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Publisher: Oxford University Press   (Total: 406 journals)

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Showing 1 - 200 of 406 Journals sorted alphabetically
ACS Symposium Series     Full-text available via subscription   (SJR: 0.189, CiteScore: 0)
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 5, SJR: 0.79, CiteScore: 2)
Adaptation     Hybrid Journal   (Followers: 9, SJR: 0.143, CiteScore: 0)
Advances in Nutrition     Hybrid Journal   (Followers: 53, SJR: 2.196, CiteScore: 5)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.434, CiteScore: 1)
Aesthetic Surgery J. Open Forum     Open Access  
African Affairs     Hybrid Journal   (Followers: 66, SJR: 1.869, CiteScore: 2)
Age and Ageing     Hybrid Journal   (Followers: 90, SJR: 1.989, CiteScore: 4)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 19, SJR: 1.376, CiteScore: 3)
American Entomologist     Full-text available via subscription   (Followers: 8)
American Historical Review     Hybrid Journal   (Followers: 169, SJR: 0.467, CiteScore: 1)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 44, SJR: 2.113, CiteScore: 3)
American J. of Clinical Nutrition     Hybrid Journal   (Followers: 174, SJR: 3.438, CiteScore: 6)
American J. of Epidemiology     Hybrid Journal   (Followers: 198, SJR: 2.713, CiteScore: 3)
American J. of Health-System Pharmacy     Full-text available via subscription   (Followers: 52, SJR: 0.595, CiteScore: 1)
American J. of Hypertension     Hybrid Journal   (Followers: 25, SJR: 1.322, CiteScore: 3)
American J. of Jurisprudence     Hybrid Journal   (Followers: 19, SJR: 0.281, CiteScore: 1)
American J. of Legal History     Full-text available via subscription   (Followers: 9, SJR: 0.116, CiteScore: 0)
American Law and Economics Review     Hybrid Journal   (Followers: 27, SJR: 1.053, CiteScore: 1)
American Literary History     Hybrid Journal   (Followers: 16, SJR: 0.391, CiteScore: 0)
Analysis     Hybrid Journal   (Followers: 22, SJR: 1.038, CiteScore: 1)
Animal Frontiers     Hybrid Journal   (Followers: 1)
Annals of Behavioral Medicine     Hybrid Journal   (Followers: 16, SJR: 1.423, CiteScore: 3)
Annals of Botany     Hybrid Journal   (Followers: 38, SJR: 1.721, CiteScore: 4)
Annals of Oncology     Hybrid Journal   (Followers: 56, SJR: 5.599, CiteScore: 9)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 10, SJR: 0.722, CiteScore: 1)
Annals of Work Exposures and Health     Hybrid Journal   (Followers: 34, SJR: 0.728, CiteScore: 2)
Antibody Therapeutics     Open Access  
AoB Plants     Open Access   (Followers: 4, SJR: 1.28, CiteScore: 3)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 17, SJR: 0.858, CiteScore: 2)
Applied Linguistics     Hybrid Journal   (Followers: 59, SJR: 2.987, CiteScore: 3)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 1.241, CiteScore: 1)
Arbitration Intl.     Full-text available via subscription   (Followers: 21)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 14)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 30, SJR: 0.731, CiteScore: 2)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 3)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 44, SJR: 0.146, CiteScore: 0)
Behavioral Ecology     Hybrid Journal   (Followers: 52, SJR: 1.871, CiteScore: 3)
Bioinformatics     Hybrid Journal   (Followers: 338, SJR: 6.14, CiteScore: 8)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 9, SJR: 1.446, CiteScore: 3)
Biometrika     Hybrid Journal   (Followers: 20, SJR: 3.485, CiteScore: 2)
BioScience     Hybrid Journal   (Followers: 29, SJR: 2.754, CiteScore: 4)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.146, CiteScore: 0)
Biostatistics     Hybrid Journal   (Followers: 17, SJR: 1.553, CiteScore: 2)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 186, SJR: 2.115, CiteScore: 3)
BJA Education     Hybrid Journal   (Followers: 65)
