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The vast majority of elderly people in Sweden are in good health and can take care of themselves into a very advanced age. However, many suffer from illnesses and injuries that can cause various functional impairments and subsequent need for care. Elderly people treated in inpatient facilities or living in municipal “special housing” often suffer from several concurrent chronic diseases (multimorbidity) and conditions after injuries (stroke, fractures, etc.) – and many concurrent treatments (multiple treatments). This group of elderly patients often needs significant care from the public sector.

Swedish Council on Health Technology Assessment (SBU).

Version: April 2003

Patients in hospitals, nursing care facilities and rehabilitation units sometimes fall out of bed. Associated injuries include skin lacerations, bone fractures, joint dislocations and brain haemorrhage, and these injuries may result in permanent disability and death. Bed rails are the most common intervention designed to prevent patients falling out of bed. However, reports of fatal bed rail entrapment have caused uncertainty regarding their use. Determining which interventions effectively and safely prevent patient injuries from their beds would be beneficial and allow healthcare staff an evidence‐based practice.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

In geriatric long‐term care, physical restraints (PR) such as bedrails and belts in bed or chair are commonly used. Nurses justify them as safety measures, primarily for the prevention of falls, for controlling disruptive behaviour and for the safe use of medical devices. However, it is questionable whether PR are effective and safe devices. There is evidence of various adverse effects such as injuries, reduced psychological well‐being or decreased mobility related to the use of PR. Therefore, restraint‐free care should be the aim of high quality nursing care. We reviewed whether interventions aimed at preventing and reducing the use of PR in geriatric long‐term care settings are effective. We identified five small‐sized randomised controlled studies suitable for inclusion. All studies examined educational interventions targeted at nursing staff. Four studies investigated residents in nursing homes and one in group dwelling units. The methodological quality of all studies was limited. Results of the studies were inconsistent. One study with higher methodological quality showed no reduction in PR use. Three other studies with lower methodological quality found their intervention to be effective. Thus, current evidence on interventions for the reduction or prevention of PR use in long‐term geriatric care does not support a clear conclusion. Ongoing and unpublished research might alter the results of the review.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

This guideline provides guidance on the assessment and management of major trauma, including resuscitation following major blood loss associated with trauma. For the purposes of this guideline, major trauma is defined as an injury or a combination of injuries that are life-threatening and could be life changing because it may result in long-term disability. This guideline covers both the pre-hospital and immediate hospital care of major trauma patients but does not include any management after definitive lifesaving intervention. It has been developed for health practitioners and professionals, patients and carers and commissioners of health services.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010

Older people generally lose muscle strength as they age. This reduction in muscle strength and associated weakness means that older people are more likely to have problems carrying out their daily activities and to fall. Progressive resistance training (PRT) is a type of exercise where participants exercise their muscles against some type of resistance that is progressively increased as their strength improves. The exercise is usually conducted two to three times a week at moderate to high intensity by using exercise machines, free weights, or elastic bands.This review sets out to examine if PRT can help to improve physical function and muscle strength in older people.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

In the fast-growing geriatric population, we are confronted with both osteoporosis, which makes fixation of fractures more and more challenging, and several comorbidities, which are most likely to cause postoperative complications. Several models of shared care for these patients are described, and the goal of our systematic literature research was to point out the differences of the individual models. A systematic electronic database search was performed, identifying articles that evaluate in a multidisciplinary approach the elderly hip fracture patients, including at least a geriatrician and an orthopedic surgeon focused on in-hospital treatment. The different investigations were categorized into four groups defined by the type of intervention. The main outcome parameters were pooled across the studies and weighted by sample size. Out of 656 potentially relevant citations, 21 could be extracted and categorized into four groups. Regarding the main outcome parameters, the group with integrated care could show the lowest in-hospital mortality rate (1.14%), the lowest length of stay (7.39 days), and the lowest mean time to surgery (1.43 days). No clear statement could be found for the medical complication rates and the activities of daily living due to their inhomogeneity when comparing the models. The review of these investigations cannot tell us the best model, but there is a trend toward more recent models using an integrated approach. Integrated care summarizes all the positive features reported in the various investigations like integration of a Geriatrician in the trauma unit, having a multidisciplinary team, prioritizing the geriatric fracture patients, and developing guidelines for the patients' treatment. Each hospital implementing a special model for geriatric hip fracture patients should collect detailed data about the patients, process of care, and outcomes to be able to participate in audit processes and avoid peerlessness.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

