Archives of gerontology and geriatrics
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Arch Gerontol Geriatr · Jan 2014
Can elderly patients without risk factors be discharged home when presenting to the emergency department with syncope?
Age is often a predictor for morbidity and mortality. Although we previously proposed risk factors for adverse outcome in syncope, after accounting for the presence of these risk factors, it is unclear whether age is an independent risk factor for adverse outcomes in syncope. Our objective was to determine whether age is an independent risk factor for adverse outcome following a syncopal episode. ⋯ This was confirmed in a regression model accounting for the interaction between age>65 and risk factors. Although the elderly with syncope are at greater risk for adverse outcomes overall and in patients with risk factors, age ≥ 65 alone was not a predictor of adverse outcome in syncopal patients without risk factors. Based on this data, it may be safe to discharge home from the ED patients with syncope, but without risk factors, regardless of age.
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Arch Gerontol Geriatr · Jan 2014
Comparative Study Clinical TrialAgeism perceived by the elderly in Taiwan following hip fracture.
This qualitative, longitudinal study explored the feelings about and responses to discrimination experiences related to perceived ageism of older persons following hip fracture. Five male and six female hip-fractured elderly patients were sampled from a medical center in northern Taiwan. Semi-structured questionnaires were used to explore participants' experiences of and responses to ageism-related experiences. ⋯ Furthermore, participants' responses were divided into two categories: disregard and tolerance of ageism, or becoming more independent because of ageism. The elderly participants considered that the influences of positive ageism in the early months after discharge reduced their autonomy and deprived them of power. This response to ageism was temporary; over time the participants tried to regain autonomy by overcoming their dependency and improving their physical functioning.
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Arch Gerontol Geriatr · Jan 2014
Risk factors for 28-day mortality in elderly patients with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia.
Gram-negative bacteremia is common in elderly patients and, compared with younger patients, mortality rates in bacteremic elderly patients are high. ESBL-producing organisms were one of the most important risk factors associated with mortality. In addition, older age is one of risk factors for colonization or infection with ESBL-producing organisms. ⋯ The all-cause 28-day mortality rate was 24.6% (47/191). In multivariate analysis, prior antimicrobial therapy (p=0.014) and an elevated SOFA score (p<0.001) were independent risk factors for increased mortality, while urinary tract infection (UTI) was an independent determinant for non-mortality (p=0.011). In the current study, prior antimicrobial therapy within 30 days, an elevated SOFA score and nonurinary source of infection were significantly associated with adverse outcomes in elderly patients with ESBL-producing gram-negative bacteremia.
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Arch Gerontol Geriatr · Jan 2014
Validation and psychometric properties of the Delirium Motor Subtype Scale in elderly hip fracture patients (Dutch version).
The Delirium Motor Subtype Scale (DMSS) was developed to capture all the previous different approaches to delirium motor subtyping into one new instrument and emphasize disturbances of motor activity rather than associated psychomotoric symptoms. We investigated reliability and validity of the DMSS Dutch version. Elderly patients who had undergone hip fracture surgery received the DMSS and the Delirium Rating Scale Revised-98 (DRS-R-98). ⋯ The sensitivity and specificity of DMSS to detect each subtype ranged from 0.56 to 1 and from 0.88 to 0.98, respectively. This study suggests that the Dutch version of the DMSS is a reliable and valid instrument. The DMSS has scientific validity that could allow for greater precision in further research on motor subtypes.
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Arch Gerontol Geriatr · Jan 2014
Multicenter StudyThe frequency of and reasons for acute hospital transfers of older nursing home residents.
The purpose of the study was to examine the frequency of and reason for transfer from nursing homes to the emergency department (ED), whether these transfers led to admission to a hospital ward, and whether the transfer rate differs as a function of type of nursing home provider and to identify the frequency of avoidable hospitalizations as defined by the Swedish Association of Local Authorities and Regions (SALAR). The design was retrospective, descriptive. Data were collected in a Swedish municipality where 30,000 inhabitants are 65 years or older. ⋯ The frequency of avoidable hospitalizations was 16% among the 375 hospitalizations. The proportion of transfers to the ED ranged widely between nursing homes. The reasons for this finding ought to be explored.