Objective: a systematic review of all randomised controlled trials (RCTs), updating previous work and evaluating a broader range of therapeutic interventions intended for use in adults recovering from stroke and dysphagia.

Methods: using multiple databases, we identified RCTs published between the years 1966 and August 2007 examining the efficacy of dysphagia therapies following stroke. Across studies, results of similar treatments and outcomes were compared and evaluated.

Results: fifteen articles were retrieved assessing a broad range of treatments that included texture-modified diets, general dysphagia therapy programmes, non-oral (enteral) feeding, medications, and physical and olfactory stimulation. Across the studies there was heterogeneity of the treatments evaluated and the outcomes assessed that precluded the use of pooled analyses. Descriptively these findings present emerging evidence that nasogastric tube feeding is not associated with a higher risk of death compared to percutaneous feeding tubes; and general dysphagia therapy programmes are associated with a reduced risk of pneumonia in the acute stage of stroke.

Conclusions: dysphagia is known to be a common and potentially serious complication of stroke. Despite the recent newly published RCTs, few utilise the same treatment and outcomes thereby limiting the evidence to support the medical effectiveness of common dysphagia treatments used for patients recovering from stroke.

Design: a two-stage structured, retrospective, patient case-note review.

Setting: a large NHS hospital in England.

Population: a random sample of 1,006 non-psychiatric patients.

Main Outcome Measures: proportion of patients with adverse events, the proportion of preventable adverse events and the types and consequences of adverse events in patients ≥75 and under 75 years old.

Results: forty five [13.5%; 95% confidence interval (CI) 10–17] of 332 patients ≥75 years and 42 (6.2%; 95% CI 4–8) of 674 patients <75 years had at least one adverse event. There was a significantly raised risk of experiencing an adverse event with increasing age [odds ratio (OR) = 1.03 adverse events per year of life, P < 0.001]. There was no statistically significant difference in preventability of adverse events and also in experiencing disability or death as a result of an adverse event by age after adjustment for potential confounders.

Conclusion: adverse events are significantly more common in non-psychiatric elderly inpatients than younger patients. There is little evidence that adverse events in older patients are more preventable and lead to disability or death more frequently.

Objective: to identify, at discharge from hospital, those who are most at risk of repeated falls.

Methods: consecutively hospitalised people with stroke (independently mobile prior to stroke and with intact gross cognitive function) were recruited. Subjects completed a battery of tests (balance, function, mood and attention) within 2 weeks of leaving hospital and at 12 months post hospital discharge.

Results: 122 participants (mean age 70.2 years) were recruited. Fall status at 12 months was available for 115 participants and of those, 63 [55%; 95% confidence interval (CI) 46–64] experienced one or more falls, 48 (42%; 95% CI 33–51) experienced repeated falls, and 62 (54%) experienced near-falls. All variables available at discharge were screened as potential predictors of falling. Six variables emerged [near-falling in hospital, Rivermead leg and trunk score, Rivermead upper limb score, Berg Balance score, mean functional reach, and the Nottingham extended activities of daily living (NEADL) score]. A score of near-falls in hospital and upper limb function was the best predictor with 70% specificity and 60% sensitivity.

Conclusion: participants who were unstable (near-falls) in hospital with poor upper limb function (unable to save themselves) were most at risk of falls.

Methods: in a prospective observational study, with blinded end-point evaluation, 200 patients admitted to a geriatric rehabilitation hospital had a STRATIFY and Downton Fall Risk assessment and were observed for wandering behaviour.

Results: wandering had a predictive accuracy of 78%. A total of 157/200 were identified correctly compared to 100/200 using the Downton score (P < 0.0001 95%, CI 0.18–0.42), or 93/200 using STRATIFY (P < 0.0001; 95% CI 0.15–0.37). The Downton and STRATIFY tools demonstrated predictive accuracies of 50% and 46.5%, respectively, with no statistical significance between the two (P = 0.55; 95% CI 0.77–1.71). Sensitivity for predicting falls using wandering was 43.1% (22/51). This was significantly worse than Downton 92.2% (47/51: P < 0.001) and STRATIFY 82.3% (42/51: P < 0.001).

