Introduction: there is evidence to suggest that delirium incidence can be reduced in older people admitted to medical services using multi-component interventions that target delirium risk factors. The cost-effectiveness of this approach is uncertain. We therefore developed a novel cost-effectiveness model for delirium prevention.

Method: we compared multi-component delirium prevention intervention with usual care using a model based on a decision tree analysis. The model was used to estimate the incremental net monetary benefit (INMB). The robustness of the cost-effectiveness result was explored using deterministic and probabilistic sensitivity analyses.

Result: the multi-component prevention intervention was cost-effective when compared with usual care. It was associated with an INMB of £2,200 using a cost-effectiveness threshold of £20,000 per quality-adjusted life year (QALY). It remained cost-effective in the majority of the deterministic sensitivity analyses and was cost-effective in 96.8% of the simulations carried out in the probabilistic sensitivity analysis.

Discussion: our analysis has shown convincingly that multi-component prevention interventions for delirium should be considered as a cost-effective health-care strategy for medically ill people admitted to hospital. It is an attractive intervention for health-care planners as they strive to reconfigure their services to better meet the needs of an ageing population.

Background: thrombolysis for stroke has been licensed in the UK since 2007 and needs to be administered within 4.5 h. Given this time critical factor, the media may have an important role in public awareness.

Methods: this review aimed to find out how stroke thrombolysis was reported in UK national and London local newspapers and how treatment risks and benefits were communicated. Newspapers published between 1 January 2007 and 31 March 2010 were searched for articles on thrombolysis. Fifty-six articles were included and dispositive analysis, a qualitative analysis method, was used to identify themes.

Results: four main themes were identified: inaccurate description of thrombolysis, stroke clinicians’ involvement, presentation of risks and benefits and patient stories. Inaccuracies included the presentation of thrombolysis as a treatment for transient ischaemic attack. Clinicians were quoted to suggest that thrombolysis produced complete recovery but were not reported to discuss risks or broader stroke management. The articles reported little or no risks of treatment. Patients' stories were used to reinforce that thrombolysis produces full recovery.

Conclusions: this review found that newspaper media provides the public with inaccurate perspectives on thrombolysis. Clinicians may wish to check press articles prior to publishing and to consider the impact of reporting thrombolysis as a treatment which produces complete recovery.

Background: cognitive impairment is an established fall risk factor; however, it is unclear whether a disease-specific diagnosis (i.e. dementia), measures of global cognition or impairments in specific cognitive domains (i.e. executive function) have the greatest association with fall risk. Our objective was to evaluate the epidemiological evidence linking cognitive impairment and fall risk.

Methods: studies were identified through systematic searches of the electronic databases of MEDLINE, EMBASE, PyschINFO (1988–2009). Bibliographies of retrieved articles were also searched. A fixed-effects meta-analysis was performed using an inverse-variance method.

Results: twenty-seven studies met the inclusion criteria. Impairment on global measures of cognition was associated with any fall, serious injuries (summary estimate of OR = 2.13 (1.56, 2.90)) and distal radius fractures in community-dwelling older adults. Executive function impairment, even subtle deficits in healthy community-dwelling older adults, was associated with an increased risk for any fall (summary estimate of OR = 1.44 (1.20, 1.73)) and falls with serious injury. A diagnosis of dementia, without specification of dementia subtype or disease severity, was associated with risk for any fall but not serious fall injury in institution-dwelling older adults.

Conclusion: the method used to define cognitive impairment and the type of fall outcome are both important when quantifying risk. There is strong evidence global measures of cognition are associated with serious fall-related injury, though there is no consensus on threshold values. Executive function was also associated with increased risk, which supports its inclusion in fall risk assessment especially when global measures are within normal limits.

Background: referral for echocardiography for all geriatric outpatients suspected of heart failure (HF) is not feasible. Diagnostic algorithms could be helpful.

Objective: to investigate whether available diagnostic algorithms accurately identify (older) patients (aged 70 years or over) eligible for echocardiography, with acceptable numbers of false-negatives.

Methods: algorithms (European Society of Cardiology (ESC)) guideline, National Institute for Health and Clinical Excellence (NICE) guideline, multidisciplinary guideline the Netherlands (NL) and algorithm by Mant et al. were validated in 203 geriatric patients (mean age 82 ± 6 years, 30% men) suspected of new, slow onset HF. HF was adjudicated by an outcome panel. Applicability of algorithms was evaluated by calculating proportion of patients (i) referred for echocardiography, (ii) with HF among referred patients and (iii) without HF in the non-referred.

