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Publisher: Oxford University Press   (Total: 392 journals)

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Showing 1 - 200 of 392 Journals sorted alphabetically
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 5, SJR: 0.881, h-index: 38)
Adaptation     Hybrid Journal   (Followers: 8, SJR: 0.111, h-index: 4)
Advances in Nutrition     Hybrid Journal   (Followers: 42, SJR: 2.075, h-index: 36)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 65, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 86, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 18, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 147, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 40, SJR: 1.441, h-index: 77)
American J. of Clinical Nutrition     Hybrid Journal   (Followers: 147, SJR: 3.771, h-index: 262)
American J. of Epidemiology     Hybrid Journal   (Followers: 169, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 25, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 18)
American J. of Legal History     Full-text available via subscription   (Followers: 9, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 27, SJR: 0.824, h-index: 23)
American Literary History     Hybrid Journal   (Followers: 15, SJR: 0.185, h-index: 22)
Analysis     Hybrid Journal   (Followers: 21)
Animal Frontiers     Hybrid Journal  
Annals of Behavioral Medicine     Hybrid Journal   (Followers: 14, SJR: 2.112, h-index: 98)
Annals of Botany     Hybrid Journal   (Followers: 35, SJR: 1.912, h-index: 124)
Annals of Oncology     Hybrid Journal   (Followers: 47, SJR: 4.362, h-index: 173)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 8, SJR: 0.642, h-index: 53)
Annals of Work Exposures and Health     Hybrid Journal   (Followers: 29, SJR: 0.837, h-index: 57)
AoB Plants     Open Access   (Followers: 4, SJR: 0.78, h-index: 10)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 16, SJR: 0.884, h-index: 31)
Applied Linguistics     Hybrid Journal   (Followers: 55, SJR: 1.749, h-index: 63)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 0.779, h-index: 11)
Arbitration Intl.     Full-text available via subscription   (Followers: 20)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 14)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 30, SJR: 0.96, h-index: 71)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 3, SJR: 0.102, h-index: 20)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 42, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 51, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 291, SJR: 4.643, h-index: 271)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 10, SJR: 1.646, h-index: 149)
Biometrika     Hybrid Journal   (Followers: 20, SJR: 2.801, h-index: 90)
BioScience     Hybrid Journal   (Followers: 30, SJR: 2.374, h-index: 154)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.213, h-index: 9)
Biostatistics     Hybrid Journal   (Followers: 17, SJR: 1.955, h-index: 55)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 164, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 64, SJR: 0.272, h-index: 20)
Brain     Hybrid Journal   (Followers: 68, SJR: 6.097, h-index: 264)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 45, SJR: 4.086, h-index: 73)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 3, SJR: 1.771, h-index: 50)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 33, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 26, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 583, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 86, SJR: 0.771, h-index: 53)
British Medical Bulletin     Hybrid Journal   (Followers: 7, SJR: 1.391, h-index: 84)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 31)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 4, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 61, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 10, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 9, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal   (Followers: 2)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 13, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 45, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 17, SJR: 0.501, h-index: 19)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.436, h-index: 76)
Children and Schools     Hybrid Journal   (Followers: 5, SJR: 0.211, h-index: 18)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 4)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 22, SJR: 0.737, h-index: 11)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 8, SJR: 1.238, h-index: 15)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 10, SJR: 0.191, h-index: 8)
Classical Receptions J.     Hybrid Journal   (Followers: 25, SJR: 0.1, h-index: 3)
Clean Energy     Open Access  
Clinical Infectious Diseases     Hybrid Journal   (Followers: 62, SJR: 4.742, h-index: 261)
Clinical Kidney J.     Open Access   (Followers: 3, SJR: 0.338, h-index: 19)
Communication Theory     Hybrid Journal   (Followers: 20, SJR: 2.62, h-index: 53)
Communication, Culture & Critique     Hybrid Journal   (Followers: 25)
Community Development J.     Hybrid Journal   (Followers: 27, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 9, SJR: 0.371, h-index: 47)
Conservation Physiology     Open Access   (Followers: 2)
Contemporary Women's Writing     Hybrid Journal   (Followers: 9, SJR: 0.111, h-index: 3)
Contributions to Political Economy     Hybrid Journal   (Followers: 5, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Developments in Nutrition     Open Access  
Current Legal Problems     Hybrid Journal   (Followers: 27)
Current Zoology     Full-text available via subscription   (Followers: 1, SJR: 0.999, h-index: 20)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 8, SJR: 1.068, h-index: 24)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 14)
Diplomatic History     Hybrid Journal   (Followers: 20, SJR: 0.296, h-index: 22)
DNA Research     Open Access   (Followers: 5, SJR: 2.42, h-index: 77)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 3)
Early Music     Hybrid Journal   (Followers: 15, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 39, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 51, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 14, SJR: 0.144, h-index: 3)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.791, h-index: 66)
Environmental Epigenetics     Open Access   (Followers: 3)
Environmental History     Hybrid Journal   (Followers: 26, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 9, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 16, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 54, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 8, SJR: 2.044, h-index: 58)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 1)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. Supplements     Hybrid Journal   (Followers: 7, SJR: 0.152, h-index: 31)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 173, SJR: 0.722, h-index: 38)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.09, h-index: 60)
European J. of Public Health     Hybrid Journal   (Followers: 20, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 10, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 28, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 40, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 10)
Family Practice     Hybrid Journal   (Followers: 14, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 10, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 22, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 27, SJR: 7.587, h-index: 150)
Fems Yeast Research     Hybrid Journal   (Followers: 14, SJR: 1.213, h-index: 66)
Food Quality and Safety     Open Access  
Foreign Policy Analysis     Hybrid Journal   (Followers: 23, SJR: 0.859, h-index: 10)
Forest Science     Hybrid Journal   (Followers: 4, SJR: 0.872, h-index: 59)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 0.903, h-index: 44)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.108, h-index: 6)
French History     Hybrid Journal   (Followers: 32, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 20, SJR: 0.119, h-index: 7)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.102, h-index: 3)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 12, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 35, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 22, SJR: 0.437, h-index: 13)
