***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE To test the effectiveness of a nursing-centered intervention to prevent functional decline among hospitalized elderly medical patients . DESIGN Prospect i ve cohort study with stratified and matched cohort analyses . SETTING General medicine wards of a university teaching hospital . PATIENTS Two hundred sixteen patients aged > or = 70 years ( 85 intervention and 131 control patients ) . INTERVENTION The intervention included identification and surveillance of frail older patients , twice-weekly rounds of the Geriatric Care Team , and a nursing-centered educational program . MAIN OUTCOME MEASURE Functional decline , defined as a net decline in five activities of daily living ( ADLs ) . RESULTS In stratified analyses , the intervention result ed in a beneficial effect with a relative risk of 0.82 ( 95 % confidence interval [ CI ] 0.54 to 1.24 ) in patients ( n = 106 ) with one of four geriatric target conditions at baseline ( eg , delirium , functional impairment , incontinence , and pressure sores ) . The intervention had no effect in patients without target conditions at baseline ( n = 110 ) ; thus , this subgroup was excluded from further analyses . When patients were matched on number of target conditions and risk for functional decline at baseline ( n = 66 ) , the intervention result ed in a significant beneficial effect , with a reduction in functional decline from 64 % in controls to 41 % in the intervention group , for a relative risk of 0.64 ( 95 % CI , 0.43 to 0.96 ) . The intervention group had significantly less decline in ADL score and in individual ADLs than control subjects . Specific interventions aim ed at maximizing function , such as physical therapy , were received more often by intervention patients ; however , the beneficial effects of the intervention were achieved without increasing per-day hospital costs . CONCLUSIONS The intervention appears effective to decrease functional decline in targeted elderly hospitalized medical patients BACKGROUND This report describes changes in eight areas of functioning after a hip fracture , identifies the point at which maximal levels of recovery are reached in each area , and evaluates the sequence of recuperation across multiple functional domains . METHODS . Community-residing hip fracture patients ( n = 674 ) admitted to eight hospitals in Baltimore , Maryl and , 1990 - 1991 were followed prospect ively for 2 years from the time of hospitalization . Eight areas of function ( i.e. , upper and lower extremity physical and instrumental activities of daily living ; gait and balance ; social , cognitive , and affective function ) were measured by personal interview and direct observation during hospitalization at 2 , 6 , 12 , 18 , and 24 months . Levels of recovery are described in each area , and time to reach maximal recovery was estimated using Generalized Estimating Equations and longitudinal data . RESULTS Most areas of functioning showed progressive lessening of dependence over the first postfracture year , with different levels of recovery and time to maximum levels observed for each area . New dependency in physical and instrumental tasks for those not requiring equipment or human assistance prefracture ranged from as low as 20.3 % for putting on pants to as high as 89.9 % for climbing five stairs . Recuperation times were specific to area of function , ranging from approximately 4 months for depressive symptoms ( 3.9 months ) , upper extremity function ( 4.3 months ) , and cognition ( 4.4 months ) to almost a year for lower extremity function ( 11.2 months ) . CONCLUSIONS Functional disability following hip fracture is significant , patterns of recovery differ by area of function , and there appears to be an orderly sequence by which areas of function reach their maximal levels OBJECTIVES Delirium ( or acute confusional state ) affects 35 % to 65 % of patients after hip-fracture repair , and has been independently associated with poor functional recovery . We performed a r and omized trial in an orthopedic surgery service at an academic hospital to determine whether proactive geriatrics consultation can reduce delirium after hip fracture . DESIGN Prospect i ve , r and omized , blinded . SETTING Inpatient academic tertiary medical center . PARTICIPANTS 126 consenting patients 65 and older ( mean age 79 + /- 8 years , 79 % women ) admitted emergently for surgical repair of hip fracture . MEASUREMENTS Detailed assessment through interviews with patients and design ated proxies and review of medical records was performed at enrollment to ascertain prefracture status . Subjects were then r and omized to proactive geriatrics consultation , which began preoperatively or within 24 hours of surgery , or " usual care . " A geriatrician made daily visits for the duration of the hospitalization and made targeted recommendations based on a structured protocol . To ascertain study outcomes , all subjects underwent daily , blinded interviews for the duration of their hospitalization , including the Mini-Mental State Examination ( MMSE ) , the Delirium Symptom Interview ( DSI ) , and the Memorial Delirium Assessment Scale ( MDAS ) . Delirium was diagnosed using the Confusion Assessment Method ( CAM ) algorithm . RESULTS The 62 patients r and omized to geriatrics consultation were not significantly different ( P>.1 ) from the 64 usual-care patients in terms of age , gender , prefracture dementia , comorbidity , type of hip fracture , or type of surgical repair . Sixty-one percent of geriatrics consultation patients were seen preoperatively and all were seen within 24 hours postoperatively . A mean of 10 recommendations were made throughout the duration of the hospitalization , with 77 % adherence by the orthopedics team . Delirium occurred in 20 /62 ( 32 % ) intervention patients , versus 32 / 64 ( 50 % ) usual-care patients ( P = .04 ) , representing a relative risk of 0.64 ( 95 % confidence interval ( CI ) = 0.37 - 0.98 ) for the consultation group . One case of delirium was prevented for every 5.6 patients in the geriatrics consultation group . There was an even greater reduction in cases of severe delirium , occurring in 7/ 60 ( 12 % ) of intervention patients and 18 / 62 ( 29 % ) of usual-care patients , with a relative risk of 0.40 ( 95 % CI = 0.18 - 0.89 ) . Despite this reduction in delirium , length of stay did not significantly differ between intervention and usual-care groups ( median + /- interquartile range = 5 + /- 2 days in both groups ) , likely because protocol s and pathways predetermined length of stay . In subgroup analyses , geriatrics consultation was most effective in reducing delirium in patients without prefracture dementia or activities of daily living ( ADL ) functional impairment . CONCLUSIONS Proactive geriatrics consultation was successfully implemented with good adherence after hip-fracture repair . Geriatrics consultation reduced delirium by over one-third , and reduced severe delirium by over one-half . Our trial provides strong preliminary evidence that proactive geriatrics consultation may play an important role in the acute hospital management of hip-fracture patients BACKGROUND delirium is common and is associated with many adverse short-term consequences . OBJECTIVES to examine the relationship between an episode of delirium and subsequent dementia and death over 3 years . DESIGN prospect i ve cohort study . SETTING patients ( n = 203 ) were aged 65 years or older at baseline and survivors of the index admission . METHODS Using a st and ard assessment of cognitive function , we followed 38 in patients diagnosed with delirium ( 22 with delirium and dementia , 16 with delirium only ) and 148 patients with no delirium or dementia , for a median of 32.5 months . Follow-up was by personal interviews , supplemented by st and ardized clinical examinations . We calculated the incidence and odds of dementia and the incidence and hazard ratio for death , with adjustment for potential confounders . RESULTS The incidence of dementia was 5.6 % per year over 3 years for those without delirium and 18.1 % per year for those with delirium . The unadjusted relative risk of dementia for those with delirium was 3.23 ( 95 % confidence interval 1.86 - 5.63 ) . The adjusted relative risk of death also increased ( 1.80 ; 1.11 - 2.92 ) , while the median survival time was significantly shorter in those with ( 510 days ; 433 - 587 ) than in those without delirium ( 1122 days ; 922 - 1322 ) . CONCLUSION delirium appears to be an important marker of risk for dementia and death , even in older people without prior cognitive or functional impairment Background Delirium is a common complication in patients with hip fractures and is associated with an increased risk of subsequent dementia . The aim of this trial was to evaluate the effect of a pre- and postoperative orthogeriatric service on