Age and ageing
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the major purpose of health and social policy in old age is to increase quality of life of elderly people. In many demographically developing countries, life expectancy is increasing very rapidly, but little information is available on survival free of disability. ⋯ long-term disability is common in old age, affecting a quarter of people over 60 years. However, self-care problems are much less common and suggest that the social and health care consequences of demographic transitions are over-estimated by use of simple questions about limiting long-standing disability. Self-care life expectancy provides a useful monitoring tool for censuses and national disability surveys.
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over 60% of older people have at least one admission to hospital in their last year of life, with the majority of people having multiple admissions. In Bankstown, New South Wales, Australia, we have a diverse ethnic and cultural population. We were interested in bed utilisation, documentation, and follow through of "care plans" as well as "not for resuscitation" orders in the last year of life of the older people in our area. ⋯ this study showed that in our diverse population there were multiple admissions and utilisation of hospital beds for older people in their last year of life. Care plans and not for resuscitation orders were rarely documented prior to last admission. However, when advanced care plans were done, they were usually well documented and followed through appropriately.
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Pain is an inherently subjective experience that is difficult to prove. In a cognitively impaired older person whose verbal fluency is declining, both the experience and expression of pain are altered. Assessment poses many difficulties. ⋯ References cited within these sources were also reviewed. Searches were limited to English language studies. The quality of relevant studies retrieved was assessed and information from relevant papers synthesised using narrative summary.
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to identify the continuance of sleeping difficulty and medication use in a cohort of older Australian women from baseline to 3-year follow-up and to explore the relationship between these factors and health-related quality of life scores, falls and other health care use. ⋯ sleeping difficulty is a common and persistent complaint among older women and is strongly associated with use of sleeping medications. Both behaviours are negatively associated with health status.
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Geriatricians are often asked to make decisions about withholding cardiopulmonary resuscitation. This seems to be becoming more difficult and more controversial. There has been increased public concern about this subject recently and a recognition within the profession of the need for more openness and transparency in decision making. The implementation of The Human Rights Act led to updated guidelines from professional bodies, but these are likely to need careful interpretation in light of local circumstances before they can become a practical tool for decision making.