2024-03-28T09:31:59Zhttp://open-archive.highwire.org/handler
oai:open-archive.highwire.org:ageing:36/2/1152015-05-19HighWireOUPageing:36:2
Delirium and C-reactive protein
George, J.
Mukaetova-Ladinska, E. B.
Editorials
Oxford University Press
2007-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/36/2/115
http://dx.doi.org/10.1093/ageing/afl153
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1162015-05-19HighWireOUPageing:36:2
Parkinson's disease in Africa
Pearce, Vaughan
Wilson, Iain
Editorials
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/116
http://dx.doi.org/10.1093/ageing/afl173
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1172015-05-19HighWireOUPageing:36:2
Warfarin versus aspirin in the elderly in primary prophylaxis for atrial fibrillation
Morrison, C. M.
Gainsborough, N.
Rajkumar, C.
Editorials
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/117
http://dx.doi.org/10.1093/ageing/afl181
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1202015-05-19HighWireOUPageing:36:2
Safeguarding the rights of patients who lack capacity in general hospitals. Do the Bournewood proposals for England and Wales help or hinder?
Harwood, Rowan H.
Stewart, Robert
Bartlett, Peter
Hot Topic
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/120
http://dx.doi.org/10.1093/ageing/afl162
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1222015-05-19HighWireOUPageing:36:2
The challenge of Parkinson's disease management in Africa
Dotchin, C. L.
Msuya, O.
Walker, R. W.
Occasional Paper
Parkinson's disease (PD) is said to be less common in Africa than elsewhere in the world, but previous studies have been based on small numbers. Also, the differences may be due to the diagnostic criteria used, case finding methods and different population age structures. Developing countries have few facilities for chronic disease management and non-communicable diseases, although on the increase, tend to play second fiddle to malaria and HIV/AIDS. Previous reports suggest that, at least from anecdotal information, under-diagnosis of PD is common and long-term availability of medication, follow-up, patient education and multidisciplinary input is lacking. Published literature is scarce and there is a lack of recent information. We are currently conducting a door-to-door prevalence study in northern Tanzania in a population of 161,162. We have reviewed previous literature on PD in Africa and illustrate our personal experience of PD and its management in Africa with three cases.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/122
http://dx.doi.org/10.1093/ageing/afl172
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1282015-05-19HighWireOUPageing:36:2
News and Reviews
Diogenes,
News and Reviews
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/128
http://dx.doi.org/10.1093/ageing/afl182
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1302015-05-19HighWireOUPageing:36:2
Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings
Scott, Vicky
Votova, Kristine
Scanlan, Andria
Close, Jacqueline
Systematic Review
<b>Objective:</b> to conduct a systematic review of published studies that test the validity and reliability of fall-risk assessment tools for use among older adults in community, home-support, long-term and acute care settings. <b>Methods:</b> searches were conducted in EbscoHost and MEDLINE for published studies in the English language between January 1980 and July 2004, where the primary or secondary purpose was to test the predictive value of one or more fall assessment tools on a population primarily 65 years and older. The tool must have had as its primary outcome falls, fall-related injury or gait/balance. Only studies that used prospective validation were considered. <b>Findings:</b> thirty-four articles testing 38 different tools met the inclusion criteria. The community setting represents the largest number of studies (14) and tools (23) tested, followed by acute (12 studies and 8 tools), long-term care (LTC) (6 studies and 10 tools) and home-support (4 studies and 4 tools). Eleven of the 38 tools are multifactorial assessment tools (MAT) that cover a wide range of fall-risk factors, and 27 are functional mobility assessment tools (FMA) that involve measures of physical activity related to gait, strength or balance. <b>Conclusion:</b> fall-risk assessment tools exist that show moderate to good validity and reliability in most health service delivery areas. However, few tools were tested more than once or in more than one setting. Therefore, no single tool can be recommended for implementation in all settings or for all subpopulations within each setting.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/130
http://dx.doi.org/10.1093/ageing/afl165
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1402015-05-19HighWireOUPageing:36:2
Are hip protectors correctly positioned in use?
Minns, R. J.
Marsh, A.-M.
Chuck, A.
Todd, J.
