Low levels of ill health among elderly non-consulters in general practice.

The characteristics of random samples of elderly patients (over 65 years of age), designated as consulters (n = 200) and non-consulters (n = 196), in a group general practice were compared using a postal questionnaire that was validated by comparison with findings by general practitioners in a random sample of 58 responders. A response rate of 90% was obtained, and all non-responders were visited by their general practitioner. The questionnaire had a sensitivity of 79% and a specificity of 82% when compared with general practitioner findings. The use of hospital and social services by non-consulters was low in this practice. Measures of disability and state of health showed that non-consulters were a fit group of the aged. Case finding for problems among elderly people should initially be confined to consulters, who have a high prevalence of problems. Non-consulters are a low risk group that can be assessed only with special effort and extra resources. Once an effective case finding system has been developed it might then be reasonable to consider ways of finding the few patients who have problems but do not consult their doctor.     

Improving the health behaviours of elderly people: randomised controlled trial of a general practice education programme

ObjectivesTo establish the effect of an educational intervention for general practitioners on the health behaviours and wellbeing of elderly patients.DesignRandomised controlled trial with 1 year follow up.SettingMetropolitan general practices in Melbourne, Australia.Subjects42 general practitioners and 267 of their patients aged over 65 years.InterventionEducational and clinical practice audit programme for general practitioners on health promotion for elderly people.ResultsPatients in the intervention group had increased (a) walking by an average of 88 minutes per fortnight, (b) frequency of pleasurable activities, and (c) self rated health compared with the control group. No change was seen in drug usage, rate of influenza vaccination, functional status, or psychological wellbeing as a result of the intervention. Extrapolations of the known effect of these changes in behaviour suggest mortality could be reduced by 22% if activity was sustained for 5 years.ConclusionsEducation of the general practitioners had a positive effect on health outcomes of their elderly patients. General practitioners may have considerable public health impact in promotion of health for elderly patients.

Key messages

• Few educational interventions for doctors have shown benefit to the health of patients
• Elderly people were identified in the UK health initiatives as in need of additional attention, and levels of health protective behaviours were low in community surveys
• A multifaceted educational intervention for general practitioners was effective in improving walking behaviour, self rated health status, and the frequency of social contacts in elderly patients
• General practitioners are effective in improving health and health behaviours in their elderly patients

     

General practitioner response to elderly patients discharged from hospital.

OBJECTIVE--To determine the effect of discharge information given to general practitioners on their management of newly discharged elderly patients. DESIGN--A random sample of 133 elderly patients who had unplanned readmission to a district general hospital within 28 days of discharge was compared with a matched control sample of patients who were not readmitted. Information was gathered from the hospital, the patients, the carers, and the general practitioners about the information that the hospital had sent the general practitioner and the general practitioners'' response to this information. SETTING--All specialties in a district general hospital. PATIENTS--266 Patients aged over 65 representative in the main demographic indices of the population of elderly patients admitted to hospital. RESULTS--Ten weeks after discharge the doctors had received notice of discharge about 169 of the patients, but fewer than half the discharge notices were received within the first week. General practitioners were dissatisfied with the information in 60 cases. A general practitioner visited 174 of the patients after their discharge from hospital and three quarters of the visits took place within two weeks of the discharge. These visits were more likely to have been initiated by patients or families than by the doctor, and this was not influenced by the doctor receiving notice of the patient''s discharge. Older patients and those who had carers were the most likely to be visited. Nearly half of the carers were dissatisfied with some aspect of general practitioner care, problems with home visiting being the commonest source of complaint. CONCLUSIONS--Hospital communications to general practitioners about the discharge of elderly patients still cause concern, particularly in the time they take to arrive. Written instruction to vulnerable elderly patients asking them to inform their general practitioner of the discharge might be helpful. Carers complained of lack of support, and it is clearly important for someone (either the general practitioner or another health worker) to visit elderly people shortly after their discharge.     

Evaluation of a course for general practitioners on muscles and joints.

