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Publisher: Oxford University Press   (Total: 368 journals)

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Showing 1 - 200 of 368 Journals sorted alphabetically
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 6, SJR: 0.881, h-index: 38)
Adaptation     Hybrid Journal   (Followers: 8, SJR: 0.111, h-index: 4)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 57, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 76, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 14, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 5)
American Historical Review     Hybrid Journal   (Followers: 120, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 41, SJR: 1.441, h-index: 77)
American J. of Epidemiology     Hybrid Journal   (Followers: 147, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 19, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 15)
American journal of legal history     Full-text available via subscription   (Followers: 4, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 26, SJR: 0.824, h-index: 23)
American Literary History     Hybrid Journal   (Followers: 12, SJR: 0.185, h-index: 22)
Analysis     Hybrid Journal   (Followers: 23)
Annals of Botany     Hybrid Journal   (Followers: 33, SJR: 1.912, h-index: 124)
Annals of Occupational Hygiene     Hybrid Journal   (Followers: 24, SJR: 0.837, h-index: 57)
Annals of Oncology     Hybrid Journal   (Followers: 49, SJR: 4.362, h-index: 173)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 9, SJR: 0.642, h-index: 53)
Annals of Work Exposures and Health     Hybrid Journal  
AoB Plants     Open Access   (Followers: 4, SJR: 0.78, h-index: 10)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 18, SJR: 0.884, h-index: 31)
Applied Linguistics     Hybrid Journal   (Followers: 51, 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: 19)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 12)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 25, SJR: 0.96, h-index: 71)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 20)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 46, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 47, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 221, SJR: 4.643, h-index: 271)
Biology Methods and Protocols     Hybrid Journal  
Biometrika     Hybrid Journal   (Followers: 18, SJR: 2.801, h-index: 90)
BioScience     Hybrid Journal   (Followers: 28, 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: 15, SJR: 1.955, h-index: 55)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 132, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 65, SJR: 0.272, h-index: 20)
Brain     Hybrid Journal   (Followers: 61, SJR: 6.097, h-index: 264)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 43, SJR: 4.086, h-index: 73)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 50)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 32, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 24, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 488, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 77, 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: 25)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 3, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 55, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 9, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 10, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal  
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 11, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 37, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 15, 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: 3)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 18, 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: 11, SJR: 0.191, h-index: 8)
Classical Receptions J.     Hybrid Journal   (Followers: 17, SJR: 0.1, h-index: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 58, SJR: 4.742, h-index: 261)
Clinical Kidney J.     Open Access   (Followers: 4, SJR: 0.338, h-index: 19)
Community Development J.     Hybrid Journal   (Followers: 23, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 8, SJR: 0.371, h-index: 47)
Conservation Physiology     Open Access   (Followers: 1)
Contemporary Women's Writing     Hybrid Journal   (Followers: 11, SJR: 0.111, h-index: 3)
Contributions to Political Economy     Hybrid Journal   (Followers: 6, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Legal Problems     Hybrid Journal   (Followers: 25)
Current Zoology     Full-text available via subscription   (SJR: 0.999, h-index: 20)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 11, SJR: 1.068, h-index: 24)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 12)
Diplomatic History     Hybrid Journal   (Followers: 18, SJR: 0.296, h-index: 22)
DNA Research     Open Access   (Followers: 4, SJR: 2.42, h-index: 77)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 2)
Early Music     Hybrid Journal   (Followers: 13, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 46, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 45, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 12, 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: 1)
Environmental History     Hybrid Journal   (Followers: 25, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 1, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 10, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 15, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 46, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 9, 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: 8, SJR: 0.152, h-index: 31)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 7, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 140, 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: 23, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 12, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 25, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 37, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 12, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 8, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 19, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 24, SJR: 7.587, h-index: 150)
Fems Yeast Research     Hybrid Journal   (Followers: 13, SJR: 1.213, h-index: 66)
Foreign Policy Analysis     Hybrid Journal   (Followers: 22, SJR: 0.859, h-index: 10)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 17, 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: 29, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 19, 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: 10, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 31, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 24, SJR: 0.437, h-index: 13)
GigaScience     Open Access   (Followers: 3)
Global Summitry     Hybrid Journal  
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.692, h-index: 101)
Health and Social Work     Hybrid Journal   (Followers: 46, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 12, SJR: 0.814, h-index: 80)
Health Policy and Planning     Hybrid Journal   (Followers: 21, SJR: 1.628, h-index: 66)
Health Promotion Intl.     Hybrid Journal   (Followers: 19, SJR: 0.664, h-index: 60)
History Workshop J.     Hybrid Journal   (Followers: 25, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 22, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 10, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 73, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 15, 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: 53, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 8)
ILAR J.     Hybrid Journal   (Followers: 1, 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   (Followers: 2, 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: 8, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 29, SJR: 0.184, h-index: 15)
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: 4, SJR: 0.743, h-index: 35)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 27)
Intl. Health     Hybrid Journal   (Followers: 4, SJR: 0.835, h-index: 15)
Intl. Immunology     Hybrid Journal   (Followers: 4, SJR: 1.613, h-index: 111)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 32, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 50, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 114, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 3, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 18, SJR: 0.307, h-index: 15)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 8, 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: 4, SJR: 1.69, h-index: 79)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 8, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 33, 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. Mathematics Research Surveys - advance access     Hybrid Journal  
Intl. Political Sociology     Hybrid Journal   (Followers: 24, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 17, SJR: 0.539, h-index: 17)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 7, SJR: 0.998, h-index: 28)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 33, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 17, 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: 2, SJR: 0.102, h-index: 4)
J. of African Economies     Hybrid Journal   (Followers: 15, SJR: 0.647, h-index: 30)
J. of American History     Hybrid Journal   (Followers: 38, SJR: 0.286, h-index: 34)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 13, SJR: 1.038, h-index: 60)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 20, SJR: 2.157, h-index: 149)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 3, SJR: 0.563, h-index: 43)
J. of Biochemistry     Hybrid Journal   (Followers: 43, SJR: 1.341, h-index: 96)
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 Competition Law and Economics     Hybrid Journal   (Followers: 34, SJR: 0.442, h-index: 16)
J. of Complex Networks     Hybrid Journal   (Followers: 1, SJR: 1.165, h-index: 5)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 11, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 38, 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: 2)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 8, SJR: 0.69, h-index: 36)
J. of Design History     Hybrid Journal   (Followers: 15, SJR: 0.166, h-index: 14)
J. of Economic Entomology     Full-text available via subscription   (Followers: 6, SJR: 0.894, h-index: 76)
J. of Economic Geography     Hybrid Journal   (Followers: 31, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 25, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 19)
J. of Experimental Botany     Hybrid Journal   (Followers: 13, SJR: 2.798, h-index: 163)
J. of Financial Econometrics     Hybrid Journal   (Followers: 21, SJR: 1.314, h-index: 27)
J. of Global Security Studies     Hybrid Journal   (Followers: 1)
J. of Heredity     Hybrid Journal   (Followers: 3, SJR: 1.024, h-index: 76)
J. of Hindu Studies     Hybrid Journal   (Followers: 7, SJR: 0.186, h-index: 3)
J. of Hip Preservation Surgery     Open Access  
J. of Human Rights Practice     Hybrid Journal   (Followers: 21, SJR: 0.399, h-index: 10)
J. of Infectious Diseases     Hybrid Journal   (Followers: 39, SJR: 4, h-index: 209)
J. of Insect Science     Open Access   (Followers: 9, SJR: 0.388, h-index: 31)
J. of Integrated Pest Management     Open Access   (Followers: 1)