Research Papers
There are many designs of hip protectors ranging from small elliptical shaped hard shell designs to large circular soft pads. They are held in position usually by being contained in a close fitting pocket on a garment that patients wear all the time they are at risk of sustaining a fracture of the hip if they fall onto the area of the greater trochanter (GT). It is important for the function of the hip protector that the pad element is positioned over the GT when the subject falls onto a surface such as the floor so as to provide the maximal protection by reducing the large forces transmitted to the femoral neck that lead to the fracture of the bone. In this study, anatomical measurements show where the GT is relevant to the centre of the hip protector, and position and movement studies have shown that generally the hard shell design of the hip protector lies posterior and proximal to the GT both for erect and flexed positions of the hip. The position of the GT relevant to the anterior superior iliac crest was established using ultrasound examinations on control and patients admitted with a fracture of the hip due to a fall. The diagonal surface distance for the three groups of test subjects was approximately 12 cm and a template was developed that could be used to locate the GT. A ‘zone’ of GT position and movement has been established relative to the anterior superior iliac crest, and designers of garments should ensure that this zone is within the area of protection provided by their hip protector pad design.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/140
http://dx.doi.org/10.1093/ageing/afl186
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1452015-05-19HighWireOUPageing:36:2
Psychosocial factors associated with fall-related hip fractures
Peel, Nancye M.
McClure, Roderick J.
Hendrikz, Joan K.
Research Papers
<b>Background:</b> fall-related injuries in older people are a major public health concern. This study examined the relationship between psychosocial determinants of healthy ageing and risk of fall-related hip fracture in community-dwelling older people. The purpose was to contribute evidence for promotion of healthy ageing strategies in population-based interventions for fall injury prevention. <b>Methods:</b> a case-control study was conducted with 387 participants, with at least two controls recruited per case. Cases of fall-related hip fracture in community-dwelling people aged 65 and older were recruited from hospital admissions in Brisbane, Australia, in 2003–2004. Community-based controls, matched by age, sex and postcode, were recruited via electoral roll sampling. A questionnaire assessing psychosocial factors, identified as determinants of healthy ageing, was administered at face-to-face interviews. <b>Results:</b> psychosocial factors having a significant independent protective effect on hip fracture risk included being currently married [OR: 0.44 (0.22 to 0.88)], living in present residence for 5 years or more [OR: 0.43 (0.22 to 0.84)], having private health insurance [OR: 0.49 (0.27 to 0.90)], using proactive coping strategies [OR: 0.52 (0.29 to 0.92)], having a higher level of life satisfaction [OR: 0.47 (0.27 to 0.81)], and engagement in social activities in older age [OR: 0.30 (0.17 to 0.54)]. <b>Conclusion:</b> this study suggests that psychosocial determinants of healthy ageing are protective in fall-related hip fracture injury in older people. Reduction in the public health burden caused by this injury may then be achieved by implementing healthy ageing strategies involving community-based approaches to enhance the psychosocial environments of older people.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/145
http://dx.doi.org/10.1093/ageing/afl167
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1512015-05-19HighWireOUPageing:36:2
A randomised controlled trial of warfarin versus aspirin for stroke prevention in octogenarians with atrial fibrillation (WASPO)
Rash, Amar
Downes, Tom
Portner, Robin
Yeo, Wilf W.
Morgan, Nicolette
Channer, Kevin S.
