We aimed to investigate the relationships between parental age and frailty and longevity in older adults.

Methods: in the Canadian Study of Health and Aging (CSHA), data was collected on individuals aged ≥65 using a Self-Assessed Risk Factor Questionnaire and screening interview. In this secondary analysis, 5112 participants had complete data for parental age, frailty status and 10-year survival. Parental age was divided into three groups, with cut-offs at 25 and 45 for fathers and at 25 and 40 for mothers. Frailty was defined by an index of deficits. Survival was analysed using Kaplan-Meier curves and Cox regression with analyses adjusted for subject's age, sex and age of the other parent.

Results: mean maternal age at subject's birth was 29.2y (SD 6.8) and mean paternal age 33.3y (SD 7.8). There was no effect of maternal or paternal age on survival for either sons or daughters. Similarly, there was no association between parental age and subject frailty in old age.

Conclusion: we did not identify an association between parental age and frailty or longevity in older adult participants in the CSHA.

Methodology: eligible stroke patients were assessed for delirium on admission and for four consecutive weeks using the Confusion Assessment Method (CAM). Risk factors for delirium were recorded. Our outcome measures were length of stay, inpatient mortality and discharge destination.

Results: of 110 eligible patients, 82 were recruited over 7 months. Delirium was detected in 23 patients (28%); 21 of these were delirious on their first assessment. Sixty-nine per cent of patients who had four weekly assessments were delirious at 4 weeks. Multivariate logistic regression analysis was performed, and two models were identified. With unsafe swallow in the analysis, delirium was associated with an unsafe swallow on admission (OR 28.4, P<0.001), Barthel score < 10 (OR 32.1, P = 0.004) and poor vision pre-stroke (OR 110.8, P = 0.01). With unsafe swallow removed from the analysis, delirium was associated with an admission C-reactive protein (CRP) > 5 mg/l (OR 10.2, P = 0.009), Barthel score < 10 (OR 46.5, P = 0.001) and poor vision pre-stroke (OR 85.2, P = 0.01). Delirious patients had a higher mortality (30.4% vs. 1.7%, P<0.001), longer length of stay (62.2 vs. 28.9 days, P<0.001) and increased risk of institutionalisation (43.7 vs. 5.2%, OR 14, P<0.001).

Conclusions: delirium is common post-stroke. Most cases develop at stroke onset and remain delirious for an appreciable period. Delirium onset is associated with stroke severity (low admission Barthel), unsafe swallow on admission, poor vision pre-stroke and a raised admission CRP. Delirium is a marker of poor prognosis.

Design: a prospective randomised controlled multi-centre trial.

Setting and participants: a total of 155 geriatric patients were randomly admitted to either the new DTTP SGS (n = 83) or the standard DTTP (n = 72) for insulin-treated patients with type 2 diabetes mellitus (HbA1c 8.0 ± 1.4%, age 76.2 ± 6.3 years).

Measurements: biometrical data, metabolic control, acute complications, diabetes knowledge, self-management.

Results: SGS participants showed improved levels of HbA1c 6 months after the DTTP, and less acute complications than the standard group (P<0.009). Both groups demonstrated a good capacity for diabetes self-management and improvement in diabetes knowledge after the DTTP (P<0.01).

Conclusion: the new SGS diabetes education programme, focusing on the learning capabilities and the particular needs of older persons, is effective in improving metabolic control and in maintaining auto-sufficiency in geriatric patients with diabetes mellitus.

Design: a retrospective case–control analysis.

Setting: tertiary care academic hospital.

Population: 7,089 adults (age >18 years), including 949 (15%) advanced elderly (age >75 years), who underwent flexible bronchoscopy between January 1995 and June 2007.

Measurements: in those patients with foreign body aspiration (FBA) (n = 20), a comparison of multiple clinical characteristics based on defined age groups (group 1, age <75 years and group 2, age >75 years) was performed.

