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Kharicha K, Manthorpe J, Iliffe S, Chew-Graham CA, Cattan M, Goodman C, Kirby-Barr M, Whitehouse JH, Walters K. Managing loneliness: a qualitative study of older people's views. Aging Ment Health 2021; 25:1206-1213. [PMID: 32091237 DOI: 10.1080/13607863.2020.1729337] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Engaging with older people who self-identify as lonely may help professionals in mental health and other services understand how they deal with loneliness. The evidence-base for effective interventions to address loneliness is inconclusive. This study aimed to explore how community-dwelling lonely older people in England manage their experiences of loneliness. Twenty eight community-dwelling older people identifying as lonely, based on responses to two loneliness measures (self-report and a standardised instrument), participated in in-depth interviews between 2013 and 2014. Fifteen lived alone. Thematic analysis of transcribed interviews was conducted by a multidisciplinary team including older people.Participants drew on a range of strategies to ameliorate their distress which had been developed over their lives and shaped according to individual coping styles and contexts. Strategies included physical engagement with the world beyond their home, using technologies, planning, and engagement with purpose in an 'outside world', and acceptance, endurance, revealing and hiding, positive attitude and motivation, and distraction within an 'inside world'. Strategies of interests and hobbies, comparative thinking, religion and spirituality and use of alcohol straddled both the inside and outside worlds. Participants conveyed a personal responsibility for managing feelings of loneliness rather than relying on others. This study includes the experiences of those living with loneliness whilst also living with other people. When developing policy and practice responses to loneliness it is important to listen attentively to the views of those who may not be engaging with services designed for 'the lonely' and to consider their own strategies for managing it.
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Affiliation(s)
- K Kharicha
- Department of Primary Care and Population Health, University College London, Royal Free Campus, London, UK
| | - J Manthorpe
- NIHR Policy Research Unit on Health and Social Care Workforce, King's College London, London, UK
| | - S Iliffe
- Department of Primary Care and Population Health, University College London, Royal Free Campus, London, UK
| | - C A Chew-Graham
- School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - M Cattan
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - C Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - M Kirby-Barr
- Patient and Public Involvement Member, London, UK
| | | | - K Walters
- Department of Primary Care and Population Health, University College London, Royal Free Campus, London, UK
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Brooke-Wavell K, Duckham RL, Iliffe S, Kendrick D, Skelton DA, Taylor R, Masud T. 77INFLUENCE OF FALL PREVENTION EXERCISE PROGRAMMES ON MARKERS OF INFLAMMATION AND CARDIOVASCULAR RISK IN OLDER PEOPLE. Age Ageing 2019. [DOI: 10.1093/ageing/afz059.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Brooke-Wavell
- School of Sport, Exercise and Health Sciences, Loughborough University
| | - R L Duckham
- School of Sport, Exercise and Health Sciences, Loughborough University
- Institute for Physical Activity and Nutrition, Deakin University, Australia
| | - S Iliffe
- Department of Primary Care & Population Health, University College London
| | - D Kendrick
- School of Medicine, University of Nottingham
| | - D A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University
| | - R Taylor
- Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - T Masud
- Healthcare for Older People, Nottingham University Hospitals NHS Trust
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Kojima G, Avgerinou C, Iliffe S, Jivraj S, Sekiguchi K, Walters K. Erratum to: Fruit and Vegetable Consumption and Frailty: A Systematic Review. J Nutr Health Aging 2018. [DOI: 10.1007/s12603-018-1074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kendrick D, Orton E, Lafond N, Audsley S, Maula A, Morris R, Vedhara K, Iliffe S. Keeping active: maintenance of physical activity after exercise programmes for older adults. Public Health 2018; 164:118-127. [PMID: 30286342 DOI: 10.1016/j.puhe.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/09/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To explore factors associated with maintenance of moderate-to-vigorous physical activity (MVPA) in community-dwelling adults aged ≥65 years after completing a 24-week exercise programme. STUDY DESIGN This is a cohort study nested within a randomised controlled trial evaluating group- and home-based exercise programmes for older people in England. METHODS MVPA levels and factors potentially associated with physical activity (PA) were self-reported at recruitment, 6, 12, 18 and 24 months after exercise programme. Multilevel logistic regression estimated odds ratios (ORs) for achieving target MVPA level (150 min/week) 6-24 months after exercise programmes ended. RESULTS Older people (OR per year increase: 0.89, 95% confidence interval [CI] 0.86, 0.93) and women (OR 0.47, 95% CI 0.33, 0.67) were less likely to achieve target MVPA. Those physically active at recruitment (OR 11.28, 95% CI 7.95, 16.01), with wider social networks (OR per unit increase in Lubben Social Network Scale: 1.06, 95% CI 1.03, 1.10) and performing more sit-to-stands in 30 s (OR for quartile 3 compared with quartile 1: 1.87, 95% CI 1.12, 3.10), were more likely to achieve target MVPA. Negative exercise expectations increased the odds of achieving target MVPA but only among the less active at recruitment (OR per unit increase in Outcome and Expectation for Exercise negative subscale: 1.90, 95% CI 1.39, 2.60). Associations did not differ significantly across the follow-up period. CONCLUSION A range of factors are associated with maintenance of PA 6-24 months after exercise programmes. Factors are not more strongly associated with shorter vs longer term PA maintenance. Commissioners and providers should consider targeting maintenance interventions to those least likely to maintain PA.
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Affiliation(s)
- D Kendrick
- School of Medicine, Division of Primary Care, Tower Building, University Park, Nottingham, NG7 2RD, UK.
| | - E Orton
- School of Medicine, Division of Primary Care, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - N Lafond
- School of Medicine, Division of Primary Care, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - S Audsley
- School of Medicine, Division of Primary Care, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - A Maula
- School of Medicine, Division of Primary Care, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - R Morris
- School of Social and Community Medicine, University of Bristol, Office 3.05, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - K Vedhara
- School of Medicine, Division of Primary Care, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - S Iliffe
- Research Department of Primary Care and Population Health, UCL, Royal Free Campus, Rowland Hill St, London NW3 2PF, UK
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Kojima G, Avgerinou C, Iliffe S, Jivraj S, Sekiguchi K, Walters K. 15FRUIT AND VEGETABLE CONSUMPTION AND FRAILTY: A SYSTEMATIC REVIEW. Age Ageing 2018. [DOI: 10.1093/ageing/afy134.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Kojima
- Department of Primary Care and Population Health, University College London
| | - C Avgerinou
- Department of Primary Care and Population Health, University College London
| | - S Iliffe
- Department of Primary Care and Population Health, University College London
| | - S Jivraj
- Department of Epidemiology and Public Health, University College London
| | - K Sekiguchi
- Department of General Medicine, Shinshu University School of Medicine
| | - K Walters
- Department of Primary Care and Population Health, University College London
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Austin T, Wilcock J, Bryans M, Turner S, Downs M, Iliffe S. Design and Implementation of a Computer Decision Support System for the Diagnosis and Management of Dementia Syndromes in Primary Care. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Background:
Diagnosis and management of dementia is a complex process and primary care physicians are under-equipped to deal with uncertainties in the provision of optimal care for the patient.
