Journal of the American Geriatrics Society
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To assess the effectiveness of a novel combined education and quality improvement (QI) program for management of pain in older adults in the emergency department (ED). ⋯ The I-PREP intervention substantially improved pain management in older adults in the ED with moderate to severe musculoskeletal or abdominal pain. Significant reductions in pain intensity were achieved, the timing of pain assessments and reassessments was improved, and analgesics were delivered faster. Tightly linking education to targeted QI improved pain management of older adults in the ED.
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To study the associations between protein energy malnutrition, micronutrient malnutrition, brain atrophy, and cerebrovascular lesions. ⋯ Malnutrition and lower vitamin B1 and B12 levels were independently associated with greater risk of WMHs. Underlying mechanisms need to be further clarified, and whether nutritional interventions can modify these findings also needs to be studied.
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The population is aging, and breast cancer incidence increases with age, peaking between the ages of 75 and 79. However, it is not known whether mammography screening helps women aged 75 and older live longer because they have not been included in randomized controlled trials evaluating mammography screening. Guidelines recommend that older women with less than a 10-year life expectancy not be screened because it takes approximately 10 years before a screen-detected breast cancer may affect an older woman's survival. ⋯ To inform decision-making, tools are available to estimate life expectancy and to educate older women about the benefits and harms of mammography screening. Guides are also available to help clinicians discuss stopping screening with older women with less than a 10-year life expectancy. Ideally, screening decisions would consider an older woman's life expectancy, breast cancer risk, and her values and preferences.