Elderly Care Unit Research Articles

Frailty and 6-month trajectory of elderly trauma patients over the age of 65 years admitted to intensive care unit for severe trauma: experience of a level 1 trauma center

BackgroundThe aging global population forecasts a significant rise in severe trauma cases among individuals aged 65 and above. Frailty emerges as a paramount predictor of post-traumatic outcomes, surpassing age and trauma severity indices. Despite this, scant attention is given to the trajectory of elderly patients post-intensive care unit (ICU) stay following severe trauma, justifying this study. The objective of this study was to analyze trajectories (frailty, place of residence) following a major trauma requiring an ICU stay.Materials and methodsAn observational cohort study was conducted, leveraging data from a level 1 trauma center spanning 2018 to 2023. Inclusion criteria included elderly patients aged 65 and above admitted to the ICU for severe trauma. Data encompassed demographic profiles, trauma severity scores, clinical parameters, and frailty assessments sourced from the Traumabase database.ResultsAmong 293 patients included 190 were non-frail, frailty was correlated with elevated mortality rates (114 (38.9%) at 6 months), heightened incidence of traumatic brain injuries, and notable declines in post-traumatic autonomy. Only 39.2% of patients had resumed residence at home six months post-injury, with a conspicuous trend towards institutionalization, particularly among frail individuals.ConclusionThis study highlights the role of frailty in determining the outcomes of elderly patients following severe trauma. Frailty is associated with higher mortality, increased rates of institutionalization, and a decline in functional status. These results highlight the importance of assessing frailty in the trajectory of severely injured patients over the age of 65 years-old.

Constructing inclusion and exclusion in and through leaders’ communication discourses and practices

This study explores the discourses and communication practices of five leaders working in elderly care units in a mid-size city in Sweden and the construct of inclusion and exclusion by examining their daily communicative leadership practices with their work groups, consisting of Swedish-born and foreigner-born migrants. The results were drawn from an analysis of interviews with five leaders and the observation of eight meetings led by three of them. The findings indicate that leaders’ different strategies of inclusion are related to the engagement and participation of workers in discussions and decision-making. Some salient practices and discourses are pertinent to leaders’ cultural biases that can lead to ethnocentrism and essentialism, which might have a negative impact on inclusion. Leaders who practice inclusiveness through connecting, relating, and giving space for engagement and participation might better contribute to workplaces. The aspects and strategies of inclusion and exclusion are embedded in leaders’ practices and discourses and present them as bridge builders, empathetic and supportive, and culture enhancers. This study presents leaders' communication styles to include and exclude migrant workers and their strategies for engagement and participation in workplace issues. The leaders' communication styles emerged from the data and were defined as bridge builders, empathetic and supportive, and culture enhancers.

Machine learning for the prediction of delirium in elderly intensive care unit patients

Machine learning for the prediction of delirium in elderly intensive care unit patients

Interpretable machine learning models for predicting the incidence of antibiotic- associated diarrhea in elderly ICU patients

BackgroundAntibiotic-associated diarrhea (AAD) can prolong hospitalization, increase medical costs, and even lead to higher mortality rates. Therefore, it is essential to predict the incidence of AAD in elderly intensive care unit(ICU) patients. The objective of this study was to create a prediction model that is both interpretable and generalizable for predicting the incidence of AAD in elderly ICU patients.MethodsWe retrospectively analyzed data from the First Medical Center of the People’s Liberation Army General Hospital (PLAGH) in China. We utilized the machine learning model Extreme Gradient Boosting (XGBoost) and Shapley’s additive interpretation method to predict the incidence of AAD in elderly ICU patients in an interpretable manner.ResultsA total of 848 adult ICU patients were eligible for this study. The XGBoost model predicted the incidence of AAD with an area under the receiver operating characteristic curve (ROC) of 0.917, sensitivity of 0.889, specificity of 0.806, accuracy of 0.870, and an F1 score of 0.780. The XGBoost model outperformed the other models, including logistic regression, support vector machine (AUC = 0.809), K-nearest neighbor algorithm (AUC = 0.872), and plain Bayes (AUC = 0.774).ConclusionsWhile the XGBoost model may not excel in absolute performance, it demonstrates superior predictive capabilities compared to other models in forecasting the incidence of AAD in elderly ICU patients categorized based on their characteristics.

Effect of a 36-Week Supervised Exercise Training Program on Physical and Cognitive Function in Older Patients With Dementia.

