Journal of the American Medical Directors Association
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With an aging population, a growing number of older adults experience physical or cognitive decline that necessitates admission to residential aged care facilities (RACF). Each year a considerable proportion of these residents has at least 1 emergency transfer to hospital, which may result in a number of adverse outcomes. Rates of transfer from RACF to hospital can vary considerably between different RACFs suggesting the presence of potentially modifiable risk factors for emergency department (ED) transfer. ⋯ This review has identified a number of potentially modifiable patient and organizational factors that should reduce the need for burdensome transfer to the ED and improve the quality of both acute care and end-of-life care for this population of frail, elderly individuals. A number of these determinants, including facility staffing, the role of specialist geriatricians, and advance directives, should be further examined, ideally through interventional trials to evaluate their impact on the pre-hospital and emergency management of these patients.
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Review Meta Analysis
Nonpharmacologic Interventions to Heal Pressure Ulcers in Older Patients: An Overview of Systematic Reviews (The SENATOR-ONTOP Series).
Pressure ulcers (PUs) are more frequent in older patients, and the healing process is usually challenging. Nonpharmacologic interventions may play a role in the treatment of older people with PUs, but most systematic reviews (SRs) have not addressed this specific population using convincing outcome measures. ⋯ In older patients with PUs, evidence to use any nonpharmacologic therapy to increase the rates of wound healing is inconclusive, except for low quality evidence that supports the use of electrotherapy. This situation is especially alarming for interventions that are usually standard clinical practice (repositioning, support surfaces). Although there is some evidence in younger populations and other types of ulcers, studies in older populations with PUs using sound methodology are needed.
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Review Meta Analysis
Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: a systematic review and meta-analysis.
Numerous studies have reported the prevention of falls through exercise among cognitively healthy older people. This study aimed to determine whether the current evidence supports that physical exercise is also efficacious in preventing falls in older adults with cognitive impairment. ⋯ The present analysis suggests that physical exercise has a positive effect on preventing falls in older adults with cognitive impairment. Further studies will be required to determine the modality and frequency of exercise that are optimal for the prevention of falls in this population.
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Review Meta Analysis
Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: a systematic review and meta-analysis.
Numerous studies have reported the prevention of falls through exercise among cognitively healthy older people. This study aimed to determine whether the current evidence supports that physical exercise is also efficacious in preventing falls in older adults with cognitive impairment. ⋯ The present analysis suggests that physical exercise has a positive effect on preventing falls in older adults with cognitive impairment. Further studies will be required to determine the modality and frequency of exercise that are optimal for the prevention of falls in this population.
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Body wasting in the context of chronic illness is associated with reduced quality of life and impaired survival. Recent clinical trials have investigated different approaches to improve patients' skeletal muscle mass and strength, exercise capacity, and survival in the context of cachexia and body wasting, many of them in patients with cancer. The aim of this article was to summarize clinical trials published over the past 2 years. Therapeutic approaches discussed include appetite stimulants, such as megestrol acetate, L-carnitine, or melatonin, anti-inflammatory drugs, such as thalidomide, pentoxyphylline, or a monoclonal antibody against interleukin-1α as well as ghrelin and the ghrelin agonist anamorelin; nutritional support, and anabolics, such as enobosarm and testosterone.