Methods: to evaluate the evidence for any relationship between incident cognitive decline or dementia in the elderly and alcohol consumption, a systematic review and meta-analyses were carried out. Criteria for inclusion were longitudinal studies of subjects aged ≥65, with primary outcomes of incident dementia/cognitive decline.

Results: 23 studies were identified (20 epidemiological cohort, three retrospective matched case-control nested in a cohort). Meta-analyses suggest that small amounts of alcohol may be protective against dementia (random effects model, risk ratio [RR] 0.63; 95% CI 0.53–0.75) and Alzheimer's disease (RR 0.57; 0.44–0.74) but not for vascular dementia (RR 0.82; 0.50–1.35) or cognitive decline (RR 0.89; 0.67–1.17) However, studies varied, with differing lengths of follow up, measurement of alcohol intake, inclusion of true abstainers and assessment of potential confounders.

Conclusions: because of the heterogeneity in the data these findings should be interpreted with caution. However, there is some evidence to suggest that limited alcohol intake in earlier adult life may be protective against incident dementia later.

Design: cost-effectiveness study embedded within a randomised controlled trial.

Setting: seven community hospitals and five general hospitals at five centres in the midlands and north of England.

Participants: 490 patients needing rehabilitation following hospital admission with an acute illness.

Intervention: multidisciplinary team care for older people in community hospitals.

Measurements: EuroQol EQ-5D scores transformed into quality-adjusted life years; health and social service costs during the 6-month period following randomisation.

Results: there was a non-significant difference between the community hospital and general hospital groups for changes in quality-adjusted life-year values from baseline to 6 months (mean difference 0.048; 95% confidence interval –0.028 to 0.123; P = 0.214). Resource use was similar for both groups. The mean (standard deviation) costs per patient for health and social services resources used were comparable for both groups: community hospital group £8,946 (£6,514); general hospital group £8,226 (£7,453). These findings were robust to sensitivity analyses. The incremental cost-effectiveness ratio estimate was £16,324 per quality-adjusted life year. A cost effectiveness acceptability curve suggests that if decision makers' willingness to pay per quality-adjusted life year was £10,000, then community hospital care was effective in 47% of cases, and this increased to only 50% if the threshold willingness to pay was raised to £30,000.

Conclusions: the cost effectiveness of post-acute rehabilitation for older people was similar in community hospitals and general hospitals.

Objective: the aim of this study was to examine oxygen levels during night in inpatients on geriatric medical wards to find out if they needed nocturnal oxygen therapy.

Design: prospective observational study.

Setting/Participants: we consecutively examined 133 patients with SpO₂ ≥92% in sitting position by an overnight -8-h pulse oximetry. Patients with severe obesity, dementia or pulmonary disease were excluded. The test was performed at least 4 days after the event in stroke cases.

Outcome Variables: ninety two patients, m/f 43/49, with mean age 78.3 ± 6.9 SD completed the test. Sixty six patients suffered from stroke; 34 left-sided and 19 right-sided stroke. Nine patients suffered from a heart disease only, and 17 patients suffered from other diseases.

Results: according to the guidelines for long-term oxygen therapy recommendations for nocturnal oxygen therapy, we found that 26% of the patients fulfilled the criteria of SpO₂ ≤90% for ≥30% of the time. There was a significant positive correlation between age and the amount of time with SpO₂ between 80 and 84% (0.215, P < 0.05). Diagnosis or severeness of disease did not significantly affect nocturnal SpO₂ %. The 1-year survival rate was 75% in group I (hypoxaemic) versus 84% in group II (normoxaemic) (NS).

Conclusion: nearly 30% of the inpatients in geriatric medical wards suffered from severe oxygen-requiring nocturnal hypoxaemia irrespective of diagnosis.

