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Elderly Drivers with Cognitive Impairment

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121. Is it time for a change? A cost-effectiveness analysis comparing a Multidisciplinary Integrated Care model for residential homes to usual care

Health Survey. The effectiveness data were from a multicentre cluster randomised controlled trial (RCT), conducted in 10 residential care homes, with 340 residents. The homes were matched before randomisation, based on the percentage of cognitively impaired residents; the two facilities with the highest percentages were matched, and so on. Patients were recruited from December 2006 to December 2007. Exclusion criteria were reported. Patient outcomes were assessed at the start and at six months (...) residential care homes for the elderly. Interventions The Multidisciplinary Integrated Care model started with a quarterly in-home, systematic, computerised assessment of functional health status and care needs. The interRAI Long-Term Care Facilities Assessment System was used to assess function, mental and physical health, social support, medication, and service use. The identified problem areas were the basis for an individual care plan. The outcomes of the assessment were discussed

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2012 NHS Economic Evaluation Database.

122. CVD Prevention in clinical practice

Introduction: why do individuals ?nd it hard to change their lifestyle? . . . . . . . . . . . . . . . . . . . . . . . . . .1660 4.1.2 Effective communication and cognitive-behavioural strategies as a means towards lifestyle change . . . .1660 4.1.3 Multimodal, behavioural interventions . . . . . . . . . .1661 4.2 Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1661 4.2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . .1661 4.2.2 Dosage and type (...) Global Secondary Prevention Strategies to Limit Event Recurrence After MI GRADE Grading of Recommendations Assessment, Development and Evaluation HbA 1c glycated haemoglobin HDL high-density lipoprotein HF-ACTION Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing HOT Hypertension Optimal Treatment Study HPS Heart Protection Study HR hazard ratio hsCRP high-sensitivity C-reactive protein HYVET Hypertension in the Very Elderly Trial ICD International Classi?cation

2012 European Society of Cardiology

123. Vitamin D and health in adults in Australia and New Zealand: a position statement

, such as office workers, factory or warehouse workers, taxi drivers, night-shift workers 4 Key evidence that low serum 25-hydroxyvitamin D levels are associated with disease* Level I Vitamin D plus calcium supplementation reduces risk of falls , and fractures , - All-cause mortality Level II Insulin resistance , Level III Cancer (Level III-1) Influenza type A (Level III-1) Autoimmune disorders, rheumatoid arthritis, type 1 diabetes, multiple sclerosis, cardiovascular disease, , schizophrenia, cognitive (...) dietary sources, bone resorption increases under the influence of PTH, to maintain circulating calcium levels. Severe vitamin D deficiency causes impaired bone mineralisation, resulting in rickets in children and osteomalacia in adults. There is Level II evidence that optimal mineral metabolism, bone density and muscle function is achieved at serum 25-OHD concentrations of 50–60 nmol/L, - with no consistent evidence that higher levels are beneficial. Although most of these studies have been in older

2012 MJA Clinical Guidelines

124. Exploring potential reasons for Glasgow's 'excess' mortality: results of a three-city survey of Glasgow, Liverpool and Manchester

there is some evidence that Glasgow’s population may be more risk-seeking). It is probably still unknown whether the ‘anomie’ hypothesis holds true: the data presented here suggest it is unlikely, but whether this kind of population survey is the best means by which to examine the hypothesis is unclear; similarly, it is probably fair to say that data weaknesses impair our ability to assess the evidence of the impact of political effects (albeit some evidence of more negative perceptions of the 1980s did (...) , to understand and address this situation – the ultimate aim of this continuing programme of research. This, however, must be alongside, not in place of, efforts to reduce poverty and deprivation, the fundamental drivers of poor health in any society. Introduction11 1. Introduction Background – ‘excess’ mortality in Scotland and Glasgow The poor health profile of Scotland, and particularly that of its largest city, Glasgow, has been much documented. Traditional explanations have focused on the effects

2013 Health Economics Research Unit

125. Psychological, social and biological determinants of ill health (pSoBid)

study also reported a significantly higher prevalence of cognitive and functional impairment in elderly individuals living in socioeconomically deprived areas regardless of their own socioeconomic status (Basta et al., 2007). A small number of research studies have shown that ethnic minority status is also a risk factor for poorer cognitive function in older age (Zsembik and Peek, 2001; Masel and Peek, 2009) but the impact of ethnicity on the rates of cognitive decline in old age remains unclear. 21 (...) to explain the potential association between low socioeconomic status and cognitive decline. Evidence is now well established that vascular risk factors, such as blood pressure (Singh-Manoux and Marmot, 2005) and indicators of vascular disease are associated with cognitive impairment and dementia (Muller et al., 2007). Vascular disease has been reported to be predictive of poor cognitive function in the general population. The presence of vascular disease was associated with diminished cognitive function