To investigate the effects of an exercise training program on physical and cognitive function in older patients with dementia. Thirty-eight patients with early-middle dementia (31 females and seven males), aged 80.6±6.9 years, residents in an Elderly Care Unit, either completed a 36-week structured exercise program (Intervention Group, IG; n=19), or received the usual medical care (Control Group, CG; n=19). Before and after the 36-week intervention, cognitive function was evaluated in both groups by Mini-Mental State Examination (MMSE) and depression by Geriatric Depression Scale (GDS); physical function was assessed using handgrip test, Timed Up to Go (TUG), Berg Balance Scale (BBS) and Chair-Stand Test (CST), and daily living functionality by Functional Rating Scale for Symptoms of Dementia (FRSSD). As a result of exercise intervention, participants scored better in all functional and cognitive test assessments compared to the control group, as reflected by absolute and relative (%) differences in all metrics after the 36-week exercise program (p<0.001). A 36-week supervised exercise training program was found to result in significant improvements in physical and cognitive function of elderly patients in early to middle stages of dementia at an Elderly Care Unit. The promising results of this study shed more light on the adaptability of elderly patients with early and mild dementia to long-term exercise training and verified the feasibility of applying such programs in this clinical population.

Risk factors in ICU patients with initial acquisition of carbapenemase-resistant Klebsiella Pneumoniae.

OBJECTIVE: To identify the risk factors associated with antimicrobial use on the initial acquisition of carbapenem-resistant Klebsiella pneumoniae (CRKP) in elderly intensive care unit (ICU) patients.METHODS: Respiratory secretion, blood, urine, anal swab and peritoneal drainage samples from all elderly patients with non-colonised CRKP who had been hospitalised from January 2021 to December 2022 were collected, and screened for CRKP colonisation using surveillance culture at the time of the first ICU admission and weekly thereafter in Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China. Cumulative antibiotic variables included duration of antibiotic use, total amount of antimicrobials received in grams, total antibiotic consumption (defined daily dose) and the types of antimicrobial exposure. A time-dependent model based on Cox regression analysis was used to investigate the effect of each variable on the initial acquisition of CRKP infection or colonisation.RESULTS: Of 214 patients, 44 were infected or had CRKP colonies and death rate was 34.1%. males were the risk factor for acquiring CRKP in culture (HR 2.12, 95% CI 1.06-4.21; P = 0.033). It is notable that the hazard of acquiring CRKP increased by 9% with every single-point increase in the APACHE II score (HR 1.09, 95% CI 1.01-1.18; P = 0.025). The hazard of acquiring CRKP doubled when carbapenems were administered (HR 1.81, 95% CI 1.42-2.30; P < 0.001), In contrast, exposure to quinolone antimicrobials had a smaller effect on acquiring CRKP (HR 1.07; 95% CI 1.01-1.14; P = 0.024).CONCLUSION: This study found that male sex, APACHE II score and exposure to quinolones and carbapenems were independent risk factors for acquiring CRKP.

Comparison of Ketamine to Haloperidol for Preventing Delirium in ICU Elderly Patients

Background: Delirium is a common concern among elderly intensive care unit (ICU) patients. Ketamine’s effectiveness in preventing delirium remains controversial despite its demonstrated neuroprotective properties and cognitive benefits in previous studies. Objectives: This study aimed to compare the safety and efficacy of ketamine and haloperidol in preventing delirium in elderly ICU patients. Methods: This randomized clinical trial involved 44 non-intubated patients aged over 65 years in a general ICU. The patients received low-dose intravenous ketamine (20 mg) or intramuscular haloperidol (2.5 mg). Delirium was assessed using the Richmond Agitation Sedation Scale (RASS) at 5, 10, and 15 minutes. The primary outcome was the percentage of patients achieving adequate sedation (RASS ≤ +1). The secondary outcome was time to reach adequate sedation. Adverse effects and physician satisfaction were evaluated after 60 minutes. Results: No significant difference in delirium was observed between the groups after interventions or within each group over time. However, the ketamine group had significantly lower delirium incidence at 5 minutes. The percentage of patients achieving adequate sedation was higher in the ketamine group (86.4%) than in the haloperidol group (36.4%) (P = 0.002). There was a delirium difference between groups at 10 minutes (P = 0.31) or 15 minutes (P = 0.082). Physician satisfaction did not differ significantly (P = 0.144). Conclusions: The present study suggests that the administration of low-dose ketamine to elderly ICU patients might reduce delirium incidence, supporting its beneficial effect for delirium control.

