness, along with connecting with family and friends. Preliminary findings highlight the important role of education, good self-rated health, religion and gender as positive predictors of the level of social capital produced and consumed. The findings of this study will provide relevant data on the importance and significance of the contribution of social capital to the wellbeing of the older person in an Irish context.

Asha Devi is Professor of Zoology and Co-ordinator of UGC-CPEPA Program at Bangalore University, India. She completed her postdoctoral studies from Hiroshima University, Japan (1988); University of Texas Medical Branch, USA (1993); and Tulane University Medical Centre, USA (1994). Her interest includes Exercise, Nutrition and Aging. She is a recipient of Commonwealth Fellowship, Aberdeen (2007) and INSA-JSPS visiting Fellowships, University of Tokyo (2005 and 2012). Asha has published several papers/chapters and is a referee for journals of high repute. She is a member of SFRR, IABS, IAN, IAGG (India) and has received research grants from UGC, DST, DRDO and ICMR.

While it is known that the brain is responsible for the maintenance and responses to environmental stress with increased vulnerability, studies relating to the role of antioxidant vitamins for oxidative stress control in its different regions are necessary for preventing the loss of function more so in the aged. Here in our study, we investigated the intervention of vitamins C and E on the oxidative stress (OS) biomarkers in the frontoparietal cortex (FPC) and hippocampus (HC) of adult (3 months), late-adult (12-months), middle-aged (18-months) and old (24 months) male Wistar rats that were exposed to intermittent cold (ICE) lasting 2h/day for 4 weeks. Supplement was a daily dose of vitamins C and E. ICE-induced OS was reflected in terms of age-related increases levels of hydrogen peroxide, protein carbonyl and thiobarbituric acid reactive substances in the FPC and HC. These changes were accompanied with increased neuronal damage in the FPC and HC. Our results demonstrate age as a significant factor in the severity of the OS during ICE. However, the extent of these changes was lowered by supplementation with vitamins C and E. Although it is not clinically proven for their benefits with ICE, it does offer hope as a nutritional intervention in alleviating the severity of the OS during cold exposures of an intermittent nature.

Hsin-Yin, Hsu has been Graduated from Medicine department of Chang Gung University in Taiwan, Hsin-Yin, Hsu as Medical Doctor, with the specialties including Family Medicine, Hospice Palliative Medicine. Later on she started working at The Mackay Memorial Hospital, Department of Family Medicine where she has continued her research. Presently she is working at the in the Taipei City.

Elderly adults are at a higher risk of functional decline and malnutrition, especially those who are hospitalized. The aim of this study was to investigate the impact of serum albumin levels on functional status and hospital outcome in oldest-old inpatients. All the acutely ill patients aged more than 75 years admitted to the medical center in North Taiwan from March to July in 2009 were included and their medical data were reviewed. A total of 2804 admissions was included with the mean age of patients being 82.0 ± 5.4 years. The main activity of daily living score is 1.5 ± 1.9 in the most severe hypoalbuminemia group, 2.3 ± 2.2 in the mild hypo-group, and 3.8 ± 2.3 in the normal group (p < 0.01). The average length of hospital stay is 18.8 ± 16.0 days in the most severe hypoalbuminemia group, 12.8 ± 12.6 days in the mild hyp-group, and 9.5 ± 9.8 days in the normal group (p < 0.01). The in-hospital mortality rate is 25.8% in the severe hypoalbuminemia group, 6.6% in the mild

hypo-group, and 2.0% in the normal group (p < 0.01). Compared with the normal albumin group, the adjusted odds ratios of albumin level associated with in-hospital mortality were 3.9 in the mild hypo-group and 17.4 in the severe hypo-group. In this admission database study of oldest-old patients, lower albumin level was statistically significant (p < 0.01) correlated with poorer functional status, longer length of hospital stay, and higher in-hospital mortality rate.

Jiraporn has been graduated from Khonkaen University, Thailand as a medical doctor, with the Diploma in emergency medicine from Ramathibodi Hospital,

Mahidol University, Bangkok, Thailand. Later on she obtained her post graduation from Massachusetts General Hospital, Harvard Medical School, USA with subjects about the research in Geriatric Emergency Medicine. Presently she is working at the emergency department, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. Since 2010, she has developed her specialist interest in improving the care of older patients. Her research focus is on acute care for older patients, delirium and falls.

