Disability and Dependence in the Elderly at Home

Akhtar, Abbasi J.; Broe, G. A.; Crombie, Agnes; McLean, William M.; Andrews, Gary R.; Caird, F. I.

doi:10.1093/ageing/2.2.102

Cited by 87 publications

(32 citation statements)

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“…This assessment included a standardized medical history examining both past and current health, a neuro-psychological test battery and detailed medical and neurological examination. The elderly people were diagnosed for a range of systemic and neuro-degenerative disorders following the methods of an earlier study [11]. This interview included the Mini-Mental State Examination (MMSE) [12].…”

Section: Methodsmentioning

confidence: 99%

“…The informant completed the 30-item version of the General Health Questionnaire (GHQ), measuring minor psychiatric disorder (predominantly anxiety and depression) [13] (a = 0.90), the life satisfaction index-A [14] (a = 0.78) and the interpersonal bonding measure [15] which has scales for care and control experienced in the relationship with the elderly person (as of 0.93 and 0.91). Disability in the elderly person was assessed by asking the informant about mobility, continence, cooking, housework, shopping, dressing, feeding and toileting [11]. Each item was scored on a 0 to 1 scale, with 0 representing maximum independence and 1 maximum dependence, to yield a total score ranging from 0 to 8 (a = 0.84).…”

Section: Methodsmentioning

confidence: 99%

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Carer distress in the general population: results from the Sydney Older Persons Study

Broe

Jorm²,

Creasey³

et al. 1999

Age and Ageing

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Objective: to assess distress in a sample of carers who were selected from a community survey rather than recruited via community-service agencies. Methods: a community survey was carried out on 630 people aged 75 or over living in Sydney, Australia. Informants nominated by these elderly people were divided into full carer (n = 21), partial carer (n = 187) and noncarer groups (n = 344). Informants completed the General Health Questionnaire (a continuous measure of psychiatric symptoms), the life satisfaction index (a measure of well-being) and the interpersonal bonding measure (a measure of quality of the relationship with the elderly person). Elderly participants had a medical examination, were assessed for disability and were questioned about use of services. Results: elderly people who had a full carer were more disabled and had more medical diagnoses. Full, but not partial, carers reported more psychiatric symptoms and lower life satisfaction. In multivariate analysis, the main determinant of carer distress was a relationship in which the carer felt controlled by the elderly person. Conclusion: when carers are selected from a population-based sample, only those who are full carers are more distressed. However, relationship factors are the most important determinant of distress.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Carer distress in the general population: results from the Sydney Older Persons Study

Broe

Jorm²,

Creasey³

et al. 1999

Age and Ageing

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“…The results, reported in 1971, are given in table 3. Akhtar et al [7] reported in 1973 on three surveys where disability was assessed as inability to exist at home without help. Thirty-six percent of men and 47% of women over the age of 75 were defined as 'disabled'.…”

Section: Studies Of Screening In the Elderlymentioning

confidence: 99%

Should Medical Screening of the Elderly Population Be Promoted?

Bulpitt¹,

Benos²,

Nicholl³

et al. 1990

Gerontology

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This article reviews the history of screening in the elderly, the conditions that should be considered, whether or not screening in the elderly is of benefit, whether we should look for disability or diseases and where screening should take place. Thirteen conditions are discussed: hearing loss and anaemia in some detail. Both disability and precise diagnostic criteria are considered. The place where screening is best carried out depends on the mobility of the subject and the nature of the particular screening tests selected for the 13 conditions. The desirability of screening was assessed on the following criteria: prevalence of the condition, severity of the problem, acceptability by the patient of the screening test, false positive rate, consequences of making a false positive diagnosis, the false negative rate and the consequences of this error, the effect of treatment, the cost of the screening test and the burden on the health services produced by the screening test. The criteria were scored 1–5 on a scale defined for each assessment, with higher scores favouring screening. We provide evidence that screening may be worthwhile for: need for chiropody, varicose veins/ulcer, hearing loss, obesity, visual impairment, hypothyroidism, hypertension, anaemia and diabetes mellitus. However, the assessments discussed in this paper need to be tested prospectively in randomised controlled trials.

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“…Acute myocardial infarction and stroke are responsible for 50-60% of deaths in the over 65s in countries in the developed world. 1 Vascular disease is also the leading cause of major disability in the elderly, 2 and an important contributor to cognitive decline. 3 Randomised controlled trials (including patients up to 85 years of age) have shown that antihypertensive drug treatment in the elderly reduces the risk of both fatal and non-fatal stroke and of deaths due to myocardial infarction and heart failure.…”

mentioning

confidence: 99%

Hypertension in the elderly

Stott

1998

J Hum Hypertens

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Hypertension is widely recognised as an important modifiable risk factor for vascular disease in old age. Acute myocardial infarction and stroke are responsible for 50-60% of deaths in the over 65s in countries in the developed world. 1 Vascular disease is also the leading cause of major disability in the elderly, 2 and an important contributor to cognitive decline. 3 Randomised controlled trials (including patients up to 85 years of age) have shown that antihypertensive drug treatment in the elderly reduces the risk of both fatal and non-fatal stroke and of deaths due to myocardial infarction and heart failure. 4 The strength of the evidence is overwhelming. How well are we doing at putting this research evidence into clinical practice? Published in this Journal issue is a paper by De Backer et al 1 that gives some answers to this question. They performed a cross-sectional study of elderly people in Belgium between 1994 and 1996. Approximately one-quarter of all elderly subjects were taking antihypertensive drugs. In general, blood pressure (BP) control in those treated for hypertension was good, with twothirds having satisfactory levels, even although the majority of patients were taking a single antihypertensive agent. This contrasts with the WHO-WHL hypertension management audit project where less than one-third of middle-aged subjects treated for hypertension were found to have good BP control. 5 It may be easier to control BP in elderly hypertensives than in younger patients. This is likely to be at least partly a survivorship effect, as poor BP control is associated with increased mortality. 6 The treatment regimens used in the De Backer study were conservative with the commonest drugs being diuretics, followed by beta-blockers, then calcium channel blockers. These groups of drugs have all been shown to reduce vascular events in elderly hypertensives. 4,7 In the absence of specific contraindications, different agents seem to be tolerated equally well in elderly patients; between 10 and 15% will have an adverse reaction requiring a change of drug. 8 Thiazides are of proven value and are cheap. Fifteen years ago they were used in more than half of the elderly hypertensives who received Correspondence: Professor David J Stott drug treatment. 8 Since then there has been a gradual trend to the use of newer (and more expensive) agents, despite consistent advice from most authorities that thiazides should remain as a first choice.Raised BP (defined as systolic у160 and/or diastolic у95 mm Hg) was found in approximately onequarter of screenees in the De Backer study. 1 Older studies have reported between 35 and 50% of the over-65s with elevated BP on a single screening visit. 9 Therefore it is tempting to believe that improvements are being made in the detection of raised BP in elderly people. Of course not all patients with elevated BP at a single visit will have sustained hypertension; if recordings are repeated over several months many subjects will be found to be normotensive. Therefore the above figures will...

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Disability and Dependence in the Elderly at Home

Cited by 87 publications

References 0 publications

Carer distress in the general population: results from the Sydney Older Persons Study

Carer distress in the general population: results from the Sydney Older Persons Study

Should Medical Screening of the Elderly Population Be Promoted?

Hypertension in the elderly

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