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Background: Influenza vaccination will have added importance this winter given the possibility of further waves of the COVID-19 pandemic. This study examines the impact of an electronic medical record (EMR) reminder on influenza vaccine uptake among eligible hospital inpatients.Methods: We included a convenience sample of 750 adults (median age 77 years) who are eligible for influenza vaccination (⩾65 years and/or length of stay >30 days). A live electronic dashboard identified patients eligible for vaccination, prompting reminders sent to the clinical teams via the EMR.Results: The EMR reminder was associated with almost a 50% higher likelihood of vaccination after adjusting for other covariates (odds ratio 1.48 (95% confidence interval 1.00–2.20); p= 0.048).Discussion: Reminders sent to the clinical team via the EMR appear to be an effective means of increasing vaccine uptake and should be considered as part of this year’s drive to vaccinate eligible patients in hospital.

Emerging evidence suggests that deficiencies of folate-related B vitamins can arise with metformin treatment and are independently linked with cognitive dysfunction, a comorbidity of diabetes.

Dietary polyphenols, including flavan-3-ols (F3O), are associated with better health outcomes. The relationship of plasma phenyl-γ-valerolactones (PVLs), the products of colonic bacterial metabolism of F3O, with dietary intakes is unclear.

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Hypertension is a condition of persistently elevated blood pressure, associated with increased cardiovascular risk. Non-invasive BP measurement using Korotkoff sounds is the most common method of screening for the condition. The possibility of inaccurate readings leading to a false diagnosis of hypertension (pseudo-hypertension) is of concern. Stiffened arteries in the elderly have been proposed as being the primary cause of pseudo-hypertension. Non-invasive detection of pseudo-hypertension remains problematic. This paper reviews clinical literature on pseudo hypertension and approaches to measuring the compressive stiffness of arteries, as well as biomechanical literature regarding models of arterial stiffness and the origin of Korotkoff sounds. Models of the latter show the importance of the relationship between transmural pressure and cross-sectional area (P_t/Csa curve) of the brachial artery as it closes under the influence of the pressure cuff. The review concludes that future research on pseudo-hypertension should include development of new instrumentation to measure the P_t/Csa curve of the brachial artery in vivo using non-invasive techniques suitable for application to an elderly population.

Hip fracture is common in older people and often leads to increased levels of disability and mortality and increased functional impairment. Cognitive impairment is also common and has been suggested to influence hip fracture outcome.This study evaluated the impact of cognitive impairment on functional outcome in older patients with femoral hip fracture, and patients' responses to a standard acute inpatient physiotherapy programme. Patients aged 65 years and older who underwent surgery for hip or upper femoral fracture were studied. Cognition was assessed using the Abbreviated Mental Test Score (AMTS) and mobility was measured using the Elderly Mobility Scale (EMS). Patient details and duration of physiotherapy treatment were recorded. Moderate to severe (although not mild to moderate) cognitive impairment had a strong negative impact on functional outcome and discharge, which was independent of the amount of physiotherapy received.An increased understanding of the complex relationship between cognition, ambulation and rehabilitation outcome is required and poses a significant challenge to health-care professionals.

AbstractObjectives:To evaluate the sensitivity of the CAMCOG naming subscale to anomia in Alzheimer's disease (AD) patients identified as anomic on the Boston Naming Test (BNT); and to compare the sensitivities of BNT, category (semantic) fluency (CF), and episodic memory (Delayed Word Recall, DWR) in detecting AD.Method:Data from 140 probable AD patients (NINCDS/ADRDA) were analysed. Anomic AD patients were identified (BNT) and the sensitivity to anomia of the CAMCOG naming subscale was calculated. Sensitivity (to AD) and specificity of the BNT, CF and DWR were compared in a subgroup of 60 patients age-matched to controls.Results:On BNT 81% of ADs were classified as anomic (87% specificity). Of these anomic ADs, 23 scored 6/6 on CAMCOG naming (sensitivity = 80%), and sensitivity fell to 30% using a 5/6 cut-off. Correlation between BNT and CAMCOG naming yielded Kendall's tau = 0.48 (p<0.0001). Compared to age-matched controls BNT correctly classified 70% of ADs and 87% of controls (overall accuracy = 77%). On CF 68% of ADs and 83% of controls were correctly classified (overall accuracy = 72%). BNT and CF were moderately correlated (r = 0.49, p<0.0001). DWR correctly classified 93% ADs and 98% controls (overall accuracy = 95%).Conclusions:Given its brevity, we recommend the inclusion of a split-half form of the BNT in screening test batteries for the detection of AD. The observed pattern of cognitive impairment is consistent with current models in which semantic memory deficits occur in AD only when the neuropathology extends beyond the entorhinal/hippocampal region to the temporal neocortex.

AbstractObjectives:To examine the associations of self-reported alcohol consumption in a community based sample of elderly subjects.Methods:A total of 518 non-institutionalised community dwelling elderly identified from general practice registers were interviewed in their own homes using the Geriatric Mental State (GMS-AGECAT), the Mini-Mental State Examination and the sociodemographic questionnaire. Physical health was rated on a six-point scale. Self reported alcohol consumption was recorded in units per week. The group was then divided according to the presence or absence of excessive alcohol consumption (ie. consumption of over 14 units per week for females and 21 units per week for males). Results were analysed using multivariate regression analysis with excessive alcohol consumption as the dependent variable.Results:The mean age of the sample was 73 (range 65-95), 63% (n = 329) were female. Thirty-six per cent of the population were abstinent and 7% reported excessive alcohol consumption. Analysis of the data revealed no association between excessive alcohol consumption and diagnosis, age, cognitive function or poor physical health. Excess consumption was found to be significantly associated with gender (male) and widowed status (p < 0.001, p = 0.013 respectively).Conclusions:As alcohol misuse is commonly missed in the elderly identifying high risk groups is important for the development of intervention strategies. Our results suggest that elderly widowers may be more at risk than their peers of alcohol misuse.