[Detection, investigation, and management of delirium in hospitalized elderly].

Delirium is common in hospitalized older adults. The condition is frequently not recognized, or managed appropriately, and has a poor prognosis. This review finds that a proactive multicomponent interdisciplinary non-farmacological approach can reduce incidence.

Use of Drugs with Anticholinergic Properties at Hospital Admission Associated with Mortality in Older Patients: A Danish Nationwide Register-Based Cohort Study.

Background: Use of drugs with anticholinergic properties (DAP) has a negative impact on older people.

Objective: Our aim was to examine the association between DAP at hospital admission and mortality in older patients.

Patients And Methods: We performed a nationwide population-based cohort study including patients aged ≥ 65 years admitted to Danish geriatric medicine departments during 2005-2014.

[Assessment of older patients upon admission at the emergency department].

Older patients admitted to the emergency departments represent a heterogeneous group, some are frail with reduced reserve capacity and without ability to compensate to acute illness. They often present with nonspecific complaints and atypical presentation and are at-risk of complications and adverse events. These patients need a fast comprehensive interdisciplinary and multicomponent assessment and intervention to reduce the risk of further functional decline and to optimize their overall health status, independency and quality of life.

Multidisciplinary telephone conferences about medication therapy after discharge of older inpatients: a feasibility study.

Background Studies have shown poor post-discharge implementation by the general practitioner of changes made to patients' medication during admission. Objective To assess the feasibility of conducting telephone conferences delivering information about changes in older patients' medications from hospital to general practitioners. Setting Two departments of geriatric medicine in a Danish routine healthcare setting.

Are older adults insufficiently included in clinical trials?-An umbrella review.

Treatment guidelines are primarily based on randomized clinical trials (RCTs). RCTs tend to some extent to exclude older adults despite the fact that physicians need guidance when treating this patient group. By summarizing existing literature, we aimed to (a) quantify the proportion of RCTs and other clinical studies (CTs) that did not adequately include older adults; (b) identify the main barriers for this non-inclusion; and (c) identify suggested solution for inclusion of older adults in RCTs and other CTs.

Association between the level of municipality healthcare services and outcome among acutely older patients in the emergency department: a Danish population-based cohort study.

Objectives: This study aims to describe the association between use of municipality healthcare services before an emergency department (ED) contact and mortality, hospital reattendance and institutionalisation.

Design: Population-based prospective cohort study.

Setting: ED of a large university hospital.

Declining cancer incidence at the oldest ages: Hallmark of aging or lower diagnostic activity?

Background: The incidence of most cancers increases with age from early adulthood into old age but tends to level off or decrease at the highest ages. This decline may be caused by age-related mechanisms or due to lower diagnostic activity, leaving some cancers undiagnosed at the oldest ages.

Methods: For breast, colon, lung, and all sites except non-melanoma skin cancer, age-specific incidence rates of verified as well as suspected cancer were estimated up to ages 95+ years for a random sample of the Danish population, 1994-2011, based on nationwide health registers (40,008 verified and 9110 suspected cancers).

Disability and morbidity among older patients in the emergency department: a Danish population-based cohort study.

Objectives: The objective was to describe the prevalence of geriatric conditions among older medical patients in the emergency department (ED) and the association with admission, mortality, reattendance and loss of independency.

Design: Population-based prospective cohort study.

Setting: ED of a large university hospital.

General practitioners' continuation and acceptance of medication changes at sectorial transitions of geriatric patients - a qualitative interview study.

Background: Follow-up in general practice on medication initiated during hospitalisation is often perceived to be inadequate, which leads to unintended drug interaction and over- or underdosage of medication. Little is known about General Practitioners (GPs') views on medication changes during the transition from hospital to primary care. We conducted a qualitative interview study to understand GPs' views on the medication changes made for their patients by hospital physicians in a geriatric ward and the GPs' actions after discharge.

[Teminal care in a nursing home].

This article focuses on patients with limited life expectancy who no longer benefit from preventive medication but not yet qualify for palliative care - a time frame often referred to as End-of-Life (EOL). The purpose of this article is to identify and assess international guidelines for prescribing in EOL. No relevant clinical trials were available, but we found advice mainly based on logic assumptions and thoughts.

Medication reconciliation and prescribing reviews by pharmacy technicians in a geriatric ward.

Objective: Incomplete medication histories obtained on hospital admission are responsible for more than 25% of prescribing errors. This study aimed to evaluate whether pharmacy technicians can assist hospital physicians' in obtaining medication histories by performing medication reconciliation and prescribing reviews. A secondary aim was to evaluate whether the interventions made by pharmacy technicians could reduce the time spent by the nurses on administration of medications to the patients.

