Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

River ecosystem response to prescribed vegetation burning on blanket peatland

Catchment-scale land-use change is recognised as a major threat to aquatic biodiversity and ecosystem functioning globally. In the UK uplands rotational vegetation burning is practised widely to boost production of recreational game birds, and while some recent studies have suggested burning can alter river water quality there has been minimal attention paid to effects on aquatic biota. We studied ten rivers across the north of England between March 2010 and October 2011, five of which drained burned catchments and five from unburned catchments. There were significant effects of burning, season and their interaction on river macroinvertebrate communities, with rivers draining burned catchments having significantly lower taxonomic richness and Simpson's diversity. ANOSIM revealed a significant effect of burning on macroinvertebrate community composition, with typically reduced Ephemeroptera abundance and diversity and greater abundance of Chironomidae and Nemouridae. Grazer and collector-gatherer feeding groups were also significantly less abundant in rivers draining burned catchments. These biotic changes were associated with lower pH and higher Si, Mn, Fe and Al in burned systems. Vegetation burning on peatland therefore has effects beyond the terrestrial part of the system where the management intervention is being practiced. Similar responses of river macroinvertebrate communities have been observed in peatlands disturbed by forestry activity across northern Europe. Finally we found river ecosystem changes similar to those observed in studies of wild and prescribed forest fires across North America and South Africa, illustrating some potentially generic effects of fire on aquatic ecosystems