Age and Ageing - Advance Access

Stroke knowledge and awareness: an integrative review of the evidence

Jones, S. P., Jenkinson, A. J., Leathley, M. J., Watkins, C. L. — Fri, 06 Nov 2009 04:34:24 PST

Background: the recognition of stroke symptoms by the public and activation of the emergency medical services (EMS) are the most important factors in instigating pre-hospital stroke care. Studies have suggested that poor recognition of the warning signs of stroke is the main cause of delay in accessing the EMS.

Methods: an integrative review of published studies about stroke knowledge and awareness was performed by searching online bibliographic databases, using keywords, from 1966 to 2008. Studies were included in the review if they focussed on risk factors, signs and symptoms, action and information. Each study was reviewed by two researchers (SJ and MJ).

Results: we identified 169 studies of which 39 were included in the review. The ability to name one risk factor for stroke varied between studies, ranging from 18% to 94% when asked open-ended questions and from 42% to 97% when asked closed questions. The ability to name one symptom ranged from 25% to 72% when asked open-ended questions and from 95% to 100% when asked closed questions. When asked what action people would take if they thought they were having a stroke, between 53% and 98% replied that they would call the EMS. People generally obtained information about stroke from family and friends. Older members of the population, ethnic minority groups and those with lower levels of education had consistently poor levels of stroke knowledge.

Conclusions: generally, levels of knowledge about recognising and preventing stroke were poor. Nevertheless, most participants stated they would contact the EMS at the onset of stroke symptoms.

Risk factors of new onset diabetes mellitus among elderly Chinese in rural Taiwan

Peng, L.-N., Lin, M.-H., Lai, H.-Y., Hwang, S.-J., Chen, L.-K., Chiou, S.-T. — Fri, 06 Nov 2009 04:34:23 PST

The association between orthostatic hypotension and medication use in the British Women's Heart and Health Study

Kamaruzzaman, S., Watt, H., Carson, C., Ebrahim, S. — Fri, 06 Nov 2009 04:34:22 PST

Objective: to determine the prevalence of orthostatic hypotension (OH) and associations with medication use in community-dwelling older women.

Design: cross-sectional analysis using data from the British Women’s Heart and Health Study.

Setting: general practices in 23 towns in the UK.

Participants: 3,775 women aged 60–80 years from 1999 to 2001.

Main outcome measure: orthostatic hypotension—drop of ≥20 mmHg in systolic and/or a drop of ≥10 mmHg in diastolic blood pressure on standing.

Results: prevalence of OH was 28% (95% confidence interval [CI] 26.6, 29.4), which increased with age and hypertension. Regardless of treatment status or diagnosed hypertension, raised blood pressure was strongly associated with OH (P < 0.001). OH was strongly associated with number of antihypertensives taken (none vs three or more: odds ratio [OR] 2.24, 95% CI 1.47–3.40, P < 0.001); the association was slightly attenuated after allowing for age and co-morbidities (OR 1.99; 95% CI 1.30, 3.05; P = 0.003). Women with multiple co-morbidities had markedly increased odds of OH independent of age, number and type of medications taken (none vs four or more diagnoses: OR 2.28, 95% CI 1.58–3.30, P = 0.005).

Conclusion: uncontrolled hypertension, use of three or more antihypertensives and multiple co-morbidities are predictors of OH in older women. Detection or monitoring of OH in these groups may prevent women from suffering its adverse consequences.

Interaction of HDL cholesterol concentrations on the relationship between physical function and inflammation in community-dwelling older persons

Thu, 05 Nov 2009 02:10:27 PST

Background: the existence of a relationship among inflammation, high-density lipoprotein cholesterol (HDL-C) and physical function has been suggested.

Objective: the aim of the study is to investigate the possible interaction of HDL-C on inflammation and physical function.

Design: cross-sectional study.

Setting: town of Tuscania (Italy).

Subjects: all the 329 community-dwelling older persons aged ≥75 years (mean age 79.8 ± 5.2 years, women 56.2%).

Methods: HDL-C, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and interleukin-6 (IL-6) were measured. Activities of daily living (ADL), instrumental ADL (IADL) and 4-m walking speed were assessed. Linear regression models were performed.

Results: given the multiple significant interactions, models were stratified according to HDL-C concentrations. In participants with normal HDL-C concentrations, only IL-6 showed a significant association with IADL (β = –0.439, SE = 0.176, P = 0.01). In participants with low HDL-C concentrations, all three inflammatory biomarkers were significantly associated with 4-m walking speed and IADL. IL-6 was also significantly associated with ADL (β = –0.755, SE = 0.259, P = 0.006), whereas borderline significances were reported for CRP and ESR.

Conclusions: the association between inflammation and physical function is particularly enhanced in elders with low HDL-C concentrations. Though HDL-C may merely act as a wellbeing index, HDL-C concentrations should be considered in studies evaluating inflammation and physical function.

Improving metamemory in ageing and Parkinson's disease

Smith, S. J., Souchay, C., Conway, M. A. — Thu, 05 Nov 2009 03:00:05 PST

Blood disorders in the elderly

Sayers, G. — Wed, 04 Nov 2009 08:18:47 PST

Finding the right outcome measures for care home research

Hoppitt, T., Sackley, C., Wright, C. — Wed, 04 Nov 2009 08:18:46 PST

Detecting potential respiratory pathogens in the mouths of older people in hospital

Fri, 11 Sep 2009 11:05:18 PDT

The changing face of geriatric medicine

Partridge, J. S. L., Solomon, C. A. — Thu, 20 Aug 2009 22:45:57 PDT

Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia

Cabre, M., Serra-Prat, M., Palomera, E., Almirall, J., Pallares, R., Clave, P. — Fri, 26 Jun 2009 08:47:12 PDT

Background: oropharyngeal dysphagia is a common condition among the elderly but not systematically explored.

Objective: to assess the prevalence and the prognostic significance of oropharyngeal dysphagia among elderly patients with pneumonia.

Design: a prospective cohort study.

Setting: an acute geriatric unit in a general hospital.

Subjects: a total of 134 elderly patients (>70 years) consecutively admitted with pneumonia.

Methods: clinical bedside assessment of oropharyngeal dysphagia and aspiration with the water swallow test were performed. Demographic and clinical data, Barthel Index, Mini Nutritional Assessment, Charlson Comorbidity Index, Fine's Pneumonia Severity Index and mortality at 30 days and 1 year after admission were registered.

Results: of the 134 patients, 53% were over 84 years and 55% presented clinical signs of oropharyngeal dysphagia; the mean Barthel score was 61 points indicating a frail population. Patients with dysphagia were older, showed lower functional status, higher prevalence of malnutrition and comorbidities and higher Fine's pneumonia severity scores. They had a higher mortality at 30 days (22.9% vs. 8.3%, P = 0.033) and at 1 year of follow-up (55.4% vs. 26.7%, P = 0.001).

Conclusions: oropharyngeal dysphagia is a highly prevalent clinical finding in elderly patients with pneumonia and is an indicator of disease severity in older patients with pneumonia.