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Journal Cover Age and Ageing
  [SJR: 1.611]   [H-I: 107]   [76 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  [368 journals]
  • Editor's view
    • PubDate: 2017-02-27
       
  • Can orthogeriatics do more than save lives'
    • Authors: Dunbar J; Aspray TJ.
      PubDate: 2017-02-27
       
  • Associations of fat and muscle tissue with cognitive status in older
           adults: the AGES-Reykjavik Study
    • Authors: Spauwen PJ; Murphy RA, Jónsson PV, et al.
      Abstract: AbstractBackground/Objectivestudies on the association of dementia with specific body composition (BC) components are scarce. Our aim was to investigate associations of BC measures with different levels of cognitive function in late-life.Methodswe studied 5,169 participants (mean age 76 years, 42.9% men) in the AGES-Reykjavik Study of whom 485 (9.4%) were diagnosed with mild cognitive impairment (MCI) and 307 (5.9%) with dementia. Visceral fat, abdominal and thigh subcutaneous fat, and thigh muscle were assessed by computed tomography. MCI and dementia were based on clinical assessment and a consensus meeting; those without MCI or dementia were categorised as normal. Multinomial regression models assessed the associations stratified by sex and in additional analyses by midlife body mass index (BMI).Resultsamong women, there was a decreased likelihood of dementia per SD increase in abdominal subcutaneous fat (OR 0.72; 95% CI: 0.59–0.88), thigh subcutaneous fat (0.81; 0.67–0.98) and thigh muscle (0.63; 0.52–0.76), but not visceral fat, adjusting for demographics, vascular risk factors, stroke and depression. Inverse associations of fat with dementia were attenuated by weight change from midlife and were strongest in women with midlife BMI
      PubDate: 2017-02-27
       
  • Duloxetine for the management of pain in older adults with knee
           osteoarthritis: randomised placebo-controlled trial
    • Authors: Abou-Raya S; Abou-Raya A, Helmii M.
      PubDate: 2017-02-13
       
  • List of Reviewers
    • PubDate: 2017-01-19
       
  • Cardiorespiratory fitness and brain volumes in men and women in the FINGER
           study
    • Authors: Pentikäinen H; Ngandu T, Liu Y, et al.
      Abstract: AbstractBackground:high cardiorespiratory fitness (CRF) is associated with larger brain volumes but data on sex differences in the association of CRF with brain volumes are scarce. We investigated whether the association of CRF with total grey matter (GM) and white matter volumes as well as medial temporal lobe and striatum volumes is different between men and women at increased risk for Alzheimer's disease (AD).Methods:we used baseline data from The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) in which the inclusion criteria were set to select individuals with cognitive performance at the mean level or slightly lower than expected for age according to Finnish population norms. Our sub-study included 39 randomly selected men and 29 women aged 61–75 years. CRF was assessed as peak oxygen consumption (VO2peak) measured in a maximal exercise test on cycle ergometer. Brain structural imaging was performed using a 1.5-T scanner.Results:in men, VO2peak was associated with cortical GM volume (β = 0.56, P = 0.001) and total GM volume (β = 0.54, P = 0.001). In women, no associations were found between VO2peak and brain volumes. VO2peak accounted for 23% and 1% of total variance of cortical GM volume as well as 25% and 4% of total variance of total GM volume in men and women, respectively.Conclusion:CRF is associated with cortical GM and total GM volumes in elderly men at increased risk for AD, but not in women.
      PubDate: 2017-01-07
       
  • Adverse outcomes in older adults attending emergency departments: a
           systematic review and meta-analysis of the Identification of Seniors At
           Risk (ISAR) screening tool
    • Authors: Galvin R; Gilleit Y, Wallace E, et al.
      Abstract: AbstractBackgroundolder adults are frequent users of emergency services and demonstrate high rates of adverse outcomes following emergency care.Objectiveto perform a systematic review and meta-analysis of the Identification of Seniors At Risk (ISAR) screening tool, to determine its predictive value in identifying adults ≥65 years at risk of functional decline, unplanned emergency department (ED) readmission, emergency hospitalisation or death within 180 days after index ED visit/hospitalisation.Methodsa systematic literature search was conducted in PubMed, EMBASE, CINAHL, EBSCO and the Cochrane Library to identify validation and impact analysis studies of the ISAR tool. A pre-specified ISAR score of ≥2 (maximum score 6 points) was used to identify patients at high risk of adverse outcomes. A bivariate random effects model generated pooled estimates of sensitivity and specificity. Statistical heterogeneity was explored and methodological quality was assessed using validated criteria.Resultsthirty-two validation studies (n = 12,939) are included. At ≥2, the pooled sensitivity of the ISAR for predicting ED return, emergency hospitalisation and mortality at 6 months is 0.80 (95% confidence interval (CI) 0.70–0.87), 0.82 (95% CI 0.74–0.88) and 0.87 (95% CI 0.75–0.94), respectively, with a pooled specificity of 0.31 (95% CI 0.24–0.38), 0.32 (95% CI 0.24–0.41) and 0.35 (95% CI 0.26–0.44). Similar values are demonstrated at 30 and 90 days. Three heterogeneous impact analysis studies examined the clinical implementation of the ISAR and reported mixed findings across patient and process outcomes.Conclusionthe ISAR has modest predictive accuracy and may serve as a decision-making adjunct when determining which older adults can be safely discharged.
      PubDate: 2016-12-15
       
