Age and ageing
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heart failure is primarily a disease of elderly people. Current guidelines suggest all patients with suspected heart failure should undergo objective assessment, usually by echocardiography. In the UK resources are limited and not all patients have access to echocardiography. The electrocardiogram is widely used as a pre-screening investigation. Recently the natriuretic peptides have been shown to correlate well with left ventricular function, and evidence is accumulating which suggests that B-type natriuretic peptide may have a role in detecting cardiovascular disease. Elderly patients attending day hospital often have non-specific cardiovascular symptoms. B-type natriuretic peptide measurement in parallel with conventional electrocardiogram, may offer a novel method of identifying those with significant cardiac disease, which may warrant treatment. This study assessed the role of B-type natriuretic peptide and electrocardiogram in the detection of cardiac disease in patients attending Day Hospital. ⋯ B-type natriuretic peptide may be a useful marker for cardiac disease in patients attending Day Hospital. Half of the patients assessed had cardiac disease detected. Both the electrocardiogram and B-type natriuretic peptide were sensitive in the detection of left ventricular systolic dysfunction but lacked specificity. B-type natriuretic peptide was superior to the electrocardiogram in the detection of valvular disease. If used to pre-screen cardiovascular disease in Day Hospital patients, B-type natriuretic peptide and the electrocardiogram could reduce the need for echocardiography in some patients before implementing evidence-based treatments. B-type natriuretic peptide increases progressively as the number of different cardiac abnormalities increases and this may explain why B-type natriuretic peptide is of such prognostic value in older patients.
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Randomized Controlled Trial Clinical Trial
Evaluation of a nurse-led falls prevention programme versus usual care: a randomized controlled trial.
to evaluate a nurse-led management plan and care pathway for older people discharged from an Accident and Emergency Department after a fall. ⋯ although the differences were not significant, patients in the intervention group had fewer falls, less hospital attendances and spent less time in hospital. Moreover, patients in the intervention group were more functionally independent at 6 months post-Index fall.
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Randomized Controlled Trial Clinical Trial
Substitution of a nursing-led inpatient unit for acute services: randomized controlled trial of outcomes and cost of nursing-led intermediate care.
To evaluate the outcome and cost of transfer to a nursing-led inpatient unit for 'intermediate care'. The unit was designed to replace a period of care in acute hospital wards and promote recovery before discharge to the community. ⋯ The nursing-led inpatient unit led to longer hospital stays. Since length of stay is the main driver of costs, this model of care-at least as implemented here-may be more costly. However, since the unit may substitute for both secondary and primary care, longer-term follow-up is needed to determine whether patients are better prepared for discharge under this model of care, resulting in reduced primary-care costs.
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To estimate active and cognitive impairment-free life expectancy at older ages from longitudinal data collected during two consecutive rounds of health checks for patients aged > or =75 years. ⋯ The extra years lived by women over men appear to be spent with some form of activity restriction, although not all with cognitive impairment. Monitoring these trends over time will be important to ascertain whether we are exchanging longer life for poorer health.
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Historical Article
Intermediate care--a challenge to specialty of geriatric medicine or its renaissance?
The specialism of geriatric medicine has developed considerably in the last half of the twentieth century. In Great Britain it has emerged from its sombre beginnings in Victorian poor law institutions to become one of the largest specialities in medicine encompassing a wide range of disciplines and interests. More recently, there has been a parallel development in "intermediate care" a sweeping phrase that encompasses a wide diversity of practices in a plethora of venues. ⋯ Elderly people need a full multi-disciplinary assessment (comprehensive geriatric assessment) and continued involvement of skilled and trained personnel in their continuing care (geriatric evaluation and management). The recommendations of the British Geriatrics Society on intermediate care are commended and should be adhered to by all planners and providers of intermediate care. There is considerable logic in developing ways in which the two developments can be integrated to build upon the best features of both.