Objective:
To develop a computer decision support system (CDSS) which could assist physicians with diagnosis and management and improve patient care.
Methods:
A design group including general practitioners derived logic pathways for diagnosis and management of dementia and validated them with a multi-professional expert group. Logic pathways were used to construct a comprehensive CDSS rendered as a series of expert consultations. The CDSS was inserted into commercially available GP systems and bench and field-tested.
Results:
The complexity of dementia diagnosis and management can be captured in logic pathways which can be expressed as decision trees within existing electronic patient records. The resulting CDSS appears useable in routine practice.
Conclusion:
The impact of this CDSS will be evaluated in a randomised controlled trial of educational interventions in primary care.
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Kojima G, Avgerinou C, Iliffe S, Jivraj S, Sekiguchi K, Walters K. Fruit and Vegetable Consumption and Frailty: A Systematic Review. J Nutr Health Aging 2018; 22:1010-1017. [PMID: 30272107 PMCID: PMC6182506 DOI: 10.1007/s12603-018-1069-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify currently available evidence on fruit and vegetable consumption in association with frailty by conducting a systematic review of the literature and to summarise and critically evaluate it. DESIGN Systematic review. SETTING Four electronic databases (Embase, MEDLINE, CINAHL and PsycINFO) were systematically searched in August 2017 for observational cohort studies providing cross-sectional or prospective associations between fruit and vegetable consumption and frailty risks. Additional studies were searched by manually reviewing the reference lists of the included studies and related review papers and conducting forward citation tracking of the included studies. The methodological quality of prospective studies was assessed using the Newcastle-Ottawa scale. PARTICIPANTS Community-dwelling general populations. RESULTS A total of 6251 studies were identified, of which five prospective studies with follow-up periods of 2-10.5 years and two cross-sectional studies were included. Among the five prospective studies, three had adequate methodological quality. Because of different measurements and statistical methodologies, a meta-analysis was not possible. The two studies of good quality showed that fruit and vegetable consumption was mostly associated with lower risk of incident frailty. The other study as a sub-analysis retrospectively examined baseline fruit and vegetable consumption of those who developed frailty and those who did not at follow-up and showed no significant associations. CONCLUSIONS Although good quality studies on this topic are scarce, there is some suggestion that higher fruit and vegetable consumption may be associated with lower frailty risk. More high quality research is needed.
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Affiliation(s)
- G Kojima
- Gotaro Kojima, MD, Department of Primary Care and Population Health, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK, Phone: +44 (0)20 7794 0500, Fax: +44 (0)20 7472 6871,
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Hanratty B, Stow D, Clegg A, Iliffe S, Barclay S, Robinson L, Matthews F, Exley C. PRIMARY CARE FOR FRAIL OLDER ADULTS AT THE END OF LIFE: CAN A FRAILTY INDEX ENHANCE ROUTINE CARE? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B. Hanratty
- Newcastle University, Newcastle upon Tyne, United Kingdom,
| | - D. Stow
- Newcastle University, Newcastle upon Tyne, United Kingdom,
| | - A. Clegg
- University of Leeds, Leeds, United Kingdom,
| | - S. Iliffe
- University College London, London, United Kingdom
| | - S. Barclay
- University of Cambridge, Cambridge, United Kingdom,
| | - L. Robinson
- Newcastle University, Newcastle upon Tyne, United Kingdom,
| | - F. Matthews
- Newcastle University, Newcastle upon Tyne, United Kingdom,
| | - C. Exley
- Newcastle University, Newcastle upon Tyne, United Kingdom,
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Gordon A, Goodman C, Davies S, Handley M, Iliffe S, Bowman C, Victor C, Martin F. DEVELOPING A PROGRAMME THEORY OF HEALTH CARE IN UK CARE HOMES—REVIEWS, SURVEYS, AND INTERVIEWS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A. Gordon
- University of Nottingham, Nottingham, United Kingdom
| | - C. Goodman
- University of Hertfordshire, Hatfield, United Kingdom,
| | - S. Davies
- University of Hertfordshire, Hatfield, United Kingdom,
| | - M. Handley
- University of Hertfordshire, Hatfield, United Kingdom,
| | - S. Iliffe
- University College London, London, United Kingdom,
| | - C. Bowman
- City University London, London, United Kingdom,
| | - C. Victor
- Brunel University London, London, United Kingdom,
| | - F. Martin
- Kings College London, London, United Kingdom,
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Davies N, Lamahewa K, Mathew R, Wilcock J, Manthorpe J, Sampson E, Iliffe S. DEVELOPMENT OF HEURISTICS TO GUIDE DECISION MAKING AT THE END OF LIFE FOR SOMEONE WITH DEMENTIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N. Davies
- University College London, London, United Kingdom,
| | - K. Lamahewa
- University College London, London, United Kingdom,
| | - R. Mathew
- University College London, London, United Kingdom,
| | - J. Wilcock
- University College London, London, United Kingdom,
| | | | - E.L. Sampson
- University College London, London, United Kingdom,
- North Middlesex University Hospital, London, United Kingdom
| | - S. Iliffe
- University College London, London, United Kingdom,
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Kharicha K, Iliffe S, Manthorpe J, Chew-Graham C, Cattan M, Kirby-Barr M, Goodman C, Walters K. HOW DO OLDER PEOPLE MANAGE LONELINESS FOR THEMSELVES? A QUALITATIVE STUDY IN ENGLAND. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K. Kharicha
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
| | - S. Iliffe
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
| | | | | | - M. Cattan
- Northumbria University, Newcastle upon Tyne, United Kingdom,
| | - M. Kirby-Barr
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
| | - C. Goodman
- University of Hertfordshire, Hertfordshire, United Kingdom
| | - K. Walters
- Centre for Ageing Population Studies, Department of Primary Care and Population Health, University College London, London, United Kingdom,
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Harris T, Furness C, Limb E, Kerry S, Victor C, Whincup P, Iliffe S, Ussher M, Wahlich C, Cook D. P98 From effective trial to NHS implementation: progressing the primary care Pedometer and consultation evaluation (PACE-UP) randomised controlled trial into routine practice. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Papachristou E, Wannamethee SG, Iliffe S, Papacosta AO, Lennon LT, Whincup PH, Ramsay SE. OP26 Self-reported frailty components predict incident disability, falls and all-cause mortality in later life: results from a prospective study of older British men. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mathew R, Davies N, Manthorpe J, Iliffe S. Making decisions at the end of life when caring for a person with dementia: a literature review to explore the potential use of heuristics in difficult decision-making. BMJ Open 2016; 6:e010416. [PMID: 27436665 PMCID: PMC4964249 DOI: 10.1136/bmjopen-2015-010416] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Decision-making, when providing care and treatment for a person with dementia at the end of life, can be complex and challenging. There is a lack of guidance available to support practitioners and family carers, and even those experienced in end of life dementia care report a lack of confidence in decision-making. It is thought that the use of heuristics (rules of thumb) may aid decision-making. The aim of this study is to identify whether heuristics are used in end of life dementia care, and if so, to identify the context in which they are being used. DESIGN A narrative literature review was conducted taking a systematic approach to the search strategy, using the Centre for Reviews and Dissemination guidelines. Rapid appraisal methodology was used in order to source specific and relevant literature regarding the use of heuristics in end of life dementia care. DATA SOURCES A search using terms related to dementia, palliative care and decision-making was conducted across 4 English language electronic databases (MEDLINE, EMBASE, PsycINFO and CINAHL) in 2015. RESULTS The search identified 12 papers that contained an algorithm, guideline, decision tool or set of principles that we considered compatible with heuristic decision-making. The papers addressed swallowing and feeding difficulties, the treatment of pneumonia, management of pain and agitation, rationalising medication, ending life-sustaining treatment, and ensuring a good death. CONCLUSIONS The use of heuristics in palliative or end of life dementia care is not described in the research literature. However, this review identified important decision-making principles, which are largely a reflection of expert opinion. These principles may have the potential to be developed into simple heuristics that could be used in practice.
