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Objective: dimensional guidelines for bedrails have been developed to minimise the risk of patient entrapment within the bed. We examined whether bedrails in a large Irish teaching hospital complied with these standards.Design and setting: survey of 60 accessible beds in six hospital wards.Methods: a specialised cone and cylinder tool that mimics the size and weight of a small adult neck and head was used to determine gaps in the four zones most associated with entrapment.Results: the number of failures for each zone was 15 beds for zone 1 (any space between the perimeters of the rail); 42 beds for zone 2 (the space under the rail); 41 beds for zone 3 (the space between the inside surface of the bedrail and the mattress) and 13 beds for zone 4 (the space between the mattress and rail at the end of the rail). Failures were more common with hydraulic adjusted than with electric profiling beds. Mattresses that were the wrong size (usually too narrow) or too soft and bedrails that were loose or were poorly maintained accounted for many failures.Conclusion: many beds used in our hospital did not comply with dimensional standards to minimise entrapment risks. This emphasises the need for careful selection of patients for whom bedrails are to be used as well as the need for monitoring and maintenance of bed systems. [ABSTRACT FROM AUTHOR]

Objective: to determine the prevalence and predictors of bedrail use in an acute hospital.Design and setting: overnight survey in a University teaching hospital.Subjects: Three-hundred and twenty-seven beds and patients in 14 wards.Methods: data were collected on bedrail use and on the bed system, ward and patient characteristics. Medical, nursing and physical therapy notes were examined and the night and day nurses and, if necessary, the doctors and therapists caring for the patient interviewed to determine patients' diagnoses, functional and cognitive status.Results: there were 133 (40.7%) beds with one or more raised rails. Independent predictors of bedrail use were use of electric profiling beds, confusion, reduced alertness and any difficulty with transferring from bed. The most common reported indication for bedrail use was ‘to prevent rolling out of bed’ (59%); ‘to prevent getting out of bed’ was recorded in 11% of cases. Use of bedrails was judged inappropriate in 27/133 (20.3%) patients and in 14/43 (32.6%) patients with abnormal mental status; misuse was particularly common in those with confusion or agitation [13/34 (38.2%)]. Failure to use bedrails was potentially inappropriate in 32/194 (16.5%) of those without bedrails.Conclusion: this study using individual patient data shows that the use of electric profiling beds, abnormal mental states and difficulty transferring from bed are the main predictors of bedrail use in acute hospitals. Inappropriate use of bedrails is common in those with cognitive impairment or with agitation. [ABSTRACT FROM AUTHOR]

Coeliac disease (CD) results from immunologically mediated inflammation of the small intestinal mucosa precipitated by ingestion of gluten in wheat and other cereals in genetically susceptible people. There is a broad spectrum of clinical and histological features associated with gluten sensitivity. Overt clinical malabsorption is uncommon, and clinical symptoms are often non-specific. This is particularly true of older people and the diagnosis of CD may be delayed or missed as a result. The incidence of metabolic bone disease, neurological symptoms and nutritional deficiencies are high in older people with CD and respond well to treatment. Sensitive and specific serological tests are now available and these have improved ease of detection of CD in patients without classical symptoms. Hence, a high index of suspicion is warranted in older people with potential symptoms of CD. [ABSTRACT FROM PUBLISHER]

BACKGROUND: Testing of orientation to time is an important part of mental status examination. The validity of errors in different aspects of temporal orientation was examined in older hospital patients as a guide to the presence of dementia or delirium and as a measure of the severity of dementia, as defined by the Global Deterioration Scale. METHODS: Inpatients and outpatients attending an acute hospital underwent independent assessments by two doctors on the same day to determine orientation to time and cognitive status. Optimum cut-offs for error scores on the different aspects of temporal orientation were calculated to maximise the sum of sensitivity and specificity for detection of dementia or delirium. RESULTS: Of the 262 patients assessed, 62 (23.7%) had dementia or delirium. The best cut-offs for detection of these disorders were: any error in identifying the year, month, day of the month or day of the week; and an error of more than 1 h in identifying the time of day. Failure to identify the year correctly was the most valuable single sign of dementia or delirium (sensitivity 86% and specificity 94%); failure to identify either year or month correctly was 95% sensitive and 86.5% specific for the detection of cognitive impairment. Severity of temporal disorientation, measured using a number of approaches, was strongly associated with severity of dementia. CONCLUSION: Disorientation to time is a useful guide to the presence and severity of dementia or delirium in older hospital patients. Failure to identify the year or month correctly is a sufficiently sensitive and specific indicator of dementia or delirium to warrant more detailed cognitive assessment in this population. [ABSTRACT FROM AUTHOR]

Editorial. Deals with biochemical thiamine deficiency among elderly people. Daily requirement of thiamine; Measurement of thiamine status; Major clinical manifestations of thiamine deficiency; Association of thiamine deficiency with a diffuse decrease in cerebral glucose metabolism and in cholinergic neurotransmission.

