la donna anziana fragile: le malattie cardiovascolari · prevalenza delle malattie cardiovascolari...
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La donna anziana fragile:
le malattie cardiovascolari
Marco Stramba-Badiale
Direttore, Dipartimento Geriatrico-Cardiovascolare
IRCCS Istituto Auxologico Italiano, Milano
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Frailty in Older Women
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Frailty: Fried criteria
Eur Heart J 2014; 35, 1726–1731
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Frailty and Age
Eur Heart J 2014; 35, 1726–1731
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Physical Performance
in Men and Women
Journal of Aging and Health 2016:1–
23
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Factors Associated with Frailty
Development
J Am Geriatr Soc 2016, on line
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Disability in Men and Women
Quaderni del Ministero della Salute 2010; 6:1-17
Age (years)
Dis
abili
ty R
ate
Men
Women
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Journal of Aging and Health 2016:1–
23
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Frailty Components in Men and Women
Journal of Aging and Health 2016:1–
23
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Frailty and Cardiovascular Risk
Am Coll Cardiol 2015;65:976–83
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Frailty Components and
Cardiovascular Risk
Am Coll Cardiol 2015;65:976–83
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Prevalenza delle malattie cardiovascolari
in base ad età e genere
11.2
22.9
86.4
36.2
52.9
68.5
77.8
6.2
17.6
36.6
56.5
75.0
0
10
20
30
40
50
60
70
80
90
100
20-34 35-44 45-54 55-64 65-74 75+
Ages
Percen
t o
f P
op
ula
tio
n
Males
Females
CDC/NCHS and NHLBI 2008
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Eur Heart J 2006;27:994-1005
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https://www.escardio.org/static_file/Escardio/EU-Affairs/WomensHearts-RedAlert.pdf
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Frailty and Cardiovascular Diseases
• Increase in the risk of cardiovascular and total mortality
• Increase in complications from medical therapy
• Reduction in benefits of cardiac interventions such as TAVR, PCI and CABG
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Frailty and Age
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Interventions to Reduce Frailty
Am Coll Cardiol 2015;65:976–83
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High-end and Low-End Virtual Reality
Systems for the Rehabilitation of Frailty in
the Elderly
Ricerca Finalizzata 2013
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Virtual Reality for Reducing the Physical
Decline in the Elderly
1. Design, develop and test a VR intervention for reducing the physical decline in the elderly;
2. Compare the effects of a virtual reality (VR) protocol with usual care.
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Virtual Reality in Motor
Rehabilitation The VR programs offer the possibility to create a realistic home-like environments where the performance can be tested and
trained systematically.
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The use of advanced motion tracking tools allows the
processing of motion parameters in real-
time. With these information it is
possible to provide an immediate
feedback.
Virtual Reality in Motor
Rehabilitation
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Computerized Automatic Virtual Environment
4-wall CAVE
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Five-week Rehabilitation Programs
• 10 biweekly inpatients sessions using high-end VR systems in the health care center
• 10 biweekly outpatients sessions using low-end VR systems at home.
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The Hypotheses
• IMPROVE PHYSICAL FUNCTIONING (Timed Up & Go Test, the Timed 10-Meter, Hand grip strength, and the Perdue Pegboard Test);
• REDUCE DISABILITY (Modified Barthel Index - MBI);
• HAVE A POSITIVE EFFECT on a number of secondary outcome measures including depressive symptoms and health-related quality of life.
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Aknowledgements Karine Goulene, MD, PhD, Head, Outpatients Rehabilitation
Unit, Dept of Geriatrics and Cardiovascular Medicine,
IRCCS Istituto Auxologico Italiano
Giuseppe Riva, PhD, Director, Applied Technology for
Neuro-Psychology Laboratory, IRCCS Istituto Auxologico
Italiano
Andrea Gaggioli, PhD, Applied Technology for Neuro-
Psychology Laboratory, IRCCS Istituto Auxologico Italiano
Elisa Pedroli, PhD, Applied Technology for Neuro-
Psychology Laboratory , IRCCS Istituto Auxologico Italiano
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Conclusions • Physical performance is worst in older women when compared to older
men.
• The development of frailty is more common in women than in men.
• The prevalence of disability is higher in older women than in older
men.
• The components of frailty associated with higher risk of cardiovascular
disesases are more prevalent in older women than in older men.
• Traditional interventions such as physical exercise to prevent or reduce
frailty are controversial.
• New technologies, such as Virtual Reality are currently under
investigation in both older women and men.