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Affiliation(s)
- R Mathew
- Research Department of Primary Care & Population Health, University College London, UK
| | - N Davies
- Research Department of Primary Care & Population Health, University College London, UK
| | - J Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - S Iliffe
- Research Department of Primary Care & Population Health, University College London, UK
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Gawler S, Skelton DA, Dinan-Young S, Masud T, Morris RW, Griffin M, Kendrick D, Iliffe S. Reducing falls among older people in general practice: The ProAct65+ exercise intervention trial. Arch Gerontol Geriatr 2016; 67:46-54. [PMID: 27420150 DOI: 10.1016/j.archger.2016.06.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Falls are common in the older UK population and associated costs to the NHS are high. Systematic reviews suggest that home exercise and group-based exercise interventions, which focus on progressively challenging balance and increasing strength, can reduce up to 42% of falls in those with a history of falls. The evidence is less clear for those older adults who are currently at low risk of falls. AIM ProAct65+, a large, cluster-randomised, controlled trial, investigated the effectiveness of a home exercise programme (Otago Exercise Programme (OEP)) and a group-based exercise programme (Falls Management Exercise (FaME)) compared to usual care (UC) at increasing moderate to vigorous physical activity (MVPA). This paper examines the trial's secondary outcomes; the effectiveness of the interventions at reducing falls and falls-related injuries. SETTING & PARTICIPANTS 1256 community-dwelling older adults (aged 65+) were recruited through GP practices in two sites (London and Nottingham). Frequent fallers (≥3 falls in last year) and those with unstable medical conditions were excluded, as were those already reaching the UK Government recommended levels of physical activity (PA) for health. METHODS Baseline assessment (including assessment of health, function and previous falls) occurred before randomisation; the intervention period lasted 24 weeks and there was an immediate post-intervention assessment; participants were followed up every six months for 24 months. Falls data were analysed using negative binomial modelling. OUTCOME MEASURES Falls data were collected prospectively during the intervention period by 4-weekly diaries (6 in total). Falls recall was recorded at the 3-monthly follow-ups for a total of 24 months. Balance was measured at baseline and at the end of the intervention period using the Timed Up & Go and Functional Reach tests. Balance confidence (CONFbal), falls risk (FRAT) and falls self-efficacy (FES-I) were measured by questionnaire at baseline and at all subsequent assessment points. RESULTS 294 participants (24%) reported one or two falls in the previous year. There was no increase in falls in either exercise group compared to UC during the intervention period (resulting from increased exposure to risk). The FaME arm experienced a significant reduction in injurious falls compared to UC (incidence rate ratio (IRR) 0.55, 95% CI 0.31, 0.96; p=0.04) and this continued during the 12 months after the end of the intervention (IRR 0.73, 95% CI 0.54, 0.99; p=0.05). There was also a significant reduction in the incidence of all falls (injurious and non-injurious) in the FaME arm compared with UC (IRR 0.74, 95% CI 0.55, 0.99; p=0.04) in the 12 month period following the cessation of the intervention. There was a non-significant reduction in the incidence of all falls in the OEP arm compared with UC (IRR 0.76, 95% CI 0.53, 1.09; p=0.14) in the 12 months following the cessation of the intervention. The effects on falls did not persist at the 24 months assessment in either exercise arm. However, when those in the FaME group who continued to achieve 150min of MVPA per week into the second post-intervention year were compared to those in the FaME group who did not maintain their physical activity, there was a significant reduction in falls incidence (IRR=0.49, 95% CI 0.30, 0.79; p=0.004). CONFbal was significantly improved at 12 months post intervention in both intervention arms compared with UC. There were no significant changes in any of the functional balance measures, FES-I or FRAT, between baseline and the end of the intervention period. CONCLUSION Community-dwelling older adults who joined an exercise intervention (FaME) aimed at increasing MVPA did not fall more during the intervention period, fell less and had fewer injurious falls in the 12 months after cessation of the intervention. However, 24 months after cessation of exercise, the beneficial effects of FaME on falls reduction ceased, except in those who maintained higher levels of MVPA. OEP exercise appears less effective at reducing falls in this functionally more able population of older adults.
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Affiliation(s)
- S Gawler
- Research Dept. of Primary Care & Population Health, UCL, Royal Free Campus, Rowland Hill St., London NW3 2PF, UK.
