Specific needs of elderly people
NICE GUIDELINE (2015) Transition between inpatient hospital settings and community or care home settings for adults with social care needs (NG27).

NICE GUIDELINE (2010) Delirium: prevention, diagnosis and management, NICE guidance (CG103)

NICE (2016) Multimorbidity: clinical assessment and management [NG56]

Abdulla A, Adams N, Bone M et al (2013) Guidance on the management of pain in older people. Age Ageing, 42, (suppl 1): i1-i57. doi: 10.1093/ageing/afs200

Abrahamsen JF, Haugland C, Ranhoff AH (2016) Assessment of recovery in older patients hospitalized with different diagnoses and functional levels, evaluated with and without geriatric assessment. Europ Rev Aging Physical Activity; 13:5. doi: 10.1186/s11556-016-0166-y

Achterberg WP, Pieper MJC, van Dalen-Kok AH et al (2013) Pain management in patients with dementia. Clin Intervent Aging; 8:1471-82
• pain has been identified in 50% of people with dementia

Agnoletti D, Valbusa F, Labat C et al (2016) Evidence for a prognostic role of orthostatic hypertension on survival in a very old institutionalized population. Hypertension; 67:191-196. doi: 10.1161/HYPERTENSIONAHA.115.06386
• with ageing, BP is less stable on position change

Ailon T, Shaffrey CI, Lenke LG et al (2015) Progressive spinal kyphosis in the aging population. Neurosurgery; 77 Suppl 4:S164-72. doi: 10.1227/NEU.0000000000000944

Albertson T (2013) The pharmacological approach to the elderly COPD patient. Drugs Aging; 30(7):467-77

Al-Momani M, Al-Momani F, Alghadir AH et al (2016) Factors related to gait and balance deficits in older adults. Clin Interventions Aging; 11:1043-1049. doi: https://dx.doi.org/10.2147/CIA.S112282

Anderson KN, Catt M, Collerton J et al (2014) Assessment of sleep and circadian rhythm disorders in the very old: the Newcastle 85+ Cohort Study. Age Ageing; 43(1):57-63. doi:10.1093/ageing/aft153

Ashfield TA, Syddall HE, Martin HJ (2010) Grip strength and cardiovascular drug use in older people. Age Ageing, 39, 185-91
• some cardiac drugs (furosamide, nitrates and calcium channel blockers) are associated with reduced grip strength

Avelar BP, Costa JN, Safons MP et al (2016) Balance exercises circuit improves muscle strength, balance, and functional performance in older women. Age (Dordr); 38(1):14. doi: 10.1007/s11357-016-9872-7

Azeredo LM, Leandro M, Nemer SN et al (2017) The integrative weaning index in elderly ICU subjects. Respir Care; 62(3): 333-339
• weaning outcome can be predicted by the Integrative Weaning Index

Baijens LW, Clavé P, Cras P LC et al (2016) European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interventions Aging, 11:1403-1428

Baldasseroni S, Pratesi A, Francini S et al (2016) Cardiac rehabilitation in very old adults: effect of baseline functional capacity on treatment effectiveness. J Am Geriatr Soc; 64(8):1640-5. doi: 10.1111/jgs.14239
• cardiac rehabilitation in the oldest patients after surgery or a cardiac event brings improvement in all domains of physical performance

Bakken MS, Engeland A, Engesæter LB et al (2013) Increased risk of hip fracture among older people using antidepressant drugs: data from the Norwegian Prescription Database and the Norwegian Hip Fracture Registry. Age Ageing, 42, 4, 514-520. doi:10.1093/ageing/aft009

Ballard C, Orrell M, YongZhong S et al (2016) Impact of antipsychotic review and nonpharmacological intervention on antipsychotic use, neuropsychiatric symptoms, and mortality in people with dementia living in nursing homes. Am J Psychiatry; 173(3):252-62. doi: 10.1176/appi.ajp.2015.15010130
• exercise reduces agitation

Bastiaanse LP, Hilgenkamp TIM, Echteld MA et al (2012) Prevalence and associated factors of sarcopenia in older adults with intellectual disabilities. Res Developmental Disabilities, 33, 6, 2004–2012

Bauer U, Pitzer S, Schreier MM et al (2016) Pain treatment for nursing home residents differs according to cognitive state – a cross-sectional study. BMC Geriatrics; 16:124. doi: 10.1186/s12877-016-0295-1.
• pain in care homes has been identified in 66% of residents and 80% of residents with dementia

Bieryla KA, Dold NM (2013) Feasibility of Wii Fit training to improve clinical measures of balance in older adults. Clin Intervent Aging; 8:775-81

