Melatonin shows potential for reducing delirium among older people after surgery
Taking melatonin around the time of surgery is linked with lower odds of delirium onset in older people, compared with placebo or no treatment. In a systematic review and meta-analysis, around 15% of the melatonin group developed delirium after surgery compared with around 20% of the comparison group.
Delirium is an acute state of mental confusion associated with longer hospital stays and increased mortality. UK clinical guidelines do not recommend specific medications to prevent this condition...
People leave hospital after surgery sooner if hospitals follow ‘enhanced recovery protocols’
Strategies to improve or enhance recovery after planned surgery can reduce the amount of time people over 60 spend in hospital, compared with standard care. These strategies include minimising fasting before operations, targeted anaesthesia, getting people up and about quickly after surgery and an early return to eating.
In this review, hospital stay could be reduced by up to five days with the use of enhanced recovery protocols. Exercises and nutritional programmes to prepare for surgery (&lsq...
5% fluorouracil cream is the best first-line treatment for actinic keratosis skin lesions
Comparison of four common treatment regimens for actinic keratosis found that twice daily 5% fluorouracil cream was the most effective and least expensive. It was also found to be convenient and well tolerated by patients.
Actinic keratosis, also known as solar keratosis, is a scaly skin lesion that develops following long-term sun exposure. It is a common disease in older adults that very occasionally can develop into skin cancer.
This Dutch study assessed 624 patients who had five or more ac...
Long-term exercise programmes reduce falls and injuries in older adults
Older people who participate in year-long exercise programmes fall less and are less likely to be injured if they do fall. Exercise does not increase or decrease their risk of hospitalisation.
The people aged 60 or over (average age 73 years) who were included in this review took part in supervised training programmes. Typically, about half of people at this age can fall at least once a year. These programmes combined aerobic, strength and balance training, exercising at a moderate intensity fo...
Antimicrobial stewardship programmes reduce antibiotic use in long-term care homes
Antimicrobial stewardship programmes have been found to reduce antibiotic use in long-term care residences by 14% when pooling evidence across a range of study types and interventions.
Antimicrobial resistance is a public health threat, and overuse of antimicrobials is one of the main causes. Antimicrobial stewardship programmes are a government strategy to support the appropriate prescribing of antimicrobials within the NHS. There has been little evidence for their use or effectiveness in lon...
Reviewing inhaler technique for older people with COPD can improve disease control
Educating older adults with chronic obstructive pulmonary disease or asthma about the correct way to use their inhalers, as part of disease management, can reduce their risk of exacerbations. Either a demonstration using a placebo inhaler or written information appears effective for this.
This review pooled the results of four trials, with a total of 1,225 participants. It found that a pharmacist or nurse intervention to improve inhaler technique for older adults can reduce exacerbations. Peopl...
Repeat thyroid function tests for healthy older people are not needed
Older adults with normal thyroid function or subclinical thyroid dysfunction show notable long-term stability of their thyroid hormone levels. This suggests that it is safe for GPs not to routinely retest older adults unless they have risk factors or develop clinical symptoms of overt thyroid dysfunction.
Over five years, about 0.2% older adults with normal thyroid function will develop overt hypothyroidism and about 3.5% will develop subclinical hypothyroidism. Amongst those with subclinical h...
Aspirin did not prevent deaths or disability in healthy older adults
In the ASPREE trial, older adults with no apparent cardiovascular disease who took daily aspirin saw no benefit in terms of reducing the chance of dying or having dementia or disability. Instead, it slightly increased their mortality and bleeding risk - aspirin was associated with an excess of 1.6 deaths per 1,000 people per year. Half of these deaths were due to cancer.
Aspirin is an established ‘secondary’ preventative treatment for people who have known cardiovascular disease. Ho...
Routine measurement of grip strength can help assess frailty in hospital
Training clinical staff to routinely measure grip strength can help identify frail older hospital inpatients. This could help tailor their care.
This NIHR-funded study was conducted across five acute medical wards in one hospital in England over a nine-month period. Nursing staff were trained to measure grip strength of people aged over 80 years. They were instructed to assess if those with low grip required nutritional supplements and to refer them to physiotherapy for consideration of strengt...
UK-wide study reveals a pattern of delay in referrals to specialist end-of-life care
Referrals to hospice-based specialist palliative care occur closer to death in older than in younger people and in those without cancer. Existing evidence shows that some people near the end of life have a better quality of life and symptom control if they receive specialist palliative care. This research highlights the need to better understand the reasons for any delay.
In this large NIHR-funded hospice study people aged under 50 years were referred to hospice specialist palliative care about...