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All medications given to dementia patients

Simone Brefka, Dhayana Dallmeier, Viktoria Mühlbauer, Christine A F von Arnim, Claudia Bollig, Graziano Onder, Mirko Petrovic, Carlos Schönfeldt-Lecuona, Moritz Seibert, Gabriel Torbahn, Sebastian Voigt-Radloff, Walter E Haefeli, Jürgen M Bauer, Michael D Denkinger
When treating older adults, a main factor to consider is physical frailty. Because specific assessments in clinical trials are frequently lacking, critical appraisal of treatment evidence with respect to functional status is challenging. Our aim was to identify and categorize assessments for functional status given in clinical trials in older adults to allow for a retrospective characterization and indirect comparison of treatment evidence from these cohorts. We conducted 4 separate systematic reviews of randomized and nonrandomized controlled clinical trials in older people with hypertension, diabetes, depression, and dementia...
January 9, 2019: Journal of the American Medical Directors Association
Scott M Rowley
CASE STUDY RS, a 36-year-old female, presented to the emergency department (ED) of a large academic medical center upon the advice of her primary care provider because of 3 weeks of progressive mental status changes, weakness, and decreased oral intake. According to her husband, RS was diagnosed with stage IIIA large cell lung cancer 8 months earlier and was treated with concurrent chemotherapy (carboplatin, pemetrexed, and bevacizumab) and radiation therapy that was completed 4 months prior to admission. No other specific information about her treatment or outside health records was available...
March 2018: Journal of the Advanced Practitioner in Oncology
Stéphanie Sidorkiewicz, Viet-Thi Tran, Philippe Ravaud
BACKGROUND: Achieving good medication adherence is a major challenge for patients with chronic conditions. Our study aimed to assess the Threshold for Unacceptable Risk of Non-adherence (TURN), defined as the threshold at which physicians consider the health risks incurred by patients due to medication non-adherence unacceptable, for the most commonly prescribed drugs in France. METHODS: We conducted an online study using a crowdsourcing approach among French general practitioners and specialists from September 2016 to August 2017...
2018: PloS One
Jennifer A Watt, Tara Gomes, Susan E Bronskill, Anjie Huang, Peter C Austin, Joanne M Ho, Sharon E Straus
BACKGROUND: Trazodone is increasingly prescribed for behavioural and psychological symptoms of dementia, but little is known about its risk of harm. Our objective was to describe the comparative risk of falls and fractures among older adults with dementia dispensed trazodone or atypical antipsychotics. METHODS: The study cohort included adults with dementia (excluding patients with chronic psychotic illnesses) living in long-term care and aged 66 years and older...
November 26, 2018: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Espen Benjaminsen, Karl B Alstadhaug, Marie Gulsvik, Farid K Baloch, Francis Odeh
OBJECTIVE: There are some indications of increasing incidence of amyotrophic lateral sclerosis (ALS). Awareness of cognitive impairment in ALS has increased in recent years. We describe the epidemiology and clinical features of ALS in a county in northern Norway over a period of 15 years. METHODS: All patients with motor neuron disease (MND) living in Nordland County in the period 2000-2015 were identified and the medical records were scrutinized. The average annual incidence was calculated for the whole period and for five-year periods...
September 28, 2018: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration
Toshiki Maeda, Akira Babazono, Takumi Nishi
Background: This study aimed to investigate the rate of first-generation H1-antihistamines use for older adults with dementia in Japan. Methods: The study design was retrospective cohort using claims data between fiscal years 2010 and 2013. Subjects were 75 years or older, diagnosed with dementia, and given H1-antihistamines orally during the study period after being diagnosed with dementia. We investigated the cumulative number of oral H1-antihistamines administered and the relationship between first-generation H1-antihistamine use and each explanatory variable using crude and adjusted odds ratio...
2018: Current Gerontology and Geriatrics Research
J Hunter Mehaffey, Robert B Hawkins, Margaret C Tracci, William P Robinson, Kenneth J Cherry, John A Kern, Gilbert R Upchurch
OBJECTIVE: Dementia represents a major risk factor for medical complications and has been linked to higher rates of complication after surgery. Given the systemic nature of vascular disease, medical comorbidities significantly increase cost and complications after vascular surgery. We hypothesize that the presence of dementia is an independent predictor of increased postoperative complications and higher health care costs after vascular surgery. METHODS: The Vascular Quality Initiative database was queried for all patients undergoing vascular surgery at a single academic medical center from 2012 to 2017...
