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oai:open-archive.highwire.org:ageing:32/1/12015-05-19HighWireOUPageing:32:1
Age and Ageing - introducing our Associate Editors
Wilcock, Gordon K.
Editorials
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/1
http://dx.doi.org/10.1093/ageing/32.1.1
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Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/102015-05-19HighWireOUPageing:32:1
News and reviews
News and reviews
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/10
http://dx.doi.org/10.1093/ageing/32.1.10
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/1022015-05-19HighWireOUPageing:32:1
Explicit, evidence-based criteria to assess the quality of prescribing to elderly nursing home residents
Alice Oborne, C.
Hooper, Richard
Swift, Cameron G.
Jackson, Stephen H. D.
Research paper
<b>Background</b>: prescribing in nursing homes is frequently suboptimal. Indicators to measure prescribing quality, including appropriateness of prescribing certain drugs or combinations of drugs, to hospital inpatients have been developed previously. <b>Objective</b>: to modify prescribing indicators, including appropriateness of prescribing algorithms developed in the hospital setting, for use in nursing homes. <b>Design</b>: an audit of prescribing to patients resident in a random sample of nursing homes on a single day. <b>Setting, subjects</b>: 22 nursing homes in the former South Thames Region selected from lists of nursing homes with more than 35 residents. All residents aged 65 years or over were eligible. <b>Methods</b>: prescribing indicators, including evidence‐based indicators of appropriateness of prescribing benzodiazepines, steroids with β<inf>2</inf> agonists, antithrombotics with digoxin and aspirin with nitrates were adapted: to reflect where prophylaxis was not justified in terms of quality of life; and for use with primary care clinical records. Indicators were used to evaluate drugs prescribed to each resident to determine whether prescribing was appropriate. <b>Results</b>: 13 indicators were successfully modified and applied. The 934 residents included were prescribed a mean of 5.1 regular items. Only 496/934 (55%) drug sensitivity statements were completed. Although 24% residents received benzodiazepines, clinical data indicated that only 7% received benzodiazepines appropriately. Over three‐quarters of residents with ischaemic heart disease received appropriate aspirin therapy, but fewer than half residents with atrial fibrillation received appropriate antithrombotic therapy. It was not possible to derive reference ranges of observed prescribing that included homes demonstrating appropriate prescribing whilst excluding those with inappropriate prescribing. Intra‐cluster correlations ranged from 0.027 to 0.335. <b>Conclusion</b>: quality of prescribing indicators were successfully modified for the nursing home setting. Application identified suboptimal prescribing to nursing home residents.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/102
http://dx.doi.org/10.1093/ageing/32.1.102
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/1092015-05-19HighWireOUPageing:32:1
Hospital re-admissions in relation to acute stroke unit care versus conventional care in elderly patients the first year after stroke: the Goteborg 70+ Stroke study
Claesson, Lisbeth
Gosman-Hedström, Gunilla
Fagerberg, Björn
Blomstrand, Christian
Research paper
<b>Background:</b> re‐hospitalisation after discharge following index stroke varies over time and with age and comorbidity. There is little knowledge about whether stroke unit care reduces the need of re‐admissions. <b>Objectives:</b> to examine whether stroke unit care as compared with care in general medical wards was associated with fewer re‐hospitalisations for conditions judged to be secondary to acute stroke and to identify the influence of stroke severity on re‐admission rates. <b>Design:</b> we conducted a one‐year randomised study to compare the outcome of treatment at an acute stroke unit in a care continuum with the outcome of treatment at general medical wards. <b>Settings</b>: acute and geriatric hospitals in Göteborg, Sweden. <b>Subjects:</b> 216 elderly patients aged ≥70 years discharged to their own homes or to institutionalised living after index stroke. <b>Methods:</b> comparison of comorbidity classified according to Charlson's morbidity index, re‐admission rates, length of hospital stay, number of re‐admissions and diagnoses between a group treated at a stroke unit and a group treated at general wards. <b>Results:</b> the re‐admission rates, length of hospital stay and causes of re‐admissions did not differ between the two groups. Complications related to the damage to the brain and concomitant heart disease were the most common causes of re‐admissions in both groups. Index stroke severity did not influence the re‐admission rates. <b>Conclusions</b>: re‐admissions for conditions judged to be secondary to acute stroke were equal in the two groups in this prospective study.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/109
http://dx.doi.org/10.1093/ageing/32.1.109
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Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/1142015-05-19HighWireOUPageing:32:1
Hyperkalaemic paralysis
Muensterer, Oliver J.
