In a JAMA survey, 44% of participants who drank reported lower alcohol use within three months, though the self-reported findings remain preliminary

Background: Delirium is common among older adults, particularly those with cognitive impairment. However, delirium among patients with dementia or mild cognitive impairment (MCI) in long-term care (LTC) hospitals has received limited attention. Objective: This study aimed to examine delirium occurrence and associated factors among patients with dementia or MCI in LTC hospitals. Methods: This cross-sectional study included 142 patients aged 65 years or older with dementia (n=100, 70.4%) or MCI (n=42, 29.6%) at 2 LTC hospitals in South Korea between September 2021 and August 2022. Delirium occurrence was defined as at least 1 positive Short Confusion Assessment Method assessment during twice-daily assessments over 4 weeks, including the first assessment. Multivariable logistic regression examined associated factors overall and within each cognitive group. Results: Delirium was identified in 55 (38.7%) of 142 patients. The proportion was 41% (41/100) in patients with dementia and 33.3% (14/42) in patients with MCI. Hypoactive delirium was the most common subtype (33/55, 60%). Overall, female sex (adjusted odds ratio [aOR] 4.344, 95% CI 1.794-10.515; P=.001), immobility (aOR 4.953, 95% CI 1.857-13.205; P=.001), and analgesic use (aOR 3.641, 95% CI 1.262-10.501; P=.02) were associated with delirium. Infection was inversely associated with delirium (aOR 0.251, 95% CI 0.101-0.623; P=.003). In patients with dementia, female sex, immobility, analgesic use, and pain were associated with delirium. Diaper use was associated with delirium in patients with MCI. Conclusions: Delirium was common among patients with dementia or MCI in LTC hospitals. The findings support regular delirium assessment, with attention to mobility and pain-related care needs. Further studies are needed to clarify the factors associated with delirium in each cognitive group.

Two new studies reveal hospital care challenges faced by people living with MLTC and healthcare professionals

Background: Existing risk scores for nonvariceal upper gastrointestinal bleeding (NVUGIB) may not adequately represent the heterogeneity of coexisting chronic conditions. Routinely collected hospital discharge records may enable data-driven characterization of clinically meaningful comorbidity profiles. Objective: This formative study aimed to identify reproducible comorbidity profiles among patients hospitalized with NVUGIB and examine their associations with in-hospital outcomes and health care use. Methods: We conducted a retrospective cohort study of 3193 adults hospitalized with NVUGIB at a tertiary hospital in China between 2015 and 2025. Of 55 prespecified chronic conditions, 33 with a prevalence of at least 1% were included as binary clustering variables. Patients were randomly divided into an 80% training subset and a 20% held-out validation subset. Comorbidity profiles were identified in the training subset using a self-organizing map and Ward hierarchical clustering and then assigned to the validation subset using the fixed clustering solution. Profile reproducibility was evaluated by comparing condition prevalence vectors between subsets. Multivariable regression models assessed associations with severe in-hospital outcomes, intensive care unit admission, in-hospital death, length of stay, and hospital costs. Results: At least 1 selected comorbidity was recorded in 89.7% (2864/3193) of patients. Six profiles were identified: low-burden heterogeneous (cluster 1), non–upper gastrointestinal neoplastic-metastatic (cluster 2), circulatory-renal (cluster 3), cardiometabolic-renal (cluster 4), atherosclerotic-vascular (cluster 5), and rheumatologic-neurological (cluster 6). Profile composition was broadly reproducible between the training and validation subsets (weighted mean Spearman correlation=0.891, SD 0.04; =.001). The circulatory-renal profile had the strongest associations with severe in-hospital outcomes (adjusted odds ratio [aOR] 8.57, 95% CI 5.39-14.01), intensive care unit admission (aOR 10.38, 95% CI 4.87-25.76), and in-hospital death (aOR 4.66, 95% CI 1.97-13.75). The rheumatologic-neurological and cardiometabolic-renal profiles were also associated with higher odds of these outcomes. All 6 profiles were associated with longer hospital stays and higher hospital costs. Conclusions: Using routinely collected hospital discharge records, we identified clinically interpretable comorbidity profiles among patients with NVUGIB. The profiles were broadly reproducible within the study population and showed different associations with clinical outcomes and resource use. Profile-based information may complement established risk assessment and could be examined further as an electronic health record–based approach to clinical management and resource planning.

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An increasing number of people worldwide are experiencing fertility and this trend is reflected in the data from the United Kingdom. However, most research focuses on the experiences of women and so t...