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Nutritional advice in common clinical situations (revised August 2009)
- Author:
- BRITISH GERIATRICS SOCIETY
- Publisher:
- British Geriatrics Society
- Publication year:
- 2009
- Place of publication:
- London
Under-nutrition in older people admitted to hospital is common, and the risk of being malnourished increases during hospitalisation. It is also poorly detected by nursing and medical staff. This good practice guide paper covers nutrition screening, the importance of creating the right environment to support eating and drinking, management of under-nutrition in hospital, ethical and legal considerations, nutrition and stroke, nutrition and dementia, and nutrition in the community and care homes. It includes reference to key resources and guidance about nutritional care in hospital, and makes recommendations covering the advice of dieticians and speech and language therapists, training to enable health professionals to assess and meet nutritional demands, management of dysphagia, policies for review of patients, and development of policies to support nutrition which include auditable standards.
Early response as predictor of final remission in elderly depressed patients
- Authors:
- KOK Rob M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(11), November 2009, pp.1299-1303.
- Publisher:
- Wiley
Several studies have attempted to predict the final response or remission based on improvement during the early course of treatment of major depression, but there is variation in the cut offs used to define early response and in the best week to predict final results. This study aimed to compare different cut-offs at different time points early in the treatment of elderly depressed patients, using a 12 week randomised controlled trial in 81 elderly inpatients with major depression comparing venlafaxine with nortriptyline. The results showed that in elderly in patients, prediction of final remission is possible as early as week 3. In conclusion the researchers suggested that, combining the results from this study and other studies addressing this issue, treatment should be changed in the elderly if after 3-4 weeks less than 30% improvement in depression score has been achieved.
Discharge planning from hospital to home for elderly patients: a meta-analysis
- Authors:
- PREYDE Michele, MACAULAY Cheryl, DINGWALL Tracey
- Journal article citation:
- Journal of Evidence-Based Social Work, 6(2), April 2009, pp.198-216.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This systematic review covers 25 randomised, controlled or quasi-experimental trials of discharge planning for patients aged 65 or more, published between 1995 and 2005 and identified from seven health and social services databases. Key finding include the small number of published trials conducted by social work professionals, and the lack of appropriate reporting of methods and results. Meta-analysis was conducted where data were available and produced an average effect size of 0.51. Large effect sizes were noted for patient satisfaction, and moderate effect sizes for patients’ quality of life and readmission rates.
Eat, drink and be healthy: malnutrition on the wards
- Author:
- TAYLOR Jennifer
- Journal article citation:
- Health Service Journal, 4.6.09, 2009, pp.22-23.
- Publisher:
- Emap Healthcare
The health of many older patients in hospital is being jeopardised through lack of attention at meal times. This article provides some tips on how to ensure older patients eat properly. These include a short case study which outlines a volunteering programme at Darlington Memorial Hospital.
The 6 and 12 month outcomes of older medical inpatients who recover from delirium
- Authors:
- COLE Martin G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(3), March 2008, pp.301-307.
- Publisher:
- Wiley
The aim was to compare the 6 and 12 month outcomes of patients who recovered from delirium by 8 weeks with those who did not have an index episode. Older medical inpatients were assessed for delirium using the Confusion Assessment Method. All patients with delirium and a sample of patients without delirium were enrolled. Recovery from delirium at 8 weeks was determined using the Delirium Index and an algorithm based on DSM-III-R criteria. The primary composite outcome was cognitive or functional decline, institutional residence or death at 6 and 12 months. The authors fitted two logistic regression models to predict outcome odds ratio (OR) of delirium-recovered vs no delirium groups, adjusting for co-morbidity, severity of physical illness and demographic variables. In secondary analyses, each component of the primary outcome was examined separately. Of 361 patients enrolled, 59 died, 33 withdrew and one was lost to follow-up before 8 weeks. Of 268 patients assessed at 8 weeks, 115 and 95 were in delirium-recovered and no delirium groups, respectively. The 6 month OR for the primary composite outcome was 0.89 (95% CI 0.46, 1.70); the 12 month OR was 1.5 (95% CI 0.77, 2.90). Secondary analyses revealed a clinically important increase in mortality at 6 and 12 months. Among patients who survived, there were no significant differences in cognition, function or institutional status between delirium-recovered and no delirium groups at 6 and 12 months. If replicated, these findings have potentially important implications for clinical practice and research.
The period of hypotension following orthostatic challenge is prolonged in dementia with Lewy bodies
- Authors:
- ANDERSSON S., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(2), February 2008, pp.192-198.