  • Cross-national comparison of medication use in Australian and Dutch
           nursing homes
    • Authors: Taxis K; Kochen S, Wouters H, et al.
      Abstract: AbstractBackgroundcross-national comparisons can be used to explore therapeutic areas and identify potential medication issues.Methodswe used cross-sectional pharmacy supply data to explore medication use for nursing home residents in Australia (AU n = 26 homes, 1,560 residents) and the Netherlands (NL n = 6 homes, 2,037 residents). Binary logistic regression analysis was used to calculate the sex and aged adjusted odds ratios (OR) and associated 95% confidence intervals with a flexible Bonferroni–Holm procedure used to adjust for multiple hypothesis testing.Resultstotal use of antipsychotics (AU: 37.7%, NL: 40.3%; OR 0.91 (0.79–1.04, P = 0.16) and antibacterials (66.8% AU, 62.4% NL, OR 1.08 (0.93–1.24, P = 0.31) was similar, but choice of individual agents differed between the two countries. Differences were observed in the use of antithrombotics (46.7% AU, 64.7% NL, OR 0.48 (0.42–0.56, P > 0.01), ophthalmologicals (44.3% AU, 22.1% NL, OR 2.80 (2.42–3.24, P < 0.001), laxatives (77.1% AU, 65.8% NL, OR 1.65 (1.41–1.92, P < 0.001).Conclusionwhile the general prevalence of medication use in nursing home residents was similar across the two countries, distinct differences existed in the choice of agent among therapeutic groups. Comparing use between countries identified a number of potential medication related problem areas that need further exploration.
      PubDate: 2016-12-14
       
  • Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE)
           case presentation and comparison with other polyarthritides affecting
           older people
    • Authors: Eguia HA; Parodi Garcia J, Ramas Diez C, et al.
      Abstract: AbstractRemitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome mainly affects elderly men and responds well to steroids. Since this syndrome can resemble other diseases, its diagnosis is a significant challenge. Through the following paper, we hope to improve the diagnosis of RS3PE by presenting a table comparing RS3PE to two other common polyarthritic conditions affecting the elderly.
      PubDate: 2016-12-08
       
  • Multi-compartment compliance aids—a clinical reminder
    • Authors: Illsley A; Brown A.
      PubDate: 2016-12-08
       
  • Is the higher mortality among men with hip fracture explained by
           sex-related differences in quality of in-hospital care' A
           population-based cohort study
    • Authors: Kristensen P; Johnsen S, Mor A, et al.
      Abstract: AbstractBackgroundmortality after hip fracture is two-fold higher in men compared with women. It is unknown whether sex-related differences in the quality of in-hospital care contribute to the higher mortality among men.Objectiveto examine sex-related differences in quality of in-hospital care, 30-day mortality, length of hospital stay and readmission among patients with hip fracture.Designpopulation-based cohort study.Measuresusing prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry, we identified 25,354 patients ≥65 years (29% were men). Outcome measures included quality of in-hospital care as reflected by seven process performance measures, 30-day mortality, length of stay (LOS) and readmission within 30 days after discharge. Data were analysed using multivariable regression techniques.Resultsin general, there were no substantial sex-related differences in quality of in-hospital care. The relative risk for receiving the individual process performance measure ranged from 0.91 (95% confidence interval (CI) 0.85–0.97) to 0.97 (95% CI 0.94–0.99) for men compared with women. The 30-day mortality was 15.9% for men and 9.3% for women corresponding to an adjusted odds ratio (OR) of 2.30 (95% CI 2.09–2.54). The overall readmission risk within 30 days after discharge was 21.6% for men and 16.4% for women (adjusted OR of 1.38 (95% CI 1.29–1.47)). No difference in LOS was observed between men and women.Conclusionssex differences in the quality of in-hospital care appeared not to explain the higher mortality and risk of readmission among men hospitalised with hip fracture.
      PubDate: 2016-12-08
       
  • The effects of a high-intensity functional exercise group on clinical
           outcomes in hospitalised older adults: an assessor-blinded,
           randomised-controlled trial
    • Authors: Raymond MM; Jeffs KJ, Winter A, et al.
      Abstract: AbstractObjectiveto investigate a high-intensity functional exercise (HIFE) group in hospitalised older adults.Designassessor-blinded, randomised-controlled trial.Settingsub-acute wards at a metropolitan rehabilitation hospital.Participantsolder adults ≥65 years (n = 468) able to stand with minimum assistance or less from a chair and follow instructions.Intervention‘group’ participants were offered a standing HIFE group three times a week and individual physiotherapy sessions twice a week. Control participants were offered daily individual physiotherapy sessions.Main outcome measuresthe primary outcome measure was the Elderly Mobility Scale (EMS). Secondary measures included the Berg Balance Scale, gait speed, Timed Up and Go Test, falls, length of stay and discharge destination.Resultsparticipants’ mean age was 84.3 (7.1) years and 61% were female. There was no difference between groups for the improvement in EMS from admission to discharge (effect size −0.07, 95% confidence interval: −0.26 to 0.11, P = 0.446) and no difference in discharge destination, P = 0.904. Therapists saved 31–205 min/week treating group participants compared with control participants.Conclusionthe results suggest that a HIFE group programme combined with individual physiotherapy may improve mobility to a similar extent to individual physiotherapy alone in hospitalised older adults. Providing physiotherapy in a group setting resulted in increased therapist efficiency. A high-intensity exercise group with individual physiotherapy may be an effective and efficient method to provide care to older inpatients.
      PubDate: 2016-12-08
       
