In this study of delirium in older hip fracture patients, the MDAS, a continuous severity measure, was a useful adjunct to the CAM, a dichotomous diagnostic measure. In patients with CAM-defined delirium, severe delirium was generally associated with worse outcomes than was mild delirium. In patients who did not fulfill CAM criteria, subsyndromal delirium was associated with worse outcomes than having few or no symptoms of delirium. Patients with subsyndromal delirium had outcomes similar to patients with mild delirium, suggesting that a dichotomous approach to diagnosis and management may be inappropriate. Pure hypoactive delirium was more common than delirium with any hyperactive features, tended to be milder, and was associated with better outcomes even after adjusting for severity. Future studies should confirm our preliminary associations and examine whether treatment to reduce the severity of delirium symptoms can improve outcomes after hip fracture repair.

Likelihood of a patient's treatment preference being consistent with care differ by age and treatment preferences. Older patients preferring life-prolonging therapies are less likely to receive them than younger patients; middle-aged patients who want to avoid life-prolonging care are more likely to do so than younger patients. Both findings have implications for patients' quality-of-death, indicating a need for further research.

This study provides normal baselines of knee muscle strength for women up to 86 years of age. Knee muscle strength (torque) was measured during maximum isometric and dynamic (isokinetic) contractions in 72 normal healthy women in three age groups between 20 and 86 years. Strength of the oldest group ranged from 56 to 78% of that in the youngest group, depending on knee joint position. Strength values were greater for isometric contractions than for isokinetic contractions (performed at 36 degrees per second) and were approximately twice as great for the extensor as for the flexor muscles. For both muscle groups, the torque generated with the knee in 30 degrees of flexion was usually lower than that generated with the knee at the 45- or 60-degree position. Despite the significant deficit found in the strength of the oldest group, it is likely that this relative weakness would not be detected on routine clinical examination using manual muscle testing.

Salivary cortisol is a simple, nonstressful method for assessing activity of the hypothalamic-pituitary-adrenal (HPA) axis in the elderly population. A major finding was an elevation in the late night nadir in cortisol secretion. We also suggest that elevated cortisol secretion in elderly people may contribute to the age-related loss in bone mineral density and that this effect is prevented by HRT.