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.

Design: prospective study.

Setting: population-based sample of community-dwelling older persons.

Participants: 660 older participants (age ≥65 years).

Measurements: usual gait speed, fastest gait speed, gait speed during ‘walking-while-talking’, depression, comorbidities, education, smoking and demographics were assessed at baseline. Cognition was evaluated at baseline and follow-up. A decline in MMSE score by ≥3 points was considered as significant cognitive decline (SCD).

Results: adjusting for confounders, only fast speed was associated with cognitive performance at 3-year follow-up. One hundred thirty-five participants had SCD over 3 years. Participants in the lowest quartile of usual speed or walking-while-talking speed were more likely to develop SCD. Conversely, participants in the third and fourth quartiles of fast speed were more likely to develop SCD. J-test showed that the model including fast speed quartiles as a regressor was significantly more predictive of SCD than the models with usual speed or walking-while-talking speed quartiles.

Conclusion: measuring fast gait speed in older persons may assist in identifying those at high risk of cognitive decline.

Objective: to determine the relationship between age and in-hospital mortality of elderly patients, admitted to ICU, requiring and not requiring invasive ventilatory support.

Design: prospective observational cohort study conducted over a period of 11 months.

Setting: medical-surgical ICU at a Brazilian university hospital.

Subjects: a total of 840 patients aged 55 years and older were admitted to ICU.

Methods: in-hospital death rates for patients requiring and not requiring invasive ventilatory support were compared across three successive age intervals (55–64; 65–74 and 75 or more years), adjusting for severity of illness using the Acute Physiologic Score.

Results: age was strongly correlated with mortality among the invasively ventilated subgroup of patients and the multivariate adjusted odds ratios increased progressively with every age increment (OR = 1.60, 95% CI = 1.01–2.54 for 65–74 years old and OR = 2.68, 95% CI = 1.58–4.56 for ≥75 years). For the patients not submitted to invasive ventilatory support, age was not independently associated with in-hospital mortality (OR = 2.28, 95% CI = 0.99–5.25 for 65–74 years old and OR = 1.95, 95% CI = 0.82–4.62 for ≥75 years old).

Conclusions: the combination of age and invasive mechanical ventilation is strongly associated with in-hospital mortality. Age should not be considered as a factor related to in-hospital mortality of elderly patients not requiring invasive ventilatory support in ICU.

Method: we used data collected in the Hypertension in the Very Elderly Trial (HYVET), and cognitive function was assessed using the Mini-Mental State Examination (MMSE) at baseline and annually. Participants with a fall in MMSE to <24 or with a fall of 3 points in any 1 year were investigated further. The association of baseline sociodemographic, medical and lifestyle factors with incident dementia or decline in MMSE scores was assessed by regression models.

Results: incident dementia occurred in 263 of 3,336 participants over a mean follow-up of 2 years. In multivariate analyses, being underweight, BMI < 18.5 (HR 1.90, 95% CI 1.06–3.39) or obese, BMI >30 (HR 1.84, 95% CI 1.24–2.72), increased risk of incident dementia as did piracetam use (HR 2.72, 95% CI 1.60–4.63). Receiving formal education was associated with a reduced risk (HR 0.59, 95% CI 0.45–0.78). There was no association with smoking, alcohol and gender. Similar results were found when examining mean annual change in the MMSE score.

Discussion: our results for BMI and education agree with those from other studies. The increased risk associated with piracetam may reflect awareness of memory problems before any diagnosis of dementia has been made. Trial participants may be healthier than the general population and further studies in the general population are required.

Design and setting: face to face home interview survey across England.

Measures: physical, psychological, social, and socio-economic status and circumstances.

Results: excess risk of mortality, which had been noted up to six months post bereavement among males aged 75+, had disappeared. In contrast to findings up to 13 years post-bereavement, neither psycho-social factors, social circumstances nor social class independently predicted differentials in mortality when analysed up to 28 years post-bereavement. The most significant, independent predictors, up to the 28-year term, were, as would be expected, male sex, older age, poorer physical functioning, and expressed ‘relief at the death of the spouse’. When the sample was split by duration of widow(er)hood male sex and older age retained significance.

