Reasons for poor detection of frequent falls in elderly people by general practitioners.

Frequent falls in old people are an important marker for other serious diseases, but are poorly detected by general practitioners. This paper examined the reason for this in 603 people aged 65 and over taken from a random sample of the population of those living at home in Cardiff in South Wales. The people were questioned about whether they suffered from falls, whether they had sought advice, and whether the treatment they obtained was effective. Most people said that they would report frequent falls to their general practitioner. However, people who actually suffered the problem were unlikely to report it. Those who did were subsequently less likely to earmark their general practitioner as useful for treating the problem than those who had not attended. The poor detection of frequent falls by general practitioners appears to be a combination of two things. Firstly, there is a reluctance on the part of elderly people to report the problem, and secondly the relative inability of general practitioners to manage the problem successfully.

Responses of people of different ages to health problems.

There is relatively little information available about the response of people of different ages, particularly elderly people, to symptoms of ill health. This background information is essential for altering inappropriate responses, for such responses may cause long delays or even a complete lack of treatment for people who may be responsive to such treatment. This paper indicates that older people may not choose as wide a range of different health care services as younger people. They tend to concentrate their attention on calling the general practitioner or, in the case of foot trouble, the chiropodist, without recourse to other services. In particular, they tend to avoid using the emergency services, even where appropriate, and prefer to refer problems to the general practitioners, rather than the practice or community-based nurses. It will be necessary to help older people to understand the wider roles that nurses in particular are undertaking if primary care is to be seen as the central focus of health services in future. There is need for more health education by general practitioners for elderly people. This is especially important since the role of general practitioners is likely to change as the emphasis on primary care increases.

Can a house call by a public health nurse improve the quality of the discharge process for geriatric patients?

OBJECTIVE: To determine whether there was any benefit from a single house call by a health visitor (a public health nurse) to an elderly person after discharge home from a geriatric hospital. METHODS: A randomized controlled trial with blind assessments at 28 days was conducted. Subjects included residents of Bath, England, with an average age of 83 years, who were discharged consecutively from a geriatric hospital to their homes. Intervention was a single visit by a health visitor 72 hours after discharge, to ensure the patient was settled at home, or normal post-discharge care. Outcome measures taken at 28 days by a research nurse included survival, hospital readmissions, nursing home admissions, cognitive and physical function, services requested and supplied, and drug therapy. RESULTS: There were no important differences between the intervention and control groups at 28 days on any of the outcome measurements. The control subjects did better than the study subjects on many of the outcome measures. CONCLUSION: A house call by a health visitor to elderly patients after discharge from geriatric wards does not measurably improve the quality of the discharge.

Health visitor intervention to reduce days of unplanned hospital re-admission in patients recently discharged from geriatric wards: the results of a randomised controlled study.

A randomised controlled trial was conducted to assess whether a single intervention by a health visitor reduced the unplanned re-admission of elderly people discharged from geriatric wards. Two hundred and four consecutive discharges from geriatric wards were randomly allocated to receive either a single visit from the health visitor at 72 h in addition to normal follow-up services or to a control group receiving the normal follow-up services. The primary outcome measure was the unplanned re-admissions over the following 6 months. There were 40 cases and 43 control patients with unplanned re-admissions in the first 6 months. The total lengths of the unplanned re-admissions were 1237 days for cases and 1427 for controls, an average of 12.1 days for cases and 14.0 for controls (95% confidence interval -4.9 to 8.7 days, not significant). A visit by a health visitor to elderly patients after discharge from geriatric wards is unlikely to be of sufficient benefit to the patients for the service to be funded from a saving in unplanned re-admissions.

Is there a right age for case finding in elderly people?

If age is a useful basis for determining a screening policy the benefit of the resulting interventions should vary with age. The choice of the screening age will be such as to maximize the benefit. Data from a study of the screening of elderly people by a Health Visitor produced no evidence to support the choice of 75 as minimum age for screening in primary care. Indeed there was a suggestion that age might be more useful as a maximum rather than a minimum criterion.

Supporting elderly dependent people at home.

OBJECTIVE: To clarify the relation between the dependency of elderly people and the assistance they receive from others by using a detailed but simple measure of dependency. DESIGN: Secondary analysis of data from a survey of people aged 70 and over. SETTING: Two general practices in south Wales. SUBJECTS: 1280 people aged 70 and over. MAIN OUTCOME MEASURES: Dependency on others to perform essential functions; detailed data on who assists with those functions. RESULTS: Increasing dependency was associated with increased use of more than one member of the family or friends and an increase in the provision of statutory services. CONCLUSION: The complexity of the relation between dependency and those who care for dependent people has previously been underestimated. The presence of providers of statutory services at the household of elderly dependent people suggests that these services can be developed further to help those caring for elderly people at home.

Can health visitors prevent fractures in elderly people?

