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Objectives: The contested categorical personality disorder (PD) criteria are not well suited to inform PD diagnoses in older adults. Yet, the classification of PDs is undergoing a critical transition phase with a paradigm shift to a dimensional approach for diagnosing PDs. No special attention was given to the expression of PDs in older age when the dimensional ICD‐11 model was developed. Given that PDs are highly prevalent in older adults, there is an urgent need to examine if ICD‐11 related instruments are able to adequately assess for PDs in older adults. Methods: The age‐neutrality of ICD‐11 measures was examined in a sample of 208 Dutch community‐dwelling adults (N = 208, M age = 54.96, SD = 21.65), matched on sex into 104 younger (age range 18–64) and 104 older (age range 65–93) adults. An instrument is considered not to be age‐neutral if a collective large level of differential item functioning (DIF) exists in a group of items of an instrument (i.e., 25% or more with DIF). We therefore set out to detect possible DIF in the following ICD‐11 self‐report measures: the Standardized Assessment of Severity of Personality Disorder (SASPD), the Personality Inventory for ICD‐11 (PiCD), and the Borderline Pattern Scale (BPS). Results: DIF analyses using a non‐parametric odds ratio approach demonstrated that SASPD, PiCD, and BPS were age‐neutral with less than 25% of items showing DIF. Yet, impact of DIF at scale level, examined by way of differential test functioning (DTF), indicated a DTF effect on the SASPD total score. Conclusions: These results of age‐neutrality of the PiCD and BPS are promising for measuring ICD‐11 traits and the borderline pattern. Yet, the age‐neutral measurement of PD severity requires further research. With a rapidly aging population, its accurate assessment across the entire adult life span, including older age, is a prerequisite for an adequate detection of PDs. Key points: Personality disorders (PDs) in older adults are prevalent, therefore accurate assessment instruments are needed.The classification and assessment of PDs is shifting toward a dimensional approach, given the critiques on categorical approaches.The current study demonstrates that the dimensional ICD‐11 model of PDs and related assessment instruments allow for accurate assessment of maladaptive traits and the borderline pattern in older adults by corroborating the age‐neutrality of the PiCD and borderline pattern scale instruments.Accurate assessment of PD severity across the adult life span requires further research. [ABSTRACT FROM AUTHOR]

Background: Albumin after large volume paracentesis (LVP) reduces paracentesis-induced circulatory dysfunction (PICD). The most efficacious dose of albumin for LVP is unclear. Objective: To evaluate the impact of implementing a standardized LVP order set on albumin utilization and patient outcomes. Methods: This is a retrospective review of patients with ascites due to cirrhosis who received a therapeutic paracentesis at a large, academic institution. Primary outcome was amount of albumin used prior to and after order set implementation. Albumin doses were standardized in the order set to 25 g (5-6 L removed), 50 g (7-10 L), and 75 g (>10 L). Patient outcomes were rates of hyponatremia, renal impairment, and hypotension. Results: There were 100 patients included in each arm of the final analysis. Patients prior to order set implementation received a higher amount of albumin per liter removed compared to those post-implementation (8.3 g/L vs 6.5 g/L, respectively; P <.01). There were no significant differences between groups in absolute changes in serum sodium (0 mEq/L vs −1 mEq/L, P =.64), serum creatinine (0.06 mg/dL vs 0.05 mg/dL, P =.94), or systolic blood pressure (−4 mm Hg vs −3 mm Hg, P =.96). There were no differences between groups in rates of hyponatremia (1.6% vs 6.6%, P =.21), renal impairment (11.3% vs 11.5%, P =.97), or hypotension (17.4% vs 17.6%, P =.97). Conclusions: Use of an order set to guide albumin dosing based on amount of ascitic fluid removed during LVP resulted in a significant reduction in the amount of albumin given with no difference in adverse effects. [ABSTRACT FROM AUTHOR]