Conclusion: the increasing frailty of the sample overall, and reduced statistical power in split-sample analyses, may explain the loss of significance of physical functioning and ‘expressed relief at the death’ in the split-sample results. The psycho-social risk factors for mortality after bereavement reduce over time, although further examination of expressed relief would be worthwhile.

Methods: two waves of data from the Singapore Longitudinal Ageing Studies were analyzed for 2,716 Singaporeans aged 55 or above at baseline and 1,754 at 2-year follow-up. Trained research nurses interviewed participants (non-volunteering retiree, volunteering retiree, and working seniors) on mental health status (geriatric depression scale, Mini Mental State Examination, positive mental wellbeing and life satisfaction).

Results: about 88% of seniors were retired (78% non-volunteering, 10% volunteering) and 12% were still working in paid employment or business. At baseline and 2 year follow up, and regardless of physical health status, volunteering retirees and working seniors gave significantly better MMSE cognitive performance scores, fewer depressive symptoms, and better mental well-being and life satisfaction than non-volunteering retirees.

Conclusion: the results of this study suggest that continued work involvement or volunteerism provides opportunities for social interaction and engagement and may be associated with enhanced mental well-being. Future research should clarify which specific aspects of volunteerism are related to long-term mental well-being.

Methods: we studied 113 (84 females) spirometry-naïve inpatients, mean age of 84 years (range 74–97). All performed the MMSE, IP, CLOX 1 and 2 and then attempted to perform assisted spirometry to the American Thoracic Society/European Respiratory Society standard.

Results: of 113, 49 met the criteria for adequate spirometry. Using normative thresholds for probable impairment, inability to perform spirometry was predicted by MMSE <24/30 with a sensitivity of 81% and specificity of 90% (P<0.0000); by inability to copy IP with a sensitivity of 92% and specificity of 100% (P<0.0000); by CLOX1 <10/15 with a sensitivity of 81% and specificity of 49% (P<0.001); and by CLOX2 <12/15 with a sensitivity of 63% and specificity of 65% (P<0.001).

Conclusion: CLOX tests did not perform better than MMSE and IP to identify subjects unlikely to be able to perform spirometry. Achieving assisted spirometry from the naïve state in old age might be more determined by global cognitive function and ideo-motor praxis than by executive control function.

Methods: this randomised trial included 110 caregiver/patient dyads who were followed up for 6 months. Primary analyses were intention-to-treat analyses of caregiver burden assessed with Zarit Burden Interview (ZBI; 0–88; higher means more burden). Preplanned subgroup analyses were conducted for cognition, living arrangement and patient/caregiver co-residence.

Results: overall, perceived caregiver burden showed no significant differences between study groups in changes over time. However, perceived burden was at baseline more than eight points higher in caregivers sharing a household with patients (n = 23) compared to caregivers living separately (n = 87). The intervention performed better in caregivers living together with the patient than in caregivers living separately (P for interaction = 0.04). Co-resident caregivers experienced six-Zarit point improvement compared with four-point deterioration in the non-co-resident caregivers.

Conclusions: GEM at home benefited patients, but maybe not caregivers. Caregiver effects are related to whether caregivers live with the patient or not.

Methods: we studied 124 healthy adults aged 20–86 years. Progressive external airflow resistance loading was used to measure the inspiratory and expiratory load detection thresholds (LDTs) during tidal breathing at rest.

Results: the mean inspiratory LDT rose from 4.00 (3.06 SD) kPa.s/L in the 20–39 age group to 6.51 (6.20) in the 40–64 age group (NS) and 29.10 (13.58) in the 65 + age group (P < 0.00001). The inspiratory LDT was significantly correlated with age, mainly due to the higher thresholds in people over the age of 65 (r = 0.7860, P < 0.00001), but did not correlate with age-corrected forced vital capacity or respiratory rate. Expiratory LDT values and correlations were very similar. Day-to-day variability in LDTs tended to be higher in older subjects.

Conclusion: the threshold for detecting external resistive loads during tidal breathing rises in old age. This appears to be a consequence of ageing processes rather than pathology, and might be a manifestation of a fall in proprioceptive acuity in elderly people. This finding has clinical implications for the self-management of asthma in old age. There is a need to conduct a similar study in patients with airways disease.

