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Copyright of Zeitschrift für Gerontologie und Geriatrie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVES Although delirium is often investigated, little is known about the outcomes of patients having acute neuropsychological changes at a single time point without fulfilling the criteria of full delirium. Our aim was to determine point prevalence, predictors, and long‐term outcomes of delirium and acute neuropsychological changes in patients aged 60 years and older across different departments of a university hospital with general inpatient care. DESIGN Prospective observational study. SETTING University hospital excluding psychiatric wards. PARTICIPANTS At baseline, 669 patients were assessed, and follow‐ups occurred at months 6, 12, 18, and 36. MEASUREMENTS Measurements were obtained using the Confusion Assessment Method (CAM), comprehensive geriatric assessment, health‐related quality of life, functional state (month 6), and mortality rates (months 6, 12, 18, and 36). Subjects were classified into (1) patients with delirium according to the CAM, (2) patients with only two positive CAM items (2‐CAM state), and (3) patients without delirium. RESULTS: Delirium was present in 10.8% and the 2‐CAM state in an additional 12.7% of patients. Highest prevalence of delirium was observed in medical and surgical intensive care units and neurosurgical wards. Cognitive restrictions, restricted mobility, electrolyte imbalance, the number of medications per day, any fixations, and the presence of a urinary catheter predicted the presence of delirium and 2‐CAM‐state. The mean Karnofsky Performance Score and EuroQol‐5D were comparable between delirium and the 2‐CAM state after 6 months. The 6‐, 12‐, 18‐, and 36‐month mortality rates of patients with delirium and the 2‐CAM state were comparable. The nurses' evaluation of distinct patients showed high specificity (89%) but low sensitivity (53%) for the detection of delirium in wide‐awake patients. CONCLUSION: Patients with an acute change or fluctuation in mental status or inattention with one additional CAM symptom (ie, disorganized thinking or an altered level of consciousness) have a similar risk for a lower quality of life and death as patients with delirium. J Am Geriatr Soc 68:1469‐1475, 2020. [ABSTRACT FROM AUTHOR]

Objective: From April 2013 to February 2014 we performed a multicentre prospective cross-sectional study in 541 German nursing home residents. We determined pharyngeal carriage of Streptococcus pneumoniae (primary objective) and other bacteria (secondary objective) in naso- and oropharyngeal swabs by culture-based standard procedures and explored the influence of multimorbidity and functional status on bacterial carriage. Methods: Socio-demographic data, vaccination status, multimorbidity, nutrition and functional status defined by Comprehensive Geriatric Assessment were evaluated. We estimated carriage rates with 95% confidence intervals (CI) and explored potential risk factors by logistic regression analysis. Results: Pneumococcal post-serotyping carriage rate was 0.8% (95%CI 0.2–1.9%; 4/526). Serotyping revealed serotypes 4, 7F, 23B and 23F and S. pseudopneumoniae in two other cases. Odds of carriage were higher in men (Odds ratio OR 5.3 (95%CI 0.9–29.4)), in malnourished residents (OR 4.6 (0.8–25.7)), residents living in shared rooms (OR 3.0 (0.5–16.5)) or having contact with schoolchildren (OR 2.0 (0.2–17.6)). The most frequent pathogen was Staphylococcus aureus (prevalence 29.5% (25.6–33.6%)) with meticillin-resistant Staphylococcus aureus prevalence of 1.1%. Gram-negative bacteria (GNB) were found in 22.5% (19.0–26.3%) with a prevalence of extended-spectrum beta lactamase (ESBL) producing bacteria of 0.8%. Odds of S. aureus carriage were higher for immobility (OR 1.84 (1.15–2.93)) and cognitive impairment (OR 1.54 (0.98–2.40)). Odds of GNB carriage were higher in residents with more severe comorbidity (OR 1.13 (1.00–1.28)) and malnutrition (OR 1.54 (0.81–2.91)). Conclusions: Given the observed data, at least long-term carriage of S. pneumoniae in nursing home residents seems to be rare and rather unlikely to cause nursing home acquired pneumonia. The low rate of colonization with multi drug resistant (MDR) bacteria confirms that nursing home residency is not a risk factor for MDR pneumonia in Germany. For individual risk assessment in this susceptible population, immobility and malnutrition should be considered as signs of functional impairment as well as comorbidity. [ABSTRACT FROM AUTHOR]

Objective: This systematic review sought to assess the costs and benefits of interventions preventing hospital-acquired infections and to evaluate methodological and reporting quality. Methods: We systematically searched Medline via PubMed and the National Health Service Economic Evaluation Database from 2009 to 2014. We included quasi-experimental and randomized trails published in English or German evaluating the economic impact of interventions preventing the four most frequent hospital-acquired infections (urinary tract infections, surgical wound infections, pneumonia, and primary bloodstream infections). Characteristics and results of the included articles were extracted using a standardized data collection form. Study and reporting quality were evaluated using SIGN and CHEERS checklists. All costs were adjusted to 2013 US$. Savings-to-cost ratios and difference values with interquartile ranges (IQRs) per month were calculated, and the effects of study characteristics on the cost-benefit results were analyzed. Results: Our search returned 2067 articles, of which 27 met the inclusion criteria. The median savings-to-cost ratio across all studies reporting both costs and savings values was US $7.0 (IQR 4.2–30.9), and the median net global saving was US $13,179 (IQR 5,106–65,850) per month. The studies’ reporting quality was low. Only 14 articles reported more than half of CHEERS items appropriately. Similarly, an assessment of methodological quality found that only four studies (14.8%) were considered high quality. Conclusions: Prevention programs for hospital acquired infections have very positive cost-benefit ratios. Improved reporting quality in health economics publications is required. [ABSTRACT FROM AUTHOR]

Copyright of Heilberufe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Older adults are the most frequent users of emergency services. Comprehensive geriatric assessment (CGA) can help identify high-risk older adults at an early stage. We conducted a systematic review and meta-analysis to identify and evaluate CGA tools used in the emergency department (ED), analyze their predictive validity for adverse outcomes and recommend tools for this particular situation. We systematically searched Medline, Web of Science and CENTRAL for eligible articles published in peer-reviewed journals that observed patients ≥65 years admitted to the ED, used at least one assessment tool and reported adverse outcomes of interest. We performed a descriptive analysis and a bivariate meta-analysis of the diagnostic accuracy and predictive validity of the assessment tools for the chosen adverse outcomes. 28 eligible studies were included. The pooled sensitivity (95% CI) of the assessment tools for predicting mortality within short (28–90 days) and long (180–365 days) periods after the first ED visit was 0.77 (0.61–0.89) and 0.79 (0.46–0.96), respectively, with specificity (95% CI) values of 0.45 (0.32–0.59) and 0.37 (0.14–0.65). These findings indicate that the tools used in the included studies had modest predictive accuracy for mortality and were more appropriate for identifying individuals at high risk of readmission in the short term than in the long term. Early use of assessment tools in the ED might improve clinical decision making and reduce negative outcomes for older adults. • The obsolescence of the population requires changes in medical care, especially in the emergency department (ED) • CGA may help to identify high-risk older adults (OA) at an early stage in order to treat them with geriatric therapy promptly • For the different domains of CGA there is a great variety of assessment tools • We evaluated the predictive validity for adverse outcomes and try to recommend assessment tools for OAs admitted to ED [ABSTRACT FROM AUTHOR]