Methods: this was a prospective observational study performed in an ambulatory rehabilitation setting. We enrolled 74 patients aged 65–83 years (mean: 74.2, SD: 4.4) with stable COPD in GOLD stage 3–4. About half (45.6%) of them had a basal O₂ saturation of 90% or less. After a baseline multi-dimensional assessment, patients underwent a 20-session rehabilitation cycle including training of the upper and lower extremities, and respiratory exercises, along with education sessions. The difference between final and basal 6'WD was expressed as a per cent of the basal value (6'WD gain). Patients were divided into two groups according to whether the 6'WD gain was above or under the 75th percentile, corresponding to 33% gain.

Results: patients whose 6'WD improved more had lower baseline forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) (46.0 versus 52.2%, P = 0.03) and baseline 6'WD, both as an absolute value (329.5 versus 408.9 m, P = 0.01) and as a per cent of the predicted (71.1 versus 93.5%, P = 0.002). After correction for potential confounders, baseline 6'WD was the only variable associated with the outcome (OR for 5% increments: 0.79; 95% CI 0.65-0.95).

Conclusions: among elderly patients with COPD, a comprehensive rehabilitation programme can significantly improve the 6'WD even in the presence of chronic hypoxemia. The most physically impaired patients achieve the greatest benefit from rehabilitation, but we could not develop a model accurately predicting the response to rehabilitation.

Methods: clinical risk factors were assessed at baseline for 2,005 older people (473 males, 1,532 females; mean age 85.7 years, SD 7.1 years) living in aged-care facilities. Fractures were ascertained for 2 years from baseline. Cox regression model was used to identify significant risk factors for fracture. Hazard ratios (HRs) from the model were assigned as weights. The risk index was calculated by multiplying the weights of all risk factors.

Results: during a mean follow-up of 1.64 years, 401 fractures occurred in 338 participants. Significant independent clinical risk factors for fracture were institution type, balance, history of previous fracture, cognitive function, number of medications, weight and lower leg length (n = 1,813). The index was capable of identifying higher-risk individuals, with almost an 8-fold increase in the risk of fracture for residents from the lowest 15% to the highest 18% of the score. Among 1-year survivors, a high score (≥15) indicated approximately a one-in-six chance of fracture, while a low score (<8) indicated only a one-in-forty chance of fracture within a year. The area under the receiver operating characteristic (ROC) curve was 0.69 (95% CI: 0.65–0.72) and 0.68 (95% CI: 0.65–0.71) for identifying someone who would have a fracture in 1 and 2 years respectively.

Conclusions: this risk index could identify individuals at higher fracture risk among institutionalised older people, and thus, could help to rationalise the provision of fracture prevention programs in this population.

Methods: data on standards relating to both organisations and process of care were extracted from the audits to look for trends in service provision, continence care planning and discharge destination of incontinent versus continent stroke survivors. In addition, 2004 data was analysed statistically to look for a link between stroke units meeting certain standards and the likelihood of patients having continence plans.

Results: UI rates have changed little over the four audit cycles. The influence of UI on discharge destination has also altered little. Stroke unit care is more strongly associated with management planning for UI in stroke.

Aims: to examine the process by which consultant old age psychiatrists prescribe for BPSD and explore the factors that influence their decisions.

Method: a focus group generated initial questions for interviews with eight consultant old age psychiatrists, using a grounded theory methodology.

Results: differences in how assessment information was utilised resulted in inconsistencies in choice of medication between psychiatrists. Psychiatrists felt pressured to prescribe, largely due to resource issues and lack of viable alternative treatments.

Conclusion: the ways in which psychiatrists prescribe for BPSD varies amongst clinicians. Guidelines do exist, but are difficult to implement in practice. Alternative non-pharmacological strategies are required, but as yet they are difficult to access and have a questionable evidence base.

Methods: community-dwelling patients over the age of 75 years were invited from two general practitioners in Auckland, New Zealand. Participants completed the 11-item BRIGHT questionnaire twice and were assessed at home using the Minimum Dataset for Home Care (MDS-HC) comprehensive geriatric assessment tool by a trained gerontology nurse. Retest reliability of the BRIGHT was assessed with a correlation coefficient, and receiver operator characteristic (ROC) curves were used to assess the utility of the tool against standard outputs from the MDS-HC reflecting level of disability; the instrumental activities of daily living clinical assessment protocol (IADL CAP), and the MAPle score for dependency.