Bossers WJ, van der Woude LH, Boersma F et al (2016) Comparison of effect of two exercise programs on activities of daily living in individuals with dementia: a 9-week randomized, controlled trial. J Am Geriatr Soc; 64(6):1258-66. doi: 10.1111/jgs.14160

Braude P, Partridge JSL, Hardwick J et al (2016) Geriatricians in perioperative medicine: developing subspecialty training. Br J Anaesth; 116(1):4-6. doi: 10.1093/bja/aev403

Brogi D, Espinosa E, Lilli A et al (2016) Nutrition and malnutrition in the intensive coronary care unit. Fundamentals for the clinical cardiologist. G Ital Cardiol (Rome); 17(4):259-67. doi: 10.1714/2214.23898
• hospital malnutrition can reach 50% in patients aged more than 75 years old

Brown R, Howard R, Candy B et al (2015) Opioids for agitation in dementia. Cochrane Database Syst Rev; 14;5:CD009705. doi: 10.1002/14651858.CD009705.pub2

Buchman AS, Wilson RS, Yu L et al 2014) Total daily activity declines more rapidly with increasing age in older adults. Arch Geront Geriatr; 58(1):74-79

Budnitz DS, Lovegrove MC, Shehab N (2011) Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med, 365, 2002-12
• adverse side effects are a significant preventable cause of hospitalization in older adults

Buswell M, Lumbard P, Prothero L et al (2016) Unplanned, urgent and emergency care: what are the roles that EMS plays in providing for older people with dementia? An integrative review of policy, professional recommendations and evidence. Emerg Med J; 33:61-70. doi:10.1136/emermed-2014-203941

Casteran M, Putot A, Pfitzenmeyer F et al (2016) Analysis of the impact of a cognitive task on the posture of elderly subjects with depression compared with healthy elderly subjects. Clin Neurophysiol; 127(11):3406-3411. doi: 10.1016/j.clinph.2016.09.007
• depression increases the risk of falls

Chiang H-L, Chia Y-Y, Lin H-S et al (2016) The implications of tobacco smoking on acute postoperative pain: a prospective observational study. Pain Research & Management; 9432493. doi: 10.1155/2016/9432493.
• smokers require extra postop analgesia

Christakis NA, Allison PD (2006) Mortality after the hospitalization of a spouse. N Engl J Med; 354:719–30

Closs SJ (2004) Cognitive status and analgesic provision in nursing home residents. Br J Gen Pract, 54, 919-21
• inadeguate analgesia is given to cognitively-impaired patients

Cowan DT, Roberts JD (2003) The need for effective assessment and management of pain among older people in care homes. Rev Clin Gerontol, 13, 4, 335-41

Cudennec T, Brissonière OG, Coscas R et al (2013) Delirium in elderly vascular surgery patients. Ann Vasc Surg; 28(3):781-6. doi: 10.1016/j.avsg.2013.08.013

Dahlen I, Westin L, Adolfsson A (2012) Experience of being a low priority patient during waiting time at an emergency department. Psych Res Behav Manage, 5, 1-9

Denker MG, Cohen DL (2013) What is an appropriate blood pressure goal for the elderly: review of recent studies and practical recommendations. Clin Intervent Aging; 8:1505-1517

De Souza e Silva CG, Franklin BA, Forman DE et al (2016) Influence of age in estimating maximal oxygen uptake. J Geriatr Cardiol; 13(2):126-131. doi: 10.11909/j.issn.1671-5411.2016.02.010.

Dongen EJI, Steijns JM et al (2016) Translation of a tailored nutrition and resistance exercise intervention for elderly people to a real-life setting. BMC Geriatrics; 17:25. doi: 10.1186/s12877-017-0413-8

Ebihara S, Sekiya H, Miyagi M et al (2016) Dysphagia, dystussia, and aspiration pneumonia in elderly people. J Thorac Dis; 8(3):632-9. doi: 10.21037/jtd.2016.02.60 www.ncbi.nlm.nih.gov/pmc/articles/PMC4805832/

Ewan V, Sails A, Walls A et al (2013) Hospital acquired pneumonia, dental plaque and oral colonisation with respiratory pathogens: untangling complex relationships. Age Ageing, 42 (suppl 2): ii30. doi: 10.1093/ageing/aft026
• importance of oral hygiene in the elderly

Falzone E (2013) Postoperative analgesia in elderly patients. Drugs Aging; 30(2):81-90