October 2018: Journal of Vascular Surgery
Merete Osler, Maarten Pieter Rozing, Gunhild Tidemann Christensen, Per Kragh Andersen, Martin Balslev Jørgensen
BACKGROUND: Electroconvulsive therapy (ECT) is the most effective treatment for severe episodes of mood disorders. Temporary memory loss is a common side-effect, but ongoing discussions exist regarding potential long-term adverse cognitive outcomes. Only a few studies have examined the frequency of dementia in patients after ECT. The aim of this study was to examine the association between ECT and risk of subsequent dementia in patients with a first-time hospital diagnosis of affective disorder...
April 2018: Lancet Psychiatry
Alicja Cieslak, Eric E Smith, John Lysack, Zahinoor Ismail
Mild behavioral impairment (MBI) is characterized by later life acquired, sustained, and impactful neuropsychiatric symptoms (NPS) of any severity that cannot be better accounted for by other formal medical and psychiatric nosology. MBI is an "at risk" state for incident cognitive decline and dementia, and for some, MBI is the index manifestation of neurodegeneration, observed in advance of cognitive impairment. Initially described in Frontotemporal Dementia (FTD), MBI evolved to describe a preclinical stage of all cause dementia, and has been operationalized in the International Society to Advance Alzheimer's Research and Treatment-Alzheimer's Association (ISTAART-AA) proposed research diagnostic criteria...
February 2018: International Psychogeriatrics
Christina A Mosk, Marnix Mus, Jos Pam Vroemen, Tjeerd van der Ploeg, Dagmar I Vos, Leon Hgj Elmans, Lijckle van der Laan
BACKGROUND: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. METHODS: This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc...
2017: Clinical Interventions in Aging
Mary A Dolansky, Misty A W Hawkins, Julie T Schaefer, Abdus Sattar, John Gunstad, Joseph D Redle, Richard Josephson, Shirley M Moore, Joel W Hughes
BACKGROUND: Subclinical cognitive impairment is prevalent in heart failure (HF); however, its role in important clinical outcomes, such as HF treatment adherence, is unclear. Given the complex polypharmacy in HF treatment, cognitive deficits may be important in predicting medication management. Thus, the objective of the current study was to examine the impact of cognitive function on medication adherence among community-dwelling patients with HF using objective assessments. METHODS AND RESULTS: A prospective observational cohort design of 309 community-dwelling patients with HF (59...
December 2016: Circulation. Heart Failure
Lisa Smith, Jennifer Medves, Margaret B Harrison, Joan Tranmer, Brett Waytuck
BACKGROUND: Policies concerning restricted or open visiting hours are being challenged in health care institutions internationally, with no apparent consensus on the appropriateness of the visiting hour policies for pediatric and adult patients. The rules that govern practice are often based on the institutional precedent and assumptions of staff, and may have little or no evidence to support them. Policy and practice related to visiting hours is of pressing concern in Canada, and in Ontario specifically, following the reaction to the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 and subsequent changes in visiting policies in most health care settings...
2009: JBI Library of Systematic Reviews
Roman Romero-Ortuno, Stephen Wallis, Richard Biram, Victoria Keevil
AIM: Frail individuals may be at higher risk of death from a given acute illness severity (AIS), but this relationship has not been studied in an English National Health Service (NHS) acute hospital setting. METHODS: This was a retrospective observational study in a large university NHS hospital in England. We analyzed all first non-elective inpatient episodes of people aged ≥75years (all specialties) between October 2014 and October 2015. Pre-admission frailty was assessed with the Clinical Frailty Scale (CFS) of the Canadian Study on Health & Aging, and AIS in the Emergency Department was measured with a Modified Early Warning Score (ED-MEWS<4 was considered as low acuity, and ED-MEWS≥4 as high acuity)...
