Journal of the American Medical Directors Association
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The Mini-Nutritional Assessment (MNA) is recommended to assess malnutrition in older people. However, its implementation is challenging in large elderly population, nursing home, or community or large clinical research programs. The Simplified Nutritional Appetite Questionnaire (SNAQ), a self-assessment nutritional screening tool that predicts weight loss, could be used to screen older people at risk of malnutrition or malnourishment. Our objective was to assess whether the SNAQ is related to the MNA and can screen older people at risk of malnutrition or malnourishment. ⋯ The SNAQ is a poor screening tool to predict older people with an abnormal MNA score. However, an abnormal SNAQ might identify those who will lose weight earlier than will the MNA.
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Moral distress (MD) occurs when the health care provider feels certain of the ethical course of action but is constrained from taking that action. The purpose was to examine MD in geriatric nursing care and to identify factors related to MD. ⋯ Providing futile and inadequate care contributes to moral distress more than euthanasia and believing to hasten an unconscious patient's death by increasing morphine in geriatric end-of-life care. Nurses' moral distress is related to situational and work characteristics as well as to burnout and job-leave.
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Inappropriate prescriptions are common in older people admitted to nursing homes. Commonly used instruments to detect potential inappropriate prescriptions have limitations that have precluded wide use, and new instruments are needed. ⋯ A high number of potentially inappropriate drug prescriptions can be detected at the time of admission to nursing home care by the use of systematic instruments. Both STOPP-START criteria and the Australian criteria performed well in this setting. The impact of this detection on health outcomes and costs should be assessed before they can be widely recommended.
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Warfarin doses vary greatly among patients and warfarin administration is accompanied by risk of bleeding. Genes responsible for its metabolism (CYP2C9) and effect on clotting (VKORC1) have been identified. It has been suggested that genotyping for variants in these genes can improve warfarin dosing and decrease bleeding complications. We evaluated performance of pharmacogenetic-based warfarin dosing estimation algorithms in old and very old patients. ⋯ Pharmacogenetic data add to our understanding of variability in warfarin dosing requirements but do not accurately identify older patients requiring the lowest warfarin doses. Therefore, the most prudent approach to warfarin therapy in older patients should include low initial doses in the absence of genotype variants associated with very low warfarin sensitivity and careful monitoring of INR responses.
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To identify testable solutions that may improve the quality and safety of care transitions between nursing homes (NHs) and emergency departments (EDs). ⋯ Participants advised additional structure to NH-ED care transitions, similar to hospital-to-hospital transfers, that includes a 2-way, statewide transfer form; a checklist; and verbal communication.