Conclusions: this study showed that clinical observation had a higher accuracy than two used falls risk-assessment tools. However it was significantly less sensitive implying that fewer patients who fell were correctly identified as being at risk.

Methods: in this randomized controlled trial, female patients in the intervention group received the multidisciplinary clinical pathway consisting of a series of 12 visits over a 6-week period in an outpatient clinic.

Results: ninety-one community dwelling female patients aged 63 to 89 were randomized. Comparison of change between the two groups from baseline in the Minnesota Living with Heart Failure Questionnaire score did not show a difference (P<0.470). There was also no difference between the two groups in functional outcome as measured by change from baseline by the Physical Self-Maintenance Scale (P<0.321). The treatment group had significantly more hospitalizations, and cardiologist visits during the study period (P < 0.0001).

Conclusion: It is feasible to conduct a randomized study in a frail community-based older female population and to test a complex multidisciplinary pathway. Future studies should provide insight into the optimal intensity and duration of heart failure management programs with optimal targeting.

Objective: to analyse sex-specific associations of APOE genotypes with impairments in (instrumental) activities of daily living [(I)ADL] and mortality.

Design: population-based 1999 National Long Term Care Survey (NLTCS) of the US older (65+) individuals.

Participants: genetic data are available for 1,805 individuals.

Methods: each of six genotypes of three common alleles of the APOE locus (2, 3 and 4) was tested on the association with a disability index or mortality.

Results: APOE 3/3 genotype significantly decreases odds ratio (OR) for IADL disability in males [OR = 0.48; 95% Confidence Interval (CI) 0.31–0.76] while it exhibits no association in females. The OR for ADL disability is 0.19 (CI 0.04–0.99) for 4/4 female carriers. The 2/3 genotype increases the chances of IADL disability for males (OR = 2.33; CI 1.28–4.25). No significant association between APOE polymorphism and mortality was found. A surprising observation was that 4/4 female carriers have a 5.3 times lower chance of having ADL disability than non-4/4-carriers.

Conclusions: association of the APOE polymorphism with disability and lack of association with mortality support the view that APOE gene actions may be more significant as modulators of frailty than of longevity.

Objectives: the purpose of our study was to suggest hypothesis on the possible ways of MRSA transmission to residents in or outside a LTCF.

Methods: data concerning patients on the day of the survey and within the preceding year were collected. Multivariate analysis was performed by logistic regression to identify characteristics associated with MRSA carriage. MRSA strains were analysed by pulsed-field gel electrophoresis (PFGE) and the relatedness between DNA patterns was studied with Gel Compar software.

Results: the prevalence of MRSA carriage was 37.6%. Treatment with fluoroquinolones or third-generation cephalosporins [odds ratio (OR) = 12.07; 95% confidence interval (CI) = 5.90–24.7], treatment with other antimicrobial agents (OR = 4.40; 95% CI = 2.43–7.97), at least one medical imaging session (OR = 5.08; 95% CI = 2.66–9.69) within the 12 preceding months, and the presence of a subcutaneous catheter on the day of the survey (OR = 3.09; 95% CI = 1.87–5.10) were independently associated with MRSA carriage. Twenty-eight of the 38 strains tested were clustered in two major groups. In each of these groups, strains had at least a 90% relatedness. These strains were isolated in patients hospitalised in different areas of the LTCF.

Conclusion: we identified that both molecular and epidemiological arguments support the hypothesis of the possibility of MRSA cross-transmission inside the LTCF. Further studies are needed to confirm and explain the association identified between MRSA carriage and medical imaging.

Methods: data were from the English Longitudinal Study of Ageing (ELSA), for 2,925 participants, aged 65+. Multivariate models were used to assess the associations between balance and dizziness and disease status, health behaviours, grip strength and socio-economic markers.

