Archives of gerontology and geriatrics
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Arch Gerontol Geriatr · Jan 2007
Affective, behavior and cognitive disorders in the elderly with chronic musculoskelatal pain: the impact on an aging population.
Chronic musculoskeletal pain is a common, disabling condition that affects at least one in four elderly people. Figures are much higher in nursing homes, in which as many as 45-80% of residents has pain that contributes to functional impairment and decreased quality of life. Multiple comorbidity, under-reporting of symptoms and cognitive impairment make pain evaluation often difficult. ⋯ In a large Italian home care study, age of 85 years or more and low cognitive performance were predictors of failing to receive adequate analgesics. However, most patients with cognitive impairment and even those with severe dementia can be assessed using one of the available pain-intensity scales (verbal or not verbal). Structured programs are needed for routine pain assessment and treatment in older people.
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Arch Gerontol Geriatr · Nov 2006
Inpatient falls and injuries in older patients treated for femoral neck fracture.
A prospective inpatient study was performed at the Orthopedic and Geriatric Departments at the Umeå University Hospital, Sweden, to study inpatient falls, fall-related injuries, and risk factors for falls following femoral neck fracture surgery. Ninety-seven patients with femoral neck fracture aged 70 years or older were included, background characteristics, falls, injuries, and other postoperative complications were assessed and registered during the hospitalization. There were 60 postoperative falls among 26/97 patients (27%). ⋯ Forty-five percent of the patients were delirious the day they fell. Intervention programs, including prevention and treatment of delirium and sleeping disturbances, as well as better supervision of male patients, could be possible fall prevention strategies. Improvement of the quality of care and rehabilitation, with the focus on fall prevention based on these results, should be implemented in postoperative care of older people.
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This study investigates the relationships between delirium, cognitive impairment and acute illness severity with adverse clinical outcomes; in-hospital mortality, hospital length of stay, or new entry to a care home. It is a prospective observational study of medical inpatients 70 years or older, with repeated measurements of cognition, delirium status, delirium severity, and severity of physical illness every 3 days until the 18th day and then the 28th day of hospitalization. Of 94 participants, 33 had delirium and 14 recovered during their hospitalization. ⋯ The presence of delirium was not related to measures of the severity of physical illness or disability. High mortality was associated with delirium but was specifically associated with cognitive impairment. Prolonged length of stay of delirious people may depend on discharge destination.
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Arch Gerontol Geriatr · Nov 2005
Comparative StudyEmergency department fall-related presentations do not trigger fall risk assessment: a gap in care of high-risk outpatient fallers.
We wanted to determine whether women aged 70 years and older, who presented to the emergency department (ED) with a fall and injury, received guideline care within 18 months of presentation. Women aged 70 years and older who presented to the ED with a fall were recorded prospectively from August 1, 2001 to May 1, 2002 (n=226). ⋯ We concluded that most older women who presented to the ED with a fall did not appear to be receiving current guideline care. We propose that future research use a prospective study design to assess whether or not guideline care is being delivered by a variety of health care providers after the patients leave the ED.
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Arch Gerontol Geriatr · Nov 2005
Comparative StudyImpact of age on in-hospital mortality of surgical patients in a German university hospital.
Although the frequency of major surgical procedures in elderly patients is increasing, the impact of age as an independent factor on in-hospital mortality and capacity planning is uncertain. Therefore, we analyzed how age, gender, number of diagnoses, and number of operations per patient are reflecting the demographic changes going on in the last decade. Furthermore, we analyzed the influence of age, main diagnoses, and comorbidities on in-hospital mortality, and cost factors, like duration of in-hospital stay, number of operations, and stay at the intensive care unit using multiple regression analysis. ⋯ Nevertheless, oncologic diseases and pre-existing comorbidities are also significant independent factors for the clinical course and costs resulting from treating elderly patients. We conclude that decisions for surgical treatment should not be solely based on patient's age. The demographic changes in Europe result in an over-proportional increase in expenditures, which should be included when planning the capacities of a surgical department.