Design: cross-sectional study.

Setting: community-living elderly Chinese in Hong Kong.

Objective: this study examines the relationship between self-rated social economic status and telomere length in Hong Kong Chinese men and women aged 65 years and over living in the community.

Subjects and method: information was collected from 958 men and 978 women regarding possible confounding factors such as the presence of chronic diseases, smoking, physical activity level, dietary intake and body mass index. Telomere length was measured by quantitative PCR.

Result: in men only, after adjustment for age and other confounding factors, a higher ranking in community standing was associated with shorter telomere length.

Conclusion: men with higher self-rated socioeconomic status have shorter telomeres, possibly mediated through psychosocial rather than lifestyle factors or the presence of chronic disease. There may be cultural ethnic and age-related differences in social determinants of health.

Objective: we conducted a multicentre survey of knowledge of and attitudes to delirium in trainee general physicians.

Design: questionnaire-based survey in 34 acute hospitals in the UK.

Methods: we developed a questionnaire designed to test knowledge of delirium prevalence, DSM-IV diagnostic criteria, use of specific screening tools, association with adverse outcomes, and pharmacological management. Questionnaires were completed and returned by hand to the researchers immediately after recruitment. Participants were a convenience sample of trainee doctors in general and emergency medicine.

Results: 784 trainee physicians participated. Most participants expressed the view that delirium has a high prevalence and that it is associated with serious adverse outcomes. However, they had poor knowledge of its diagnosis and treatment, reporting the need for better training. Experience working in geriatric medicine had only a modest effect on the ability to diagnose delirium.

Conclusions: UK training doctors' lack of basic knowledge of the diagnosis and management of delirium, rather than a lack of awareness of its high prevalence and clinical significance, appears to be important in determining its under-recognition.

Methods: the subjects were 52 young (20–34 year; 30 men and 22 women) and 51 elderly individuals (60–77 year, 19 men and 32 women). The MV and maximal anatomical CSA (ACSA) of elbow flexors were determined by magnetic resonance imaging. The torque developed during maximal voluntary contraction of isometric elbow joint flexion was converted to force by dividing it by the forearm length of each subject.

Results: torque was significantly correlated with MV in young and elderly individuals (r = 0.564–0.926). Similarly, force was also significantly correlated with ACSA in each of them (r = 0.637–0.906). However, the y-intercepts of the regression lines for the ACSA-force relationship in young men and women were significantly higher than zero. There was no age effect on torque per MV, whereas force per ACSA was significantly higher in young adults than in elderly individuals.

Conclusion: for elbow flexors, MV compared to ACSA is appropriate for evaluating the size–strength relationship and the existence of age-related difference in muscle strength per size.

Design: analysis of data from a longitudinal cohort study.

Subjects: community-dwelling women aged ≥65 years, admitted to one of two hospitals in Baltimore with a new, non-pathological fracture of the proximal femur between 1992 and 1995.

Methods: information on falls was collected from a falls diary. At the baseline, 6- and 12-month evaluations, subjects were asked about the number of times in the 2 weeks prior to the evaluation they had participated in 10 categories of social activities. We examined the association of repeated falls with social participation using generalized estimating equations. The effect of physical and psychological functions was examined by including measures of lower extremity functional performance and depressive symptoms into the model.

Results: the analyses included 196 women, mean age = 80.2 years. Eighty-one subjects fell. The subjects with >1 fall between evaluations participated in a mean (95% CI) of 3.5 (0.12, 6.9) and 4.3 (0.9, 7.7) fewer social activities at 6 and 12 months post-fracture, respectively, compared to those who did not fall (P = 0.0003). These results were attenuated by adjustment for depressive symptoms, but not by lower extremity functional performance.

Conclusions: in the year post-fracture, repeated falls in women were associated with decreased social participation independent of lower extremity function. Depressive symptoms in repeated fallers may partly explain this association.

Design: prospective, single-blind, randomised controlled trial in two centres.

Participants: a total of 265 patients with a disabling stroke and their carers.

Interventions: a structured re-assessment system for patients and their carers at 6 months post-stroke or existing care.

