Journal of the American Geriatrics Society
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To characterize antibiotics prescribed to older adults to guide efforts to improve antibiotic use. ⋯ On average, in 2014, U.S. adults aged 65 and older received enough outpatient antibiotic courses for every older adult to receive at least 1. Quinolones and azithromycin are potential targets for assessing the appropriateness of antibiotic prescribing in this population. Interventions to improve use targeting internists and family physicians in the South Census region might have the potential to have the greatest effect.
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To evaluate the utility of monitoring emergency medical services (EMS) call patterns to identify older adults who may benefit from targeted fall prevention and medical monitoring strategies. ⋯ Certain older individuals are at risk of having multiple fall-related calls to EMS over short periods of time, sometimes within hours of previous calls. In our current healthcare system, no significant intervention or follow-up is offered or available by emergency first response teams to prevent subsequent falls. This study demonstrates the need for a paradigm change in our healthcare system that helps reduce resource utilization for the first responder community for fall-related calls in older adults and re-directs those resources to implement nationwide fall-prevention strategies to decrease fall related disability and death.
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To examine associations between healthcare transitions at the end of life (EOL; late transitions) and bereaved family members' and friends' assessment of EOL quality of care (QOC). ⋯ Transitions in the last 3 days of life are associated with more unmet needs, higher rate of concerns, and lower rating of QOC than when such late transitions are absent, especially when that transition is between a nursing home and hospital.
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Multicenter Study Observational Study
Hypotensive Drugs and Syncope Due to Orthostatic Hypotension in Older Adults with Dementia (Syncope and Dementia Study).
To determine whether hypotensive drugs may play a pivotal role in inducing orthostatic hypotension (OH)-related syncope. ⋯ In older adults with dementia, OH-related syncopal falls are significantly related to treatment with nitrates, combinations of ACE-Is and diuretics, and combinations of ACE-Is and nitrates.
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To elicit decisions that diverse older adults and surrogates perceive as serious, difficult, or important and explore what helped them make those decisions. ⋯ Diverse older adults and surrogates perceive life-threatening illness and day-to-day decisions about chronic disease to be serious, difficult, and important. The surrogates' goal of avoiding suffering of older adults may differ from older adults' priorities of self-sufficiency and maximizing survival. Clinicians should support older adults and surrogates in identifying important and difficult decisions and learn about the values and information sources they bring to decision-making. With this knowledge, clinicians can customize decision support and achieve person-centered care.