GigaScience     Open Access   (Followers: 3)
Global Summitry     Hybrid Journal   (Followers: 1)
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.692, h-index: 101)
Health and Social Work     Hybrid Journal   (Followers: 55, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 13, SJR: 0.814, h-index: 80)
Health Policy and Planning     Hybrid Journal   (Followers: 24, SJR: 1.628, h-index: 66)
Health Promotion Intl.     Hybrid Journal   (Followers: 21, SJR: 0.664, h-index: 60)
History Workshop J.     Hybrid Journal   (Followers: 29, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 26, SJR: 0.115, h-index: 13)
Human Communication Research     Hybrid Journal   (Followers: 13, SJR: 2.199, h-index: 61)
Human Molecular Genetics     Hybrid Journal   (Followers: 8, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 72, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 17, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 60, SJR: 0.7, h-index: 21)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 51, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 12)
ILAR J.     Hybrid Journal   (Followers: 2, SJR: 1.099, h-index: 51)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.329, h-index: 26)
IMA J. of Management Mathematics     Hybrid Journal   (SJR: 0.351, h-index: 20)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.661, h-index: 28)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 2.032, h-index: 44)
Industrial and Corporate Change     Hybrid Journal   (Followers: 10, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 34, SJR: 0.184, h-index: 15)
Inflammatory Bowel Diseases     Hybrid Journal   (Followers: 42, SJR: 1.994, h-index: 107)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 7, SJR: 1.911, h-index: 90)
Interacting with Computers     Hybrid Journal   (Followers: 10, SJR: 0.529, h-index: 59)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 6, SJR: 0.743, h-index: 35)
Intl. Affairs     Hybrid Journal   (Followers: 56, SJR: 1.264, h-index: 53)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 31)
Intl. Health     Hybrid Journal   (Followers: 5, SJR: 0.835, h-index: 15)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 1.613, h-index: 111)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 34, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 64, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 196, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 5, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 30, SJR: 0.307, h-index: 15)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 10, SJR: 0.404, h-index: 18)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.457, h-index: 12)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.69, h-index: 79)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 9, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 35, SJR: 0.231, h-index: 21)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 12, SJR: 0.833, h-index: 12)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.052, h-index: 42)
Intl. Political Sociology     Hybrid Journal   (Followers: 36, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 22, SJR: 0.539, h-index: 17)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 9, SJR: 0.998, h-index: 28)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 44, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 20, SJR: 0.783, h-index: 38)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 1, SJR: 0.155, h-index: 4)
ITNOW     Hybrid Journal   (Followers: 1, SJR: 0.102, h-index: 4)
J. of African Economies     Hybrid Journal   (Followers: 14, SJR: 0.647, h-index: 30)
J. of American History     Hybrid Journal   (Followers: 45, SJR: 0.286, h-index: 34)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 14, SJR: 1.038, h-index: 60)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 14, SJR: 2.157, h-index: 149)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 4, SJR: 0.563, h-index: 43)
J. of Biochemistry     Hybrid Journal   (Followers: 41, SJR: 1.341, h-index: 96)
J. of Burn Care & Research     Hybrid Journal   (Followers: 9, SJR: 0.713, h-index: 57)
J. of Chromatographic Science     Hybrid Journal   (Followers: 18, SJR: 0.448, h-index: 42)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.167, h-index: 11)
J. of Communication     Hybrid Journal   (Followers: 50, SJR: 3.327, h-index: 82)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 35, SJR: 0.442, h-index: 16)
J. of Complex Networks     Hybrid Journal   (Followers: 2, SJR: 1.165, h-index: 5)
J. of Computer-Mediated Communication     Open Access   (Followers: 26, SJR: 2.878, h-index: 80)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 13, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 41, SJR: 4.896, h-index: 121)
J. of Crohn's and Colitis     Hybrid Journal   (Followers: 9, SJR: 1.543, h-index: 37)
J. of Cybersecurity     Hybrid Journal   (Followers: 3)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 8, SJR: 0.69, h-index: 36)

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Journal Cover Age and Ageing
  [SJR: 1.611]   [H-I: 107]   [86 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-0729 - ISSN (Online) 1468-2834
   Published by Oxford University Press Homepage  [392 journals]
  • Editor’s view
    • Authors: Stott D.
      Pages: 321 - 321
      PubDate: Tue, 03 Apr 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy047
      Issue No: Vol. 47, No. 3 (2018)
  • Identifying who lives in a care home—a challenge to be conquered
    • Authors: Burton J; Guthrie B.
      Pages: 322 - 323
      PubDate: Tue, 16 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afx200
      Issue No: Vol. 47, No. 3 (2018)
  • Pain assessment in the older population: what the literature says
    • Authors: Schofield P; Abdulla A.
      Pages: 324 - 327
      Abstract: Assessment of pain in the older adult presents a number of challenges, especially related to communication. This commentary summarises the revised evidence-based Guidelines on the Assessment of Pain in Older Adults which have been developed by the British Pain Society and British Geriatrics Society. The guideline summarises the pain assessment tools that have been developed and validated for use in the older population. Recommendations are made for use of specific tools in older people and in those with dementia. The need for education and training of health care professionals is emphasised. Gaps in the evidence are identified as subjects for future research. It is hoped that the guideline will improve recognition of pain in older people, and help to drive the future research agenda.
      PubDate: Sat, 24 Mar 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy018
      Issue No: Vol. 47, No. 3 (2018)
  • Reappraising ‘the good death’ for populations in the age of
    • Authors: Pollock K; Seymour J.
      Pages: 328 - 330
      Abstract: This is the second in an occasional series of paired commentaries in Age and Ageing, the Journal of the British Geriatrics Society and the Journal of the American Geriatrics Society (JAGS). The aim is to address issues of current significance and to foster dialogue and increased understanding between academics and clinicians working in comparative international settings. Both commentaries address the urgent need to improve palliative care for older people, with a critique of some stereotypes surrounding palliative care and the ‘good death’. The companion commentary, published in JAGS, was written by Alexander Smith and Vyjeyanthi Periyakoil, and is grounded in their experience as academic clinicians (Smith AK, Periyakoil V. Should we bury ‘The Good Death’' Journal of the American Geriatrics Society 2018; in press). In the present paper, we offer a perspective on the outcome and wider consequences of misalignment between current UK policy and aspirations for end of life care in relation to epidemiological trends and patient experience of death and dying.
      PubDate: Thu, 08 Mar 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy008
      Issue No: Vol. 47, No. 3 (2018)
  • The therapeutic ‘make-over’ of dementias—an introduction
    • Authors: Mukaetova-Ladinska E.
