The prevalence of faecal incontinence in older people living at home.

BACKGROUND: faecal incontinence affects quality of life and causes caregiver strain. Patients are often reluctant to seek help because of embarrassment and perceived lack of effective treatment. Persisting faecal soiling may lead to unwanted and premature institutionalization. OBJECTIVE: to ascertain the prevalence of faecal incontinence and to identify health and socio-demographic characteristics of patients with this problem. DESIGN: a sample of 3000 older people, living at home in the UK, randomly selected from three Family Health Service Authorities. PARTICIPANTS: we interviewed 2818 men and women aged > or =65 years in their own homes: a response rate of 94%. RESULTS: 78 respondents (3%) reported faecal incontinence. There was a small but non-significant association with increasing age: 38 (2%) of those reporting incontinence were aged 65-74 years; 40 (3%) were aged > or =75 years. Faecal incontinence was significantly associated with sex, with reports from 15 men (1%) versus 63 women (4%; P<0.0005). It was also significantly associated with anxiety and with depression (P<0.00001) and very significantly associated with increasing disability (P<0.00001). Forty-six (59%) of those who had faecal incontinence had severe disability, compared with 426 (16%) of those who did not (P<0.00001). The association with urinary incontinence was also strong: 54 (69%) of those with faecal incontinence (2% of the total sample) had coexistent urinary incontinence. Over 50% had not discussed their problems with a healthcare professional. CONCLUSIONS: a reluctance to report symptoms and a significant association between faecal incontinence and symptoms of anxiety, depression and disability suggest that older people should be asked about faecal incontinence. Increasing the awareness of the scale of the problem among health- and social-care professionals, older people and their carers may lead to more appropriate management and effective provision of care.

The Parkinson's Disease Activities of Daily Living Scale: a new simple and brief subjective measure of disability in Parkinson's disease.

OBJECTIVE: To develop a brief, valid and reliable self-report scale for the assessment of activities of daily living in Parkinson's disease (PD). DESIGN: Self-report questionnaire development. SUBJECTS: One hundred and seventy subjects with a diagnosis of clinically probable PD living in the community. MEASURES: The self-rating scale--Parkinson's Disease Activities of Daily Living Scale (PADLS), Webster Scale, CAMCOG neuropsychological test,15-item Geriatric Depression Scale (GDS-15) and the self-rated Parkinson's Disease Quality of Life (PDQL) questionnaire. METHODS: The PADLS was initially validated and test-retest reliability assessed in a group of PD patients (n = 38). Next a convenience sample of 132 patients was drawn from a community-based PD register. Subjects were invited to complete the PADLS, PDQL, GDS-15, Webster scale and CAMCOG test. RESULTS: The PADLS correlated significantly with increasing age, duration of illness, disease severity, increasing depression, impaired cognition and poorer health-related quality of life. CONCLUSION: The PADLS was found to be a reliable and valid measure of ADL, demonstrating acceptable internal consistency and strong associations with existing measurers of disease severity, depression, cognitive screening and health-related quality of life. The PADLS allows patients to subjectively report the impact that PD has upon daily activities and will complement existing formal clinical measures in PD.

Uptake of breast cancer screening in older women.

OBJECTIVES: to determine breast screening uptake in older women and to ascertain from previous non-attenders whether they would accept screening if invited. DESIGN: a random sample of older women randomly selected from three Family Health Service Authorities were interviewed in their homes. PARTICIPANTS: 1604 women aged 65 years and over living at home, a response rate of 94%. RESULTS: 120 respondents (8%) had previously been screened. Rates were higher among those who were married, separated or divorced than those who were single (P < 0.01). Of those who had not previously been screened, 742 (50%) reported that they would attend if invited. Age influenced potential attendance: 67% of those aged 65-69 would accept compared with 27% of those aged 80 and over (P < 0.0001). Future attenders were significantly more likely to belong to the upper social class and to be currently married, and were significantly less likely to be disabled or depressed, but more likely to be anxious (P < 0.05). CONCLUSIONS: it is unjustifiable to exclude women over 65 from breast screening on the basis of assumed low uptake rates. Certain categories of women--such as those who were physically disabled, depressed, single or from lower social classes--could be targeted to achieve maximum uptake rates.

Ownership and use of assistive devices amongst older people in the community.

AIMS: To determine the ownership and use of various assistive devices by older people living at home. METHOD: A random sample of 1405 elderly people aged 65 years and over, in three health authorities, were asked about ownership and use of a number of disability aids, spectacles and hearing aids. RESULTS: 74% of respondents owned one or more aid, 97% had spectacles and 16% a hearing aid. The most commonly owned assistive devices were a non-slip bath mat (50%), a walking stick (24%) and a bath rail (21%). Many severely disabled people, however, had no aids. For example, 75% had no stair rail, 68% had no lavatory rail and 46% had no non-slip bath mat. Most of the equipment owned was used. Walking frames and wheelchairs were used more by those over 75, as were all bathroom and lavatory appliances. Gender influenced the use of some aids, with more women using their walking frames and bathroom rails than men. CONCLUSION: Our study confirms that ownership and use of aids varies with age, gender, living arrangements and disability. Very disabled people need but do not own certain basic and relatively inexpensive appliances. Community services currently aim to promote autonomy and independence in elderly people in the community. This may be facilitated and enhanced by provision of appropriate equipment and increasing awareness of the value of assistive devices among elderly people, informal carers and health- and social-care professionals. Knowledge of who owns and uses various items of equipment may help improve strategic planning.