Gerontology
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Ambulation is one of the most important elements of mobility, and difficulty with ambulation is often cited as a common problem among older adults. Self-report assessments (e.g. walking confidence) provide complementary information to performance tests (e.g. the Timed Up and Go Test, TUG) because they offer data not obtainable from a test of walking performance. ⋯ The ASCQ is reliable and support for validity is evident for this sample of community-dwelling older adults. Further studies are needed to assess the reliability and validity in a frailer older adult sample. The ASCQ may be useful to clinicians and researchers alike for determining an older adult's confidence with their walking ability.
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Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of hyponatremia in elderly hospitalized patients; however in many patients the etiology remains unclear even after routine investigations. ⋯ Potentially, urinary retention by itself may cause hyponatremia. The possible mechanism for this is SIADH, triggered by bladder distention or pain due to bladder distention. Urinary catheterization may be the key to treatment in these cases of hyponatremia.
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Bereavement is often associated with increased levels of depression, anxiety, and stress. The question of whether grief is associated with cognitive deficits in older adults remains largely unanswered. Although Xavier and coworkers (see text) found preliminary evidence that grief, in the absence of depression, impacted on memory in a sample of the oldest-old in Brazil, the impact of bereavement on cognitive functioning, independent of the effects of mood, has not been adequately examined. ⋯ The evidence suggests that grief associated with death of a spouse has limited associations with cognition beyond those that would be expected to occur as a result of depression, anxiety, and stress.
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Previous studies have found inconsistent links between suboptimal prescribing and negative patient outcomes. While suboptimal prescribing consists of multiple components, e.g. drugs to avoid in the elderly (DAE), potential drug interactions (PDI) and polypharmacy, most research has focused on the impact of drugs to avoid. This study explores the relationship between suboptimal prescribing, comorbid disease, and change in lower extremity functional limitation (LEFL). ⋯ The effect of suboptimal prescribing on change in LEFL was limited to both direct and mediational effects of polypharmacy. Additional research exploring the association between suboptimal prescribing and a variety of quality measures using a diverse set of outcomes would improve our understanding of the impact of suboptimal prescribing more broadly defined.
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Understanding comorbidity prevalence and the effects of comorbidities in older veterans with lower extremity amputations may aid in assessing patient outcomes, resource use, and facility-level quality of care. ⋯ Merging outpatient with inpatient data may reduce the under coding of comorbidities but does not enhance mortality prediction. Compared to the Charlson/Deyo, the Elixhauser has a more complete coding scheme for comorbid conditions, such as diabetes mellitus and peripheral vascular disease, important to addressing lower extremity amputation etiology.