We attempted to evaluate a course on muscle and joint problems for general practitioners using a practice log diary and a factual test paper, which were completed both before and after the course by the doctors attending. A significant improvement was shown in the group score in the test paper taken after the course (p less than 0.001). Scores in the tests before and after had a negative correlation with age (p less than 0.001). In comparing the data in the second log diary with those in the first there was a significant reduction in the prescribing of drugs (p less than 0.001), use of heat treatment (p less than 0.001), and in "other" forms of treatment (p less than 0.01). No appreciable change in investigations or number of hospital referrals was shown. Those doctors who had low scores in the first factual test referred appreciably more patients to hospital and requested more x ray examinations (p less than 0.01).     

老年帕金森病患者睡眠障碍的危险因素及其对认知功能、心理状态和衰弱的影响

摘要 目的：探讨老年帕金森病（PD）患者睡眠障碍的危险因素,并观察睡眠障碍对认知功能、心理状态和衰弱的影响。方法：选取2018年3月~2021年9月期间中国人民解放军海军青岛特勤疗养中心收治的91例老年PD患者作为研究对象,根据是否存在睡眠障碍将入选的91例患者分为睡眠障碍组（n=56）及非睡眠障碍组（n=35）。采用蒙特利尔认知评估量表（MoCA）评估所有患者的认知功能状况。采用汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评价患者焦虑、抑郁情况。采用Tilburg衰弱评估量表评估所有患者的衰弱情况。采用多因素Logistic回归分析探讨老年PD患者睡眠障碍的危险因素,并观察睡眠障碍对认知功能、心理状态和衰弱的影响。结果：睡眠障碍组的视空间与执行功能、语言、命名、延迟回忆、注意、抽象、定向评分及总分均低于非睡眠障碍组（P<0.05）。睡眠障碍组的HAMA、HAMD评分均高于非睡眠障碍组（P<0.05）。睡眠障碍组的心理衰弱、躯体衰弱、社会衰弱评分及总分均高于非睡眠障碍组（P<0.05）。多因素Losgistic回归分析结果显示：HAMA评分偏高、多巴丝肼片等效剂量偏高、HAMD评分偏高、Hcy偏高是老年PD患者睡眠障碍的危险因素（P<0.05）。结论：HAMA评分偏高、Hcy偏高、多巴丝肼片等效剂量偏高、HAMD评分偏高是老年PD患者睡眠障碍的危险因素。同时,睡眠障碍可加重老年PD患者的认知功能障碍和衰弱程度,增加抑郁焦虑情绪。     

Preventie en behandeling van osteoporose bij kortdurende revalidatie in het verpleeghuis: een taak voor de verpleeghuisarts

Prevention and treatment of osteoporosis in short stay departments of nursing homes: a nursing home physician’s task. This research shows that nursing home physicians might play an important part in the diagnostics and treatment of vitamin-D deficiency. 96 rehabilitating elderly who had undergone a hip operation were investigated. 36% had a vitamin-D deficiency (vitamin-D<30nmol/l). Vitamin-D deficiency was 53 % in the fracture group and 26 % in the arthritis group. Deficiencies were treated with vitamin-D medication. After the patient’s discharge the general practitioner was sent a questionnaire. The results show that general practitioners agree to nursing home physicians’ investigating vitamin-D deficiencies and to nursing home physicians’ initiating vitamin-D medication in case of a deficiency. The general practitioners themselves do not often investigate vitamin-D deficiency. Tijdschr Gerontol Geriatr 2007; 38:147-153     

Prevention and treatment of osteoporosis in short stay departments of nursing homes: a nursing home physician's task

This research shows that nursing home physicians might play an important part in the diagnostics and treatment of vitamin-D deficiency. 96 rehabilitating elderly who had undergone a hip operation were investigated. 36% had a vitamin-D deficiency (vitamin-D < 30 nmol/l). Vitamin-D deficiency was 53 % in the fracture group and 26% in the arthritis group. Deficiencies were treated with vitamin-D medication. After the patient's discharge the general practitioner was sent a questionnaire. The results show that general practitioners agree to nursing home physicians' investigating vitamin-D deficiencies and to nursing home physicians' initiating vitamin-D medication in case of a deficiency. The general practitioners themselves do not often investigate vitamin-D deficiency.     

Effects of preventive home visits to elderly people.