Case Report
<b>Background</b>: hyperkalaemic paralysis is a rare, treatable, and potentially fatal entity presenting with flaccid motor weakness. <b>Case report</b>: a patient with acute hyperkalaemic paralysis caused by erroneous oral potassium supplementation in the context of chronic renal failure. The clinical picture of quadriplegia was initially interpreted as spinal cord injury due to a pathological cervical fracture. <b>Discussion</b>: the diagnosis of hyperkalaemic paralysis requires a high index of suspicion. Instructions for over‐the‐counter supplements must be clear and concise to prevent life‐threatening medication errors.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/114
http://dx.doi.org/10.1093/ageing/32.1.114
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Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/116-a2015-05-19HighWireOUPageing:32:1
Anaemia - a common co-existing ailment that is commonly neglected
Guptha, Sunku H.
Letters
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/116-a
http://dx.doi.org/10.1093/ageing/32.1.116-a
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/1162015-05-19HighWireOUPageing:32:1
Infective endocarditis in older people
Sivakumar, R.
Ghosh, P.
Khan, S. A.
Letters
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/116
http://dx.doi.org/10.1093/ageing/32.1.116
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/117-a2015-05-19HighWireOUPageing:32:1
Palliative care is an important aspect of heart failure management
Athavale, Nandkishor V.
Letters
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/117-a
http://dx.doi.org/10.1093/ageing/32.1.117-a
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/1172015-05-19HighWireOUPageing:32:1
Evaluation of skills and knowledge on orthostatic blood pressure measurement in elderly patients
Jolobe, O. M. P.
Letters
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/117
http://dx.doi.org/10.1093/ageing/32.1.117
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/1192015-05-19HighWireOUPageing:32:1
Forthcoming meetings
Forthcoming meetings
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/119
http://dx.doi.org/10.1093/ageing/32.1.119
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/122015-05-19HighWireOUPageing:32:1
Urinary incontinence in nursing homes for older people
Durrant, Joanna
Snape, Jeremy
Review
At least 50% of nursing home residents in Britain and North America suffer from urinary incontinence. It is associated with resident and staff morbidity. The assessment and management of such residents will depend on the capacity of the care staff and the capability of the resident. The minimum data set and resident assessment protocol may have a role in the assessment of incontinent residents. Behavioural strategies are more likely to be beneficial than drug treatment.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/12
http://dx.doi.org/10.1093/ageing/32.1.12
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/192015-05-19HighWireOUPageing:32:1
Non-pharmacological management of primary and secondary insomnia among older people: review of assessment tools and treatments
Petit, Lyndal
Azad, Nahid
Byszewski, Anna
Sarazan, Francine F.-A.
Power, Barbara
Review
<b>Background:</b> primary and secondary insomnia, especially among older adults, is frequently encountered by family physicians. Pharmacological interventions, although effective in some circumstances, can be detrimental in others. Non‐pharmacological management of insomnia may allow the patients to self‐administer the treatment. <b>Objectives:</b> review of published literature of assessment tools and treatments for primary and secondary insomnia. <b>Results:</b> two frequently used self‐reporting methods for obtaining sleep data are sleep diaries and Pittsburg Sleep Quality Index. A large amount of research supports the use of non‐pharmacological treatments such as stimulus control, sleep restriction, sleep hygiene education, cognitive therapy, multi‐component therapy and paradoxical intention. <b>Conclusion:</b> assessing the nature of insomnia by using an effective assessment tool and providing patients with a non‐pharmacological treatment should be the first intervention for insomnia. It is shown that non‐pharmacological treatments for primary and secondary insomnia are feasible and effective alternatives to the use of benzodiazepines, and that family physicians should consider these when managing older patients with insomnia.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/19
http://dx.doi.org/10.1093/ageing/32.1.19
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Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/262015-05-19HighWireOUPageing:32:1
Visual factors should be assessed in older people presenting with falls or hip fracture
Abdelhafiz, Ahmed H.
Austin, Christopher A.
