Objective: we performed a systematic review to evaluate the diagnostic accuracy of plasma natriuretic peptide measurement in elderly patients from the general population.

Methods: electronic searches of MEDLINE and EMBASE from January 1985 to May 2008 were performed. Diagnostic cohort and cross-sectional studies on the accuracy of natriuretic peptides for diagnosis of cardiac dysfunction or chronic heart failure in people aged 75 and over in the community were included. The quality of the selected studies was assessed with the modified QUADAS tool and the data extracted by two independent reviewers.

Results: five studies were included. The general quality of the studies was moderate. The extracted data could not be pooled. Negative likelihood ratios for cardiac dysfunction ranged from 0.09 to 0.29.

Conclusion: we found limited evidence supporting the use of plasma natriuretic peptide measurement for diagnosis of cardiac dysfunction or heart failure in the elderly of 75 years and over in the general population. Important questions about the implementation of plasma natriuretic peptide measurement in daily practice remain unresolved.

Design: MRC CFAS recruited a sample of 13,004 individuals aged 65 years and above from five communities in the UK. Participants underwent a baseline interview between 1990 and 1994 and were re-assessed 2 years later.

Participants: the participants who reported that they were unable to perform any IADL without difficulty or help at baseline (‘disabled’) were included in the analysis.

Methods: logistic regression was used to estimate odds ratios (OR) for improvement from disabled to non-disabled state at follow-up (‘recovery’).

Results: at baseline, 50% reported disability of whom 9% reported independent function at follow-up. Women (OR = 0.4) and participants aged ≥75 years (OR = 0.2) were least likely to recover, followed by those with poor self-rated health (OR = 0.5), using at least one medication (OR = 0.6) and having more than or equal to two co-morbidities (OR = 0.6).

Conclusion: a minority of participants reporting disability at baseline then reported independent function at 2 years. It may be important to focus on those who seem least likely to recover once they have become disabled. Several factors that have been shown to increase the risk of disability were inversely associated with recovery, suggesting that intervention programmes could target these same factors.

Design: cross-sectional.

Setting: community-based settings in New York City, including senior centres and residential complexes.

Subjects: four hundred and twenty independently living adults aged 60 or older (mean 73.8 years).

Methods: participants completed the Mini-Mental State Exam (MMSE), animal naming test (ANT) and Wechsler Memory Scale III (WMS) Story A immediate and delayed subtests. Scores were examined by strata of language, age or education and for different thresholds of the MMSE. We tested the association of language and cognitive test performance using multivariable linear regression.

Results: twenty-one per cent of subjects were interviewed in Spanish and 16.2% reported poor-fair English proficiency. The mean WMS scores were not statistically different between English and Spanish groups (immediate recall, 9.9 vs 9.5, P = 0.44; delayed recall, 8.0 vs 7.6, P = 0.36, respectively), whereas ANT scores did differ (16.6 vs 14.3, P < 0.0001). These associations were consistent across MMSE thresholds. The association of language and ANT score was not significant after accounting for education.

Conclusions: we found little difference in performance on the Story A subtests from the WMS suggesting that this test may be used for both English- and Spanish-speaking populations. Results suggest that variations in ANT performance may be accounted for by adjusting for the level of education. These results have important implications for the generalisability of test scores among diverse older populations.

Methods: eighty-two patients with established PD aged 65 years or older and 68 age-, sex- and body mass index (BMI)-matched healthy control subjects were recruited. Exclusion criteria included other known causes of osteoporosis. Data including BMI, sunlight exposure, Hoehn and Yahr stage, disease duration and history of previous falls and/or fractures were collected. Bone mineral density was measured using dual energy x-ray absorptiometry. Sera were analysed for ionised calcium, vitamin D, bone alkaline phosphatase (BALP) and urinary N-terminal telopeptide of type I collagen (NTx). Physical and mental performance was also assessed.

Results: the findings show that the bone mineral density (BMD) of all PD patients was significantly lower compared to controls. PD patients had significantly decreased vitamin D levels, significantly increased BALP and NTx levels, reduced physical and mental performance and more falls and/or fractures in comparison to healthy controls.

Conclusion: PD is associated with an increased incidence of osteoporosis, falls and fractures. PD is thus a risk factor for osteoporosis and appropriate therapeutic interventions should be initiated to slow or prevent disability.

Objective: we conducted a retrospective observational study to investigate the haemodynamic and symptom responses of a large cohort of patients undergoing carotid sinus massage (CSM).

Methods: the electronically stored haemodynamic data of 302 consecutive patients, aged 71 ± 11 years, investigated with CSM for unexplained falls and syncope was analysed. Bilateral sequential CSM was performed in the supine and upright positions with continuous electrocardiogram (ECG) and non-invasive beat-to-beat blood pressure monitoring (Taskforce^TM, CN Systems, Austria). CSH (CSH) was defined by maximal R–R interval ≥3 s (cardioinhibitory) and/or a systolic blood pressure drop of ≥50 mmHg (vasodepressor).

