Age and ageing
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to study the recognition of cognitive impairment in elderly medical inpatients by medical staff. ⋯ 46% of the patients found to be cognitively impaired by the researcher had no record of cognitive impairment in the medical notes. However, 14 out of 15 of the patients with DSM IIIR delirium, and 22 out of the 26 patients with DSM IIIR dementia, were identified as cognitively impaired by the physicians. This suggests that the physicians were detecting the vast majority of patients with clinically significant cognitive impairment.
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The aim of this study was to evaluate the type and frequency of falls presenting to an inner city casualty department, and to identify modifiable risk factors in these patients. A prospective descriptive study evaluated those over 65 years presenting to an inner city casualty department with falls. Over a 4-week recruitment period, all consenting subjects completed a semi-structured questionnaire regarding their falls and cognitive status. ⋯ Falls are a common presenting complaint yet a fall is readily explained in less than one-third of cases. Investigation of RF and UF has a high yield for possibly modifiable cardiac and non-cardiac risk factors. Targeted multi-disciplinary rapid assessment of patients attending the Accident and Emergency Department because of a fall might reduce the number of hospital admissions.
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Seasonal fluctuations in mortality are associated with age, outdoor temperature, and influenza. The relative excess winter mortality is approximately twice as high in the UK compared with the Scandinavian countries. ⋯ In the British data only, a marked and statistically significant negative relationship existed between outdoor temperature and excess winter mortality, corresponding to an increase of approximately 3,500 deaths in England and Wales (approximately 2/10,000 in the population aged 45 years and over) per 1 degree C reduction in winter temperature, after adjustment for age and influenza. Using data from 20 Western European countries, a highly significant positive correlation (R = 0.71, p < 0.001) was found between total mortality rates for the elderly (65 years and over) and relative excess winter mortality.
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The type of environmental hazards implicated in the aetiology of a consecutive series of 787 hip-fracture patients was prospectively studied. Most falls occurred between 09 h 00 and midday and there was no seasonal variation. Fifty-one different environmental hazards were implicated in the aetiology of the fall for 58% of patients. The nature of environmental hazards was diverse, implying that measures to reduce the risk of falls due to these factors are unlikely to lead to a significant reduction in the incidence of hip fractures.
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Delirium is a common and serious complication of acute illness in elderly patients. The aim of this study was to develop and validate a model for predicting development of delirium in elderly medical inpatients who did not have delirium on admission. Consecutive admissions to an acute geriatric unit underwent standardized cognitive assessment every 48 hours. ⋯ Independent predictors of delirium in a derivation group of 100 patients were determined using stepwise logistic regression analysis; the predictive model comprised dementia, severe illness and elevated serum urea. This model performed well in a validation group of 84 patients. We conclude that elderly medical patients can be stratified according to their risk for developing delirium using a simple clinical model.