  • Predicting functional decline in older emergency patients—the Safe
           Elderly Emergency Discharge (SEED) project
    • Authors: Lowthian JA; Straney LD, Brand CA, et al.
      Abstract: AbstractObjectiveto profile the trajectory of, and risk factors for, functional decline in older patients in the 30 days following Emergency Department (ED) discharge.Methodsprospective cohort study of community-dwelling patients aged ≥65 years, discharged home from a metropolitan Melbourne ED, 31 July 2012 to 30 November 2013. The primary outcome was functional decline, comprising either increased dependency in personal activities of daily living (ADL) or in skills required for living independently instrumental ADL (IADL), deterioration in cognitive function, nursing home admission or death. Univariate analyses were used to select risk factors and logistic regression models constructed to predict functional decline.Resultsat 30 days, 34.4% experienced functional decline; with 16.7% becoming more dependent in personal ADL, 17.5% more dependant in IADL and 18.4% suffering deterioration in cognitive function. Factors independently associated with decline were functional impairment prior to the visit in personal ADL (Odds Ratio [OR] 3.21, 95% confidence interval [CI] 2.26–4.53) or in IADL (OR 6.69, 95% CI 4.31–10.38). The relative odds were less for patients with moderately impaired cognition relative to those with normal cognition (OR 0.38, 95% CI 0.19–0.75). There was a 68% decline in the relative odds of functional decline for those with any impairment in IADL who used an aid for mobility (OR 0.32, 95% CI 0.14–0.7).Conclusionolder people with pre-existing ADL impairment were at high risk of functional decline in the 30 days following ED presentation. This effect was largely mitigated for those who used a mobility aid. Early intervention with functional assessments and appropriate implementation of support services and mobility aids could reduce functional decline after discharge.
      PubDate: 2016-12-08
       
  • Sauna bathing is inversely associated with dementia and Alzheimer's
           disease in middle-aged Finnish men
    • Authors: Laukkanen T; Kunutsor S, Kauhanen J, et al.
      Abstract: AbstractBackgroundthere are no previous studies linking repeated heat exposure of sauna and the risk of memory diseases. We aimed to investigate whether frequency of sauna bathing is associated with risk of dementia and Alzheimer's disease.Settingprospective population-based study.Methodsthe frequency of sauna bathing was assessed at baseline in the Kuopio Ischaemic Heart Disease population-based prospective cohort study of 2,315 apparently healthy men aged 42–60 years at baseline, with baseline examinations conducted between 1984 and 1989. Hazard ratios (HRs) with 95% confidence intervals (CIs) for dementia and Alzheimer's disease were ascertained using Cox-regression modelling with adjustment for potential confounders.Resultsduring a median follow-up of 20.7 (interquartile range 18.1–22.6) years, a total of 204 and 123 diagnosed cases of dementia and Alzheimer's disease were respectively recorded. In analysis adjusted for age, alcohol consumption, body mass index, systolic blood pressure, smoking status, Type 2 diabetes, previous myocardial infarction, resting heart rate and serum low-density lipoprotein cholesterol, compared with men with only 1 sauna bathing session per week, the HR for dementia was 0.78 (95% CI: 0.57–1.06) for 2–3 sauna bathing sessions per week and 0.34 (95% CI: 0.16–0.71) for 4–7 sauna bathing sessions per week. The corresponding HRs for Alzheimer's disease were 0.80 (95% CI: 0.53–1.20) and 0.35 (95% CI: 0.14–0.90).Conclusionin this male population, moderate to high frequency of sauna bathing was associated with lowered risks of dementia and Alzheimer's disease. Further studies are warranted to establish the potential mechanisms linking sauna bathing and memory diseases.
      PubDate: 2016-12-08
       
  • Danish register-based study on the association between specific
           antipsychotic drugs and fractures in elderly individuals
    • Authors: Torstensson M; Leth-Møller K, Andersson C, et al.
      Abstract: AbstractBackgroundantipsychotic drugs (APs) have been associated with falls and fractures in elderly individuals but limited knowledge on specific drugs exist.Objectiveto investigate the association between individual APs and fractures in elderly persons.Design and settingnationwide register-based cohort study.Subjectsall Danish individuals aged ≥65 who had not been in treatment with any AP in the year before inclusion.Methodsincidence rate ratios (IRRs) of fractures of hip, pelvis or upper extremities during treatment with commonly used APs were assessed in multivariable Poisson models. Exposure was divided into time periods from initiation of treatment: 0–30 days, 31–365 days or >365 days.Resultsone year prior to inclusion, 1,540,915 individuals ≥65 years had not received APs and of these 93,298 initiated treatment with APs. Mean follow-up was 9.6 years. During follow-up, 246,057 (16%) experienced a fracture. Associations were for all APs highest in the initial treatment period (0–30 days) with IRRs for risperidone 1.97 (95% CI: 1.70–2.28), olanzapine 2.31 (95% CI: 1.96–2.73), quetiapine 2.09 (95% CI: 1.73–2.52), zuclopenthixol 2.19 (95% CI: 1.82–2.63), chlorprothixen 1.62 (95% CI: 1.18–2.24), flupenthixol 1.43 (95% CI: 1.06–1.93), levomepromazine 1.19 (95% CI 0.86–1.66), haloperidol 2.98 (95% CI 2.57–3.45), compared with the background population.Conclusionsuse of APs is associated with fractures in elderly persons especially in the initial treatment period. If AP use in an elderly person is deemed necessary, individual falls prophylaxis should be considered.
      PubDate: 2016-12-08
       
  • Increased orthogeriatrician involvement in hip fracture care and its
           impact on mortality in England
    • Authors: Neuburger J; Currie C, Wakeman R, et al.
      Abstract: AbstractObjectivesto describe the increase in orthogeriatrician involvement in hip fracture care in England and its association with improvements in time to surgery and mortality.Study designanalysis of Hospital Episode Statistics for 196,401 patients presenting with hip fracture to 150 hospitals in England between 1 April 2010 and 28 February 2014, combined with data on orthogeriatrician hours from a national organisational survey.Methodswe examined changes in the average number of hours worked by orthogeriatricians in orthopaedic departments per patient with hip fracture, and their potential effect on mortality within 30 days of presentation. The role of prompt surgery (on day of or day after presentation) was explored as a potential confounding factor. Associations were assessed using conditional Poisson regression models with adjustment for patients’ sex, age and comorbidity and year, with hospitals treated as fixed effects.Resultsbetween 2010 and 2013, there was an increase of 2.5 hours per patient in the median number of hours worked by orthogeriatricians—from 1.5 to 4.0 hours. An increase of 2.5 hours per patient was associated with a relative reduction in mortality of 3.4% (95% confidence interval 0.9% to 5.9%, P = 0.01). This corresponds to an absolute reduction of approximately 0.3%. Higher numbers of orthogeriatrician hours were associated with higher rates of prompt surgery, but were independently associated with lower mortality.Conclusionin the context of initiatives to improve hip fracture care, we identified statistically significant and robust associations between increased orthogeriatrician hours per patient and reduced 30-day mortality.
      PubDate: 2016-12-02
       
