Alzheimer's disease in the United Kingdom: developing patient and carer support strategies to encourage care in the community.
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Alzheimer's disease is a growing challenge for care providers and purchasers. With the shift away from the provision of long term institutional care in most developed countries, there is a growing tendency for patients with Alzheimer's disease to be cared for at home. In the United Kingdom, this change of direction contrasts with the policies of the 1980s and 90s which focused more attention on controlling costs than on assessment of the needs of the patient and carer and patient management. In recent years, the resources available for management of Alzheimer's disease have focused on institutional care, coupled with drug treatment to control difficult behaviour as the disease progresses. For these reasons, the current system has led to crisis management rather than preventive support--that is, long term care for a few rather than assistance in the home before the crises occur and institutional care is needed. Despite recent innovations in the care of patients with Alzheimer's disease, the nature of the support that patients and carers receive is poorly defined and sometimes inadequate. As a result of the shift towards care in the community, the informal carer occupies an increasingly central role in the care of these patients and the issue of how the best quality of care may be defined and delivered is an issue which is now ripe for review. The objective of this paper is to redefine the type of support that patients and carers should receive so that the disease can be managed more effectively in the community. The needs of patients with Alzheimer's disease and their carers are many and this should be taken into account in defining the quality and structure of healthcare support. This paper shows how new initiatives, combined with recently available symptomatic drug treatment, can allow patients with Alzheimer's disease to be maintained at home for longer. This will have the dual impact of raising the quality of care for patients and improving the quality of life for their carers. Moreover, maintaining patients in a home environment will tend to limit public and private expenditure on institutional care due to a possible delay in the need for it. (+info)
Strategies to improve the quality of oral health care for frail and dependent older people.
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The dental profile of the population of most industrialised countries is changing. For the first time in at least a century most elderly people in the United Kingdom will soon have some of their own natural teeth. This could be beneficial for the frail and dependent elderly, as natural teeth are associated with greater dietary freedom of choice and good nutrition. There may also be problems including high levels of dental disease associated with poor hygiene and diet. New data from a national oral health survey in Great Britain is presented. The few dentate elderly people in institutions at the moment have poor hygiene and high levels of dental decay. If these problems persist as dentate younger generations get older, the burden of care will be substantial. Many dental problems in elderly people are preventable or would benefit from early intervention. Strategies to approach these problems are presented. (+info)
A simple and reproducible method for collecting nasal secretions in frail elderly adults, for measurement of virus-specific IgA.
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The standard method for collection of respiratory secretions, by use of a nasal wash (NW) to measure virus-specific IgA, is problematic in frail elderly adults. Therefore, a simplified collection approach using a nasal swab (NS) is described. NW and NS samples were collected from healthy young and frail elderly adults, and IgA titers to respiratory syncytial virus (RSV) fusion and attachment glycoproteins were determined by enzyme immunoassay. Correlation between IgA titers in NW and NS was excellent for each of the antigens (correlation coefficients,.71-.93). In addition, NS results were reproducible when frail elderly subjects were sampled several weeks apart and were nearly equivalent to results from NW samples. The ability to sample nasal secretions by use of an NS when an NW is not technically feasible will facilitate the study of mucosal immunity to RSV as well as the study of mucosal response to candidate RSV vaccines in frail elderly populations. (+info)
Development of sex-specific equations for estimating stature of frail elderly Hispanics living in the northeastern United States.
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BACKGROUND: The accurate measurement of stature is not possible in many frail elderly persons because of problems affecting their ability to stand straight. In such cases, knee height may be used to estimate stature. OBJECTIVE: This study was designed to explore the applicability of published regression equations to estimate stature of Puerto Rican and other Hispanic elderly persons living in the northeastern United States and to formulate ethnicity-specific equations for these persons. DESIGN: The study subjects (60-92 y of age) included 569 Hispanics and a comparison group of 153 non-Hispanic whites. Equations to estimate stature of Hispanics and Puerto Ricans living in the northeastern United States were developed with regression models in a randomly selected subgroup of the Hispanics. These equations were tested with the remaining Hispanic subgroup. RESULTS: The published equations significantly overestimated stature of our Hispanic subjects. Equations developed for Massachusetts Hispanics and Puerto Ricans provided estimates of stature that did not differ significantly from measured stature. We found further that equations for non-Hispanic whites published in 1985 predicted statures of our relatively low-income, non-Hispanic white subjects better than did newer 1998 equations developed from a national sample. CONCLUSIONS: The stature of elderly Hispanics from the northeastern United States can be estimated by using equations derived from the same population. These, or similar equations, should be used to estimate stature of frail elderly persons for whom standing height cannot be taken accurately. Socioeconomic status as well as ethnicity may affect results when knee height equations are used. (+info)
How ready are health plans for Medicare?