Fassier T, Valour E, Colin C et al (2016) Who am i to decide whether this person is to die today? physicians' life-or-death decisions for elderly critically ill patients at the emergency department-icu interface: a qualitative study. Ann Emerg Med; 68(1):28-39.e3. doi: 10.1016/j.annemergmed.2015.09.030

Freudenberger P, Petrovic K, Sen A (2016) Fitness and cognition in the elderly: The Austrian Stroke Prevention Study. Neurology; 86(5):418-24. doi: 10.1212/WNL.0000000000002329

Galloway RV, Karmarkar AM, Graham JE et al (2016) Hospital readmission following discharge from inpatient rehabilitation for older adults with debility. Phys Ther; 96(2):241-251; doi: 10.2522/ptj.20150030

Gobo S et al (2014) Effects of exercise on dual-task ability and balance in older adults: A systematic review. Arch Geront Geriatr; 58(2):177-187

Gomez P, Filippou D, Pais B et al (2016) Breathing and affective picture processing across the adult lifespan. Biol Psychol; 119:101-11. doi: 10.1016/j.biopsycho.2016.07.011

Gschwind YJ, Schoene D, Lord SR et al (2015) The effect of sensor-based exercise at home on functional performance associated with fall risk in older people – a comparison of two exergame interventions. European Review of Aging and Physical Activity;12:11. doi: 10.1186/s11556-015-0156-5.
• exercise increases cognition, balance, strength and vision, and decreases falls, using ‘exergames’ at home

Guo Y, Sun L, Li L et al (2016) Impact of multicomponent, nonpharmacologic interventions on perioperative cortisol and melatonin levels and postoperative delirium in elderly oral cancer patients. Arch Gerontol Geriatr; 62:112-7. doi: 10.1016/j.archger.2015.10.009

Haas CS, Loik PS, Gay SE (2007) Airway clearance applications in the elderly and in patients with neurologic or neuromuscular compromise. Respir Care, 52, 10,1362–1381

Higashijima M (2013) Relationship between swallowing dysfunction and decreased respiratory function in dementia patients. J Phys Ther Science, 25(8):941-942

Holloway KL, Williams LJ, Brennan-Olsen SL et al (2016) Anxiety disorders and falls among older adults. J Affect Disord; 205:20-27. doi: 10.1016/j.jad.2016.06.052
• anxiety triples the likelihood of falls in elderly men

Hulzebos EH, van Meeteren NL (2016) Making the elderly fit for surgery. Br J Surg; 103(2):e12-5. doi: 10.1002/bjs.10033. Erratum in: Br J Surg; 103(4):463.

Hwang U, Carpenter C (2016) Assessing geriatric vulnerability for post emergency department adverse outcomes: challenges abound while progress is slow. Emerg Med J; 33:2-3. doi:10.1136/emermed-2015-204983

Hwang HF, Chen SJ, Lee-Hsieh J et al (2016) Effects of home-based Tai Chi and lower extremity training and self-practice on falls and functional outcomes in older fallers from the emergency department-a randomized controlled trial. J Am Geriatr Soc; 64(3):518-25. doi: 10.1111/jgs.13952

Iaboni A (2013) The complex interplay of depression and falls in older adults: a clinical review. Am J Geriatr Psychiatry, 21, 5, 484-92. doi: 10.1016/j.jagp.2013.01.008

Inglés M, Gambini J, Villaplana L (2013), Potential role of physiotherapists in polymedication of the elderly. Geriatr Gerontol Internat; 13:1086–7

Johnson MJ, Bland JM, Gahbauer EA (2016) Breathlessness in elderly adults during the last year of life sufficient to restrict activity: prevalence, pattern, and associated factors. J Am Geriatr Soc; 64(1):73-80. doi: 10.1111/jgs.13865

Josaleen D et al (2013) Mobilization of ventilated older adults. J Geriatr Phys Ther; 36(4):162-168. doi: 10.1519/JPT.0b013e31828836e7

Koeneman MA, Chorus A, Hopman-Rock M (2017) A novel method to promote physical activity among older adults in residential care: an exploratory field study on implicit social norms. BMC Geriatrics; 17:8

Koppitz, A., Bosshard, G., Blanc, G., et al. 2017. Pain Intervention for people with dementia in nursing homes (PID): study protocol for a quasi-experimental nurse intervention. BMC Palliative Care. 16:27

Kvasnovsky CL, Adams K, Sideris M et al (2016) Elderly patients have more infectious complications following laparoscopic colorectal cancer surgery. Colorectal Dis; 18(1):94-100. doi: 10.1111/codi.13109