Results: there were 21.5% (n = 619) participants with impaired balance and 11.1% (n = 375) reported dizziness. Impaired balance was statistically significantly associated with age, diabetes (OR = 1.53), arthritis (OR = 1.33), eyesight (OR = 1.94) and grip strength. The wealthiest 20% of participants were less likely to have impaired balance than the poorest 20% (OR = 0.46). Dizziness problems were not associated with age, gender or wealth, but were significantly associated with an abnormal heart rhythm (OR = 1.85), hearing (OR = 1.81), eyesight (OR = 1.72) and grip strength.

Conclusion: the epidemiology of impaired balance differs from that of dizziness, and risk assessment approaches to prevent falls may need to elicit information on different problem-specific factors. Impaired balance test performance in older people may be added to the many outcomes showing strong socio-economic gradients.

Design: clustered randomised controlled trial.

Methods: ten nursing wards from 7 nursing homes were randomised in a control (5 wards) and intervention (5 wards) group. The nurses from the intervention group received multi-faceted training about the occurrence of accidental falls, risk factors for falls and possible environmental modifications. For each fall they were asked to record the relevant risk factors, to keep a fall diary and to evaluate fall causes and possible preventive actions. For all residents, cognition and mobility were evaluated using a Mini-Mental State Examination (MMSE) and a Timed Up and Go Test (TUGT). Fall rates were recorded in an identical way for 6 months before and after the start of the intervention.

Main outcome measures: primary outcome measure was the number of participants with at least one accidental fall requiring an intervention by a physician or a nurse during each period of recording. Secondary outcome was the number of falls for each participant during each period of recording.

Results: the relative risk of falling at least once in people of the intervention versus the control group adjusted for the pre-intervention results was 0.46 (95% CI: 0.26-0.79). There was no difference between residents with and without cognitive impairment or impaired mobility. In those falling at least once, the difference between the average number of falls in the two intervention arms was not significant (P = 0.10).

Conclusion: a simple staff-oriented intervention had a substantial effect on the frequency of accidental falls.

Design and Setting: nationally representative cross-sectional sample of adults living in England.

Participants: 3,346 non-institutionalised adults aged ≥65, taking part in the Health Survey for England (HSE) 2001.

Measurements: height, weight and demi-span measurements were taken according to standardised HSE protocols. DEH was calculated using Bassey's equation.

Results: the height measurement was lower than the DEH from age group 70–74 years onwards in men and in each age group in women. No significant differences in mean DEH and measured height were found for men (–0.46) or women (–2.64). BMI derived from measured height did not differ significantly from BMI derived from DEH. The prevalence of underweight was lower when using measured height than when using DEH in women aged ≥65, particularly in those aged 80 years and over. The prevalence of overweight and obesity was higher using measured height than DEH in women aged ≥65.

Conclusion: we confirmed in a large nationally representative sample that demi-span measurement may be a useful estimate of stature in people (particularly women) aged ≥65 for BMI calculations.

Methods: healthy normotensive volunteers (n = 60, 30 women) aged 20–82 years were split into subgroups: young (aged 20–22), middle-aged (49–52) and elderly (77–82). Serum enzyme activity was assessed using fluorometric methods.

Results: overall, active MMP-9 concentration and trypsin activity decreased with age, and 1-antitrypsin concentration and plasmin activity increased. Activity of elastase increased with age when compared to the young age group. An inverse correlation was identified between MMP-9 concentration and BMI and a direct correlation found between BMI and elastase, plasmin activity and 1-antitrypsin concentration. In the middle-aged group, glucose correlated directly with trypsin activity and inversely with MMP-9 concentration. Trypsin activity and MMP-9 concentration correlated inversely with cholesterol concentration and plasmin and elastase activity, and the 1-antitrypsin concentration correlated with cholesterol concentration in the overall group.

Conclusions: the results confirm the influence of the ageing process on the activity of serum proteolytic enzymes. The activity of individual proteolytic enzymes in the serum changes with age.