  • New Horizons in orthostatic hypotension
    • Authors: Frith J; Parry SW.
      Abstract: AbstractBackgroundorthostatic hypotension (OH) is a common disabling condition associated with increased morbidity and mortality. Much of the evidence available is derived from younger populations with chronic neurological disease leading to uncertainty for the diagnosis and management of older people.Objectiveto provide an overview of recent and emerging evidence for the diagnosis, management and prognosis of OH in older persons.Methodsa narrative review of recent studies, emerging therapies and relevant regulatory updates.Findingsrevisions to the diagnostic criteria for OH include the duration of the blood pressure drop, specific criteria for initial and delayed OH and OH with hypertension. Non-drug therapies remain the first-line treatment option and Comprehensive Geriatric Assessment appears to result in lower rates of OH. Recent evidence concerning withdrawal of causative medication is inconsistent. Midodrine has recently become the only licenced medication for OH in the UK. Other emerging treatments include atomoxetine and droxidopa but these require further evaluation. Many other agents may be used but are not supported by high-quality evidence. The increase in mortality associated with OH is less apparent in older people.SummaryOH remains common in older people, the new diagnostic criteria address some of the previous uncertainty but evidence concerning withdrawal of antihypertensives is conflicting. Midodrine is now the only licenced medication for OH in the UK, but non-drug therapies remain first line and fludrocortisone may be considered before midodrine. We may see other agents such as droxidopa becoming increasingly used over the coming years.
      PubDate: 2016-11-18
       
  • Munchausen syndrome by proxy—illness fabricated by another in older
           people
    • Authors: Moreno-Ariño M; Bayer A.
      PubDate: 2016-11-17
       
  • Establishing a set of research priorities in care homes for older people
           in the UK: a modified Delphi consensus study with care home staff
    • Authors: Shepherd V; Wood F, Hood K.
      Abstract: AbstractBackgroundcurrently, there is little evidence base for much of the care provided for older people in care homes. Given the wide range of topics that require further investigation, and limited resources, one solution is to identify the priorities for future research.Methodsa modified Delphi technique was used to identify research topics and develop consensus among care home staff participants. The survey was conducted across three rounds. Firstly to elicit topics that were considered by participants to require further research, secondly to prioritise the long list of research questions, followed by a third round to reach a consensus on the highest ranked 15 questions.Resultseighty-three participants responded to the initial survey, providing 144 questions. Following analysis and review against existing evidence, 76 research questions remained. Of note, 40/83 participants responded to the interim prioritisation round and 43/83 participants responded to the final round, which ranked the top 15 research questions by importance. Two other groups of health and social care professionals also participated in the final ranking. The results from these groups had a similar ordering to those of the original cohort of participants.Conclusionthis is the first study to establish a set of research priorities for older people in the UK care homes. It is hoped that sharing these results with clinicians, researchers and funding bodies will help to begin the process of ensuring that the future research agenda can be focused on the areas of greatest need. Further work to identify the priorities of other key stakeholders is required.
      PubDate: 2016-11-14
       
  • Health professional perspectives on the management of multimorbidity and
           polypharmacy for older patients in Australia
    • Authors: Mc Namara K; Breken B, Alzubaidi H, et al.
      Abstract: AbstractBackgrounddelivering appropriate care for patients with multimorbidity and polypharmacy is increasingly challenging. Challenges for individual healthcare professions are known, but only little is known about overall healthcare team implementation of best practice for these patients.Objectiveto explore current approaches to multimorbidity management, and perceived barriers and enablers to deliver appropriate medications management for community-dwelling patients with multimorbidity and polypharmacy, from a broad range of healthcare professional (HCP) perspectives in Australia.Methodsthis qualitative study used semi-structured interviews to gain in-depth understanding of HCPs’ perspectives on the management of multimorbidity and polypharmacy. The interview guide was based on established principles for the management of multimorbidity in older patients. HCPs in rural and metropolitan Victoria and South Australia were purposefully selected to obtain a maximum variation sample. Twenty-six HCPs, from relevant medical, dentistry, nursing, pharmacy and allied health backgrounds, were interviewed between October 2013 and February 2014. Fourteen were prescribers and 12 practiced in primary care. Interviews were digitally audio-taped, transcribed verbatim and analysed using a constant comparison approach.Resultsmost participants did not routinely use structured approaches to incorporate patients’ preferences in clinical decision-making, address conflicting prescriber advice, assess patients’ adherence to treatment plans or seek to optimise care plans. Most HCPs were either unaware of medical decision aids and measurements tools to support these processes or disregarded them as not being user-friendly. Challenges with coordination and continuity of care, pressures of workload and poorly defined individual responsibilities for care, all contributed to participants’ avoiding ownership of multimorbidity management. Potential facilitators of improved care related to improved culture, implementation of electronic health records, greater engagement of pharmacists, nurses and patients, families in care provision, and the use of care coordinators.Conclusionextensive shortcomings exist in team-based care for the management of multimorbidity. Delegating coordination and review responsibilities to specified HCPs may support improved overall care.
      PubDate: 2016-11-10
       
