Health status, social networks and support systems of so called old old in a population-based comparative study of residents ages 69-74 and 75-80

To analyze the different features of health status, social support and networks of elderly people by age groups, a survey was performed of the social environment and health related issues among residents aged 69-74 and 75-80, the so called old-old, in Takasu, a small farming town in Hokkaido. The results were as follows: 1. The percentage of elderly having some of the symptoms related to dementia, lower scores of ADL, and poorer conditions of eye sight or hearing were significantly higher among the elderly aged 75-80 compared to those aged 69-74. The prevalence of diseases, such as senile cataracts in both sexes, and heart diseases in men were also higher among those aged 75 and over. 2. Although there were no differences in the mean number of hospital admissions or in the percentage of those having been sick in bed for more than 1 week during the previous one year, both the mean number of out-patient visits and percentage having a family physician were significantly higher in the elderly over 75 than under. Deterioration of IADL were prominent in the item on being able to go far away by themselves. 3. Almost 70% of the elderly participated in community-based social activities in Takasu. There were only small differences in social support and network among the different categories of family structure of the elderly. However women over 75 had statistically significantly lower number of the social supports compared to the younger age groups. A significantly smaller percentage of people was able to obtain the emotional or care support from their spouse for in elderly over 75 than for elderly under 75. 4. The results of this study suggest the need to provide more social support and networks for the old-old over 75 years old who tend to have more diseases and to be in poorer health condition, both physically or mentally than younger old.     

Evaluation of changes in primary health care availability and provision from the patient perspective

This study was designed to investigate changes in primary care following recent NHS reforms. The study was carried out by home interview of random samples of people aged 65 years and over in three district health authorities; 1500 in 1990 and 1500 in 1992, before and after the introduction of the reforms. The response rate was 94% (1413 in 1990 and 1405 in 1992). Few patients (6%) changed their general practitioner (GP) in 1990 or 1992. There was an increase in the provision of written practice information in 1992, but more than 60% of patients could not recall receiving leaflets. More practices included practice nurses and appointments systems and fewer used rotas of local practices or deputizing services for 'out of hours' calls. In 1992 more patients aged 75 years and over saw their GP within the previous year and significantly more were assessed for vision, hearing, continence, foot problems and blood pressure and had their urine tested, but most of these health assessments, except blood pressure (64%), were recalled by few patients. There have been small changes in the provision and use of primary health care by older people since the introduction of the new GP contract.     

A study of the services provided by the women's health nurses in a Sydney Area Health Service

OBJECTIVES: To describe the client characteristics and nature of services provided by women's health nurses and to examine whether the goals set for the service are being met. DESIGN: A retrospective study of women's health nurse (WHN) records from 1987 to 1991. SETTING AND SUBJECTS: All women attending the women's health nurse in the Southern Sydney Area Health Service, 1987 to 1991. Older women and women of non English-speaking background are specific targets for this service. OUTCOME MEASURES: Pap test and breast self-examination practices were examined in relation to age and ethnic background. Use of general practitioner services was examined for all women attending the women's health nurse in 1991. RESULTS: Forty-five per cent of clients were aged over 50, and 29 per cent were from a non English-speaking background. Older women were more likely to return for subsequent visits to the women's health nurse. The practice of breast self-examination increased significantly between visits among all women. Forty-one per cent of women had not had a Pap test for at least three years, 93 per cent of these women were screened at their first visit. Eighty-seven per cent of women on their first visit and 86 per cent of women revisiting the women's health nurse had seen their general practitioner within the previous year. CONCLUSION: Women's health nurses are meeting the goals set for their service in relation to health promotion and the screening of women. Their services are perceived by their clients as complementary to those provided by their general practitioners.     