Hospital territorial integration in the National Recovery and Resilience Plan era: if not now, when?

Integrating hospital and territorial services is essential, particularly for elderly patients, as they are at risk of yearly hospitalizations for multimorbidity, frailty, and complex diagnostic procedures. The emergency room organization aims to focus mainly on acute time-dependent diseases and cannot meet the needs of older patients. The authors present the preliminary results of an integration protocol between the hospital’s services and those of the territorial elderly home care unit in Avellino, Italy.

Risk factors of aspiration occurrence with different feeding patterns in elderly intensive care unit patients: a cross-sectional study.

Elderly intensive care unit (ICU) patients represent a high-risk group of aspiration. Different feeding patterns will lead to different incidences of aspiration. However, there are few studies on the risk factors of aspiration in elderly ICU patients under different feeding patterns. The aim of this study was to analyze the effects of different eating styles on the occurrence of overt and silent aspiration in elderly ICU patients and to compare the independent risk factors, in order to provide a basis for targeted aspiration prevention. We retrospectively analyzed the incidence of aspiration in elderly patients admitted to the ICU from April 2019 to April 2022, a total of 348 cases. The patients were divided into the oral feeding group, gastric tube feeding group, and post-pyloric feeding group according to their feeding method. Multi-factor logistic regression was used to analyze the independent risk factors for overt and silent aspiration caused by the different eating patterns of patients. Among the 348 elderly ICU patients included, the overall incidence of aspiration was 72%, with a 22% rate of overt aspiration and a 49% rate of silent aspiration. The overt aspiration rates were 16%, 30%, and 21% in the oral, the gastric tube and the post-pyloric feeding group, respectively; while the silent aspiration rates were 52%, 55%, and 40% in the three groups, respectively. Multiple logistic regression analysis showed that the independent risk factors for both overt and silent aspiration were history of aspiration [odds ratio (OR) =0.075, P=0.004; OR =0.205, P=0.042] and gastrointestinal tumor (OR =0.100, P=0.028; OR =0.063, P=0.003) in the oral feeding group. In the gastric tube feeding group, the independent risk factor for both overt and silent aspiration was the history of aspiration (OR =4.038, P=0.040; OR =4.658, P=0.012). In the post-pyloric feeding group, the independent risk factors for both overt and silent aspiration were mechanical ventilation (OR =0.211, P=0.019; OR =0.336, P=0.037) and intra-abdominal hypertension (OR =0.225, P=0.020; OR =0.329, P=0.032). There were significant differences in the influencing factors and characteristics of aspiration among the elderly patients in the ICU with different feeding patterns. Personalized precautions should be implemented early, so as to reduce the possibility of aspiration.

Risk factors of aspiration occurrence with different feeding patterns in elderly intensive care unit (ICU) patients: a cross-sectional study

Risk factors of aspiration occurrence with different feeding patterns in elderly intensive care unit (ICU) patients: a cross-sectional study

Multidisciplinary development of Smart Jacket for elder care

Limitations in physical and cognitive functioning are common among elderly people. Due to these limitations, activities of daily living, such as dressing, can be difficult, even with the help of another person. The limitations may also challenge using the assistive tools meant to support the independent living of elderly people. One significant assistive tool is a nurse call -button whose aim is to support the elder’s independent living and ensure the assistance of others when needed. In severe cases, using of such assistive tools is entirely prevented because of the user’s limited abilities. The purpose of this study was to create a solution for the above-mentioned challenges with smart clothing. The objectives of this study were to design a Smart Jacket that 1) is easy to put on and 2) includes an easy-to-use nurse call button. The product development utilized design thinking through four different Smart Jacket versions, three of which were evaluated in multidisciplinary design workshops. The newly designed and created upper-body garment with assistive zippers in the sleeves can be put on when assistance is available without any movement of the user’s upper limbs. Further, the developed passive RFID (radiofrequency identification)-based jacket with integrated nurse call -button is functional without an on-jacket energy -source and is thus maintenance free. The nurse call -button is functional more than four meters from an RFID reader antenna. Based on the initial expert evaluations, the developed Smart Jacket could operate as part of a bigger safety system, for example in an elderly care unit or domestic care, bringing a needed new alternative as merged nurse call -button and assistive cloth.

