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oai:open-archive.highwire.org:ageing:29/6/4732015-05-19HighWireOUPageing:29:6
Defeating depression
Wattis, John
Editorials
Oxford University Press
2000-11-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/29/6/473
http://dx.doi.org/10.1093/ageing/29.6.473
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Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/4752015-05-19HighWireOUPageing:29:6
Pulse oximetry as a screening tool in detecting aspiration
Exley, Catherine
Editorials
Oxford University Press
2000-11-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/29/6/475
http://dx.doi.org/10.1093/ageing/29.6.475
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/4772015-05-19HighWireOUPageing:29:6
Cognitive links across the lifecourse and implications for health in later life
Richards, Marcus
Editorials
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/477
http://dx.doi.org/10.1093/ageing/29.6.477
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/4792015-05-19HighWireOUPageing:29:6
Assessment of need
Crome, Peter
Phillipson, Chris
Editorials
Oxford University Press
2000-11-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/29/6/479
http://dx.doi.org/10.1093/ageing/29.6.479
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/4812015-05-19HighWireOUPageing:29:6
Changing the image of long-term care
Kane, Robert L.
Commentaries
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/481
http://dx.doi.org/10.1093/ageing/29.6.481
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/4852015-05-19HighWireOUPageing:29:6
Longitudinal studies of ageing: a key role in the evidence base for improving health and quality of life in older adults
Huppert, Felicia A.
Brayne, Carol
Jagger, Carol
Metz, David
Commentaries
Oxford University Press
2000-11-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/29/6/485
http://dx.doi.org/10.1093/ageing/29.6.485
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/4872015-05-19HighWireOUPageing:29:6
News and reviews
News and reviews
Oxford University Press
2000-11-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/29/6/487
http://dx.doi.org/10.1093/ageing/29.6.487
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/4892015-05-19HighWireOUPageing:29:6
Inappropriate use of loop diuretics in elderly patients
Kelly, James
Chambers, John
Review
Oxford University Press
2000-11-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/29/6/489
http://dx.doi.org/10.1093/ageing/29.6.489
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/4952015-05-19HighWireOUPageing:29:6
The combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool
Smith, Hilary A.
Lee, Steven H.
O'Neill, Paul A.
Connolly, Martin J.
Research papers
<b>Background:</b> dysphagia is common in acute stroke. Accurate detection of the presence or absence of aspiration by bedside swallowing assessment is difficult without objective methods, tending to over‐diagnose aspiration. As a result, some patients suffer restricted oral intake unnecessarily. <b>Objective:</b> we examined the predictive values of pulse oximetry and speech and language therapy bedside swallowing assessment in the detection of aspiration compared with videofluoroscopy. <b>Design:</b> a double‐blind observational study. <b>Setting:</b> two university teaching hospitals. <b>Subjects:</b> we studied 53 patients whose acute strokes were confirmed by computed tomography scan. <b>Methods:</b> Each subject had initial standard bedside swallowing assessment, closely followed by simultaneous and mutually blinded pulse oximetry, swallowing assessment and videofluoroscopy. <b>Results:</b> 15 of 53 subjects aspirated. Bedside swallowing assessment and saturation assessment at ⩾2% desaturation gave good sensitivity (80% and 87% respectively), but low positive predictive values (50% and 36% respectively). Both assessments mistook laryngeal penetration for aspiration. Re‐analysis with aspiration±penetration as a new endpoint improved bedside swallowing assessment positive predictive values to 83% (<it>χ</it>2=3.59, <it>P</it>=0.032). Sensitivity of saturation assessment was maintained at 86%, positive predictive values of saturation assessment improved to 69% (<it>χ</it>2=6.74, <it>P</it>=0.009). The combination of bedside swallowing assessment and saturation assessment <it>versus</it> aspiration±penetration gave a positive predictive value of 95%. <b>Conclusions:</b> screening by saturation assessments detects 86% of aspirators/penetrators and should be followed immediately by bedside swallowing assessment, as the combination of the two assessments gives the best positive predictive value. For patients with acute stroke, we advocate a 10 ml water‐swallow screening test with simultaneous pulse oximetry by suitably trained medical and nursing staff. Use of this screening test would improve dysphagia detection whilst minimizing unnecessary restriction of oral intake in stroke patients.
Oxford University Press
2000-11-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/29/6/495
http://dx.doi.org/10.1093/ageing/29.6.495
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5012015-05-19HighWireOUPageing:29:6
A diagnostic service for eliciting carotid sinus hypersensitivity and vasovagal symptoms in a district general hospital
Bacon, Michael
Grunstein, John A. H.