Objectives: Fall-related injuries are a leading cause of morbidity and mortality among older adults. We seek to describe the rate of and risk factors for recurrent falls, emergency department (ED) revisits, subsequent hospitalizations and death within 6 months after a fall-related ED presentation.

 

Methods: This was a secondary analysis of a retrospective cohort of elderly fall patients who presented to the ED from one urban teaching hospital. We included patients aged 65 and older who had an ED fall visit in 2012. We examined the frequency of adverse events (composite of recurrent falls, ED revisits, subsequent hospitalizations and death at 7 days, 30 days and 6 months) controlling for important covariates.

 

Results: Our study included 350 older adults. Adverse events steadily increased with time, from 7.7% at 7 days, 21.4% at 30-days and 50.3% at 6 months. Within 6 months, 22.6% had at least one recurrent fall, 42.6% revisited the ED, 31.1% had subsequent hospitalizations and 2.6% died. In multivariable logistic regression analysis, psychological and/or sedative drug use and noninsulin anti-diabetic drug use predicted recurrent falls, ED revisits, subsequent hospitalizations and adverse events.

 

Conclusions: Our study shows at the very least, there appears to be an association with a history of falls and the use of certain classes of medications with subsequent adverse events. Falls appear to be a marker of physical disability and future health care utilization. Therefore, patients presenting to the ED with falls should be assessed for underlying risk factors and targeted for

preventive interventions.

Boris Punchik has completed his MD from Medical Academy, Samara, Russia, Family Medicine residence in 2002 (Beer Sheva, Israel), Health Systems Management (M.H.A.) in 2005 (Ben Gurion University of the Negev) and Geriatric Medicine residence in 2012 from Department of Geriatrics, Soroka University Medical Center, Beer-Sheva, Israel. He is a Geriatrician of Ambulatory Geriatric Services, Clalit Health Services, Beer Sheva, Israel. He has published more than 10 papers in reputed journals, co-authored a book chapter and active Lecturer of Ben Gurion University of the Negev, Beer Sheva, Israel.

Aim: To assess the effect of moving geriatric consultation from the primary care clinic to another setting, on the rate of implementation of geriatric recommendations by family physicians.

 

Methods: A retrospective review of the computerized medical records of elderly patients in four primary care clinics. The rate of implementation of geriatric recommendations was compared between clinics in which a geriatric consultant was physically present (control clinics) and a clinic where the consultation took place elsewhere (study clinic). In addition, the results of the

present study were compared to a previous study in which the geriatric consultation was carried out in the study clinic and the family doctor was an active participant.

 

Results: 127 computerized files were reviewed in the study clinic and 133 in the control clinics. The mean age of the patients was 81.1±6.3 years and 63.1% were women. The overall implementation of geriatric recommendations by family doctors in the study clinic was 55.9%, a statistically significant decrease compared to the previous study where the rate was 73.9% (p<0.0001). In contrast, there was no change in the implementation rate in the control clinics 65.0% in the present study and 59.9% in the previous one (p=0.205).

 

Conclusions: Direct, person-to-person contact between the geriatric consultant and the family doctor has a beneficial effect on the implementation of geriatric recommendations. This should be considered by healthcare policy makers when planning, geriatric services in the community.

Isaac M. Danat is a PhD student in epidemiology and global health research under the supervison of Dr Ruoling Chen at the University of Wolverhampton (UoW), UK. In 2014 Isaac was awarded with Master of Public Health degree (MPH) at UoW after obtaining a MBA at Ahmadu Bello University and a Bacherlor of Pharmacy degree at University of Jos, Nigeria. Before entry into the PhD program he worked as a Senior Analyst, and also a Senior Program Officer, on the Essential medicine project, with an international public health NGO “Clinton Health Access Initiative”. At present Isaac focuses on dementia research.