Brain     Hybrid Journal   (Followers: 68, SJR: 5.858, CiteScore: 7)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 50, SJR: 2.505, CiteScore: 5)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 3, SJR: 2.15, CiteScore: 3)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 36, SJR: 2.161, CiteScore: 2)
British J. of Aesthetics     Hybrid Journal   (Followers: 25, SJR: 0.508, CiteScore: 1)
British J. of Criminology     Hybrid Journal   (Followers: 605, SJR: 1.828, CiteScore: 3)
British J. of Social Work     Hybrid Journal   (Followers: 86, SJR: 1.019, CiteScore: 2)
British Medical Bulletin     Hybrid Journal   (Followers: 6, SJR: 1.355, CiteScore: 3)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 34)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 4, SJR: 1.376, CiteScore: 1)
Cambridge J. of Economics     Hybrid Journal   (Followers: 70, SJR: 0.764, CiteScore: 2)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 12, SJR: 2.438, CiteScore: 4)
Cambridge Quarterly     Hybrid Journal   (Followers: 10, SJR: 0.104, CiteScore: 0)
Capital Markets Law J.     Hybrid Journal   (Followers: 2, SJR: 0.222, CiteScore: 0)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.135, CiteScore: 5)
Cardiovascular Research     Hybrid Journal   (Followers: 14, SJR: 3.002, CiteScore: 5)
Cerebral Cortex     Hybrid Journal   (Followers: 47, SJR: 3.892, CiteScore: 6)
CESifo Economic Studies     Hybrid Journal   (Followers: 22, SJR: 0.483, CiteScore: 1)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.42, CiteScore: 3)
Children and Schools     Hybrid Journal   (Followers: 6, SJR: 0.246, CiteScore: 0)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 5, SJR: 0.412, CiteScore: 0)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 22, SJR: 0.329, CiteScore: 0)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 10, SJR: 1.392, CiteScore: 2)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 10, SJR: 0.183, CiteScore: 0)
Classical Receptions J.     Hybrid Journal   (Followers: 27, SJR: 0.123, CiteScore: 0)
Clean Energy     Open Access   (Followers: 1)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 69, SJR: 5.051, CiteScore: 5)
Communication Theory     Hybrid Journal   (Followers: 24, SJR: 2.424, CiteScore: 3)
Communication, Culture & Critique     Hybrid Journal   (Followers: 27, SJR: 0.222, CiteScore: 1)
Community Development J.     Hybrid Journal   (Followers: 27, SJR: 0.268, CiteScore: 1)
Computer J.     Hybrid Journal   (Followers: 9, SJR: 0.319, CiteScore: 1)
Conservation Physiology     Open Access   (Followers: 3, SJR: 1.818, CiteScore: 3)
Contemporary Women's Writing     Hybrid Journal   (Followers: 9, SJR: 0.121, CiteScore: 0)
Contributions to Political Economy     Hybrid Journal   (Followers: 6, SJR: 0.906, CiteScore: 1)
Critical Values     Full-text available via subscription  
Current Developments in Nutrition     Open Access   (Followers: 2)
Current Legal Problems     Hybrid Journal   (Followers: 29)
Current Zoology     Full-text available via subscription   (Followers: 3, SJR: 1.164, CiteScore: 2)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 8, SJR: 1.791, CiteScore: 3)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 14, SJR: 0.259, CiteScore: 1)
Diplomatic History     Hybrid Journal   (Followers: 21, SJR: 0.45, CiteScore: 1)
DNA Research     Open Access   (Followers: 5, SJR: 2.866, CiteScore: 6)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 4)
Early Music     Hybrid Journal   (Followers: 17, SJR: 0.139, CiteScore: 0)
Econometrics J.     Hybrid Journal   (Followers: 32, SJR: 2.926, CiteScore: 1)
Economic J.     Hybrid Journal   (Followers: 111, SJR: 5.161, CiteScore: 3)
Economic Policy     Hybrid Journal   (Followers: 46, SJR: 3.584, CiteScore: 3)
ELT J.     Hybrid Journal   (Followers: 24, SJR: 0.942, CiteScore: 1)
English Historical Review     Hybrid Journal   (Followers: 56, SJR: 0.612, CiteScore: 1)
English: J. of the English Association     Hybrid Journal   (Followers: 17, SJR: 0.1, CiteScore: 0)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.818, CiteScore: 2)