Research Papers
<b>Background:</b> atrial fibrillation (AF) is the commonest chronic arrhythmia with a prevalence of 9% in octogenarians and accounts for 24% of the stroke risk in this population. Although trials demonstrate reductions in stroke with warfarin, audit data show that it is still underused. However, anti-coagulation in the very elderly is not without risk. <b>Methods:</b> randomised open labelled prospective study of primary thromboprophylaxis for AF. Patients aged >80 and <90 were randomised to receive dose-adjusted warfarin (INR 2.0–3.0) or aspirin 300 mg. All patients had permanent AF, were ambulant, had Folstein mini mental score >25 and had no contraindications to either treatment. Follow-up was for 1 year with 3 monthly visits. The primary outcome measure was a comparative frequency of combined endpoints comprising death, thromboembolism, serious bleeding and withdrawal from the study. <b>Results:</b> seventy-five patients (aspirin 39; warfarin 36) were entered (mean age 83.9, 47% male). There were significantly more adverse events with aspirin (13/39; 33%) than warfarin (2/36; 6%), <it>P</it> = 0.002. 10/13 aspirin adverse events were caused by side effects and serious bleeding; there were three deaths (two aspirin, one warfarin). <b>Conclusion:</b> dose-adjusted warfarin was significantly better tolerated with fewer adverse events than aspirin 300 mg in this elderly population. Although aspirin 75 mg may have been better tolerated, there is no evidence for efficacy in AF at this dose.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/36/2/151
http://dx.doi.org/10.1093/ageing/afl129
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1572015-05-19HighWireOUPageing:36:2
Non-valvular atrial fibrillation and cognitive decline: a longitudinal cohort study
Park, Helen
Hildreth, Anthony
Thomson, Richard
O'Connell, Janice
Research Papers
<b>Objectives:</b> non-valvular atrial fibrillation (NVAF) is an established risk factor for thromboembolism and stroke. Small cross-sectional studies suggest associations between NVAF, silent cerebral infarction and decreased cognitive function. We compared change in cognitive function between patients with recent onset NVAF and controls 12 and 36 months after baseline assessment, and examined the impact of anti-thrombotic therapy. <b>Design:</b> prospective longitudinal cohort study with follow-up at 12 and 36 months. <b>Setting:</b> Sunderland and South Tyneside, North East of England. <b>Participants:</b> community-dwelling men and women aged over 60 with recently identified NVAF or in sinus rhythm, matched for age, sex and general practice (<it>N</it> = 362, 174 NVAF, 188 sinus rhythm). Participants were stratified for use of anti-thrombotic therapy. <b>Measurements:</b> assessment included stroke risk factors and a comprehensive battery of neuropsychological tests. <b>Results:</b> at 3 years, 74 cases and 86 controls remained, giving an attrition rate for cases (59%) versus controls (52%); <it>p</it> = 0.15. Analysis of change in cognitive function between baseline and follow-up at 12 and 36 months revealed no clinically important differences between cases and controls, nor between subgroups on aspirin, warfarin or neither. Age and other confounders did not influence the results. <b>Conclusions:</b> there was no association between overall cognitive decline and NVAF after 3 years' follow-up, nor any apparent effect of anti-thrombotic therapy. This is consistent with our baseline results, but conflicts with previous studies. Cognitive decline is probably multifactorial and any influence of NVAF was not identified in this study.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/36/2/157
http://dx.doi.org/10.1093/ageing/afl164
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1642015-05-19HighWireOUPageing:36:2
Cognitive impairment and MRI correlates in the elderly patients with type 2 diabetes mellitus
van Harten, Barbera
Oosterman, Joukje
Muslimovic, Dino
van Loon, Bert-Jan Potter
Scheltens, Philip
Weinstein, Henry C.
Research Papers
<b>Background:</b> exact mechanisms underlying cognitive dysfunction in diabetes mellitus (DM) remain unclear. Imaging studies of the brain could help to identify possible structural brain lesions underlying cognitive dysfunction. <b>Objective:</b> to describe a detailed neuropsychological profile in patients functioning independently with type 2 DM. Secondly, correlations were studied between cognitive impairment and brain lesions on magnetic resonance imaging (MRI), i.e. periventricular hyperintensities (PVH), deep white matter lesions (DWML), medial temporal lobe atrophy (MTA), cerebral atrophy and lacunar infarcts. In addition, the influence of relevant disease variables of DM was studied. <b>Methods:</b> 92 patients with type 2 DM (mean age 73.2 ± 5.7 years, mean duration 13.8 ± 10.8 years) and 44 control subjects (mean age 72.9 ± 5.3 years) were included and underwent an extensive neuropsychological test battery and an MRI of the brain. <b>Results:</b> neuropsychological scores were worse for each cognitive domain except for memory functions after adjustment for hypertension in a group of elderly patients with type 2 DM compared to healthy control subjects. Only PVH were independently associated with motor speed, whereas all other MRI measures were not independently associated with cognitive impairment. Interactions between the different MRI measures were not present. Glycosylated haemoglobin (HbA<inf>1<it>c</it></inf>) and duration of DM were significantly associated with cognitive dysfunction. <b>Conclusions:</b> the data of this cross-sectional study show that type 2 DM is associated with diminished cognitive function in different cognitive domains, while memory is less affected after adjustment for hypertension. The association of cognitive impairment with MRI measures is equivocal, whereas HbA<inf>1<it>c</it></inf> and duration of DM were significantly associated with cognitive dysfunction.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/164
http://dx.doi.org/10.1093/ageing/afl180
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1712015-05-19HighWireOUPageing:36:2
Person-centred dementia services are feasible, but can they be sustained?