Review
Visual impairment, although not routinely assessed, is an important risk factor for falls and hip fracture in older people. Impaired vision is highly prevalent and commonly unreported in the elderly population particularly in women and those living in nursing homes. Measurement of visual functions such as visual acuity, contrast sensitivity and depth perception may identify older people at risk of falls and hip fracture. Visual loss in older people is correctable in most cases. Intervention strategies, for example, change of glasses or cataract extraction may have the potential of improving visual function and preventing falls in older people.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/26
http://dx.doi.org/10.1093/ageing/32.1.26
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/312015-05-19HighWireOUPageing:32:1
A test to assess the mechanical power sustainable during everyday activities in older people
Capodaglio, Edda Maria
Saibene, Franco
Research paper
<b>Objective:</b> to define with a simple test the power sustainable by older people during everyday occupations. <b>Methods:</b> nine healthy subjects (65–71 years) performed two series of 5–6 trials on bicycle and arm ergometers at constant power. Throughout the exercise they reported their evaluation of the effort, referred either to perceived whole body exertion or to the working muscles, using Borg's category‐ratio, CR10, scale. The exercise was interrupted when CR7 was attained. From a linear regression of the individual data of the work done from the start of each trial to the transition from CR4 to CR5, corresponding to ‘somewhat heavy’ and ‘heavy’, and the corresponding duration it was possible to calculate the slope of the work/time relationship. This was considered as the value of power sustainable for leg or arm muscles. <b>Results:</b> on average the sustainable power for the work done on the bicycle ergometer represented 55% of the maximal mechanical power. During the control trial on the bicycle ergometer at a power corresponding to their sustainable power the subjects were able to exercise for 30 min without symptoms of fatigue or discomfort, with an average CR of 3. The average heart rate was 114 bpm and the blood lactate concentration at the end of the exercise was always lower than 4 mmol/l. Sustainable power calculated for the arm muscles was about one quarter that of the leg muscles, but all subjects reported the evaluation of the effort as more difficult. <b>Conclusion:</b> the determination of power sustainable for the leg muscles with this simple test appears reliable and accurate.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/31
http://dx.doi.org/10.1093/ageing/32.1.31
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/372015-05-19HighWireOUPageing:32:1
Alpha 1-acid glycoprotein is an independent predictor of in-hospital death in the elderly
Henry, Olivier F.
Blacher, Jacques
Verdavaine, Jacqueline
Duviquet, Monique
Safar, Michel E.
Research paper
<b>Objectives</b>: to determine the contribution of the two acute phase proteins alpha 1‐acid glycoprotein, and C‐reactive protein to the prediction of overall mortality in hospitalised elderly patients. <b>Design</b>: prospective cohort study. <b>Setting</b>: a department of geriatric medicine of Charles Richet Hospital, in the Paris‐Ile de France area. <b>Subjects</b>: 433 consecutive patients (mean age 84±7 years) admitted for rehabilitation in a department of geriatric medicine. <b>Methods</b>: clinical and laboratory examinations were performed at baseline. Follow‐up ended at hospital discharge or death. Prognostic factors of survival were identified using Cox proportional hazards regression model. <b>Results</b>: compared with the survivor group, the mean serum levels of both C‐reactive protein and alpha 1‐acid glycoprotein at baseline were higher in the deceased group (44±51 mg/l <it>versus</it> 22±34 mg/l and 1691±69 mg/l <it>versus</it> 1340±456 mg/l respectively; <it>P</it><0.001 for each). Baseline levels of albumin and prealbumin were significantly lower in patients who died than in patients who survived. In multivariate analysis, alpha 1‐acid glycoprotein (but not C‐reactive protein), previous stroke, previous heart failure, and age emerged as the only parameters significantly and independently related to overall mortality. <b>Conclusion</b>: this study shows that the increase in plasma levels at admission of two acute‐phase proteins, alpha 1‐acid glycoprotein and C‐reactive protein, were associated with in‐hospital mortality in a population of hospitalised elderly patients. Furthermore, associations of overall mortality with inflammation differed among the markers and only alpha 1‐acid glycoprotein entered the multivariate prediction model. Our findings support the hypothesis that alpha 1‐acid glycoprotein may be superior to C‐reactive protein in mortality risk assessment strategies for elderly patients.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/37
http://dx.doi.org/10.1093/ageing/32.1.37
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/42015-05-19HighWireOUPageing:32:1
Spirometry in old age
Allen, Stephen C.
