Age and Ageing

WADE, D., T.

doi: 10.1093/ageing/17.5.289pmid: 2976574

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HEBERT,, R.;CARRIER,, R.;BILODEAU,, A.

doi: 10.1093/ageing/17.5.293pmid: 2976575

Abstract The Functional Autonomy Measurement System (SMAF) is an instrument developed for the measurement of the needs of the elderly and the handicapped. Its elaboration was based on the World Health Organization's classification of impairments, disabilities and handicaps. A functional autonomy rating scale, using a four-level measurement scale, quantifies a subject's performance on 29 functions in five sectors of activity: activities of daily living, mobility, communication, mental functions and instrumental activities of daily living. For each function, the evaluator must also estimate available resources to compensate for any identified disability in order to estimate the handicap. The disability and handicap profile obtained is the basis for the prescription of home care or the allocation of chronic care beds. An inter-observer study concluded that the scale is reliable for evaluators from different professions in the community as well as in institutional settings. The instrument is rapid to administer (on average 42 min) and the reliability is not influenced by training. A study of concurrent validity has shown a strong correlation between the disability index obtained by the SMAF and the amount of required nursing-care time. This instrument can be used for clinical purposes and in epidemiological and evaluative research. This content is only available as a PDF. © Oxford University Press

MOLLOY, D., W.;McLaughlin, J., Samuel;RICHARDSON, L., DELAQUERRIERE;CRILLY, R., G.

doi: 10.1093/ageing/17.5.303pmid: 3068971

Abstract This randomized controlled trial examined the effect of a 3-month exercise programme on neuropsychological function in a population of very elderly institutionalized women. Baseline neuropsychological testing was performed, and following 3 months of exercise or control intervention, subjects were retested 3ndash;7 days after the completion of the study period. Apart from the Word Fluency Test, there was no significant improvement in any of the neuropsychological test scores. This study may not have shown any significant improvement in neuropsychological function because our exercise programme was too light to improve aerobic fitness, or because neuropsychological tests were repeated 3–7 days after exercise was completed and any acute effects of exercise may have disappeared by that time. This content is only available as a PDF. © Oxford University Press

GERARD,, KAREN

doi: 10.1093/ageing/17.5.311pmid: 3148271

Abstract Three alternative day care settings for a defined subgroup of frail elderly people are evaluated using cost-effectiveness analysis. This subgroup of frail elderly people is a significant minority of day-care users who have specific and separately identifiable needs. Their utilization of day care often results in the expensive use of day hospital resources or inappropriate social centre facilities. By using a mixture of published and original data sources this paper argues that specialist day services for frail elderly people can be considered at least as effective as either day hospital or social centre care. However, although it is concluded that the use of a specialist day service is more cost-effective than the day hospital, more analysis of the benefits of care in social centres is required before any judgement can be made about the relative cost-effectiveness between these settings. This content is only available as a PDF. © Oxford University Press

BOYCE, W., J.;VESSEY, M., P.

doi: 10.1093/ageing/17.5.319pmid: 3232586

Abstract Physical inactivity is associated with low bone mass in adults, and might therefore be a risk factor for proximal femoral fracture in old age. This hypothesis was tested in a case-control study of 139 selected patients with confirmed proximal femoral fracture and 139 age- and sex-matched community controls, using an interviewer-administered questionnaire. Patients had been significantly less physically active in middle age than had controls, a difference that was greater in the younger subjects. It is suggested that the progressive decrease during the present century in the amount of physical activity associated with everyday life has resulted in increased numbers of elderly people being at risk of femoral fracture and may be the cause of the rises in age-specific incidence rates now being observed. If this explanation is correct, a planned increase in leisure-time physical activity in middle age and beyond may be the most effective method of preventing these fractures. This content is only available as a PDF. © Oxford University Press

GIBBINS, F., J.;SEN,, I.;VAZ, F., S.;BOSE,, S.

doi: 10.1093/ageing/17.5.328pmid: 3148272

Abstract Over-prescribing on long-stay wards for the elderly is a common problem. A scheme of senior doctor surveillance of prescribing on long-stay wards in a district general hospital is described, which involved stopping all drugs except those considered essential. A reduction of over 50% in the number of drugs taken per patient, and a saving of 34% in drug costs was achieved, without detriment to patients' well-being. Increased drug utilization on some wards is considered to occur because of the ward sister's demand for patients to be given drugs such as sedatives and tranquillizers. Regular re-education of nursing and junior medical staff to reduce over-prescribing is recommended. This content is only available as a PDF. © Oxford University Press

CAMPBELL, R., R.;BEERE,, D.;WILCOCK, G., K.;BROWN, E., M.

doi: 10.1093/ageing/17.5.333pmid: 3232587

Abstract A recent report suggested that Clostridium difficile ( Cl. difficile ) was endemic in chronic-care facilities. We have examined the prevalence of Cl. difficile carriage in 67 patients in a large geriatric hospital. CI. difficile was sought by both toxin and culture methods, but was not detected in the stools of any patient. These findings suggest that Cl. difficile is not part of the normal faecal flora in elderly in-patients. This content is only available as a PDF. © Oxford University Press

BLACK, D., A.;HEDUAN,, E;MITCHELL,, D

doi: 10.1093/ageing/17.5.337pmid: 3232588

Abstract Post-mortem concentrations of hepatic retinyl and retinyl esters were determined in 40 subjects aged over 65 years to assess the effects of disease and malnutrition on vitamin A reserves. Three groups of patients (mean age 79.6 years) were studied: (1) previously healthy, (2) chronically ill, (3) chronically ill and wasted. There was no significant difference in height or age between the groups, but group 3 was lighter than both group 1 ( P <0.001) and group 2 ( P <0.05). Free retinol and retinyl esters.were measured by high pressure liquid chromatography, and the total hepatic retinol calculated. Analysis of variance showed that the three groups differed significantly ( P <0.02) with regard to total retinol, retinyl palmitate and total retinyl ester content. This content is only available as a PDF. © Oxford University Press

BREEN, EUGENE, G.;COGHLAN, JOHN, G.;EGAN,, ERNEST;MCCARTHY, CIARAN, F.

doi: 10.1093/ageing/17.5.343pmid: 3232589

Abstract Six elderly patients with accidental hypothermia were prospectively evaluated for impaired coagulation. All patients had abnormal coagulation profiles. Three patients with severe coagulopathies and serious underlying conditions died while hypothermic. Despite investigation, no cause for disordered coagulation was found in four patients. We conclude that hypothermia per se contributes to disordered coagulation in the elderly. This content is only available as a PDF. © Oxford University Press

MACPHEE, GRAEME J., A.;CROWTHER, JOHN, A.;MCALPINE, CHRISTINE, H.

doi: 10.1093/ageing/17.5.347pmid: 3068972

Abstract This study investigated the reliability of simple bedside free-field voice testing in the detection of hearing impairment in patients admitted to a geriatric unit. Sixty-two consecutive admissions were assessed at four graduated levels of loudness by geriatrician and otolaryngologist independently. Pure tone audiometry was then performed blind. Voice testing by both observers was concordant in 88% of all ears and in 100% of ears able to hear a whispered voice (WV) at 2 ft (≈ 0.6 m). The WV at 2 ft was the most discriminant test with a sensitivity of 100%, a specificity of 84% and a predictive value of 92% for hearing impairment likely to benefit from provision of a hearing aid. Free-field voice testing appears a simple, reliable and reproducible test for detecting hearing impairment in elderly patients. This content is only available as a PDF. © Oxford University Press