Fadi Ramadan

A multifactorial intervention to reduce prevalence of delirium and shorten hospital length of stay.

Objectives: To improve outcomes for cognitively impaired and delirious older adults.

Radiographic resolution of community-acquired bacterial pneumonia in the elderly

Objectives: To investigate the radiographic clearance of proven community‐acquired nontuberculous bacterial pneumonia in nonimmunocompromised older patients to provide working estimates of the rate of radiographic resolution as a function of the patient cumulative comorbidities, extent of initial radiographic involvement, functional status, and causative pathogens.

Outcome of older patients with severe pneumonia predicted by recursive partitioning

OBJECTIVES: To develop a prognostic model to predict outcome of older patients with severe pneumonia requiring mechanical ventilation.

Treatment of Verbal Agitation with a Selective Serotonin Reuptake Inhibitor

The objective of this study was to examine the safety and efficacy of paroxetine as an alternative to neuroleptic medications for the treatment of verbal agitation in demented patients. An open case series design was used, and the setting included two nursing homes and an outpatient geriatric clinic. Participants were eight consecutive nursing home residents and seven community-dwelling older adults diagnosed with dementia who exhibited verbal agitation in the form of repetitive questions or unwarranted request for attention. Patients received paroxetine orally in doses of 10 mg to 40 mg per day. The Cohen-Mansfield Agitation Inventory (CMAI) was used to rate the frequency of verbal agitation. A baseline score was obtained before starting paroxetine. Six scores were then obtained at 2-week intervals over a period of 3 months. All patients had reduction (2-4 points per item) in the CMAI scores at the end of the first month of treatment with paroxetine. Scores were further reduced (up to 5 points per item, 67%-71% reduction from baseline) in five patients at the end of the third month of treatment. Most patients tolerated paroxetine well. In this report, the use of paroxetine was associated with reduction in verbal agitation. This finding supports the possibility that verbal agitation in demented patients could be a manifestation of underlying depression. (J Geriatr Psychiatry Neurol 2000; 13:56-59).

Overview of respiratory failure in older adults.

Older adults comprise 48% of the critically ill population in intensive care units and will continue to represent a substantial proportion of patients requiring intensive care for decades to come. Aging both decreases the reserve capacity of vital organs and increases the risk of concurrent illnesses that challenge the respiratory system, such as pneumonia, renal failure, or heart diseases. Because respiratory failure is one of the leading causes of death in intensive care units, implementation of strategies to prevent the need for reintubation should be considered early in the course of respiratory decompensation. For those who require mechanical ventilation, protocols to identify patients who are ready to wean should facilitate liberation from respiratory support and reduce complications of mechanical ventilation. Finally, allocation of potentially limited health care resources necessitates knowing about the risk-benefit of mechanical ventilation and other treatment for respiratory failure in this population.

A comparative study of community-and nursing home-acquired empyema thoracis

OBJECTIVES: To compare the clinical presentation, microbiological features, and outcomes of patients with community‐acquired empyema (CAE) with those of patients with nursing home‐acquired empyema (NHAE).

A Longitudinal Study of Idiopathic Exudative Lymphocytic Pleural Effusion in Older People

Objectives: To assess the long‐term prognosis of older patients with idiopathic exudative lymphocytic pleural effusion.

Correlates of behavioral disturbances and pattern of psychotropic medication use in five skilled nursing facilities.

There are several treatment options for behavioral disturbances (BDs) in dementia. However, the choice of a specific psychotropic agent is directed by personal preferences and local community practice patterns. We examined the relationship between common clusters of BDs and the use of different classes of psychotropic agents in our community. A cross-sectional study of 430 long-term care residents from 5 nursing homes was undertaken. The Behavior Measurement Scale (BMS) was used to measure the frequency of BDs grouped in 4 categories. Residents with > 4 BD episodes in at least one category during a 2-week observation period were the behavior group and were considered to have clinically significant BDs. A sample of patients who had < 4 BDs in all BMS categories during the same observation period defined the nonbehavior group. A BD cluster was defined as > 4 BDs occurring in one or more BMS categories during the 2-week observation. Data on functional status, comorbidity, use of benzodiazepines, antidepressants, and neuroleptic agents were collected with chart review. The chi-square test was used to examine the correlation between variables. Clinically significant BDs were identified in 27.2% (117/430) of the residents in the sample. Five of 15 behavior clusters accounted for 73% of all clinically significant BDs. The 5 clusters were verbally nonaggressive behaviors (cluster 1, 20.5%), behaviors from all 4 categories (cluster 2, 17.9%), verbally and physically nonaggressive behaviors (cluster 3, 14.5%), physically nonaggressive behaviors (cluster 4, 12.8%), and verbally aggressive and nonaggressive behaviors (cluster 5, 7.7%). Cluster 5 had a negative correlation with functional impairment (P = .009). There was a significant correlation between cluster 2 and benzodiazepine use (P = .014). No other significant correlation was found between any of the 5 clusters and demographic variables, comorbidity status, and use of antidepressant or neuroleptic medications. Residents in the behavior group had higher impairment in self-feeding (P = .036) and bathing (P < .001) and were more likely to be treated with benzodiazepines (P = .004) and neuroleptic agents (P = .009) than residents in the nonbehavior group (n = 116). The higher use of neuroleptics and benzodiazepines in the behavior group compared with the nonbehavior group indicates that BDs are being identified for treatment, but the medications used may not be efficacious. The lack of association between specific classes of psychotropic medications and distinct behavior clusters indicates that clinicians are not using a standardized approach to target the neurochemical abnormalities that may underlie certain behavior clusters. Some behavior clusters correlate with impairment in specific activities of daily living categories such as bathing and feeding, making room for nonpharmacologic interventions. (J Geriatr Psychiatry Neurol 2003; 16:8-14).