Center for Quality Aging

Metropolitan Government of Nashville-Davidson (balance), TN, United States

Center for Quality Aging

Metropolitan Government of Nashville-Davidson (balance), TN, United States
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Brummel N.E.,Geriatric Research | Brummel N.E.,Center for Health Services Research | Brummel N.E.,Center for Quality Aging | Vasilevskis E.E.,Geriatric Research | And 6 more authors.
Critical Care Medicine | Year: 2013

Objective:: To review delirium screening tools available for use in the adult ICU and PICU, to review evidence-based delirium screening implementation, and to discuss common pitfalls encountered during delirium screening in the ICU. DATA Sources:: Review of delirium screening literature and expert opinion. Results:: Over the past decade, tools specifically designed for use in critically ill adults and children have been developed and validated. Delirium screening has been effectively implemented across many ICU settings. Keys to effective implementation include addressing barriers to routine screening, multifaceted training such as lectures, case-based scenarios, one-on-one teaching, and real-time feedback of delirium screening, and interdisciplinary communication through discussion of a patient's delirium status during bedside rounds and through documentation systems. If delirium is present, clinicians should search for reversible or treatable causes because it is often multifactorial. Conclusion:: Implementation of effective delirium screening is feasible but requires attention to implementation methods, including a change in the current ICU culture that believes delirium is inevitable or a normal part of a critical illness, to a future culture that views delirium as a dangerous syndrome which portends poor clinical outcomes and which is potentially modifiable depending on the individual patients circumstances. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

Schnelle J.F.,Center for Quality Aging | Schnelle J.F.,Geriatric Research | Leung F.W.,Sepulveda Ambulatory Care Center | Leung F.W.,University of California at Los Angeles | And 7 more authors.
Journal of the American Geriatrics Society | Year: 2010

Objectives: To evaluate effects of a multicomponent intervention on fecal incontinence (FI) and urinary incontinence (UI) outcomes. Design: Randomized controlled trial. Setting: Six nursing homes (NHs). Participants: One hundred twelve NH residents. Intervention: Intervention subjects were offered toileting assistance, exercise, and choice of food and fluid snacks every 2 hours for 8 hours per day over 3 months. Measurements: Frequency of UI and FI and rate of appropriate toileting as determined by direct checks from research staff. Anorectal assessments were completed on a subset of 29 residents. Results: The intervention significantly increased physical activity, frequency of toileting, and food and fluid intake. UI improved (P=.049), as did frequency of bowel movements (P<.001) and percentage of bowel movements (P<.001) in the toilet. The frequency of FI did not change. Eighty-nine percent of subjects who underwent anorectal testing showed a dyssynergic voiding pattern, which could explain the lack of efficacy of this intervention program alone on FI. Conclusion: This multicomponent intervention significantly changed multiple risk factors associated with FI and increased bowel movements without decreasing FI. The dyssynergic voiding pattern and rectal hyposensitivity suggest that future interventions may have to be supplemented with bulking agents (fiber), biofeedback therapy, or both to improve bowel function. © 2010 The American Geriatrics Society.

Morandi A.,Ancelle Hospital | Morandi A.,Geriatric Research Group | Morandi A.,Center for Quality Aging | Barnett N.,Vanderbilt University | And 12 more authors.
Journal of Critical Care | Year: 2013

Purpose: The pathophysiology of delirium in critical illness is unclear. 25-OH vitamin D (25-OHD) has neuroprotective properties but a relationship between serum 25-OHD and delirium has not been examined. We tested the hypothesis that low serum 25-OHD is associated with delirium during critical illness. Materials and Methods: In a prospective cohort of 120 medical intensive care unit (ICU) patients, blood was collected within 24 hours of ICU admission for measurement of 25-OHD. Delirium was identified once daily using the Confusion Assessment Method for the ICU. Multivariable logistic regression was used to analyze the association between 25-OHD and delirium assessed the same day and the subsequent day after25-OHD measurement, with adjustments for age and severity of illness. Results: Median age was 52 years (interquartile range, 40-62), and Acute Physiology and Chronic Health Evaluation II was 23 (interquartile range, 17-30). Thirty-seven patients (41%) were delirious on the day of 25-OHD measurement. 25-OHD levels were not associated with delirium on the day of 25-OHD measurement (odds ratio, 1.01; 95% confidence interval, 0.98-1.02) or on the day after measurement (odds ratio, 1.01; 95% confidence interval, 0.99-1.03). Conclusions: This pilot study suggests that 25-OHD levels measured early during critical illness are not important determinants of delirium risk. Since 25-OHD levels can fluctuate during critical illness, a study of daily serial measurements of 25-OHD levels and their relationship to delirium during the duration of critical illness may yield different results. © 2013 Elsevier Inc.

Saraf A.A.,Center for Quality Aging | Bell S.P.,Center for Quality Aging
Current Cardiovascular Risk Reports | Year: 2016

Older adults presenting with an acute myocardial infarction (MI) have an increased morbidity and mortality as compared to younger adults. The management of MI in older adults is dependent on accurate risk stratification incorporating the vast patient heterogeneity characteristic of this population. Traditional risk stratification methods differ in their predictive validity as age increases and important geriatric risk factors such as multimorbidity and geriatric syndromes (e.g., frailty) are often not taken into consideration when developing patient-centered care plans. The dearth of specific clinical practice guidelines for this population, due in part to the exclusion of representative older adults in clinical trials, has resulted in elderly patients with an MI receiving evidence based reperfusion and secondary prevention therapies at much lower rates compared to their younger counterparts. Recent developments in geriatric cardiology have begun to identify and address these gaps, but much evidence still needs to be established in this area. © 2016, Springer Science+Business Media New York.

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