  • Withdrawal of active treatment after intracerebral haemorrhage in the
           INTERACT2 study
    • Authors: Muñoz Venturelli P; Wang X, Zahuranec DB, et al.
      Abstract: AbstractBackgroundin the second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2), a minority of patients received withdrawal of active treatment (WAT). We wished to determine the characteristics of these patients, and the relation of this decision-making to subsequent management and final outcome.Methodsthe INTERACT2 cohort of acute intracerebral haemorrhage (ICH) patients had a decision of WAT within 7 days after hospital admission recorded. Multivariable logistic regression was used to identify the determinants of WAT and poor outcome at 90 days, defined by modified Rankin scale (mRS) scores 3–6.Resultsof 2,779 participants with available data, WAT occurred in 121 (4%) and this was significantly associated with increasing age, greater neurological severity, larger haematoma volume, intraventricular extension and randomisation to intensive BP lowering. Compared to other patients, those with WAT had greater mortality (81/121 [67%] versus 205/2624 [8%]; P < 0.001) and survivors were more likely to be severely disabled (mRS score 4–5, 19/39 [49%] versus 695/2419 [29%]; P = 0.006).ConclusionsWAT was undertaken in patients with recognised predictors of poor prognosis, who subsequently were more likely to die or be left with severe disability. Improved understanding of specific factors determining WAT in ICH patients might improve care delivery and outcomes.Clinical Trial Registrationthe INTERACT2 study is registered with ClinicalTrials.gov (NCT00716079).
      PubDate: 2016-11-08
       
  • Delirium risk stratification in consecutive unselected admissions to acute
           medicine: validation of a susceptibility score based on factors identified
           externally in pooled data for use at entry to the acute care pathway
    • Authors: Pendlebury ST; Lovett NG, Smith SC, et al.
      Abstract: AbstractBackgroundrecognition of prevalent delirium and prediction of incident delirium may be difficult at first assessment. We therefore aimed to validate a pragmatic delirium susceptibility (for any, prevalent and incident delirium) score for use in front-line clinical practice in a consecutive cohort of older acute medicine patients.Methodsconsecutive patients aged ≥65 years over two 8-week periods (2010–12) were screened prospectively for delirium using the Confusion Assessment Method (CAM), and delirium was diagnosed using the DSM IV criteria. The delirium susceptibility score was the sum of weighted risk factors derived using pooled data from UK-NICE guidelines: age >80 = 2, cognitive impairment (cognitive score below cut-off/dementia) = 2, severe illness (systemic inflammatory response syndrome) = 1, infection = 1, visual impairment = 1. Score reliability was determined by the area under the receiver operating curve (AUC).Resultsamong 308 consecutive patients aged ≥65 years (mean age/SD = 81/8 years, 164 (54%) female), AUC was 0.78 (95% CI 0.71–0.84) for any delirium; 0.71 (0.64–0.79), for prevalent delirium; 0.81 (0.70–0.92), for incident delirium; odds ratios (ORs) for risk score 5–7 versus
      PubDate: 2016-11-04
       
  • Differences in diagnostic process, treatment and social Support for
           Alzheimer's dementia between primary and specialist care: resultss from
           the Swedish Dementia Registry
    • Authors: Garcia-Ptacek S; Modéer I, Kåreholt I, et al.
      Abstract: AbstractBackgroundthe increasing prevalence of Alzheimer's dementia (AD) has shifted the burden of management towards primary care (PC). Our aim is to compare diagnostic process and management of AD in PC and specialist care (SC).Designcross-sectional study.Subjectsa total of, 9,625 patients diagnosed with AD registered 2011–14 in SveDem, the Swedish Dementia Registry.Methodsdescriptive statistics are shown. Odds ratios are presented for test performance and treatment in PC compared to SC, adjusted for age, sex, Mini-Mental State Examination (MMSE) and number of medication.Resultsa total of, 5,734 (60%) AD patients from SC and 3,891 (40%) from PC. In both, 64% of patients were women. PC patients were older (mean age 81 vs. 76; P 
      PubDate: 2016-11-03
       
  • Secular trend in the incidence of hip fracture in Catalonia, Spain,
           2003–2014
    • Authors: Pueyo-Sánchez M; Larrosa M, Suris X, et al.
      Abstract: AbstractObjectivesto describe the secular trend and seasonal variation in the incidence of hip fracture (HF) over 12 years (2003–2014) in Catalonia, the community with the highest incidence of HF in Spain.Methodsdata about age, gender, type of fracture and month of hospitalisation among patients aged 65 years and older discharged with a diagnosis of HF were collected. Crude and age-standardised annual incidence rate were reckoned. To analyse HF trend, the age/sex-adjusted average annual change in incidence (incidence rate ratio, IRR) was calculated.Resultswe identified 100,110 HF in the period, with an increase of 16.9% (women 13.4%; men 28.4%). Trochanteric fractures were the most frequent (55.8%). The crude incidence rate (per 100,000 population) decreased from 677.2 (95% confidence interval (95% CI) 662.0–692.7) to 657.6 (95% CI 644.0–671.5). The standardised incidence rate decreased from 754.0 (95% CI 738.6–769.3) to 641.5 (95% CI 627.7–655.3), with a sharp decrease in women (−16.8%) while it was stable in men. The incidence by type of fracture was stable. The trend throughout the period showed a slight decrease with IRR 0.99 (95% CI 0.98–0.99; P = 0.025). The incidence was stable in the oldest group (+85 years), while there was a downward trend in the younger groups. A significant seasonal pattern was observed, with more cases in winter and less in summer (spring as reference).Conclusionsthe secular trend reveals a decreasing incidence of HF although the absolute number has increased in the last 12 years in Catalonia. Trochanteric fractures were the most prevalent and a seasonal pattern was observed, with more cases in winter.
      PubDate: 2016-10-28
       
  • Pituitary apoplexy masquerading as functional decline in an older person
    • Authors: Rais N; Merchant R, Seetharaman S.
      Abstract: AbstractWe report the case of an older lady who was admitted to a tertiary teaching hospital with sub-acute functional decline of two months' duration, which was initially attributed to a concomitant urinary tract infection. Further investigations, however, revealed the diagnosis of pituitary apoplexy with central hypocortisolism. Subsequent treatment with physiological doses of steroids improved patient’s function and overall well-being. This report adds to the sparse literature on pituitary apoplexy in the older adults and emphasizes the non-specific presentation of this clinical syndrome.
      PubDate: 2016-10-28
       
