Fewer restraints for ventilated older adults with sepsis: no delirium benefit, but more days off the ventilator

The edition in brief

Today's geriatrics edition ends on a randomised trial of physical restraint. In five Chinese ICUs, 485 adults aged 65 and over with sepsis on mechanical ventilation were assigned to restraints only for severe agitation or routine restraint until awake and extubated. Days alive without delirium or coma did not differ, but low use was associated with about 0.7 more ventilator-free days and 0.5 more coma-free days, with no difference in mortality or safety events. In 3,073 community-dwelling adults aged 70–79 in the Health ABC study, reported poor appetite was associated with a 44% higher hazard of persistent mobility limitation, and those with poor appetite and raised inflammatory markers lost function fastest. A network meta-analysis of 20 trials (2,160 older adults) found nutritional supplements overall improved muscle mass, grip and gait speed, with whey protein plus vitamin D plus leucine the most consistent combination, though certainty was low to very low. In the CREST-H substudy, carotid revascularisation for asymptomatic high-grade stenosis did not improve cognition at one year in people with reduced baseline cognition, whatever their cerebral perfusion. The pearl covers practical alternatives to restraint in delirium.