Journal of the American Geriatrics Society
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Randomized Controlled Trial Comparative Study Clinical Trial
Post-operative delirium: predictors and prognosis in elderly orthopedic patients.
To compare the effect of post-operative analgesia using epidural versus intravenous infusions on the incidence of delirium after bilateral knee replacement surgery in elderly patients. Additional risk factors and impact on post-operative recovery were also assessed. ⋯ There is a high incidence of post-operative delirium in elderly non-demented patients following bilateral knee replacement, regardless of whether post-operative analgesia is administered by the epidural or intravenous route.
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To ascertain factors influencing the level of advance directives selected by nursing home residents or surrogates and the time delay to documentation of these choices in the medical record after implementation of a facility-wide policy. ⋯ In logistic models, nursing home-employed physicians were more likely to write restricted advance directive orders than community-based physicians even after controlling for resident age, cognitive status, and physical function. In addition, implementation of a formal nursing home advance directive policy can shorten time to physician documentation of resident advance directive status.
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To determine survival, functional independence, and cognitive performance of older patients 2 years after an episode of delirium. ⋯ Delirium identifies older patients at risk for mortality or loss of independence. Delirium may also identify patients at risk for future cognitive decline.
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Comparative Study
Outcomes of skilled cardiopulmonary resuscitation in a long-term-care facility: futile therapy?
To assess whether cardiopulmonary resuscitation performed by in-house physicians is effective for long-term-care residents. ⋯ We conclude that cardiopulmonary resuscitation, even when performed by a trained and experienced physician and team, has limited benefit for elderly long-term-care populations.