Editorials
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/4
http://dx.doi.org/10.1093/ageing/32.1.4
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/432015-05-19HighWireOUPageing:32:1
Quality of spirometric performance in older people
Pezzoli, Licia
Giardini, Gianluca
Consonni, Silvia
Dallera, Ilaria
Bilotta, Claudio
Ferrario, Gianluca
Cristina Sandrini, Maria
Annoni, Giorgio
Vergani, Carlo
Research paper
<b>Objectives</b>: chronic obstructive pulmonary disease and asthma are major causes of hospitalisation and mortality among older patients but respiratory diseases are often under‐ or misdiagnosed because spirometry is not extensively used at this age. <b>Design</b>: we examined 715 elderly subjects with respiratory symptoms; all underwent a spirometric test and were administered the Mini Mental State Examination, Activities of Daily Living, Instrumental Activities of Daily Living and Geriatric Depression Scale questionnaires for cognitive, functional and effective evaluation. Their educational level and Body Mass Index were also taken into consideration. <b>Results</b>: a total of 585 patients (81.8%) were able to perform spirometry according to ATS'94 criteria while 130 (18.2%) were unable to do it. As regards educational level, Mini Mental State Examination, Activities of Daily Living and Instrumental Activities of Daily Living scores showed a significant difference (<it>P</it><0.001) between the groups of patients with high‐quality spirometries and those with inadequate ones. There was no difference between the two groups in terms of age, Body Mass Index or Geriatric Depression Scale score. <b>Conclusions</b>: the majority of elderly subjects can perform spirometry according to international guidelines; age itself cannot be considered a risk factor for a bad spirometric performance, but it becomes influential if it is associated with cognitive and functional impairment.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/43
http://dx.doi.org/10.1093/ageing/32.1.43
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/472015-05-19HighWireOUPageing:32:1
An economic analysis of external hip protector use in ambulatory nursing facility residents
Colón-Emeric, Cathleen S.
Datta, Santanu K.
Matchar, David B.
Research paper
<b>Objective</b>: to evaluate the economic impact of external hip protector use in nursing facilities. <b>Design</b>: cost‐effectiveness and cost‐utility analyses. <b>Measurements</b>: event probabilities, intervention effectiveness, treatment costs, and utility of hip fracture state were determined from peer‐reviewed medical literature and public use data. <b>Methods</b>: a societal perspective with an 18‐month time horizon was used. A decision tree model was constructed. Expected cost, effectiveness, and incremental cost‐effectiveness ratio were calculated. One and two‐way sensitivity analyses and threshold analyses were performed. <b>Results</b>: the strategy of using external hip protectors saves approximately US$300 per subject and adds 0.01 quality adjusted life year over 18 months. The model remains dominant over the entire range of input values for all variables except the cost of hip protectors. At the maximum estimated cost of US$695/subject/18 months, the incremental cost‐effectiveness ratio was $30,600/quality adjusted life year. The strategy of using hip protectors was cost saving or cost neutral if the cost of hip protector strategy is ≤US$397/subject/18 months. <b>Conclusions</b>: using external hip protectors in nursing facilities is cost saving or economically attractive over a wide range of cost and utility assumptions.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/47
http://dx.doi.org/10.1093/ageing/32.1.47
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/532015-05-19HighWireOUPageing:32:1
Economic evaluation of a geriatric day hospital: cost-benefit analysis based on functional autonomy changes
Tousignant, Michel
Hébert, Réjean
Desrosiers, Johanne
Hollander, Marcus J.