| | - D A Skelton
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - S Dinan-Young
- Research Dept. of Primary Care & Population Health, UCL, Royal Free Campus, Rowland Hill St., London NW3 2PF, UK
| | - T Masud
- Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK
| | - R W Morris
- Research Dept. of Primary Care & Population Health, UCL, Royal Free Campus, Rowland Hill St., London NW3 2PF, UK; School of Social & Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol BS8 2PS, UK
| | - M Griffin
- Research Dept. of Primary Care & Population Health, UCL, Royal Free Campus, Rowland Hill St., London NW3 2PF, UK
| | - D Kendrick
- School of Medicine, Division of Primary Care, Tower Building, University Park, University of Nottingham, Nottingham, NG7 2RD, UK
| | - S Iliffe
- Research Dept. of Primary Care & Population Health, UCL, Royal Free Campus, Rowland Hill St., London NW3 2PF, UK
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Kojima G, Iliffe S, Walters K. 61SMOKING AS A PREDICTOR OF FRAILTY: A SYSTEMATIC REVIEW. Age Ageing 2016. [DOI: 10.1093/ageing/afw033.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Walters K, Hardoon S, Petersen I, Iliffe S, Omar RZ, Nazareth I, Rait G. Predicting dementia risk in primary care: development and validation of the Dementia Risk Score using routinely collected data. BMC Med 2016; 14:6. [PMID: 26797096 PMCID: PMC4722622 DOI: 10.1186/s12916-016-0549-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/16/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Existing dementia risk scores require collection of additional data from patients, limiting their use in practice. Routinely collected healthcare data have the potential to assess dementia risk without the need to collect further information. Our objective was to develop and validate a 5-year dementia risk score derived from primary healthcare data. METHODS We used data from general practices in The Health Improvement Network (THIN) database from across the UK, randomly selecting 377 practices for a development cohort and identifying 930,395 patients aged 60-95 years without a recording of dementia, cognitive impairment or memory symptoms at baseline. We developed risk algorithm models for two age groups (60-79 and 80-95 years). An external validation was conducted by validating the model on a separate cohort of 264,224 patients from 95 randomly chosen THIN practices that did not contribute to the development cohort. Our main outcome was 5-year risk of first recorded dementia diagnosis. Potential predictors included sociodemographic, cardiovascular, lifestyle and mental health variables. RESULTS Dementia incidence was 1.88 (95% CI, 1.83-1.93) and 16.53 (95% CI, 16.15-16.92) per 1000 PYAR for those aged 60-79 (n = 6017) and 80-95 years (n = 7104), respectively. Predictors for those aged 60-79 included age, sex, social deprivation, smoking, BMI, heavy alcohol use, anti-hypertensive drugs, diabetes, stroke/TIA, atrial fibrillation, aspirin, depression. The discrimination and calibration of the risk algorithm were good for the 60-79 years model; D statistic 2.03 (95% CI, 1.95-2.11), C index 0.84 (95% CI, 0.81-0.87), and calibration slope 0.98 (95% CI, 0.93-1.02). The algorithm had a high negative predictive value, but lower positive predictive value at most risk thresholds. Discrimination and calibration were poor for the 80-95 years model. CONCLUSIONS Routinely collected data predicts 5-year risk of recorded diagnosis of dementia for those aged 60-79, but not those aged 80+. This algorithm can identify higher risk populations for dementia in primary care. The risk score has a high negative predictive value and may be most helpful in 'ruling out' those at very low risk from further testing or intensive preventative activities.
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Affiliation(s)
- K Walters
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - S Hardoon
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - I Petersen
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - S Iliffe
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - R Z Omar
- Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - I Nazareth
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | - G Rait
- Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK
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Liljas AEM, Wannamethee S, Whincup P, Papacosta O, Walters K, Iliffe S, Lennon L, Carvalho L, Ramsay S. 52SENSORY IMPAIRMENTS AND MORTALITY IN OLDER BRITISH COMMUNITY-DWELLING MEN: A 10-YEAR FOLLOW-UP STUDY. Age Ageing 2015. [DOI: 10.1093/ageing/afv109.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Brooke-Wavell K, Duckham RL, Taylor R, Kendrick D, Carpenter H, Iliffe S, Morris R, Skelton DA, Dinan S, Gage H, Masud T. 46DOES ADHERENCE TO FALLS PREVENTION EXERCISE PROGRAMMES BENEFIT BONE MINERAL DENSITY IN OLDER PEOPLE? THE PROACT65+ BONE STUDY. Age Ageing 2015. [DOI: 10.1093/ageing/afv108.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
INTRODUCTION End of life care guidance for people with dementia is lacking and this has been made more problematic in England with the removal of one of the main end of life care guidelines which offered some structure, the Liverpool Care Pathway. This guidance gap may be eased with the development of heuristics (rules of thumb) which offer a fast and frugal form of decision-making. OBJECTIVE To develop a toolkit of heuristics (rules of thumb) for practitioners to use when caring for people with dementia at the end of life. METHOD AND ANALYSIS A mixed-method study using a co-design approach to develop heuristics in three phases. In phase 1, we will conduct at least six focus groups with family carers, health and social care practitioners from both hospital and community care services, using the 'think-aloud' method to understand decision-making processes and to develop a set of heuristics. The focus group topic guide will be developed from the findings of a previous study of 46 interviews of family carers about quality end-of-life care for people with dementia and a review of the literature. A multidisciplinary development team of health and social care practitioners will synthesise the findings from the focus groups to devise and refine a toolkit of heuristics. Phase 2 will test the use of heuristics in practice in five sites: one general practice, one community nursing team, one hospital ward and two palliative care teams working in the community. Phase 3 will evaluate and further refine the toolkit of heuristics through group interviews, online questionnaires and semistructured interviews. ETHICS AND DISSEMINATION This study has received ethical approval from a local NHS research ethics committee (Rec ref: 15/LO/0156). The findings of this study will be presented in peer-reviewed publications and national and international conferences.
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Affiliation(s)
- N Davies
- Research Department of Primary Care & Population Health, UCL, London, UK
| | - J Manthorpe
- Social Care Workforce Research Unit, Kings College London, London, UK
| | - E L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, London, UK
| | - S Iliffe
- Research Department of Primary Care & Population Health, UCL, London, UK
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Sartini C, Wannamethee SG, Iliffe S, Morris RW, Ash S, Lennon L, Whincup PH, Jefferis BJ. OP93 Objectively measured physical activity and sedentary behaviour in older men: diurnal patterns and their determinants. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Furness CA, Howard EL, Harris T, Kerry SM, Victor CR, Ussher M, Whincup P, Shah S, Iliffe S, Ekelund U, Limb E, Fox-Rushby J, Cook DG. OP95 Evaluating implementation fidelity in the pace-up (pedometer and consultation evaluation-up) complex walking intervention. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Liljas AEM, Wannamethee SG, Whincup PH, Papacosta O, Walters K, Iliffe S, Lennon LT, Carvalho LA, Ramsay SE. OP07 Sensory impairments and mortality in older british community-dwelling men: a 10-year follow-up study. J Epidemiol Community Health 2015. [DOI: 10.1136/jech-2015-206256.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Liljas AEM, Wannamethee SG, Whincup PH, Papacosta O, Walters K, Iliffe S, Lennon LT, Carvalho LA, Ramsay SE. Socio-demographic characteristics, lifestyle factors and burden of morbidity associated with self-reported hearing and vision impairments in older British community-dwelling men: a cross-sectional study. J Public Health (Oxf) 2015; 38:e21-8. [PMID: 26177816 DOI: 10.1093/pubmed/fdv095] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hearing and vision problems are common in older adults. We investigated the association of self-reported sensory impairment with lifestyle factors, chronic conditions, physical functioning, quality of life and social interaction. METHODS A population-based cross-sectional study of participants of the British Regional Heart Study aged 63-85 years. RESULTS A total of 3981 men (82% response rate) provided data. Twenty-seven per cent (n = 1074) reported hearing impairment including being able to hear with aid (n = 482), being unable to hear (no aid) (n = 424) and being unable to hear despite aid (n = 168). Three per cent (n = 124) reported vision impairment. Not being able to hear, irrespective of use of hearing aid, was associated with poor quality of life, poor social interaction and poor physical functioning. Men who could not hear despite hearing aid were more likely to report coronary heart disease (CHD) [age-adjusted odds ratios (ORs) 1.89 (95% confidence interval 1.36-2.63)]. Vision impairment was associated with symptoms of CHD including breathlessness [OR 2.06 (1.38-3.06)] and chest pain [OR 1.58 (1.07-2.35)]. Vision impairment was also associated with poor quality of life, poor social interaction and poor physical functioning. CONCLUSIONS Sensory impairment is associated with poor physical functioning, poor health and poor social interaction in older men. Further research is warranted on pathways underlying these associations.
