Traumatic brain injury (TBI) is a significant problem in older adults. In persons aged 65 and older, TBI is responsible for more than 80,000 emergency department visits each year; three-quarters of these visits result in hospitalization as a result of the injury. Adults aged 75 and older have the highest rates of TBI-related hospitalization and death. Falls are the leading cause of TBI for older adults (51%), and motor vehicle traffic crashes are second (9%). Older age is known to negatively influence outcome after TBI. Although geriatric and neurotrauma investigators have identified the prognostic significance of preadmission functional ability, comorbidities, sex, and other factors such as cerebral perfusion pressure on recovery after illness or injury, these variables remain understudied in older adults with TBI. In the absence of good clinical data, predicting outcomes and providing care in the older adult population with TBI remains problematic. To address this significant public health issue, a refocusing of research efforts on this population is justified to prevent TBI in the older adult and to discern unique care requirements to facilitate best patient outcomes. Keywords traumatic brain injury; head injury; geriatric; trauma; injury; epidemiology; outcomes; functional statusThe Centers for Disease Control and Prevention has termed traumatic brain injury (TBI) the "silent epidemic," 1 and within this silent epidemic, there is a seemingly silent population: older adults with TBI. Older age is a variable known to negatively influence outcome after TBI, 2-4 but analyses illuminating why this is the case, as well as information regarding ageappropriate care of elderly patients with TBI are sparse. Furthermore, despite the fact that geriatric and neurotrauma investigators have identified the prognostic significance of preadmission functional ability, 5 the presence of comorbidities, 6,7 sex, 8 and other factors such as cerebral perfusion pressure (CPP) 9 on recovery after illness or injury, these variables remain understudied in older adults with TBI. The relative neglect of these variables in neuroscience research may partially explain why predicting outcomes and providing care in the older adult population with TBI remains so problematic. The current "one size fits all" approach to

A small but significant proportion of elderly emergently admitted hospital patients acquire pressure ulcers soon after their admission. New models of care may be required to ensure that preventive interventions are provided very early in the elderly person's hospital stay.

The growth in Asian immigration and a diversity of Asian populations living in Western English-speaking societies pose many opportunities for qualitative research. Cultural competence is essential to credible qualitative nursing research employing interview data. The purpose of this article is to describe culturally competent qualitative research with Asian immigrants, especially in the design, interview phases, and analysis. Strategies to achieve cultural competence are synthesized within the model of cultural competence, integrating the literature review and data exemplars. Strategies for successful conduct of qualitative research in Asian immigrant populations, including preparation of the research team, techniques for the conduct of research interviews with Asian immigrants, and contextual meanings and timing of translation are offered. The article concludes with a summary of implications for future research.

The purpose of this study was to estimate the incidence of hospital-acquired pressure ulcers among elderly patients hospitalized for hip fracture surgery and to identify extrinsic factors that are associated with increased risk. We conducted a secondary analysis of data abstracted from medical records at 20 hospitals in Pennsylvania, Texas, New Jersey, and Virginia. Participants were patients aged 60 years and older admitted with hip fracture to the study hospitals between 1983 and 1993. The incidence of hospital-acquired pressure ulcers was 8.8% (95% confidence interval 8.2%-9.4%). After adjusting for confounding variables, longer wait before surgery, intensive care unit stay, longer surgical procedure, and general anesthesia were significantly associated with higher pressure ulcer risk. Extrinsic factors may be important markers for high pressure ulcer risk in hospitalized hip fracture patients. Although it is not possible to eliminate factors such as requiring an intensive care unit stay or having a long surgical procedure, it may be possible to develop interventions that minimize pressure ulcer risk in patients who experience these factors.

SGDs may be an appropriate assistive communication strategy for postoperative patients with head and neck cancer. Nurses can facilitate effective patient communication with SGDs by cuing patients on device options and positioning SGDs within easy reach.