Influence of paid work on the perceived health state in women

BACKGROUND: Several studies show that paid work has a positive effect on women's health, although few studies have shown this relationship in Southern-European countries. The aim of this paper was to analyze the self-perceived health status of women of Barcelona, Spain according to their type of work (homemaker or worker). PATIENTS AND METHODS: Cross sectional study using the 1992 Barcelona Health Interview Survey data. Subjects: 1194 women aged 25 to 64 years old. Bivariate analysis of women's perceived health status by all other variables. A logistic regression model was performed with the dependent variable being women's self-perceived health status and the independent variables: type of work (homemaker or worker), age, number of chronic diseases, medical care visits, children under 12 years and elderly over 65 years living at home and social class based on occupation. RESULTS: 15.8% of workers and 31.4% of homemakers reported poor self-perceived health status (p < 0.05). This same distribution was maintained when adjusting for all independent variables. Social class had an important relationship with health, with women from lower social classes reporting poorer self-perceived health status than homemakers from upper social classes. CONCLUSIONS: The 1992 Barcelona Health Interview Survey analysis confirms that in Barcelona as well, paid work has a positive relationship on women's self-perceived health status.     

Evaluating blood loss in children''s orthopaedic surgery: a simplified method of photometric analysis of eluted swabs

People aged eighty-five years and over (the oldest old) will form an increasing proportion of the population of New Zealand and many other countries. Because of their smaller numbers and relative inaccessibility, their health status has sometimes been extrapolated from populations of people aged sixty-five to eighty-four years. For people aged sixty-five to eighty-four years an exponential relationship is seen between age and morbidity and mortality. We explore if this exponential relationship extends to people aged ninety years and over. We analyzed data from the New Zealand 1991 Census and 1992 hospital discharge records and, for people aged sixty to eighty-nine years, confirmed an exponential relationship between age and mortality, inactivity, hospital utilization, and occupation of residential institutions. This exponential trend did not continue for people aged ninety years and over for whom mortality rates and indicators of morbidity were considerably lower than expected, and conclude that the actual health status of people aged ninety years and over is better than the status extrapolated from that of people aged sixty to eighty-nine years.     

Chronicity of back problems during working life

STUDY DESIGN: A follow-up study of a cohort of 444 patients aged 16 to 59 years who consulted with their general practitioners (GPs) in 1987-1988 for an incident episode of back pain. OBJECTIVES: To determine the proportion of patients with back pain in whom chronic back problems develop after a follow-up of 7 years, to compare health outcomes and labor force participation of patients with and without chronic back problems and to identify determinants of chronicity. SUMMARY OF BACKGROUND DATA: The incidence and prevalence of back pain are very high. A large proportion of the costs related to medical consumption, absence from work, and disability are probably caused by chronic back problems. It is unknown what proportion of back problems become chronic, especially after a long follow-up period, and which factors can predict chronicity. METHODS: Data on the course of the symptoms and medical consumption from the period between 1987-1988 and 1991 were gathered retrospectively. Data on several health outcomes, including LFP, and data on some work characteristics were collected prospectively in 1991. A more extensive data set on health outcomes including psychologic status and working situation was collected in 1994. RESULTS: Chronic back problems developed in 28% of the patients. These patients reported more pain, higher levels of medical resource consumption, worse health outcomes, and lower labor force participation. Episodes of back pain before 1987-1988, severe pain in 1991, and disability score in 1991 were positively associated with chronicity in 1994, difficulties with job performance in 1991, and frequent stooping in the subgroup of patients who held a paying job in the follow-up period. CONCLUSIONS: Even after a follow-up of 7 years, the proportion of people with chronic back problems was high. The consequences for quality of life, labor force participation, and consumption of medical resources are clear. Further research is necessary to examine determinants and ways to prevent chronicity.     

A functional analysis of Notch mutations in Drosophila

In 1900, the world population was less than 1.7 billion people; the United Nations projects that in 2000 it will be 6.2, and in 2020, 7.9 billion. The proportion of the elderly (65 years and over), will increase from 5.1% (1950) to 6.8% by the year 2000 and to 8.8% by 2020, when out of an elderly population of 796 million people, 124 million are projected to be 80 years and over. Due to an increasing gender inequality in life expectation, the majority of the elderly will be women. An aged population is a basically new feature in the history of humanity, the implications of which are-as yet-incompletely understood. It is clear, however, that the last years of life are accompanied by an increase in disability and sickness, with very high demands for health and social services. Hence, the soaring elderly population will raise major social, economic and ethical issues worldwide and may strain to the limit the ability of health, social and economic infrastructures of many countries. It may also result in an increasingly large proportion of humanity (the elderly in general and elderly women, in particular) living in absolute poverty. The demographic, health, socioeconomic and ethical dimensions of the problem are discussed with particular emphasis on the situation of elderly women and a plea is made for greatly increased medical and socioeconomic research.     

