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Acute care of the elderly

Joanne Brooke, Claire Manneh
AIMS: To explore the lived experience of caring for a patient during an acute episode of delirium by nurses working in cardiology, elderly care, renal, or respiratory specialities. BACKGROUND: A missed or delayed diagnosis of delirium in an acute hospital setting adversely impacts on patient outcomes. Nurses are the best placed health care professionals to identify a change in patient's cognitive status but struggle to do so. DESIGN: Inductive interpretative phenomenology...
March 12, 2018: International Journal of Nursing Practice
Sarah Prattley, James Voss, Stephanie Cheung, Robert Geraghty, Patrick Jones, Bhaskar K Somani
OBJECTIVE: To assess outcomes of ureteroscopy for treatment of stone disease in the elderly. Ureteroscopy (URS) is an increasingly popular treatment modality for urolithiasis and its applications are ever expanding with the development of newer technologies. Its feasibility and outcomes within the elderly population to our knowledge remain under-reported. MATERIALS AND METHODS: We examined the patient demographics and surgical outcomes from our prospective database for patients ≥70 years who underwent URS for urolithiasis, in a 5-year period between March 2012 and December 2016...
March 9, 2018: International Braz J Urol: Official Journal of the Brazilian Society of Urology
Mary Patricia Nowalk
Influenza is an acute viral respiratory disease caused by the influenza A and B viruses. The epidemiologic characteristics of influenza are in constant flux as the viruses mutate frequently, and the subsequent spread of illness depends on the affected population's susceptibility to the new antigens. These viral mutations necessitate frequent updates to the annual seasonal influenza vaccine. Those most at risk for serious complications of influenza are young children and elderly persons. Although influenza vaccination rates are highest among adults 65 years or older, vaccine effectiveness in this age group is often less than among younger persons...
March 2018: American Journal of Managed Care
Xiujuan Xu, Geng Zhang, Mahong Hu, Chunlian Ji, Jianbiao Meng, Zhizhen Lai, Muhua Dai, Lisha Pang, Wei Zhang
OBJECTIVE: To study the influence of clinical nutritional support on the effects of mechanical ventilation (MV), and to find the factors affecting the outcome of patients undergoing MV. METHODS: A case-control study was conducted. The clinical data of 235 patients undergoing MV admitted to intensive care unit (ICU) of Tongde Hospital of Zhejiang Province from January 2015 to June 2017 were retrospectively analyzed. The patients were divided into two groups according to whether weaning successfully within 7 days...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Mahir Elder, Nimrod Blank, Amir Kaki, M Chadi Alraies, Cindy L Grines, Marvin Kajy, Reema Hasan, Tamam Mohamad, Theodore Schreiber
BACKGROUND: Right ventricular (RV) failure due to pulmonary embolism (PE) increases morbidity and mortality and contributes to prolonged hospital length of stay and higher costs of care. RV mechanical circulatory support (MCS) including Impella RP devices have been increasingly used in hemodynamically compromised PE patients who are refractory to intravascular volume expansion and inotropic therapy. However, effectiveness and safety of Impella RP, in hemodynamically unstable PE patients is unknown...
March 7, 2018: Journal of Interventional Cardiology
Heilok Cheng, Jielan Kong, Catherine Underwood, Peter Petocz, Vasant Hirani, Beryl Dawson, Fiona O'Leary
The loss of lean body mass, muscle strength and physical function causes significant problems in older adults. Protein and amino acid supplements can preserve muscle strength but the effect on function is variable. We conducted a systematic literature review and meta-analysis to investigate the effect of protein and amino acid supplementation on fat-free mass, muscle strength and physical function in malnourished, frail, sarcopenic, dependent or elderly with acute or chronic conditions, with or without rehabilitation exercise...
March 2018: British Journal of Nutrition
Koki Yamaguchi, Tatsuya Hirase, Tetsuji Koizumi, Sigeru Inoguchi
AIM: Efforts to improve the treatment of frail elderly patients in acute care hospitals are urgently needed because a low physical activity level due to hospitalization is reported to be associated with a risk of disability. The aim of this study was to clarify the characteristics of frail elderly patients in acute care hospitals. METHODS: We assessed 198 elderly patients who were admitted to acute care hospitals. The factors that were evaluated included the presence of frailty, the age, gender, and nutritional status of the patients, and complications that developed during hospitalization...