Research paper
<b>Objective</b>: to investigate whether the benefits related to a geriatric day hospital programme exceeded the costs, using a cost‐benefit analysis based on changes in functional autonomy. <b>Design</b>: a quasi‐experimental design with a historical cohort as comparison group. <b>Setting</b>: the geriatric day hospital programme at the Sherbrooke Geriatric University Institute in the Province of Quebec, Canada. <b>Subjects</b>: 151 geriatric day hospital patients. <b>Methods</b>: after admission to and at discharge from the geriatric day hospital programme, functional autonomy was assessed by a trained nurse using the Functional Autonomy Measurement System. Based on financial reports, costs associated with resources consumed at the geriatric day hospital programme by each subject were established. The benefit in dollars per day was estimated with a societal perspective through regression equations based on functional autonomy changes related to the geriatric day hospital programme. A model for spreading the benefit per day was proposed: the median time to institutionalisation or death. <b>Results</b>: for every dollar invested in the geriatric day hospital programme, the benefit for the health system was $2.14 (95% confidence interval: $1.72–$2.56). <b>Conclusion</b>: based on our sample of Sherbrooke Geriatric University Institute patients, the benefit related to the geriatric day hospital programme seems to exceed the costs.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/53
http://dx.doi.org/10.1093/ageing/32.1.53
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/62015-05-19HighWireOUPageing:32:1
Explicit evidence-based prescribing criteria - an important step in achieving quality therapeutics in nursing homes
Roberts, Michael S.
Stokes, Julie A.
Editorials
Oxford University Press
2003-01-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/32/1/6
http://dx.doi.org/10.1093/ageing/32.1.6
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/602015-05-19HighWireOUPageing:32:1
Application of a case-mix classification based on the functional autonomy of the residents for funding long-term care facilities
Tousignant, Michel
Hébert, Réjean
Dubuc, Nicole
Simoneau, France
Dieleman, Linda
Research paper
<b>Introduction</b>: increasing public costs for the care of the elderly have created fundamental changes that are redefining the basic principles of health care funding. In the past, overall institutional funding was predominantly tied to spending. In view of the limitations of this approach to funding long‐term care facilities, case‐mix classification tries to take into account the characteristics of the residents as a tool for predicting costs. Recently, a new case‐mix classification based on the functional autonomy profile of the residents – ISO‐SMAF profile – was developed in the Province of Quebec, Canada. This classification can be used to change the funding system to base it on the functional autonomy characteristics of the residents. <b>Objectives</b>: the main objective of this study was to apply the ISO‐SMAF classification to funding long‐term care facilities in one area of the Province of Quebec and to compare the results of this new funding methodology to the formal methodology. <b>Design</b>: this study used a cross‐sectional design. <b>Methodology</b>: the population under study comprised all residents of all 11 long‐term care facilities in the Eastern Townships area of Quebec. Each resident was assessed using the Functional Autonomy Measurement System. The theoretical budget was calculated based on the adjusted cost per year associated with each ISO‐SMAF profile derived from a previous economic study. <b>Results</b>: the theoretical budget based on the ISO‐SMAF profiles may highlight the under‐ or over‐funding of a facility when compared to the usual funding system based predominantly on the number of beds and hours of care. <b>Conclusion</b>: the results of this study show the feasibility of applying the new funding approach to long‐term care facilities. However, implementation of the ISO‐SMAF classification for funding must be supported by continued and computerised residents' medical files including the Functional Autonomy Measurement System.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/60
http://dx.doi.org/10.1093/ageing/32.1.60
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/672015-05-19HighWireOUPageing:32:1
Effects of physical training on the physical capacity of frail, demented patients with a history of falling: a randomised controlled trial
Toulotte, Claire
Fabre, Claudine
Dangremont, Bénédicte
Lensel, Ghislaine
Thévenon, André
Research paper
<b>Background:</b> to develop a physical training programme to improve balance in dependent, demented, people with a history of falling, and so decrease falls and increase autonomy. <b>Methods:</b> the study was undertaken on 20 demented elderly people with a history of falling with an average age of 81.4±4.7 years and an average mini mental state score of 16.3±6.5. They had all passed ‘get up and go’, ‘chair sit and reach’, walking speed and static balance tests. They were assigned to a control group or a training group; the latter were trained with two sessions a week for 16 weeks. <b>Results:</b> walking, mobility, flexibility and static balance were significantly improved in the training group (<it>P</it><0.05), but not in the controls. The trained subjects did not suffer a relapse, while the controls did during the training period. <b>Conclusion:</b> the balance of frail, demented, elderly patients with a history of falling can be improved by training.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/32/1/67
