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https://www.readbyqxmd.com/read/28800801/behavioral-emergencies-special-considerations-in-the-geriatric-psychiatric-patient
#1
REVIEW
Awais Aftab, Asim A Shah
This article reviews psychiatric considerations and common psychiatric emergencies in the elderly. The elderly are vulnerable to medication side-effects because of pharmacokinetic changes from aging, and require lower doses and slower titration. They are a high-risk group for suicide, with more serious intent, fewer warning signs, and more lethality. Prompt diagnosis and treatment of delirium in emergency settings is essential, given association with worse outcomes when undiagnosed. Pharmacologic options with demonstrable efficacy for agitation in dementia are limited to antipsychotics, which are, however, associated with an increased risk of mortality; behavioral interventions are universally recommended as first-line measures...
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28791772/functional-trajectories-of-older-patients-admitted-to-an-acute-care-unit-for-elders
#2
Andreina D'Onofrio, Christophe Büla, Eve Rubli, Fabiana Butrogno, Diane Morin
AIMS AND OBJECTIVES: To describe the functional trajectories of older medical inpatients and to identify factors associated with overall and in-hospital functional decline. BACKGROUND: Functional decline during a hospital stay is an important clinical outcome because independence remains a major determinant of older persons' quality of life and health care demands. DESIGN AND METHODS: Participants (n = 189) were admitted to the Acute Care Unit for Elders of a Swiss academic hospital and were aged 65 years and older...
August 9, 2017: International Journal of Older People Nursing
https://www.readbyqxmd.com/read/28767209/preventive-effects-of-suvorexant-on-delirium-a-randomized-placebo-controlled-trial
#3
Kotaro Hatta, Yasuhiro Kishi, Ken Wada, Takashi Takeuchi, Shigeo Ito, Akiko Kurata, Kazunori Murakami, Manabu Sugita, Chie Usui, Hiroyuki Nakamura
OBJECTIVE: No highly effective pharmacologic interventions to prevent delirium have been identified. We examined whether suvorexant, a potent and selective orexin receptor antagonist, is effective for the prevention of delirium. METHODS: We conducted a multicenter, rater-blinded, randomized, placebo-controlled clinical trial in intensive care units and regular acute wards between April 2015 and March 2016. Eligible patients were 65 to 89 years old, newly admitted due to emergency, and able to take medicine orally and had an expected stay or life expectancy of 48 hours or more...
August 1, 2017: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/28760515/mri-markers-of-neurodegenerative-and-neurovascular-changes-in-relation-to-postoperative-delirium-and-postoperative-cognitive-decline
#4
REVIEW
Ilse M J Kant, Jeroen de Bresser, Simone J T van Montfort, Arjen J C Slooter, Jeroen Hendrikse
Postoperative delirium (POD) and postoperative cognitive decline (POCD) are common in elderly patients. The aim of the present review was to explore the association of neurodegenerative and neurovascular changes with the occurrence of POD and POCD. Fifteen MRI studies were identified by combining multiple search terms for POD, POCD, and brain imaging. These studies described a total of 1,422 patients and were all observational in design. Neurodegenerative changes (global and regional brain volumes) did not show a consistent association with the occurrence of POD (four studies) or POCD (two studies)...
June 28, 2017: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/28752905/the-quality-of-life-of-patients-developed-delirium-after-coronary-artery-bypass-grafting-is-determined-by-cognitive-function-after-discharge-a-cross-sectional-study
#5
Yuling Chen, Shu Ding, Xiangjun Tao, Xinwei Feng, Sai Lu, Yuzhi Shen, Ying Wu, Xiangguang An
AIMS: Postoperative delirium (POD) and declined cognitive function were common in patients (especially elderly patients) who underwent coronary artery bypass grafting (CABG), which may affect quality of life (QoL). The aim of this study was to determine the relationships among age, POD, declined cognitive function, and QoL in patients who underwent CABG. METHODS: Consecutive patients who underwent first time elective CABG and assessed for POD using Confusion Assessment Method for intensive care unit for 5 postoperative days from November 2013 to March 2015 were recruited...