[Uncertain evidence for effect of medication reviews of the prescriptions for elderly patients].

Elderly patients are often prescribed several drugs, which might increase the risk of drug-related harms and the risk of not using the drugs as prescribed, both of which can result in increased costs. The literature supports the conclusions in a newly published Cocranereview on four randomized controlled trials (RCT) showing that it is uncertain whether medication reviews reduce mortality or hospital readmissions, but medication reviews seem to reduce emergency department contacts. However, further RCT are needed before implementing medication reviews.

The influence of comprehensive geriatric assessment on drug therapy in elderly patients.

Background: Comprehensive geriatric assessment of hospitalised patients implies optimising patients' medical treatment, and good coordination between hospital and general practice is essential for the quality of the drug treatment. Only a few studies have investigated the continuation of patients' medication from primary care to hospital and back again to primary care.

Objectives: To describe changes of drug therapy during hospital stay in a geriatric ward and the following acceptance of these changes in primary cares after discharge.

[Methods for systematic listing of medication in the elderly].

To improve medication in the elderly several screening tools have been developed. The most used tool is the Beers 2003 criteria; however, the newer STOPP/START criteria have proven more effective and easier to use. Based on the literature we aim to compare these tools according to a list of desired properties and to suggest the best template for a Danish tool, though it is still to be determined, whether the identification and correction of potentially inappropriate medication leads to a better outcome in terms of decreased morbidity and mortality and improved health economics.

[Video recordings can be used for easier and faster evaluations of the performances of postgraduate trainees].

Evaluating post-graduate trainees under direct observation is troublesome, and there are concerns about rater-variability. The aim of this study was to explore if video recordings could be used for evaluation. The performances of five trainees were video recorded.

Auscultatory versus oscillometric measurement of blood pressure in octogenarians.

Background: Auscultatory measurement using a sphygmomanometer has been the predominant method for clinical estimation of blood pressure, but it is now rapidly being replaced by oscillometric measurement.

Objective: To compare blood pressure by auscultatory and oscillometric measurements in patients ≥ 80 years.

Method: 100 patients had blood pressure measured by auscultation with a sphygmomanometer and by an electronic device using the oscillometric method.

[Evidence-based pedagogical principles used at medical specialist workshop].

How should a theoretical postgraduate course be organized to obtain maximum effect? We report an example of a two-day course planned and implemented according to educational approaches previously shown to be effective. The theme of the course is "The old patient", and the course is compulsory for residents in internal medicine. This case study showed that the methods used were feasible, and the participants gained knowledge.

Increased use of antidepressants at the end of life: population-based study among people aged 65 years and above.

Background: The new antidepressants are generally effective and safe for older people, but may have serious side-effects. The use has been rapidly increasing, but focus on upper age groups has been limited. The pattern of antidepressant use as death approaches has never been analysed.

Early discontinuation of antidepressants in general practice: association with patient and prescriber characteristics.

Background: Most antidepressant treatment is initiated and continued in general practice but, despite current guidelines, treatment duration is often short among patients with depression. Discontinuation may, however, be caused by a complexity of factors, but so far research has focused on drug effects, adverse effects and drug regimens.

Objective: Our aim was to analyse whether early discontinuation of first-time antidepressant treatment in general practice may be predicted by (i) social position and psychiatric history of the patient; and (ii) demography, practice activity and the general prescribing behaviour of the GP.

Socio-economic inequalities in first-time use of antidepressants: a population-based study.

Objective: To analyse whether first-time use of antidepressants (incidence) and selection of TCAs (tricyclic antidepressants) versus new-generation drugs are associated with socio-economic status and psychiatric history.

Method: We conducted a population-based cohort study using registry data covering Funen County, Denmark. A total of 305,953 adult residents without antidepressant prescriptions 5 years prior to the study period (1998) were included.

Antidepressant drug use in general practice: inter-practice variation and association with practice characteristics.

Objective: The use of antidepressants (ADs) has escalated and prompted considerable debate. Many depressed patients go unrecognised or under-treated and the area of indication of the new ADs is widening. The aim of this study was to analyse (i).

[Treatment with antidepressants in geriatric departments. Occurrence and record keeping].

Introduction: The aim of the present study was to describe the occurrence of antidepressant treatment in geriatric departments in Denmark and assess the notes of the patient records in connection with prescription.

Material And Methods: Patient records for consecutively referred patients in seven geriatric departments were examined and basic information was noted. For users of antidepressants further information about the treatment was noted.