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Journal Highlights From the April Issue of JAMDA

        Graphical abstract

        Chest Ultrasound

        Point-of-care chest ultrasound may represent a valid bedside diagnostic aid when caring for older individuals with an acute respiratory disease, according to a study conducted in Italy.
        Led by Andrea Ticinesi, MD, PhD, of the University of Parma, researchers conducted a literature search using the terms “chest ultrasound,” “lung ultrasound,” “geriatric,” and “older individuals.” Of the 16 manuscripts they found with a focus on geriatric patients, only five reported original data.
        Reporting on studies that enrolled patients with a mean age of 70 or older, the researchers found several advantages to chest ultrasound, including versatility and portability. Specifically, the technician can perform the test at the bedside, avoiding the transfer of the patient, and with the patient lying supine or seated. Also, modern ultrasound equipment is portable, and smaller, handheld pocket devices are achieving good levels of diagnostic accuracy in individuals with interstitial lung disease. (The researchers did note, however, that the image quality of handheld pocket devices is considered inferior to that of standard ultrasound devices.)
        An additional advantage of chest ultrasound is its ability to diagnose pre-test clinical suspicions. Artifacts appear on the ultrasound images of individuals who have common respiratory conditions such as pneumonia, pleural effusion, pulmonary edema, and interstitial lung disease. In addition, the researchers said, chest ultrasound can help diagnose causes of acute dyspnea and provide reliable diagnostic signs for less common conditions, including pneumothorax, lung abscess, lung cancer, and pleural mesothelioma.
        Chest ultrasound may be especially useful in geriatric patients for several reasons. First, the aging respiratory system is characterized by some peculiarities that make X-rays and, to a lesser extent, CT more difficult to perform and less accurate to interpret even when a respiratory disease is absent,” the researchers said. ”The age-related modifications of lower airways, increases in interstitial connective tissue, and reduction of parenchymal vascularization may, in fact, contribute to so-called ‘dirty chest.’ Ultrasound is influenced by all these phenomena as well, but its diagnostic performance is maintained thanks to its defined semiotics and the clinical interpretation of signs.”
        Ultrasound may also prove useful in patients who have mobility-limitations or who are unable to follow instructions due to cognitive impairment, both of which can reduce the diagnostic accuracy of chest X-ray or CT scans. “Ultrasound is only marginally influenced by these factors, exhibiting good performance also in the sickest and in those with severe disability,” the researchers said.
        Finally, ultrasound tends to be cheaper and safer than traditional imaging examinations. “Its routine use optimizes follow-up of critical patients, reducing the number of X-rays and, possibly, CTs, with lower costs and radiation exposure,” the researchers said. “This advantage is particularly useful in geriatric patients, who have often a high level of clinical complexity requiring several diagnostic resources.”
        Source: Ticinesi A, et al. The Geriatric Patient: The Ideal One for Chest Ultrasonography? A Review From the Chest Ultrasound in the Elderly Study Group (GRETA) of the Italian Society of Gerontology and Geriatrics (SIGG) [published online ahead of print August 6, 2019]. J Am Med Dir Assoc. doi: https://doi.org/10.1016/j.jamda.2019.06.018/.Also in JAMDA: Long-term care facilities and the coronavirus epidemic: Practical guidelines for a population at highest risk, by David Dosa, MD, MPH, and colleagues (http://bit.ly/2x2nD54)

        Fall Prevention

        By placing older individuals in beds next to a window (window beds), hospitals may reduce the incidence of falls, according to the results of a retrospective cohort study in Japan.
        Led by Junko Iwamoto, RN, PhD, of Tenri Health Care University, Nara, Japan, researchers compared the incidence of in-hospital falls among 2,767 patients at a community hospital. They found a significantly lower incidence of in-hospital falls among patients in window beds than in patients in beds away from a window (non-window beds). Among 1,273 patients in window beds, 21 experienced falls during an observation period of 14,038 person-days for an incidence rate of 1.50 per 1,000 person-days. Among the 1,494 individuals in non-window beds, 36 experienced falls during an observation period of 11,412 person-days for an incidence rate of 3.15 per 1,000 person-days.
        The results may be due to adverse effects of circadian misalignment. “In-hospital fall incidence shows clear circadian and seasonal patterns as per the highest incidence in early morning and winter,” the researchers said. “Additionally, risk factors for falls include sleep disturbances, cognitive impairment, and depressed mood; the pathophysiology of these medical conditions is significantly involved in circadian misalignment between internal and environmental rhythms.”
        According to the researchers, a large-scale, prospective, multi-center study is required.
        Source: Iwamoto J, et al. Lower Incidence of In-Hospital Falls in Patients Hospitalized in Window Beds Than Nonwindow Beds [published online ahead of print August 22, 2019]. Am Med Dir Assoc. doi: https://doi.org/10.1016/j.jamda.2019.07.006.

        Exercise Programs

        A simple inpatient exercise program can significantly decrease the risk of hospitalization-associated disability, defined as the loss of ability to perform one or more basic activities of daily living (ADL), in acutely hospitalized geriatric patients, according to a randomized controlled trial conducted in Madrid, Spain.
        Led by Javier Ortiz Alonso, MD, PhD, of Hospital General Universitario, researchers assigned 268 patients (mean age of 88) to the intervention or control group. Individuals in the intervention group performed simple exercises, namely rising from a seated to an upright position and supervised walking exercises along the corridor, for about 20 minutes daily.
        Using the Katz index to measure ADL function, the researchers found the risk of hospitalization-associated disability decreased by about 70% among the individuals who did the exercises, and that exercise improved their functional ability.
        Still, the researchers said, “this type of intervention requires close supervision and thus an additional time involvement of the hospital staff with respect to their daily duties or reliance on external staff […](i.e., fitness specialists).”
        Source: Ortiz-Alonso J, et al. Effect of a Simple Exercise Program on Hospitalization-Associated Disability in Older Patients: A Randomized Controlled Trial [published online ahead of print January 20, 2020 ]. J Am Med Dir Assoc. doi: https://doi.org/10.1016/j.jamda.2019.11.027