      Pages: 331 - 333
      Abstract: The online themed collection of 15 papers recently published provides an update on the advances of pharmacological and non-pharmacological interventions in dementia over the last 15 years. The published studies reflect the efficacy of the current anti-dementia treatments, preventive treatments of cardio and cerebrovascular incidents (known to be risk factors for dementia), alongside the use of antidepressant medication and non-pharmacological interventions for treatment of behavioural and psychopathological symptoms of dementia. We also address the future preventative steps and therapeutic strategies currently in development to combat the devastating consequences of dementia.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy019
      Issue No: Vol. 47, No. 3 (2018)
  • Implications of guidelines for osteoporosis and its treatment
    • Authors: Tuck S; Little E, Aspray T.
      Pages: 334 - 339
      Abstract: The development of clinical guidelines is now a more uniform process, with formalised methods to ensure that recommendations are based on current best available evidence from randomised controlled trials and systematic reviews. Over the past 20 years we have seen a growth in guidelines including those relating to osteoporosis, with recommendations varying between and within countries. Some guidelines are concerned with case finding and primary or secondary prevention, such as those produced by the National Institute for Health and Care Excellence (NICE CG146, TA-160, -161, -464), while others focus on specific conditions or risk factors associated with osteoporosis, such as the menopause, coeliac disease and eating disorder. Clinicians can be confused as to which to follow in any particular clinical scenario. International guidelines, such as those from North America (NOF, CAROC, AACE) and Scotland (SIGN 142), differ from those of England, Wales and Northern Ireland, with recent recommendations from NICE (TA464) shifting the focus of treatment from those at greatest fracture risk to an apparent blanket approach, based on cost-effectiveness, rather than clinical effectiveness.Osteoporosis treatment should be targeted at those who can benefit most, outweighing the potential for harm. If the low health economic threshold of NICE TA464 were adopted as a clinical threshold, the most important group—older people at greatest risk of fracture, would not be prioritised. We risk overwhelming clinical services, while causing harm to some at low fracture risk from adverse effects of treatment, yet failing to treat the older population at highest fracture risk.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afx197
      Issue No: Vol. 47, No. 3 (2018)
  • New horizons in systemic anti-cancer therapy in older people
    • Authors: Parry J; Hall P, Young J.
      Pages: 340 - 348
      Abstract: Cancer is a disease associated with ageing. Increased life expectancy means that cancer in older adults is becoming an increasingly common problem. There are unique issues to consider when making decisions about cancer treatment in older populations. Unfortunately, however, this group is still under-represented in clinical trials for new cancer therapies meaning there are less evidence-based data to guide management. This article aims to look at how we can optimise the cancer treatment for older patients with a focus on systemic anti-cancer therapy and addressing particular issues around patient selection, improving treatment tolerance and use of newer agents with different toxicity profiles.
      PubDate: Sat, 31 Mar 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy024
      Issue No: Vol. 47, No. 3 (2018)
  • Review of Diagnostic Test Accuracy (DTA) studies in older people
    • Authors: Takwoingi Y; Quinn T.
      Pages: 349 - 355
      Abstract: Diagnostic Test Accuracy (DTA) describes a field of research that aims to assess how well a test is able to detect or exclude a condition of interest. Although geriatric medicine is not as reliant on investigations as other medical disciplines, almost all patient encounters with older adults will involve some form of diagnostic assessment. Thus, understanding the terminology and methods of DTA is essential for any clinician. In this review we use examples based around the diagnosis of dementia to highlight issues in DTA research. Some of these are generic to any DTA research and some are particularly pertinent to older adults. One can apply a test accuracy framework to a clinical question by defining four key components: the condition of interest; the index test(s) (i.e. the assessment(s) of interest); the reference standard (the best available method for assessing the condition of interest) and the population or healthcare setting in which testing takes place. Test accuracy is often described using complementary measures of sensitivity and specificity. However, many other metrics to describe test accuracy are available; in clinical practice predictive values may have greater utility. These and other descriptive statistics can be derived from a two by two table that cross-classifies the index test results with the reference standard results. Test performance and utility is not only determined by accuracy, other measures such as feasibility and acceptability should be considered and may be of particular importance when describing test performance in older adults with physical and cognitive impairments.
      PubDate: Thu, 08 Mar 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy023
      Issue No: Vol. 47, No. 3 (2018)
  • Cost-effectiveness of food, supplement and environmental interventions to
           address malnutrition in residential aged care: a systematic review
    • Authors: Hugo C; Isenring E, Miller M, et al.
      Pages: 356 - 366
      Abstract: Backgroundobservational studies have shown that nutritional strategies to manage malnutrition may be cost-effective in aged care; but more robust economic data is needed to support and encourage translation to practice. Therefore, the aim of this systematic review is to compare the cost-effectiveness of implementing nutrition interventions targeting malnutrition in aged care homes versus usual care.Settingresidential aged care homes.Methodssystematic literature review of studies published between January 2000 and August 2017 across 10 electronic databases. Cochrane Risk of Bias tool and GRADE were used to evaluate the quality of the studies.Resultseight included studies (3,098 studies initially screened) reported on 11 intervention groups, evaluating the effect of modifications to dining environment (n = 1), supplements (n = 5) and food-based interventions (n = 5). Interventions had a low cost of implementation (<£2.30/resident/day) and provided clinical improvement for a range of outcomes including weight, nutritional status and dietary intake. Supplements and food-based interventions further demonstrated a low cost per quality adjusted life year or unit of physical function improvement. GRADE assessment revealed the quality of the body of evidence that introducing malnutrition interventions, whether they be environmental, supplements or food-based, are cost-effective in aged care homes was low.Conclusionthis review suggests supplements and food-based nutrition interventions in the aged care setting are clinically effective, have a low cost of implementation and may be cost-effective at improving clinical outcomes associated with malnutrition. More studies using well-defined frameworks for economic analysis, stronger study designs with improved quality, along with validated malnutrition measures are needed to confirm and increase confidence with these findings.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afx187
      Issue No: Vol. 47, No. 3 (2018)
  • Effects of resistance training, endurance training and whole-body
           vibration on lean body mass, muscle strength and physical performance in
           older people: a systematic review and network meta-analysis
    • Authors: Lai C; Tu Y, Wang T, et al.