Comparison of PhD programs in clinical and counseling psychology

Some specific characteristics of the aging of the Brazilian population in different areas, states and communities all over the country, have shown significant variations. Historical series of demographic and health indicators for the population in their sixties and over in Brazil, state of S. Paulo and in the municipal district of Araraquara are listed as follows: level of education and urban population growth rate, income distribution, mortality rates and main causes of death. In 1991 the aged constituted were 7.8% of the Brazilian population and 9.7% in Araraquara community. The elderly population (of 70 years of aged and above) as a proportion of the whole, has increased and already stands for 40%. The same trend holds good for both the proportion of aged within the urban population and their level of education which increased to 90% in 1991. The main causes of death are chronic degenerative diseases which have replaced the infectious illness: first, the diseases of the circulatory system (which account for more than 40% of all deaths) and the neoplasms (which let to 15% of the deaths). On the basis of these health and demographic data relating to people of 60 years of age and over, this study suggests some procedures for the improvement of the quality of the assistance given to the target population: a) the assistance give to the aged should be improved by providing gerontological training for general physicians and nurses, both of public and private clinics; b) the already existing educational activities for the aged, for health workers and for teachers of secondary education should be further developed; c) the number of day-hospitals should be increased for the purpose of avoiding unnecessary confinement so as maintain the low rate of institutionalization in homes for the elderly (0.7% in Araraquara). It is reported that at least 35% of the aged population in this area is entitled to private health assistance, which brings out the importance of including such services in the local health programs for this group.     

Tumor-specific adoptive T-cell therapy for CD40+ B-cell malignancies

Hip fracture, the most dramatic complication of osteoporosis, constitutes a serious health problem of the elderly, with great socioeconomic consequences. Hip fracture epidemiology has been studied by many investigators. Until now, reported studies in Greece include either data from only one region, or they do not include all the epidemiological parameters concerning hip fractures. We studied hip fractures that occurred in Greece in 1992 and compared the findings with those of previous years (1977, 1982, 1987), in order to identify age and sex incidence and increase rate during 1977-1992. There has been an average annual increase of 7.6%, thus total hip fractures in Greece increased from 5,100 in 1977 (54.75 fractures/100,000 inhabitants) to 10,953 in 1992 (107.30 fractures/100,000 inhabitants). In 1992, 70% of the patients were women. During the 1977-1992 period, age-adjusted incidence for people aged over 50 increased in both sexes (from 173.54 fractures/100,000 inhabitants in 1977 to 314.07 fractures/100,000 inhabitants in 1992, an increase of age-adjusted incidence of 80. 97%). Approximately 50% of the patients in 1992 were aged 80 and over, whereas in 1977 there were only 22.49% patients of the same age. The increase in hip fracture numbers is greater than expected due to population aging, suggesting the existence of other factors influencing this increase. The most affected age group is 80 and over.     

The safety of Bacille Calmette-Guérin vaccination in HIV infection and AIDS

Health promotion and prevention are critical elements of public health programs designed to improve health status and extend life chances. The pattern of mortality and morbidity in rural Australia suggests a particularly important role for health promotion and preventive measures in country areas. However, the importance of preventive health measures and how people access health-related information is not well understood. This study examines which sources of health-related information are most valued by rural residents and whether the importance attributed to different sources varies according to age, sex and geographic location. The results demonstrate the overwhelming importance of the general practitioner and pharmacist in provision of preventive health information for all rural people. There is a need to ensure that the work carried out by all those involved with health promotion is closely integrated with that of rural general practitioners.     