Research papers
<b>Aim:</b> to describe the technical, diagnostic and logistical problems encountered in a syncope and falls clinic in a district general hospital. <b>Methods:</b> we have reviewed 157 consecutive patients and the problems encountered in their assessment at the clinic. <b>Results:</b> 143 patients (91%) completed assessment, which included head-up tilt and carotid sinus massage. We reached a diagnosis in 75 of these (52%). Difficulties with continuous blood pressure monitoring caused testing to be abandoned in four cases and caused considerable delay (up to 30 min) in 45% of the rest. Eight patients (5%) refused consent for carotid sinus massage and two others had neurological sequelae. Some patients fulfilled diagnostic criteria on testing but remained asymptomatic, making an attributable diagnosis difficult. This was most noticable with vasodepressor carotid sinus hypersensitivity. The limited facilities in a district general hospital and the time-consuming nature of the testing resulted in a considerable delay between referral and assessment (58 days ± 25.9), which may adversely affect diagnostic yield. <b>Conclusions:</b> syncope clinics have a role in the assessment of elderly people with recurrent syncope and unexplained falls. Enthusiasm for this approach has to be tempered with an awareness of the limitations of the tests involved and an appreciation of the logistical problems likely to be encountered in a district hospital.
Oxford University Press
2000-11-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/29/6/501
http://dx.doi.org/10.1093/ageing/29.6.501
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5052015-05-19HighWireOUPageing:29:6
Assessing needs from patient, carer and professional perspectives: the Camberwell Assessment of Need for Elderly people in primary care
Walters, Katherine
Iliffe, Steve
Tai, Sharon See
Orrell, Martin
Research papers
<b>Background:</b> despite evidence that needs assessment of older people can improve survival and function when linked to effective long‐term management, there is no structured needs assessment tool in widespread use. The Camberwell Assessment of Need for the Elderly is a new tool not previously evaluated in primary care. It includes the views of patients, carers and health professionals, enabling a direct comparison of their perspectives. <b>Aim:</b> <?Pub Caret1>to conduct a feasibility study of Camberwell Assessment of Need for the Elderly in primary care and to compare the needs identified by patients, carers and health professionals. <b>Methods:</b> we selected a random sample of 1:20 of all people aged 75 and over from four general practices in inner‐city and suburban north‐west London. We interviewed the patients, their informal carers and lead health professionals using the Camberwell Assessment of Need for the Elderly schedule. <b>Results:</b> 55 (65.5%) of 84 patients, 15 (88.2%) of 17 carers and all of 55 health professionals completed interviews. The patients' three most frequently identified unmet needs were with ‘eyesight/hearing’, ‘psychological distress’ and ‘incontinence’. The carers' three most frequently identified unmet needs were with ‘mobility’, ‘eyesight/hearing’ and ‘accommodation’ and the health professionals' were with ‘daytime activities’, ‘accommodation’ and ‘mobility’. <it>κ</it> tests comparing patient and health professional assessments showed poor or fair agreement with 18 of the 24 variables and moderate or good agreement with six. None showed very good agreement. <b>Conclusion:</b> the Camberwell Assessment of Need for the Elderly schedule is feasible to use in primary care and can identify perceived needs not previously known about by health professionals. A shorter version of Camberwell Assessment of Need for the Elderly focusing on areas of poor agreement and high levels of need might be useful in the assessment of needs in older people in primary care.
Oxford University Press
2000-11-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/29/6/505
http://dx.doi.org/10.1093/ageing/29.6.505
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5112015-05-19HighWireOUPageing:29:6
Development and validation of a brief observer-rated screening scale for depression in elderly medical patients
Hammond, Margaret F.
O'Keeffe, Shaun T.
Barer, David H.