      Pages: 367 - 373
      Abstract: BackgroundA variety of different types of exercise are promoted to improve muscle strength and physical performance in older people.ObjectiveWe aimed to determine the relative effects of resistance training, endurance training and whole-body vibration on lean body mass, muscle strength and physical performance in older people.DesignA systematic review and network meta-analysis.SubjectsAdults aged 60 and over.MethodsEvidence from randomised controlled trials of resistance training, endurance training and whole-body vibration were combined. The effects of exercise interventions on lean body mass, muscle strength and physical performance were evaluated by conducting a network meta-analysis to compare multiple interventions and usual care. Risk of bias of included studies was assessed using the Cochrane Collaboration’s tool. A meta-regression was performed to assess potential effect modifiers.ResultsData were obtained from 30 trials involving 1,405 participants (age range: 60–92 years). No significant differences were found between the effects of exercise or usual care on lean body mass. Resistance training (minimum 6 weeks duration) achieved greater muscle strength improvement than did usual care (12.8 kg; 95% confidence interval [CI]: 8.5–17.0 kg). Resistance training and whole-body vibration were associated with greater physical performance improvement compared with usual care (2.6 times greater [95% CI: 1.3–3.9] and 2.1 times greater [95% CI: 0.5–3.7], respectively).ConclusionsResistance training is the most effect intervention to improve muscle strength and physical performance in older people. Our findings also suggest that whole-body vibration is beneficial for physical performance. However, none of the three exercise interventions examined had a significant effect on lean body mass.
      PubDate: Sat, 17 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy009
      Issue No: Vol. 47, No. 3 (2018)
  • Projections of multi-morbidity in the older population in England to 2035:
           estimates from the Population Ageing and Care Simulation (PACSim) model
    • Authors: Kingston A; Robinson L, Booth H, et al.
      Pages: 374 - 380
      Abstract: Backgroundmodels projecting future disease burden have focussed on one or two diseases. Little is known on how risk factors of younger cohorts will play out in the future burden of multi-morbidity (two or more concurrent long-term conditions).Designa dynamic microsimulation model, the Population Ageing and Care Simulation (PACSim) model, simulates the characteristics (sociodemographic factors, health behaviours, chronic diseases and geriatric conditions) of individuals over the period 2014–2040.Populationabout 303,589 individuals aged 35 years and over (a 1% random sample of the 2014 England population) created from Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II.Main outcome measuresthe prevalence of, numbers with, and years lived with, chronic diseases, geriatric conditions and multi-morbidity.Resultsbetween 2015 and 2035, multi-morbidity prevalence is estimated to increase, the proportion with 4+ diseases almost doubling (2015:9.8%; 2035:17.0%) and two-thirds of those with 4+ diseases will have mental ill-health (dementia, depression, cognitive impairment no dementia). Multi-morbidity prevalence in incoming cohorts aged 65–74 years will rise (2015:45.7%; 2035:52.8%). Life expectancy gains (men 3.6 years, women: 2.9 years) will be spent mostly with 4+ diseases (men: 2.4 years, 65.9%; women: 2.5 years, 85.2%), resulting from increased prevalence of rather than longer survival with multi-morbidity.Conclusionsour findings indicate that over the next 20 years there will be an expansion of morbidity, particularly complex multi-morbidity (4+ diseases). We advocate for a new focus on prevention of, and appropriate and efficient service provision for those with, complex multi-morbidity.
      PubDate: Wed, 24 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afx201
      Issue No: Vol. 47, No. 3 (2018)
  • Association between pain and the frailty phenotype in older men:
           longitudinal results from the Concord Health and Ageing in Men Project
    • Authors: Megale R; Ferreira M, Ferreira P, et al.
      Pages: 381 - 387
      Abstract: Objectivesto determine whether pain increases the risk of developing the frailty phenotype and whether frailty increases the risk of developing chronic or intrusive pain, using longitudinal data.Design/Settinglongitudinal data from the Concord Health and Ageing in Men Project (CHAMP), a prospective population based cohort study.Participantsa total of 1,705 men aged 70 years or older, living in an urban area of New South Wales, Australia.Measurementsdata on the presence of chronic pain (daily pain for at least 3 months), intrusive pain (pain causing moderate to severe interference with activities) and the criteria for the Cardiovascular Health Study (CHS) frailty phenotype were collected in three waves, from January 2005 to October 2013. Data on age, living arrangements, education, smoking status, alcohol consumption, body mass index, comorbidities, cognitive function, depressive symptoms and history of vertebral or hip fracture were also collected and included as covariates in the analyses.Resultsa total of 1,705 participants were included at baseline, of whom 1,332 provided data at the 2-year follow-up and 940 at the 5-year follow-up. Non-frail (robust and pre-frail) men who reported chronic pain were 1.60 (95% confidence interval (CI): 1.02–2.51, P = 0.039) times more likely to develop frailty at follow-up, compared to those with no pain. Intrusive pain did not significantly increase the risk of future frailty. Likewise, the frailty status was not associated with future chronic or intrusive pain in the adjusted analysis.Conclusionsthe presence of chronic pain increases the risk of developing the frailty phenotype in community-dwelling older men.
      PubDate: Wed, 21 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy012
      Issue No: Vol. 47, No. 3 (2018)
  • Association of early- and adult-life socioeconomic circumstances with
           muscle strength in older age
    • Authors: Cheval B; Boisgontier M, Orsholits D, et al.
      Pages: 398 - 407
      Abstract: Backgroundsocioeconomic circumstances (SEC) during a person’s lifespan influence a wide range of health outcomes. However, solid evidence of the association of early- and adult-life SEC with health trajectories in ageing is still lacking. This study assessed whether early-life SEC are associated with muscle strength in later life—a biomarker of health—and whether this relationship is caused by adult-life SEC and health behaviours.Methodswe used data from the Survey of Health Ageing and Retirement in Europe, a 12-year population-based cohort study with repeated measurement in six waves (2004–15) and retrospective collection of life-course data. Participants’ grip strength was assessed by using a handheld dynamometer. Confounder-adjusted logistic mixed-effect models were used to examine the associations of early- and adult-life SEC with the risk of low muscle strength (LMS) in older age.Resultsa total of 24,179 participants (96,375 observations) aged 50–96 living in 14 European countries were included in the analyses. Risk of LMS was increased with disadvantaged relative to advantaged early-life SEC. The association between risk of LMS and disadvantaged early-life SEC gradually decreased when adjusting for adult-life SEC for both sexes and with unhealthy behaviours for women. After adjusting for these factors, all associations between risk of LMS and early-life SEC remained significant for women.Conclusionearly-life SEC are associated with muscle strength after adjusting for adult-life SEC and behavioural lifestyle factors, especially in women, which suggests that early life may represent a sensitive period for future health.