November 2016: European Journal of Internal Medicine
Valentina Lichtner, Dawn Dowding, Nick Allcock, John Keady, Elizabeth L Sampson, Michelle Briggs, Anne Corbett, Kirstin James, Reena Lasrado, Caroline Swarbrick, S José Closs
BACKGROUND: Pain is often poorly managed in people who have a dementia. Little is known about how this patient population is managed in hospital, with research to date focused mainly on care homes. This study aimed to investigate how pain is recognised, assessed and managed in patients with dementia in a range of acute hospital wards, to inform the development of a decision support tool to improve pain management for this group. METHODS: A qualitative, multi-site exploratory case study...
August 24, 2016: BMC Health Services Research
Sharon Ooms, Yo-El Ju
Sleep and circadian disorders occur frequently in all types of dementia. Due to the multifactorial nature of sleep problems in dementia, we propose a structured approach to the evaluation and treatment of these patients. Primary sleep disorders such as obstructive sleep apnea should be treated first. Comorbid conditions and medications that impact sleep should be optimally managed to minimize negative effects on sleep. Patients and caregivers should maintain good sleep hygiene, and social and physical activity should be encouraged during the daytime...
September 2016: Current Treatment Options in Neurology
M J C Pieper, A L Francke, J T van der Steen, E J A Scherder, J W R Twisk, C R Kovach, W P Achterberg
OBJECTIVE: To investigate whether implementation of a stepwise multidisciplinary intervention ('STA OP!' ['STAND UP!']) is effective in reducing behavioural problems and depressive symptoms in nursing home residents with advanced dementia. DESIGN: Cluster randomised controlled trial. METHOD: We implemented the STA OP! protocol on the intervention units by training the entire multidisciplinary team. This team was trained in all 6 steps of the protocol during five 3-hour sessions...
2016: Nederlands Tijdschrift Voor Geneeskunde
Elles Konijnenberg, Seyed-Mohammad Fereshtehnejad, Mara Ten Kate, Maria Eriksdotter, Philip Scheltens, Peter Johannsen, Gunhild Waldemar, Pieter Jelle Visser
BACKGROUND: Early-onset dementia (EOD) is a rare condition, with an often atypical clinical presentation, and it may therefore be challenging to diagnose. Specialized memory clinics vary in the type of patients seen, diagnostic procedures applied, and the pharmacological treatment given. The aim of this study was to investigate quality-of-care indicators in subjects with EOD from 3 tertiary memory clinics in 3 European countries. METHODS: We included 1325 newly diagnosed EOD patients, ages 65 years or younger, between January 1, 2007 and December 31, 2013, from the Danish Dementia Registry (Rigshospitalet, Copenhagen), the Swedish Dementia Registry ("SveDem", Karolinska University Hospital, Stockholm), and the Amsterdam Dementia Cohort (VU University Medical Center)...
April 2017: Alzheimer Disease and Associated Disorders
Thomas A Jackson, Alasdair M J MacLullich, John R F Gladman, Janet M Lord, Bart Sheehan
BACKGROUND: delirium and dementia are common in the general hospital, being present in nearly 50% of older unselected admissions to hospital. Cognitive impairment is a risk factor for delirium, but the prevalence of previously undiagnosed cognitive impairment (dementia or mild cognitive impairment) in patients with delirium is unknown. METHODS: we performed a prospective cohort study of people over 70 years admitted to hospital with delirium to establish the prevalence of previously unrecognised prior cognitive impairment...
July 2016: Age and Ageing
Li-Jung Elizabeth Ku, Ming-Chyi Pai, Pei-Yu Shih
OBJECTIVE: Given the shortage of cost-of-illness studies in dementia outside of the Western population, the current study estimated the annual cost of dementia in Taiwan and assessed whether different categories of care costs vary by severity using multiple disease-severity measures. METHODS: This study included 231 dementia patient-caregiver dyads in a dementia clinic at a national university hospital in southern Taiwan. Three disease measures including cognitive, functional, and behavioral disturbances were obtained from patients based on medical history...
2016: PloS One
David Basic, Tabitha J Hartwell
PURPOSE: To examine the association between falls in hospital and new placement in a nursing home among older people hospitalized with acute illness. MATERIALS AND METHODS: This prospective cohort study of 2,945 consecutive patients discharged alive from an acute geriatric medicine service used multivariate logistic regression to model the association between one or more falls and nursing home placement (primary analysis). Secondary analyses stratified falls by injury and occurrence of multiple falls...
2015: Clinical Interventions in Aging
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