OBJECTIVES: To assess whether intervention by a health visitor could reduce the number of fractures, over a four year period, in those aged 70 and over. DESIGN: Randomised, controlled trial; randomisation by household. SETTING: General practice in a market town. SUBJECTS: Of 863 patients aged 70 and over on the practice records, 674 were traced and successfully interviewed; 350 were assigned to the intervention group, 324 as controls. INTERVENTION: The people in the intervention group were allocated to the care of a health visitor. The approach was four pronged: assessment and correction of nutritional deficiencies, including reducing smoking and alcohol intake; assessment and referral of medical conditions such as heart block or inappropriate medication; assessment and correction of environmental hazards in the home such as poor lighting; assessment and improvement of fitness--for example, exercise classes for the moderately fit. The intervention continued for four years. MAIN OUTCOME MEASURE: Fracture rate over four years. RESULTS: The incidence of fractures was 5% (16/350) in the intervention group and 4% (14/324) in the control group (difference not significant). CONCLUSIONS: A health visitor visiting a group of people aged 70 and over and using simple preventive measures had no effect on the incidence of fractures.

Angina among elderly people and its relationship with disability.

A postal questionnaire was sent to 2705 people aged 60 and over requesting information about anginal symptoms, their degree of disability and dependency and the use they made of community services. Those with angina showed marked degrees of disability and dependency and used some services to a considerable extent. Postal questionnaires are a satisfactory screening device for identifying individuals at risk and can assist practitioners in organizing their workload for patients with disabling conditions.

Smoking prevention among people aged 60 and over: a randomized controlled trial.

This study aimed to test the hypothesis that people aged 60 and older respond to assistance in stopping smoking. Using a single general practitioner visit backed up by a practice nurse, 14% of the smokers had discontinued the habit 6 months after the intervention period. The intervention group also showed some improvements in a standardized measure of breathlessness.

Prevalence and treatment of symptoms of rheumatism and arthritis among over 65 year olds: a community profile.

A group of people aged 65 years and over was given a self-completion questionnaire requesting information about symptoms compatible with arthritis and rheumatism. Such symptoms were very common, more so in women than in men and were associated with marked degrees of disability and some dependency. The great majority of respondents said that they regarded their general practitioner as the best person for the treatment of such symptoms, but those with symptoms were slightly less likely than those without to suggest the general practitioner. Many people with symptoms had not reported them to any health service personnel, but had chosen to treat them themselves, suggesting a degree of scepticism about the effectiveness of professional treatment.

Attitudes of the fit elderly to health issues compared with younger people.

This study examined the habits and attitudes of a group of elderly fit people in relation to health when compared with younger individuals in order to ascertain whether or not a 'successful' group in terms of longevity and morbidity differs from the rest of the adult population. Fit elderly people were, in general, less likely to adhere to standard guidelines for healthy eating than their unfit counterparts or younger age groups.

The relationship between symptoms of chronic disease and dependence.

A total of 2705 people aged 60 years and over were sent a postal questionnaire requesting information about the symptoms of four common conditions--exertional chest pain, chronic productive cough, breathlessness, and exertional pain in the calves. These were elicited using a standardized questionnaire. The effect of these symptoms on the dependence of those suffering them was assessed in relation to a series of activities associated with normal daily living. There was a consistent rank order in the activities that people were unable to perform for the different symptoms studied, but this order altered with increasing severity and multiple symptoms. There was a consistency about the activities which changed order. It is suggested that symptoms and their associated dependence need to be assessed in relation to each other, using simple scaling systems by professional service personnel, managers/, and planners, in order to bring together the therapeutic rehabilitative, and social aspects of health needs. These are felt to be vital before decisions about service development can be made.

The relationship between dietary habits and beliefs in elderly people compared with younger people.

This study examined the habits and attitudes of a group of people aged 65 and over, in relation to their dietary beliefs and habits when compared with younger individuals. It was found that these older people had similar attitudes to food as those under 65, and these were in line with dietary advice given by health promotion experts. However they had not changed their habits to the same extent, nor did they intend to do so. Reasons for these findings are discussed.

Opinions of people aged over 75 years on private and local authority residential care.

Two hundred and fifty-one randomly sampled elderly people aged 75 years and over living in their own homes were questioned about their experiences, knowledge and opinions of private rest homes and local authority residential homes. Very few respondents had stayed in either type of institution, and more had visited local authority homes than had visited private rest homes. For both types of institution, one-fifth of respondents or less stated that they would be pleased to enter them, and this did not vary significantly between the two institutions. For both types of institution, 'being well cared for' was the main perceived advantage, but while loss of independence was the main perceived disadvantage of local authority homes, cost was the most frequently cited disadvantage of private care.

The collection of health data from the elderly in primary care using a postal questionnaire.

Standardised information on patients in a general practice, suitable for preventive, case-finding or epidemiological study is rarely available. This paper describes a simple postal questionnaire method of obtaining information cheaply and accurately for the development of a practice basic records system.