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Objectives To develop mortality risk prediction models for older adults with chronic kidney disease ( CKD) that include comorbidities and measures of health status and use not associated with particular comorbid conditions (nondisease-specific measures). Design Retrospective cohort study. Setting Kaiser Permanente Northwest ( KPNW) Health Maintenance Organization. Participants Individuals with severe CKD (estimated glomerular filtration rate <30 mL/min per 1.73 m2; N = 4,054; n = 1,915 aged 65-79, n = 2,139 aged ≥80) who received care at KPNW between 2000 and 2008. Measurements Cox proportional hazards analysis was used to examine the association between selected participant characteristics and all-cause mortality and to generate age group-specific risk prediction models. Predicted and observed risks were evaluated according to quintile. Predictors from the Cox models were translated into a points-based system. Internal validation was used to provide best estimates of how these models might perform in an external population. Results The risk prediction models used 16 characteristics to identify participants with the highest risk of mortality at 2 years for adults aged 65 to 79 and 80 and older. Predicted and observed risks agreed within 5% for each quintile; a 4 to 5 times difference in 2-year predicted mortality risk was observed between the highest and lowest quintiles. The c-statistics for each model (0.68-0.69) indicated effective discrimination without evidence of significant overfit (slope shrinkage 0.06-0.09). Models for each age group performed similarly for mortality prediction at 6 months and 2 years in terms of discrimination and calibration. Conclusion When validated, these risk prediction models may be helpful in supporting discussions about prognosis and treatment decisions sensitive to prognosis in older adults with CKD in real-world clinical settings. [ABSTRACT FROM AUTHOR]

Objectives To evaluate whether implementation of symptom-triggered administration of a benzodiazepine protocol reduces the severity (total cumulative dose), duration, and complications of alcohol withdrawal syndrome ( AWS). Design Retrospective health record review. Setting Tertiary care center in Vancouver, Canada. Participants Individuals aged 70 and older admitted to the Acute Care for Elders and Acute Medicine Unit wards with diagnostic codes for AWS from 2008 to 2012. Measurements Median duration and cumulative dose of benzodiazepine treatment, number of severe AWS complications, severe benzodiazepine-associated adverse effects, and need for adjunct therapy. Results Thirty-three participants in the preprotocol group and 30 in the protocol-implemented group met the inclusion criteria. Median duration of benzodiazepine treatment decreased from 96 hours (interquartile range ( IQR) 72-120 hours) in the preprotocol period to 48 hours ( IQR 0-108 hours; P = .04), and median cumulative benzodiazepine dose administered decreased from 9 mg ( IQR 5-19.8 mg) to 3 mg ( IQR 0-10 mg; P = .001). Statistically significantly lower incidence of severe AWS complications ( P = .007) and adjunct therapy use ( P = .02) was seen in the protocol-implemented group. Conclusion A symptom-triggered protocol for dosing of benzodiazepine therapy in the management of AWS in individuals aged 70 and older significantly reduced the total duration of benzodiazepine use, cumulative benzodiazepine dose, and use of adjunctive medications in the treatment of AWS. [ABSTRACT FROM AUTHOR]

Objectives To report 25 hydroxyvitamin D (25 OHD) concentrations, an indicator of vitamin D status, in older adults living in residential care 1 year after a protocol of weekly 20,000 IU of vitamin D was started. Design Cross-sectional. Setting Five residential care facilities in British Columbia, Canada. Participants Residents aged 65 and older from five facilities (N = 236). Measurements Participants provided a blood sample. Demographic and health information was obtained from the medical record. Results Mean 25 OHD was 102 nmol/L (95% confidence interval ( CI) = 98-106 nmol/L). Three percent of residents had a 25 OHD concentration of less than 40 nmol/L, 6% <50 nmol/L, and 19% <75 nmol/L. In those who received 20,000 IU/wk or more for 6 months or longer (n = 147), mean 25 OHD was 112 nmol/L (95% CI = 108-117 nmol/L), and none had a 25 OHD level of less than 50 nmol/L. Hypercalcemia (>2.6 mmol/L), a potential consequence of too much vitamin D, was present in 14%, although 25 OHD levels did not differ in those with and without hypercalcemia (108 vs 101 nmol/L; P = .17). Conclusion Twelve months after implementation of a 20,000- IU/wk vitamin D protocol for older adults in residential care, mean 25 OHD concentrations were high, and there was no evidence of poor vitamin D status. Given the absence of demonstrated benefit of high 25 OHD concentrations to the residential care population, dosages less than 20,000 IU/wk of vitamin D are recommended. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate the feasibility of a follow-up hip fracture clinic which could be used to promote mobility in older adults following hip fracture and hip fracture fixation. Researchers evaluated the use of the clinic with 110 subjects. They found that the clinic led to improved mobility and concluded that the clinic was feasible.