Age and ageing
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Comparative Study Observational Study
The relationship between cognitive impairment, mortality and discharge characteristics in a large cohort of older adults with unscheduled admissions to an acute hospital: a retrospective observational study.
older people with dementia admitted to hospital for acute illness have higher mortality and longer hospital stays compared to those without dementia. Cognitive impairment (CI) is common in older people, and they may also be at increased risk of poor outcomes. ⋯ the admission characteristics, mortality and length of stay of patients with CI resemble those of patients with diagnosed dementia. Whilst attention has been focussed on the need for additional support for people with dementia, patients with CI, which may include those with undiagnosed dementia or delirium, appear to have equally bad outcomes from hospitalisation.
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Comparative Study
Identifying frailty in the Emergency Department-feasibility study.
identifying the most at risk older people in Emergency Departments (EDs) may help guide clinical practice, and service improvement in emergency care, but little is known about how to implement such tools in practice. ⋯ validated risk stratification tools are quick, simple, easy to use and 75% of staff would use the tools again in the future.
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delirium following surgery is common and is associated with negative outcomes. Preoperative cognitive impairment has been shown to be a risk factor for post-operative delirium. Often the cognitive tests used are cumbersome. This study tests the hypothesis that the quantification of brain vulnerability, using Apolipoprotein E (ApoE) status and neuropsychological tests, both traditional and more easily administered, can quantify the risk of post-operative delirium following elective primary arthroplasty surgery. ⋯ this study challenges the assertion that ApoE4 genotype predicts post-operative delirium. It replicates previous work suggesting cognitive impairment predicts post-operative delirium and shows for the 1st time that simple cognitive tests can be as effective as more detailed tests.
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this paper aims to investigate the nature and extent of physical restraint deaths reported to Coroners in Australia over a 13-year period. ⋯ this national study confirms that the use of physical restraint does cause fatalities, although rare. Further research is still needed to identify which alternatives strategies to restraint are most effective, and to examine the reporting system for physical restraint-related deaths.
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to validate STOPPFrail, a list of explicit criteria for potentially inappropriate medication (PIM) use in frail older adults with limited life expectancy. ⋯ STOPPFrail comprises 27 criteria relating to medications that are potentially inappropriate in frail older patients with limited life expectancy. STOPPFrail may assist physicians in deprescribing medications in these patients.