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Affiliation(s)
- A E M Liljas
- Department of Primary Care and Population Health, University College London, London, UK
| | - S G Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
| | - P H Whincup
- Population Health Research Centre, Division of Population Health Sciences and Education, St George's, University of London, London, UK
| | - O Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - K Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - S Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - L T Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | - L A Carvalho
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - S E Ramsay
- Department of Primary Care and Population Health, University College London, London, UK
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Voss S, Benger J, Black S, Cheston R, Cullum S, Purdy S, Iliffe S. Training on dementia for emergency ambulance staff: research agenda and opportunities. Int J Geriatr Psychiatry 2015; 30:549-50. [PMID: 25855208 DOI: 10.1002/gps.4270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/23/2015] [Indexed: 11/11/2022]
Affiliation(s)
- S Voss
- University of the West of England, Health and Applied Sciences, UK
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Kojima G, Masud T, Treml J, Iliffe S. 44 * DOES THE TIMED UP AND GO TEST PREDICT FUTURE FALLS AMONG BRITISH COMMUNITY-DWELLING OLDER PEOPLE? Age Ageing 2015. [DOI: 10.1093/ageing/afv032.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Warlow G, Satkunasingham TS, Iliffe S. 18 * REDUCING GERIATRIC RE-ADMISSIONS AND LENGTH OF STAY THROUGH TRIAGE RAPID ELDERLY ASSESSMENT TEAM (TREAT) AND POST ACUTE CARE ENABLEMENT (PACE). A RETROSPECTIVE BEFORE AND AFTER COHORT STUDY. Age Ageing 2015. [DOI: 10.1093/ageing/afv029.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ramsay SE, Arianayagam DS, Whincup PH, Lennon LT, Cryer J, Papacosta AO, Iliffe S, Wannamethee SG. Cardiovascular risk profile and frailty in a population-based study of older British men. Heart 2014; 101:616-22. [PMID: 25480883 PMCID: PMC4392309 DOI: 10.1136/heartjnl-2014-306472] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Frailty in older age is known to be associated with cardiovascular disease (CVD) risk. However, the extent to which frailty is associated with the CVD risk profile has been little studied. Our aim was to examine the associations of a range of cardiovascular risk factors with frailty and to assess whether these are independent of established CVD. METHODS Cross-sectional study of a socially representative sample of 1622 surviving men aged 71-92 examined in 2010-2012 across 24 British towns, from a prospective study initiated in 1978-1980. Frailty was defined using the Fried phenotype, including weight loss, grip strength, exhaustion, slowness and low physical activity. RESULTS Among 1622 men, 303 (19%) were frail and 876 (54%) were pre-frail. Compared with non-frail, those with frailty had a higher odds of obesity (OR 2.03, 95% CI 1.38 to 2.99), high waist circumference (OR 2.30, 95% CI 1.67 to 3.17), low high-density lipoprotein-cholesterol (HDL-C) (OR 2.28, 95% CI 1.47 to 3.54) and hypertension (OR 1.79, 95% CI 1.27 to 2.54). Prevalence of these factors was also higher in those with frailty (prevalence in frail vs non-frail groups was 46% vs 31% for high waist circumference, 20% vs 11% for low HDL and 78% vs 65% for hypertension). Frail individuals had a worse cardiovascular risk profile with an increased risk of high heart rate, poor lung function (forced expiratory volume in 1 s (FEV1)), raised white cell count (WCC), poor renal function (low estimated glomerular filtration rate), low alanine transaminase and low serum sodium. Some risk factors (HDL-C, hypertension, WCC, FEV1, renal function and albumin) were also associated with being pre-frail. These associations remained when men with prevalent CVD were excluded. CONCLUSIONS Frailty was associated with increased risk of a range of cardiovascular factors (including obesity, HDL-C, hypertension, heart rate, lung function, renal function) in older people; these associations were independent of established CVD.
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Affiliation(s)
- S E Ramsay
- Department of Primary Care & Population Health, UCL, London, UK
| | - D S Arianayagam
- Department of Primary Care & Population Health, UCL, London, UK
| | - P H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - L T Lennon
- Department of Primary Care & Population Health, UCL, London, UK
| | - J Cryer
- Department of Primary Care & Population Health, UCL, London, UK
| | - A O Papacosta
- Department of Primary Care & Population Health, UCL, London, UK
| | - S Iliffe
- Department of Primary Care & Population Health, UCL, London, UK
| | - S G Wannamethee
- Department of Primary Care & Population Health, UCL, London, UK
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Heseltine R, Skelton D, Kendrick D, Morris RW, Griffin M, Haworth D, Masud T, Iliffe S. 58 * SEDENTARY OLDER PARTICIPANTS WHO VOLUNTEER FOR STRUCTURED EXERCISE PROGRAMMES ARE NOT LIKE OTHER COMMUNITY DWELLING OLDER SEDENTARY PEOPLE. Age Ageing 2014. [DOI: 10.1093/ageing/afu130.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kojima G, Bowling A, Iliffe S. 71 * EFFECTS OF MULTICENTRE CLUSTER RANDOMISED CONTROLLED TRIAL OF GROUP- AND HOME-BASED EXERCISE PROGRAMMES ON QUALITY OF LIFE AMONG COMMUNITY-DWELLING OLDER PEOPLE: THE PROACT65+ TRIAL. Age Ageing 2014. [DOI: 10.1093/ageing/afu133.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kumar A, Carpenter H, Cook J, Skelton DA, Stevens Z, Haworth D, Belcher CM, Gawler SJ, Gage H, Masud T, Bowling A, Pearl M, Morris RW, Iliffe S, Zijlstra GAR, Delbaere K, Kendrick D. 55 * EXERCISE FOR REDUCING FEAR OF FALLING IN OLDER PEOPLE LIVING IN THE COMMUNITY: A COCHRANE SYSTEMATIC REVIEW. Age Ageing 2014. [DOI: 10.1093/ageing/afu130.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Normansell RA, Holmes R, Victor CR, Cook DG, Kerry S, Iliffe S, Ussher M, Ekelund U, Fox-Rushby J, Whincup P, Harris TJ. OP23 Exploring the reasons for non-participation in physical activity interventions: PACE-UP trial qualitative findings. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Harris T, Kerry S, Victor C, Ekelund U, Woodcock A, Iliffe S, Whincup P, Beighton C, Ussher M, Limb E, David L, Brewin D, Adams F, Rogers A, Cook D. OP03 Does a complex intervention by primary care nurses increase walking in 60–75 year olds? Outcomes at three and twelve months from the PACE-Lift (Pedometer Accelerometer Consultation Evaluation – Lift) cluster randomised controlled trial. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Davies N, Rait G, Iliffe S. IS END OF LIFE CARE AT HOME FOR PEOPLE WITH DEMENTIA POSSIBLE? VIEWS OF FAMILY CARERS. