Journal of the American Geriatrics Society
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To describe patterns of, and factors associated with, statin use and discontinuation in nursing home (NH) residents progressing to advanced dementia and followed for at least 90 days. ⋯ Most NH residents who use statins at the time of progression to advanced dementia continue use in follow-up.
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To describe the cognitive functioning of independent community-dwelling elderly adults visiting the emergency department (ED) for minor injuries and at 3- and 6-month follow-up assessments and to document the occurrence of falls, return to the ED, and hospital visits over time according to cognitive level. ⋯ Cognition is not optimal in many community-dwelling elderly adults visiting an ED for a minor injury, which may affect their capacity to comprehend, recall, and adhere to medical recommendations after their injury and put them at risk of further negative health events such as falls.
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To examine individual and regional factors associated with the use of intensive medical procedures in the last 6 months of life. ⋯ Individual characteristics and regional practice patterns are important determinants of intensive procedure use in the last 6 months of life. The effect of nonclinical factors highlights the need to better align treatments with individual preferences.
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Older adults are vulnerable to hospital-associated complications such as falls, pressure ulcers, functional decline, and delirium, which can contribute to prolonged hospital stay, readmission, and nursing home placement. These vulnerabilities are exacerbated when the hospital's practices, services, and physical environment are not sufficiently mindful of the complex, multidimensional needs of frail individuals. Several frameworks have emerged to help hospitals examine how organization-wide processes can be customized to avoid these complications. ⋯ Taken together, these results informed 12 recommendations to support hospitals at all stages of development in becoming friendly to older adults. Priorities for system-wide action were identified, encouraging hospitals to implement or further develop their processes to better address hospital-acquired delirium and functional decline. These recommendations led to collaborative action across the province, including the development of an online toolkit and the identification of accountability indicators to support hospitals in quality improvement focusing on senior-friendly care.