- Publisher:
- Wiley
The aim was to determine whether orthostatic hypotension (OH) is more common in patients with dementia than in older people without cognitive impairment and to identify key differences in the profile of the orthostatic response and the pulse drive during orthostatic challenge between Alzheimer's disease (AD) and dementia with Lewy bodies (DLB).The orthostatic response was evaluated in 235 patients with AD, 52 patients with DLB and 62 elderly controls. The blood pressure and pulse rate were measured in supine position, immediately after standing up and after 1, 3, 5 and 10 min of standing. OH was defined as a reduction of systolic blood pressure (SBP) of at least 20 mm Hg or a reduction of diastolic blood pressure (DBP) of at least 10 mm Hg. OH occurred in 69% of the DLB patients and in 42% of the AD patients, but only in 13% of the controls. The DLB patients had a greater drop in SBP than the other study groups during orthostatic challenge and had a more prolonged period of orthostasis. The pulse drive on orthostatic challenge was similar in between groups. However, in the DLB group it was not adequate to restore the blood pressure to supine values. Patients with DLB react different to orthostatic challenge than patients with AD or controls, with important clinical implications for key disease symptoms and treatment.
A choice too far
- Author:
- CRESSWELL Rick
- Journal article citation:
- Professional Social Work, March 2008, pp.10-11.
- Publisher:
- British Association of Social Workers
A social worker involved in assessing the capacity of patients to understand and make decisions, uses the example of an elderly women confronted with the prospect of losing her leg, and possibly her life, to highlight why, sometimes, there are no right and wrong answers to professional decision making.
Religiosity of depressed elderly inpatients
- Authors:
- PAYMAN Vahid, GEORGE Kuruvilla, RYBURN Bridget
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(1), January 2008, pp.16-21.
- Publisher:
- Wiley
The aim was to determine the prevalence of religious practices and beliefs of depressed elderly Australian inpatients and their relationship to physical, social, and cognitive variables known to influence the prognosis of depression in the elderly. To compare the results obtained with those from similar North American studies. Inpatients with a DSM-IV diagnosis of major depression were interviewed on admission to the psychogeriatric unit of a Melbourne geriatric centre. Information collected included patient demographics, intrinsic and extrinsic religiosity, cognitive function, severity of depression, number of chronic illnesses, physical function, and numbers and quality of social support. Pearson correlation and multivariate analysis using a standard regression model were used to examine relationships between the religious and other variables. Of the 86 patients who completed the assessment, 25% attended church regularly and 37% prayed, meditated, or read the Bible, at least once a day. Just over half rarely or never engaged in such behaviours. Three out of every eight patients were intrinsically religious. Religious patients expressed higher levels of social support and physically disabled patients were more likely to be religious. Depressed elderly Australian inpatients are less religious than their North American counterparts. Nevertheless, religion remains important for a large minority of such individuals. Clinicians need to be aware that such individuals may turn to religion when depressed, especially to cope with the presence of physical disability.
Hungry to be heard: the scandal of malnourished older people in hospital
- Author:
- AGE CONCERN ENGLAND
- Publisher:
- Age Concern England
- Publication year:
- 2006
- Pagination:
- 26p.
- Place of publication:
- London
Six out of 10 older people are at risk of becoming malnourished, or their situation getting worse, in hospital. Up to 14% of older people aged over 65 years in the UK are malnourished. Four out of 10 older people admitted to hospital are malnourished on arrival.Patients over the age of 80 admitted to hospital have a five times higher prevalence of malnutrition than those under the age of 50. Up to 50% of older people in general hospitals have mental health needs. Patients who are malnourished stay in hospital for a longer time, require more medications, and are more likely to suffer from infections. The toll of malnutrition on health and health care costs is estimated to exceed £7.3 billion per year (much more than obesity). Over half of this cost is expended on people aged 65 years and above.
Depressive symptom profile in Parkinson's disease: a comparison with depression in elderly patients without Parkinson's disease
- Authors:
- EHRT Uwe, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(3), March 2006, pp.252-258.
- Publisher:
- Wiley
Depression is a common neuropsychiatric syndrome in Parkinson's disease (PD), and may be etiologically related to the neurochemical changes accompanying this disease. It is still unclear whether the disturbances of neurotransmitter activities lead to a specific profile of depressive symptoms, that is characteristic for PD and differs from that in depressed patients without PD. The authors compared the individual depressive symptoms of 145 non-demented depressed patients with PD and 100 depressed patients without PD by comparing item scores on the Montgomery-Åsberg Depression Rating Scale by way of MANCOVA. The severity of depression and the level of cognitive functioning in depressed PD patients were comparable with that of depressed control subjects. However, patients with PD showed significant less reported sadness, less anhedonia, less feelings of guilt and, slightly less loss of energy, but more concentration problems than depressed control subjects. The profile of depressive symptoms in PD differs from that in depressed subjects without PD. This finding is important for the conceptualisation and clinical diagnosis of depression in PD.