  • Objectively measured physical activity and physical performance in old age
    • Authors: Jantunen H; Wasenius N, Salonen M, et al.
      Abstract: AbstractBackgroundphysical performance is a key factor that determines how older people cope with daily tasks and maintain independency. There is strong evidence suggesting that physical activity (PA) is important in maintaining physical performance in old age. However, most studies have been done using self-reported PA. Our aim was to explore the association between objectively measured PA and physical performance in old age.Methodswe studied 695 participants (mean age 70.7 years, SD 2.7) from the Helsinki Birth Cohort Study. Physical performance was assessed with the Senior Fitness Test (SFT) and PA with a multisensory activity monitor SenseWear Pro 3 Armband.Resultstotal volume of PA was significantly associated with the overall SFT score (β = 0.08; 95% confidence interval: 0.07–0.10, P
      PubDate: 2016-10-28
       
  • How empowering is hospital care for older people with advanced
           disease' Barriers and facilitators from a cross-national ethnography
           in England, Ireland and the USA
    • Authors: Selman L; Daveson BA, Smith M, et al.
      Abstract: AbstractBackgroundpatient empowerment, through which patients become self-determining agents with some control over their health and healthcare, is a common theme across health policies globally. Most care for older people is in the acute setting, but there is little evidence to inform the delivery of empowering hospital care.Objectivewe aimed to explore challenges to and facilitators of empowerment among older people with advanced disease in hospital, and the impact of palliative care.Methodswe conducted an ethnography in six hospitals in England, Ireland and the USA. The ethnography involved: interviews with patients aged ≥65, informal caregivers, specialist palliative care (SPC) staff and other clinicians who cared for older adults with advanced disease, and fieldwork. Data were analysed using directed thematic analysis.Resultsanalysis of 91 interviews and 340 h of observational data revealed substantial challenges to empowerment: poor communication and information provision, combined with routinised and fragmented inpatient care, restricted patients’ self-efficacy, self-management, choice and decision-making. Information and knowledge were often necessary for empowerment, but not sufficient: empowerment depended on patient-centredness being enacted at an organisational and staff level. SPC facilitated empowerment by prioritising patient-centred care, tailored communication and information provision, and the support of other clinicians.Conclusionsempowering older people in the acute setting requires changes throughout the health system. Facilitators of empowerment include excellent staff–patient communication, patient-centred, relational care, an organisational focus on patient experience rather than throughput, and appropriate access to SPC. Findings have relevance for many high- and middle-income countries with a growing population of older patients with advanced disease.
      PubDate: 2016-10-28
       
  • English translation and validation of the SarQoL ® , a quality of life
           questionnaire specific for sarcopenia
    • Authors: Beaudart C; Edwards M, Moss C, et al.
      Abstract: AbstractBackgroundthe first quality of life questionnaire specific to sarcopenia, the SarQoL®, has recently been developed and validated in French. To extend the availability and utilisation of this questionnaire, its translation and validation in other languages is necessary.Objectivethe purpose of this study was therefore to translate the SarQoL® into English and validate the psychometric properties of this new version.Designcross-sectional.SettingHertfordshire, UK.Subjectsin total, 404 participants of the Hertfordshire Cohort Study, UK.Methodsthe translation part was articulated in five stages: (i) two initial translations from French to English; (ii) synthesis of the two translations; (iii) backward translations; (iv) expert committee to compare the backward translations with the original questionnaire and (v) pre-test. To validate the English SarQoL®, we assessed its validity (discriminative power, construct validity), reliability (internal consistency, test–retest reliability) and floor/ceiling effects.Resultsthe SarQoL® questionnaire was translated without any major difficulties. Results indicated a good discriminative power (lower score of quality of life for sarcopenic subjects, P = 0.01), high internal consistency (Cronbach's alpha of 0.88), consistent construct validity (high correlations found with domains related to mobility, usual activities, vitality, physical function and low correlations with domains related to anxiety, self-care, mental health and social problems) and excellent test–retest reliability (intraclass coefficient correlation of 0.95, 95%CI 0.92–0.97). Moreover, no floor/ceiling has been found.Conclusionsa valid SarQoL® English questionnaire is now available and can be used with confidence to better assess the disease burden associated with sarcopenia. It could also be used as a treatment outcome indicator in research.
      PubDate: 2016-10-27
       
  • A multidisciplinary intervention to prevent subsequent falls and health
           service use following fall-related paramedic care: a randomised controlled
           trial
    • Authors: Mikolaizak A; Lord SR, Tiedemann A, et al.
      Abstract: AbstractBackgroundapproximately 25% of older people who fall and receive paramedic care are not subsequently transported to an emergency department (ED). These people are at high risk of future falls, unplanned healthcare use and poor health outcomes.Objectiveto evaluate the impact of a fall-risk assessment and tailored fall prevention interventions among older community-dwellers not transported to ED following a fall on subsequent falls and health service use.Design, setting, participantsRandomised controlled trial involving 221 non-transported older fallers from Sydney, Australia.Interventionthe intervention targeted identified risk factors and used existing services to implement physiotherapy, occupational therapy, geriatric assessment, optometry and medication management interventions as appropriate. The control group received individualised written fall prevention advice.Measurementsprimary outcome measures were rates of falls and injurious falls. Secondary outcome measures were ambulance re-attendance, ED presentation, hospitalisation and quality of life over 12 months. Analysis was by intention-to-treat and per-protocol according to self-reported adherence using negative binominal regression and multivariate analysis.ResultsITT analysis showed no significant difference between groups in subsequent falls, injurious falls and health service use. The per-protocol analyses revealed that the intervention participants who adhered to the recommended interventions had significantly lower rates of falls compared to non-adherers (IRR: 0.53 (95% CI : 0.32–0.87)).Conclusiona multidisciplinary intervention did not prevent falls in older people who received paramedic care but were not transported to ED. However the intervention was effective in those who adhered to the recommendations.Trial registrationthe trial is registered at the Australian New Zealand Clinical Trials Registry: ACTRN 12611000503921, 13/05/2011.
      PubDate: 2016-10-25
       
