Background: Stress-related biomarkers have the potential to provide objective measures of whether interventions directed at people with dementia (PWD) and their family caregivers (FCG) are successful. The use of such biomarkers has been limited by logistical barriers to sample collection. Objective: Explore saliva concentration of steroid hormones in dementia care dyads during a music intervention. Methods: Consecutive PWD attending a memory evaluation center and their FCG were allocated to either an intervention-with-music or a non-intervention control group. All were living at home. Stress biomarkers, salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S) samples were collected by the PWD and their FCG, in the morning and evening, 5 days a week, for 8 consecutive weeks. Biomarker concentrations of the intervention and the control groups were compared at week 8, in an intention-to-treat approach with adjustment for baseline value. Results: Twenty-four PWD in the intervention group and 10 in the control group, and their FCG were included in the analyses. The mean number of morning saliva collections was similar in the intervention and the control groups, ranging from 4.3 to 4.9 per participant weekly during the first 7 weeks, declining to 3.3 during week 8. Median log morning cortisol (pg/mL) among caregivers was lower in the intervention group than in the control group (8.09 vs. 8.57, P = 0.0133). Conclusion: This study demonstrates that music intervention was associated with lower morning saliva cortisol concentrations for FCGs.

Background: Older adults have the highest incidence of traumatic brain injury and are often on antiplatelet therapy. This study examines the association between preinjury antiplatelet agent use and intracranial hemorrhage in geriatric emergency department (ED) patients with blunt head injury from a fall. Methods: We conducted a secondary analysis of the GREAT STOP project, a large prospective study of geriatric ED patients who sustained head trauma. This project enrolled patients from two level one trauma centers over 1 year beginning 1 August 2019. Trained research associates enrolled patients who met study criteria. The primary outcome was intracranial hemorrhage. Rates of intracranial hemorrhage were compared between patients who were prescribed preinjury antiplatelet agents versus those who were not on any antiplatelet or anticoagulant therapy. Results: 3709 patients were included in the final analysis. Overall, 12.8% (475) had intracranial hemorrhage, and 6.4% (237) had a significant intracranial hemorrhage. Delayed intracranial hemorrhage occurred in 0.3% (10) of patients with one of these classified as a significant intracranial hemorrhage (1). Patients on aspirin or dual antiplatelet therapy had increased adjusted ORs of intracranial hemorrhage compared with patients not on antiplatelet therapy (1.4, 95% CI 1.1 to 1.8; and 1.7, 95% CI 1.1 to 2.6, respectively). Use of P2Y12 inhibitors alone did not show this effect (1.0, 95% CI 0.6 to 1.6). Conclusions: In geriatric ED patients who have sustained blunt head trauma from a fall, aspirin and especially dual antiplatelet therapy are associated with a significant risk of intracranial hemorrhage, while P2Y12 antiplatelet agents do not appear to carry this risk. The benefits from the use of these agents in older patients need to be weighed against their risk for fall and potential fall-related injury such as intracranial hemorrhage.

Falls are common in adults aged 65 years and older and are the leading cause of traumatic brain injuries in this age group. Alcohol use may increase the risk of falls as well as the severity of resultant injuries. The aim of this study was to examine the association between self‐reported alcohol use and the prevalence of intracranial hemorrhage (ICH) in this patient group. This was a secondary analysis of the Geriatric Head Trauma Short Term Outcomes Project (GREAT STOP), a study of older adults with blunt head trauma from a fall. We determined the characteristics of every fall event, including patient demographics and medical history, and clinical signs and symptoms related to head trauma. Self‐reported alcohol use was categorized as none, occasionally, weekly, or daily. We defined ICH as any acute ICH detected by computed tomography scan. We evaluated the association between alcohol use frequency and ICH, adjusted for patient factors and head injury risk factors. Of 3128 study participants, 18.2% (n = 567) reported alcohol use: 10.3% with occasional use, 1.9% with weekly use, and 6.0% with daily use. ICH was more common in patients who used alcohol (20.5%, 22.0%, and 25.1% for occasional, weekly, and daily alcohol users, respectively, vs. 12.0% for non‐users, p < 0.001). The frequency of alcohol use was independently associated with ICH, adjusted for patient and head injury risk factors. The adjusted odds ratios (with 95% confidence intervals) for occasional, weekly, and daily alcohol users increased from 2.0 (1.5‒2.8) to 2.1 (1.1‒4.1) and 2.5 (1.7‒3.6), respectively, and showed the characteristics of dose‒response effect. Alcohol use in older adult emergency department patients with head trauma is relatively common. Self‐reported alcohol use appears to be associated with a higher risk of ICH in a dose‐dependent fashion. Fall prevention strategies may need to consider alcohol mitigation as a modifiable risk factor.