OBJECTIVES--To assess the effect of preventive home visits by public health nurses on the state of health of and use of services by elderly people living at home. DESIGN--Randomised controlled trial. SETTING--General population of elderly people in one of the southern regions of the Netherlands. SUBJECTS--580 subjects aged between 75 and 84 years randomly allocated to intervention (292) or control (288) group. INTERVENTIONS--Four visits a year over three years in intervention group. Control group received no home visits. MAIN OUTCOME MEASURES--Self rated health, functional state, well being, loneliness, aspects of the mental state (depressive complaints, memory disturbances), and mortality. Use of services and costs. RESULTS--Visits had no effect on the health of the subjects. In the group visited no higher scores were seen on health related measures, fewer died (42 (14%) v 50 (17%)), and community care increased slightly. In the control group more were referred to outpatient clinics (166 (66%) v 132 (55%)), and they had a 40% increased risk of admission (incidence rate ratio 1.4; 90% confidence interval 1.2 to 1.6). No differences were found in long term institutional care, and overall expenditure per person in the intervention group exceeded that in the control group by 4%. Additional analyses showed that visits were effective for subjects who initially rated their health as poor. CONCLUSIONS--Preventive home visits are not beneficial for the general population of elderly people living at home but might be effective when restricted to subjects with poor health.     

Health education and exercise stimulation for older people: development and evaluation of the program "Healthy and Vital"

In order to promote health in people of 65 years and older, TNO Prevention and Health developed, evaluated, and implemented "Healthy & Vital" (also known as "Ageing Well and Healthily"). Healthy & Vital consists of six sessions of health education and low-intensity exercises. This paper reports on the theoretical basis of the intervention, the methods and results of a Randomised Controlled Trial (n = 50), and a Community Intervention Trial (in 8 municipalities, n = 448). A brief report is given of the implementation study. Healthy & Vital had a number of positive physiological effects, such as a decrease in blood pressure (effect size -0.55), the Body Mass Index (effect 0.62), and the level of blood glucose (1.00), especially in women and in elderly people who are less active physically. Participants' understanding of health and illness increased significantly (effect 0.78). Due to ceiling effects only a few effects on subjective general health were found, and they disappeared after 6 months. A positive effect on feelings of loneliness remained even after 6 months (p < 0.1). The most important effect of Healthy & Vital was the increase in physical activity, especially in the least active elderly (p < 0.001). Twenty-five per cent of the participants continued activities with More Exercise for Seniors, 28% were still considering this, and 19% continued at home with the exercises they had learnt. Currently, Healthy & Vital is being implemented nationally by the Local Policy for the Elderly Knowledge Centre (www.lokoud.nl).     

老年稳定期精神分裂症患者睡眠障碍现状调查及对记忆功能的影响

摘要 目的：调查老年稳定期精神分裂症患者睡眠障碍现状,分析其影响因素,并分析老年稳定期精神分裂症患者睡眠障碍与记忆功能的关系。方法：选择2018年5月~2021年5月期间我院收治的100例老年稳定期精神分裂症患者。采用自制临床资料调查问卷采集患者临床资料,采用匹茨堡睡眠质量指数（PSQI）评价所有患者的睡眠状况,采用多维记忆评估量表（MMAS）评价所有患者的记忆功能,单因素及多因素Logistic回归分析老年稳定期精神分裂症患者睡眠障碍的影响因素。Pearson检验分析PSQI评分与记忆功能评分的相关性。结果：纳入的100例老年稳定期精神分裂症患者中,有68例发生睡眠障碍,睡眠障碍发生率为68.00%。根据患者有无睡眠障碍分为两组：睡眠障碍组（n=68）和无睡眠障碍组（n=32）。单因素分析结果显示：老年稳定期精神分裂症患者睡眠障碍与年龄、性别、户籍所在地、文化水平、婚姻状况、发病情况、收入情况有关（P<0.05）,而与精神症状无关（P>0.05）。多因素Logistic回归分析显示婚姻状况为未婚/离异/丧偶、户籍所在地为城镇、性别男、年龄>70岁、文化水平为中学、收入情况为无是老年稳定期精神分裂症患者睡眠障碍的危险因素（P＜0.05）。睡眠障碍组汉词记忆、汉词配对、图画记忆评分低于无睡眠障碍组,PSQI评分高于无睡眠障碍组（P<0.05）。老年稳定期精神分裂症伴睡眠障碍患者PSQI评分与汉词配对、图画记忆、汉词记忆评分呈负相关（P＜0.05）。结论：老年稳定期精神分裂症患者存在较高的睡眠障碍发生率,且受到年龄、性别、户籍所在地等多种因素的影响。睡眠障碍可影响患者记忆功能状况,睡眠障碍越严重,记忆功能越差。     

Quality of Life Is Related to Social Support in Elderly Osteoporosis Patients in a Chinese Population

Objective

To explore the association between quality of life and social support in elderly osteoporosis patients in a Chinese population.

