Geriatría HGG Journal Club

Epidemiologic studies have indicated an association of motoric cognitive risk syndrome (MCR), a pre-dementia stage characterized by the presence of cognitive complaints and a slow gait, with increased risk of incident dementia.

Our results confirm that MCR is an independent risk factor of incident all-cause dementia and AD. Future studies are needed to better understand the mechanisms underlying this association.

A higher DBI may be associated with an increased risk of falls and decreased function and cognition. Higher DBI was inconsistently associated with increased mortality, length of stay, frailty, hospitalization or reduced quality of life. Human observational findings with respect to functional outcomes are supported by preclinical interventional studies. The DBI may be used as a tool to identify older adults at higher risk of harm.

Despite advances in minimally invasive revascularisation techniques and reduction in amputation incidence, survival remains poor for many with CLTI. Shared decision-making is essential, and conservative management is often appropriate for older patients. There is emerging evidence of the benefit of specialist geriatric team input in the perioperative management of older patients undergoing surgery for CLTI. Recent UK guidelines now recommend screening for frailty, cognitive impairment and delirium in older vascular surgery patients as well as recommending all vascular surgery services have support and input from specialist geriatrics teams.

Nursing home (NH) Minimum Data Set (MDS) have frequently been used to measure medication use in epidemiologic studies, but there is little evidence on the accuracy of MDS-based medication records. We compared antipsychotic use estimated using 2 data sources—MDS and NH electronic medication administration records (eMAR).

Agreement between the MDS and eMAR in antipsychotic use is high, suggesting that the MDS is a valid tool to measure antipsychotic use in epidemiologic studies. Further studies with large and diverse populations are warranted to confirm our findings.

For clinical work, it remains vitally important to minimize the impact of precipitants to avoid further declines in function and independence. This study, and similar work, highlight how a frailty metric may identify a subset of the most vulnerable individuals for whom to target preventive measures. Most importantly, it is time to (a) categorize risk when enrolling populations and stratify by frailty; (b) consider composite outcomes for geriatric syndromes such as falls, delirium, and even phenotypic frailty, as a final common pathway after a precipitating event; and (c) further interrogate the inter-relationship of cognition, function, and physiological change as all part of soon-to-be modifiable hallmarks of accelerated biological aging.

Preferred goals of care are not related to frailty status, while the importance ascribed to individual goals is slightly lower with higher frailty status. Future research should prioritise outcomes related to the shared goals of fit, mildly frail and severely frail older people to improve personalised medicine for older patients.

The US Centers for Medicare & Medicaid Services (CMS) recently finalized a rule establishing the first minimum staffing requirements for nursing homes after an earlier version was proposed last September. The new rule will “hold nursing homes accountable for providing safe and high-quality care” for the 1.2 million people who are cared for in Medicare- and Medicaid-certified long-term care facilities, the agency announced.

This review summarizes current evidence regarding the diagnosis and treatment of interstitial lung disease.