July 28, 2017: International Journal of Nursing Practice
https://www.readbyqxmd.com/read/28750419/pipamperone-and-delirium-a-preliminary-evaluation-of-its-effectiveness-in-the-management-of-delirium-and-its-subtypes
#6
Soenke Boettger, Silvana Knöpfel, Maria Schubert, David Garcia Nuñez, Michael Martin Plichta, Richard Klaghofer, Josef Jenewein
INTRODUCTION: Delirium has been recognised as an underdiagnosed and undermanaged syndrome with substantial prevalence rates and potentially deleterious consequences in the medically ill population. Despite its frequent administration in the management of delirium, the effectiveness of pipamperone has not yet been evaluated. METHODS: In this retrospective, descriptive cohort study of 192 patients, pipamperone as monotherapy and as an adjunct to haloperidol, haloperidol alone, or atypical antipsychotics were compared with respect to their effectiveness in the management of delirium and its subtypes over the course of 20 days...
July 27, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28743315/tight-intra-operative-blood-pressure-control-versus-standard-care-for-patients-undergoing-hip-fracture-repair-hip-fracture-intervention-study-for-prevention-of-hypotension-hip-hop-trial-study-protocol-for-a-randomised-controlled-trial
#7
Iain Keith Moppett, Stuart White, Richard Griffiths, Donal Buggy
BACKGROUND: Hypotension during anaesthesia for hip fracture surgery is common. Recent data suggest that there is an association between the lowest intra-operative blood pressure and mortality, even when adjusted for co-morbidities. This is consistent with data derived from the wider surgical population, where magnitude and duration of hypotension are associated with mortality and peri-operative complications. However, there are no trial to data to support more aggressive blood pressure control...
July 25, 2017: Trials
https://www.readbyqxmd.com/read/28741583/elderly-patients-with-an-atypical-presentation-of-illness-in-the-emergency-department
#8
M R Hofman, F van den Hanenberg, I N Sierevelt, C R Tulner
BACKGROUND: Very little information is available on the prevalence and clinical outcome of elderly patients with atypical presentations of illness in the emergency department. The objective was to determine the prevalence and clinical outcome of elderly patients seen in the emergency department with an atypical presentation. METHODS: A monocentric retrospective observational study on 355 elderly patients presenting to the emergency department. Patients of 80 years and older were included...
July 2017: Netherlands Journal of Medicine
https://www.readbyqxmd.com/read/28741278/italian-intersociety-consensus-on-prevention-diagnosis-and-treatment-of-delirium-in-hospitalized-older-persons
#9
Giuseppe Bellelli, Alessandro Morandi, Marco Trabucchi, Guido Caironi, Daniele Coen, Carlo Fraticelli, Ciro Paolillo, Carolina Prevaldi, Angela Riccardi, Gianfranco Cervellin, Corrado Carabellese, Salvatore Putignano, Stefania Maggi, Antonio Cherubini, Paola Gnerre, Andrea Fontanella, Nicola Latronico, Concezione Tommasino, Antonio Corcione, Giovanni Ricevuti, Nicola Ferrara, Francesco De Filippi, Alberto Ferrari, Mario Guarino, Maria Pia Ruggieri, Pietro Amedeo Modesti, Carlo Locatelli, Patrizia Hrelia, Marco Otto Toscano, Emi Bondi, Antonio Tarasconi, Luca Ansaloni, Francesco Perticone
Delirium is a severe neuropsychiatric syndrome characterized by inattention and global cognitive dysfunction in the setting of an acute medical illness, medical complication, drug intoxication, or drug withdrawal. The most important risk factors are advanced age and dementia, whereas pain, dehydration, infections, stroke, metabolic disturbances, and surgery are the most common triggering factors. Although delirium is a common clinical syndrome in different settings of care (acute care hospitals, inpatient rehabilitation facilities, nursing homes, and hospices), it often remains under-recognized, poorly understood, and inadequately managed...