Results: ninety-two (45%) patients had HF. Applying algorithms resulted in referral for echocardiography in 52% (normal NT-proBNP; ESC), 72% (normal ECG; ESC), 56% (NICE), 93% (NL) and 70% (Mant) of all patients, diagnosing HF in 78, 56, 76, 49 and 62% of those referred, respectively. In patients not referred for echocardiography HF was absent in 90, 82, 93, 100 and 95%, respectively.

Conclusion: the ESC NT-proBNP (<400 pg/ml)-based algorithm combines the lowest number of referrals for echocardiography (of whom 78% has HF) with a limited number (10%) of false negatives in the non-referred.

Background: negative mood is an important construct when assessing the health of older persons. The profile of mood states questionnaire is commonly used to measure mood; however, it might not be suitable for older adults with low education level and those who are not originated North American.

Objective: to examine a negative mood scale formed by nine items in the Mood Section of the Minimum Data Set-Home Care of the Resident Assessment Instrument.

Methods: a secondary analysis of data from 3,523 older persons aged 60 or over who had first applied for the long-term care services in Hong Kong and completed the screening tool in 2006. Exploratory and confirmatory factor analyses were used to test the factor structure and multiple-group confirmatory factor analysis to test the gender invariance of the Negative Mood Scale in the Minimum Data Set-Home Care. Its reliability using Cronbach's alpha was examined.

Results: both a three-factor model at the first level and a one-factor model at the second level provided excellent fits to the overall data, and held equally well for both males and females, and two randomly split samples. Multiple-group confirmatory factor analyses revealed both genders demonstrating an equivalent pattern of factor loadings. Cronbach's alpha value was acceptable for the overall data (0.66).

Conclusions: the Negative Mood Scale is a reliable and valid scale and both genders responded to it using the same framework and metric, suggesting it could be used to measure negative mood in Chinese community-dwelling older adults. Further testing of the instrument is needed.

Background: hip fracture represents a huge medical, social and financial burden on patients, their carers and the health and social care systems. For survivors, return to their own home may be a key outcome. The Nottingham Hip Fracture Score (NHFS) is a validated score, based on admission characteristics, for predicting 30-day and 1-year mortality that may be of benefit in predicting return-to-home, directly from the acute orthopaedic ward.

Objective: to assess the utility of the NHFS as a predictor of return-to-home in patients following hip fracture.

Methods: the NHFS was calculated for all patients admitted from their own home and the correlation between the NHFS and eventual return-to-home was calculated, as well as the probability of discharge by within 7, 14 and 21 days.

Results: a total of 6,123 patients were available for analysis. Of which, 3,699 (60%) were discharged from acute hospital to their own home. Increasing NHFS was negatively correlated with eventual return-to-home (r² = 0.949) and with the proportion of patients discharged back to their own home at 7, 14 and 21 postoperative days, respectively (r² = 0.84, 0.94, 0.96, respectively).

Conclusions: the NHFS is a reliable tool for predicting return-to-home. It may be useful for discharge planning, and for the design of future research trials.

Background: muscle strength is essential for physical functions and an indicator of morbidity and mortality in older adults. Among the factors associated with muscle strength loss with age, ethnicity has been shown to play an important role.

Objective: to examine the patterns and correlates of muscle strength change with age in a population-based cohort of middle-aged and older Afro-Caribbean men.

Methods: handgrip strength and body composition were measured in 1,710 Afro-Caribbean men. Data were also collected for demographic variables, medical history and lifestyle behaviours.

Results: the age range of the study population was 29–89 years. Grip strength increased below age 50 years, and decreased after age 50 years over 4.5-year follow-up. The average loss in grip strength was 2.2% (0.49% per year) for ages 50 years or older and 3.8% (0.64% per year) for ages 65 years or older. The significant independent predictors of grip strength loss included older age, a greater body mass index, lower initial arm lean mass and greater loss of arm lean mass.

Conclusion: Afro-Caribbean men experience a significant decline in muscle strength with advanced age. The major independent factors associated with strength loss were similar to other ethnic groups, including age, body weight and lean mass.

Background: stroke is a leading cause of death and disability globally. The economic costs of stroke are high but not often fully quantified. This paper estimates the economic burden of stroke and transient ischaemic attack (TIA) in Ireland in 2007.

Methods: a prevalence-based approach using a societal perspective is adopted. Both direct and indirect costs are estimated.

Results: total stroke costs are estimated to have been 489–805 million in 2007, comprising 345–557 million in direct costs and 143–248 million in indirect costs. Nursing home care and indirect costs together account for the largest proportion of total stroke costs (74–82%). The total cost of TIA was approximately 11.1 million in 2007, with acute hospital care accounting for 90% of the total.

Conclusions: the chronic phase of the disease accounts for the largest proportion of the total annual economic burden of stroke. This highlights the need to maximise functional outcomes to lessen the longer term economic and personal impacts of stroke.