Health status assessment of the elderly

Life chance characteristics of older users of Swedish massage

The characteristics of those who use complementary and alternative medicine (CAM), as an approach to chronic disease management, are poorly understood. They may however be important to nurses and other health professionals given that CAM is increasingly used by their patients with chronic disorders. In these contexts, the purpose of this study was to ascertain unique life chance population characteristics which significantly influence the use of Swedish massage therapy (SMT), a popular form of CAM, by older adults with chronic health dysfunctions. A multi-site and cross-sectional design was used, as well as a pre-tested postal questionnaire. One hundred forty-one (141) urban, non-institutionalized, English-speaking older persons participated, ranging in age from 60 to 94 years. Findings denote the essential role life chances have on individuals accessing alternative forms of care.

Quality of life in older people: a structured review of generic self-assessed health instruments

OBJECTIVE

To review evidence relating to the measurement properties of multi-item generic patient or self-assessed measures of health in older people.

METHODS

Systematic literature searches to identify instruments. Pre-defined criteria relating to reliability, validity and responsiveness.

RESULTS

122 articles relating to 15 instruments met the inclusion criteria. The most extensive evidence was found for the SF-36, COOP Charts, EQ-5D, Nottingham Health Profile (NHP) and SIP. Four instruments have evidence of both internal consistency and test-retest reliability--NHP, SF-12, SF-20, SF-36. Four instruments lack evidence of reliability--HSQ-12, IHQL, QWB, SQL. Most instruments were assessed for validity through comparisons with other instruments, global judgements of health, or clinical and socio-demographic variables. Five instruments lack evidence of responsiveness--GQL, HSQ-12, IHQL, QLI and QWB.

CONCLUSION

There is good evidence for reliability, validity and responsiveness for the SF-36, EQ-5D and NHP. There is more limited evidence for the COOP, SF-12 and SIP. The SF-36 is recommended where a detailed and broad ranging assessment of health is required, particularly in community dwelling older people with limited morbidity. The EQ-5D is recommended where a more succinct assessment is required, particularly where a substantial change in health is expected. Instrument content should be assessed for relevance before application. The concurrent evaluation of generic instruments in older people is recommended.

Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study

BACKGROUND

Older patients are often referred to geriatricians because of complaints of progressive difficulties in walking. The diagnostic and therapeutic approach to these patients is complex. Multiple physiologic subsystems may influence the ability to walk, and no standard criteria are currently available to establish whether these subsystems are functioning within the normal range. To address this lack of knowledge we conducted the InCHIANTI study.

OBJECTIVE

To identify measures that clinicians can use to understand the causes of walking difficulties in older persons.

DESIGN

A population-based study of persons living in the Chianti geographic area (Tuscany, Italy).

PARTICIPANTS

1,453 persons (age-range 20-102 years; 91.6% of the eligible) selected from city registry of Greve in Chianti and Bagno a Ripoli (Tuscany, Italy), using a multistage sampling method.

MEASUREMENTS

Factors that influence walking ability were classified into six main physiologic subsystems: central nervous system, perceptual system, peripheral nervous system, muscles, bone/joints, and energy production/delivery. Measures of the integrity and functioning of each of these proposed subsystems were identified and administered to all participants.

CONCLUSIONS

Data collected in InCHIANTI will be used to identify the main risk factors that influence loss of the ability to walk in older persons, to define physiologic subsystems that are critical for walking, to select the best measures of their integrity, and to establish critical ranges in these measures that are compatible with "normal" walking ability. The final goal is to translate epidemiological research into a geriatric clinical tool that makes possible more precise diagnosis and more effective treatment in patients with walking dysfunction.