Age and ageing
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accurate classification of older people into fallers and non-fallers is crucial for falls research, but largely dependent on the accuracy of fall reporting by the participants. ⋯ good memory appears to influence the recording of falls in community-dwelling older people and likely reflects a reporting bias. In research studies, there may be value in using a combination of injurious falls and multiple falls when classifying people into faller and non-faller groups.
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delirium and frailty are common among hospitalised older people but delirium is often missed and frailty considered difficult to measure in clinical practice. ⋯ delirium was associated with higher levels of frailty: the identification of frail patients may help to target those at a greatest risk of delirium. Survival following delirium was poor with the combination of frailty and delirium conferring a particularly bleak prognosis.
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stroke is a leading cause of death and disability globally. The economic costs of stroke are high but not often fully quantified. This paper estimates the economic burden of stroke and transient ischaemic attack (TIA) in Ireland in 2007. ⋯ the chronic phase of the disease accounts for the largest proportion of the total annual economic burden of stroke. This highlights the need to maximise functional outcomes to lessen the longer term economic and personal impacts of stroke.
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hip fracture represents a huge medical, social and financial burden on patients, their carers and the health and social care systems. For survivors, return to their own home may be a key outcome. The Nottingham Hip Fracture Score (NHFS) is a validated score, based on admission characteristics, for predicting 30-day and 1-year mortality that may be of benefit in predicting return-to-home, directly from the acute orthopaedic ward. ⋯ the NHFS is a reliable tool for predicting return-to-home. It may be useful for discharge planning, and for the design of future research trials.
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advance care planning (ACP) allows a patient to state their preferences for care, so that if in future they cannot make decisions their wishes are known. Our aim was to review systematically the effectiveness of ACP interventions in people with cognitive impairment and dementia. ⋯ there is limited evidence for the effectiveness of ACP in people with cognitive impairment/dementia in terms of ACP documentation and health-care use. In terms of capacity to discuss ACP, nursing home settings may be too late for people with dementia.