Clinical medicine (London, England)
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Older adults may experience a number of physiological changes that influence how acute pain is perceived, diagnosed and managed by healthcare professionals. Understanding these differences enables the identification, assessment and treatment of acute pain in older adults. Combining careful selection of pain medications with appropriate titration and monitoring allows the analgesic needs of this group to be met.
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A recent article identified weaknesses in the management of patients with traumatic brain injury (TBI). The authors suggested some reasons but overlooked two of the reasons for the low quality of services: a lack of resources and a systemic failure to organise rehabilitation services. They suggested early involvement of a condition-specific service with a new 'neuroscience clinician' and additional neuro-navigators, but the evidence shows this approach does not work. ⋯ We revise and develop their proposal, suggesting an alternative way to improve services. Rehabilitation teams should work in parallel with acute services and remain responsible for the rehabilitation of patients as they move through different settings. This suggested development of rehabilitation mirrors the development followed by geriatric medicine from 40 years ago.