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CONTEXT: The Medicare program is encouraging its beneficiaries to enroll in capitated health plans. OBJECTIVE: To determine how prepared these plans are to handle chronically ill and frail elderly persons. DESIGN: Telephone survey of 28 health plans that together serve about one fourth of all enrollees of the Medicare Risk program. MEASURES: The degree of readiness (high, intermediate, or low) of health plans in seven domains that experts believe are important to the management of an elderly population. RESULTS: None of the 28 health plans had high readiness scores for all seven domains. The two domains for which the plans were most prepared were risk assessment and member self-care. The plans were least prepared for the domains of cooperative team care and geriatric consultations. CONCLUSIONS: Many plans do not offer the programs that experts believe are important for Medicare enrollees. They may hesitate to adopt strategies that lack data on effectiveness. (+info)
Serological response to influenza vaccination and nutritional and functional status of patients in geriatric medical long-term care.
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INTRODUCTION: in the UK the Department of Health recommends influenza vaccination for elderly people resident in institutional care. However, the efficacy of vaccination may be reduced in very frail elderly people with functional impairment, undernutrition and multiple pathologies. Nutritional and functional status is claimed to affect vaccine responses in healthy elderly subjects. We wished to determine if a relationship could be seen between nutritional and functional status and seroconversion in patients receiving long- term care. METHODS: all patients in geriatric medical long-term care were offered vaccine. Consenting patients had pre- and post-vaccine serology measured using single radial haemolysis. Anthropometry was measured to enable body mass index (BMI) to be calculated. Functional independence was assessed using the 20-point Barthel index. RESULTS: of 260 patients who received influenza vaccine, 137 (36 male, 101 female) consented to venesection for serology and thus form the study population. Mean age was 82 years (SD 7.9). The median Barthel score was 3/20 and the mean BMI was 21.6 (SD 4.6, range 13-36.2). Antibodies to influenza A were undetectable both pre- and post-vaccination in 63/137 patients. In 49 patients the antibody titre rose after vaccination and 25 had detectable antibody titres pre-vaccination which failed to rise post-vaccine. There were no significant associations between post-vaccination influenza antibody responses and BMI, Barthel score or age. CONCLUSION: frail elderly patients in geriatric medical long-term care had a poor antibody response to influenza vaccination. Within this group, serological responses could not be predicted by nutritional or functional status. (+info)
OBJECTIVE: To guide family physicians through assessment of why treating elderly people's osteoporosis is necessary, who to treat, and how to treat in a practical way. QUALITY OF EVIDENCE: Evidence of the efficacy of treatment for osteoporosis is shown by a reduced probability of fracture. This can be ascertained by direct evaluation for bisphosphonates, calcium, and calcitonin, or indirectly by ascertaining benefit to bone mineral density for hormone replacement therapy (HRT) and exercise. MAIN MESSAGE: Unless medically contraindicated, all elderly people should take supplementary vitamin D (800 IU/d) and calcium (1500 mg/d). Those with risk factors for osteoporosis (e.g., smoking, thinness, previous fracture when older than 50 years, fracture in first-degree relatives older than 50 years, and steroid use) should have a bone density measurement. Those meeting World Health Organization criteria for osteoporosis should also be treated with HRT or bisphosphonates or possibly with selective estrogen receptor modulators. CONCLUSIONS: Good evidence indicates that adequate treatment of osteoporosis can prevent fractures and thus reduce associated morbidity and mortality among vulnerable elderly people. Because of the prevalence of osteoporosis, the onus falls on family physicians to be the front-line managers. (+info)
Resistance exercise training increases mixed muscle protein synthesis rate in frail women and men >/=76 yr old.
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Muscle atrophy (sarcopenia) in the elderly is associated with a reduced rate of muscle protein synthesis. The purpose of this study was to determine if weight-lifting exercise increases the rate of muscle protein synthesis in physically frail 76- to 92-yr-old women and men. Eight women and 4 men with mild to moderate physical frailty were enrolled in a 3-mo physical therapy program that was followed by 3 mo of supervised weight-lifting exercise. Supervised weight-lifting exercise was performed 3 days/wk at 65-100% of initial 1-repetition maximum on five upper and three lower body exercises. Compared with before resistance training, the in vivo incorporation rate of [(13)C]leucine into vastus lateralis muscle protein was increased after resistance training in women and men (P < 0.01), although it was unchanged in five 82 +/- 2-yr-old control subjects studied two times in 3 mo. Maximum voluntary knee extensor muscle torque production increased in the supervised resistance exercise group. These findings suggest that muscle contractile protein synthetic pathways in physically frail 76- to 92-yr-old women and men respond and adapt to the increased contractile activity associated with progressive resistance exercise training. (+info)