      PubDate: Tue, 20 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy003
      Issue No: Vol. 47, No. 3 (2018)
  • Hospitalisation and surgery: are there hidden cognitive consequences'
           Evidence from The Irish Longitudinal study on Ageing (TILDA)
    • Authors: O’ Brien H; O’ Leary N, Scarlett S, et al.
      Pages: 408 - 415
      Abstract: Backgroundthe dramatic shift in the global population demographic has led to increasing numbers of older people undergoing hospitalisation and surgical procedures.Objectivesto determine whether hospitalisation or hospitalisation with surgery under general anaesthesia is associated with poorer cognitive performance in adults over the age of 50.Methodscognitive function in the domains of global cognition, memory and executive function was assessed in 8,023 individuals at waves 1 and 2 of The Irish Longitudinal Study on Ageing (TILDA), 2 years apart. Mixed-effects models were used to investigate the hypothesis after adjustment for risk factors for cognitive decline and potential confounders.Resultsduring the 12 months preceding wave 1, 472 participants were hospitalised (mean age 67.0, 54.9% female) and a further 560 participants (mean age 64.6, 52.1% female) were hospitalised and underwent surgery with general anaesthesia; 6,938 (mean age 63.5, 54.5% female) were not hospitalised. There was a 14% higher error rate (IRR[95% CI] = 1.14[1.06, 1.22]) in the MMSE in the hospitalisation group and a 6% higher error rate (IRR[95% CI] = 1.06[0.99, 1.13]) in the surgery group compared to those with no hospitalisation. Poorer cognitive performance in the memory tasks was evident in both hospitalisation and hospitalisation with surgery groups (immediate recall: [95% CI] = −0.13 words[−0.22,−0.04] versus −0.13 words[−0.21,−0.04] and delayed recall: −0.20 words[−0.33,−0.06] versus −0.20[−0.32, −0.07]) compared to those with no hospitalisation. Increased error in the time-based prospective memory task was observed in the hospitalisation group and the surgery group (OR[95% CI] = 1.32[1.08, 1.60] versus 1.29[1.07, 1.55]).Conclusionhospitalisation and hospitalisation with surgery and general anaesthesia are associated with poorer global and domain specific cognitive performance.
      PubDate: Tue, 13 Mar 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy020
      Issue No: Vol. 47, No. 3 (2018)
  • ACTN3 genotype and physical function and frailty in an elderly Chinese
           population: the Rugao Longevity and Ageing Study
    • Authors: Ma T; Lu D, Zhu Y, et al.
      Pages: 416 - 422
      Abstract: ObjectiveTo examine the associations of the actinin alpha 3 gene (ACTN3) R577X polymorphism with physical performance and frailty in an older Chinese population.MethodsData from 1,463 individuals (57.8% female) aged 70–87 years from the Rugao Longevity and Ageing Study were used. The associations between R577X and timed 5-m walk, grip strength, timed Up and Go test, and frailty index (FI) based on deficits of 23 laboratory tests (FI-Lab) were examined. Analysis of variance and linear regression models were used to evaluate the genetic effects of ACTN3 R577X on physical performance and FI-Lab.ResultsThe XX and RX genotypes of the ACTN3 R557X polymorphism accounted for 17.1 and 46.9%, respectively. Multivariate regression analysis revealed that in men aged 70–79 years, the ACTN3 577X allele was significantly associated with physical performance (5-m walk time, regression coefficient (β) = 0.258, P = 0.006; grip strength, β = −1.062, P = 0.012; Up and Go test time β = 0.368, P = 0.019). In women aged 70–79 years, a significant association between the ACTN3 577X allele and the FI-Lab score was observed, with a regression coefficient of β = 0.019 (P = 0.003). These findings suggest an age- and gender-specific X-additive model of R577X for 5-m walk time, grip strength, Up and Go Test time, and FI-Lab score.ConclusionThe ACTN3 577X allele is associated with an age- and sex-specific decrease in physical performance and an increase in frailty in an older population.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy007
      Issue No: Vol. 47, No. 3 (2018)
  • Physical activity level as a predictor of healthy and chronic disease-free
           life expectancy between ages 50 and 75
    • Authors: Leskinen T; Stenholm S, Aalto V, et al.
      Pages: 423 - 429
      Abstract: Backgroundphysical activity promotes healthy aging. However, little is known about the relationship between physical activity levels and healthy and chronic disease-free life expectancy (LE). The study aim was to examine healthy and chronic disease-free LE between ages 50 and 75 and across various levels of physical activity by sex and different occupational statuses.Methodsoverall, 34,379 women (mean age 53.2 (SD 2.9) years) and 8,381 men (53.6 (SD 3.2) years) from the Finnish Public Sector study were categorized into five physical activity levels (inactive to vigorously active) according to self-reported physical activity and into three occupational statuses at the first observation point. Partial LE between ages 50 and 75 based on discrete-time multistate life table models was defined using two health indicators: healthy LE based on self-rated health and chronic disease-free LE based on chronic diseases. The average follow-up time for health indicators was 6.8 (SD 5.2) years.Resultsa clear dose–response relationship between higher physical activity levels and increased healthy and chronic disease-free LE in men and women, and within occupational statuses was found. On average, vigorously active men and women lived 6.3 years longer in good health and 2.9 years longer without chronic diseases between ages 50 and 75 compared to inactive individuals. The difference in years in good health between vigorously active and inactive individuals was the largest in individuals with low occupation status (6.7 years).Conclusionhigher levels of physical activity increase healthy and chronic disease-free years similarly in men and women, but more among persons with low than with high occupational status.
      PubDate: Thu, 15 Mar 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy016
      Issue No: Vol. 47, No. 3 (2018)
  • The effect of biannual medication reviews on the appropriateness of
           psychotropic drug use for neuropsychiatric symptoms in patients with
           dementia: a randomised controlled trial
    • Authors: van der Spek K; Koopmans R, Smalbrugge M, et al.