Gladman, J. R. F.
Jones, R. G.
Radford, K.
Walker, E.
Rothera, I.
Research Papers
<b>Background:</b> we evaluated a specialist community-based dementia service to establish whether high quality care was being delivered and the conditions for doing so. The service was in an urban part of Rushcliffe Primary Care Trust, Nottinghamshire, United Kingdom. The service comprised an assessment team of an occupational therapist, a community psychiatric nurse and a community care officer, supported by 235 h per week of care delivered by a team of specially trained community care workers. <b>Methods:</b> a qualitative study was performed using non-participant observation, semi-structured interviews and focus groups, and analysed using a thematic framework approach. There were 2 focus groups involving staff, 11 interviews of staff and stakeholders, and interviews of 15 carers of people with dementia. <b>Results:</b> the care provided was appreciated by carers, and the service was approved by staff and stakeholders. Care was delivered using a rehabilitative style that aimed to maintain personhood, rather than to promote independence. Clients were usually referred with the object of preventing unwanted admission to institutional care but, over time, moving into an institution ceased to be a uniformly undesirable outcome. The service's resources were reduced during the evaluation period, in part to meet mental health needs in intermediate care services. <b>Conclusions:</b> an appropriately resourced and constructed specialist service using an adaptive rehabilitation approach aimed at maintaining personhood can deliver good individualised care to people with dementia, but specific and appropriate commissioning for these services is needed to nurture them.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/171
http://dx.doi.org/10.1093/ageing/afl161
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1772015-05-19HighWireOUPageing:36:2
Vitamin B12 deficiency in the aged: a population-based study
Loikas, Saila
Koskinen, Pertti
Irjala, Kerttu
Löppönen, Minna
Isoaho, Raimo
Kivelä, Sirkka-Liisa
Pelliniemi, Tarja-Terttu
Research Papers
<b>Background:</b> vitamin B12 deficiency is common in the aged, but it is controversial whether only some risk groups should be investigated instead of screening the entire aged population. <b>Objectives:</b> to describe the prevalence of vitamin B12 deficiency in the Finnish aged, and to find out if the subjects especially prone to vitamin B12 deficiency could be identified by the risk factors or clinical correlates. <b>Design:</b> a cross-sectional, population-based study of 1048 aged subjects (age 65–100 years) was carried out. Data on lifestyle factors and clinical conditions were collected, physical examinations were conducted and laboratory variables related to vitamin B12 were measured. <b>Results:</b> vitamin B12 deficiency had been previously diagnosed in 27 (2.6%) subjects, and a laboratory diagnosis (total vitamin B12 <150 pmol/l, or total vitamin B12 150–250 pmol/l and holotranscobalamin ≤37 pmol/l and homocysteine ≥15 μmol/l) was made for 97 (9.5%) subjects. Low serum total vitamin B12 (<150 pmol/l) was observed in 6.1% and borderline total vitamin B12 (150–250 pmol/l) in 32% of the subjects. Male gender (OR 1.9, 95% CI 1.2–2.9), age ≥75 (OR 2.2, 95% CI 1.4–3.4) and refraining from milk products (OR 2.3, 95% CI 1.2–4.4) increased the probability for vitamin B12 deficiency. Anaemia (OR 1.3, 95% CI 0.7–2.3) or macrocytosis (OR 1.2, 95% CI 0.6–2.7) did not predict vitamin B12 deficiency. <b>Conclusion:</b> undiagnosed vitamin B12 deficiency is remarkably common in the aged, but no specific risk group for screening can be identified. Thus, biochemical screening of unselected aged population is justified. General practitioners play a key role in diagnosing early vitamin B12 deficiency.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/177
http://dx.doi.org/10.1093/ageing/afl150
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1842015-05-19HighWireOUPageing:36:2
Prognosis assessment in stroke patients at discharge from hospital
Olai, Lena
Omne-Pontén, Marianne
Borgquist, Lars
Svärdsudd, Kurt
Research Papers
