Age and ageing
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The Neuberger report failed to show that the Liverpool Care Pathway was the cause of poor end-of-life care and made it the scapegoat for poor communication and faulty decision-making. The report's discrediting of a quality assurance mechanism that had the potential for improvement is a disservice to dying patients. Several of the report's recommendations are puzzling, but two consequences of the report, an excellent review of care pathways and a recommendation to establish a national end-of-life coalition, have the potential to improve care of the dying individual.
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rapid specialist assessment of patients with transient ischaemic attack (TIA) reduces the risk of recurrent stroke. National guidelines advise that high-risk patients are assessed within 24 h and low-risk patients within 7 days. ⋯ factors contributing to delay include incorrect interpretation of symptoms and failure to invoke emergency services. Delays after presentation could be addressed by direct referral by out of hours services, paramedics and optometrists.
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Randomized Controlled Trial Multicenter Study
Which factors are associated with fear of falling in community-dwelling older people?
fear of falling (FOF) is common in older people and associated with serious physical and psychosocial consequences. Identifying those at risk of FOF can help target interventions to both prevent falls and reduce FOF. ⋯ a range of factors identify those with FOF. A simpler model performs as well as a more complex model containing functional assessments and could be used in primary care to identify those at risk of FOF, who could benefit from falls prevention interventions.
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place of death is an important component of the quality of a person's death. The aim of this study was to undertake a systematic review and narrative synthesis of the literature concerning place of death of people with dementia and the preferences for location of death of people with dementia as well as family carers and healthcare providers preferred location of death for patients with dementia. ⋯ this study on place of death raises exploratory questions on end-of-life care for patients with dementia which has implications on health and social care policies related to dementia.
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Multicenter Study
Specialty experience in geriatric medicine is associated with a small increase in knowledge of delirium.
delirium is underdiagnosed and undertreated. Understanding of delirium among doctors in medical and ICU settings has previously been shown to be low. We hypothesised that junior doctors who had gained experience in geriatrics, neurology or psychiatry may have an increased knowledge of delirium. ⋯ experience in geriatric medicine leads to a small improvement in understanding of delirium among junior doctors.