http://dx.doi.org/10.1093/ageing/32.1.67
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/742015-05-19HighWireOUPageing:32:1
Proximal femur fracture in older patients - rehabilitation and clinical outcome
Röder, Frank
Schwab, Matthias
Aleker, Thomas
Mörike, Klaus
Thon, Klaus-Peter
Klotz, Ulrich
Research paper
<b>Background</b>: hip fracture is a major cause of morbidity and mortality in older people; optimal post‐surgical treatment is a matter of controversy. <b>Objective</b>: to examine the effects of rehabilitation on the clinical outcome following surgical treatment of hip fracture. <b>Design</b>: prospective longitudinal study in three groups of patients with different post‐surgical care. <b>Methods</b>: initial screening of 283 elderly patients with proximal femur fracture; documentation of medical and social history and clinical data; geriatric assessments (Activities of Daily Living and Instrumental Activities of Daily Living) during hospital stay and follow‐up for 12 months. One hundred and forty‐five patients (≥65 years) of normal mental status were eligible for the study. Successful follow‐up could be monitored in 120 and 117 patients for 6 and 12 months, respectively. Sixty‐nine and 39 patients underwent supervised inpatient rehabilitation in an orthopaedic or geriatric hospital, respectively (intervention groups A and B, respectively) whereas 34 patients received no special rehabilitation as they were directly discharged home (control group C). <b>Results</b>: initially a fall‐/surgical‐induced reduction (<it>P</it><0.001) of the main outcome measure (Activities of Daily Living) was observed in all patients. Within 6 months of rehabilitation there was an improvement (<it>P</it><0.01) in Activities of Daily Living; however the pre‐fracture scores were not reached. The same time pattern was seen in group C. Therefore no significant differences between the three groups of patients in approaching the baseline status was visible. Moreover, the one‐year total mortality in the studied population with normal mental status averaged 11.7% and did not differ between the three groups. <b>Conclusion</b>: based on our measured outcome variables institutional rehabilitation after surgical treatment of hip fracture apparently had no significant impact on mortality and morbidity in older patients of normal mental status.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/32/1/74
http://dx.doi.org/10.1093/ageing/32.1.74
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/82015-05-19HighWireOUPageing:32:1
Growing knowledge about hip fracture in older people
Qureshi, Aamir
Gwyn Seymour, D.
Editorials
Oxford University Press
2003-01-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/32/1/8
http://dx.doi.org/10.1093/ageing/32.1.8
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/812015-05-19HighWireOUPageing:32:1
Relationship between changes in depressive symptoms and unhealthy lifestyles in late middle aged and older persons: results from the Longitudinal Aging Study Amsterdam
van Gool, Coen H.
Kempen, Gertrudis I. J. M.
Penninx, Brenda W. J. H.
Deeg, Dorly J. H.
Beekman, Aartjan T. F.
van Eijk, Jacques T. M.
Research paper
<b>Background</b>: depressed mood is common in late life, more prevalent among the chronically diseased than in the general population, and has various health‐related consequences. So far, the association between depression and unhealthy lifestyles among chronically diseased has not been examined longitudinally in older persons. <b>Primary objective</b>: to determine if depressed mood is associated with unhealthy lifestyles in late middle aged and older people, with or without chronic somatic diseases. <b>Methods</b>: in a sample of 1,280 community‐dwelling people from the Netherlands, the associations between depressive symptoms and lifestyle domains were analysed cross‐sectionally and longitudinally – using logistic regression analyses and multivariate analyses of variance. <b>Results</b>: after controlling for confounders, depressed people (<it>n</it>=176 at baseline) were more likely to be smokers (odds ratio 1.71; 95% confidence interval 1.17–2.52). A persistent depression was associated with an increase in cigarette consumption (<it>P</it>=0.036). Having an emerging depression (<it>n</it>=155) was most likely to co‐occur with a person's change from being physically active to being sedentary (relative risk‐ratio 1.62; 95% confidence interval 1.05–2.52), and was associated with the largest decrease in minutes of physical activity (<it>P</it>=0.038). This effect was not modified or confounded by chronic somatic disease. A persistent depression tended to be associated with incident excessive alcohol use (relative risk‐ratio 4.04; 95% confidence interval 0.97–16.09; <it>P</it>=0.056). <b>Conclusions</b>: depression is associated with smoking behaviour, and with an increase in cigarette consumption. An emerging depression is associated with becoming sedentary, irrespective of a person's disease status at baseline, and is associated with decrease in minutes of physical activity.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/81
http://dx.doi.org/10.1093/ageing/32.1.81
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/882015-05-19HighWireOUPageing:32:1
Depression in older people after fall-related injuries: a prospective study
Scaf-Klomp, Winnie
Sanderman, Robbert
Ormel, Johan
Kempen, Gertrudis I. J. M.