<b>Background:</b> accurate prognostic assessments of need of help, health and dwelling situation in stroke patients are important for patient management, rehabilitation, discharge planning, and for providing reliable information to patients and their relatives. <b>Objective:</b> to analyse factors affecting the accuracy of discharge prognosis assessments. <b>Design:</b> prospective study of stroke patients discharged from hospital. <b>Setting:</b> two cities in central Sweden. <b>Subjects:</b> three hundred and ninety stroke patients, 65 years or older, living in their own homes and having no dementia diagnosis prior to hospital admission. <b>Methods:</b> at discharge, physicians, nurses, occupational therapists and physiotherapists in the Departments of Internal Medicine and Geriatrics were asked to make an individual prognosis assessment regarding patients’ need for help, health and dwelling situation at 3 and 12 months after admission to hospital. <b>Results:</b> the prognosis assessments were on average accurate in 68.4% (3 months) and 61.5% (12 months), far better than chance (33.3%). There were no significant differences between staff categories. The accuracy was influenced by a number of patient linked factors, such as activity degree, household situation before admission, and Mini Mental State Examination level and need of help measured 1 week after discharge, and ranged from 22 to 89%, depending on factor combinations. <b>Conclusions:</b> prognosis assessments based on clinical judgement were on average quite accurate but the accuracy varied markedly with patient linked factors. Feedback of outcome might be one way to further improve the accuracy of prognosis assessment.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/184
http://dx.doi.org/10.1093/ageing/afl146
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1902015-05-19HighWireOUPageing:36:2
Proactive care of older people undergoing surgery ('POPS'): Designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients
Harari, Danielle
Hopper, Adrian
Dhesi, Jugdeep
Babic-Illman, Gordana
Lockwood, Linda
Martin, Finbarr
Research Papers
<b>Background:</b> older people undergoing elective surgery have significant post-operative problems prolonging hospitalisation. <b>Objective:</b> to design, embed, and evaluate an evidence-based comprehensive geriatric assessment (CGA) service for at-risk older patients undergoing elective surgery. <b>Setting:</b> urban teaching hospital. <b>Subjects:</b> elective surgical patients aged 65+. <b>Intervention:</b> multidisciplinary preoperative CGA service with post-operative follow-through (proactive care of older people undergoing surgery [‘POPS’]). <b>Methods:</b> observational cohort study and multilevel surveys (development and modelling phase). Prospective ‘before and after’ comparison (exploratory evaluation). <b>Results:</b> findings from the development phase showed high levels of preoperative co-morbidity, no multidisciplinary preoperative input, and multiple potentially preventable post-operative problems delaying discharge in older elective surgery patients. Comparison of 2 cohorts of elective orthopaedic patients (pre-POPS vs POPS, N = 54) showed the POPS group had fewer post-operative medical complications including pneumonia (20% vs 4% [<it>p</it> = 0.008]) and delirium (19% vs 6% [<it>p</it> = 0.036]), and significant improvements in areas reflecting multidisciplinary practice including pressure sores (19% vs 4% [<it>p</it> = 0.028]), poor pain control (30% vs 2% [<it>p</it><0.001]), delayed mobilisation (28% vs 9% [<it>p</it> = 0.012]) and inappropriate catheter use (20% vs 7% [<it>p</it> = 0.046]). Length of stay was reduced by 4.5 days. There were fewer delayed discharges relating to medical complications (37% vs 13%) or waits for OT assessment or equipment (20% vs 4%). <b>Conclusion:</b> a proactive evidence-based CGA service for at-risk older elective surgical patients was developed according to MRC framework for complex interventions. Pre/post comparison in elective orthopaedic patients showed improved (within methodological limitations) post-operative outcomes indicative of better clinical effectiveness and efficiency, and contributed to the service obtaining mainstream funding. Informed by the present study, a randomised controlled trial is ongoing.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/190
http://dx.doi.org/10.1093/ageing/afl163
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/1972015-05-19HighWireOUPageing:36:2
Dignity and the challenge of dying in nursing homes: the residents' view
Pleschberger, Sabine
Research Papers