2018: Nihon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Tony Rosen, Nisha Mehta-Naik, Alyssa Elman, Mary R Mulcare, Michael E Stern, Sunday Clark, Rahul Sharma, Veronica M LoFaso, Risa Breckman, Mark Lachs, Nancy Needell
PROBLEM DEFINITION: Hospitals have an opportunity to improve the quality of care provided to a particularly vulnerable population: victims of elder mistreatment. Despite this, no programs to prevent or stop elder abuse in the acute care hospital have been reported. An innovative, multidisciplinary emergency department (ED)-based intervention for elder abuse victims, the Vulnerable Elder Protection Team (VEPT), was developed at NewYork-Presbyterian / Weill Cornell Medical Center (New York City)...
March 2018: Joint Commission Journal on Quality and Patient Safety
Takatoshi Anno, Hideaki Kaneto, Ryo Shigemoto, Fumiko Kawasaki, Yasuhiro Kawai, Noriyo Urata, Hirofumi Kawamoto, Kohei Kaku, Niro Okimoto
Hypoglycemia is induced by many causes, especially over-dose of insulin or oral hypoglycemic agents in diabetic subjects. In such a case, hyperinsulinemic hypoglycemia is usually observed. On the other hand, it is important to classify secondary hypoglycemia and hypoinsulinemic hypoglycemia. Liver injury-induced hypoglycemia is one of the causes of hypoinsulinemic hypoglycemia but rarely observed in clinical practice. Herein, we experienced similar 2 cases of non-diabetic hypoinsulinemic hypoglycemia. Both of them were elderly subjects with low body weight...
2018: Endocrinology, Diabetes & Metabolism Case Reports
L Ryom, C Boesecke, M Bracchi, J Ambrosioni, A Pozniak, J Arribas, G Behrens, Pgm Mallon, M Puoti, A Rauch, J M Miro, O Kirk, C Marzolini, J D Lundgren, M Battegay
BACKGROUND: The European AIDS Clinical Society (EACS) Guidelines have since 2005 provided multidisciplinary recommendations for the care of HIV-positive persons in geographically diverse areas. GUIDELINE HIGHLIGHTS: Major revisions have been made in all sections of the 2017 Guidelines: antiretroviral treatment (ART), comorbidities, coinfections and opportunistic diseases. Newly added are also a summary of the main changes made, and direct video links to the EACS online course on HIV Management...
March 1, 2018: HIV Medicine
Emmanuelle Magny, Hélène Le Petitcorps, Maria Pociumban, Zineb Bouksani-Kacher, Éric Pautas, Joël Belmin, Sylvie Bastuji-Garin, Carmelo Lafuente-Lafuente
BACKGROUND: Factors associated with delirium among community-dwelling older adults have been poorly studied. Our aim was to describe the prevalence of predisposing and precipitating factors for delirium among patients admitted for delirium and to assess whether these factors were appropriately recognized at the first patient assessment at hospital. METHODS: Consecutive community-dwelling individuals admitted to three geriatric acute care units with a confirmed initial diagnosis of delirium were prospectively included...
2018: PloS One
Sharon K Inouye
This article is based on the M. Powell Lawton Award Lecture that I delivered at the 2016 Gerontological Society of America Annual Meeting. I provide an overview of my journey in geriatric medicine and delirium research. I created new measures, including the Confusion Assessment Method, for identification of delirium; conceptualized a multifactorial risk model; and developed and tested intervention strategies for delirium prevention. The Hospital Elder Life Program arose from this work. In addition, like Dr...
February 23, 2018: Journal of the American Geriatrics Society
Dirk Müller-Wieland
Diabetes in older adults has a high prevalence and is frequently associated with comorbidities of the cardiovascular system, dysfunction of cognition as well as depression and impaired mobility or increased frailty. Furthermore, impaired renal function, heart failure, risk for hypoglycemia and polypharmacy has to be considered in the decision about the diabetes treatment strategy. The goal of blood glucose management is driven by patient relevant issues and patient self-esteem, quality of life defined by the patient, preservation of physical and social mobility rather than potential long-term effects on reduction of cardio- and microvascular events in the future, which is limited by patient-inherent reduced life expectancy of the aged individual...
