Design: randomised controlled trial.

Setting: post-hospital rehabilitation.

Participants: two hundred and twenty-nine hospitalised patients referred for ambulatory rehabilitation.

Interventions: hospital-based day rehabilitation programme versus home-based rehabilitation programme.

Main Outcome Measures: at 3 months, information was collected on hospital readmission, transfer to residential care, functional level, quality of life, carer stress and carer quality of life. At 6 months, place of residence, hospital re-admissions and mortality status were collected.

Results: there were significant improvements in the functional outcomes from baseline to 3 months for all participants. At discharge, carers of patients in day hospital reported higher Caregiver Strain Index (CSI) scores in comparison to home rehabilitation carers (4.95 versus 3.56, P = 0.047). Patients in day hospital had double the risk of readmission compared to those in home rehabilitation (RR = 2.1; 95% CI 1.2–3.9). This effect persisted at 6 months.

Conclusions: day hospital patients are more likely to be readmitted to hospital possibly due to increased access to admitting medical staff. This small trial favours the home as a better site for post-hospital rehabilitation.

Objective: to test the effects of different strategies for recruitment into a study of physical activity in older people.

Design: factorial randomised controlled trial. Randomisation by household into four groups: telephone contact plus questionnaire, telephone contact only, questionnaire only, neither.

Setting: primary care, Oxfordshire, United Kingdom.

Participants: 560 patients ≥ 65 years randomly selected after exclusions.

Interventions: questionnaire to assess health, functional ability and physical activity. Telephone contact by the research nurse a week after sending study information.

Main Outcome Measure: recruitment into physical activity study.

Results: telephone contact increased recruitment: contact 47.9% (134/280), no contact 37.9% (106/280), difference (adjusted for the clustering effect of household) 10.0% (95% CI 0.2-19.8). Questionnaire inclusion did not significantly reduce recruitment: no questionnaire 44.3% (124/280) questionnaire 41.4% (116/280) difference –2.9% (95% CI –12.7–7.0).

Conclusions: telephone contact significantly increased recruitment and should be considered in studies where recruitment may be low. While inclusion of a questionnaire provided valuable information on non-participants and did not significantly reduce recruitment, an adverse recruitment effect could not be excluded.

Methods: we used STEP-assessment, an instrument developed by European General Practitioners (GPs), which identifies only problems that can be improved; 37 questions had to be answered by the patient and 4 tests had to be done by the GP. Additionally in the study, GP and patient had to indicate separately which of the problems were seen as relevant and what both accepted to do for improvement. A year later, participating GPs were asked by a not-announced questionnaire to report on improvements and reasons for failure.

Results: of the 220 eligible GPs, 45 enrolled a random sample of 894 patients (average age 77 years). In all 7.8 out of 32 possible problems per patient were found. Of those, 1.4 problems were not known to the GP. More than two-thirds of the ‘new problems’ are perceived as relevant by GP, patient or by both. GPs assessed medical problems and patients assessed social/psychological problems as more relevant. The length and quality of the relationship with the patient was reflected in the number of new problems, with fewer new problems in those well-known. A year later, GPs had offered treatment for 47% of the newly diagnosed problems, with a success-rate of 81%.

Conclusion: geriatric screening can detect unidentified problems in general practice. Once detected and dealt with, a high proportion of the undetected problems showed improvement. GPs focussed more on medical, while patients more on psychosocial issues. To increase the outcome of screening, it is necessary to discuss the relevance assessed by the patient.

Design: we determined vascular stiffness in patients with a clinical and radiological diagnosis of either AD or VAD and compared them to normal age- and sex-matched controls.

Methods: In all, 16 patients with late onset AD, 13 subjects with VAD and 16 age- and sex-matched controls were recruited to this study. Central arterial compliance (CAC), augmentation index (AI) and pulse wave velocity (PWV) (measures of arterial stiffness) were measured.

Results: the mean age was 77.7 ± 8.3 years (mean ± SD) in the AD group, 79.7 ± 8.9 years in the VAD group and 76.4 ± 6.9 in the controls (P = 0.44). CAC was significantly lower in subjects with VAD compared to both the AD and the control groups (0.57 ± 0.46 ml/mm Hg versus 1.12 ± 0.57 and 1.1 ± 0.47 ml/mm Hg respectively, P = 0.01). AI was significantly higher in the subjects with VAD compared to both the AD and the control groups (13.3 ± 9.0 versus 3.5 ± 11.4 and 4.2 ± 9.7% respectively, P = 0.03). PWV in the muscular and elastic arteries were not statistically different between the three groups but tended to be highest in the VAD group for carotid-radial measurements.

Conclusions: the reduced CAC and increased AI in VAD subjects indicate that the disease process is associated with less vascular compliance of the large elastic arteries in these patients, but not in patients with AD.

Objective: to estimate the relative contributions of genetic and environmental factors in determining inter-individual variation in neurocognitive abilities in the Italian population.

Design: cross-sectional analysis of twin data.

Setting: a sample of older twins with normal cognition from the population-based Italian Twin Registry (ITR).

Subjects: twin pairs resident in Rome and born between 1926 and 1940, identified through the ITR in 2002. The final study population included 93 twin pairs.

Methods: subjects underwent neuropsychological tests providing information about different cognitive domains. The contributions of genetic and environmental effects were assessed using standard univariate twin modelling based on linear structural equations.

Results: the best-fitting model incorporated additive genetic (A) and unique environmental (E) sources of variance for the following tests: Mini-Mental State Examination (A = 55%), Raven (A = 56%), Attentional Matrices (A = 79%), Copying Drawings (A = 69%) and Story Recall (A = 54%).

For Phonological and Semantic Verbal Fluency, the best model included non-additive (D) and unique environmental influences (D = 62 and 54%, respectively). Cigarette smoking was estimated to be negatively associated with the score of Phonological Verbal Fluency. For Token test, the inter-individual variance was entirely due to environmental factors not shared by the twins.

Conclusion: our data showed that most of the specific cognitive abilities are moderately to highly heritable, and that the environmental factors of relevance for these abilities are those causing within-family differences.

Methods: the intra-rater and inter-rater reliability studies were performed with 20 participants each. The prospective study was performed with 344 community-dwelling older people presenting to an emergency department after a fall and being discharged directly home. Following a home-based assessment, including the FROP-Com, Timed Up and Go (TUG) and functional Reach (FR), participants were monitored for falls for 12 months.

Results: the intra-class correlation coefficient (ICC) for intra-rater reliability and inter-rater reliability for the FROP-Com was 0.93 (95% CI 0.84-0.97) and 0.81 (95% CI 0.59-0.92) respectively. The AUC for the FROP-Com was 0.68 (95% CI 0.63-0.74). At the cut-off 18/19, sensitivity was 71.3% (95% CI 64.4-78.3) and specificity was 56.1% (95% CI 48.9-63.4). The AUC for the TUG was 0.63 (95% CI 0.57-0.69) and for the FR was 0.60 (95% CI 0.54-0.66).

Conclusion: the FROP-Com demonstrated good reliability and a moderate capacity to predict falls.