<b>Background:</b> human dignity is discussed in almost all public debates on the care of the dying, as well as in international policies for health and social care of older people. Because nursing homes are gaining importance as places where residents live out their lives in modern western societies and since there is evidence that end-of-life care in nursing homes lacks quality, there is a growing discussion on introducing improved end-of-life care in these institutions. In order to accomplish this, the view of those who are most affected is of utmost importance. <b>Objective:</b> to explore the meaning of dignity with regard to end-of-life issues from the perspective of older nursing home residents in western Germany. <b>Methods:</b> this qualitative study is based on the Grounded Theory Approach, and the design included three steps of data generation; narrative interviews with residents of nursing homes constitute the main data pool (<it>n</it> = 20) of the results presented in this paper. Theoretical sampling was aimed at maximising the variety of organisational as well as residents' characteristics. Analysis of the transcripts was supported by Atlas/ti program and followed several different coding procedures and aimed at generating a concept of dignity. <b>Results:</b> dignity was differentiated into intrapersonal dignity and relational dignity, socially constructed by the act of recognition. Social relations and encounters are a prerequisite for relational dignity, which underlines the vulnerability of nursing home residents' who increasingly lack social networks. A broad spectrum of attitudes and behaviour, which aimed at recognising dignity, was bundled under the category ‘not being a burden’. In this light, dignity was challenged most by the threat of illness and having care needs. This was fostered by the perception of insufficient care in the nursing homes. In the light of this concept, death with dignity meant ‘death at the right time’, though the residents in the sample did not want to comment on the time of death, other than aspects like (i) being active to the very last, (ii) respecting one's will and being allowed to die, (iii) not being in pain, (iv) being amongst persons close to one (valediction and showing respect). <b>Conclusion:</b> the study emphasizes the high vulnerability of nursing home residents with regard to dignity. They place their dignity under the constraints of the need for help and care into question. This appears alarming, if one does not manage to, with the help of different ethics, obtain a new perspective on these phases of life. It is evident that the understanding of dignity is not solely individualistic and personal, but rather has a close relationship to social ideas of value, which ultimately influence the basic requirements of institutions in which ‘frail old people’ live.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/197
http://dx.doi.org/10.1093/ageing/afl152
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2032015-05-19HighWireOUPageing:36:2
Type of alcohol consumed, changes in intake over time and mortality: the Leisure World Cohort Study
Paganini-Hill, Annlia
Kawas, Claudia H.
Corrada, María M.
Research Papers
<b>Background:</b> modifiable behavioural risk factors including smoking and alcohol consumption are major contributing or actual causes of mortality. <b>Objective:</b> to examine the effect of alcohol intake on all-cause mortality in older adults. <b>Design and Setting:</b> prospective population-based cohort study of residents of a California, United States retirement community. <b>Subjects:</b> 8,877 women and 5,101 men (median age, 74 years) who in the early 1980s completed a postal health srvey incluing details on alcohol consumption. <b>Methods:</b> participants were followed for 23 years (1981–2004) including two follow-up questionnaires (in 1992 and 1998) asking about current alcohol intake. Age-adjusted and multivariate-adjusted risk ratios of death and 95% confidence intervals were calculated separately for men and women, using proportional hazard regression. <b>Results:</b> of the 8,644 women and 4,980 men with complete information on the variables of interest and potential confounders, 6,930 women and 4,456 men had died (median age, 87 years). Both men and women who drank alcohol had decreased mortality compared with non-drinkers. Those who drank two or more drinks per day had a 15% reduced risk of death. The reduced risk was not limited to one type of alcohol. Stable drinkers (those who reported drinking both at baseline and follow-up) had a significantly decreased risk of death compared with stable non-drinkers. Those who started drinking at follow-up also had a significantly lower risk. Women who quit drinking were at increased risk of death. <b>Conclusion:</b> in elderly men and women, moderate alcohol intake exhibits a beneficial effect on mortality. Those who quit may do so for health reasons that affect mortality.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/203
http://dx.doi.org/10.1093/ageing/afl184
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2092015-05-19HighWireOUPageing:36:2
Profiling disability within nursing homes: a census-based approach
Falconer, Marianne
O'Neill, Desmond