      Pages: 430 - 437
      Abstract: ObjectiveWe studied the efficacy of biannual structured medication reviews to improve the appropriateness of psychotropic drug (PD) prescriptions for neuropsychiatric symptoms (NPS) in nursing home patients with dementia.Study Design and SettingIn this randomised controlled trial, the intervention encompassed a structured multidisciplinary medication review by physician, pharmacist and nurse. During this 18-month study, the patient’s medical files were assessed every 6 months. The primary outcome was the appropriateness of PD prescriptions defined by the Appropriate Psychotropic drug use In Dementia (APID) index sum score, lower scores indicating more appropriate use.ResultsAt baseline, 380 patients were included, of which 222 were randomised to the intervention group. Compared to the control group, the APID index sum score in the intervention group improved significantly for all PD prescriptions (−5.28, P = 0.005).ConclusionWe advise the implementation of a structured, repeated medication review with the essential roles of pharmacist, physician and nurse, into daily practice. This work was supported and funded by the Netherlands Organisation for Health Research and Development (ZonMw). Netherlands Trial Register (NTR3569).
      PubDate: Thu, 08 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy001
      Issue No: Vol. 47, No. 3 (2018)
  • Improved hearing in Swedish 70-year olds—a cohort comparison over more
           than four decades (1971–2014)
    • Authors: Hoff M; Tengstrand T, Sadeghi A, et al.
      Pages: 437 - 444
      Abstract: Objectivethe world population is ageing rapidly. In light of these demographic changes, it is of interest to generate current data regarding the prevalence and characteristics of age-related hearing loss. The purpose of this study was to investigate hearing acuity and the prevalence of hearing loss in a contemporary age-homogenous cohort of old adults, and to assess secular trends in hearing function during the last half-century (1971–2014).Methodswe performed a prospective population-based cohort comparison study of unscreened populations. As part of a geriatric population-based study (H70), a new cohort of 70-year olds (n = 1,135) born in 1944 was tested with computerised automated pure-tone audiometry. The hearing thresholds were compared to three earlier born cohorts of 70-year olds, born in 1901–02 (n = 376), 1906–07 (n = 297) and 1922 (n = 226), respectively.Resultssignificant improvements in median pure-tone thresholds were seen at several frequencies in both men (range: 5–20 dB, P < 0.01) and women (range: 5–10 dB, P < 0.01). When investigating the effect of birth cohort on hearing in a linear regression, significant trends were found. Men’s hearing improved more than women’s. The prevalence of hearing loss declined in the study period (1971–2014) from 53 to 28% for men and 37 to 23% for women (P < 0.01).Conclusionsthese results indicate that the hearing acuity in Swedish 70-year olds has improved significantly over more than four decades. The largest improvements were seen at 4–6 kHz in men, possibly reflecting a decrease in occupational noise exposure. Further studies are required to pinpoint the reasons for improved hearing-health among older people.
      PubDate: Sat, 03 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy002
      Issue No: Vol. 47, No. 3 (2018)
  • Development and validation of Visual Impairment as a Risk for Falls
    • Authors: Labreche T; Nandakumar K, Althomali M, et al.
      Pages: 444 - 450
      Abstract: Purposevisual impairment is associated with an increased risk of falls, yet eye care professionals are infrequently members of falls prevention clinics. The aim of this preliminary study was to validate a newly created Visual Impairment as a Risk for Falls Questionnaire intended to be used by those professionals not involved in eye care.Methodsabout 53 participants with various visual impairments known to be associated with falls and 33 participants with normal sight were contacted within 4 months of a full oculo-visual assessment and were asked the questions from the current questionnaire pertaining to their visual function. A retrospective file review was undertaken and the sensitivity and specificity of participants’ responses were calculated compared to the actual vision impairment based on the findings from their visual assessment.Resultsthe question regarding ability to read was included to identify people with central vision loss, a risk factor for falling. It was found to have sensitivity of 74% and specificity of 87%. Both sensitivity and specificity improved when participants with cognitive impairment were excluded. The question on recognising facial features gave sensitivity of 73% and specificity of 97% for this subgroup. However, questions related to impairments in stereopsis and peripheral fields were not useful.Conclusionthe study demonstrates that several questions of the new questionnaire are useful; however, further testing with a larger population is needed to fully validate the questionnaire for use by health care professionals.
      PubDate: Mon, 29 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afx202
      Issue No: Vol. 47, No. 3 (2018)
  • The decision to work after state pension age and how it affects quality of
           life: evidence from a 6-year English panel study
    • Authors: Di Gessa G; Corna L, Price D, et al.
      Pages: 450 - 457
      Abstract: Backgrounddespite an increasing proportion of older people working beyond State Pension Age (SPA), little is known about neither the motivations for this decision nor whether, and to what extent, working beyond SPA affects quality of life (QoL).MethodsQoL was measured using the CASP-19 scale. Respondents in paid work beyond SPA were distinguished based on whether they reported financial constraints as the main reason for continuing in work. Linear regression models were used to assess the associations between paid work beyond SPA and CASP-19 scores among men aged 65–74 and women aged 60–69 (n = 2,502) cross-sectionally and over time using Wave 4 and Wave 7 of the English Longitudinal Study of Ageing.Resultsapproximately, one in five respondents were in paid work beyond SPA, one-third of whom reported financial issues as the main reason. These individuals reported significantly lower CASP-19 scores (β = −1.21) compared with those who retired at the expected/usual age. Respondents who declared being in paid work beyond SPA because they enjoyed their work or wanted to remain active, reported significantly higher QoL (β = 1.62). Longitudinal analyses suggest that those who were working post-SPA by choice, but who had stopped working at follow-up, also reported marginally (P < 0.10) higher CASP-19 scores.Conclusionspotential QoL benefits of working beyond SPA need to be considered in light of individual motivations for extending working life. Given the trend towards working longer and the abolishment of mandatory retirement ages, it is important that older people maintain control over their decision to work in later life.
      PubDate: Wed, 10 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afx181
      Issue No: Vol. 47, No. 3 (2018)
  • The barriers and facilitators for recognising distress in people with
           severe dementia on general hospital wards
    • Authors: Crowther G; Brennan C, Bennett M.