Results: 101 participants completed both the BRIGHT questionnaires and the comprehensive MDS-HC assessment. Test-retest reliability was modest with a correlation of 0.77. A sensitivity of 0.86 and specificity of 0.86 were observed for a score of 3 or more on the questionnaire in relationship to the IADL CAP. A sensitivity of 0.65 and specificity of 0.84 were observed when BRIGHT questionnaire score of 3+ was related to the MAPLe score from the MDS-HC assessment.

Conclusions: the BRIGHT questionnaire has acceptable utility in identifying community-dwelling older people with disability, and excellent utility in ruling them out of needing further assessment. This tool may be useful as part of an intervention process to detect unmet needs and to improve systematic surveillance of primary care populations.

Objective: to investigate the association between markers of vascular disease and cognition in a community-dwelling non-demented elderly population while adjusting for vascular and non-vascular confounds.

Design: cross-sectional community based assessment.

Participants: 466 subjects with mean age 75.45 (s.d., 6.06) years. 208 (44.6%) were male.

Results: higher levels of homocysteine were consistently associated with poorer performance in tests assessing visual memory and verbal recall. No other vascular biomarker was found to be associated with cognitive performance. Factors such as alcohol use, tea intake, life satisfaction, hypertension and smoking were positively correlated with global cognitive performance. Negative correlations existed between cognitive performance and depression, past history of stroke, intake of fruit and use of psychotropic medication.

Conclusions: homocysteine was the only vascular biomarker associated with poorer function in a number of domains on neuropsychological testing, independent of vascular and non-vascular confounds. Other psychosocial factors may need to be taken into account as potential confounds in future studies investigating cognition.

Methods: a randomised controlled trial was undertaken in three London primary care group practices.

Functionally independent community-dwelling patients older than 65 years (n = 2,503) received a self-administered Health Risk Appraisal for Older Persons (HRA-O) questionnaire leading to computer-generated individualised written feedback to participants and general practitioners (GPs), integrated into practice information-technology (IT) systems. All primary care staff received training in preventative health in older people. The main outcome measures were self-reported health behaviour and preventative care uptake at 1-year follow-up.

Results: of 2,503 individuals randomised, 2,006 respondents (80.1%) (intervention, n = 940, control n = 1,066) were available for analysis. Intervention group respondents reported slightly higher pneumococcal vaccination uptake and equivocal improvement in physical activity levels compared with controls. No significant differences were observed for any other categories of health behaviour or preventative care measures at 1-year follow-up.

Conclusions: HRA-O implemented in this way resulted in minimal improvement of health behaviour or uptake of preventative care measures in older people. Supplementary reinforcement involving contact by health professionals with patients over and above routine clinical encounters may be a prerequisite to the effectiveness of IT-based delivery systems for health promotion in older people.

Objective: to summarise and critically evaluate evidence on the effect of bedrails on falls and injury

Design: systematic literature review using the principles of QuoRoM guidance.

Setting and Subjects: adult healthcare settings

Review Methods: using the keyword, bedrail, and synonyms, databases were searched from 1980 to June 2007 for direct injury from bedrails or where falls, injury from falls, or any other effects were related to bedrail use.

Results: 472 papers were located; 24 met the criteria. Three bedrail reduction studies identified significant increases in falls or multiple falls, and one found that despite a significant decrease in falls in the discontinue-bedrails group, this group remained significantly more likely to fall than the continue-bedrails group; one case-control study found patients who had their bedrails raised significantly less likely to fall; one retrospective survey identified a significantly lower rate of injury and head injury in falls with bedrails up. Twelve papers described direct injury from bedrails.

Discussion: it is difficult to perform conventional clinical trials of an intervention already embedded in practice, and all included studies had methodological limitations. However, this review concludes that serious direct injury from bedrails is usually related to use of outmoded designs and incorrect assembly rather than being inherent, and bedrails do not appear to increase the risk of falls or injury from falls.

