Improving Delirium Identification in Hospitalized Older Adults

Delirium affects one-third of hospitalized older adults and is associated with prolonged length of stay, institutional discharge, long-term functional and cognitive decline, Alzheimer disease and related dementias (AD/ADRD), and death. Moreover, the costs of delirium exceed $182 billion annually in the US alone. Despite these compelling data, accurate identification of delirium remains challenging, with more than half of delirium going unrecognized in routine care. While delirium prevention has advanced substantially, delirium treatment, which relies on early and accurate identification, lags. More than 40 tools are available for delirium assessment, ranging from short structured screens to in-depth reference standards. Evidence on how to implement these tools to improve delirium identification at the bedside, including which tool to use, who should administer it, how often, and how to educate and engage the care team, remains limited.

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Effect of aerobic exercise combined with meditation on cognitive frailty: study protocol for a parallel group randomised controlled trial

Introduction
Cognitive frailty (CF) is a clinical syndrome characterised by the concurrent occurrence of physical frailty and cognitive impairment, excluding Alzheimer’s disease and other forms of dementia. Recent studies have shown that combining aerobic exercise (AE) and meditation (ME) effectively enhances both physical and cognitive functions in individuals with CF. The study aims to determine whether the combined application of AE and ME can elicit significantly greater improvements in physical and cognitive functions among individuals with CF compared with the independent practice of either AE or ME alone.

Methods and analysis
The research design employs a four-arm, assessor-blind randomised controlled trial. A total of 140 qualified subjects will be randomly allocated among four groups: AE, ME, AE combined with ME and a health education control group, ensuring equivalent distribution across groups. The intervention phase of the study will last for 12 weeks. The primary outcomes will include the Edmonton Frailty Scale, while secondary outcomes will encompass evaluations of cognitive functions (including global cognitive function, memory, attention, executive function and visuospatial abilities), physical performance (measured by gait speed and lower extremity strength), subjective experiences (such as fatigue, quality of life, mindfulness, mood and sleep quality), as well as structural and functional MRI assessments and serum biomarkers. Outcomes will be evaluated at baseline and following the 12-week intervention.

Ethics and dissemination
The Ethics Committee of the Affiliated Rehabilitation Hospital of the Fujian University of Traditional Chinese Medicine granted ethical approval for the study (2023KY-012–02). The findings will be disseminated through publications in peer-reviewed journals and presentations at academic conferences.

Trial registration number
ChiCTR2300073563.

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