Journal of the American Geriatrics Society
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Multicenter Study Observational Study
Real-World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl-life Multicenter Survey Evaluating Stroke Study.
To compare the clinical characteristics of and use of oral anticoagulant (OAC) therapy in individuals aged 80 and older with atrial fibrillation (AF) with those of individuals younger than 80 with AF in clinical practice. ⋯ Nearly one-fifth of individuals with NVAF in this real-world sample were aged 80 and older. Participants aged 80 and older were more likely to be female and have more comorbidities than those who were younger than 80. Those aged 80 and older with AF were less likely to receive anticoagulants than those who were younger than 80, but having more comorbidities and other individual-level characteristics may explain this difference. When they were prescribed OACs, participants aged 80 and older had poorer quality of anticoagulation than those who were younger, suggesting opportunities for improvement.
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Multicenter Study
Potential Value of Impaired Cognition in Stroke Prediction: A U.K. Population-Based Study.
To determine whether the association between impaired cognition and greater risk of incident stroke is also observed when cognitive impairment is defined using different criteria for mild cognitive impairment (MCI). ⋯ Criteria for MCI, defined using MMSE scores or clinical criteria, can capture individuals at greater stroke risk. The results highlight the need to focus on stroke risk in individuals even with MCI.
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To determine whether a bundled risk screening and warning or action card system improves formal delirium diagnosis and person-centered outcomes in hospitalized older adults. ⋯ Participants with a positive risk screen were significantly more likely (relative risk = 6.0, 95% confidence interval = 4.9-7.3) to develop delirium, and the proportion of at-risk participants with a positive screen was constant across three study phases. Delirium detection rate in participants undergoing the final intervention (Phase 3) was 12.1% (a 2% absolute and 17% relative increase from the baseline rate) but this was not statistically significant (P = .29), and a similar relative increase was seen over time in participants not receiving the intervention CONCLUSION: A risk screening and warning or action card intervention in the ED did not significantly improve rates of delirium detection or other important outcomes.
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To explore the performance of the neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation that predicts prognosis of several diseases, in a cohort of elderly adults with community-acquired pneumonia (CAP). ⋯ These results would encourage early discharge of individuals with a NLR of less than 11.12, short-term in-hospital care for those with a NLR between 11.12 and 13.4, middle-term hospitalization for those with a NLR between 13.4 and 28.3, and admission to a respiratory intensive care unit for those with a NLR greater than 28.3.
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To report frequencies and associated risk factors for 4 distinct causes of live discharge from hospice. ⋯ Further research into factors that underlie live discharge events, especially acute hospitalization, is warranted given their cost and burden for patients/families. Hospices should develop strategies to address acute medical crises and thoroughly evaluate patients' suitability, unmet needs, and knowledge about end-of-life issues at the time of hospice enrollment, especially for those with non-cancer diagnoses.