Inflammatory Cytokines Are Associated with Cognitive Dysfunction and Depressive State during Acute Bacterial Infections and the Recovery Phase.

During a bacterial infection, individuals may present with behavioral changes referred to as sickness behavior, which has been suggested is induced by the inflammatory markers that are released because of the infective immunological challenge. However, few studies have explored this multidimensional phenomenon in naturally occurring conditions. A longitudinal observational study was conducted to explore the role of inflammatory cytokines in mediating the sickness behavior during a bacterial infection.

The threshold for detecting a rise in airflow resistance during tidal breathing is lower in older patients with COPD than in healthy people of similar age.

Introduction: To investigate whether or not the threshold for subjectively detecting an increase in the resistance to airflow (LDT) during tidal breathing at rest rises in older age in patients with COPD, as it does in healthy people and asthmatics in remission.

Material And Methods: We conducted an open cross-sectional study of 31 older patients (age 55-89) with COPD and 60 healthy volunteers (age 55-86). Inspiratory and expiratory resistive load detection thresholds (ILDT and ELDT respectively) and spirometry were measured.

Relationship between lung function and grip strength in older hospitalized patients: a pilot study.

Objective: Older people with reduced respiratory muscle strength may be misclassified as having COPD on the basis of spirometric results. We aimed to evaluate the relationship between lung function and grip strength in older hospitalized patients without known airways disease.

Methods: Patients in acute medical wards were recruited who were aged ≥70 years; no history, symptoms, or signs of respiratory disease; Mini Mental State Examination ≥24; willing and able to consent to participate; and able to perform hand grip and forced spirometry.

Systemic Inflammation in the Genesis of Frailty and Sarcopenia: An Overview of the Preventative and Therapeutic Role of Exercise and the Potential for Drug Treatments.

The clinical, pathological and biological characteristics of frailty and sarcopenia are becoming better understood and defined, including the role of systemic inflammation. It is increasingly apparent that in older adults there is a tendency for the innate immune network to shift toward a pro-inflammatory setting, often due to the presence of chronic inflammatory diseases but also associated with age alone in some individuals. Furthermore, acute inflammation tends to resolve more slowly and less completely in many elderly people.

A prospective observational study of outcomes from rehabilitation of elderly patients with moderate to severe cognitive impairment.

Objectives: To evaluate rehabilitation outcomes in patients with moderate to severe cognitive impairment.

Design: Prospective observational cohort study.

Setting: Rehabilitation unit for older people.

The airflow resistance sensing threshold during tidal breathing rises in old age in patients with asthma.

Background: in a previous study, we showed that the ability to detect a rise in airflow resistance at rest was reduced in some non-asthmatic subjects in old age.

Objective: to determine whether airflow resistance detection is attenuated in elderly subjects with asthma.

Methods: we studied 60 adult subjects with stable asthma (age range 20-88).

Perforated colonic diverticulum in old age: surgical or medical management?

Perforation of a colonic diverticulum is a common surgical emergency particularly in older people. Surgical treatments result in the best outcomes for patients with good functional and physiological status, but for frailer patients there are minimally invasive and medical alternatives. This article considers the evidence for the different options.

Perioperative use of nonsteroidal anti-inflammatory drugs: results of a UK regional audit.

Background And Objective: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is well established as a part of multimodal perioperative analgesia treatment, especially in day-case surgery where opioid sparing is important. The aim of this study was to assess the current perioperative use of NSAIDs, the specific drugs used, and the route by which they were administered.

Methods: A pilot study was undertaken, followed by a second, larger study.

The threshold for sensing airflow resistance during tidal breathing rises in old age: implications for elderly patients with obstructive airways diseases.

Objective: to determine whether the ability of elderly subjects to detect a rise in airflow resistance is attenuated in old age, and to measure the magnitude and variability of such a change.

Methods: we studied 124 healthy adults aged 20-86 years. Progressive external airflow resistance loading was used to measure the inspiratory and expiratory load detection thresholds (LDTs) during tidal breathing at rest.

A comparison of four tests of cognition as predictors of inability to perform spirometry in old age.

Background: previous studies have shown that a Mini Mental State Examination (MMSE) score of <24/30 and inability to copy intersecting pentagons (IP) predicts inability to perform spirometry. We hypothesised that clock drawing tests (CLOX 1 and 2), being validated tests of cognitive executive function, might predict spirometry performance with a higher sensitivity and specificity than the MMSE or IP.

Methods: we studied 113 (84 females) spirometry-naïve inpatients, mean age of 84 years (range 74-97).

Neuropathic pain - the case for opioid therapy.

For many patients, neuropathic pain (NeP) is arguably more difficult to control than nociceptive or 'normal' pain. We also now recognise the great burden that NeP has on the lives of patients - it is not only a matter of treating pain in isolation, but managing all of the issues that affect the patient's quality of life. Until relatively recently we have had little understanding of the pathophysiology causing NeP and have relied on the secondary effects of non-analgesic drugs as the mainstays of treatment.

Fall risk-assessment tools compared with clinical judgment: an evaluation in a rehabilitation ward.

Objectives: to compare the use of two falls risk-identification tools (Downton and STRATIFY) with clinical judgment (based upon the observation of wandering behaviour) in predicting falls of medically stable patients in a rehabilitation ward for older people.

Methods: in a prospective observational study, with blinded end-point evaluation, 200 patients admitted to a geriatric rehabilitation hospital had a STRATIFY and Downton Fall Risk assessment and were observed for wandering behaviour.

Results: wandering had a predictive accuracy of 78%.

Predictors for falls among hospital inpatients with impaired mobility.

Gait and balance disturbances have been shown to predispose to falls in hospital. We aimed to investigate the patient characteristics associated with an unsafe gait and to determine what features predispose to falling in this group of hospital inpatients. In a prospective open observational study we studied 825 patients admitted for rehabilitation following acute medical illness or a surgical procedure.

Characteristics of early fallers on elderly patient rehabilitation wards.

Background: falls are one of the most frequent complications on rehabilitation wards for elderly patients.

Objective: to study the characteristics of early and late fallers.

Design: prospective observational study with blinded end-point evaluation.

Acquisition and short-term retention of inhaler techniques require intact executive function in elderly subjects.

Background: patients with dementia are almost invariably unable to use any form of inhaler. Some elderly patients are unable to learn to use a metered dose inhaler or Turbohaler despite a normal abbreviated mental test score. Studies have shown that in many people this is due to unrecognised cognitive impairment and/or dyspraxia.

Characteristics of single fallers and recurrent fallers among hospital in-patients.

Background: Recurrent fallers constitute a minority of patients who fall but contribute considerably to the total number of falls recorded.

Objective: To study the characteristics of recurrent fallers in a hospital setting.

Methods: In a prospective observational study we investigated the characteristics of 1,025 patients admitted to a geriatric non-acute hospital.