Killin LOJ, Starr JM, Shiue IJ et al (2016) Environmental risk factors for dementia: a systematic review. BMC Geriatrics; 16:175. doi: 10.1186/s12877-016-0342-y
• approximately a third of Alzheimer’s dementia cases could be attributed to potentially modifiable risk factors: diabetes and obesity, smoking, hypertension, depression, cognitive inactivity, and low educational attainment

Kirk-Sanchez NJ, McGough EL (2014) Physical exercise and cognitive performance in the elderly: current perspectives. Clin Intervent Aging; 9:51-6

Lalley PM (2013) The aging respiratory system — pulmonary structure, function and neural control. Resp Physiol Neurobiol; 187(3):199-210

Liao L-Y, Chen K-M, Chung W-S et al (2016) Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Internat J Chronic Obstructive Pulmonary Dis; 10:1703-1709. doi:10.2147/COPD.S90673

Lowery EM, Brubaker AL, Kuhlmann E et al (2013) The aging lung. Clin Intervent Aging; 8:1489-1496

Manning J, Cefalu JE (2017) Infection in the critically ill older adult. Crit Care Nurs Clin; 29(1):25–35

Marshall KA, Burson R, Gall K et al (2016) Hospital admissions for malnutrition and dehydration in patients with dementia. Home Healthc Now; 34(1):32-7. doi: 10.1097/NHH.0000000000000327

Mędrzycka-Dąbrowska WA, Dąbrowski S, Basiński A et al (2016) Perception of barriers to postoperative pain management in elderly patients in Polish hospitals with and without a “Hospital Without Pain” Certificate – a multi-center study. Arch Med Sci;12(4):808-818. doi:10.5114/aoms.2015.54768.
• the heaviest burden of inadequate pain management is borne by the weakest, including elders and people with dementia
• elderly patients are more likely to fear addiction with analgesia
• elderly patients are often reluctant to ‘bother the busy nurses’
• obstacles to adequate treatment in Western countries include racial and age discrimination

Muniz de Souza H, Rocha T, Campos SL et al (2016) Acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women. Respir Physiol Neurobiol; 227:27-33. doi: 10.1016/j.resp.2016.02.004

Nick N, Petramfar P, Ghodsbin F et al (2016) The effect of yoga on balance and fear of falling in older adults. PM R. 2016 Feb;8(2):145-51. doi: 10.1016/j.pmrj.2015.06.442

Oliveira J, Mesquita-Bastos J, Argel de Melo C et al (2016) Postaerobic exercise blood pressure reduction in very old persons with hypertension. J Geriatr Phys Ther; 39(1):8-13. doi: 10.1519/JPT.0000000000000049
• a single session of aerobic exercise acutely reduces BP in very old adults - hypertension may be an important nonpharmacological strategy to control hypertension in this age group

Otremba I, Wilczyński K, Szewieczek J (2016) Delirium in the geriatric unit: proton-pump inhibitors and other risk factors. Clinical Interventions in Aging; 11:397-405. doi: 10.2147/CIA.S103349.

Peake MD (2003) Ageism in the management of lung cancer. Age and Ageing, 32, 171-7
• undertreatment of lung cancer in the elderly is common, resulting in large age-related differences in management and survival

Pieper MJ, Francke AL, van der Steen JT et al (2016) Effects of a stepwise multidisciplinary intervention for challenging behavior in advanced dementia: a cluster randomized controlled trial. J Am Geriatr Soc; 64(2):261-9. doi: 10.1111/jgs.13868

Pop-Vicas A (2013) Over-distension of the airways by mechanical ventilation in the elderly: adding insult to injury. Crit Care, 17:165. doi:10.1186/cc12754

Porter SKN, McDonald SR, Weidner JA et al (2016) Challenges in the management of geriatric obesity in high risk populations. Nutrients; 8(5):262. doi: 10.3390/nu8050262

Prostran M, Vujović KS, Vučković S et al (2013) Pharmacotherapy of pain in the older population: the place of opioids. Front Aging Neuroscience; 8:144. doi: 10.3389/fnagi.2016.00144.

Qin J, Li G, Zhou J (2016) Characteristics of elderly patients with COPD and newly diagnosed lung cancer, and factors associated with treatment decision. Internat J COPD; 11:1515-1520. doi:10.2147/COPD.S104670.