The aim is to examine prediction of body mass index (BMI) measured at older age to dementia risk, through a systematic review and a new study. We searched PubMed and 4 other electronic databases till July 2016 and identified 11 cohort studies for review. Four were from USA, two from Finland, two from Sweden, and one each from Denmark, Italy and Australia. Two studies showed a significant prediction of BMI to dementia development, while 9 studies showed a reverse association of BMI with dementia, of which 7 were statistically significant. We examined a random sample of 2755 participants aged ≥60 years in China, who were without dementia and had BMI (kg/m2) measured at baseline. Over a 10-year follow up until 2011, there were 320 dementia occurred. After adjustment for age, sex, education level, urban-rural areas, marital status, life styles, cardiovascular diseases and diabetes, odds ratio for dementia was 0.89 (95%CI 0.66-1.21) in participants with BMI of 23-<26, 0.94 (0.67-1.32) in BMI ≥26, and 0.93 (0.64-1.37) in BMI <22 compared to BMI of 20-<23. In pooling all data available according to different categorized BMI analysis, a relative risk (RR) of dementia was 0.78 (0.64-0.96) in obese people, 0.79 (0.71-0.88) in overweight and 0.95 (0.79-1.14) in underweight in comparison with normal weight, while the pooled RR from those taking continuous BMI analysis was 0.96 (0.93-0.995). The pooled-RR for other different categorised BMI analysis demonstrated similar prediction trends. We conclude that preserving a certain body weight in older age may prevent from

dementia.

Hannon-Fletcher graduated with a 1st Class Honors from Ulster University in Biomedical Scientist (1995) with the specialties in Cellular Pathology, Haematology and Biochemistry. In 2000 she obtained a PhD from Ulster in Biomedical Sciences, with speclaisms in Oxidative Damage and Cytochrome p450 Metabolism. Mary worked in Ulster as a Researcher, Lecturer, Senior Lecturer and now Head of School in Health Sciences. She obtained her Post Graduate Certificate in Higher Education Practice in 2003 and Fellowship of the HEA 2004. Mary is a Fellow of the Institute of Biomedical Sciences (FIBMS), a Chartered Scientist, and a Registered Biomedical Scientist, HCPC.

End stage renal disease (ESRD) is associated with an increase in oxidative stress, cardiovascular disease and cancer. The main treatment for ESRD, haemodialysis (HD), itself induces repetitive bouts of oxidative stress through membrane biocompatibility and endotoxin challenge. The resulting higher levels of reactive oxygen species in turn produce increased levels of oxidative DNA damage leading to genomic instability. We measured levels of oxidative DNA damage in thirty eight patients receiving HD in the Western Health and Social Services Trust (WHSCT), and 8 age and gender matched control volunteers. Volunteers gave informed consent and non-fasting morning blood samples were taken and assessed for DNA damage using the Modified Comet to identify oxidative specific damage by introduceing an enzymatic step with the bacterial enzymes endonuclease III (Endo III, recognise pyrimidine-pyrimidine breaks) and formamidepyrimidine DNA glycosilase (FPG, recognise purine-purine breaks. The HD patients had significantly elevated levels of alkaline DNA damage (19.46 ± 8.35 vs 3.86 ± 0.99 % tail DNA, p<0.05) and oxidative DNA damage formamidepyrimidine DNA glycosilase (5.81 ± 6.63 vs 1.23 ± 0.39 % tail DNA, p<0.0) and endonuclease III (6.04 ± 6.11 vs 1.98 ± 0.85% tail DNA, p<0.01) compared to controls, respectively. A positive correlation was observed between the duration on dialysis (months) and levels of Endo III specific damage (p=0.041). We conclude, the significant increase in oxidative DNA damage and the positive correlation with duration of HD treatment and Endo III damage  may contribute to the increased cancer risk observed in this patient group.

Gunnar Johansson is a Professor of Health Sciences at Halmstad University, Sweden. He defended his doctoral thesis on diet and cancer at the Karolinska Institute, Stockholm, Sweden 1990.

There is substantial evidence that vegetarians have lower incidence of several cancer forms and coronary heart diseases, but there is a debate as to why this is the case. The objective of the study was to explore whether a shift from a mixed diet to a lacto-vegetarian diet would lead to a decrease in risk for cancers and coronary heart diseases indicated by surrogate markers. Twenty volunteers participated in the study (4 men and 16 women, mean age 44 years, range 27-61) from a town in western Sweden. Clinical examinations were performed, blood samples were drawn, fecal and urine samples were collected and dietary survey, i.e. repeated 24-h recalls were carried out before (0 months) and 3, 6, 12 and 48 months after the shift from a mixed diet to a lacto-vegetarian diet. A dietician educated the volunteers with regard to the vegetarian diet regimen, organized and taught the vegetarian cooking courses. The dietary change led to an increase in the intake of total carbohydrates and fibre and a decrease in fat, protein and sucrose. The disease risk markers, body weight, body mass index, fecal and urinary mutagenic activity, several fecal enzymes, systolic and diastolic blood pressure, total cholesterol and low-density lipoprotein cholesterol decreased significantly. To conclude, there was a decrease in disease risk markers. The main finding in this study is that there

was a simultaneous decrease in risk markers, both for cancers and coronary heart diseases.

