Characteristics of elderly fall patients with baseline mental status: high-risk features for intracranial injury.

BACKGROUND: Falls are a major cause of morbidity in the elderly. OBJECTIVES: We describe the low-acuity elderly fall population and study which historical and clinical features predict traumatic intracranial injuries (ICIs). METHODS: This is a prospective observational study of patients at least 65 years old presenting with fall to a tertiary care facility. Patients were eligible if they were at baseline mental status and were not triaged to the trauma bay. At presentation, a data form was completed by treating physicians regarding mechanism and position of fall, history of head strike, headache, loss of consciousness (LOC), and signs of head trauma. Radiographic imaging was obtained at the discretion of treating physicians. Medical records were subsequently reviewed to determine imaging results. All patients were called in follow-up at 30 days to determine outcome in those not imaged. The study was institutional review board approved. RESULTS: A total of 799 patients were enrolled; 79.5% of patients underwent imaging. Twenty-seven had ICIs (3.4%). Fourteen had subdural hematoma, 7 had subarachnoid hemorrhage, 3 had cerebral contusion, and 3 had a combination of injuries. Logistic regression demonstrated 2 study variables that were associated with ICIs: LOC (odds ratio, 2.8; confidence interval, 1.2-6.3) and signs of head trauma (odds ratio, 13.2; confidence interval, 2.7-64.1). History of head strike, mechanism and position, headache, and anticoagulant and antiplatelet use were not associated with ICIs. CONCLUSION: Elderly fall patients who are at their baseline mental status have a low incidence of ICIs. The best predictors of ICIs are physical findings of trauma to the head and history of LOC.

A Case of Sacral Osteomyelitis Causing Ascending Spinal Canal Infection.

Sacral osteomyelitis is an infection of the bone that extends posterior to the pelvis at the base of the spine. This condition typically occurs in elderly or bedbound/immobile patients and is treated with wound debridement, wound care, surgery, and antibiotic therapy. In this report, a case is presented of a rare complication of sacral osteomyelitis where the infection extended through the bone into the spinal canal causing an ascending spinal canal infection. This report is meant to provide an individual example of this rare complication which can hopefully be used to improve surveillance, treatment, and outcomes of this rare condition.

A review of the risks and relationships between oral health and chronic diseases.

Advances in medical science and in preventive dentistry have changed the context of oral health. The American population is living longer with numerous complex chronic diseases. This paper is to raise awareness about the impact of multiple chronic diseases and their associations with oral diseases. Comorbidities can worsen the course of dental treatment. Inflammation has been the connecting factor in the bidirectional pattern of oral and systemic diseases. High occurrences of chronic diseases generally occur in aging as well as disadvantaged populations. Serious infections, slow healing, prolonged bleeding, and hospitalizations can escalate in patients with uncontrolled chronic diseases. A multidisciplinary team-based approach to patient management can minimize complications and unexpected challenges.

Depression and the Likelihood of Hospital Admission from the Emergency Department among Older Patients with HIV.

OBJECTIVE: The objective was to determine if depression was associated with an increased likelihood of hospital admission following an emergency department (ED) visit among older patients diagnosed with HIV. METHODS: We performed secondary analysis of data from the Nationwide Emergency Department Sample (NEDS) in the United States using multivariable Poisson regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). We included adults aged 50 years and older, diagnosed with HIV using International Classification of Diseases, 9th revision (ICD-9-CM) codes. We controlled for demographic characteristics, hospital characteristics, and comorbid conditions in the analysis. RESULTS: In the final multivariable model, there was a 45% increase in the likelihood of hospital admission following an ED visit among older patients with HIV diagnosed with depression compared with those not diagnosed with depression (PR = 1.45, 95% CI = 1.39-1.52). CONCLUSIONS: Depression was associated with hospital admission among adults aged 50 and over.

Association between elevated depressive symptoms and clinical disease severity in African-American adults with sickle cell disease.

OBJECTIVE: The purpose of this cross-sectional study was to examine the association between elevated depressive symptoms and the clinical severity of sickle cell disease (SCD) using African-American adults with and without SCD. STUDY DESIGN: The population consisted of 102 African-American adults with SCD, diagnosed using hemoglobin electrophoresis, individually matched on age (+/-5 years), gender and recruitment location to 103 African-American adults without SCD (mean age of all subjects was 35.4 years, 55.6% female). Logistic regression was used to examine the association between SCD clinical severity and elevated depressive symptoms in bivariate and multivariable analyses. RESULTS: The prevalence of elevated depressive symptoms as measured using the 10-item Center for Epidemiological Studies Depression Scale (CES-D) was 38.6% in those with SCD, compared to 27.5% in those without SCD; however, this difference was not statistically significant (p>0.05). Compared to African Americans without SCD, African Americans with SCD were less educated, had lower incomes, and were more likely to be unemployed or disabled (p<0.01). The odds of having elevated depressive symptoms were 1.78 (CI: 0.94, 3.38) for those with high clinical SCD severity compared to those without SCD in bivariate analysis and 1.37 (CI: 0.62, 3.02) in multivariable analysis after adjusting for socioeconomic factors. CONCLUSIONS: The reported relationship between elevated depressive symptoms and SCD may be a result of the adverse economic conditions associated with SCD.

Self-perceived loss of control and untreated dental decay in African American adults with and without sickle cell disease.

The aim of this cross-sectional study was to investigate the association between self-perceived loss of control as measured by dental external locus of control summary scores, with the amount of untreated dental decay in African American adults with sickle cell disease (SCD) and African Americans adults without SCD. The sample included 102 subjects with SCD and 103 subjects without SCD matched on age, sex, and recruitment location (mean age of all subjects 35.4 years, 55.6% female). Subjects with SCD in the highest quartile for dental external locus of control summary scores had 2.58-fold (CI 1.05, 6.34) as much untreated decay as those in the lowest quartile (p<.05) in multivariable analysis using the negative binomial regression model. For subjects without SCD, those in the highest quartile for dental external locus of control summary scores had 3.00-fold (CI 1.38, 6.49) as much untreated decay as those in the lowest quartile (p<.05) using similar analysis. This study showed that higher dental external locus of control is associated with increased untreated tooth decay, both for African Americans with and without SCD and that the magnitude of the association did not differ across groups.

The association between sickle cell disease and dental caries in African Americans.

This study sought to determine whether there was an association between sickle cell disease (SCD) and dental caries in African-American adults. A sample of 102 African-American adult patients with SCD from Washington, D.C., and Baltimore, Maryland, were matched to 103 African-American adult subjects, who did not have SCD. The match was by age, gender and recruitment location. Each subject underwent a standardized oral examination as well as an interview to ascertain risk factors for dental caries. For individuals with incomes of less than dollars 15,000, subjects with SCD had more decayed (10.36 versus 1.58) and fewer filled (2.86 versus 8.45) surfaces compared to subjects without SCD with both differences being statistically significant (p<0.05) after adjusting for age and gender. The results suggest that low-income African Americans with SCD may be at increased risk for dental caries and are less likely to receive treatment with a restoration.