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Maria Devita,1,2 Rossella De Salvo,1 Adele Ravelli,2 Marina De Rui,2 Alessandra Coin,2 Giuseppe Sergi,2 Daniela Mapelli1 1Department of General Psychology (DPG), University of Padua, Padua, Italy; 2Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, ItalyCorrespondence: Maria Devita, Department of General Psychology, Via Venezia 8, Padua, 35128, Italy, Tel +390498218949, Email maria.devita@unipd.itAbstract: Depression is one of the most common mood disorders in the late-life population and is associated with poor quality of life and increased morbidity, disability and mortality. Nevertheless, in older adults, it often remains undetected and untreated. This narrative review aims at giving an overview on the main definitions, clinical manifestations, risk and protective factors for depression in the elderly, and at discussing the main reasons for its under/misdiagnosis, such as cognitive decline and their overlapping symptomatology. A practical approach for the global and multidisciplinary care of the older adult with depression, derived from cross-checking evidence emerging from the literature with everyday clinical experience, is thus provided, as a short and flexible “pocket” guide to orient clinicians in recognizing, diagnosing and treating depression in the elderly.Keywords: late-life depression, older adults, mood disorders, geriatric depression

Little is known of the factors that transform fear of falling (FOF) from a normal adaptive to a maladaptive response that could alter its impact on fall risk. Focusing on judgment capacity, we investigated whether it is associated with FOF and FOF-related activity restriction (AR), and whether it modifies the influence of FOF on fall risk. Data came from 2625 community-dwelling older adults enrolled in the Progetto Veneto Anziani. Baseline FOF and AR were assessed through personal interviews, and judgment capacity-high, moderate, or poor-through situational tests. At follow-up after 4.4 years, self-reported falls during the previous year were recorded. The associations between judgment and FOF/AR, and between FOF and the risk of at least one fall or recurrent falls (two or more falls), stratified by judgment capacity, were evaluated using multinomial logistic regressions. Compared with high-judgment participants, lower judgment participants were 20% more likely to report FOF; moderate judgment participants were 54% more likely and poor judgment participants twice as likely to report AR. After adjusting for potential confounders, including physical activity and physical performance, FOF increased the reporting of at least one fall only in the poor judgment group. The association between FOF and recurrent falls was stronger in individuals with poor (odds ratio [OR] = 3.66, 95% confidence interval [CI]: 2.10-6.36) than with moderate (OR = 2.81, 95% CI: 2.22-3.55) or high (OR = 1.65, 95% CI: 1.48-1.83) judgment. Poor judgment capacity increases the probability of FOF and AR in older adults, and may exacerbate the effect of FOF in increasing fall risk.

Background: aortic valve stenosis (AVS) is becoming more and more common in the elderly population, involving around 13.2% of subjects older than 75 years. In addition to worsening quality of life, untreated severe AVS has been associated with high short term mortality rate. However, these adverse outcomes could be modified by aortic valve replacement (AVR). In recent years, in particular, newer surgery procedures and anesthesiological techniques have allowed also older and frailer patients access to AVR procedures. Previous studies have evaluated the effectiveness of AVR in older subjects in terms of peri- and post-operative mortality, but its impact on frail patients’ global health has been scarcely investigated. Aim of the study: the aim of our study was to evaluate the impact of AVR procedure on older patients’ physical performance, cognitive status and quality of life at 45 days, three and six months after surgery. Subjects and methods: this prospective study included 46 patients over 70 years, enrolled in collaboration with the Department of Cardiac Surgery of the University of Padova. All subjects were affected by AVS, and were recommended to undergo AVR. Study participants were evaluated with a multidimensional geriatric assessment before AVR (T0) and 45 days (T1), three (T2) and six months (T3) after surgery. In particular, for each participant we collected data on clinical examination, self-sufficiency (using the Activites of Daily Living and Instrumental Activites of Daily Living scales), cognitive status (using the Mini Mental State Examination and the Montreal Cognitive Assessment), presence of depressive symptom (through the Geriatric Depression Scale), quality of life (using the Short-Form 36 items Health Survey) and physical performance (through the Short Physical Performance Battery, gait speed, 6-minute walking test, and measurements of upper and lower limbs strength). Results: of the initial sample of 46 patients, 22 reached the 6-month follow-up