February 2018: Deutsche Medizinische Wochenschrift
Stephanie M Ozalas, Victoria Huang, Luigi Brunetti, Timothy Reilly
OBJECTIVE: To compare the performance of the 2003 and 2012 Beers criteria (BC) to predict negative clinical outcomes associated with potentially inappropriate medications in hospitalized older adults. DESIGN: Retrospective cohort study. SETTING: Acute Care of Elders (ACE) unit in a community-based teaching hospital. PARTICIPANTS: All patients admitted to an ACE unit who were older than 65 years of age and prescribed at least one medication upon hospital admission...
December 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
S I Alam, M A Hossain, M Aftabuddin, M A Hye, M K Mondal
The aim of the study was to describe the characteristics of patients admitted to intensive care unit and their outcome in Bangabandhu Sheikh Mujib Medical University, Bangladesh. This retrospective, descriptive study was conducted in the intensive care unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2016 to June 2016. Data was retrieved from hospital records of all admitted patients regarding age, gender, admission source, reason for admission, length of ICU stay, requirement of mechanical ventilation, number of organ failure and their outcome...
January 2018: Mymensingh Medical Journal: MMJ
Sheeren Khaled, Rajaa Matahen
BACKGROUND: Acute coronary syndrome (ACS) remains a leading cause of death in the United States. Numerous studies have shown that the degree of LV systolic dysfunction is a major if not the most important determinant of long-term outcome in ACS. OBJECTIVES: To identify the most important risk factors and other clinical predictors which might have impact on left ventricular ejection fraction in patients with ACS. RESULTS: The total patients (299) admitted to our center from July, 2015 till December, 2015; with established diagnosis of ACS were classified in to two groups: Group I: 193 patients with impaired LVEF <40% (64...
January 2018: Indian Heart Journal
Kudret Keskin, Gökhan Çetinkal, Serhat Sığırcı, Süleyman Sezai Yıldız, Şükrü Çetin, Ahmet Gürdal, Betül Balaban Kocaş, Kadriye Orta Kılıçkesmez
BACKGROUND: The prevalence of coronary artery disease is on the rise as the life expectancy of the population increases. However, treatment of acute coronary syndrome in the elderly patients has its own problems that have not been thoroughly addressed in the clinical trials. Since these patients are generally fragile and have multiple co-morbidities, the course of acute coronary syndrome can frequently be complicated. Infection, which co-exists either at the initial presentation or is acquired during the hospital stay, is a condition about which there is little published data...
February 10, 2018: Archives of Gerontology and Geriatrics
Chien-Yuan Chen, Wang-Huei Sheng, Feng-Ming Tien, Po-Chu Lee, Shang-Yi Huang, Jih-Luh Tang, Woei Tsay, Hwei-Fang Tien, Po-Ren Hsueh
BACKGROUND/PURPOSE: This study was aimed to investigate clinical characteristics and treatment outcomes of pulmonary invasive fungal infection (IFI) among patients with hematological malignancy. METHODS: All patients with hematological malignancy who were treated at a medical centre from 2008 to 2013 were evaluated. Pulmonary IFI was classified according to the European Organization for Research and Treatment of Cancer 2008 consensus. RESULTS: During the study period, 236 (11...
January 31, 2018: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
Masatoshi Uchida, Toshikazu Abe, Kazuyuki Ono, Nanako Tamiya
Aim: Our aim was to evaluate the effect of ulinastatin on 28-day mortality in patients who developed multiple organ failure (MOF) related to their acute illness and were admitted to the intensive care unit (ICU). Methods: We carried out a retrospective observational study of MOF patients in a general ICU of a tertiary care hospital in Japan from January 2009 to December 2012. The primary outcome was 28-day all-cause mortality. Secondary outcomes were ventilator-free days, ICU-free days, and vasopressor-free days at day 28...
January 2018: Acute Medicine & Surgery
Niklas Ekerstad, Göran Östberg, Maria Johansson, Björn W Karlson
Objectives: Our aim was to study whether the acute care of frail elderly patients directly admitted to a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit in terms of patient satisfaction. Design: TREEE (Is the TReatment of frail Elderly patients Effective in an Elderly care unit?) is a clinical, prospective, controlled, one-center intervention trial comparing acute treatment in CGA units and in conventional wards...
2018: Patient Preference and Adherence
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