Anthea Tinker has been Professor of Social Gerontology at King’s College London since 1988. She has been on the staff of three Universities and three Government Departments and has been a Consultant to the WHO, EU and OECD. She chaired the College Research Ethics Committee from 2001 – 2011. The sole author of 11 books, co-author of 21 and over 300 articles she has carried out a wide range of research on ageing. She was awarded the CBE in 2000, elected a Founding Member of the Academy of Learned Societies for the Social Sciences in 1999, a Fellow of King’s College London in 1998 and was President of the Section of Geriatrics and Gerontology, Royal Society of Medicine 1998-2000. She was awarded the title of Fellow of the British Society of Gerontology in 2008. She was one of the Women of the Year in 2002. In 2010 she was awarded the Alan Walker prize by the British Society of Gerontology for her significant and lasting contribution to Social Gerontology.

The General Medical Council guides undergraduate medical education in the United Kingdom (General Medical Council 2009). However, there is some variation between medical schools including, for example, between the social science modules relevant to Social Gerontology. This includes Psychology, Sociology and Social Policy. We believe there is a strong case for the universal inclusion of Social Gerontology in the training of tomorrow’s doctors. There has been a well-known shift to a population with increased numbers of older people and most doctors will have this group amongst their patients who will have heterogeneous living arrangements and social backgrounds. Patients must be viewed holistically given the non-clinical factors influencing health and well-being. Consideration of psychological factors such as resilience and health seeking behaviours in older age is of paramount importance. Delivering personalised care requires an awareness of the coping strategies increasingly used in later life, for example, by older people who have disabilities or who are widowed. The sociology of later life is warranted by the augmented risk of social exclusion, loneliness and poverty. These sociological issues, amongst others, affect the provision of care. Doctors are becoming increasingly influential at local, regional and national levels of decision-making. This places added importance on understanding social policy at an undergraduate level.

Medical schools should incorporate Social Gerontology into their curricula, to equip medical students with the knowledge and skills to care for our ageing population. This presentation will draw on the literature and the personal experience of the authors.

Osama Alshogran has received his Bachelors and Masters degrees from the Faculty of Pharmacy at Jordan University of Science and Technology (JUST) with the specialties including clinical pharmacy and pharmaceutical care. Later on, he has obtained his PhD degree from the School of Pharmacy at the University of Pittsburgh, USA, with special interest in clinical pharmaceutical sciences in the setting of kidney disease. He has continued his research as a post-doctoral fellow at the School of Medicine in Pittsburgh. Presently, he has been working as an Assistant Professor at Faculty of Pharmacy at JUST, Jordan.

Warfarin is the most commonly prescribed oral anticoagulant worldwide. Warfarin metabolism is decreased in chronic kidney disease (CKD), suggesting its nonrenal clearance can be altered in CKD patients. However, little is known about warfarin pharmacokinetics in patients with different levels of kidney function. We aimed to explore the impact of impaired kidney function on steady-state pharmacokinetics of warfarin and its alcohol metabolites in elderly patients. Blood samples were collected from patients (total n=25, age: 52-87 years) with varying levels of kidney function (i.e., eGFR ranges from 3-80

mL/min/1.73m2), who were on long-term warfarin therapy. Total and free concentrations of warfarin, warfarin enantiomers, and alcohol metabolites were measured using LC-MS/MS. Warfarin clearance, S/R warfarin ratio, and exposure of warfarin alcohols were compared between groups using ANOVA. Regression analysis was performed to determine the impact of kidney function and other covariates on warfarin clearance and warfarin dosing. Warfarin S/R ratio was 2.5-fold higher in end-stage renal disease (ESRD) patients versus control/mild CKD patients (P<0.05). Age was a significant modifier of average weekly warfarin dose and total warfarin clearance. As age increases, a significant decline in warfarin dose and clearance is observed. Collectively, our data provide evidence for increased exposure of the warfarin alcohol 2 metabolite and a possible decrease in CYP2C9-mediated warfarin metabolism in ESRD patients. Decreased warfarin dosing with aging support the known

physiological reduction of liver and kidney function in elderly.