2013 Glasgow Centre for Population Health

126. Psychosis and schizophrenia

Psychosis and schizophrenia Psychosis and schizophrenia - NICE CKS Share Psychosis and schizophrenia: Summary Psychosis is a disordered mental state characterized principally by positive symptoms such as hallucinations, delusions, and thought disorder. Psychotic symptoms are cardinal features of psychotic disorders such as schizophrenia, but may be caused by medicines and substance misuse, and by medical conditions such as sepsis in the elderly. Psychotic disorders, including schizophrenia (...) drug should not be given to the person while awaiting specialist assessment unless it is done under advice from a consultant psychiatrist. For people who are at risk of developing a psychotic disorder, specialist mental health services will usually offer treatment with individual cognitive behavioural therapy (CBT) with or without family intervention. For people with a diagnosed psychotic disorder, specialist mental health services will usually offer a therapeutic trial of an oral antipsychotic

2016 NICE Clinical Knowledge Summaries

127. Delirium

circumstances The recommendations on when management of delirium in primary care may be appropriate are based on expert opinion in review articles [ ; ; ]. Delirium is serious and is often best managed in hospital. However, admitting the person to hospital for care must be balanced against the potentially negative effects of a sudden change in environment on elderly people or those who have cognitive impairment [ ]. Management plans should be formulated with the person's and their family and/or carer's (...) cognitive impairment is suspected following an episode of delirium, follow local protocols for cognitive impairment assessment. For further information, see the CKS topic on . Specialist treatment What specialist treatment is available? Specialists such as elderly care psychiatrists, the challenging behaviour team, or elderly care physicians may suggest pharmacological measures as a last resort for severe agitation or psychosis if [ ; ]: Verbal and non-verbal de-escalation techniques are inappropriate

2016 NICE Clinical Knowledge Summaries

128. Palliative care - nausea and vomiting

of the person’s illness, their prognosis, the severity of their symptoms, and the wishes of the person and their family. Simple measures may help relieve nausea and vomiting in palliative care. They include: Ensuring access to a large bowl, tissues, and water. Eating snacks consisting of a few mouthfuls rather than large meals. Drinking cool fizzy drinks rather than still or hot drinks. Relaxation techniques. Parenteral hydration, if appropriate. Cognitive behavioural therapy (for anticipatory nausea (...) be useful to relieve symptoms. Consider cognitive behavioural therapy for anticipatory nausea or vomiting. In general, avoid nasogastric suction. It has no role in the management of most causes of nausea and vomiting. Basis for recommendation Basis for recommendation These recommendations are based on palliative care literature from textbooks [ ; ; ] and published journal articles [ ; ]. CKS could not find studies relating to acupuncture or relaxation for people experiencing nausea and vomiting

2016 NICE Clinical Knowledge Summaries

129. Diabetes - type 1

does not cover the prescribing of insulin or the management of women with type 1 diabetes who are pregnant, planning a pregnancy, or breastfeeding. It also does not cover the diagnosis and management of impaired glucose regulation, or make detailed recommendations on the diagnosis and management of other types of diabetes. There are separate CKS topics on , , and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact (...) an informed discussion with the person about the risks and benefits of treatment, taking into account factors such as co-morbidities, potential benefits from lifestyle intervention, the person's preference, and life expectancy. December 2013 — minor update. Text has been removed from the section on antiplatelet treatment and links added to the updated CKS topic on Antiplatelet treatment . July 2013 — minor update. Links to the Driver and Vehicle Licensing Agency (DVLA) website have been updated. June 2013

2016 NICE Clinical Knowledge Summaries

130. Palliative care - secretions

inflammation of the mucosa, which triggers copious mucus production [ ]. Gastric reflux may also cause pooling of fluid in the hypopharynx [ ]. Oropharyngeal or gastric contents may be aspirated into the larynx and lower respiratory tract. Factors predisposing to aspiration include impaired consciousness, old age, impaired cough or gag reflex, and structural diseases of the airway and upper gastrointestinal tract. People who aspirate may have recurrent episodes of choking, coughing, or pneumonia (...) . Have reduced cognition, and are drowsy or comatose. Are bed-bound. Take little food or fluid, and have difficulty taking oral medication. Are peripherally cyanosed and cold. Have an altered breathing pattern Basis for recommendation Basis for recommendation These recommendations are based on guidance from the National Institute for Health and Care Excellence [ ; ] and expert opinion [ ]. Pooling of saliva is the most common cause of rattling breathing in a person who is terminally ill