The article discusses research being done on the use of bedrails in hospitals. It references the study "Which Bed Designs and Patient Characteristics Increase Bed Rail Use?," by S. Hignett, G. Sands, M. Fray, P. Xanthopoulou and F. Healey and P. Griffiths published in the 2013 issue of "Age and Aging: Oxford Journals." The study found that bedrails were raised for 52% of patients surveyed, while bedrails were raised for 75% of patients who are described as confused.

A letter to the editor is presented in response to the article "The effect of bedrails on falls and injury: A systematic review of clinical studies."

Recurrent complex visual hallucinations (RCVH), particularly of people, are common during delirium and in dementia, especially Lewy body disease, and acquired eye disease. Studies in those with acquired eye disease suggest that facial distortions, with exaggerated eyes and mouths, are a common feature. We report, and discuss the possible mechanism, of two examples of similar facial distortions in hallucinations occurring during delirium, including one where the patient was able to draw what he experienced. The hallucinations in this report are consistent with the Perception and Attention Deficit model for RCVH and suggest that in delirium, where attentiveness is reduced, the eyes and mouth may receive much of the available attentional focus resulting in hallucinated faces with exaggeration of these features., Competing Interests: Declarations. Conflict of interest: The authors declare no conflicts of interest. Ethical approval: Research ethics approval was not required for this report. Informed consent: Written informed consent was obtained from each participant. Mr A consented to his drawing being published., (© 2025. The Author(s), under exclusive licence to European Geriatric Medicine Society.)

Competing Interests: Competing interests: None declared.

While the adverse medical complications and consequences of delirium has been well studied, the same is not true of the psychological morbidity associated with the condition. A better understanding of what it is like to be delirious has the potential to improve recognition, management and treatment of delirium. This article examines the literature relating to the experience of delirium from the perspective of patients, families, and staff. Finally, suggestions for further work that might advance might advance our understanding of these issues are outlined.

Introduction: Although most patients wish to be fully informed about bad news such as a diagnosis of cancer, a significant minority prefer no or minimal information. We examined the value of asking patients about their disclosure preferences at the outset of hospitalization., Methods: Consecutive patients admitted to a respiratory and a geriatric unit were asked whether and how they would wish to be told of cancer or Alzheimer disease., Results: Of the 207 patients interviewed, 174 (84%) wanted to be told about cancer or dementia; the proportion who would wish to be told did not differ between older patients (89 of 108 patients; 82%) and younger patients (85 of 99 patients; 86%; p = 0.34). Thirty patients (15%) sought reassurance during or after the interview, and 13 patients (6%) reported that they had been bothered by the questions. Of the 207 patients, cancer or dementia was diagnosed in 23 patients (11%). Preferences for disclosure or nondisclosure were honored for 20 patients (87%)., Conclusions: Seeking preferences regarding truth disclosure at the outset of hospitalization is helpful and feasible in everyday practice, and the results can be used by clinicians to improve communication with patients and families in accordance with patients' own wishes.

Background: Secondary causes of restless legs syndrome (RLS) have been reported to be more common in those with late-onset RLS. However, 'late-onset' in previous studies was defined as onset after 45 years., Objective: To determine the prevalence of secondary causes of RLS and the relationship between aetiological factors and age of symptom onset in an older population., Design: Prospective study conducted over a 5-year period., Participants: 80 consecutive non-related patients diagnosed with RLS., Measurements: Patients were assessed according to a standard protocol. Age at symptom onset, severity of symptoms, neurological findings and laboratory tests were examined., Results: Iron deficiency (serum ferritin <50 ng/ml) was present in 22% of patients with onset before 50 years, 39% of those with onset at 50 to 64 years and 58% in those with onset after 64 years (P = 0.009). Clinical neuropathy was also more common in older-onset patients (P = 0.08). Family history was positive in 39%, 23% and 8% of these groups, respectively (P = 0.008)., Conclusion: Secondary causes of RLS become more common and a positive family history less common with increased age of symptom onset.