Aging clinical and experimental research
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Dementia is prevalent in the elderly but it is usually unrecognized. The Rowland Universal Dementia Assessment Scale (RUDAS) appears to be a good screening tool for dementia detection. The objectives are to validate RUDAS-Thai for detecting dementia according to Diagnostic and Statistical Manual of Mental Disorders- IV-Text Revised (DSM-IV-TR) criteria in a geriatric outpatient setting and to determine its optimal cut point. ⋯ The RUDAS-Thai is a good screening tool for dementia detection in a geriatric outpatient setting. It is portable, short-time consuming, and avoids some limitations of the Mini-Mental State Examination (MMSE). However, education does affect the scores. The scores of 24 or lower is an optimal cut point for an indication of developing dementia.
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This case report concerns an elderly woman referred with a 6-month history of rising and falling fever in the range 38-40°C. She was examined repeatedly by her family doctor and given various antibiotic treatments before being hospitalized in our geriatric unit. Laboratory tests and microbiological studies led to a diagnosis of chronic Q fever, a zoonosis caused by Coxiella burnetii, a Gram-negative obligate intracellular coccobacillus; humans usually become infected by inhaling infectious airborne particles. ⋯ As the most frequent and severe manifestation of Q fever is endocarditis, severe consequences may ensue. In our patient, broad-spectrum antibiotics were given before the serology results were available and rapid clinical improvement was achieved. This unusual disease should therefore also be considered in differential diagnosis of fever in the elderly, and age should not be considered as a contraindication for not performing all studies, because timely and adequate treatment is important partly to preserve elderly patients' self-sufficiency and to prevent them from becoming bedridden.
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In Italy there is a paucity of empirical data on practices concerning end-of-life decisions (ELDs) in geriatrics. We aimed to investigate the frequency and characteristics of ELDs made by Italian physicians and nurses in the geriatric setting. ⋯ In geriatrics, DELs often precede the deaths of terminally-ill Italian patients. Nurses report making DELs more often than physicians, especially in incompetent patients. Continuous deep sedation was adopted by 39.5% of the Italian physicians for deaths not occurring suddenly and unexpectedly. Our report on physicians' and nurses' experiences of ELD making in geriatric settings can offer a valuable contribution to the current debate on end-of-life treatment, an issue that goes beyond national borders.