2016 NICE Clinical Knowledge Summaries

131. Insulin therapy in type 2 diabetes

, the absolute blood glucose level at which signs and symptoms begin to occur can vary. The severity of hypoglycaemia is defined by the clinical manifestations: Mild hypoglycaemia presents with a wide variety of symptoms, including hunger, anxiety or irritability, palpitations, sweating, or tingling lips. As the blood glucose levels fall, the person may experience weakness and lethargy, impaired vision, and confusion or irrational behaviour. Cognitive function deteriorates when blood glucose levels fall (...) , sweating, or tingling lips. Severe hypoglycaemia may result in convulsions, loss of consciousness, and coma. People with severe hypoglycaemia are unable to self-manage a hypoglycaemic episode and require help from another person to achieve normal blood glucose levels. Impaired awareness of hypoglycaemia occurs when a person with diabetes loses the ability to recognize the usual symptoms of hypoglycaemia, or when these symptoms are absent or blunted. Management of hypoglycaemia includes: Giving oral

2016 NICE Clinical Knowledge Summaries

132. Insulin therapy in type 1 diabetes

. However, the absolute blood glucose level at which signs and symptoms begin to occur can vary. The severity of hypoglycaemia is defined by the clinical manifestations: Mild hypoglycaemia presents with a wide variety of symptoms, including hunger, anxiety or irritability, palpitations, sweating, or tingling lips. As the blood glucose levels fall lower, the person may experience weakness and lethargy, impaired vision, and confusion or irrational behaviour. Cognitive function deteriorates when blood (...) % of the time and to calibrate it as needed. Children with one or more of the following: frequent hypoglycaemia; impaired awareness of hypoglycaemia associated with adverse consequences (for example seizures or anxiety); or inability to recognize, or communicate about, symptoms of hypoglycaemia (for example because of cognitive or neurological disabilties). Basis for recommendation Basis for recommendation These recommendations are based on the National Institute for Health and Care Excellence (NICE

2016 NICE Clinical Knowledge Summaries

133. Palliative cancer care - pain

, or verbal rating scales [ ]. This recommendation was based on expert opinion and non-analytic studies. There is no universally accepted tool for the assessment of cancer pain. Standardized pain assessment tools that have been recommended by the European Association of Palliative Care for use in research and clinical practice include visual analogue scales, numerical rating scales, and verbal rating scales [ ]. These are also valid tools for measuring pain in very elderly or cognitively impaired people (...) . The person, if competent and able to communicate, is the most reliable source of information about their pain. If it is not possible to ask them (because of cognitive impairment or communication deficits, for example), the family or healthcare professionals may be able to help with the assessment, bearing in mind that family members may overestimate, and healthcare professionals underestimate, the person's pain. Assess each pain a person has with a view to establishing an underlying , bearing in mind

2016 NICE Clinical Knowledge Summaries

134. High Quality Women?s Health Care

their expectations. In addition, the service must be efficient, local and one in which the woman’s informed choice is respected, where practical. I believe there is a window of opportunity to change the face of women’s health care very significantly. Some of the drivers for this opportunity include the proposed changes in the health system, the ramifications of the Working Time Regulations and the variation in clinical services and outcomes in all parts of the UK. In the UK, the majority of out-of-hours acute (...) in training, particularly since the introduction of the WTR, have required different approaches to staffing the acute 24/7 service in obstetrics and gynaecology. This issue has also had to be considered in neonatology, anaesthesia, midwifery and nursing. There is also a planned reduction in trainee numbers by the Centre for Workforce Intelligence, which potentially will act as a major driver for change. While the WTR provided a driver for further consultant expansion with more consultants directly

2011 Royal College of Obstetricians and Gynaecologists

135. Guidelines for the management of dyslipidaemias

dysbetalipoproteinaemia. . . . . . . . . .1800 10.1.4 Familial lipoprotein lipase de?ciency . . . . . . .1800 10.1.5 Other genetic disorders of lipoprotein metabolism . . . . . . . . . . . . . . . . . . . . . . .1800 10.2 Children . . . . . . . . . . . . . . . . . . . . . . . . . . . .1801 10.3 Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1801 10.4 The elderly . . . . . . . . . . . . . . . . . . . . . . . . . .1802 10.5 Metabolic syndrome and diabetes . . . . . . . . . . . .1803 10.6 Patients (...) proprotein convertase subtilisin/Kexin 9 ESC/EAS Guidelines 1771PPAR peroxisome proliferator-activated receptor PPP Pravastatin Pooling Project PROCAM Prospective Cardiovascular Munster study PROSPER Prospective Study of Pravastatin in the Elderly at Risk PROVE-IT Pravastatin or Atorvastatin Evaluation and Infection Therapy PUFA polyunsaturated fatty acid RAAS system renin–angiotensin–aldosterone system RCT randomized controlled trial REVEAL Randomized Evaluation of the Effects of Anacetrapib Through