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vass CD, Sahota O, Drummond A, Kendrick D, Grainge M, Gladman J, Sach T, Avis M, O'Halloran AM, King-Kallimanis B, Kenny RA, Kumar A, Carpenter H, Morris R, Iliffe S, Kendrick D, Bamford C, Parry S, Deary V, Finch T, Cronin H, Savva G, O'Regan C, Donoghue OA, Kearney P, Kenny RA, Sutton GM, Hussain R, Bhangu J, King-Kallimanis B, Cunningham C, Kenny RA, Duggan E, Finucane C, Cronin H, O'Regan C, Savva G, Loughman J, Kenny RA, Donoghue OA, Horgan F, Savva G, Cronin H, O'Regan C, Kenny RA, Shipway DJH, Shipway MDH, Shah M, Jenkin RP, Wang Q, Chua EC. Falls, fractures and trauma. Age Ageing 2013. [DOI: 10.1093/ageing/aft019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Koch T, Iliffe S, Manthorpe J, Stephens B, Fox C, Robinson L, Livingston G, Coulton S, Knapp M, Chew-Graham C, Katona C. The potential of case management for people with dementia: a commentary. Int J Geriatr Psychiatry 2012; 27:1305-14. [PMID: 22359407 DOI: 10.1002/gps.3783] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 01/12/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND A recent review of studies of case management in dementia argues that lack of evidence of cost-effectiveness should discourage the use of this approach to care. We argue that that this is too conservative a stance, given the urgent need throughout the world to improve the quality of care for people with dementia and their caregivers. We propose a research agenda on case management for people with dementia. METHOD A critical comparison was made of the studies identified in two systematic reviews of trials of case management for dementia, with selective inclusion of non-trial studies and economic evaluations. RESULTS Our interpretation of the literature leads us to four provisional conclusions. First, studies with long follow-up periods tend to show delayed relocation of people with dementia to care homes. Second, the quality of life of people with dementia and their caregivers may also influence the likelihood of relocation. Third, different understandings of what constitutes case management make interpretation of studies difficult. Fourth, we agree that the population most likely to benefit from case management needs to be characterised. Earlier intervention may be more beneficial than intervening when the condition has progressed and the individual's situation is highly complex. However, this runs counter to some definitions of case management as an administrative, professional, and systemic focus on people with high needs and where expensive support is accessed or in prospect. CONCLUSIONS More work needs to be carried out in a more focused way in order to establish the value of case management for people with dementia. Since care home residence is such a sizeable contributor to the costs of dementia care, studies need to be long enough to capture possible postponed relocation. However, case management studies with shorter follow-up periods can still contribute to our understanding, since they can demonstrate improved quality of life. Future research should be built around a common, agreed definition of types of case management.
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Affiliation(s)
- T Koch
- Department of Primary Care and Population Health, University College London, London, UK
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Jefferis B, Iliffe S, Kerse N, Kendrick D, Trost S, Lennon L, Ash S, Wannamethee G, Morris R, Whincup P. How is objectively measured physical activity associated with recurrent falls and fear of falling in older community dwelling men?*. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jefferis BJ, Iliffe S, Kerse N, Kendrick D, Trost S, Lennon LT, Ash S, Wannamethee SG, Morris R, Whincup PH. OP16 How is Objectively Measured Physical Activity Associated with Falls and fear of Falling in Older Community Dwelling Men? Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Davies N, Iliffe S, Maio L, Manthorpe J, Ahmedzai S. European model of palliative care for dementia: Study protocol. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000264.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Iliffe S, Kharicha K, Harari D, Swift C, Goodman C, Manthorpe J. User involvement in the development of a health promotion technology for older people: findings from the SWISH project. Health Soc Care Community 2010; 18:147-159. [PMID: 19708867 DOI: 10.1111/j.1365-2524.2009.00882.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Successive English government policies about older people's health and well-being aim to improve health and quality of life by promoting independence. Improving access to information and services that can improve health and well-being and reduce health risks is central to the modernisation of health and social care. Most recently, tailored and person-centred approaches with a strong emphasis on promoting health and well-being are central to policy, including the proposals for 'Life Checks' and the recent emphasis on commissioning 'community well-being'. We carried out a qualitative study to identify the key aspects of social situations that affect health and well-being, from the perspectives of older people and professionals, to enrich and expand an existing health risk appraisal tool so that it could be used for self-assessment of health and social well-being. This tool, Health Risk Appraisal in Older people (HRAO), has been evaluated in different European settings, including English general practice. Focus groups were recruited from general practice, older people's forums, social care and voluntary organisations in two London boroughs where the HRAO tool had previously been tested. The social factors determining health that were prioritised by older people and service providers and recommended for inclusion in the health risk appraisal tool were recent life events, housing and garden maintenance, transport, both public and private, financial management, career status & needs, the local environment and social networks and social isolation. This study has identified key social determinants of health that could usefully be added to 'Life Checks' for older people and that could also inform the commissioning of community well-being. Modified with the addition of social domains, the HRAO technology could be a suitable tool to achieve current policy objectives.
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Affiliation(s)
- S Iliffe
- Department of Primary Care & Population Health, University College London, London, UK.
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Villars H, Oustric S, Andrieu S, Baeyens JP, Bernabei R, Brodaty H, Brummel-Smith K, Celafu C, Chappell N, Fitten J, Frisoni G, Froelich L, Guerin O, Gold G, Holmerova I, Iliffe S, Lukas A, Melis R, Morley JE, Nies H, Nourhashemi F, Petermans J, Ribera Casado J, Rubenstein L, Salva A, Sieber C, Sinclair A, Schindler R, Stephan E, Wong RY, Vellas B. The primary care physician and Alzheimer's disease: an international position paper. J Nutr Health Aging 2010; 14:110-20. [PMID: 20126959 DOI: 10.1007/s12603-010-0022-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert's opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP's intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver's confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a "case finding" strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies 'typical' cases. In typical cases, among older subjects, the diagnosis of "probable AD" can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and "emergency" hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients' right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force.
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Affiliation(s)
- H Villars
- Gérontopôle, Alzheimer's Disease Research and Clinical Center, Toulouse University Hospital, Toulouse, France.