Physical function and perceived health: cohort differences and interrelationships in older people

Differences between seven-year birth cohorts in physical functioning (as measured by independence in activities of daily living) are compared with corresponding inter-cohort differences in perceived health, in people aged 75 years and over. Age-period-cohort models were fitted to two linked cross-sectional surveys undertaken in 1981 (N = 1,203) and 1988 (N = 1,579). The proportion of older people who were dependent in ADLs was lower in succeeding cohorts but, by contrast, the proportion with less than good self-perceived health was higher. These inter-cohort differences in perceived health were particularly marked for the comparison between 1981 and 1988 of men aged 75-81 years in the dependent subpopulation. Furthermore, self-perceived health remained as strong a predictor of mortality in 1988 as in 1981. Self-perceived health may be indexing a higher prevalence of mild chronic conditions in newer cohorts of older people, with implications for primary health care providers.     

Correlates and prognosis in relation to intellectual dysfunction in a community-residing elderly population

To estimate the risk factors for intellectual dysfunction and examine its prognosis in a community-residing (non-institutionalized) elderly population, a randomly selected sample of 1,473 elderly people aged 65 years and over living in S city, Osaka Prefecture, was studied in October 1992, and data were obtained from 1,383, a response rate of 93.9%. A cohort of 1,383 was followed for 42 months and follow-up was completed for 1,300 (94.0%). The main results were as follows: 1) The prevalence of intellectual dysfunction did not differ significantly between sexes, and there was an increasing prevalence of intellectual dysfunction with age in both sexes. The prevalence of severe intellectual dysfunction was found to increase highly at age 85 and over. 2) By univariate analysis, odds ratios for age older than 75 years, low Activities of Daily Living (ADL), urinary and fecal incontinence, and no participation in social activities were significantly higher than 1 in any level of mild, moderate, and severe intellectual dysfunction. In the multivariate analysis using logistic regression, age older than 75 years and urinary and fecal incontinence showed significant higher odds ratios than 1 for severe intellectual dysfunction, and low ADL and treatment for hypertension also showed significant higher odds ratios than 1 for moderate intellectual dysfunction. 3) From analysis using the Kaplan-Meier method, the cumulative survival rates decreased with a decline in intellectual functioning in both age groups of 65-74 and 75 years and older. 4) Application of the Cox proportional hazards model resulted in adjusted hazard ratio for severe intellectual dysfunction of 1.79 (95% confidence interval, 1.02-3.12), controlling for other factors such as sex, age, general health status, incontinence and social activities.     

Clinical governance

Clinical governance has marked a significant shift towards involving clinicians in the assurances of both quality and accountability in healthcare delivery. The White Paper (Department of Health (DoH), 1997) stated that: 'The Government will require every NHS trust to embrace the concept of clinical governance, so that quality is at the core, both of their responsibilities as organizations, and of each of their staff as individual professionals.' In order to achieve this the Government will bring forward legislation to give NHS trusts a new duty for maintaining quality care. Under these arrangements, chief executives will carry ultimate responsibility for assuring the quality of the services provided by their NHS trust, just as they are already accountable for the proper use of resources. In 'A First Class Service Quality in the NHS' (DoH, 1998), clinical governance is defined as 'a framework through which NHS organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish'. The principles of clinical governance apply to all those who provide or manage patient care services in the NHS. It requires staff to work in partnerships, breaking down boundaries by providing integrated care within health and social care teams (Wilson, 1996), and between practitioners and managers and between the NHS, patients and the public.     

Hysterectomy trends in Finland in 1987-1995--a register based analysis

BACKGROUND: The study objective was to identify trends in the use of hysterectomy by nationwide register based analysis in Finland. METHODS: All women (n=89,069) undergoing hysterectomy in 1987-1995 according to the Finnish Hospital Discharge Register were the numerator. The annual denominator data were obtained from the population database of Statistics Finland. RESULTS: From 1987 to 1992 the hysterectomy rate increased by 22%, from 340 to 414 per 100,000 females, almost half of this being attributable to the changing age structure. From 1993 on, ambiguity in coding laparoscopically assisted vaginal hysterectomies prohibited detailed analyses. However, the overall trend continued at least among women 50 years and over until 1995. The age-adjusted 12% increase from 1987 to 1992 coincided with a rapid increase in operation rates in postmenopausal groups (60% or more among women aged 55 59 and 70-79 years). Among women aged 55-64 years, operations for fibroids and uterine bleeding more than doubled, suggesting an influence of increased use of estrogen replacement therapy. Among all women, operations due to bleeding disorders and genital prolapse showed the largest increase (41% and 42% respectively). Bilateral oophorectomy became more common in all age groups over 46 years. CONCLUSIONS: There was a modest increase in the overall hysterectomy rate. However, the operation became far more common in postmenopausal women, possibly due to the growing use of estrogen replacement therapy. Register data can be used for describing changes in clinical practice, but other methods are needed to confirm the causal relationships underlying the changes.     