Research paper
<b>Background</b>: objectives of the study were i) to describe changes in depression in independently living people aged 57 or older with fall‐related injuries, and ii) to examine the effect of incomplete recovery of physical functions on depression one year post‐injury. <b>Method</b>: prospective cohort‐study, including a pre‐injury baseline and post‐injury assessments at 8 weeks, 5 months and one year. The sample consisted of 159 patients who sustained various kinds of fall‐related injuries to the limbs. Physical functioning was measured by the Groningen Activity Restriction Scale, depression by the Hospital Anxiety and Depression Scale. Additional variables in the study were age, gender, chronic medical conditions and severity of the injury (three level‐groups). Pre‐ and post‐injury levels of depression were compared by using Student's <it>t</it>‐test and effect size indices. Hierarchical multivariate regression analysis was used to examine the contribution of change in physical functioning between baseline and one year post‐injury to depression one year post‐injury. <b>Results</b>: severity of the injury was not associated with depression. Mean depression levels of all patients remained stable until 5 months post‐injury but increased between 5 months and one year. Physical functioning decreased between baseline and 8 weeks post‐injury, increased between 8 weeks and 5 months but did not change after 5 months. One year post‐injury, both disability and depression were higher than at baseline. Change in physical functioning between baseline and one year post‐injury accounted for 19% of the variance in depression explained by the regression model. <b>Conclusions</b>: depressive reactions did not occur as long as patients experienced improvement in physical functioning but became manifest as recovery appeared to stagnate. No significant differences in this respect were found between hip fracture patients and patients with other injuries.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/88
http://dx.doi.org/10.1093/ageing/32.1.88
en
Copyright (C) 2003, British Geriatrics Society
oai:open-archive.highwire.org:ageing:32/1/952015-05-19HighWireOUPageing:32:1
Infectious aetiologies in elderly patients hospitalised with non-pneumonic lower respiratory tract infection
Lieberman, David
Lieberman, Devora
Ben-Yaakov, Miriam
Lazarovich, Zilia
Ohana, Bella
Friedman, Maureen G.
Dvoskin, Bella
Leinonen, Maija
Boldur, Ida
Research paper
<b>Objective</b>: to identify the infectious aetiologies of non‐pneumonic lower respiratory tract infections in hospitalised elderly patients, and to characterise the patients in terms of demographic, clinical and therapeutic variables. <b>Design</b>: a prospective, non‐interventional, purely serologically based diagnostic study. <b>Setting</b>: a tertiary university hospital in southern Israel. <b>Subjects</b>: 133 elderly patients hospitalised for non‐pneumonic lower respiratory tract infections. <b>Methods</b>: paired sera were obtained for each of the hospitalisations and were tested using immunofluorescence or enzyme immunoassay methods to identify 13 different pathogens. Only significant changes in antibody titers or levels between the paired sera were considered diagnostic. <b>Results</b>: at least one infectious aetiology was identified in 77 patients (58%). At least one of seven viral aetiologies was identified in 52 patients (39%). A bacterial aetiology was identified in 27 patients (20%) including <it>Streptococcus pneumoniae</it> in 24 (18%). An atypical bacterium was found in 27 patients (20%) including <it>Mycoplasma pneumoniae</it> in 15 (11%) and <it>Legionella</it> spp. in nine (7%). More than one aetiology was found in 23 patients (17%). One hundred and twenty nine patients (96%) suffered from serious chronic co‐morbidity. One hundred and twenty one patients received antibiotics during their hospitalisation, 106 (80%) with a beta‐lactam and 42 (31%) with another antibiotic. <b>Conclusions</b>: non‐pneumonic lower respiratory tract infection is caused in hospitalised elderly patients by a broad spectrum of aetiological agents, primarily respiratory viruses with a significant, though lesser, prevalence of classical and atypical bacteria. Despite this distribution of aetiologies, most patients are treated with beta‐lactam antibiotics. The indication for antibiotic therapy in these patients and the choice of antibiotic preparation should be addressed in further studies.
Oxford University Press
2003-01-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/32/1/95
http://dx.doi.org/10.1093/ageing/32.1.95
en
Copyright (C) 2003, British Geriatrics Society