European courts and old people.

There are two major European Courts, the European Court of Justice (ECJ) and the European Court of Human Rights (ECHR). The ECJ deals with legal matters, mainly involving the interpretation of EU law and ensuring that the law is applied evenly across all 27 EU member states. The ECHR aims to make certain that civil and political rights of citizens in the 46 member states of the Council of Europe are observed. Most cases involving older citizens are about social policy (such as pension arrangements, equality, age discrimination and mandatory retirement). There have been few cases dealing with patients' rights, long-term care or housing. Referrals of selected cases involving old people should be considered if their rights are not being protected. In this Commentary, there is an account of how these Courts have evolved, together with guidance on whom to refer, to which Court, and when and how referrals should be made.

Hospital bathrooms and showers: a continuing saga of inadequacy.

Previous surveys of UK hospitals have highlighted many deficiencies in the standards of hospital inpatient washing and bathing facilities--especially inadequate access for wheelchair users, insufficient bathing equipment, and unsatisfactory cleanliness and privacy. We conducted a qualitative survey in three hospitals in the North of England to see whether these facilities have improved. There have been some improvements, particularly in the provision of bath hoists, adapted taps, alarm call systems, shower seats and wheelchair access to bathrooms. But many basic problems remain-absent locks and signs, inadequate heating, poor standards of privacy, insufficient bath aids, wet floors, and the inappropriate use of bathrooms as store rooms. The overall condition of hospital bathrooms and showers remains unsatisfactory. Too many hospital bathrooms are austere, cold, smelly and poorly maintained.

Is stair negotiation measured appropriately in functional assessment scales?

BACKGROUND: A decline in mobility may result in problems with the negotiation of stairs, which can potentially be hazardous. In practice, stair negotiation is an important aspect of daily living and therefore needs to be assessed carefully. METHODS: We conducted a systematic literature review to identify the way functional assessment scales assess stair negotiation. We evaluated whether stair negotiation could be assessed in a valid and reliable way with these scales. RESULTS: Forty-three of the 92 identified scales have an item on stair negotiation. In these scales, the definition of 'negotiation of stairs' varies, as does the definition of independence. Important aspects such as safety on stairs are missing from all scales. In contrast to older scales, newer scales consist of items that have been tested for validity and reliability. In none of the scales was the stair negotiation item tested separately for validity. Only two scales examined test-retest reliability and only one measured inter-observer agreement. DISCUSSION: In current functional assessment scales stair negotiation is measured with great heterogeneity and insufficient validity. In patients and in studies in which assessment of stair negotiation ability is a key part of functional assessment, an improved, well-validated scale is needed. This scale should include not only the subject's physical ability to negotiate stairs, but also safety and change in ability over time.

Pacemaker explosions in crematoria: problems and possible solutions.

The number of artificial cardiac pacemakers is increasing, as is the number of bodies being cremated. Because of the explosive potential of pacemakers when heated, a statutory question on the cremation form asks whether the deceased has a pacemaker and if so whether it has been removed. We sent a questionnaire to all the crematoria in the UK enquiring about the frequency, consequences and prevention of pacemaker explosions. We found that about half of all crematoria in the UK experience pacemaker explosions, that pacemaker explosions may cause structural damage and injury and that most crematoria staff are unaware of the explosive potential of implantable cardiac defibrillators. Crematoria staff rely on the accurate completion of cremation forms, and doctors who sign cremation forms have a legal obligation to provide such information.