Methods

A total of 214 elderly patients who underwent bone mineral density screening were divided into two groups: elderly patients with primary osteoporosis (case group, n = 112) and normal elderly patients (control group, n = 102). Quality of life and social support were compared between the two groups.

Results

Quality of life and social support were significantly different between the case and control groups. The physical function, role-physical, bodily pain, general health, vitality, social-functioning, role-emotional and mental health scores in case group were significantly lower than those in the control group (P < 0.01). The objective support, subjective support, utilization of support, and total scores in case group were significantly lower than those in the control group (P < 0.01). Quality of life and social support were positively correlated in the case group (r = 0.672, P < 0.01).

Conclusion

Quality of life and social support in elderly patients with osteoporosis in China were poorer than in elderly patients without osteoporosis and were positively correlated. Our findings indicate that increased efforts to improve the social support and quality of life in elderly osteoporosis patients are urgently needed in China. Further longitudinal studies should be conducted to provide more clinical evidence to determine causative factors for the observed association between risk factors and outcomes.     

Life satisfaction in persons of the third age after retirement

The aim of this research was to determine the role of gender, type of residence, living arrangement, self-rated health status, loneliness, and sense of humor in self-reported life satisfaction in elderly retirees. The study included 300 elderly retirees from Zagreb, Croatia. Demographic data were collected with a structured questionnaire, whereas data on self-reported health status, loneliness, and sense of humor were collected with the UCLA Loneliness Scale, Life Satisfaction Index, HOPA-86, and SF-36 Health Survey. Participants living in a retirement home showed higher life satisfaction than those who lived in their own households. Those who had children showed greater life satisfaction No differences in life satisfaction were found with respect to gender, marital status, or living arrangement. The investigated demographic variables, self-rated health status, self-rated loneliness, and a sense of humor explained 52.8% of variance in life satisfaction. An active sense of humor was the most significant predictor. Living in a retirement home, having children, and having an active sense of humor had a positive influence on self-reported life satisfaction, whereas poorer self-rated health and loneliness had a negative influence. Taking into account the predictors of life satisfaction in preventive activities may contribute to successful aging.     

Are elderly people living alone an at risk group?

OBJECTIVE--To test the hypothesis that elderly people living alone are an at risk group with a high level of morbidity that makes high demands on health and social services. DESIGN--Secondary analysis of data from a community survey of 239 people aged 75 and over, identified from general practitioners'' age-sex registers. SETTING--Nine practices in the London boroughs of Brent and Islington. MAIN OUTCOME MEASURES--Scores on the mini-mental state examination; stated satisfaction with life; assessment of mobility; numbers of diagnoses of major physical problems; numbers of prescribed drugs taken; urinary incontinence; alcohol consumption; contacts with general practitioners and hospital outpatient and inpatient services; contact with community health and social services. RESULTS--There were significantly more women among those living alone (93/120 (78%) v 63/119 (53%); p < 0.0005) and the median age of elderly people living alone was higher (81 v 80; p < 0.04). Those living alone and those living with others showed no significant differences in measures of cognitive impairment, numbers of major physical diagnoses, impaired mobility, or use of general practitioner or hospital services. Stated satisfaction with life was somewhat higher in those living alone. Elderly people living alone were significantly more likely to have contact with chiropody, home help, and meals on wheels services and less likely to have someone they could contact in an emergency or at night. Living alone increased the likelihood of contact with one or more community health professionals (district nurses, health visitors, or chiropodists) considered as a group and also increased the likelihood of contact with social services as a whole. There was a tendency for more of those living alone than those living with others to have home visits from their general practitioners, but there were no significant differences in contact with hospital services between the two groups. CONCLUSIONS--Elderly people living alone do not have an excess of morbidity compared with those living with others and do not seem to be an at risk group requiring specifically targeted assessments. More help is needed to provide elderly people living alone with a point of contact in case of emergency.     