Research papers
<b>Objective:</b> to develop a depression screening scale that does not rely on verbal communication. <b>Setting:</b> an acute geriatric unit in a teaching hospital. <b>Subjects:</b> 96 patients (mean age 81 years, range 68–92, 59 women); 40% of the initial study group of 50 and 22% of the validation group of 46 were diagnosed as depressed. <b>Methods:</b> we devised a scale using nine items which could be rated by an observer; we determined inter‐rater reliability, sensitivity, specificity and predictive values for each item compared with a Geriatric Mental State‐AGECAT diagnosis of depression; we validated a final scale of six items. <b>Results:</b> inter‐rater reliability was poor for two items (irritability and sleep disturbance) while two items (sleep disturbance and night sedation) had poor sensitivity; we omitted these items in a revised scale. Re‐analysis of data from the initial study showed that a cut‐off of ⩾3 on the revised scale gave a sensitivity of 83%, a specificity of 95%, a positive predictive value of 0.89 and a negative predictive value of 0.90. Spearman's correlation coefficient between the six‐item questionnaire and the Hamilton rating scale was 0.79. In the validation study, the cut‐off score of ⩾3 on the revised six‐item scale had a sensitivity of 90%, specificity of 72%, a positive predictive value of 0.69 and a negative predictive value of 0.96. <b>Conclusions:</b> this simple, short, observation‐based screening scale completed by nurses is sensitive and specific in identifying depression in elderly medically ill patients, and may be a useful addition to clinical practice.
Oxford University Press
2000-11-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/29/6/511
http://dx.doi.org/10.1093/ageing/29.6.511
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5172015-05-19HighWireOUPageing:29:6
Can strategic and tactical compensation reduce crash risk in older drivers?
De Raedt, Rudi
Ponjaert-Kristoffersen, Ingrid
Research papers
<b>Objective:</b> to determine whether the use of strategic and tactical compensation can successfully improve safety in older drivers. <b>Methods:</b> 84 healthy subjects aged between 65 and 96 were referred for a fitness‐to‐drive evaluation. Using ANOVA and contrast analysis, we tested the hypothesis that bad drivers who have had no car accidents use more active compensation strategies than bad drivers who have caused accidents in the previous 12 months. We classified drivers as bad, average or good, based on a structured road test. <b>Results:</b> drivers who select driving tasks below their capacities and compensate by adapting their driving style cause fewer accidents than those who do not apply these strategies. <b>Conclusions:</b> fitness‐to‐drive screening procedures need a broader perspective to prevent an over‐emphasis on procedures which focus more on deficit than on capacities.
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/517
http://dx.doi.org/10.1093/ageing/29.6.517
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5232015-05-19HighWireOUPageing:29:6
Mental ability age 11 years and health status age 77 years
Starr, John M.
Deary, Ian J.
Lemmon, Helen
Whalley, Lawrence J.
Research papers
<b>Objectives:</b> to measure the effects of childhood mental ability on health in old age. <b>Design:</b> longitudinal cohort study. <b>Setting:</b> community‐based. <b>Participants:</b> survivors of the 1932 Scottish Mental Survey cohort randomly selected from the Community Health Index in North East Scotland. <b>Measurements:</b> (i) presence of disease by diagnostic category; (ii) cardiovascular, respiratory, anthropomorphic, sensory and locomotor physiological variables; (iii) Barthel index of functional independence; (iv) socio‐demographic and socio‐economic variables as health status predictors; and (v) score on the Moray House Test in 1932. <b>Results:</b> There was no significant difference in Moray House Test score in 1932 between those with (mean 39.7, S.D. 13.8) and without (mean 40.1, S.D. 12.1) current disease (<it>F</it>=0.04, <it>P</it>=0.84). Physiological health status was predicted by demi‐span (<it>F</it>=6.87, <it>P</it><0.001), sex (<it>F</it>=3.69, <it>P</it>=0.001), deprivation category (<it>F</it>=1.45, <it>P</it>=0.05) and the interaction between sex and deprivation category (<it>F</it>=2.01, <it>P</it>=0.002). Moray House Test score in 1932 correlated significantly and positively with Barthel score (<it>r</it>=0.24, <it>P</it><0.001). No additional general linear models added any other significant socio‐economic variable once Moray House Test Score in 1932 was entered. Moray House Test score in 1932 remained significant (<it>β</it>=0.16, <it>P</it>=0.024) after Mini Mental State Examination score was entered and found to be significant (<it>β</it>=0.21, <it>P</it>=0.003). <b>Conclusion:</b> socio‐economic and socio‐environmental factors are important determinants of some aspects of inequalities in health in old age in this cohort. Pre‐morbid mental ability was an important independent predictor of late‐life functional independence.
Oxford University Press
2000-11-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/29/6/523
http://dx.doi.org/10.1093/ageing/29.6.523
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5292015-05-19HighWireOUPageing:29:6
Predictors of early retirement in British civil servants
Mein, Gill
Martikainen, Pekka
Stansfeld, Stephen A.
Brunner, Eric J.
Fuhrer, Rebecca
Marmot, Michael G.