2011 European Society of Cardiology

136. Alcohol-use disorders: prevention

of the following has occurred. They: show signs of moderate or severe alcohol dependence have failed to benefit from structured brief advice and an extended brief intervention and wish to receive further help for an alcohol problem show signs of severe alcohol-related impairment or have a related co-morbid condition (for example, liver disease or alcohol-related mental health problems). [1] Department of Health (2007) Safe. Sensible. Social. The next steps in the national alcohol strategy. London: Department

2010 National Institute for Health and Clinical Excellence - Clinical Guidelines

137. Richard Lehman’s journal review—19 December 2016

prescribed. And there is a good reason for that, because this study also shows that ß-blockers speed decline in those with existing functional or cognitive impairment. Lancet 10-17 Dec 2016 Vol 388 Another Alzheimer’s drug bombs , the failure rate in trials for new Alzheimer’s drugs was found to be 99.6%. Here is another for the bin list: . It did not meet its primary end-point in a large trial. However, the time may not have come to forget this egregious name altogether, since there is another trial (...) sick patients. In the end, a radical rehumanizing of medicine can be the only answer to burnout. I look forward very much to Ron Epstein’s forthcoming book, Attending: Medicine, Mindfulness, and Humanity. End of life agitati on — a re drugs the answer? One driver of burnout is not being able to deliver the kind of care that you would like to give to patients. Or maybe I should have put that the other way round—not being able to deliver the care of kindness. . “Distressing behavioral, communication

2016 The BMJ Blog

138. Briviact - brivaracetam

% of epilepsy cases), and generalised seizures which represent approximately 30 % of cases. In the remaining 10 % the classification is uncertain. Partial seizures used to be subdivided in Type IA simple partial seizures (consciousness not impaired), Type IB complex partial seizures (with impairment of consciousness) and Type IC partial seizures evolving to secondarily generalised seizures (ILAE 1981). However, such classification for focal seizures was subsequently abandoned by ILAE and later reports (...) recommended instead description of manifestation or degree of disability (Berg et al. Epilepsia, 2010). The lifetime risk of developing epilepsy (defined as a history of epilepsy regardless of the frequency of seizures or use of antiepileptic medication) is between 3% and 5%, with the highest incidence reported in neonates, young children, and the elderly (Banerjee et al, Epilepsy Research, 2009). The prevalence of active epilepsy is estimated at 5-8 per 1000 people in high-income countries and 10 per

2016 European Medicines Agency - EPARs

139. An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain - Part 2 - Guidance and Recommendations

the findings among multiple authors, Hoy et al (48) showed a variable prevalence of spinal pain with a significant recur- rence of 24% to 80%. Studies of the prevalence of low back and neck pain and its impact in the general popula- tion have shown 23% of patients reporting Grade II to IV low back pain (50) with a high pain intensity and disability compared to 15% with neck pain (51) (Fig. 1). Furthermore, the prevalence of persistent pain is highly prevalent in the elderly and closely associated

2013 American Society of Interventional Pain Physicians

140. Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology and The Obesity Society

every hour on the hour dur- ing the waking hours of the day achieves the same caloric expenditure as a 30-minute walk once (assuming the same velocity) (4 [EL2, NRCT]; 5 [EL4, NE]; 6 [EL1, RCT]). Healthy eating and physical activity must be accom- panied by proper sleep (ideally 7 to 8 hours a night; less than 6 hours a day is associated with metabolic derange- ments and cognitive impairment) and adequate time for recreation and play and for stress reduction and happiness (7 [EL3, SS]; 8 [EL3, CCS (...) the intake of vitamin B 12 in food (Grade A, BEL 1). • R7. The prevalence of vitamin D deficiency and insufficiency warrants case finding by measure - ment of 25-hydroxyvitamin D (25[OH]D) levels in populations at risk, including institutionalized elderly patients, people with hyperpigmented skin, and people with obesity (Grade B BEL 2). Older adults, people with increased skin pigmen- tation, and those exposed to insufficient sunlight should increase vitamin D intake from vitamin D-fortified foods

2013 American Association of Clinical Endocrinologists

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