Peterborough Hospital at Home scheme.

The Peterborough Hospital at Home Scheme had explored the possibilities of treating at home patients who, if it were not for the scheme, would be in hospital. The scheme has been enthusiastically received by patients, consultants, general practitioners, nurses, and other health care workers. It is difficult to compare costs. Nevertheless, the cost of Hospital at Home care cannot be regarded as too expensive compared with care in hospital. Establishment of such schemes elsewhere would affect future allocation of capital.     

Immunisation against influenza among people aged over 65 living at home in Leicestershire during winter 1991-2.

OBJECTIVES--To assess the size of the elderly population for whom influenza vaccine is indicated and how many are vaccinated. DESIGN--Cohort questionnaire study. SETTING--Leicestershire general practices. SUBJECTS--800 elderly subjects selected a random from the Leicestershire family health services authority list who were not living in residential care, 565 of whom returned a questionnaire. MAIN OUTCOME MEASURES--Patient profile, vaccine offers, vaccination status, and reasons for not accepting vaccine. RESULTS--170 of 334 (51%) people aged 65-74 years and 106 of 205 (52%) aged > or = 75 years had one or more medical indications for influenza vaccine. 195 people were offered vaccine, 49 of whom had no risk factor. 152 offers were made opportunistically during visits to the practice and only six were made in writing or by telephone. Overall 113 of 266 patients with known medical indications were immunised. Vaccine was accepted by 148 of 189 (78%) offered it, and, as judged by acceptance in sequential years, influenza vaccine was well tolerated. The main reasons for not being vaccinated were misconception about risk status and inadequate advice from doctors. CONCLUSIONS--The prevalence of medical indications for vaccine is not large enough to justify a policy of universal immunisation. Most patients offered vaccine accept it and tolerate it well. Improved targeting and education is needed to increase immunisation of people at risk.     

老年白内障患者术前焦虑障碍的影响因素分析及对术后干眼症状和视觉相关生活质量的影响

摘要 目的：探讨老年白内障患者术前焦虑障碍的影响因素,并观察术前焦虑障碍对术后干眼症状和视觉相关生活质量的影响。方法：选择2020年12月~2022年5月期间江苏省人民医院眼科收治的老年白内障患者100例作为研究对象。所有患者入院第1天采用状态-特质焦虑问卷（STAI）评估焦虑状况,采用单因素和多因素Logistic回归分析老年白内障患者发生术前焦虑障碍的影响因素,并观察其对术后干眼症状和视觉相关生活质量的影响。结果：本研究100例老年白内障患者中,有46例患者出现术前焦虑障碍,占比46.00%,平均STAI评分为（59.27±3.16）分;有54例未出现术前焦虑障碍,占比54.00%,平均STAI评分为（35.39±5.28）分。根据是否出现术前焦虑障碍将患者分为焦虑障碍组（n=46）和无焦虑障碍组（n=54）。单因素分析显示,老年白内障患者术前焦虑障碍与年龄、性别、文化程度、家庭人均月收入、外科手术史、合并基础疾病种类、是否双眼白内障、付费方式、家庭关系有关（P<0.05）,而与婚姻状况、居住地无关（P>0.05）。年龄为60~69岁、家庭关系差、性别为女、文化程度为小学及以下、无外科手术史、双眼白内障、合并基础疾病种类为2种及以上是老年白内障患者发生术前焦虑障碍的危险因素（P<0.05）。焦虑障碍组术后干眼症状评分高于无焦虑障碍组（P<0.05）。焦虑障碍组社会角色限制、精神健康状态、社交功能、近距离工作、总体视觉情况、远距离工作、周边视野、独立性、一般健康状态、驾驶、色彩视觉、眼痛分值及总分均低于无焦虑障碍组（P<0.05）。结论：年龄、家庭关系、性别、文化程度、外科手术史、双眼白内障、合并基础疾病种类是老年白内障患者术前焦虑障碍的影响因素。老年白内障患者存在术前焦虑障碍可增加术后发生干眼症状的风险,并降低其视觉相关生活质量。     

Screening the elderly in the community: controlled trial of dependency surveillance using a questionnaire administered by volunteers.

