Standardization of health assessments for patients aged 75 years and over: 3 years' experience in the Forth Valley Health Board area.

BACKGROUND: The new contract for general practitioners (GPs) was introduced in 1990. This required all GPs to offer their patients aged 75 years of over an annual assessment. AIM: The study aimed to determine if 3 years' experience had resulted in standardization of the way in which health assessments for patients aged 75 years and over are carried out. METHOD: The study was carried out in 1993. Questionnaires were sent to the principal partners of all 55 general practices in the Forth Valley Health Board (FVHB) area. The main outcome measures were the fulfilment of contractual requirements and standardization of the health assessment process. RESULTS: Completed questionnaires were returned by 49 practices (89%) Eighty per cent (39 practices) had drawn up their own assessment programme in 1990. Responsibility for assessments was most often (41 practices) shared between different members of the primary care team (84%). Although most practices satisfied contractual requirements, there were wide variations in approach, potentially influencing outcome. CONCLUSION: Despite three years' experience, no standardized approach to the health assessment of patients aged 75 years and over has been developed. Purchasers of health care require information on the needs of their client population, and this should be available in an accessible, standardized form. There is an urgent need for a review of the way in which the 1990 contract has been implemented to standardize health assessments and improve effectiveness in meeting its original aims.

Oral disease in the elderly in long-term hospital care.

OBJECTIVE: To obtain baseline information on the prevalence of oral problems and disease in institutionalized elderly in a Scottish hospital. DESIGN: A cross-sectional clinical investigation with complementary microbiological studies as appropriate. SUBJECTS AND METHODS: A cohort of 147 elderly in five long-term care wards; collection of demographic data; clinical examination to determine: i) the dental and denture status and associated lesions such as Candida-associated denture stomatitis and angular cheilitis, ii) oral mucosal disease; swabs as appropriate for microbiology. MAIN OUTCOME MEASURES: Dental status, root caries prevalence; denture status and hygiene, and associated disease; oral mucosal health. RESULTS: Median period of institutionalization of 147 patients was 15 months and 65% were aged 80 years or more; the majority were significantly mentally impaired; 52% wore complete dentures, 9% were partially dentate, 19% possessed partial or incomplete dentures; 20% were neither dentate nor had dentures. Of 80 patients who verbalised their complaints, 35% complained of dry mouth and 45% had denture-related problems, principally discomfort. The commonest oral finding was a coated tongue (56%); angular cheilitis was present in 25%, and Candida-associated denture stomatitis in 19%; none had oral ulcers. CONCLUSIONS: There was considerable unmet dental need with significant oral disease and poor levels of oral and denture hygiene in this target group; both dental and medical professionals should act in concert to deliver curative as well as preventative dental care for the elderly living in institutions to improve their quality of life.

Toleration, side-effects and efficacy of sulphasalazine in rheumatoid arthritis patients of different ages.

Sulphasalazine is an effective second-line agent in the management of rheumatoid arthritis. The risk:benefit ratio in the elderly is less well established. We studied the risk:benefit ratio in relation to age, retrospectively combining five prospective studies of enteric coated sulphasalazine therapy in 352 patients with rheumatoid arthritis. Clinical and laboratory assessments of efficacy and toxicity were made by an independent assessor at 0, 12, 24 and 48 weeks. The only significant differences between young, middle aged and elderly patients at the initial assessment were in pain perception, ESR and C-reactive protein. Sulphasalazine was equally effective in all age groups. The toxicity profile was similar in all age groups. We conclude that sulphasalazine is equally effective in rheumatoid arthritis in the elderly as in the young. There was no significant change in the frequency or nature of side-effects with increasing age.

Oral candidosis in the elderly in long term hospital care.

A total of 137 patients in long term hospital care were interviewed and examined to determine the prevalence, nature and most important causes of oral candidosis in the hospitalized elderly. Oral candidal infection as determined by the imprint culture technique was present in 47% of patients with a further 31% being carriers of Candida. The prevalence of chronic atrophic candidosis in denture wearers was 38%, while 26% of all patients had angular cheilitis, 67% of which had an infective etiology. Microbiologic examination strongly indicated the upper denture as the major source of infection in those with dentures despite the existence of a ward policy which should have encouraged good oral and denture hygiene.

A family study of vitiligo patterns.

The anatomical distribution of vitiligo has been studied in families with evidence of organ-specific autoimmune disease. No examples of similar pattern inheritance were found in first degree relatives in contrast to published reports of similar vitiligo patterns in identical twins. The genetic predisposition to develop vitiligo apparently allows for a diversity of anatomical pattern. A similar mechanism may be responsible for the occurrence of different organ-specific autoimmune diseases in members of the same family.

Skin maps in vitiligo.

Patterns of depigmentation in vitiligo are illustrated which appear to form maps of obscure local anatomical subdivisions of the human skin. These are distinctive but as yet poorly defined and do not generally correspond to known anatomical structures or boundaries.