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Goodman C, Davies S, Tai SS, Dinan S, Iliffe S. Promoting older peoples' participation in activity, whose responsibility? A case study of the response of health, local government and voluntary organizations. J Interprof Care 2009; 21:515-28. [PMID: 17891625 DOI: 10.1080/13561820701637204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The benefits for older people of participating in regular activity are well documented. This paper focuses on how publicly funded community-based organizations enable older people to engage in physical activity. The research questions were: (i) What activity promotion schemes/initiatives exist for older people? (ii) Who has responsibility for them, how are they funded and organized and what evidence exists of interagency working? (iii) Who are the older people that participate? (iv) What are the perceived and measurable outcomes of the initiatives identified? To establish the type and range of provision for older people in a sector of London, the strategies and information about existing activity promoting schemes of inner city health, local government and voluntary organizations were reviewed. Key informants were then interviewed to establish the rationale, achievements and different schemes. One hundred and nine activity-promoting initiatives for older people were identified. Most were provided within an environment of short-term funding and organizational upheaval and reflected eclectic theoretical and ideological approaches. The findings demonstrate: (i) the need for organizations to apply evidence about what attracts and sustains older people's participation in physical activity, and (ii) the need to develop funded programmes that build on past achievements, have explicit outcomes and exploit opportunities for cross agency working.
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Affiliation(s)
- C Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
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De Lepeleire J, Wind AW, Iliffe S, Moniz-Cook ED, Wilcock J, Gonzalez VM, Derksen E, Gianelli MV, Vernooij-Dassen M. The primary care diagnosis of dementia in Europe: an analysis using multidisciplinary, multinational expert groups. Aging Ment Health 2008; 12:568-76. [PMID: 18855172 DOI: 10.1080/13607860802343043] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore the extent of variation in the detection of dementia in primary care across Europe, and the potential for the development of European guidelines. METHOD A mixture of focus group and adapted nominal group methods involving 23 experts of different disciplines and from eight European countries. RESULTS The diagnosis of dementia should be 'timely' rather than 'early'. Timeliness has an impact on the patient, on the caregiver, on healthcare professionals, and on society. Ethical and moral issues may interfere with the aim of timely diagnosis. Guidelines may be important for facilitating a timely diagnosis of dementia, but were infrequently used and not even available in three of the eight countries. Referral pathways often depended on health care system characteristics, differing throughout the eight European countries, whilst diagnostic strategies differed due to varied cultural influences. There was consensus that national variations can be reduced and timely diagnosis enhanced by combining simple tests using a systematic stepwise case-finding strategy, in conjunction with a strong infrastructure of multidisciplinary collaboration. CONCLUSIONS This study identified three key themes that should be considered in harmonizing European approaches to the diagnosis of dementia in primary care: (1) a focus on timely diagnosis, (2) the need for the development and implementation of guidelines, and (3) the identification of appropriate referral pathways and diagnostic strategies including multi-professional collaboration. The content of guidelines may be determined by the perspectives of the guideline developers.
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Affiliation(s)
- J De Lepeleire
- Academisch Centrum Huisartsgeneeskunde, Katholieke Universiteit Leuven, Belgium.
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Manthorpe J, Iliffe S. Reply. Age Ageing 2008. [DOI: 10.1093/ageing/afn046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
BACKGROUND While the aims of multicomponent screening of older people are broad, any benefit arising from the inclusion of a vision component in the assessment will necessarily be dependent on improving vision. OBJECTIVES To assess the effects on vision of mass screening of older people for visual impairment. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Group Trials Register, in The Cochrane Library (Issue 1, 2006), NRR (Issue 1, 2006), MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006), PubMed (on 8th March; last 90 days), SciSearch and reference lists of relevant trial reports and review articles. We contacted investigators to identify additional published and unpublished trials. SELECTION CRITERIA We included randomised trials of visual or multicomponent screening for identifying vision impairment in people aged 65 years or over in a community setting. DATA COLLECTION AND ANALYSIS Both authors independently extracted data and assessed trial quality. MAIN RESULTS Visual outcome data were available for 3494 people in five trials of multicomponent assessment. Length of follow up ranged from two to four years. All the trials used self-reported measures for visual impairment, both as screening tools and as outcome measures. In four of the trials people reporting visual problems were referred to either eye services or a physician. In one trial people reporting visual problems received information about resources in the community designed to assist those with poor vision. The proportions of participants in the intervention and control groups who reported visual problems at the time of outcome assessment were 0.26 and 0.23 respectively (risk ratio for visual impairment 1.03, 95% confidence interval (CI) 0.92 to 1.15). Visual outcome data were also available for 1807 people aged 75 years and over in a cluster randomised trial in which physicians' general practices were randomised to two different screening strategies; universal or targeted. Three to five years after screening, the risk ratio for visual acuity less than 6/18 in either eye comparing universal with targeted screening was 1.07 (95% CI 0.84 to 1.36, P = 0.58). The mean composite score of the National Eye Institute 25 item visual function questionnaire was 85.6 in the targeted screening group and 86.0 in the universal group, a difference of 0.4 (95% CI -1.7 to 2.5, P = 0.69). AUTHORS' CONCLUSIONS There is no evidence that community-based screening of asymptomatic older people results in improvements in vision.
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Affiliation(s)
- L Smeeth
- London School of Hygiene and Tropical Medicine, Department of Epidemiology, Keppel Street, London, UK WC1E 7HT.
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Wright CE, Kunz-Ebrecht SR, Iliffe S, Foese O, Steptoe A. Physiological correlates of cognitive functioning in an elderly population. Psychoneuroendocrinology 2005; 30:826-38. [PMID: 15975730 DOI: 10.1016/j.psyneuen.2005.04.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Revised: 04/07/2005] [Accepted: 04/10/2005] [Indexed: 11/29/2022]
Abstract
Cognitive decline in old age is not universal or inevitable. Associations have been observed with neuroendocrine function, but the relevance of other physiological processes is unclear. We predicted that impairment of memory in an ageing population would be related to the dysregulation of neuroendocrine and cardiovascular responses. One hundred and thirty-nine participants (65-80 years) were recruited from general practice in London. Two standardised verbal paired-associates recall tasks were administered in order to determine declarative memory performance, and a fluid intelligence task (matrix reasoning) was also performed. Salivary cortisol samples were collected every 10 min, while blood pressure and heart rate were measured before, during and after each task. Illness history and medication use were obtained from medical records. Multiple linear regression analysis, adjusted for age, gender, education, chronic illness, and medication use, revealed that cortisol responses were inversely related to memory performance. Additionally, superior memory was associated with more effective post-task recovery of heart rate (in both men and women) and diastolic blood pressure recovery in men. Cardiovascular recovery effects were independent of covariates, and of levels of heart rate and blood pressure measured during tasks themselves. These associations were also independent of subjective ratings of stress and perceived performance. Neither neuroendocrine nor cardiovascular responses were related to performance of the reasoning task. We conclude that memory in the elderly is associated both with hypothalamic-pituitary-adrenocortical function and cardiovascular regulation. Disturbances of neuroendocrine and hemodynamic function may be related to greater vulnerability to cognitive decline.
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Affiliation(s)
- C E Wright
- Psychobiology Group, Department of Epidemiology and Public Health, University College London, UK.
