Journal of the American Geriatrics Society
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The current disease-oriented, episodic model of emergency care does not adequately address the complex needs of older adults presenting to emergency departments (EDs). Dedicated ED facilities with a specific organization (e.g., geriatric EDs (GEDs)) have been advocated. One of the few GED experiences in the world is described and its outcomes compared with those of a conventional ED (CED). ⋯ The two EDs did not differ in terms of early, late, or frequent ED return or in 6-month hospital admission or functional decline. The mortality rate was slightly but significantly lower in the GED patients (hazard ratio=0.47, 95% CI=0.22-0.99, P=.047). The data suggest noninferiority and, indirectly, a slight superiority for the GED system in the acute care of elderly people, supporting the hypothesis that ED facilities specially designed for older adults may provide better care.
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Randomized Controlled Trial
Cognitive effects of treating obstructive sleep apnea in Alzheimer's disease: a randomized controlled study.
To examine whether treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) in patients with Alzheimer's disease (AD) results in better cognitive function. ⋯ OSA may aggravate cognitive dysfunction in dementia and thus may be a reversible cause of cognitive loss in patients with AD. OSA treatment seems to improve some cognitive functioning. Clinicians who care for patients with AD should consider implementing CPAP treatment when OSA is present.
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Multicenter Study
Validation of the triage risk stratification tool to identify older persons at risk for hospital admission and returning to the emergency department.
To assess the predictive validity of the Triage Risk Stratification Tool (TRST) to identify return to the emergency department (ED) or hospitalization in a multicenter patient sample. ⋯ The TRST demonstrated only moderate predictive ability, and ideally, a better prediction rule should be sought. Future studies to develop better prediction rules should compare their performance with that of existing prediction rules, including the TRST and Identifying Seniors at Risk tool, and assess the effect of any new prediction rule on patient outcomes.