The edition · Geriatrics
After a fracture, nursing home residents were far more often on falls-risk drugs than on a bisphosphonate
Also: the Vulnerable Elders Survey-13 in cancer, a three-question oral check and mortality, sedation and restraint of older adults with agitation, and dose and duration of mind-body exercise in mild cognitive impairment.
The edition in brief
A US cross-sectional study of 192,118 nursing home residents with a recent fracture (mean age 83.8) found that 72.8% had prescriptions for drugs related to injurious falls and only 4.2% for an oral bisphosphonate. Statins (31.1%), opioids (26.7%), newer anticonvulsants (22.1%) and loop diuretics (22.1%) were common. A meta-analysis of 36 studies (7,110 patients) found the Vulnerable Elders Survey-13 had only moderate accuracy for abnormalities on geriatric assessment in cancer, with a high score linked to worse overall survival (HR 1.68) and more adverse events. A Japanese cohort of 52,789 older adults found that a three-item oral-function score was associated with all-cause mortality over ten years (adjusted HR 1.49 for a score of 3), driven by chewing difficulty and dysphagia. A US national EMS study found that older adults with behavioural emergencies who needed sedation or restraint were more often sedated (69.2% vs 61.3%) and less often restrained than younger adults. A meta-analysis of 27 trials (2,034 people) found that mind-body exercise improved global cognition in mild cognitive impairment, with dose-response patterns that need confirmation. The pearl restates that delirium is a medical emergency.
The Vulnerable Elders Survey-13 in cancer: moderate accuracy as a screen, useful as a prognostic flag
Consider VES-13 as a triage step to prioritise geriatric assessment in older people with cancer, not as a replacement for it.
A three-question oral-function score predicted ten-year mortality in older adults
Worth asking older patients three oral-function questions; chewing and swallowing difficulty were associated with higher mortality.
Older adults in behavioural emergencies were more often sedated and less often restrained by EMS than younger adults
Worth noting for emergency liaison: sedation in older adults with agitation is common, and age-specific protocols are lacking.
Mind-body exercise in mild cognitive impairment: benefit for cognition, with dose patterns that need confirmation
Consider mind-body exercise for people with mild cognitive impairment, for at least several weeks; exact dosing is not established.
New confusion in an older person is delirium until proven otherwise
Look for a medical cause in every case of sudden confusion, and avoid sedating first.
After a fracture, 73% of nursing home residents were on falls-risk drugs and 4% on a bisphosphonate
Consider a medicines review and osteoporosis assessment for every older resident after a fracture; both are often missed.
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