Geriatrics

Geriatric inpatient rehab benefits extend to patients with cognitive impairment

This secondary analysis of eight RCTs (1134 patients) tested whether baseline cognitive impairment modifies benefits of inpatient geriatric rehabilitation. Among cognitively impaired participants, rehabilitation was associated with similar reductions in mortality and long-term care home admission as in unimpaired patients. Pooled interaction analyses showed no significant modification of mortality or institutionalization benefits by cognitive status. These data suggest cognitive impairment alone should not justify withholding or downgrading inpatient geriatric rehabilitation. 1

Delirium greatly increases 90-day mortality, especially without baseline dementia

This prospective multicentre cohort followed 2556 inpatients aged ≥65 years across 43 hospitals in five countries. Delirium occurred in 37% overall and became more frequent with worsening baseline cognition, reaching 77% in severe dementia. Delirium tripled adjusted 90-day mortality (HR 3.45), with the strongest relative effect in patients without dementia. In cognitively intact patients, 90-day mortality was 54% with delirium versus 15% without; in severe dementia, 36% versus 17%. 2

Antihypertensive therapy modestly improves cognition and may reduce dementia risk

This systematic review and meta-analysis pooled four large RCTs of 16,685 hypertensive older adults without baseline dementia. Antihypertensive treatment produced a small but statistically significant improvement in cognitive test scores (SMD 0.06). There was a nonsignificant trend toward lower dementia incidence (OR 0.89) with low-certainty evidence. Exploratory network meta-analysis ranked calcium channel blockers and diuretic±ACEI combinations favorably, but each ranking relied on a single trial node. 3