the prevention of delirium and longer-term cognitive decline . Methods This was a single-center , prospect i ve , r and omized controlled trial in which patients with hip fracture were r and omized to treatment in an acute geriatric ward or st and ard orthopedic ward . Inclusion and r and omization took place in the Emergency Department at Oslo University hospital . The key intervention in the acute geriatric ward was Comprehensive Geriatric Assessment including daily interdisciplinary meetings . Primary outcome was cognitive function four months after surgery measured using a composite outcome incorporating the Clinical Dementia Rating Scale ( CDR ) and the 10 words learning and recalls tasks from the Consortium to Establish a Registry for Alzheimer ’s Disease battery ( CERAD ) . Secondary outcomes were pre- and postoperative delirium , delirium severity and duration , mortality and mobility ( measured by the Short Physical Performance Battery ( SPPB ) ) . Patients were assessed four and twelve months after surgery by evaluators blind to allocation . Results A total of 329 patients were included . There was no significant difference in cognitive function four months after surgery between patients treated in the acute geriatric and the orthopedic wards ( mean 54.7 versus 52.9 , 95 % confidence interval for the difference -5.9 to 9.5 ; P = 0.65 ) . There was also no significant difference in delirium rates ( 49 % versus 53 % , P = 0.51 ) or four month mortality ( 17 % versus 15 % , P = 0.50 ) between the intervention and the control group . In a pre-planned sub-group analysis , participants living in their own home at baseline who were r and omized to orthogeriatric care had better mobility four months after surgery compared with patients r and omized to the orthopedic ward , measured with SPPB ( median 6 versus 4 , 95 % confidence interval for the median difference 0 to 2 ; P = 0.04 ) . Conclusions Pre- and postoperative orthogeriatric care given in an acute geriatric ward was not effective in reducing delirium or long-term cognitive impairment in patients with hip fracture . The intervention had , however , a positive effect on mobility in patients not admitted from nursing homes . Trial registration Clinical Trials.gov NCT01009268 Registered November 5 , OBJECTIVES To study the effectiveness of haloperidol prophylaxis on incidence , severity , and duration of postoperative delirium in elderly hip-surgery patients at risk for delirium . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING Large medical school-affiliated general hospital in Alkmaar , The Netherl and s. PARTICIPANTS A total of 430 hip-surgery patients aged 70 and older at risk for postoperative delirium . INTERVENTION Haloperidol 1.5 mg/d or placebo was started preoperatively and continued for up to 3 days postoperatively . Proactive geriatric consultation was provided for all r and omized patients . MEASUREMENTS The primary outcome was the incidence of postoperative delirium ( Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , and Confusion Assessment Method criteria ) . Secondary outcomes were the severity of delirium ( Delirium Rating Scale , revised version-98 ( DRS-R-98 ) ) , the duration of delirium , and the length of hospital stay . RESULTS The overall incidence of postoperative delirium was 15.8 % . The percentage of patients with postoperative delirium in the haloperidol and placebo treatment condition was 15.1 % and 16.5 % , respectively ( relative risk=0.91 , 95 % confidence interval (CI)=0.6 - 1.3 ) ; the mean highest DRS-R-98 score+/-st and ard deviation was 14.4+/-3.4 and 18.4+/-4.3 , respectively ( mean difference 4.0 , 95 % CI=2.0 - 5.8 ; P<.001 ) ; delirium duration was 5.4 versus 11.8 days , respectively ( mean difference 6.4 days , 95 % CI=4.0 - 8.0 ; P<.001 ) ; and the mean number of days in the hospital was 17.1+/-11.1 and 22.6+/-16.7 , respectively ( mean difference 5.5 days , 95 % CI=1.4 - 2.3 ; P<.001 ) . No  haloperidol-related side effects were noted . CONCLUSION Low-dose haloperidol prophylactic treatment demonstrated no efficacy in reducing 
    Output:
    
Early engagement of multidisciplinary staff who addresses the risk factors of delirium as soon as the patient presents to the acute care environment is the key element of a successful delirium prevention program .
Once delirium had developed , the multicomponent interventions did not appear to make a difference to the duration or severity of delirium