Outcome measures: primary: patient independence (Frenchay activities index) and carer stress (general health questionnaire 28). Secondary: activities of daily living, mood state, satisfaction with services, carer strain index, health and social service resource use and costs.

Results: independence at 12 months post-stroke was similar in both groups (Frenchay activities index, adjusted mean difference 0.64; 95% confidence interval –0.74–2.02). Emotional distress in carers was similar in both groups (general health questionnaire 28, mean difference 0.02; 95% confidence interval –0.95–1.00). Results for the secondary outcome measures and total mean costs were similar for both groups. The intervention group patients used 301 fewer hospital bed days and 1,631 fewer care home bed days.

Conclusions: the structured, systematic re-assessment for patients and their carers was not associated with any clinically significant evidence of benefit at 12 months. Health and social care resource use and mean cost per patient were broadly similar in both groups.

Trial registration: International Standard Randomised Controlled Trial Register; number: ISRCTN55412871.

Objectives: to identify factors associated with readmissions related to the index surgical stay.

Design: retrospective cohort study.

Setting: administrative claims databases.

Subjects: patients over 75 surgically treated for hip fracture in Paris area.

Methods: we analysed all admissions in 2005, and tracked for 1-year readmissions. First readmissions (FRs) were classified as related or unrelated to the index stay, according to rules defined a priori. We analysed the association between patient characteristics and the FR.

Results: among 5,709 patients, 32% had at least one readmission, 53% were FR related. Near 80% of related readmissions occurred within 3 months from discharge. Surgical conditions caused 47% of all related readmissions, and male gender, dementia, cancer or kidney diseases were independent risks factors.

Conclusions: half of readmissions could be classified as related to the index stay and a great majority of these occurred early post discharge. Surgical conditions caused 47% of all related readmissions. Improvement in orthopedic-geriatric co-care is suitable to expect an impact on outcomes after surgery.

Objective: to evaluate the influence of admission HG [blood glucose (BG) levels >8 mmol/L] on long-term mortality after ischaemic stroke (IS) and transient ischaemic attack (TIA).

Methods: consecutive patients with IS or TIA, admitted from January 1997 until December 2002, were retrospectively screened. BG was measured within 3 days from onset of symptoms. Information on the date of death was obtained within 10 years after onset.

Results: a total of 509 patients (78% IS; 22% TIA) were included. Admission HG was present in 28% and 18% of the IS and TIA patients, respectively (P = 0.05). Mean admission BG was 7.6 ± 3.2 mmol/L in the IS and 6.7 ± 2.3 mmol/L in TIA (P = 0.002). During a mean observation of 66 ± 35 months, the overall 1- and 10-year mortality rate was 12% and 51% in IS compared to 4% and 38% in TIA patients (P = 0.004). Normoglycaemic IS patients had a longer median survival than those with HG (113 vs 84 months, P = 0.04). Admission HG did not affect the mortality rates in TIA patients.

Conclusion: admission HG is associated with greater mortality rates up to 5 years after stroke but does not influence the survival of TIA patients.

Objective: to describe the dietary patterns of a population of community-dwelling older men and women and to examine factors associated with compliance with these patterns.

Setting and Participants: 3,217 men and women aged 59–73 years who were participants in the Hertfordshire Cohort Study.

Methods: diet was assessed using an administered food frequency questionnaire; dietary patterns were identified using principal component analysis.

Results: two dietary patterns were identified. The first was characterised by high consumption of fruit, vegetables, oily fish and wholemeal cereals (‘prudent’ pattern); the second was characterised by high consumption of vegetables, processed and red meat, fish and puddings (‘traditional’ pattern). High ‘prudent’ diet scores were more common in women, in men and women in non-manual classes and in non-smokers (all P < 0.05), whilst high ‘traditional’ diet scores were more common in men, in men and women who had partners and were associated with higher alcohol consumption (all P < 0.05).

Conclusions: we have described large variations in food consumption and nutrient intake amongst older adults that are likely to have implications for future health. The specific socio-demographic correlates of the dietary patterns provide insights into the contexts within which good and poor diets exist, and may help in the identification of opportunities for dietary intervention.