Results: FBA requiring bronchoscopic removal was greater than three and a half times more likely in patients aged >75 years compared to those younger (OR 3.78, CI 1.4–10: P <0.05). Flexible bronchoscopy was 87.5% effective in the removal of foreign bodies in the advanced elderly and associated with no increase in adverse events.

Conclusion: bronchoscopic removal of foreign bodies is more likely in the advanced elderly when compared to those younger. This implies that this population may be most at risk. Flexible bronchoscopy is a safe and effective initial diagnostic and therapeutic approach in this age group.

Design: cross-sectional analysis of baseline information from three separate studies in healthy older men, women and residents of assisted living.

Setting: academic health centre in greater Hartford, CT, USA.

Participants: eight hundred and ninety-eight adults residing in the community or assisted living facility.

Measurements: participants had measurement of frailty (weight loss, grip strength, sense of exhaustion, walking speed and physical activity) and serum DHEAS levels.

Results: overall, 6% of the individuals in the study were classified as frail, 58% intermediate frail and 35% were not frail. In the bivariate analysis, there were differences between categories of frailty across age, gender and by DHEAS levels. In an ordinal logistic regression model, with frailty as a dependent measure, we found that age, DHEAS and interactions of age and BMI and DHEAS and BMI were predictive of more frailty characteristics.

Conclusion: we found an association between frailty and DHEAS levels. Whether the association is due to similar conditions resulting in lower DHEA levels and more susceptibility to frailty or whether lower DHEA levels have an impact on increasing frailty cannot be addressed by cross-sectional analysis. Gender did not impact the association between DHEAS and frailty, but obesity (BMI > 30 kg/m²) attenuated the association between higher DHEA levels and lower frailty status.

Methods: a retrospective observational study of patients admitted via the emergency department due to drug overdose between 2004 and 2007.

Results: during the study period, there were 8,059 admissions, including 4,632 women (57.5%). This included a subgroup of 361 patients (4.5%) who were >60 years of age. This subgroup was more likely to require hospital stay >1 night, odds ratio (95% confidence interval) = 4.3 (3.6–5.5, P < 0.0001), transfer to a critical care area = 3.8 (1.1–13.0, P = 0.0340) and had higher mortality = 4.8 (1.1–22.1, P = 0.0463). A higher proportion of older patients required transfer to a psychiatric unit (P < 0.0001) or to a general medical ward (P < 0.0001) than younger adults.

Conclusions: older adults that presented to hospital after drug overdose had ingested different drugs than younger patients, possibly due to different prescribing patterns, and had a poorer outcome. The use of drugs associated with significant toxicity should be avoided in older patients at risk of self-harm.

Objective: to explore the generalisability of the dignity model to older people in nursing homes.

Methods: qualitative interviews were used to explore views on maintaining dignity of 18 residents of nursing homes. A qualitative descriptive approach was used. The analysis was both deductive (arising from the dignity model) and inductive (arising from participants' views).

Results: the main categories of the dignity model were broadly supported: illness-related concerns, social aspects of the illness experience and dignity conserving repertoire. However, subthemes relating to death were not supported and two new themes emerged. Some residents saw their symptoms and loss of function as due to old age rather than illness. Although residents did not appear to experience distress due to thoughts of impending death, they were distressed by the multiple losses they had experienced.

Conclusions: these findings add to our understanding of the concerns of older people in care homes on maintaining dignity and suggest that dignity therapy may bolster their sense of dignity.

Objective: we compared a standardised fall risk assessment tool alongside nurses’ clinical judgement with nurses’ judgement alone.

Design: a 12-month cluster-randomised controlled trial.

Setting: nursing homes in Hamburg (29 per study group).

Subjects: 1,125 residents (n = 574 intervention group, IG; n = 551 control group, CG).

Interventions: all homes received structured information on fall prevention before randomisation. The IG monthly administered the Downton Index, and the CG did not use a tool. Measurements were number of participants with at least one fall, falls, fall-related injuries and medical attention, fall preventive measures, physical restraints.

