BackgroundOlder people are commonly prescribed multiple medications, including medications with anticholinergic effects. Polypharmacy and anticholinergic medications may be risk factors for the development of delirium.MethodsPatients from a medical admission unit who were over 70, with DSM-IV diagnosed delirium and patients without delirium, were investigated. Number of drugs prescribed on admission and anticholinergic burden using two scales (the Anticholinergic Cognitive Burden Scale [ACB] and the Anticholinergic Drug Scale [ADS]) were recorded from electronic prescribing records. The relationship and predictive ability of these were explored.ResultsThe sample included 125 patients with DSM-IV diagnosed delirium and 122 patients without delirium. The mean age of the sample was 84.0 years. The median number of drugs prescribed was 7: 79.8 % were prescribed ≥5 drugs and 29.0 % ≥10 drugs. The median ACB score was 1 and the median ADS score was 1.5. 73.4 % of patients had an ACB score of ≥1 and 73.0 % had a ADS score ≥1. There was no association between: number of drugs prescribed, rate of polypharmacy, rate of excessive polypharmacy, ACB score and ADS score, and a diagnosis of delirium on admission. Only acetylcholinesterase inhibitor use predicted delirium (OR 3.86, p = 0.04) and the number of drugs prescribed was negatively correlated with age (spearman rho = −0.18, p = 0.006).ConclusionNeither number of drugs prescribed, polypharmacy or anticholinergic burden were associated with delirium on admission, questioning the clinical usefulness of anticholinergic drug scales. Further research is needed to unpick fully the relationship between, drugs, anticholinergic burden, age, and prevalent delirium in older patients and whether there is any role for these scales in clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0336-9) contains supplementary material, which is available to authorized users.
The General Medical Council (GMC) provides a core curriculum for all medical degrees in the UK. However, these guidelines do not provide in-depth, specific learning outcomes for the various medical specialties. Recognising our ageing population, the British Geriatrics Society in 2013 published their own supplementary guidelines to encourage and further direct teaching on Gerontology and Geriatric Medicine in medical school curricula. Although teaching on Geriatric Medicine, a sub-discipline of Gerontology, has reassuringly increased in UK medical schools, there are convincing arguments for greater emphasis to be placed on the teaching of another sub-discipline: Social Gerontology. Considering the skills and knowledge likely to be gained from the teaching of Social Gerontology, in this paper we argue for the greater universal adoption of its teaching. This would help ensure that the doctors of tomorrow are better equipped to manage more successfully and holistically the growing cohort of older patients.
Computer classes for older people: motivations and outcomes. ABSTRACTPurpose: A 'digital divide' exists between older and younger people in terms of computer use and older people's uptake of computer training programmes in the UK remains low. This study aims to identify the motivations and outcomes of computer classes for some older people and the contributory factors.Design/methodology/approach: One-to-one qualitative semi-structured interviews were conducted with eight participants at a computer class in a London community centre. Using a topic guide interview transcripts underwent thematic analysis. The theoretical perspective of 'ageing in place' (the ability to stay in one's own home in later life) was used when interpreting the findings.Findings: Participants had been motivated to attend the class initially to gain computer skills. Initial motivation was influenced by the death of a spouse and the desire to remain mentally active. The main outcome by the class was acquisition of computer skills. Psychological and social benefits were also reported, the latter constituting motivation for continued attendance. Computer ownership and gender differences in preferred teaching style influenced class outcomes. Research limitations and implications:Although this was a small sample comprising older people solely from one community, participant backgrounds varied and the findings suggest that further research with a larger, more culturally heterogeneous sample would be valuable. Originality/value:Computer classes benefit older people wishing to learn computer skills which may facilitate 'ageing in place'. There has been little research in this area.
Studying the material relating to 45 cases of bronchiectasia in order to find out the main characteristic features of this disease to differentiate it from tbc, the author found that the chronic inflammatory fibrous process leading to bronchiectatic enlargements extends simultaneously to the bronchial walls, interstitial lung tissue and pleura, and that the most frequent localization of bronchiectasias is the lower lobe.
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