Results: a total of 74/302 (25%) subjects had CSH, 37 (50%) of which were cardioinhibitory (CI) and 37 (50%) were vasodepressor (VD) subtypes. Subjects with positive CSM were significantly older (75.2 vs 70.2 years, P < 0.001), and more likely to be male (32% vs 19%, P < 0.01). CSH was diagnosed with right-sided CSM alone in 45 (61%) subjects and erect CSM only in 36 (49%) subjects. Symptom reproduction was more likely with the CI than the VD subtypes (82% vs 28%; P < 0.001).

Conclusion: CSH was diagnosed in 25% of patients investigated with CSM at our specialist unit, lower than the prevalence of 39% reported for community-dwelling older individuals. This discrepancy may be explained by selection bias and demographic differences, but raises the possibility of CSH being an age-related epiphenomenon rather than a causal mechanism for syncope, drop attacks and unexplained falls. Our observations have important implications for clinical practice and the development of future research strategies.

Objective: we analysed outcome after hip fracture with respect to gender and cognitive function.

Design: population-based, prospective cohort study.

Setting: four university hospitals in Stockholm, Sweden.

Subjects: a total of 2,134 consecutive patients admitted with hip fracture during 2003.

Methods: gender differences in residence, walking ability and activity of daily living (ADL) were analysed at baseline, after 4 and 24 months in patients with and without intact cognitive function.

Results: women were older, more often living alone and had poorer walking ability (P < 0.001). Cognitive dysfunction was equally common by gender. Women were more often treated with a prosthesis (P < 0.001) and sent to rehabilitation (P < 0.001). In the cognitive dysfunction group, men had more co-morbidity (P < 0.001) and total loss of walking ability (P = 0.03), but more often resided in own homes (P = 0.03). There was no gender difference in ADL.

Conclusion: men had a higher risk for loss of walking ability and death only in patients with cognitive dysfunction. Cognitive function was the most important factor for returning to own home and regain pre-fracture function.

Objective: to evaluate the prognostic value of CRP and WBC in comparison with the CURB score and the pneumonia severity index (PSI) in elderly, hospitalised patients with CAP.

Methods: the charts of all patients, aged 65 years and older, who were consecutively admitted to the Department of Geriatrics, Marienhospital Herne, Germany, for treatment of CAP between January 2001 and September 2005, were reviewed. CRP, WBC, CURB and PSI were analysed in relation to 30-day mortality.

Results: in a total of 391 patients, median age 80 years, no association was found between CRP or WBC and mortality. In contrast, the CURB score and PSI were significantly associated with mortality and treatment in the intensive care unit (ICU).

Conclusion: in elderly, hospitalised patients with CAP, admission CRP and WBC are not predictors of the prognosis.

Method: we compared MDRD with an optimised version of the Cockcroft–Gault (CG_opt) method in a hospital population, using gentamicin clearance as a baseline.

Results: MDRD overestimated gentamicin clearance by 29% (P < 0.001, n = 68), while CG_opt underestimated by 10% (P < 0.01). Overestimation by MDRD increased with increasing age. This was 12%, 26% and 69% in age groups <65, 65–80 and >80 years respectively (P < 0.001). CG_opt underestimated renal function by –5%, –16% and –4% respectively (P = NS). Bias and precision of renal function estimations for the three age groups were less for CG_opt than for MDRD. Age significantly influenced MDRD overestimation in this population (P = 0.037).

Conclusion: MDRD overestimated renal function as age increased. While CG_opt underestimated renal function, this was of a smaller magnitude, consistent across age, and thus better suited for dose calculation, especially in the elderly. Larger-scale studies using gold standard markers of renal function estimation are urgently needed to determine the accuracy of MDRD in elderly hospitalised patients.

Design and setting: cross-sectional and longitudinal surveys of older people living at home in Britain.

Measures: active ageing, health, psych-social, socio-economic circumstances, and indicators of quality of life.

Results: respondents defined active ageing as having health, fitness, and exercise; psychological factors; social roles and activities; independence, neighbourhood and enablers. The ethnically diverse sample respondents were less likely to define active ageing as having physical health and fitness, and were less likely to rate themselves as ageing actively, than more homogeneous sample respondents. The lay-based measure of quality of life used was independently and consistently associated with self-rated active ageing in each sample

Conclusion: Policy models of active ageing were reflected in lay views, although the latter had a more multidimensional focus. Lay definitions of active ageing were also more dynamic, compared with definitions of quality of life and successful ageing. Differences in self-rated active ageing and perceptions of this concept by ethnic group need further exploration.

Objective: to quantify mortality rates across the care home population of Northern Ireland, and assess variation by type of care home and resident characteristics.

Design: a prospective, Census-based cohort study, with 5-year follow-up.

Participants: all 9,072 residents of care homes for people aged 65 and over at the time of the 2001 census with a special emphasis on the 2,112 residents admitted during the year preceding census day.

Measurements: age, sex, self-reported health, marital status, residence (not in care home, residential home, dual registered home, nursing home), elderly mentally infirm care provision.

Results: the median survival among nursing home residents was 2.33 years (95% CI 2.25–2.59), for dual registered homes 2.75 (95% CI 2.42–3.17) and for residential homes 4.51 (95% CI 3.92–4.92) years. Age, sex and self-reported health showed weaker associations in the sicker populations in nursing homes compared to those in residential care or among the non-institutionalised.