Shoroq Altawalbeh has been graduated from Jordan University of Science and Technology (JUST) with a Doctor of Pharmacy degree in 2010. After graduation, she worked as a teacher and research assistant at the Faculty of Pharmacy/JUST in a position of clinical pharmacy training preceptor at King Abdullah University Hospital/Intensive & Critical Care Units. Later on, she joined the PhD program in Uinversity of Pittsburgh/School of Pharmacy where she got her official training in pharmaceutical outcomes and policy research, and got her degree in 2015. Presently she has been working as an assistant professor at JUST/School of Pharmacy.

Long acting beta agonists (LABA) and leukotriene receptor antagonists (LTRA) are the major add-on treatments in older adults with persistent asthma when inhaled corticosteroids (ICS) fail to achieve adequate asthma control. The aim of this study was to evaluate the cost-utility of ICS+LABA compared with ICS+LTRA in older adults with asthma. A Markov model was developed to estimate the incremental costs and quality adjusted life expectancy associated with ICS+LABA versus ICS+LTRA in older adults with asthma in the US from the health system perspective. HCUPnet 2010 national statistics were utilized to extract the costs associated with asthma and cardiovascular hospitalizations, and inpatient mortality associated with these events. Event probabilities were predicted using Medicare 2009-2010 claims for asthmatic older adults. Treatment costs were estimated based on average wholesale drug price listings and utility estimates were extracted from the literature. To account for uncertainty, one-way sensitivity analysis and probabilistic sensitivity analysis was performed. The model predicted that, compared with ICS+LTRA treatment, ICS+LABA treatment costs $5,823 more while gaining 0.03 quality-adjusted lifeyears (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $209,090 per QALY. Hospitalization probabilities and post hospitalization utilities were the most influential parameters in one-way sensitivity analysis. Probabilistic uncertainty analysis using Monte Carlo simulations showed that the probabilities that ICS+LTRA is cost effective compared to ICS+LABA are 77% and 62% at $50,000 and $100,000 per QALY gained willingness-to-pay thresholds, respectively. Overall, the cost effectiveness of ICS+LABA treatment is economically unfavorable in the older adults when compared to LTRA as add-on treatment.

Laura Calza is a professor of Embryology, Regenerative Medicine and Cognitive Sciences at University of Bologna. She is the Director of the Health Sciences and Technologies - Interdepartmental Center for Industrial Research (HST-ICIR) at University of Bologna. Laura is the president of the scientific and technical board of the Montecatone Rehabilitation Institute for spine and brain injury. She is the scientific advisor of the Life Science Platform at High Technology Network for Emilia Romagna Region. She is the scientific director of IRET Foundation, Ozzano Emilia, Italy. She is the founder of TransMed Research srl, Ozzano Emilia, Italy. Laura is one of the members of the Neuroscience Society, and Alzheimer’s Association International Society to Advance Alzheimer’s Research and Treatment (ISTAART).

Due to increased life expectancy, the prevalence of cognitive decline related to neurodegenerative diseases and to nonneurological conditions is increasing in western countries. As with other diseases, the burden might be reduced through

personalized interventions delivered in early stages of the disease. Thus, there is an increasing demand, from both social and health care systems, for instruments and strategies recognize cognitive decline, and possibly distinguishes the precursor of serious neurodegeneration from “benign senile forgetfulness” or the temporary consequences of illness or trauma. However, this goal faces both technical and ethical issues. In this presentation I will discuss the followings: (i) re-definition of cognitive decline and its relationship with frailty definitions, starting from the recent work of international consensus groups for presymptomatic Alzheimer disease recognition; (ii) ethical problems concerning anonymous and personalized cognitive screening and the need for appropriate counselling; (iii) the need for more sensitive and specific tools to detect and distinguish pathological levels of cognitive decline and delineate the contribution of non-pathological decline to accumulated frailty impacts and (iv) the potential of the language domain and spontaneous speech analyses. Two novel ICT instruments for fast testing of the cognitive performance will be presented. The first one intends to explore in a 15min test different cognitive domains included or not in conventional dementia screening programs (amnestic, temporal orientation, immediate and delayed topographic memory, visual attention and executive functioning, constructive abilities, visual attention, object recognition, inhibition abilities, visuospatial skills), to provide a “warning index” for further neuropsychiatric investigations. The second one is based on the assessment of verbal and nonverbal abilities through the analysis of the spontaneous discourse, which allows study of the language used in a real-world context, through automatic computerized and statistical techniques from Natural Language Processing. This system will conduct a quantitative analysis of spoken texts, computing acoustic/prosodic, lexical, morpho-syntactic and semantic characteristics.