Methods: consecutive new female patients aged 65 years and older recruited from outpatient UI clinics in Quebec received a behavioural management protocol for UI. At 3-month follow-up, patients and physicians were independently asked for their global impression of change in UI status. Patients completed 3-day voiding diaries and a UI-specific quality-of-life index before and after treatment.

Results: 108 patients (mean age 73 ± 5 years, range 65-86 years) with stress, urge and mixed UI participated. There was concordance between patients' and physicians' ratings of change in 57% of cases. Among the remaining cases, patients were 1.6 times as likely to report significant improvements compared to physicians. Patients' ratings correlated more strongly with improvements in UI episodes in the voiding diary (r = 0.4, P = 0.002 versus r = 0.3, P = 0.004 for physicians) and on the quality-of-life index (r = –0.5, P < 0.0001 versus r = –0.4, P < 0.0001 for physicians).

Conclusion: physicians underestimate clinically meaningful changes in UI in older women following behavioural interventions.

Objective: the aim of this study was to measure functional performance and aerobic reserve in older adults during the serial performance of daily tasks.

Subjects: twenty-nine (n = 29) men and women (n = 23females) 70–92 years of age participated in this study.

Methods: performance based physical function was assessed using the Continuous-Scale Physical Functional Performance test (CS-PFP). A Cosmed K4b^2TM portable metabolic system was used to measure VO_2PEAK and oxygen uptake during the serial performance of a battery of daily tasks (VO_2PFP). Aerobic reserve was calculated as the difference between VO_2PEAK and VO_2PFP.

Results: the correlation coefficient between aerobic reserve and functional performance was r = 0.50(P = 0.006). Participants utilized 32.2 ± 8.1%, 42.7 ± 10.8%, and 50.3 ± 12.3% of VO_2PEAK for the low, moderate, and high workloads of the CS-PFP, respectively.

Conclusions: light housework and carrying groceries require 40 to 50% of peak oxygen consumption. This information can be used by clinicians and health professionals working with older adults as a guide to how much aerobic fitness is needed to perform ADLs and maintain independence. These can then be used as guides for assessment and for setting training goals in older adults.

Methods: DCM (version 8) was conducted in three elderly care general hospital wards and in two community hospitals. Summary statistics were calculated from the DCM data to assess feasibility and adequacy of the DCM coding system.

Results: fifty-eight participants were mapped for 84 observation hours/414 patient hours (4,968 5-min time frames). There was a relatively high proportion (942/2,376; 40% time frames) of missing data in the community hospitals due to time patients spent away from the area under observation. All 3,624 of the time frames with patient-observed data could be coded utilising the existing Behaviour Category and Mood/Engagement Value coding frameworks.

Discussion: the results from this preliminary study are promising and indicate that DCM is potentially feasible in elderly care general hospital wards, without the need for major modification.

Design: retrospective analysis of the oldest old from a population-based cohort study.

Setting: population-based study in England and Wales: two rural and three urban sites.

Methods: two types of analyses were conducted: (i) a descriptive analysis of those individuals who were aged 90 years or more, and 100 years or more, and (ii) a survival analysis of those who reached their 90th, 95th, or 100th birthday during the study. Median survival time was calculated by the Kaplan–Meier method. Effects of socio-demographic characteristics on survival were evaluated using the Cox proportional-hazards regression model.

Results: in total, 958 individuals aged 90 years or more, and 24 individuals aged 100 years or more, had been interviewed at least once during the study. Twenty-seven per cent were living in residential or nursing homes. Women aged 90 years or more were more likely to be living in residential and nursing homes, be widowed, have any disability or have lower MMSE scores. The centenarians were mostly cognitively and functionally impaired. The median survival times for those reaching their 90th (n = 2,336), 95th (n = 638), or 100th birthday (n = 92) during the study were 3.7 years (95% CI: 3.5–4.0), 2.3 (2.1–2.6) and 2.1 (1.7–2.6) years for women, and 2.9 (95% CI: 2.6– 3.1), 2.0 (1.2–3.1) and 2.2 (0.5–2.3) for men, respectively. Those living in residential and nursing homes had a shorter survival when aged 90 years, with similar non-significant effects for those aged 95 and 100 years. After the age of 100 years, the high mortality rate and small sample size limited the ability to detect any differences between the different groups.