Research Papers
<b>Background:</b> a significant minority of older people live in residential care. While disability is often a major contributory factor, it may not be measured or managed adequately by health and social services. At present there is little information comparing levels of disability within nursing homes and the community, and no mechanisms for monitoring changes in this disability ratio longitudinally. <b>Objective:</b> to examine the prevalence of disability among older nursing home residents compared to its prevalence among older people in the community using a census-based approach. <b>Design:</b> nationwide census over one night in 2002. <b>Setting:</b> all homes and dwellings in the Republic of Ireland. <b>Method:</b> disability was measured using a six-item questionnaire embedded in a census form. Prevalence of disability was quantified among the general population and nursing homes residents aged 65 and over. Comparisons were made of sex, and number and type of disabilities between nursing home residents and their age-matched peers living within the community. <b>Results:</b> the results showed a high level of disability within nursing homes with almost 90% of residents having a recorded disability compared with less than 30% of those aged 65 and over, living in the community. Nursing home residents had on average 4.5 disabilities ranging from hearing and visual problems to difficulties remembering and concentrating. <b>Conclusion:</b> there is a very high level of physical, sensory and cognitive disability among nursing home residents. Strategic health and functional questions in national censuses may be helpful in planning appropriate services for older people in residential care, as well as tracking trends in disability.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/36/2/209
http://dx.doi.org/10.1093/ageing/afl185
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2132015-05-19HighWireOUPageing:36:2
Inhaled therapy in elderly COPD patients; time for re-evaluation?
Jarvis, Sheba
Ind, Philip W.
Shiner, Robert J.
Research Papers
<b>Objective:</b> chronic obstructive pulmonary disease (COPD) prevalence steadily increases with age. However, the effectiveness of inhaled therapy in the elderly COPD population has rarely been formally evaluated. We studied a group of elderly patients with COPD with a range of severity, selected from one General Practice register to measure peak inspiratory flow (PIF) and assess patient perceived benefit. <b>Methods:</b> we recruited 53 randomly selected elderly patients with COPD (36 males) with a mean age of 73.5 years (range 65–89 years). The evaluation consisted of (i) information obtained from directed questions and (ii) objective measurements of the ability to generate adequate PIF for a variety of inhalers. Patients answered questions regarding ease of use, perceived benefit from and specific problems encountered with their inhaler. Three recordings of PIF were measured at varying inhaled resistances using the ‘In-Check Dial’. <b>Results:</b> thirty-five were classified as mild, 17 moderate and 1 severe COPD. All patients used a metered dose inhaler (pMDI), and 12 of the patients also used a dry powder inhaler (DPI). Forty six per cent of patients using a pMDI and 17% of those using a DPI rated their device difficult to use. No patient used a nebuliser. Thirty-one of the 53 patients using just a pMDI felt they were able to perceive benefit in comparison to 4 of the 12 DPI users. Even though most DPI users (10/12) had rated their inhaler as easy to use, 50% were ‘unsure’ as to whether they received any clinical benefit. Most patients were unable to generate sufficient inspiratory flow to use the higher resistance DPI's and patients with COPD who were able to generate adequate PIF were invariably mild. A significant negative correlation was found between age and the PIF achieved when assessed using the high resistance device setting (<it>R</it> = 0.84, <it>P</it><0.0001). Multivariate analysis showed the effect of age on PIF was independent of the disease grade. <b>Conclusions:</b> elderly patients with COPD, even when in a stable clinical condition, may be unable to gain optimum benefit from their inhaler.
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/213
http://dx.doi.org/10.1093/ageing/afl174
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2192015-05-19HighWireOUPageing:36:2
The effect of exercise on outcomes for hospitalised older acute medical patients: an individual patient data meta-analysis
De Morton, Natalie A.
Jones, Catherine T.
Keating, Jennifer L.
Berlowitz, David J.
MacGregor, Lachlan
Lim, Wen K.
Jackson, Bruce
Brand, Caroline A.
