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

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

PHOTOFRAGMENTATION SPECTROSCOPY OF CARBON AND NIOBIUM CLUSTERS IN A REFLECTRON TIME-OF-FLIGHT MASS SPECTROMETER

Author Institution: Department of Chemistry and Center for Analysis of Structure and Interfaces (CASI); Department of Chemistry, North Dakota State UniversityClusters are aggregates of atoms ranging in size between a few and several thousand atoms. As such, they constitute the transition between individual atoms and molecules; bulk solids and liquids. The reflectron time-of-flight (TOF) mass spectrometer provides a means of investigating the size dependence of the optical properties of these species. Cluster cations of metals and carbon are produced in a laser vaporization source, and separated according to their mass in a initial linear time-of-flight stage. The cluster of interest is then fragmented with a YAG pumped dye laser, after wha reflectron TOF stagemeasures the mass and intensity othe resulting specie(s). Photofragment distributions, and power studies of carbon and niobium clusters, and the multiphoton dissociation spectrum of cooled niobium dimer cations are presented

Response of soil carbon and plant diversity to grazing and precipitation in High Nature Value farmlands

Mediterranean oak-dominated agro-silvo-pastoral systems of southwestern Europe (called montado in Portugal and dehesa in Spain) are semi-natural, savannah-style High Nature Value farmlands (HNVfs) shaped by centuries of anthropogenic (e.g., cultivation, grazing) and natural (e.g., drought) disturbances. Therefore, changes in grazing and precipitation may alter their vegetation composition and ecosystem properties and impact upon their long-term viability. We quantified the responses of soil organic carbon (SOC) and plant taxonomic and functional trait diversities to cattle grazing and inter-annual changes in precipitation across three open-woodland sites within the montado landscape in Alentejo, southern Portugal. The sites are characterised by the presence or absence of cattle grazing and different amounts of mean annual precipitation (ranging from semiarid to dry subhumid). Three different precipitation periods were used: a shorter autumn-to-spring period and longer 12- and 18-month periods before sampling. Specific leaf area, plant height and seed mass were used to estimate single-trait community weighted means and a multi-trait measure of community functional diversity (Rao’s Q). SOC and plant species richness responded negatively to the presence of cattle grazing but positively to increase in precipitation (and its interaction with cattle grazing), while trait-based measures were largely unresponsive to cattle grazing and precipitation (though RLQ analysis revealed strong controls of the environmental variables on plant life cycle, growth form, leaf phenology and dispersal strategies). SOC was most responsive to longer-term (18-month) changes in precipitation, whereas plant species richness was most responsive to shorter-term (autumn-to-spring) changes in precipitation. These results suggest that different components of plant diversity respond differently to external drivers in montado HNVfs, while the response time of soil properties may be longer than that of plant taxonomic diversity