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Abstract
BACKGROUND Hospital at home is defined as a service that provides active treatment by health care professionals, in the patient's home, of a condition that otherwise would require acute hospital in-patient care, always for a limited period. OBJECTIVES To assess the effects of hospital at home compared with in-patient hospital care. SEARCH STRATEGY We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) specialised register (November 2004), MEDLINE (1966 to 1996), EMBASE (1980 to 1995), Social Science Citation Index (1992 to 1995), Cinahl (1982 to 1996), EconLit (1969 to 1996), PsycLit (1987 to 1996), Sigle (1980 to 1995) and the Medical Care supplement on economic literature (1970 to 1990). SELECTION CRITERIA Randomised trials of hospital at home care compared with acute hospital in-patient care. The participants were patients aged 18 years and over. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed study quality. MAIN RESULTS Twenty two trials are included in this update of the review. Among trials evaluating early discharge hospital at home schemes we found an odds ratio (OR) for mortality of 1.79 95% CI 0.85 to 3.76 for elderly medical patients (age 65 years and over) (n = 3 trials); OR 0.58; 95% CI 0.29 to 1.17 for patients with chronic obstructive pulmonary disease (COPD) (n = 5 trials); and OR 0.78; 95%CI 0.52 to 1.19 for patients recovering from a stroke (n = 4 trials). Two trials evaluating the early discharge of patients recovering from surgery reported an OR 0.43 (95% CI 0.02 to 10.89) for patients recovering from a hip replacement and an OR 1.01 (95% CI 0.37 to 2.81) for patients with a mix of conditions at three months follow-up. For readmission to hospital we found an OR 1.76; 95% CI 0.78 to 3.99 at 3 months follow-up for elderly medical patients (n = 2 trials); OR 0.81; 95% CI 0.55 to 1.19 for patients with COPD (n = 5 trials); and OR 0.96; 95% CI 0.63 to 1.45 for patients recovering from a stroke (n = 3 trials). No significant heterogeneity was observed. One trial recruiting patients following surgery for hernia or varicose veins reported 0/117 versus 2/121 patients were re admitted (Ruckley 1978); another that 2/37 (5%) versus 1/49 (2%) (difference 3%, 95% CI -5% to 12%) of patients recovering from a hip replacement, 4/47 (9%) versus 1/39 (3%) (difference 6%, 95% CI -3% to 15%) of patients recovering from a knee replacement, and 7/114 (6%) versus 13/124 (10%) (difference -4% 95% CI -11% to 3%) of patients recovering from a hysterectomy were readmitted. A third trial analysing surgical and medical patients together reported that 42/159 versus 17/81 patients were readmitted at 3 months (OR 1.34 95% CI 0.66 to 2.20). Allocation to hospital at home resulted in a small reduction in hospital length of stay, but hospital at home increased overall length of care. Patients allocated to hospital at home expressed greater satisfaction with care than those in hospital, while the view of carers was mixed. AUTHORS' CONCLUSIONS Despite increasing interest in the potential of hospital at home services as a cheaper alternative to in-patient care, this review provides insufficient objective evidence of economic benefit. Early discharge schemes for patients recovering from elective surgery and elderly patients with a medical condition may have a place in reducing the pressure on acute hospital beds, providing the views of the carers are taken into account. For these clinical groups hospital length of stay is reduced, although this is offset by the provision of hospital at home. Future primary research should focus on rigorous evaluations of admission avoidance schemes and standards for original research should aim at assisting future meta-analyses of individual patient data from these and future trials.
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Affiliation(s)
- S Shepperd
- Continuing Professional Development Centre, Department of Continuing Education, University of Oxford, 16/17 St. Ebbes Street, Oxford, UK, OX1 1PT.
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Iliffe S, Kharicha K, Harari D, Swift C, Stuck AE. Health risk appraisal for older people in general practice using an expert system: a pilot study. Health Soc Care Community 2005; 13:21-29. [PMID: 15717903 DOI: 10.1111/j.1365-2524.2005.00525.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The prevention of disability in later life is a major challenge facing industrialised societies. Primary care practitioners are well positioned to maintain and promote health in older people, but the British experience of population-wide preventive interventions has been disappointing. Health risk appraisal (HRA), an emergent information-technology-based approach from the USA, has the potential for fulfilling some of the objectives of the National Service Framework for Older People. Information technology and expert systems allow the perspectives of older people on their health and health risk behaviours to be collated, analysed and converted into tailored health promotion advice without adding to the workload of primary care practitioners. The present paper describes a preliminary study of the portability of HRA to British settings. Cultural adaptation and feasibility testing of a comprehensive health risk assessment questionnaire was carried out in a single group practice with 12,500 patients, in which 58% of the registered population aged 65 years and over participated in the study. Eight out of 10 respondents at all ages found the questionnaire easy or very easy to understand and complete, although more than one-third had or would have liked assistance. More than half felt that the length of the questionnaire was about right, and one respondent in 10 disliked some questions. Of those who completed the questionnaire and received tailored, written health promotion advice, 39% provided feedback on this with comments that can be used for increasing the acceptability of tailored advice. These findings have informed a wider exploratory study in general practice.
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Affiliation(s)
- S Iliffe
- Department of Primary Care and Population Sciences, Royal Free and University College London Medical School, London, UK.
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Iliffe S, De Lepeleire J, Van Hout H, Kenny G, Lewis A, Vernooij-Dassen M. Understanding obstacles to the recognition of and response to dementia in different European countries: a modified focus group approach using multinational, multi-disciplinary expert groups. Aging Ment Health 2005; 9:1-6. [PMID: 15841826 DOI: 10.1080/13607860412331323791] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Experts from eight European countries (Belgium, France, The Netherlands, Ireland, Italy, Portugal, Spain and the United Kingdom) and the disciplines of clinical psychology, general practice, geriatric medicine, old age psychiatry, medical sociology, nursing and voluntary body organisation met in 2003 to explore obstacles to recognition of and response to dementia in general practice within Europe. A modified focus group methodology was used in this exploratory process. Groups were conducted over a two-day period, with five sessions lasting 1-1.5 hours each. An adapted nominal group method was used to record themes arising from the group discussion, and these themes were used in a grounded theory approach to generate explanations for delayed recognition of and response to dementia. The overarching theme that arose from the focus groups was movement, which had three different expressions. These were: population movement and its consequences for localities, services and professional experience; the journey of the person with dementia along the disease process; and the referral pathway to access services and support. Change is the core issue in dementia care, with multiple pathways of change that need to be understood at clinical and organisational levels. Practitioners and people with dementia are engaged in managing emotional, social and physical risks, making explicit risk management a potentially important component of dementia care. The boundary between generalist and specialist services is a particular problem, with great potential for dysfunctionality. Stigma and ageism are variably distributed phenomena both within and between countries.
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Affiliation(s)
- S Iliffe
- Centre for Ageing Population Studies, Royal Free & UCL Medical School, London, UK.
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