      Pages: 458 - 465
      Abstract: Introductionpsychological symptoms and delirium are common, but underreported in people with dementia on hospital wards. Unrecognised and untreated symptoms can manifest as distress. Identifying distress accurately therefore could act as a trigger for better investigation and treatment of the underlying causes. The challenges faced by healthcare professionals to recognise and report distress are poorly understood.Methodssemi-structured interviews with a purposive sample of 25 healthcare professionals working with older people in general hospitals were conducted. Interviews were analysed generating themes that describe the facilitators and barriers of recognising and caring for distress in dementia.Resultsregardless of training or experience all participants had a similar understanding of distress, and identified it as a term that is easily understood and communicated. All participants believed they recognised distress innately. However, the majority also believed it was facilitated by experience, being familiar with their patients and listening to the concerns of the person’s usual carers. Barriers to distress recognition included busy ward environments, and that some people may lack the skill to identify distress in hypoactive patients.Conclusiondistress may be a simple and easily identified marker of unmet need in people with dementia in hospital. However, modifiable and unmodifiable barriers are suggested that reduce the chance of distress being identified or acted on. Improving our understanding of how distress is identified in this environment, and in turn developing systems that overcome these barriers, may improve the accuracy with which distress is identified on hospital wards.
      PubDate: Wed, 17 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afx198
      Issue No: Vol. 47, No. 3 (2018)
  • Seeking assistance in later life: how do older people evaluate their need
           for assistance'
    • Authors: Canvin K; MacLeod C, Windle G, et al.
      Pages: 466 - 473
      Abstract: Backgroundlegislation places an onus on local authorities to be aware of care needs in their locality and to prevent and reduce care and support needs. The existing literature overlooks ostensibly ‘healthy’ and/or non-users of specific services, non-health services and informal assistance and therefore inadequately explains what happens before or instead of individuals seeking services. We sought to address these gaps by exploring older adults’ accounts of seeking assistance in later life.Methodswe conducted semi-structured qualitative interviews with 40 adults aged 68–95. We invited participants to discuss any type of support, intervention, or service provision, whether medical, social, family-provided, paid or unpaid.Findingsthis paper reports older people’s accounts of how they evaluated their need for assistance. We found that the people in our sample engaged in a recursive process, evaluating their needs on an issue-by-issue basis. Participants’ progression through this process hinged on four factors: their acknowledgement of decline; the perceived impact of decline on their usual activities and independence; their preparedness to be a recipient of assistance; and, the opportunity to assert their need. In lieu of seeking assistance, participants engaged in self-management, but also received unsolicited or emergency assistance.Conclusionsolder people’s adaptations to change and attempts to meet their needs without assistance mean that they do not present to services, limiting the local authority’s knowledge of their needs and ability to plan appropriate services. Our findings offer four stages for policymakers, service providers and carers to target to address the uptake of assistance.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afx189
      Issue No: Vol. 47, No. 3 (2018)
  • Early-life predictors of future multi-morbidity: results from the
           Hertfordshire Cohort
    • Authors: Humphreys J; Jameson K, Cooper C, et al.
      Pages: 474 - 478
      Abstract: Backgroundmulti-morbidity is an increasing challenge in western medicine and has the potential to impact patients’ quality of life, treatment options and compliance with medications. The aim of this study was to identify the early-life predictors of long-term multi-morbidity in an historical cohort, the Hertfordshire Cohort Study (HCS).Methodsperinatal and infant health records were kept on all children born in Hertfordshire between 1931 and 1939. Participants who were still alive in 1998 were recruited to the HCS and data collected on major chronic diseases. They were subsequently followed up in the Clinical Outcomes Study (COS), and data recorded on all major illnesses since HCS, as well as current medications. Ordinal logistic regression analysed the association between early-life factors and the number of morbidities in these two surveys as well as medication count.Resultsa total of 2299 participants had data in COS, 1131 (49%) were female, median age (interquartile range) at recruitment to HCS was 66 (64–68) years. Higher rates of childhood illnesses were significantly associated with future multi-morbidity (multivariate odds ratio (OR) (95% confidence interval (CI)) 1.15 (1.06, 1.25)) and higher medication counts at COS (multivariate OR (95%CI) 1.14 (1.06, 1.23)).Conclusionschildren who experience more illnesses at a young age may be prone to develop multi-morbidity in later life.
      PubDate: Fri, 09 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy005
      Issue No: Vol. 47, No. 3 (2018)
  • Functional capacity and health-related quality of life outcomes post
           transcatheter aortic valve replacement: a systematic review and
    • Authors: Straiton N; Jin K, Bhindi R, et al.
      Pages: 478 - 482
      Abstract: Backgroundtranscatheter aortic valve replacement (TAVR) provides prognostic benefit for high surgical-risk patients with severe aortic stenosis (AS), yet the impact to patient outcomes is far less understood.Methodwe performed a systematic review and meta-analysis to evaluate functional capacity and health-related quality of life (HRQoL) outcomes for patients up to 12 months post TAVR. A total of 20 eligible publications, comprising randomised-controlled trials, observational studies and a registry study were identified from electronic databases, including MEDLINE, EMBASE, Cochrane Library and others (inception to February 2017).Resultsthe total sample was 2,775 with a mean age of 81.8 ± 2.1 years, more than half (52%) were female and high surgical risk 9.6 ± 4.3% mean STS (Society of Thoracic Surgeons risk model). Post TAVR, patients had significant improvement in functional capacity of >40 m in the 6-minute walk test (6MWT) (95% confidence interval (CI) 9.69–73.28) and a clinically meaningful increase in ability to perform daily physical-based tasks (Duke Activity Status Index (DASI), mean difference (MD) increase 5.42 points, 95% CI 3.16–7.68). HRQoL improved consistently following TAVR regardless of measure used. Significant increases occurred in the physical component summary scores (PCS) of the short form (SF) health surveys (MD increase 10.45 (SF36) and 10.14 (SF12) points).Conclusionfunctional capacity and HRQoL improved substantially following TAVR, despite evolving patient selection criteria, thus TAVR continues to provide a directly beneficial option for severe AS patients.
      PubDate: Thu, 25 Jan 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afx203
      Issue No: Vol. 47, No. 3 (2018)
  • The effect of chair-based pedal exercises for older people admitted to an
           acute hospital compared to standard care: a feasibility study
    • Authors: McGowan T; Ong T, Kumar A, et al.
