Late-life depression and the family physician

Late-life depression (LLD) is a common disorder seen in clinical practice. Depression in this population group is often left undetected and untreated. The majority of elderly individuals who seek help present to the primary health care setting. The family physician is ideally placed to screen for symptoms of LLD, given that they often have longitudinal knowledge of the patient's history, premorbid personality, functioning and overall health status. An understanding of risk factors, differential diagnoses, appropriate opportunistic screening toolsand decision-making around management plans can assist the family physician in the early detection and treatment of these patients. In doing so, this may lead to a decrease in mortality and morbidity and enhance the patient's quality of life.Keywords: Late life; depression; older; geriatric mental health; major depressive disorder; antidepressants; cognitive impairment; dementia.

Frailty and mortality among older patients in a tertiary hospital in Nigeria

Background: This study determined the frailty status and its association with mortality among older patients. Design: A prospective cohort design. Setting: Study was conducted at the medical wards of University College Hospital, Ibadan, Nigeria. Participants and study tools: Four hundred and fifty older patients (>60 years) were followed up from the day of admission to death or discharge. Information obtained includes socio-demographic characteristics and clinical frailty was assessed using the Canadian Study of Health and Aging (CSHA) scale. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05. Results: Overall, frailty was identified in 285 (63.3%) respondents. Mortality was significantly higher among frail respondents (25.3%) than non-frail respondents (15.4%) p=0.028. Logistic regression analysis showed factors associated with frailty were: male sex (OR=1.946 [1.005­3.774], p=0.048), non-engagement in occupational activities (OR=2.642 [1.394­5.008], p=0.003), multiple morbidities (OR=4.411 [1.944­10.006], p<0.0001), functional disability (OR=2.114 [1.029­4.343), p=0.042], malnutrition (OR=9.258 [1.029­83.301], p=0.047) and being underweight (OR=7.462 [1.499­37.037], p=0.014). Conclusion: The prevalence of frailty among medical in-hospital older patients is very high and calls for its prompt identification and management to improve their survival

Family planning desires of older adults (50 years and over) in Botswana

Background: This study analysed the views of a stratified sample of 444 older adult women from selected health districts in Botswana on their family planning (FP) use, knowledge, accessibility and availability.Methods: Four health districts (two rural and two urban) were purposively selected. The sample of 444 older adults was proportionally allocated to the districts. The snowball technique was used in identifying older adults from each district. Results: Contraceptive prevalence among the older adults is low (25. 2%); ever used rate was 23.6%, with unmet need as high as 75.2%. The traditional methods are mainly used. Knowledge, availability and accessibility of the natural methods are high. The likelihood ratio test shows that age, educational status, marital status and employment jointly significantly predicts (p < 0.05) the use of FP.Conclusion: Family planning programme developers and policy-makers should develop educational interventions that will be age specific and relevant to older adults

Advance Directives or Living Wills: Reflections of General Practitioners and Frail Care Coordinators in a Small Town in Kwazulu-Natal

Background: Living wills have long been associated with end-of-life care. This study explored the promotion of living wills by general practitioners (GPs) and frail care nursing coordinators who were directly involved in the care of the elderly in Howick; KwaZulu-Natal. The study also explored their views regarding the pro forma living will disseminated by the Living Will Society.Subjects: Seven GPs and three frail care nursing coordinators; 10 in total.Design: The design was qualitative in-depth interviews and analysis; using the Framework method.Results: Both doctors and nursing staff understood the concept of living wills and acknowledged that they were beneficial to patients; their families and staff. They were concerned about the lack of legal status of the living will. They felt that the pro forma document from the Living Will Society was simple and clear. Despite identifying the low level of living will usage among patients; doctors and nursing staff felt that third-party organisations and individuals should promote living wills to patients; rather than promoting them to patients themselves.Conclusion: GPs and frail care nurse coordinators were knowledgeable about living wills in general; and the Living Will Society pro forma document in particular. They valued the contribution that living wills make to the care of the elderly; as they benefit patients; their families; healthcare workers and the health system. They also valued the pro forma living will document from the Living Will Society for its clarity and simplicity. However; the GPs and frail care nursing coordinators viewed the living will process as patient driven. They viewed their main role to be that of custodians; and not advocates; of the living wills

Hypoclycaemia unawareness and falls in older adults with type 2 diabete

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