687 FLUID MANAGEMENT OF PATIENT ADMITTED IN ACUTE ELDERLY CARE MEDICINE WARD: A RE - AUDIT AND COMPARISON TO STANDARD RECOMMENDATION

Abstract Introduction There is considerable pressure for monitoring and recording of fluid intake in the elderly care unit We conducted a re-audit of our practice measured against standard recommended fluid intake and implemented measures following initial audit to determine an improvement of the patient care in our unit. Method A prospective analysis of recording and total fluid intake of 16 patients in a given day, data was collected from electronic records and outcomes compared to our previous audit. Standard daily fluid intake was considered in male 2000 mL and female 1,600 mL [1]. Result Patient demographics were comparable, including M: F ratio 6: 10 (previously 9: 5), median age 84.5 years (previously 85.5 years) and median clinical frailty score 6 (previously 7). Median fluid intake of male group 1,300 mL (previously 750 mL) and female group 1,000 mL (previously 700 mL). The entries of fluid recording throughout 24 hours showed day shift 81% (previously 26%), evening shift 100% (previously 95%) and night shift 94% (previously 86%). Conclusion There is evidence of improvement of fluid management in our unit following implementation of some measures however issue with daily fluid intake is lower than the recommended standard. Reference 1. Fluid (water and drinks) - British Dietetic Association - UK.COM. https://www.bda.uk.com › resource › fluid-water-drinks.

Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe

BackgroundThe primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe.MethodsThis was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265).ResultsIn total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%).ConclusionAn unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients.Trial registration numberNCT04321265, registered March 19th, 2020.

Μονάδες Φροντίδας Ηλικιωμένων στην Ελλάδα: Ένας Χρόνος Διαχείρισης της Πανδημικής Κρίσης CoViD-19

The CoViD-19 pandemic, caused by the new coronavirus SARS-Cov-2, has brought the Long-Term Care Sector (LTC) into an unprecedented emergency situation. Statistics from various European countries show that high rates of CoViD-19 -related deaths occur in elderly people living in LTC units. This article presents the results of a bibliographical study and a quantitative survey conducted through questionnaire answered by owners, directors and administrators of Elderly Care Units in Greece. An attempt was also made to record the policies followed to prevent and tackle the CoViD-19 pandemic. The results of the implementation of these policies are presented as well as the economic and operational impact on Elderly Care Units, and the psychological impact to their residents, the residents' relatives, and human resources of the Units. The LTC sector in Greece holds positive results in prevent- ing and treating the transmission of coronavirus at national level. Moreover, Greek LTC sector understood early on the seriousness of the upcoming situation; Therefore, was suitably prepared by training its human resources, by informing the relatives of the measures to be taken, and was strongly attuned to the international updates on the evolution of events. However, the economic impact on the sector was large, reflected by a loss of revenue and profits and a large increase in costs, due to the nearly non-existent state assistance. Furthermore, according to the survey responses, the negative effects of "home" restriction and the ban on visiting for more than 6 months are reflected in the psychological state of the Units’ residents and their relatives.

Pre-albumin is a strong prognostic marker in elderly intensive care unit patients

Abstract Objectives Pre-albumin (PAB) can be used to evaluate the association between nutrition status and in-hospital mortality. However, there is no literature to compare if PAB is the best indicator to predict in-hospital mortality among the nutrition indexes in a study. Methods We operated a retrospective study including 145 patients admitted to our institution’s elderly intensive care unit (ICU) from January, 2017 to December, 2019. Admission laboratory results were collected. Regression analysis and receiver operating curve (ROC) were analyzed to explore the performance of different nutrition indexes. Results The levels of PAB were significantly different between the survivor and non-survivor group (p=0.001). Univariate analysis showed nutrition indexes (lymphocytes, albumin, body mass index [BMI], geriatric nutritional risk index (GNRI), prognostic nutritional index [PNI] and PAB) were associated with in-hospital mortality (all p&lt;0.1). Following adjustment for age, platelets and creatinine (CREA), only BMI and PAB remained statistically significant (BMI: HR 2.799, 95% CI 1.167–6.715, p=0.021; PAB: HR 6.329, 95% CI 2.660–15.151, p&lt;0.001). In addition, PAB had the highest area under the curve (AUC) for predicting in-hospital mortality (AUC = 0.696) followed by BMI (AUC = 0.561) and other factors. Conclusions PAB is a better predictor of in-hospital mortality than other nutrition indexes in elderly ICU patients.

