Acute care hospitalization for older people is a major issue in terms of mortality, loss of functional independence, and reduced quality of life. The Geriatric Comprehensive Assessment may be crucial in promoting predictive models of hospitalization outcomes, including clinical, functional, and socio-demographic factors. The Geriatric Risk Assessment and Care Evaluation (GRACE) Study, a collaborative effort between the Azienda Ospedaliera San Giovanni Addolorata (AOSGA) and the Italian Society of Hospital and Community Geriatrics, is an observational, retrospective cohort study. It focuses on patients consecutively admitted to the acute geriatric care unit of AOSGA. The primary objective of the GRACE study is to identify factors that may predict in-hospital mortality. Secondary objectives include analyzing factors influencing the length of hospital stay and discharge setting. This paper details the study’s rationale and methodology and provides a brief overview of existing evidence regarding hospitalization outcomes in older adults. On behalf of the GRACE-AOSGA/SIGOT Study Group Investigators

Background: Breast cancer is frequently diagnosed in older women. However, the impact of surgery on survival is not well studied and prognosis for women ≥ 80 years of age is progressively depending on comorbidities. Methods: Medical records of consecutive women aged ≥ 80 years diagnosed with primary breast cancer treated with upfront surgery at two Breast Centers from 2011 to 2021 were retrospectively analyzed. Results: A total of 553 consecutive women with a median age of 83 years and a median tumor diameter of 21 mm were analyzed (574 lesions). Clinical Stages II or III were found in 263/574 (46%) and 101/574 cases (18%), respectively. Axillary staging was completely omitted for 94/542 invasive lesions (17%), and this increased over time from 2% to 33% (p < 0.001). Adjuvant hormone therapy and radiotherapy were omitted in 134/490 (27%) and in 122/420 patients (29%), respectively, while only 26/195 (13%) of patients with a clear clinical indication received adjuvant chemotherapy. At a median follow-up of 61 months (6–147) the 5- and 10-years overall survival (OS) were 64% and 21%, while breast cancer-specific survival (BCSS) at 5 and 10 years were 94% and 78%, respectively. Adjuvant therapies were not associated with a significant improvement in BCSS, while worse OS was associated with older age or more comorbidities as measured by the Charlson Comorbidity Index (CCI) (p < 0.001 and p = 0.012, respectively). Conclusions: Breast surgery, when possible, has a primary role even for women > 80 years of age, and it is associated with a reasonable BCSS. De-escalation of adjuvant therapies should be considered in this setting because survival is largely determined by age and co-morbidities.

Background: Mild and moderate pain represent a large proportion of emergency department (ED) presentations but are frequently underestimated and inconsistently managed, particularly in vulnerable populations such as children and older adults. Standardised and evidence-based approaches are needed to ensure timely, safe, and effective pain control across the entire emergency care pathway. Methods: A national multidisciplinary Delphi consensus was conducted under the auspices of the Italian Society of Emergency Medicine (SIMEU). A Scientific Steering Committee performed a systematic literature review and developed 26 statements comprising 92 items across four thematic areas: analgesia at triage, risk factors and analgesia at discharge, analgesia in children, and analgesia in elderly patients. Thirty-three experts from across Italy participated in three Delphi rounds, rating each item using a five-point Likert scale. Consensus was defined as ≥66% agreement (scores 4–5). Results: Consensus was achieved for 78 out of 92 items. Key recommendations include early pain assessment at triage using validated scales, paracetamol as first-line therapy for mild and moderate pain across all age groups, and the use of multimodal analgesia for moderate pain. Fixed-dose combinations of paracetamol and ibuprofen were strongly endorsed for their efficacy, safety, and opioid-sparing effect in adults, children, and elderly patients. Clear guidance was also provided for analgesic selection at discharge, duration of therapy, patient education, and management of special populations. Conclusions: This multidisciplinary Delphi consensus provides practical, evidence-based recommendations to harmonize the management of mild and moderate pain in ED. Implementation of these recommendations may improve pain control, patient safety, and quality of care in non-urgent emergency settings.

Methods: We analyzed data from 896 patients aged ≥ 65 years admitted to the acute care unit of S. Giovanni Addolorata Hospital (Rome, Italy) as part of the GRACE study (2022–2024). The MPI and BRASS scores were collected within 48 and 24 hours of admission, respectively. Associations of each tool with in-hospital mortality, institutionalization, and length of stay (LOS) were assessed using logistic regression analyses. The predictive performance of the two tools was subsequently compared through receiver operating characteristic (ROC) curve analysis. Results: Higher MPI and BRASS risk categories were associated with greater mortality, longer LOS, and higher rates of institutionalization (p < 0.0001 for all). Compared to low-risk patients, high-risk MPI patients were associated with in-hospital mortality (OR 21.28; 95% CI 2.76 164.5; <0.0001), institutionalization (OR 3.30; 95% CI 1.68–6.52; p = 0.004), and non-home discharge (OR 5.93; 95% CI 3.10–11.3; p < 0.0001). Similarly, patients with high-risk BRASS category were associated with higher odds of mortality (OR 4.15; 95% CI 1.37–12.58; p = 0.005), institutionalization (OR 3.09; 95% CI 1.77–5.37; p = 0.0003) and non-home discharge (OR 3,78; 95% CI 2.26–6.73; p < 0.0001) compared to the low risk group. ROC curves showed similar performance of both tools for mortality (AUC 0.785 vs 0.729, p = 0.13), institutionalization (AUC 0.615 vs 0.623, p = 0.73), and non-home discharge (AUC 0.702 vs 0.692, p = 0.54). Conclusions: MPI showed a higher AUC for mortality compared to BRASS although the difference did not reach statistical significance. For discharge-related outcomes, BRASS performed comparably to MPI. Given its simplicity and minimal resource requirements, BRASS may serve as a rapid, cost-effective screening tool to complement – or, when appropriate, precede - full CGA-based MPI evaluation.