Health status of the over 60 years of age population and its relationship with sociodemographic factors (ANCO Project)

OBJECTIVE: To describe the health status of a population over 60 years and to study their relationship with several socio-demographic variables. DESIGN: A cross-sectional study, population based. SETTINGS: A community. PARTICIPANTS: A randomized sample of 1,103 non institutionalized people over 60 years living in the city of Cordoba (Spain). MEASUREMENTS AND MAIN RESULTS: By mean of a personal interview at home we used the OARS-MFAQ-VE questionnaire. Low self-rated health was associated with the age, to be female sex, a low cultural background, and a low income. Only 5.2% of the study people do not suffered any illness and 56% state that their health problems are major problems for doing their current activities. 4.9% declared to have some degree of physical incapacity. 3.7% of elderly population has an important cognitive deficit. CONCLUSIONS: The majority of elderly people has good health. Age is related with a poor health. Women have more health problems than men.     

Health promotion and empowerment: reflections on professional practice

Recent reformulations of health promotion focus on empowerment as both a means and an end in health promotion practice. Both concepts, however, are rarely examined for their assumptions about social change processes or the potential of community groups, professionals, and institutions to create healthier living situations. This article attends to some of these assumptions, expressing ideas generated during 6 years of professional training workshops with over 2,500 community health practitioners in Canada, New Zealand, and Australia. The article first argues that health promotion is not a social movement but a professional and bureaucratic response to the new knowledge challenges of social movements. As such, it has both empowering and disempowering aspects. The article analyzes empowerment as a dialectical relation in which power is simultaneously given and taken, and illustrates this in the context of health promotion programs. A model of an empowering professional (institutional) health promotion practice is presented, in which linkages among personal services, small group supports, community organizing, coalition advocacy, and political action are made explicit. Practice examples are provided to illustrate each level of the empowering relation, and the article concludes with a brief discussion of the model's educational and organizational utility.     

Trends in attitudes and behaviour relevant to AIDS in Ugandan community

Behaviour-related preventive measures are still the main weapon against the spread of AIDS. Intensive AIDS prevention and control activities conducted over the last ten years need to be evaluated on the basis of their impact on attitudes and behaviour relevant to AIDS. The main objective of this study was to document and evaluate trends in attitudes and behaviour relevant to AIDS in a Ugandan community over a seven year follow up period. The study was a longitudinal community-based closed cohort. Periodic surveys were conducted on the study group and data on condom use, attitudes about condoms, rates of sexual partner change and reported frequency of sexually transmitted diseases were collected in all surveys. Data reported are from surveys conducted during 1987, 1992 and 1994 in which similar questions were asked and emerging trends identified. Reported condom use ever, increased from 3.9% in 1987 to 10.1% in 1992 and to 27.2% in 1994. This is a 7.3 fold increase over seven years. In females, reported use of condoms increased from 1.2% in 1987 to 18.2% in 1994 while in males it increased from 6.9% to 35.3% over the same period. In this study group there are still more people opposed to the ongoing intensive condom campaign than there are those supporting it. The percentage supporting the campaign was 28% in 1987, 26% in 1992 and 40.8% in 1994. This is a rising trend. The rate of sexual partner change has declined. During the baseline survey, 26.5% of the respondents reported that they had intercourse with two or more sexual partners in the six months period before the interview. This proportion decreased to 6.8% in 1992 but then increased to 17.1% in 1994. During the baseline survey, 2.6% of the study group reported that they had sexual intercourse with six or more partners during the six months period before the interview but during the 1992 and 1994 surveys, no one reported sexual intercourse with more than five partners during a similar period. The reported frequency of sexually transmitted diseases during a twelve month recall period, reflecting STD incidence, decreased from 3.5% in 1992 to 1.9% in 1994. In conclusion during the seven year followup period of this community-based closed cohort, we have identified a sharp increase in condom use, a reduced rate of sexual partner change and a decline in the reported frequency of sexually transmitted disease. The percentage of people supporting the condom campaign is rising. These are some of the outstanding outcomes of the AIDS prevention activities conducted in the country over the last 10 years.     