Effect Of Structured And Maintenance Exercise Programs On Physical And Mental Functioning Of Dementia Patients

PURPOSE: This study examined the effects of a structured exercise training program and of a subsequent maintenance exercise program on physical and mental abilities of Elderly Care Unit (ECU) patients with early to middle stage of dementia. METHODS: Eighteen patients with early to middle dementia (16 females and 2 males, age: 80.4 ± 1.8 yrs, 69.4 ± 2.8 kg, 163 ± 2 cm, mean ± SE) participated in the study. The volunteers were randomly assigned to either the intervention group (IG), which received a 50-min structured exercise program 3 days/week, or the control group (CG), which followed the usual care, for an experimental period of 9 months. After the completion of the 9-month structured exercise training program, patients of the IG continue receiving a 30-min maintenance exercise program, 2 days/week for 9 more months, while patients in the CG continue following the usual care. Functional and cognitive parameters were evaluated in both groups before (0 months, t0), after the completion of the structured exercise program (9 months, t1) and at the end of the maintenance program (18 months, t2). RESULTS: Compared to pre-exercise values (t0), significant improvements (p < 0.05-0.01) were found at t1 and t2 in the IG: HG (12.3 ± 2.0 vs 13.4 ± 2.3 vs 16.3 ± 2.7), TUG (12.2 ± 2.0 vs 10.3 ± 1.8 vs 9.9 ± 1.7 sec), Berg Balance Scale-BBS (37.4 ± 4.9 vs 40.3 ± 5.3 vs 39.1 ± 5.2, Functional Rating Scale for Symptoms of Dementia-FRSSD (4.6 ± 1.3 vs 2.4 ± 1.1 vs 3.3 ± 1.3), Geriatric Depression Scale-GDS (5.1 ± 1.0 vs 2.6 ± 0.8 vs 2.3 ± 0.7). In the CG, no changes or deterioration (p < 0.05) was observed over time compared to baseline: HG (11.4 ± 1.5 vs 10.5 ± 1.6 vs 8.8 ± 0.8), CST (9.2 ± 1.7 vs 6.4 ± 1.4 vs 5.3 ± 1.2 reps), BBS (20.2 ± 8.2 vs 17.1 ± 7.2 vs 16.4 ± 7.0), 6MWT (148.3 ± 61.8 vs 125.0 ± 56.2 vs 103.3 ± 49.3 m), FRSSD (4.2 ± 0.8 vs 7.8 ± 0.9 vs 9.6 ± 0.6), GDS (2.7 ± 1.0 vs 4.9 ± 1.2 vs 5.3 ± 0.9). CONCLUSIONS: A 9-month structured exercise training program leads to significant improvements of physical and mental performance of ECU patients in early and middle stages of dementia, while a subsequent maintenance exercise program of the same duration appears to preserve the beneficial effects of exercise training in those patients.

Venous thromboembolism risk factors and prophylaxis of elderly intensive care unit patients in a Chinese general hospital.

To analyze the venous thromboembolism (VTE) risk factors and prophylaxis of elderly patients in the intensive care unit (ICU). We retrospectively recruited 200 elderly patients with VTE and 234 non-VTE patients. VTE risk factors were got from data of all patients. The sensitivity and specificity of the Caprini scores and Padua scores were calculated. We use the receiver operating characteristic (ROC) curve and the area under the curve (AUC) to evaluate each score. We found that male sex, sepsis, being bedridden (>72 hours), pneumonia, history of deep vein thrombosis (DVT), diabetes mellitus, coronary heart disease, heart failure, glucocorticoid treatment, PaO2, hemoglobin (Hb), prothrombin time (PT), and international normalized ratio (INR), D-dimer (D-D), mechanical ventilation, and continuous renal replacement therapy (CRRT) were significantly associated with VTE in elderly ICU patients (P<0.05). For elderly patients in the ICU, the predictive ability of Caprini risk assessment model was better than that of the Padua risk assessment model. Among the high VTE risk elderly patients, the number of patients receiving mechanical prophylaxis in the high bleeding-risk group was higher than that in the low bleeding-risk group (P<0.0001). Elderly patients in the ICU have the highest risk of VTE and high bleeding risk; decisions concerning clinical prophylaxis should be made after appropriate information on the risk and benefit on an individual level is considered.

