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The study shows that hypoactive delirium is the most common subtype among hospitalized older patients. Specific clinical features were associated with different delirium subtypes. The use of standardized instruments can help to characterize the phenomenology of different motor subtypes of delirium.

Aim The aim of the present study is to investigate how delirium and adverse clinical events (ACE) contribute independently and in combination to functional outcomes in older patients admitted to rehabilitation settings after a hip fracture. Methods This is a multicenter retrospective cohort study of patients aged ≥65 years admitted after hip fracture surgical repair to three Italian rehabilitation units. Delirium on admission was evaluated with the Confusion Assessment Method. ACE during the rehabilitation stay were recorded, including infections (i.e. urinary tract infections, other infections), non‐infectious ACE (i.e. cardiovascular events, respiratory failure, pulmonary embolism) and falls. A multivariable linear regression was used to evaluate the effect of ACE and delirium on functional outcome, adjusting for covariates determined a priori. Results A total of 519 patients were included in the study. The mean ± SD age was 82.9 ± 9.4 years. ACE occurred in 277 patients (53.4%), delirium alone was present in 19 patients (3.6%). Both conditions were present in 58 patients (11.2%). Compared with patients without delirium or ACE, those with ACE or delirium were more likely to have a worse functional outcome (−6.7 Barthel Index points [−11.6; −1.7]; P = 0.008; −13.2 [−25.6; −0.8]; P = 0.038) at discharge, and patients with both conditions had an even lower Barthel Index score (−18.6 Barthel Index points [−26.9; −10.3]; P < 0.001). Conclusions ACE and delirium are very common in older patients admitted to rehabilitation settings after hip fracture, and frequently coexist. As both ACE and delirium could impact on functional outcome, alone and in combination, a clinical geriatric approach is necessary for this population to minimize risks. Geriatr Gerontol Int 2019; 19: 404–408.

Adverse clinical events (ACEs) are common in post-acute hospital care. We aimed at developing and validating a method, able to be administered in hospital wards, for identifying elderly patients at increased risk of ACEs after transferral to post-acute care (PAC) facilities. This was a prospective observational study, including 502 patients admitted to 19 PAC facilities in northern Italy from July 1(st) to August 14(th), 2009. A standardized form was used to collect data. Variables showing stable association with ACEs in testing group were used to derive the score. The relative risk (RR) of developing ACEs according to the score was measured in the validation group. Age ≥87 years, delirium, pressure sore, indwelling bladder catheter, malnutrition, and acute infection on admission were identified as stable ACE predictors. A score of 1 was assigned to each predictor. Subjects were classified as having low (score=0), medium-low (score=1), medium-high (score=2-3), or high (score ≥4) risk of ACEs. The RR of developing ≥1 ACE increased progressively from low (RR=1) to medium-low (RR=1.5, 95% confidence interval [CI] 1.1-1.9), medium-high (RR=1.6, 95% CI 1.3-2.1), and high (RR=1.8, 95% CI 1.4-2.3) risk score. The RR of being not discharged to home increased monotonically from 1.0 in low-risk to 2.7 in high-risk groups. In conclusion, this study proposes a method, able to be administered in hospital wards, for identifying patients at increased risk of ACEs after transferral to PAC. The score might also be used to identify people who will not return to home after PAC discharge.

This description of the burden on care management resulting from acute and subacute changes in clinical and functional status of chronic patients emphasizes the continuing and unpredictable nature of medical attention required in a nursing home or chronic care facility. ACEs occur far more frequently among the elderly than is generally recognized. Thus a high level of medical and nursing skill is necessary in chronic care facilities.

The effects of transcutaneous electrical stimulation on deficits of tactile perception contralateral to a hemispheric lesion were investigated in 10 right brain-damaged patients and in four left brain-damaged patients. The somatosensory deficit recovered, transiently and in part, after stimulation of the side of the neck contralateral to the side of the lesion, in all 10 patients with lesions in the right hemisphere, both with (six cases) and without (four cases) left visuo-spatial hemineglect, and in one left brain-damaged patient with right hemineglect. In three left brain-damaged patients without hemineglect, the treatment had no detectable effects. In one right brain-damaged patient, the stimulation of the side of the neck ipsilateral to the side of the lesion temporarily worsened the somatosensory deficit. These effects of transcutaneous electrical stimulation are similar to those of vestibular stimulation. The suggestion is made that these treatments modulate, through afferent sensory pathways, higher-order spatial representations of the body, which are pathologically distorted toward the side of the lesion. The modulatory effect is direction-specific: the defective internal representation of the contralesional side may be either partly restored, improving the disorder of tactile perception, or further impoverished, worsening the deficit. The possible neural basis of this modulation is discussed. (JINS, 1996, 2, 452–459.)