Journal of the American Medical Directors Association
-
Delirium superimposed on dementia (DSD) is frequently not diagnosed, at great cost. Both delirium and dementia are associated with cerebral hypoperfusion. A switch to anaerobic glycolysis in the central nervous system during delirium compared to Alzheimer's dementia (AD) suggests greater hypoperfusion in DSD. The main aims of this study were to investigate whether cerebral hypoperfusion could differentiate DSD from related entities, and the characteristics of that hypoperfusion. ⋯ Transcranial Doppler is a potential diagnostic and monitoring test for DSD. Correlation with clinical indicators of delirium suggests pathophysiological significance.
-
Delirium superimposed on dementia (DSD) is common in many settings. Nonetheless, little is known about the association between DSD and clinical outcomes. The study aim was to evaluate the association between DSD and related adverse outcomes at discharge from rehabilitation and at 1-year follow-up in older inpatients undergoing rehabilitation. ⋯ DSD is a strong predictor of functional dependence, institutionalization, and mortality in older patients admitted to a rehabilitation setting, suggesting that strategies to detect DSD routinely in practice should be developed and DSD should be included in prognostic models of health care.
-
Review
Obesity and physical frailty in older adults: a scoping review of lifestyle intervention trials.
Many frail older adults are thin, weak, and undernourished; this component of frailty remains a critical concern in the geriatric field. However, there is also strong evidence that excessive adiposity contributes to frailty by reducing the ability of older adults to perform physical activities and increasing metabolic instability. Our scoping review explores the impact of being obese on physical frailty in older adults by summarizing the state of the science for both clinical markers of physical function and biomarkers for potential underlying causes of obesity-related decline. ⋯ In summary, this scoping review identified strong clinical evidence that weight reduction and/or exercise interventions can improve physical function and biomarkers of physical dysfunction among overweight/obese older adults, supporting the suggestion that excessive adiposity contributes to physical frailty. However, the evidence also suggests a complexity of metabolic influences, both systemically and within muscle, which has not been elucidated to date. Considerable further study is needed to examine the mechanisms by which lifestyle interventions influence physical frailty before the net impact of such interventions can be fully understood.
-
Decision aids are effective to improve decision-making, yet they are rarely tested in nursing homes (NHs). Study objectives were to (1) examine the feasibility of a goals of care (GOC) decision aid for surrogate decision-makers (SDMs) of persons with dementia; and (2) to test its effect on quality of communication and decision-making. ⋯ The decision-support intervention piloted in this study was feasible and relevant for surrogate decision-makers of persons with advanced dementia in NHs, and it improved quality of communication between SDM and NH providers. A larger randomized clinical trial is underway to provide further evidence of the effects of this decision aid intervention.
-
Besides personal and professional experiences, long term care providers' own attitudes toward death may affect the care given to dying residents. ⋯ The results suggest that healthcare workers' attitudes need to be taken into account in long term care facilities. Patient assistants, volunteers, and nursing assistants seem most likely to above all benefit from training and support programs.