Riou B, Boddaert J (2016) The elderly patient and the ICU: where are we going, where should we go? Crit Care Med; 44(1):231–232. doi: 10.1097/CCM.0000000000001446

Rizk P, Morris W, Oladeji P et al (2016) Review of postoperative delirium in geriatric patients undergoing hip surgery. Geriatr Orthop Surg Rehabil; 7(2):100-5. doi: 10.1177/2151458516641162

Sallam N, Laher I (2016) Exercise modulates oxidative stress and inflammation in aging and cardiovascular diseases. Oxid Med Cell Longev; 7239639. doi: 10.1155/2016/7239639
• aging and cardiovascular diseases are both associated with a chronic state of oxidative stress and inflammation

Scuteri A, Daniele N (2016) Are hemodynamic factors involved in cognitive impairment? Hypertension; 67: 34-35. doi: 10.1161/HYPERTENSIONAHA.115.06495
• people aged >80 years are the fastest growing segment of the population

Sieber FE, Barnett SR (2011) Preventing postoperative complications in the elderly. Anesthesiol Clin, 29, 1, 83–97. doi: 10.1016/j.anclin.2010.11.011

Slooter AJ, Van De Leur RR, Zaal IJ et al 2017. Delirium in critically ill patients. Handb Clin Neurol; 141:449-466. doi: 10.1016/B978-0-444-63599-0.00025-9.

Smolarek A de C, Ferreira LHB, Mascarenhas LPG et al (2016) The effects of strength training on cognitive performance in elderly women. Clin Interventions Aging; 11:749-754. doi: 10.2147/CIA.S102126.

Suffoletto B, Miller T, Shah R et al (2016) Predicting older adults who return to the hospital or die within 30 days of emergency department care using the ISAR tool: subjective versus objective risk factors. Emerg Med J; 33:4-9. doi:10.1136/emermed-2014-203936

Taffet GE et al (2013) Considerations for managing chronic obstructive pulmonary disease in the elderly. Clin Intervent Aging; 9:23-30. doi.org/10.2147/CIA.S52999

Thiebaud RS, Fahs CA, Rossow LM et al (2016) Effects of age on arterial stiffness and central blood pressure after an acute bout of resistance exercise. Eur J Appl Physiol; 116(1):39-48. doi: 10.1007/s00421-015-3242-5

Tyler K, Stevenson D (2016) Respiratory emergencies in geriatric patients. Emerg Med Clin North Am; 34(1):39-49. doi: 10.1016/j.emc.2015.08.003

Verhofstede R, Smets T, Cohen J et al (2016) Implementing the care programme for the last days of life in an acute geriatric hospital ward: a phase 2 mixed method study. BMC Palliative Care; 15:27. doi: 10.1186/s12904-016-0102-y.
• at the end of life, patients tend to receive undesired and burdensome interventions and at the same time are under-assessed and undertreated for symptoms such as pain

Watanabe JH (2016) Medication use, falls, and fall-related worry in older adults in the United States. Consult Pharm; 31(7):385-93. doi: 10.4140/TCP.n.2016.385

Wei GX, Li YF, Yue XL et al (2016) Tai Chi Chuan modulates heart rate variability during abdominal breathing in elderly adults. Psych J; 5(1):69-77. doi: 10.1002/pchj.105
• Tai Chi induces relaxation by stablising the sympathetic/parasympathetic balance

Wirth A, Wang S, Takefuji M et al (2016) Age-dependent blood pressure elevation is due to increased vascular smooth muscle tone mediated by G-protein signalling. Cardiovasc Res; 109(1):131-40. doi: 10.1093/cvr/cvv249
• increased vascular tone can be a primary factor in the development of hypertension

Wolters AE, Peelen LM, Veldhuijzen DS et al 2017 Long-term self-reported cognitive problems after delirium in the intensive care unit and the effect of systemic inflammation. J Am Geriatr Soc; 65(4):786-791. doi: 10.1111/jgs.14660

Wozniak SE, Coleman J, Katlic MR (2016) Preoperative evaluation of the older patient. J Perioper Crit Intensive Care Nurs; 1:103. doi:10.4172/jpcic.1000103
• a more in depth assessment should address domains such as functionality, social support, cognition, polypharmacy, nutrition and frailty; this encourages decisions based on functional age rather than chronologic age

Zasadzka E, Kropińska S, Pawlaczyk M et al (2016) Effects of inpatient physical therapy on the functional status of elderly individuals. J Phys Ther Sci; 28(2):426-31. doi: 10.1589/jpts.28.426

Zhu QO, Tan CSG, Tan HL et al (2016) Orthostatic hypotension: prevalence and associated risk factors among the ambulatory elderly in an Asian population. Singapore Med J; 57(8):444-451. doi: 10.11622/smedj.2016135.
• the risk of falls is worsened by diuretics