Results: the mean follow-up was 10.8 ± 2.9 months in both groups: 105 (IG) and 114 (CG) residents died or moved away. There was no difference between the groups concerning the number of residents with at least one fall (IG: 52%, CG: 53%, mean difference –0.7, 95% confidence interval –10.3 to 8.9, P = 0.88) and the number of falls (n = 1,016 and n = 1,014). All other outcomes were also comparable between the IG and CG.

Conclusions: application of a fall risk assessment tool in nursing homes does not result in the better clinical outcome than reliance on nurses’ clinical judgement alone.

Design: a cross-sectional, list-assisted random digit dialling telephone survey of US adults from 2001 to 2003.

Subjects: 1,709 adults aged 65 or older who spoke either English or Spanish.

Methods: prevalence estimates were calculated for recent falls, fall injuries, fear of falling and fall prevention beliefs and behaviours.

Results: an estimated 3.5 million, or 9.6%, of older adults reported falling at least once in the past 3 months. About 36.2% of all older adults said that they were moderately or very afraid of falling. Few older adults who fell in the past 3 months reported making any changes to prevent future falls.

Conclusions: the high prevalence of falls and fear of falling among US older adults is of concern. Both can result in adverse health outcomes including decreased quality of life, functional limitations, restricted activity and depression. Older adults’ fear of falling and their reluctance to adopt behaviours that could prevent future falls should be considered when designing fall prevention programmes.

Methods: a total of 1,894 older people (1,433 females, 461 males; mean age 86 years, SD 7.1 years) were recruited from 52 nursing homes and 30 intermediate-care nursing care facilities in Australia during March 1999 and February 2003. We assessed clinical risk factors for hip fracture and skeletal fragility by calcaneus broadband ultrasound attenuation (BUA) at baseline and then followed up for fracture for 4 years. Hip fractures were validated by x-ray reports. Survival analysis with age as a time-dependent covariate was used to analyse the data.

Results: during a mean follow-up period of 2.65 years (SD 1.38), 201 hip fractures in 191 residents were recorded, giving an overall hip fracture incidence rate of 4.0% per person year (males 3.6% and females 4.1%). Residents living in intermediate-care hostels had a higher crude hip fracture rate (4.6% vs. 3.0%) than those living in high-care nursing homes. In multivariate analysis, an increased risk of hip fracture was significantly associated with older age, cognitive impairment, a history of fracture since age 50, lower body weight, longer lower leg length and poorer balance in intermediate-care hostel residents, but not with lower BUA.

Conclusions: institutionalised older people, who are at a higher risk of hip fracture than community-dwelling individuals, have differences in some risk factors for hip fracture that should be considered in targeting intervention programs.

Methods: we examined FoF in 100 participants aged ≥75 years, using the Activities-specific Balance Confidence scale. Participants with a mean score <67% were assigned to the FoF group. We quantified gait and balance during walking at the preferred velocity with and without a cognitive dual task (arithmetic task and verbal fluency), using an electronic walkway (Gaitrite®) and a trunk accelerometer (SwayStar®). Primary outcome measures were gait velocity, stride-length and stride-time variability, as well as mediolateral angular displacement and velocity.

Results: gait velocity was significantly lower (P < 0.05) and stride-length and stride-time variability were significantly higher (P < 0.05) in the FoF group. However, after standardisation for gait velocity, differences became non-significant. Mediolateral angular displacement and velocity were not associated with FoF. We found no difference between the FoF and no-FoF group with respect to the dual-task effect on gait and balance variables.

Conclusions: the lower gait velocity in the FoF group may be a useful adaptation to optimise balance, rather than a sign of decreased balance control. The ability to attend to a secondary task during walking is not influenced by FoF.

Objective: to use current typeface guidelines to describe the design of health information leaflets.

Design: this was a cross-sectional study of leaflets from pharmacies and seniors’ clinics.

Setting: community pharmacies, seniors’ clinics in Edmonton, Canada.