OBJECTIVES:: The purpose of this systematic review and meta-analysis was to pool and analyze outcomes and complication rates in elderly patients with intra-articular distal humerus fractures being treated with either total elbow arthroplasty (TEA) or open reduction and internal fixation (ORIF) with locking plates.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

This review concluded that fall-prevention exercise interventions have a positive effect on prevention of fall-related injuries in older community dwelling people, including the most severe falls and those that result in medical care. There were some limitations of the evidence but the authors' conclusions appear reasonable and their recommendations for further research seem appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

This review concluded that collaboration between orthopaedic surgeons and geriatricians could improve mortality after hip fracture. This conclusion reflects the evidence presented, but was mainly based on data for routine geriatric consultation and the applicability of the findings to other models of care is uncertain.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

BACKGROUND: More than 125,000 hip fractures occur in Germany every year, with a one-year mortality of about 25%. To improve treatment outcomes, models of cooperation between trauma surgery and geriatrics have been developed. Their benefit has not yet been unequivocally demonstrated.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

BACKGROUND: Falls and their associated injuries profoundly impact health outcomes, functional independence, and health care expenses, particularly for the ever-increasing elderly population. This systematic search and review assessed the current evidence for the role of fall screening assessments.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Falls represent an important source of preventable morbidity and mortality in older adults, the fastest growing segment of the U.S. population. We undertook a systematic review of falls interventions applicable to primary care populations to inform the U.S. Preventive Services Task Force’s (USPSTF’s) updated recommendation on preventing falls in older adults.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: December 2010

We conducted this systematic review to support the U.S. Preventive Services Task Force (USPSTF) in updating its recommendation on screening for cognitive impairment in older adults. Our review addresses five questions: 1) Does screening for cognitive impairment in community-dwelling older adults improve decisionmaking, patient, family/caregiver, or societal outcomes?; 2) What is the test performance of screening instruments to detect dementia or mild cognitive impairment (MCI) in community-dwelling older adult primary care patients?; 3) What are the harms of screening for cognitive impairment?; 4) Do interventions for early dementia or MCI in older adults improve decisionmaking, patient, family/caregiver, or societal outcomes?; and 5) What are the harms of interventions for cognitive impairment?

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: November 2013

To create a systematic synthesis of the published evidence about the prevalence of eight geriatric syndromes and their association with survival and institutionalization, and to provide a review of models that report survival in elderly populations.

Evidence Syntheses/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: July 2011

The study found that supervised person-centred care, communication skills and dementia-care mapping, as well as sensory therapy activities and structured music therapies, reduce agitation in care-home dementia residents. Health and social care costs were between £7000 and £15,000 depending on the severity of agitation. Further work is required to investigate interventions for agitation for use with people with dementia living in their own homes.

Health Technology Assessment - NIHR Journals Library.

Version: June 2014

Multimorbidity is usually defined as when an individual has two or more long-term conditions. Measuring the prevalence of multimorbidity is not straightforward since this will vary depending on which conditions are counted, but all recent studies show that multimorbidity is common, becomes more common as people age, and is more common in people from less affluent areas. A recent large UK based study found that 42% of the population had at least one of the 40 conditions counted, and 23% had multimorbidity. Two-thirds of people aged 65 years or over had multimorbidity, and 47% had three or more conditions. People living in the most deprived areas had double the rate of multimorbidity in middle age than those living in the most affluent areas. Put another way, they developed multimorbidity 10-15 years before their more affluent peers. The recognition of multimorbidity associated with socioeconomic depreivation is particularly important as NHS England has a legal duty to have regard to the need to reduce health inequalities. Whereas rates of multimorbidity in older people was largely due to higher rates of physical conditions, in the less affluent multimorbidity was due to combinations of physical and mental health conditions was common.

NICE Guideline - National Guideline Centre (UK).

Version: September 2016

This review concluded that the Otago exercise programme significantly reduced risks of death and falling in older community-dwelling adults. These conclusions reflected the evidence presented. The limited sample sizes of the included studies and concerns about the review methods mean that caution might be required in interpreting these conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

The authors concluded that the diversity of the interventions, study designs, populations, and quality of the included studies led to conflicting evidence and inconclusive results for fall prevention interventions in this complex population. These conclusions reflect the evidence presented and appear reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

This review concluded that some non-pharmacological interventions relieved chronic pain in older adults, but the most appropriate intervention was unknown. Further research was necessary. These conclusions should be treated with some caution given limitations in the conduct of the review.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

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