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Key summary points: Aim: We used a reduction in funding for a private nursing home-based Irish post-acute care scheme as a natural experiment to explore the effectiveness of this scheme in a single large general hospital. Findings: Those admitted to PAC after restriction of funding spent 6 days longer in acute care but had significantly reduced readmissions to hospital within 90 days of discharge and discharge to long-term care from the PAC facility. Message: Our results suggest that the longer stay in acute care was beneficial for patients and led to improved outcomes and question the value of this approach to PAC. Purpose: To determine the effectiveness of a post-acute care scheme by exploiting a natural experiment. Methods: We used a reduction in funding for an Irish PAC scheme based in private nursing homes as a natural experiment to explore the effectiveness of this scheme in a single large general hospital. Results: Compared with an equivalent 3-month period in 2017 (pre-change, N = 169), those admitted to PAC in 2019 (post-change, N = 179), spent a median 6 days longer in acute care, although total duration spent in healthcare settings was the same. Compared with 2017, readmissions to hospital within 90 days of discharge (43/179 (24.0% v 58/169 (34.3%), p = 0.03) and discharge to long-term care from the PAC facility (3 (1.7%) v 14 (8.3%), p = 0.004) were significantly lower in 2019. Conclusion: Our results suggest that the longer stay in acute care and shorter stay in PAC was beneficial for patients and led to improved outcomes. [ABSTRACT FROM AUTHOR]

Australian studies suggest a lack of consensus in interpreting mobility recommendations, particularly affecting the terms "supervision" and "stand by assistance", was common and a contributing factor in patient falls. In a web-based survey, where responses were obtained from 102/150 (68%) therapists, 79/152 (52%) nurses and 97/132 (73%) doctors, we asked participants about their understanding of what requiring "supervision" or "stand-by assistance" when walking means. Responses to all questions differed significantly between the groups and the magnitude of the differences was greatest for the "supervision" questions. Asked if stand by assistance means the same as supervision, 71% of doctors, 35% of nurses and 14% of therapists said yes (p < 0.0001). There were also substantial within-group differences even among therapists. The widespread confusion regarding the interpretation of mobility terminology among and between different healthcare groups may impact on patient safety, and standardisation of mobility terminology is required. [ABSTRACT FROM AUTHOR]

Key Summary Points: Aim: What are the indications and outcomes of home visits and assessments by geriatricians? Findings: Home visits were mainly conducted when older people would not or could not attend a clinic. Many visits occurred to socially isolated people living in poor circumstances in deprived rural areas. Message: Home visits by geriatricians remain a valuable option for selected older people. Purpose: The value of the home (domiciliary) visit (HV) by geriatricians at the request of general practitioners has been questioned. We analysed HVs conducted by geriatricians in a west of Ireland hospital over a 14-year period. Methods: From 2002 to 2016, a systematic record was maintained of all HVs conducted by a geriatrician. Results: Consent to publication was obtained for 114 (81%) of 141 visits performed. A HV was requested in 47 (41%) cases because the person would not attend a clinic, most having a long history of refusing care, and in 40 (35%) cases because the person was severely immobile or too unwell to leave home. In 27 (24%) cases, assessment was best conducted in the home for other reasons including squalor. Of the referrals, only 40 (35%) sought specific medical advice and 15 (13%) sought advice regarding end-of-life planning. In many cases, general advice regarding management of self-neglect, unexplained decline, poor home circumstances and undue risk taking was sought. The commonest decision [45 (39%) participants] was that no major intervention would be appropriate or achievable in the person's circumstances and having regard to his or her own preferences. Twenty-three (20%) participants were persuaded to accept a major intervention they had previously declined. In 14 (12%) cases, a palliative care approach in the home was agreed. An application to court to determine what care the person should receive occurred in five (5%) cases. Many medications were stopped. Conclusions: Home visits by geriatricians remain a valuable option for selected older people. [ABSTRACT FROM AUTHOR]

Purpose: Nonconvulsive status epilepticus (NCSE) is relatively common in older people. Although NCSE is a known cause of delirium, diagnosis is often delayed or missed.Methods: We report three cases where NCSE was identified as the cause of delirium in older people that illustrate the challenge of diagnosis.Results: The cases illustrate that clinical manifestations such as slight twitching of the eyelids or periorally, eye signs, automatisms and disorders of speech and language are often very subtle. Electroencephalography (EEG), and monitoring the clinical and EEG effects of intravenous anticonvulsants, are crucial to diagnosis. Increased availability of portable EEG machines will facilitate early diagnosis. In situations where an EEG is not easily available, a trial of treatment is warranted. Hypoactive delirium is the main variant seen in NCSE but psychosis may also occur.Conclusions: Clinicians should maintain a high index of suspicion for NCSE in patients with delirium especially when no other obvious cause is identified. [ABSTRACT FROM AUTHOR]

Purpose Alzheimer's disease is often seen by the public as synonymous with dementia but this may have changed in recent years. Methods We used Google Trends to examine the relative volume of internet searches from 2004 to July 2017 for the terms 'dementia' and 'Alzheimer' in English-speaking countries. For each country, a linear regression model was fitted for each search term and the slopes of the lines were compared. Results The slopes (standard error) for 'dementia' and 'Alzheimer', respectively, were: Australia--0.26 (0.02) and - 001 (0.002); Canada--0.23 (0.01) and 0.004 (0.01); Ireland: 0.33 (0.02) and - 0.04 (0.01); United Kingdom--0.36 (0.01) and 0.01 (0.001); and United States--0.23 (0.01) and - 0.01 (0.004). Differences between slopes were all significant at p < 0.001. Conclusions In all countries, there was a large increase over time in relative search volumes for 'dementia' and a flat or negative trend in searches for 'Alzheimer'. [ABSTRACT FROM AUTHOR]