Maureen B. Moran

Delirium and Other Cognitive Impairment in Older Adults in an Emergency Department

STUDY OBJECTIVE To determine the prevalence of delirium and other alterations in mental status in older adults in the emergency department setting. DESIGN Prospective, cross-sectional study. SETTING Private, nonprofit, academic medical center in a densely populated urban area. PARTICIPANTS One hundred eighty-eight adults 70 years or older who presented to the ED. INTERVENTIONS None. RESULTS Delirium and other alterations in mental status were present in 39.9% of the patients studied; 24% of these patients had delirium. Age and severity of illness were positively correlated with alteration in mental status. Patients with alterations in mental status were more likely to be admitted to an inpatient unit. Among those admitted from home, alterations in mental status in the ED were associated with a higher likelihood of institutionalization at discharge. CONCLUSION Alterations in mental status are prevalent in ED patients. Older adults with alterations in mental status, particularly alterations in consciousness and delirium, are at high risk for admission to an inpatient unit and institutionalization after discharge. Standardized mental status testing identified high-risk older adults in the ED.

Alcohol consumption among HIV-infected patients

This prospective, cohort study analyzed the prevalence of alcoholism and patterns of alcohol intake over time in a cohort of HIV-infected patients, predominantly homosexual/bisexual men. One hundred eleven HIV-positive subjects were recruited from a comprehensive HIV clinic associated with a large Midwestern university hospital. Each participant completed the Michigan Alcoholism Screening Test (MAST) survey and a standardized quantity—frequency questionnaire on alcohol intake at enrollment. The quantity—frequency scale was repeated every six months for a total of 30 months. Forty-five of the 111 subjects (41%) met the criteria for alcoholism, as defined by a MAST score 5 or higher. There was a significant decrease in alcohol consumption over time, from 6.4 drinks/week in the initial time period to 3.9 drinks/week by the final time period (p<0.001).

Reducing hospital costs for the geriatric patient admitted from the emergency department : a randomized trial

OBJECTIVE: To test the impact of a geriatric evaluation and management model on the costs of acute hospital management of emergently admitted older adults.

Screening elderly veterans for alcoholism

Objective:To determine the sensitivity and specificity of an alcoholism screening test not previously tested in the elderly.Design:Cross-sectional study, face-to-face interviews.Setting:Veterans Administration (VA) outpatient facility.Patients/participants:Men ≥70 years old seeking care in a newly established VA outpatient facility were invited to participate in a health assessment program. Of 109 participants who enrolled, 96 completed both interviews.Interventions:The screening test was administered by an internist as part of a medical history. The Michigan Alcobolism Screening Test (MAST), used as the “gold standard,” was administered by a trained interviewer as part of a longer structured interview.Measurements and main results:The screening test had a sensitivity of 0.52 and a specificity of 0.76 in this sample.Conclusions:The sensitivity and specificity of the screening test were lower in this sample in comparison with previously reported results in a younger population. Differences in the test performance may be related to differences in attitudes and drinking behaviors of elderly veterans when compared with those of younger men and women.

A Retrospective Chart Review of Antidepressant Use, Effectiveness, and Adverse Effects in Adults Age 70 and Older

The authors assessed the use, side effects, and outcomes of various antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), in adults 70 years of age and older by means of a retrospective study of outpatient records. Of these patients (N = 70), 26% improved or recovered. Patients were more likely to improve or recover if they took the antidepressant for at least 3 months. Those on TCAs were as likely to improve or recover and no more likely to discontinue because of side effects than those prescribed SSRIs. Approximately one-third of patients discontinued because of side effects, and SSRI gastrointestinal side effects were more common in patients concomitantly taking nonsteroidal anti-inflammatory drugs. Many older patients who undergo antidepressant therapy discontinue because of side effects; however patients are likely to improve or recover with sustained therapy.

Correlates of vitamin D insufficiency in an affluent adult population.

Objectives Vitamin D is necessary for bone health and calcium metabolism. Vitamin D deficiency may play a role in coronary artery disease, some cancers, autoimmune disease, and glucose tolerance. Vitamin D deficiency may be prevalent even among affluent US adults. Methods We conducted a retrospective chart review study of 287 adult patients who underwent executive physical examinations between April 2009 and May 2010 in Chicago, Illinois. Data collected included age, sex, body mass index, vitamin D levels, supplement use, fish consumption, milk consumption, hours spent outdoors, and sunscreen use. Vitamin D insufficiency was defined as <30 ng/mL. Results The mean vitamin D level was 40.0 ng/mL (standard deviation 16.6), which varied by month. The mean vitamin D level ranged from 32.9 ng/mL in January to 55.4 ng/mL in September. Insufficient levels of vitamin D were observed in 30.3% of patients. Younger age (younger than 40 years); no milk or fish consumption; no use of multivitamins, vitamin D supplements, or calcium supplements; no sun exposure; and routine use of sunscreens were positively associated with vitamin D insufficiency. Conclusion Vitamin D insufficiency in almost one-third of patients presenting for executive physicals may be indicative of a widespread nutritional deficiency in the US population.

Prevalence of cognitive impairment in an urban Hispanic community population.

level of social activity, and the presence of comorbid medical conditions. 4 Tinetti had postulated, in accordance with her findings, that self-efficacy or confidence in the ability to perform specific activities in specific situations shows a stronger association with ADL functioning and higher levels of physical and social activities than does self-reported falling. 5 The concept of self-efficacy has also been applied to fear of falls and their sequelae, which accounted for 18% of restricted activity days in older persons. 6 Our conclusion is that older women with both hip and Colle’s fractures have better rehabilitation potential despite their more-severe trauma experience and older age. The findings in this study suggest that the presence of concomitant fractures from the same trauma is a manifestation of better self-efficacy, which is a prominent positive prognostic factor.

Patterns of syphilis testing in the elderly

Objective:To evaluate the frequency of inconsistencies in the use of laboratory tests for syphilis among the elderly in an acute care setting.Design:Retrospective medical record review.Setting:Academic medical center.Patients/participants:All patients 60 years of age and older who had: 1) positive tests for syphilis and no lumbar puncture performed (n=71), 2) lumbar punctures performed and no positive test for syphilis (n=68), and 3) positive tests for syphilis and lumbar punctures performed (n=8).Interventions:None.Measurements and main results:The chronology and results of syphilis tests were abstracted from the medical records. Documentation of signs and symptoms of neurosyphilis, including dementia and depression, were abstracted from the medical records by a second reviewer. Most patients had inadequate evaluations; 51 had no follow-up of positive syphilis tests and 43 had cerebrospinal fluid syphilis tests in the absence of positive blood tests for syphilis or signs and symptoms of neurosyphilis.Conclusions:The inconsistent pattern of serologic testing in this study suggests that the testing was done as a routine procedure and not for a specific purpose. For a majority of the tested individuals, the results did not provide a public health benefit or contribute to the individual’s well-being.