July 24, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28737064/the-effects-of-delirium-prevention-guidelines-on-elderly-stroke-patients
#10
Jihye Song, Minkyung Lee, Dukyoo Jung
This study aimed to evaluate the effectiveness of the delirium prevention interventions recommended by the Delirium Prevention Guidelines for Elderly Stroke Patients (DPGESP). The DPGESP comprises nine dimensions with 28 interventions, including risk factor assessment, orientation disorder prevention, sleeping pattern maintenance, sensory interventions, constipation, dehydration, hypoxia and infection prevention, pain management, and appropriate nutrition maintenance. This quasi-experimental study used a nonequivalent control group and a pretest-posttest design...
July 1, 2017: Clinical Nursing Research
https://www.readbyqxmd.com/read/28700610/perioperative-hemodynamics-and-risk-for-delirium-and-new-onset-dementia-in-hip-fracture-patients-a-prospective-follow-up-study
#11
Bjørn Erik Neerland, Maria Krogseth, Vibeke Juliebø, Anette Hylen Ranhoff, Knut Engedal, Frede Frihagen, Johan Ræder, Torgeir Bruun Wyller, Leiv Otto Watne
BACKGROUND: Delirium is common in hip fracture patients and many risk factors have been identified. Controversy exists regarding the possible impact of intraoperative control of blood pressure upon acute (delirium) and long term (dementia) cognitive decline. We explored possible associations between perioperative hemodynamic changes, use of vasopressor drugs, risk of delirium and risk of new-onset dementia. METHODS: Prospective follow-up study of 696 hip fracture patients, assessed for delirium pre- and postoperatively, using the Confusion Assessment Method...
2017: PloS One
https://www.readbyqxmd.com/read/28699939/implementing-acove-quality-indicators-as-an-intervention-checklist-to-improve-care-for-hospitalized-older-adults
#12
Liron Sinvani, Andrzej Kozikowski, Christopher Smilios, Vidhi Patel, Guang Qiu, Meredith Akerman, Martin Lesser, David Rosenberg, Gisele Wolf-Klein, Renee Pekmezaris
BACKGROUND: Medicare patients account for approximately 50% of hospital days. Hospitalization in older adults often results in poor outcomes. OBJECTIVE: To test the feasibility and impact of using Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs) as a therapeutic intervention to improve care of hospitalized older adults. DESIGN: >Post-test only prospective intervention with a nonequivalent retrospective control group...
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28690539/neurimmirs-and-postoperative-delirium-in-elderly-patients-undergoing-total-hip-knee-replacement-a-pilot-study
#13
Rui Dong, Lingling Sun, Yayuan Lu, Xi Yang, Mian Peng, Zongze Zhang
Objective: Postoperative delirium (POD) is a frequent complication after surgery and its occurrence is associated with poor outcomes. The pathophysiology of this complication is not clear, but identification of risk factors is important for positive postoperative outcomes. The purpose of this study was to investigate the associations between the preoperative expression levels of microRNA (miR)-146a, miR-125b, and miR-181c in cerebrospinal fluid (CSF) and serum and the development and severity of POD. Methods: Forty elderly patients aged 65 years old and older admitted for elective total hip/knee replacement under spinal anesthesia...
2017: Frontiers in Aging Neuroscience
https://www.readbyqxmd.com/read/28681427/delirium-after-fast-track-hip-and-knee-arthroplasty-a-cohort-study-of-6331-elderly-patients
#14
P B Petersen, C C Jørgensen, H Kehlet
BACKGROUND: Postoperative delirium (PD) is a well-known complication among elderly surgical patients and associated with increased morbidity, mortality and length of stay (LOS). In elective orthopedic surgery, including hip and knee arthroplasty (THA/TKA), most studies report incidences between 5% and 10%. The multimodal optimization of perioperative care (fast-track) aims to enhance recovery and reduce morbidity and LOS, but limited data are available on the effect on PD. Consequently, the study investigated signs of PD associated with LOS > 4 days...
August 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28660596/risk-factors-for-mortality-in-elderly-patients-with-hip-fractures-a-meta-analysis-of-18-studies
#15
Yan Liu, Zhiqian Wang, Wenliang Xiao
BACKGROUND: Hip fracture is common and associated with poor outcomes in elderly patients. This meta-analysis aims to investigate the risk factors that might increase the mortality rate in elderly patients with hip fracture. METHODS: PubMed, Embase, and Web of Science were systematically searched for observational studies regarding the prognostic factors of mortality in elderly patients with hip fracture. A fixed-effects or random-effects model was used to calculate pooled hazard ratio (HR) and 95% confidence intervals (95% CIs)...