Suicide in the prime of life: current data

Suicide of people aged 25-59 years old is fastly increasing in France, especially for males, to 38.4 per 100,000 population in 1992 from 37.0 per 100,000 a decade earlier. In fact the suicide rate is decreasing among male adults having an occupation or a job (to 32.3 in 1992 from 33.8 in 1982). On the contrary, the economically inactive and the jobless are experiencing a tremendous growth in their suicide rate (to 74.9 per 100,000 population in 1992 from 60.9 a decade earlier). The trend is observed also among females aged 25-59 years old but the "employed/unemployed" gap is less pronounced. Marital status and occupational groups have also an influence upon the frequency of adult suicide. Since the work of Emile Durkheim a century ago, the profile of suicide has changed in France, due to societal upheavals.     

Alfentanil or fentanyl during isoflurane-based anaesthesia for day-care knee arthroscopy?

Previously published ultrasound screening programmes for abdominal aortic aneurysm (AAA) have concentrated on males in the 65 to 75 year age range, suggesting this as the most cost-effective cohort to target. In this unique study we have broadened the criteria for screening. General practitioners in one health district were approached to supply details of all males aged 50 years and over to be offered aortic ultrasound scanning. Over a period of 18 months, 4145 individuals were asked to attend and 3030 (73%) have attended. Attendance rates were: between 50 and 64 years, 73%; between 65 and 79 years, 75%; for 80 years and over, 64%--significantly less (p = 0.01-0.001) than the other two age bands. Aortic dilatation (diameter > or = 2.5 cm) was found in 6.3% of the 50 to 64 year age group, 16.8% of the 65 to 79 year age group, and 23.3% of the 80 years and over age group. An established aneurysm (> or = 4.6 cm) was found in 0.3%--6 individuals (50-64 years), 2.5% (65-79 years) and 4.1% (> or = 80 years). The results suggest that aortic screening may be worthwhile extending to a wider age band. By focusing follow-up, this should give greater value for younger men in terms of community productivity and allows for selective intervention in the elderly.     

The health project Ebeltoft: health check ups and discussions in general practice. Basic data from a 5-year, prospective, randomized, controlled population study

A study was carried out to investigate people's interest in participating in health check-up and in discussions about health with their own general practitioner, participants' health status, the proportion who received health advice following health check-up, and the lifestyle goals they set following discussion with their general practitioner. This study reports the baseline data from a five-year randomized, controlled, prospective, population-based study in general practices in Ebeltoft, Denmark. All general practitioners from the four practices in Ebeltoft and a random sample of 2,000 people aged between 30 and 50 years were invited to participate. Participants were randomly divided into three groups-one control group and two intervention groups. One intervention group was given a health check-up which included a range og tests (Table 2 and 3); this group received written feedback from the general practitioner. The other intervention group was also given a health check-up and written feedback, in addition, they were given the opportunity to attend their general practitioner to discuss health-promoting measures. A total of 1370 people participated in the study (69% response rate). Health advice was given to 76% of 905 participants following health check-up. Almost all of the 456 participants (96%) who were offered the opportunity of discussing their health with their general practitioner took up the offer: 64% of the 456 participants reported that they had decided to undertake lifestyle changes. Eleven of those who discussed their health with the doctor were referred to a specialist (2%). There was considerable interest in participating in health promotion. Three out of four of those who had a health check-up were given health advice. Two out of three of those who were offered a health talk with the general practitioner appeared willing to make relevant lifestyle changes. Longterm follow up is needed to determine effects and side effects of health check-up and health talks.