120 Improving Delirium Recognition and Management Through In-Situ Simulation

Abstract Introduction Delirium is a common condition that is often associated with increased morbidity and mortality, longer hospital admission, and discharge to a residential or nursing home. By improving our ability to recognise and manage these patients we can intervene early to help reduce the likelihood of these outcomes. Method We organised several in-situ simulation scenarios with junior staff working on the Elderly Care Unit. The research team designed a scenario to re-create a typical delirious patient on the ward. Participants had to recognise the patient was delirious and instigate a management plan. Participants completed a pre and post-intervention questionnaire to ascertain whether they felt the simulation had improved their confidence. Additionally we performed an audit to investigate whether our intervention led to an improvement in the recognition and management of delirium in patients on the ward. Results The questionnaires showed an increase in participants’ confidence and knowledge when managing a delirious patient on the ward. From reviewing patient notes pre-intervention we identified that 24 patients were delirious during admission,14 of which were accurately diagnosed with delirium. The remaining 10 patients were diagnosed with “Acute Confusion”. On reviewing these 10 patients’ notes, they were all likely to have a diagnosis of delirium. Post-intervention there were 14 patients identified as delirious during their admission. All these patients were correctly documented as having delirium with no inaccurate use of terminology. The data also showed increasing use of tools such as AMTS and 4AT to diagnose delirium. Conclusions From the data gathered, we can see participants are better at recognising and diagnosing delirium. However, our sample sizes are too small to test statistical significance between data points. To improve the project we would include a larger sample size to determine whether the simulation produces a statistically significant improvement in confidence levels.

Propofol shows less negative effects on cognitive performances than dexmedetomidine in elderly intensive care unit patients.

Due to the improved clinical management of aging population and the consequently declined mortality among patients with critical illnesses, the number of survivors from intensive care units (ICUs) keeps rising. Studies to examine the association of cognitive impairment analgesic and sedation strategies would be beneficial to improve the quality of life of ICU survivors. A prospective clinical trial was designed to compare the effects of two drugs, propofol, and dexmedetomidine, on short-term cognitive impairment after sedation in elderly ICU survivors by evaluating the extent of independence limited by the dementia-related activities of daily livings (ADLs). The plasma concentrations of brain injury biomarkers including S100β and neuron-specific enolase (NSE) were determined using an enzyme immunoassay. There were 136 patients allocated into both the dexmedetomidine group and the propofol group, respectively, with matched demographic characteristics. The dementia scale of the patients in the dexmedetomidine group was significantly higher than the propofol group at weeks 1-4. Moreover, the changes in S100β and NSE concentrations in the dexmedetomidine group were significantly more pronounced than the propofol group. ICU patients who received dexmedetomidine intervention showed higher cognitive impairment than patients who received propofol, and this protective effect of propofol was not associated with the levels of brain injury markers S100β and NSE. Our study compared the effects of commonly used medications on short-term cognitive impairment in elderly ICU patients, which would aid the selection of sedation plan for the benefit of ICU patients.

District nurses' experiences of using a clinical decision support system and an assessment tool at elderly care units in primary health care: a qualitative study.

The present study aimed to describe the experience of district nurses (DNs) in using a clinical decision support system (CDSS) and the safe medication assessment (SMA) tool during patient visits to elderly care units at primary health care centres. In Swedish primary health care, general practitioners (GPs) prescribe and have the responsibility to regularly review older adults' medications, while DN (nurses specialised in primary health care) play an important role in assessing older adults' ability to manage their medications, detecting potential drug-related problems and communicating with patients and GPs about such problems. In a previous feasibility study, we found that DNs who use a combination of a CDSS and the SMA tool identified numerous potentially harmful or dangerous factors and took a number of nursing care actions to improve the safety and quality of patients' medication use. In telephone interviews, patients indicated that they were positive towards the assessment and interventions. Individual interviews with seven DNs who worked at six different primary health care centres in Region Stockholm were carried out in 2018. In 2019, an additional group interview was conducted with two of the seven DNs so they could discuss and comment on preliminary findings. Qualitative content analysis was used to analyse the interview transcripts.Findings: Using the tools, the DNs could have a natural conversation about medication use with older adults. They could get a clear picture of the older adults' medication use and thus obtain information that could facilitate collaboration with GPs about this important component of health care for older adults. However, for the tools to be used in clinical practice, some barriers would have to be overcome, such as the time-consuming nature of using the tools and the lack of established routines for interprofessional collaboration regarding medication discussions.