Eamon C. Mulkerrin

Nocturnal leg cramps in older people

Nocturnal leg cramps are common in older people. Such cramps are associated with many common diseases and medications. Physiological methods may be useful for preventing cramps in some people, but there have been no controlled trials of these approaches. Quinine is moderately effective in preventing nocturnal leg cramps. However, there are concerns about the risk/benefit ratio with this drug. In patients with severe symptoms, a trial of 4–6 weeks’ treatment with quinine is probably still justified, but the efficacy of treatment should be monitored, for example using a sleep and cramp diary.

Use of Serial Mini‐Mental State Examinations to Diagnose and Monitor Delirium in Elderly Hospital Patients

Objectives: To determine the responsiveness of serial Mini‐Mental State Examinations (MMSEs) for the diagnosis and monitoring of delirium in elderly hospital patients.

Falls in an Acute Hospital and their Relationship to Restraint Use

BackgroundPatient falls are a common complication of hospitalisation. Use of restraints in patients who are perceived to be at risk for falling may lead to injury and even death.AimsTo determine the frequency of falls and fall-related injuries and the contribution of restraints in a hospital population.MethodsWe analysed incident reports of falls for a single year from a large teaching hospital.ResultsThe fall rate per 10,000 patient days was 13.2 (95%Cl 11.6 -14.8). Fall rate increased dramatically with increased age. Eighty-two (30.7%) falls resulted in injury of which 6 (7.3%) were serious. Injuries occurred in 71/247 (29%) unrestrained falls and in 11/20 (55%) falls in patients who were restrained. Injuries were more severe in falls with restraints in place (p<0.0001).ConclusionsRestraint use is associated with increased severity of injury in hospital patients who fall.

Aerobic and Cognitive Exercise (ACE) Pilot Study for Older Adults: Executive Function Improves with Cognitive Challenge while Exergaming

Dementia cases are increasing worldwide; thus, investigators seek to identify interventions that might prevent or ameliorate cognitive decline in later life. Extensive research confirms the benefits of physical exercise for brain health, yet only a fraction of older adults exercise regularly. Interactive mental and physical exercise, as in aerobic exergaming, not only motivates, but has also been found to yield cognitive benefit above and beyond traditional exercise. This pilot study sought to investigate whether greater cognitive challenge while exergaming would yield differential outcomes in executive function and generalize to everyday functioning. Sixty-four community based older adults (mean age=82) were randomly assigned to pedal a stationary bike, while interactively engaging on-screen with: (1) a low cognitive demand task (bike tour), or (2) a high cognitive demand task (video game). Executive function (indices from Trails, Stroop and Digit Span) was assessed before and after a single-bout and 3-month exercise intervention. Significant group × time interactions were found after a single-bout (Color Trails) and after 3 months of exergaming (Stroop; among 20 adherents). Those in the high cognitive demand group performed better than those in the low cognitive dose condition. Everyday function improved across both exercise conditions. Pilot data indicate that for older adults, cognitive benefit while exergaming increased concomitantly with higher doses of interactive mental challenge.

A randomised trial of the effect of different fluid consistencies used in the management of dysphagia on quality of life: a time trade-off study

BACKGROUND thickened fluids are commonly advised to minimise the risk of aspiration in people with dysphagia, although many do not comply with this treatment. In health economics, utilities are values that reflect an individuals preferences for different health states. We examined the healthcare utilities, elicited using a time trade-off approach (TTO), from healthcare professionals and non-dysphagic patients, associated with long-term use of thickened fluids. METHODS the risk of aspiration with thin fluids was explained to consecutive hospital patients without dysphagia (n = 76) and to a convenience sample of healthcare professionals (n = 75) who were then randomly allocated to drink as much as possible of 200 ml of pre-prepared water of Grade 1 (very mildly thick) or Grade 2 (mildly thick) consistency. A standardised script with a ping-pong approach was then used to elicit TTO utilities for use of thickened fluids using a 10-year horizon. RESULTS median (inter-quartile range) utilities were 0.7 (0.5-0.9) for those receiving Grade 1 and 0.5 (0.3-0.7) for those receiving Grade 2 consistency fluid (Mann-Whitney test, P = 0.001). Thus, for example, on average those allocated to Grade 2 fluid would be willing to sacrifice 5 years of a 10-year lifespan not to be restricted to fluid of that consistency. There were no significant differences between patient and professional values. CONCLUSION patients and professionals judge that long-term use of thickened fluids would significantly impair quality of life. Utilities associated with more viscous fluids are particularly low.

A review of Vitamin D insufficiency and its management; a lack of evidence and consensus persists

Vitamin D deficiency is the most common nutritional deficiency worldwide, however uncertainty persists regarding the benefits of vitamin D supplementation. Vitamin D is essential for calcium homeostasis, and has been linked to falls and fractures in older people. There are numerous risk factors for vitamin D deficiency, chief among them old age. Studies of vitamin D supplementation have given mixed signals, but over all there is evidence of benefit for those with risk factors for deficiency. International guidelines recommend vitamin D target levels of >25 to >80 nmol/l, best achieved by a daily dose of 800-1000 IU. Large bolus doses should be avoided. There are still unanswered questions regarding vitamin D supplementation and target levels. There is need for well designed and powered trials to achieve consensus.

Changes in Descriptive Terms for Older People in the Medical Literature Over the Last 65 Years

Recent guidelines recommend that the threshold BP should be 5–10 mmHg lower in HBP than CBP. In this study, the same normotension threshold was used with CBP and HBP. Nevertheless, using HBP, risk of death was significantly higher in the elderly group than in the younger group, although death is also common among the elderly using CBP measurement. The highly significant relationship between HBP at baseline and age in all subjects may support this view. All of the findings from this study indicated that incidences of death and microand macrovascular complications were significantly greater in the elderly than the younger subjects. Earlier identification of hypertension in elderly adults using HBP could be added to a list of risk factors in individuals with T2DM.