June 28, 2017: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28658156/comprehensive-geriatric-care-reduces-acute-perioperative-delirium-in-elderly-patients-with-hip-fractures-a-meta-analysis
#16
REVIEW
Yiyang Wang, Jun Tang, Feiya Zhou, Lei Yang, Jianbin Wu
BACKGROUND: The aim of the current meta-analysis was to assess the treatment effect of comprehensive geriatric care in reducing acute perioperative delirium in older patients with hip fractures, compared with the effect of a routine orthopedic treatment protocol. METHODS: We conducted a search of multiple databases to identify randomized controlled trials (RCTs) and quasi-RCTs comparing comprehensive geriatric care and routine orthopedic treatment regarding the following outcomes: incidence of delirium, assessment of cognitive status, and duration of delirium...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28655417/-functional-impairment-associated-with-cognitive-impairment-in-hospitalised-elderly
#17
José Mauricio Ocampo-Chaparro, José Ignacio Mosquera-Jiménez, Annabelle S Davis, Carlos A Reyes-Ortiz
INTRODUCTION: The aim of this study was to analyse the effect of cognitive impairment on functional decline in hospitalised patients aged ≥60 years. METHODS: Measurements at admission included demographic data, Charlson's comorbidity index, and cognitive impairment (according to education level). Data were also collected on hospital length of stay, depression, and delirium developed during hospitalisation. The outcome, Barthel Index (BI), was measured at admission, discharge, and 1-month post-discharge...
June 24, 2017: Revista Española de Geriatría y Gerontología
https://www.readbyqxmd.com/read/28612418/the-problem-of-delirium-following-transcatheter-aortic-valve-replacement
#18
EDITORIAL
Katia Orvin, Ran Kornowski
Delirium is a common condition among elderly patients, particularly those hospitalized following surgical procedures. A study indicates that delirium occurs in 1 out of 5 patients following TAVR and it was found to be associated with diminished survival, prolonged hospitalization, and increased healthcare utilization. Delirium is potentially preventable and treatable clinical syndrome.
June 1, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28593326/intraoperative-infusion-of-dexmedetomidine-for-prevention-of-postoperative-delirium-and-cognitive-dysfunction-in-elderly-patients-undergoing-major-elective-noncardiac-surgery-a-randomized-clinical-trial
#19
Stacie Deiner, Xiaodong Luo, Hung-Mo Lin, Daniel I Sessler, Leif Saager, Frederick E Sieber, Hochang B Lee, Mary Sano, Christopher Jankowski, Sergio D Bergese, Keith Candiotti, Joseph H Flaherty, Harendra Arora, Aryeh Shander, Peter Rock
Importance: Postoperative delirium occurs in 10% to 60% of elderly patients having major surgery and is associated with longer hospital stays, increased hospital costs, and 1-year mortality. Emerging literature suggests that dexmedetomidine sedation in critical care units is associated with reduced incidence of delirium. However, intraoperative use of dexmedetomidine for prevention of delirium has not been well studied. Objective: To evaluate whether an intraoperative infusion of dexmedetomidine reduces postoperative delirium...
June 7, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28580557/-localization-establishment-of-an-interdisciplinary-intervention-model-to-prevent-post-operative-delirium-in-older-patients-based-on-hospital-elder-life-program
#20
Yan-Yan Wang, Yu-Lin Liao, Lang-Li Gao, Xiu-Ying Hu, Ji-Rong Yue
BACKGROUND: Postoperative delirium is a significant complication in elderly patients. The occurrence of delirium may increase the related physical and psychological risks, delay the length of hospital stays, and even lead to death. According to the current evidence-based model, the application of interdisciplinary intervention may effectively prevent delirium, shorten the length of hospital stays, and save costs. PURPOSE: To establish a culturally appropriate interdisciplinary intervention model for preventing postoperative delirium in older Chinese patients...
June 2017: Hu Li za Zhi the Journal of Nursing
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