Conclusion: even at the very oldest ages, the majority live in non-institutionalised settings. Among the oldest old, women were frailer than men. Being male and living in residential nursing homes shortened survival in those aged 90 years or more.

Methods: prospective cohort study with a 2-year follow-up.

Setting: the English Longitudinal Study of Ageing (ELSA), a national probability sample of non-institutionalised older people.

Participants: 4,148 participants aged 60 years and over.

Measurements: exposure was a census-based index of neighbourhood deprivation [the Index of Multiple Deprivation (IMD)]; outcomes were measured and self-reported incident mobility difficulties.

Results: neighbourhood deprivation had a statistically significant effect on physical function following adjustment for individual socio-economic factors, health behaviours and health status. Compared to those living in the least deprived 20% of neighbourhoods, those in the most deprived neighbourhoods had a risk ratio (RR) of incident self-reported mobility difficulties of 1.75 (95% CI 1.14–2.70) and RR of incident-impaired gait speed of 1.63 (95% CI 1.01–2.62). In adjusted models, 4.0 per 100 (95% CI 3.0–5.4) older adults in neighbourhoods in the least deprived 20% had incident mobility difficulties over a 2-year period, whereas 13.6 per 100 (95% CI 10.5–17.4) older adults had incident mobility difficulties in neighbourhoods in the most deprived 20%.

Conclusions: older people living in deprived neighbourhoods are significantly more likely to experience incident mobility difficulties than those in less-deprived neighbourhoods. The mechanisms underlying this relationship are unclear and research to identify mechanisms and appropriate interventions is needed.

Objective: to evaluate the risk of early unplanned readmission, and to identify predictors in inpatients aged 75 and over, admitted to medical wards through emergency departments.

Design: prospective multi-centre study.

Setting: nine French hospitals.

Subjects: one thousand three hundred and six medical inpatients, aged 75 and older admitted through emergency departments (SAFES cohort).

Methods: using logistic regressions, factors associated with early unplanned re-hospitalisation (defined as first unplanned readmission in the thirty days after discharge) were identified using data from the first week of hospital index stay obtained by comprehensive geriatric assessment.

Results: data from a thousand out of 1,306 inpatients were analysed. Early unplanned readmission occurred in 14.2% of inpatients and was not related with sociodemographic characteristics, comorbidity burden or cognitive impairment. Pressure sores (OR = 2.05, 95% CI = 1.0–3.9), poor overall condition (OR = 2.01, 95% CI = 1.3–3.0), recent loss of ability for self-feeding (OR = 1.9, 95% CI = 1.2–2.9), prior hospitalisation during the last 3 months (OR = 1.6, 95% CI = 1.1–2.5) were found to be risk factors, while sight disorders appeared as negatively associated (OR = 0.5, 95% CI = 0.3–-0.8).

Conclusions: markers of frailty (poor overall condition, pressure sores, prior hospitalisation) or severe disability (for self-feeding) were the most important predictors of early readmission among elderly medical inpatients. Early identification could facilitate preventive strategies in risk group.

Method: design—population-based cross-sectional study; setting—local community in Southeast Region of Singapore; subjects—Chinese older adults aged 55 and above (N = 2, 550); measurements—serum albumin, haemoglobin, BMI and Mini-Mental State Examination (MMSE).

Results: in multivariable analyses controlling for gender, age, education and vascular risk factors, low albumin in the bottom quintile (OR 2.04; 95% CI 1.22–3.41) and low haemoglobin in the bottom quintile (OR 1.56; 95% CI 1.00–2.47) and low BMI with chronic comorbidity (OR 1.73; 95%CI 1.02–2.95) were independently associated with poor cognitive performance (MMSE ≤ 23). Among cognitively intact respondents (MMSE ≥ 24), albumin concentration showed a significant inverse linear relationship with MMSE scores (P for trend =0.002).

