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Objectives: To examine the association between Proton pump inhibitors (PPIs) use and falls and fractures. Design: A cross-sectional study. Setting and participants: 400 female patients aged 70 years or older who were consecutively admitted to the Trauma Center Meidling, Vienna, after a fall and who required hospital admission. Methods: We quantified the strength of the associations between PPI use and falls, and between PPI use and fractures, using a logistic regression. Results: use of PPIs was significantly associated with risk of recurrent falls (OR 1.92, 95% CI = 1.05-3.50, p = 0.04) as well as with risk of a fracture (OR 2.15, 95% CI 1.10-4.21, p = 0.03). Conclusions: In conclusion, our results provide further evidence that PPI use may increase risk of falls and fractures in older women and highlight the need for clinicians to reassess the original indication and the need for continuation of PPIs on a regular basis. [ABSTRACT FROM AUTHOR]

Background/Aims: The diagnosis of delirium is not supported by specific biomarkers. In a previous study, high neopterin levels were found in patients with a postoperative delirium. In the present study, we investigated levels of neopterin, interleukin-6 (IL-6) and insulin-like growth factor-1 (IGF-1) in acutely ill admitted elderly patients with and without a delirium. Methods: Plasma/serum levels ofneopterin, IL-6 and IGF-1 were determined in patients aged ≥65 years admitted to the wards of Internal Medicine and Geriatrics. Differences in biomarker levels between patients with and without a delirium were investigated by the analysis of variance in models adjusted for age, gender, comorbidities and eGFR (when appropriate). Results: Eighty-six patients were included; 23 of them with a delirium. In adjusted models, higher mean levels of neopterin (70.5 vs. 45.9 nmol/l, p = 0.009) and IL-6 (43.1 vs. 18.5 pg/ml, p = 0.034) and lower mean levels of IGF-1 (6.3 vs. 9.3 nmol/l, p = 0.007) were found in patients with a delirium compared to those without. Conclusions: The findings of this study suggest that neopterin might be a potential biomarker for delirium which, through oxidative stress and activation of the immune system, may play a role in the pathophysiology of delirium. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Before being used in clinical practice, a prediction model should be tested in patients whose data were not used in model development. Previously, we developed the AD F ICE_IT models for predicting any fall and recurrent falls, referred as Any_fall and Recur_fall. In this study, we externally validated the models and compared their clinical value to a practical screening strategy where patients are screened for falls history alone. Retrospective, combined analysis of 2 prospective cohorts. Data were included of 1125 patients (aged ≥65 years) who visited the geriatrics department or the emergency department. We evaluated the models' discrimination using the C-statistic. Models were updated using logistic regression if calibration intercept or slope values deviated significantly from their ideal values. Decision curve analysis was applied to compare the models' clinical value (ie, net benefit) against that of falls history for different decision thresholds. During the 1-year follow-up, 428 participants (42.7%) endured 1 or more falls, and 224 participants (23.1%) endured a recurrent fall (≥2 falls). C-statistic values were 0.66 (95% CI 0.63-0.69) and 0.69 (95% CI 0.65-0.72) for the Any_fall and Recur_fall models, respectively. Any_fall overestimated the fall risk and we therefore updated only its intercept whereas Recur_fall showed good calibration and required no update. Compared with falls history, Any_fall and Recur_fall showed greater net benefit for decision thresholds of 35% to 60% and 15% to 45%, respectively. The models performed similarly in this data set of geriatric outpatients as in the development sample. This suggests that fall-risk assessment tools that were developed in community-dwelling older adults may perform well in geriatric outpatients. We found that in geriatric outpatients the models have greater clinical value across a wide range of decision thresholds compared with screening for falls history alone. [ABSTRACT FROM AUTHOR]