Research Letters
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/219
http://dx.doi.org/10.1093/ageing/afl118
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2222015-05-19HighWireOUPageing:36:2
C-reactive protein levels predict the incidence of delirium and recovery from it
Macdonald, Alastair
Adamis, Dimitrios
Treloar, Adrian
Martin, Finbarr
Research Letters
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/222
http://dx.doi.org/10.1093/ageing/afl121
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2252015-05-19HighWireOUPageing:36:2
Failure to complete performance-based measures is associated with poor health status and an increased risk of death
Rockwood, Kenneth
Jones, David
Wang, Yan
Carver, Daniel
Mitnitski, Arnold
Research Letters
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/225
http://dx.doi.org/10.1093/ageing/afl160
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/229-a2015-05-19HighWireOUPageing:36:2
Lorazepam-reversible catatonia in the elderly can mimic dementia, coma and stroke
Alisky, Joseph Martin
Clinical Reminders
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/229-a
http://dx.doi.org/10.1093/ageing/afl168
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2292015-05-19HighWireOUPageing:36:2
Mono-osteotic Paget's disease of the hand
Das, Abhay Kumar
Schwarz, Konstantin
Clinical Reminders
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/229
http://dx.doi.org/10.1093/ageing/afl166
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2302015-05-19HighWireOUPageing:36:2
Training in geriatric medicine in UK undergraduate medical schools
Pack, Louise
Fuller, Richard
Pell, Godfrey
Roberts, Trudie
Letters to the Editor
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/230
http://dx.doi.org/10.1093/ageing/afl156
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/231-a2015-05-19HighWireOUPageing:36:2
Low serum vitamin B12 in older people: the role of alcohol and thyroid status
Varghese, Abraham I.
Varughese, George I.
Letters to the Editor
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/231-a
http://dx.doi.org/10.1093/ageing/afl158
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2312015-05-19HighWireOUPageing:36:2
Reply
Crome, Peter
Letters to the Editor
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/231
http://dx.doi.org/10.1093/ageing/afl157
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/232-a2015-05-19HighWireOUPageing:36:2
Vitamin D supplementation and the prevention of fractures and falls
Zeimer, Henry
Letters to the Editor
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/232-a
http://dx.doi.org/10.1093/ageing/afl176
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2322015-05-19HighWireOUPageing:36:2
Reply
Hin, Harold
Clarke, Robert
Letters to the Editor
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/232
http://dx.doi.org/10.1093/ageing/afl159
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2332015-05-19HighWireOUPageing:36:2
Reply
Law, Malcolm
Morris, Joan
Withers, Heather
Letters to the Editor
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/233
http://dx.doi.org/10.1093/ageing/afl177
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/234-a2015-05-19HighWireOUPageing:36:2
Video phone diagnosis of 'funny turns'
Parikh, R.
Wong, R.
Letters to the Editor
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/234-a
http://dx.doi.org/10.1093/ageing/afl171
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2342015-05-19HighWireOUPageing:36:2
Comparative analysis of mortality in patients with Alzheimer's disease treated with donepezil and galantamine
Capellà, Dolors
Vidal, Xavier
Letters to the Editor
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/234
http://dx.doi.org/10.1093/ageing/afl169
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2352015-05-19HighWireOUPageing:36:2
Reply
López-Pousa, Secundino
Garre-Olmo, Josep
Vilalta-Franch, Joan
Letters to the Editor
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/235
http://dx.doi.org/10.1093/ageing/afl170
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/236-a2015-05-19HighWireOUPageing:36:2
The Experience of Retirement * Edited by Robert S. Weiss * Cornell University Press, 2005. ISBN 978-0-8014-7252-7, $18.75
Coni, Nicholas
Book Reviews
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/236-a
http://dx.doi.org/10.1093/ageing/afl154
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2362015-05-19HighWireOUPageing:36:2
Standards in Dementia Care * Edited by Alistair Burns * Taylor and Francis, ISBN 1841845264, {pound}95
Jolley, David
Book Reviews
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/236
http://dx.doi.org/10.1093/ageing/afl151
en
Copyright (C) 2007, British Geriatrics Society
oai:open-archive.highwire.org:ageing:36/2/2382015-05-19HighWireOUPageing:36:2
Corrigendum
Corrigendum
Oxford University Press
2007-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/36/2/238
http://dx.doi.org/10.1093/ageing/afm012
en
Copyright (C) 2007, British Geriatrics Society