Conclusion: low albumin, low haemoglobin and low BMI (in the presence of chronic comorbidity) are independently associated with poor cognitive performance in community-living older adults.

Objective: the objective of this study was to examine the comparative ability and clinical utility of eight mobility tests for predicting multiple falls in older community-dwelling people.

Methods: design—prospective cohort study; subjects –362 subjects aged 74–98 years; measurements—the sit-to-stand test with one and five repetitions, the pick-up-weight test, the half-turn test, the alternate-step test (AST), the six-metre-walk test (SMWT) and stair ascent and descent tasks. Falls were monitored for 1 year with fall calendars.

Results: in the 12-month follow-up period, 80 subjects (22.1%) suffered two or more falls. Multiple fallers performed significantly worse than non-multiple fallers in the sit-to-stand test with five repetitions (STS-5), the AST, the half-turn test, the SMWT and the stair-descent test. When dichotomised using cut-off points from receiver-operated characteristics (ROC) curve analyses, these tests demonstrated reasonable sensitivity and specificity in identifying multiple fallers. A principal components analysis identified only one factor underlying the mobility tests. Poor performances in two mobility tests, however, increased the risk of multiple falls more than poor performance in one test alone (ORs = 3.66, 95% CI = 1.44, 9.27 and 1.61, 95% CI = 0.62, 4.16 respectively).

Conclusions: the mobility tests appear to be measuring a similar ‘mobility’ construct. Based on feasibility and predictive validity, the AST, STS-5 and SMWTs were the best tests.

Design: cohort study, 6-month prospective follow-up for falls.

Participants: 183 frail persons living in residential care facilities in Sweden, mean age 84 years, 73% women.

Methods: the occurrence of falls during the follow-up period were compared to the following assessments at baseline: the TUG at normal speed; the GUG-m, a rating of fall risk scored from 1 (no risk) to 5 (very high risk); the GLORF, staff's rating of fall risk as ’high’ or ’low’; a history of falls in the previous 6 months. These assessment tools were evaluated using sensitivity, specificity and positive and negative likelihood ratios (LR⁺ to rule in and LR^– to rule out a high fall risk).

Results: 53% of the participants fell at least once. Various cut-off values of the TUG (12, 15, 20, 25, 30, 35, 40 s) and the GUG-m showed LR⁺ between 0.9 and 2.6 and LR^– between 0.1 and 1.0. The GLORF showed an LR⁺ of 2.8 and an LR^– of 0.6 and fall history showed an LR⁺ of 2.4 and an LR^– of 0.6.

Conclusions: in this population of frail older people, staff judgement of their residents' fall risk as well as previous falls both appear superior to the performance-based measures TUG and GUG-m in ruling in a high fall risk. A TUG score of less than 15 s gives guidance in ruling out a high fall risk but insufficient information in ruling in such a risk. The grading of fall risk by GUG-m appears of very limited value.

Objective: to quantify the prevalence of PA in older asthmatics and to explore the potential psychosocial determinants of PA in this population.

Study Design and Setting: cross-sectional data available from the Canadian Community Health Survey (CCHS), cycle 2.1, were used. There was a total of 1,772 older asthmatics in the sample.

Results: there were significant differences in the prevalence of PA between older asthmatic females compared to middle-aged asthmatic females (² = 23.65, P < 0.0001) and older asthmatics compared to older non-asthmatics (² = 38.1, P < 0.0001). Logistic regression revealed a significant association between PA and perceived health in older asthmatic males (OR = 5.39, CI = 1.36–21.33) and females (OR = 4.81, CI = 1.41–16.38). Being a member of a volunteer organisation was also significantly associated with PA in older asthmatic females (OR = 1.59, CI = 1.11–2.30).

Conclusion: older asthmatics were less active than their non-asthmatic peers. Perceived health was an important predictor of PA in both older asthmatic males and females. Exercise interventions in this population should make an effort to improve self-perceived health.

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.