      Pages: 483 - 486
      Abstract: Backgroundchair-based pedal exercises potentially offer a simple method of improving physical activity in older people admitted to hospital.Objectiveto assess the feasibility of using chair-based pedal exercisers on acute medical wards for older people. To study if there is any effect on muscle strength, mobility and time spent physically active.Subjectsfifty participants ≥65 years who were able to pedal admitted to acute medical wards for older people in a UK hospital.Methodsparticipants were randomised to either pedal for 5 min three times a day with minimal supervision; or standard care. Outcome data (compliance with exercise and change in lower limb muscle strength, mobility and level of physical activity) were collected on day 7 or on discharge, whichever came 1st.Resultsthere were no significant differences in baseline characteristics between the intervention and standard care group. Participants remained in the study for an average of 5 days. None in the intervention group adhered to the prescribed exercise duration. The intervention group completed a median of 152 revolutions, or a median total pedal time of 5 min during the entire study period. There were no differences in change in lower limb muscle strength, mobility score or the percentage of time spent active between the two groups.Conclusionpedal exercises with minimal supervision are not feasible as a single intervention to improve physical activity in older people admitted to hospital. There may be a role for it as part of a multifaceted strategy to improve physical activity in hospital.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy017
      Issue No: Vol. 47, No. 3 (2018)
  • Large bowel obstruction: a case of uncommon aetiology of a frequent
    • Authors: Fubini P; Scheffler M, Perivier S, et al.
      Pages: 487 - 487
      PubDate: Wed, 21 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy015
      Issue No: Vol. 47, No. 3 (2018)
  • ‘Acopia’ and ‘inability to cope’ remain unhelpful and pejorative
           labels for complexity in older adults presenting to the acute hospital
    • Authors: Dyer A; Ryan D, O’Callaghan S.
      Pages: 488 - 488
      PubDate: Thu, 15 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy013
      Issue No: Vol. 47, No. 3 (2018)
  • Accurate identification of hospital admissions from care homes;
           development and validation of an automated algorithm
    • Authors: Housley G; Lewis S, Usman A, et al.
      Pages: 387 - 391
      Abstract: Backgroundmeasuring the complex needs of care home residents is crucial for resource allocation. Hospital patient administration systems (PAS) may not accurately identify admissions from care homes.Objectiveto develop and validate an accurate, practical method of identifying care home resident hospital admission using routinely collected PAS data.Methodadmissions data between 2011 and 2012 (n = 103,105) to an acute Trust were modelled to develop an automated tool which compared the hospital PAS address details with the Care Quality Commission’s (CQC) database, producing a likelihood of care home residency. This tool and the Nuffield method (CQC postcode match only) were validated against a manual check of a random sample of admissions (n = 2,000). A dataset from a separate Trust was analysed to assess generalisability.Resultsthe hospital PAS was inaccurate; none of the admissions from a care home identified on manual check had a care home source of admission recorded on the PAS.Both methods performed well; the automated tool had a higher positive predictive value than the Nuffield method (100% 95% confidence interval (CI) 98.23–100% versus 87.10% 95%CI 82.28–91.00%), meaning those coded as care home residents were more likely to actually be from a care home. Our automated tool had a high level of agreement 99.2% with the second Trust’s data (Kappa 0.86 P < 0.001).Conclusionscare home status is not routinely or accurately captured. Automated matching offers an accurate, repeatable, scalable method to identify care home residency and could be used as a tool to benchmark how care home residents use acute hospital resources across the National Health Service.
      PubDate: Mon, 18 Dec 2017 00:00:00 GMT
      DOI: 10.1093/ageing/afx182
      Issue No: Vol. 47, No. 3 (2017)
  • Social isolation and loneliness as risk factors for the progression of
           frailty: the English Longitudinal Study of Ageing
    • Authors: Gale C; Westbury L, Cooper C.
      Pages: 392 - 397
      Abstract: Backgroundloneliness and social isolation have been associated with mortality and with functional decline in older people. We investigated whether loneliness or social isolation are associated with progression of frailty.Methodsparticipants were 2,817 people aged ≥60 from the English Longitudinal Study of Ageing. Loneliness was assessed at Wave 2 using the Revised UCLA scale (short version). A social isolation score at Wave 2 was derived from data on living alone, frequency of contact with friends, family and children, and participation in social organisations. Frailty was assessed by the Fried phenotype of physical frailty at Waves 2 and 4, and by a frailty index at Waves 2–5.Resultshigh levels of loneliness were associated with an increased risk of becoming physically frail or pre-frail around 4 years later: relative risk ratios (95% CI), adjusted for age, sex, level of frailty and other potential confounding factors at baseline were 1.74 (1.29, 2.34) for pre-frailty, and 1.85 (1.14, 2.99) for frailty. High levels of loneliness were not associated with change in the frailty index—a broadly based measure of general condition—over a mean period of 6 years. In the sample as a whole, there was no association between social isolation and risk of becoming physically frail or pre-frail, but high social isolation was associated with increased risk of becoming physically frail in men. Social isolation was not associated with change in the frailty index.Conclusionolder people who experience high levels of loneliness are at increased risk of becoming physically frail.
      PubDate: Fri, 22 Dec 2017 00:00:00 GMT
      DOI: 10.1093/ageing/afx188
      Issue No: Vol. 47, No. 3 (2017)
  • CorrigendumSupported Discharge Teams for older people in hospital acute
           care: a randomized controlled trial
    • Authors: Parsons M; Parsons J, Rouse P, et al.
      Pages: 489 - 489
      PubDate: Fri, 01 Dec 2017 00:00:00 GMT
      DOI: 10.1093/ageing/afx179
      Issue No: Vol. 47, No. 3 (2017)
  • CorrigendumSTOPP/START criteria for potentially inappropriate prescribing
           in older people: version 2
    • Authors: Mahony D; Sullivan D, Byrne S, et al.
      Pages: 489 - 489
      PubDate: Wed, 22 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ageing/afx178
      Issue No: Vol. 47, No. 3 (2017)
  • CorrigendaThe Prevalence of Dementia and Cognitive Impairment in our Acute
           Medical Admissions
    • Authors: Cowley S; Ghaznain M, Basirat A, et al.
      Pages: 489 - 489
      PubDate: Tue, 21 Nov 2017 00:00:00 GMT
      DOI: 10.1093/ageing/afx176
      Issue No: Vol. 47, No. 3 (2017)
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