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

Some current trends in applied linguistics: towards a generic view.

This paper argues that the most significant trend in applied linguistics is the emergence of the field as a generic discipline, involving several subareas, all characterised by the aim of developing theoretical and empirical studies of language as a key element in real world problems. Various subsidiary trends are apparent including numerous methodological and theoretical developments. The paper argues that so far these trends respond only inconsistently to two major challenges in the relationship between the academy and the lay community: (1) identifying and studying issues held to be problems by those outside the academy; and (2) clarifying the nature of the contributions of research to those real world problems. Three themes are considered: the relationship between surface data and theory development; the problem of the specific and the general; and the importance of problematicity. The paper concludes that applied linguistics needs to be accountable to two communities, the academy and the lay communities it aims to work with

Sources, developments and directions of task-based language teaching

This paper provides an outline of the origins, the current shape and the potential directions of task-based language teaching (TBLT) as an approach to language pedagogy. It first offers a brief description of TBLT and considers its origins within language teaching methodology and second language acquisition. It then summarises the current position of TBLT from two perspectives: first, it identifies key elements in approaches to the teaching of language based on tasks, and second, it turns to a consideration of the principal issues that have been explored in TBLT research. The paper concludes by considering directions for the future development of TBLT as an approach to language pedagogy, highlighting the need for future research to be classroom-based and programme-based