Conclusions: the high mortality in care homes indicates that places in care homes are reserved for the most severely ill and dependent. Death rates may not be an appropriate care quality measure for this population, but may serve as a useful adjunct for clinical staff and the planning of care home provision.

Objective: to investigate the potential for impedance cardiography (ICG)-derived haemodynamic measures to predict HUT test outcome in unexplained syncope.

Design: prospective controlled study.

Subjects: eighty-six patients with unexplained syncope and 43 non-syncopal controls.

Methods: all subjects underwent continuous heart rate, blood pressure and ICG measurements during 10 min supine rest and during HUT. Vasovagal syncope was diagnosed when patients experienced symptom reproduction with concomitant haemodynamic derangements.

Results: during rest prior to HUT, the syncopal group had higher mean heart rate (P = 0.0008) and lower baroreceptor effectiveness index (P < 0.0001) compared to non-syncopal controls. On comparing patients who presented with unexplained syncope who subsequently had a positive HUT (therefore a diagnosis of vasovagal syncope 55 [64%]; mean age 47 years, range 17–85) to those having a negative tilt test (n = 31; mean age 47 years, range 17–88), there were no significant differences found in cardiovascular or autonomic parameters prior to HUT. A predictive ROC curve model at a 85% threshold allowed using cardiac index (CI), end-diastolic index (EDI) and left ventricular work index (LVWI) would identify those who would have a positive HUT from baseline cardiovascular measurements (CI >3.5, EDI > 77, LVWI >4.7) with 93% sensitivity and 17% specificity.

Conclusion: supine haemodynamic measures derived from transthoracic ICG can simply, non-invasively and sensitively differentiate HUT-positive patients from those with negative tilt tests. Further work is needed, particularly in older patients, before this technique can be used in clinical practice.

Objective: to evaluate the impact of a multifaceted community-based programme aimed at optimising evidence-based management of patients at risk for fall-related fractures.

Design: this was a randomised trial performed from 2003 to 2006.

Setting: community-based intervention in Ontario, Canada

Participants: eligible patients were community-dwelling, aged ≥55 years and identified to be at risk for fall-related fractures. A total of 201 patients were allocated to the intervention group or to usual care.

Intervention: components of the intervention included assessment of falls risk, functional status and home environment, and patient education.

Measurements: primary outcome was the implementation of appropriate falls risk assessment at 6 months. Secondary outcomes included falls and fractures at 6 and 12 months.

Results: the mean age of participants was 72 years, and 41% had fallen with injury in the previous year. Compared to usual care, the intervention increased the number of referrals made to physiotherapy [21% (21/101) vs 6.0% (6/100); relative risk (RR) 3.47, 95% confidence interval (CI) 1.46–8.22] and occupational therapy [15% (15/101) vs 0%; RR 30.7, 95% CI 1.86 to >500]. At 12 months, the number of falls in the intervention group was greater than in the usual care group [23% (23/101) vs 11% (11/100); RR 2.07, 95% CI 1.07–4.02].

Conclusions: compared to usual care, a multi-faceted intervention increased referrals to physiotherapy and occupational therapy but did not reduce risk of falls. Similar falls reduction interventions cannot be recommended based on the results of this study.

Methods: data from the 2006 National Audit of Continence Care for Older People were used to examine whether there was an association between organisational structure and standard of continence care for older people. ‘Quality’ scores were produced and the relationship between scores was examined.

Results: there were statistically significant correlations between organisational and process scores for continence care. Primary care scored higher than hospitals or care homes in regard to service organisation [median (IQR): 57 (45–68) vs 48 (36–65) vs 50 (38–55), P = 0.001]. Differences were less with clinical process scores for urinary incontinence (UI) [median (IQR): 42 (32–52) vs 40 (29–49) vs 43 (34–52), P = 0.06] and for faecal incontinence (FI) [median: 42 (34–53) vs 45 (36–55) vs 47 (41–53), P = 0.12].

Conclusion: those with an integrated service provide higher quality care to older people. The provision of high-quality care for continence appears to be dependent upon well-organised services with personnel who have the appropriate training and skills to deliver the care.

Methods: long-term mortality after 12-year follow-up in 125 subjects with CHF and 1,143 subjects without CHF was studied. Comorbidity was evaluated using CCI.

Findings: in elderly subjects stratified for CCI (1–3 and ≥4), mortality was higher in non-CHF subjects with CCI ≥4 (52.4% versus 70%, P < 0.002) but not in those with CHF (75.9% versus 77.6%, P = 0.498, NS). Cox regression analysis on 12 years mortality indicated that both CCI (HR = 1.15; 95% CI = 1.01–1.31; P = 0.035) and CHF (HR = 1.27; 95% CI = 1.04–8.83; P = 0.003) were predictive of mortality. When Cox analysis was performed by selecting the presence and the absence of CHF, CCI was predictive of mortality in the absence but not in the presence of CHF.

Conclusion: CCI does not predict long-term mortality in elderly subjects with CHF.