Research papers
<b>Background:</b> it is uncertain how recent changes in labour force dynamics may have influenced the increasing numbers of people taking early retirement in industrialized countries. The Whitehall II study provides an opportunity to examine the predictors of early retirement in one of the largest employers in the United Kingdom. <b>Methods:</b> we examined the factors predicting early retirement in a 7‐year follow‐up period from 1988 to 1995 using longitudinal data on 2532 male and female London‐based civil servants aged between 50 and 59.5 years. Baseline data on employment grade and duration of time working for the Civil Service were obtained from self‐completed questionnaires. The primary factors examined included health, work characteristics, questions about job demands and job satisfaction and financial insecurity, wealth and material problems. Time until early retirement was analysed using Cox proportional hazards model. <b>Results:</b> of the 2532 civil servants, 26.7% retired early during the follow‐up period. We found that men and women in the higher‐paid employment grades, those that had suffered from ill health and those that were less satisfied with their jobs were more likely to retire early, whereas material problems tended to keep people working. <b>Conclusions:</b> our results show that self‐perceived health, employment grade and job satisfaction are all independent predictors of early retirement. Qualitative analyses may further advance our understanding of the retirement process.
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/529
http://dx.doi.org/10.1093/ageing/29.6.529
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5372015-05-19HighWireOUPageing:29:6
Psychiatric illness in hip fracture
Holmes, John D.
House, Allan O.
Systematic review
<b>Objective:</b> to review the literature on the prevalence and effect on outcome of psychiatric illness in older people with hip fracture. <b>Methods:</b> searching of medical databases and bibliographies to identify relevant studies. Application of predetermined quality criteria for prevalence and outcome studies. <b>Results:</b> 19 studies met criteria for a prevalence study. Rates of psychiatric illness varied, with depression in 9–47%, delirium in 43–61% and unspecified cognitive impairment in 31–88%. Four studies met criteria for an outcome study. Psychiatric illness resulted in increased mortality and dependence and decreased activities of daily living skills. No individual study examined the prevalences and effect on outcome of depression, delirium and dementia separately. <b>Conclusions:</b> depression, delirium and dementia are common in older people with hip fracture. Further research is required to examine the effect on outcome of psychiatric illness, and the effect of psychiatric interventions in this setting.
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/537
http://dx.doi.org/10.1093/ageing/29.6.537
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5472015-05-19HighWireOUPageing:29:6
Cerebral haemorrhage
Cohen, David L.
What we do not know about...
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/547
http://dx.doi.org/10.1093/ageing/29.6.547
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/551-a2015-05-19HighWireOUPageing:29:6
Adverse drug reactions and hospital admission of older patients
Sinha, Uttam
Raha, Sandip
Wilkins, Edward
Letters
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/551-a
http://dx.doi.org/10.1093/ageing/29.6.551-a
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5512015-05-19HighWireOUPageing:29:6
Anticoagulation of older patients: a need to modify current practice
Loh, Pei Chong
Morgan, Kathy
Wynne, Hilary
Letters
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/551
http://dx.doi.org/10.1093/ageing/29.6.551
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/552-a2015-05-19HighWireOUPageing:29:6
Non-tuberculous respiratory infections
Pandya, Hasit
Barrett, James
Turnbull, Christopher J.
Letters
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/552-a
http://dx.doi.org/10.1093/ageing/29.6.552-a
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5522015-05-19HighWireOUPageing:29:6
Treating acquired haemophilia: an ethical conundrum
Starr, John M.
Letters
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/552
http://dx.doi.org/10.1093/ageing/29.6.552
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5532015-05-19HighWireOUPageing:29:6
The Short Form-12 by telephone as a measure of health-related quality of life after stroke
Rubenach, Sally
Anderson, Craig S.
Laubscher, Sara
Letters
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/553
http://dx.doi.org/10.1093/ageing/29.6.553
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5542015-05-19HighWireOUPageing:29:6
A trial of blood pressure reduction in acute stroke
Bath, Philip M. W.
Weaver, Chris
Iddenden, Robert
Bath, Fiona J.
Letters
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/554
http://dx.doi.org/10.1093/ageing/29.6.554
en
Copyright (C) 2000, British Geriatrics Society
oai:open-archive.highwire.org:ageing:29/6/5562015-05-19HighWireOUPageing:29:6
Forthcoming meetings
Forthcoming meetings
Oxford University Press
2000-11-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/29/6/556
http://dx.doi.org/10.1093/ageing/29.6.556
en
Copyright (C) 2000, British Geriatrics Society