OBJECTIVE--To test the benefits of regular surveillance of the elderly at home using an activities of daily living questionnaire administered by volunteers. DESIGN--Randomised controlled study. PATIENTS--539 Subjects aged 75 and over from two general practices. INTERVENTION--All subjects were visited at the beginning and end of the study by volunteers, who completed a scored activity of daily living questionnaire. The study group were revisited at regular intervals. Individuals with an increase in score greater than 5 were referred to their general practitioners. All interactions with social services and health authorities were recorded for both groups. MAIN OUTCOME MEASURES--Mortality, activity of daily living score, total number of days in institutions, geriatric and psychogeriatric service contacts, primary health care team contacts, use of community support services. RESULTS--The study group were admitted to hospital more often than the controls (335 occasions v 252), but the control group spent 33% more days in institutions, mainly in long term admissions to residential accommodation. The number of falls reported in the control group doubled (from 17 before the first interview to 36 before the last) and in the study group remained unchanged (12 before both interviews). The study group received community support services sooner than the control group. There was no difference between the groups in mortality or activity of daily living score. CONCLUSION--Regular visiting of old people at home by non-professional volunteers using a simple activity of daily living questionnaire is a practical way of identifying problems and initiating action for this group.     

Screening Primary-Care Patients Forgoing Health Care for Economic Reasons

Background

Growing social inequities have made it important for general practitioners to verify if patients can afford treatment and procedures. Incorporating social conditions into clinical decision-making allows general practitioners to address mismatches between patients'' health-care needs and financial resources.

Objectives

Identify a screening question to, indirectly, rule out patients'' social risk of forgoing health care for economic reasons, and estimate prevalence of forgoing health care and the influence of physicians'' attitudes toward deprivation.

Design

Multicenter cross-sectional survey.

Participants

Forty-seven general practitioners working in the French–speaking part of Switzerland enrolled a random sample of patients attending their private practices.

Main Measures

Patients who had forgone health care were defined as those reporting a household member (including themselves) having forgone treatment for economic reasons during the previous 12 months, through a self-administered questionnaire. Patients were also asked about education and income levels, self-perceived social position, and deprivation levels.

Key Results

Overall, 2,026 patients were included in the analysis; 10.7% (CI95% 9.4–12.1) reported a member of their household to have forgone health care during the 12 previous months. The question “Did you have difficulties paying your household bills during the last 12 months” performed better in identifying patients at risk of forgoing health care than a combination of four objective measures of socio-economic status (gender, age, education level, and income) (R² = 0.184 vs. 0.083). This question effectively ruled out that patients had forgone health care, with a negative predictive value of 96%. Furthermore, for physicians who felt powerless in the face of deprivation, we observed an increase in the odds of patients forgoing health care of 1.5 times.

Conclusion

General practitioners should systematically evaluate the socio-economic status of their patients. Asking patients whether they experience any difficulties in paying their bills is an effective means of identifying patients who might forgo health care.     

Patients with fatigue in general practice: a prospective study.

OBJECTIVE--To describe the characteristics of patients attending their general practitioners and complaining of fatigue or being "tired all the time." DESIGN--Prospective study of cohort aged 16 years and older with follow up at two weeks and by questionnaires at two and six months. SUBJECTS--220 patients (164 women) with mean age 43 years and an age-sex matched comparison group. SETTINGS--Doctors and patients in four practices in Lancashire, Mid Glamorgan, Suffolk, and Surrey. MAIN OUTCOME MEASURES--General clinical data, results from standard group of laboratory tests, fatigue questionnaire, and 12 item general health questionnaire. RESULTS--Over twice as many patients with fatigue had high scores on the health questionnaire compared with the comparison group (156 (75%) v 69 (34%)). Results of laboratory tests were abnormal and contributed to the diagnosis in 19 patients. 59 out of 102 patients who responded had high fatigue scores six months later. Patients with persistent fatigue were more likely to have a history of anxiety or depression and to have had fatigue for more than three months on entry to the study. CONCLUSIONS--Women are particularly at risk of fatigue. The outcome is better if patients have had symptoms for three months or less or there is no history of emotional illness.