Methods: health information leaflets and hydrochlorthiazide information sheets were collected. The body of each was evaluated, based on guidelines (from Canada, UK and USA). Adherence to recommendations was assessed descriptively.

Results: a total of 388 unique leaflets and 10 hydrochlorthiazide sheets were collected from 21 pharmacies and 3 clinics. Most leaflets were produced by pharmaceutical companies (42.8%) and contained disease information (43.8%). Only one-third of all leaflets used the minimum recommended point size (12 point), 18.6% followed American guidelines for line spacing (1.5 lines), but 77.1% had appropriate contrast.

Conclusions: although guidelines are available, most leaflets did not meet recommendations. Improvements in the leaflet design should be considered to aid seniors in the uptake of information.

Objectives: this randomised controlled trial assessed the effects of 1-year WBV training on cardiorespiratory fitness and muscle strength in community-dwelling adults over the age of 60.

Methods: a total of 220 adults (mean age 67.1 years) were randomly assigned to a WBV group, fitness group or control group. The WBV group exercised on a vibration platform, and the fitness group performed cardiovascular, resistance, balance and stretching exercises. The control group did not participate in any training. Heart rate was measured during a single WBV session. Peak oxygen uptake (VO_2peak) and time-to-peak exercise (TPE) were measured during progressive bicycle ergometry. Muscle strength was assessed by a dynamometer.

Results: heart rate increased significantly during WBV training. After 1 year, VO_2peak, TPE and muscle strength increased significantly in the WBV and fitness groups. Both training groups improved similarly in VO_2peak and muscle strength. The fitness group improved significantly more in TPE than the WBV group.

Conclusion: WBV training in community-dwelling elderly appears to be efficient to improve cardiorespiratory fitness and muscle strength.

Methods: these tests were administered with a subjective memory questionnaire and an ‘Activities of Daily Living’ scale to 21 individuals with MCI and 98 cognitively healthy controls matched for sex, education and IQ levels. The sensitivity and specificity of the tests and their discrimination between groups were determined.

Results: the HVLT had a maximum discrimination between controls and MCI cases of 90%, compared with 86% for CogState and 65% for the MMSE. Only CogState showed correlations with subjective memory complaints (SMC) and activities of daily living for the whole cohort when controlled for age, sex and years of education. Logistic regression analyses showed that diagnosis (control:MCI) was predicted by HVLT and a CogState ratio score. Age was a significant predictor of HVLT performance, while age and SMC predicted CogState performance. The computerised test battery was well tolerated by older adults, but presentation speed was a limiting factor for some participants.

Conclusions: overall, we conclude that the HVLT has better sensitivity for the detection of MCI in older adults than the CogState, but that CogState may enable the identification of cognitive deficits above and beyond impairments in memory.

Methods: a retrospective cohort study was undertaken, using data from the Data Retrieval in General Practice (DRGP) project in Northern Ireland, to identify a cohort of individuals aged 65 and over and living in the community at the outset of the study. A total of 28,064 individuals were followed up for 5 years to identify those who subsequently entered a nursing or residential care home. Controlling for the demographic, household composition and health characteristics of individuals, Poisson regression was used to estimate the incidence rate ratios of care home admission for 10 trusts.

Results: a total of 24,691 of the initial cohort had complete information for all variables and were included in the final analysis; 1,313 (5.3%) had entered a care home at the end of the 5 years of follow-up. Admission increased significantly with age, and diagnoses of dementia and stroke. Controlling for the age, sex and health composition of individuals, some variations in admission rates were found across trusts.

Conclusions: the study has highlighted the importance of age and clinical conditions as risk factors for care home admission. In addition, it appears that the area of residence might be important in determining a person's risk of care home admission. Such differences may be attributable to particular characteristics of the trust, such as the level of deprivation or degree of rurality, or to differing policies in relation to services for older people. More work is required to identify the causes of the differences to allow policies to be implemented to ensure equitable access to care homes across Northern Ireland.