ContextThere is evidence that heart rate variability (HRV) is reduced in major depressive disorder (MDD), although there is debate about whether this effect is caused by medication or the disorder per se. MDD is associated with a two to fourfold increase in the risk of cardiac mortality, and HRV is a robust predictor of cardiac mortality; determining a direct link between HRV and not only MDD, but common comorbid anxiety disorders, will point to psychiatric indicators for cardiovascular risk reduction.ObjectiveTo determine in physically healthy, unmedicated patients whether (1) HRV is reduced in MDD relative to controls, and (2) HRV reductions are driven by MDD alone, comorbid generalized anxiety disorder (GAD, characterized by anxious anticipation), or comorbid panic and posttraumatic stress disorders (PD/PTSD, characterized by anxious arousal).Design, Setting, and PatientsA case-control study in 2006 and 2007 on 73 MDD patients, including 24 without anxiety comorbidity, 24 with GAD, and 14 with PD/PTSD. Seventy-three MDD and 94 healthy age- and sex-matched control participants were recruited from the general community. Participants had no history of drug addiction, alcoholism, brain injury, loss of consciousness, stroke, neurological disorder, or serious medical conditions. There were no significant differences between the four groups in age, gender, BMI, or alcohol use.Main Outcome MeasuresHRV was calculated from electrocardiography under a standardized short-term resting state condition.ResultsHRV was reduced in MDD relative to controls, an effect associated with a medium effect size. MDD participants with comorbid generalized anxiety disorder displayed the greatest reductions in HRV relative to controls, an effect associated with a large effect size.ConclusionsUnmedicated, physically healthy MDD patients with and without comorbid anxiety had reduced HRV. Those with comorbid GAD showed the greatest reductions. Implications for cardiovascular risk reduction strategies in otherwise healthy patients with psychiatric illness are discussed.

frail older inpatients with AF are significantly less likely to receive warfarin than non-frail and appear more vulnerable to adverse clinical outcomes, with and without antithrombotic therapy.

Aim: Develop a measure of frailty for older acute inpatients to be performed by non-geriatricians. Method: The Reported Edmonton Frail Scale (REFS) was adapted from the Edmonton Frail Scale for use with Australian acute inpatients. With acute patients aged over 70 years admitted to an Australian teaching hospital, we validated REFS against the Geriatrician's Clinical Impression of Frailty (GCIF), measures of cognition, comorbidity and function, and assessed inter-rater reliability.Results: REFS was moderately correlated with GCIF (n = 105, R = 0.61, P < 0.01), Mini-Mental State Examination impairment (n = 61, R = 0.49, P < 0.001), Charlson Comorbidity Index (n = 59, R = 0.51, P < 0.001) and Katz Daily Living Scale (n = 59, R = 0.51, P < 0.001). Inter-rater reliability of REFS administered by two researchers without medical training was excellent (kappa = 0.84, n = 31). Conclusion: In this cohort of older acute inpatients, REFS is a valid, reliable test of frailty, and may be a valuable research tool to assess the impact of frailty on prognosis and response to therapy.Key words: acute care, acute illness, aged, frailty, geriatric medicine. IntroductionFrailty may affect the safety and efficacy of therapy and may be a key prognostic marker in the care of acute geriatric medicine inpatients. To test this hypothesis, a reliable, valid measure of frailty in acute inpatients is required.The core feature of frailty is increased vulnerability to stressors because of impairments in multiple inter-related systems that lead to decline in homeostatic reserve and resiliency, although the definition of frailty remains contentious [1]. Many tools for the identification of frailty, such as the phenotype model developed by Fried and colleagues [2], rely on objective measures of physical function. Purser and colleagues [3] recently described the utility of several performance-based measures and of two composite scores to identify frailty in a group of older adult inpatients with significant cardiovascular disease. However, in an acute care hospital population, performance-based measures may provide more information about the severity and type of acute illness than about the underlying frailty of a patient. The estimation of frailty just prior to acute illness in inpatients may inform decisions on management and prognosis. Self-reported function has been shown to be a good estimate of objective measures of physical function [4].Large prospective studies on the role of frailty in the prognosis of acute illness will be facilitated by the use of a frailty measure that can be performed by non-geriatrician researchers. The Edmonton Frail Scale, which is administered by a research assistant without medical training, has been validated against the Geriatricians' Clinical Impression of Frailty (GCIF) in a Canadian population referred for comprehensive geriatric assessment [5]. Interestingly, the inpatients (40% of the study population) scored significantly higher on the Edmonton Frail Scale than outpatients. While this may represent the c...

Exposure to FRIDs and other measures of high-risk medication exposures is common in older people admitted with falls, especially the frail. Number of FRIDs and to a lesser extent total number of medicines at discharge were associated with recurrent falls.

The majority of older inpatients using statins are willing to have one or more of their current medications, including statins, deprescribed. These findings can be used to inform clinical practice and interventional statin deprescribing studies to optimise medication use in older adults.