  • Timed Up and Go predicts functional decline in older patients presenting
           to the emergency department following minor trauma †
    • Authors: Eagles D; Perry JJ, Sirois M, et al.
      Abstract: AbstractBackgroundthere is no standardised test for assessing mobility in the Emergency Department (ED).Objectivewe wished to evaluate the relationship between the Timed Up and Go (TUG) and frailty, functional decline and falls in community dwelling elders that present to the ED following minor trauma.Methodsthis was a secondary analysis of a prospective cohort study conducted at eight Canadian hospitals. Evaluations included: TUG; Study of Osteoporotic Fractures Frailty Index; Older American Resources and Service Functional Scale; and self-reported falls. Of note, 3- and 6-month follow-up was conducted. Generalised linear model with log-binomial distribution was utilised. Relative risks (RR) and 95% CI were calculated.ResultsTUG scores were available for 911/2918 patients, mean age 76.2 (SD 7.8) and 57.9% female. There was an association between TUG scores and frailty (P
      PubDate: 2016-10-19
       
  • New institutionalisation following acute hospital admission: a
           retrospective cohort study
    • Authors: Harrison J; Garrido A, Rhynas SJ, et al.
      Abstract: AbstractBackgroundinstitutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition.Objectiveto characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment.Design and settinga retrospective cohort study of people admitted to a single large Scottish teaching hospital.Subjects100 individuals admitted to the acute hospital from home and discharged to a care home.Methodsa single researcher extracted data from ward-based case notes.Resultspeople discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14–231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reasons for the decision to admit to a care home. About 55% were in the acute hospital when the decision for a care home was made and 44% of that group were discharged directly from the acute hospital.Conclusionscare home admission from hospital is common and yet there are no established standards to support best practice. Decisions should involve the whole multidisciplinary team in partnership with patients and families. Documentation of assessment in the case notes is variable. We advocate the development of interdisciplinary standards to support the assessment of this vulnerable and complex group of patients.
      PubDate: 2016-10-15
       
  • Influences on diet quality in older age: the importance of social factors
    • Authors: Bloom I; Edwards M, Jameson KA, et al.
      Abstract: AbstractBackgroundpoor diet quality is common among older people, but little is known about influences on food choice, including the role of psychosocial factors at this age.Objectiveto identify psychosocial correlates of diet quality in a community-dwelling population of men and women aged 59–73 years; to describe relationships with change in diet quality over 10 years.DesignLongitudinal cohort, Hertfordshire Cohort Study (HCS).SubjectsHCS participants assessed at baseline (1998–2003: 1,048 men, 862 women); 183 men and 189 women re-assessed in 2011.Methodsdiet was assessed by administered food frequency questionnaire; diet scores were calculated to describe diet quality at baseline and follow-up. A range of psychosocial factors (social support, social network, participation in leisure activities, depression and anxiety, sense of control) were assessed by questionnaire.Resultsat baseline, better diet quality was related to a range of social factors, including increased confiding/emotional social support (men and women), practical support (men) and a larger social network (women) (all P < 0.05). For both men and women, greater participation in social and cognitive leisure activities was related to better diet quality (P < 0.005). There were few associations between measured psychosocial factors at baseline and change in diet score over 10 years, in the follow-up sub-group. However, greater participation in leisure activities, especially cognitive activities, at baseline was associated with smaller declines in diet quality over the 10-year follow-up period for both men (P = 0.017) and women (P = 0.014).Conclusionsin community-dwelling older adults, a range of social factors, that includes greater participation in leisure activities, were associated with diets of better quality.
      PubDate: 2016-10-15
       
  • Fixing the broken image of care homes, could a ‘care home innovation
           centre’ be the answer'
    • Authors: Hockley J; Harrison J, Watson J, et al.
      Abstract: AbstractThe UK has many excellent care homes that provide high-quality care for their residents; however, across the care home sector, there is a significant need for improvement. Even though the majority of care homes receive a rating of ‘good’ from regulators, still significant numbers are identified as requiring ‘improvement’ or are ‘inadequate’. Such findings resonate with the public perceptions of long-term care as a negative choice, to be avoided wherever possible—as well as impacting on the career choices of health and social care students. Projections of current demographics highlight that, within 10 years, the part of our population that will be growing the fastest will be those people older than 80 years old with the suggestion that spending on long-term care provision needs to rise from 0.6% of our Gross Domestic Product in 2002 to 0.96% by 2031. Teaching/research-based care homes have been developed in the USA, Canada, Norway, the Netherlands and Australia in response to scandals about care, and the shortage of trained geriatric healthcare staff. There is increasing evidence that such facilities help to reduce inappropriate hospital admissions, increase staff competency and bring increased enthusiasm about working in care homes and improve the quality of care. Is this something that the UK should think of developing' This commentary details the core goals of a Care Home Innovation Centre for training and research as a radical vision to change the culture and image of care homes, and help address this huge public health issue we face.
      PubDate: 2016-09-08
       
  • Self-rated health predicts decline in instrumental activities of daily
           living among high-functioning community-dwelling older people
    • Authors: Tomioka K; Kurumatani N, Hosoi H.
      Abstract: AbstractBackgroundself-rated health (SRH) is a strong predictor of mortality, but it is unclear if SRH independently predicts a decline in instrumental activities of daily living (IADL).Objectiveto verify whether SRH is an independent predictor of IADL decline.Designa population-based longitudinal cohort study.Settingtwo local municipalities in Nara, Japan.Subjectscommunity-dwelling older adults 65 years or older (2,638 males and 3,346 females) with independent IADL at baseline.MethodsSRH was assessed using a single-item measure. IADL was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Multiple logistic regressions were used to examine the association of SRH with IADL decline.Resultsduring the 3-year follow-up, 13.2% of males and 8.2% of females developed IADL decline. After adjusting for age, family, body mass index, economic situations, chronic diseases, alcohol, smoking, depression, cognitive functioning and ADL, poorer SHR was significantly associated with IADL decline in both genders. Compared with very good SRH, the odds ratios of good, poor and very poor were 1.69 (95% confidence interval: 1.14–2.51), 2.10 (1.25–3.55) and 3.11 (1.50–6.45) for males, and 0.88 (0.54–1.42), 2.08 (1.16–3.75) and 3.42 (1.57–7.42) for females, respectively. Significant associations were not affected by chronic diseases, cognitive functioning or ADL but observed only among subjects aged 65–74 or those without depression.Conclusionsthis study confirms that SRH is an independent predictor of IADL decline among non-disabled community-dwelling older adults. Our findings suggest that SRH is an effective tool for identifying older people with future risk for IADL decline, particularly among the young–old or those without depression.
      PubDate: 2016-09-08
       
 
 
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