Environmental Epigenetics     Open Access   (Followers: 2)
Environmental History     Hybrid Journal   (Followers: 26, SJR: 0.408, CiteScore: 1)
EP-Europace     Hybrid Journal   (Followers: 3, SJR: 2.748, CiteScore: 4)
Epidemiologic Reviews     Hybrid Journal   (Followers: 9, SJR: 4.505, CiteScore: 8)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 19, SJR: 0.113, CiteScore: 0)
European Heart J.     Hybrid Journal   (Followers: 66, SJR: 9.315, CiteScore: 9)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 10, SJR: 3.625, CiteScore: 3)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 2)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. : Case Reports     Open Access  
European Heart J. Supplements     Hybrid Journal   (Followers: 8, SJR: 0.223, CiteScore: 0)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9, SJR: 1.681, CiteScore: 2)
European J. of Intl. Law     Hybrid Journal   (Followers: 199, SJR: 0.694, CiteScore: 1)
European J. of Orthodontics     Hybrid Journal   (Followers: 5, SJR: 1.279, CiteScore: 2)
European J. of Public Health     Hybrid Journal   (Followers: 20, SJR: 1.36, CiteScore: 2)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 10, SJR: 1.172, CiteScore: 2)
European Review of Economic History     Hybrid Journal   (Followers: 30, SJR: 0.702, CiteScore: 1)
European Sociological Review     Hybrid Journal   (Followers: 43, SJR: 2.728, CiteScore: 3)
Evolution, Medicine, and Public Health     Open Access   (Followers: 12)
Family Practice     Hybrid Journal   (Followers: 16, SJR: 1.018, CiteScore: 2)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 16, SJR: 1.492, CiteScore: 4)
Fems Microbiology Letters     Hybrid Journal   (Followers: 28, SJR: 0.79, CiteScore: 2)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 32, SJR: 7.063, CiteScore: 13)
Fems Yeast Research     Hybrid Journal   (Followers: 13, SJR: 1.308, CiteScore: 3)
Food Quality and Safety     Open Access   (Followers: 1)
Foreign Policy Analysis     Hybrid Journal   (Followers: 24, SJR: 1.425, CiteScore: 1)
Forest Science     Hybrid Journal   (Followers: 8, SJR: 0.89, CiteScore: 2)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 1.133, CiteScore: 3)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.104, CiteScore: 0)
French History     Hybrid Journal   (Followers: 33, SJR: 0.118, CiteScore: 0)
French Studies     Hybrid Journal   (Followers: 21, SJR: 0.148, CiteScore: 0)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.152, CiteScore: 0)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 16, SJR: 2.578, CiteScore: 4)
Geophysical J. Intl.     Hybrid Journal   (Followers: 39, SJR: 1.506, CiteScore: 3)
German History     Hybrid Journal   (Followers: 23, SJR: 0.161, CiteScore: 0)
GigaScience     Open Access   (Followers: 5, SJR: 5.022, CiteScore: 7)
Global Summitry     Hybrid Journal   (Followers: 1)
Glycobiology     Hybrid Journal   (Followers: 13, SJR: 1.493, CiteScore: 3)
Health and Social Work     Hybrid Journal   (Followers: 57, SJR: 0.388, CiteScore: 1)
Health Education Research     Hybrid Journal   (Followers: 16, SJR: 0.854, CiteScore: 2)
Health Policy and Planning     Hybrid Journal   (Followers: 24, SJR: 1.512, CiteScore: 2)
Health Promotion Intl.     Hybrid Journal   (Followers: 22, SJR: 0.812, CiteScore: 2)
History Workshop J.     Hybrid Journal   (Followers: 33, SJR: 1.278, CiteScore: 1)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 28, SJR: 0.105, CiteScore: 0)
Human Communication Research     Hybrid Journal   (Followers: 15, SJR: 2.146, CiteScore: 3)
Human Molecular Genetics     Hybrid Journal   (Followers: 9, SJR: 3.555, CiteScore: 5)
Human Reproduction     Hybrid Journal   (Followers: 72, SJR: 2.643, CiteScore: 5)
Human Reproduction Open     Open Access   (Followers: 1)
Human Reproduction Update     Hybrid Journal   (Followers: 20, SJR: 5.317, CiteScore: 10)
Human Rights Law Review     Hybrid Journal   (Followers: 62, SJR: 0.756, CiteScore: 1)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 58, SJR: 1.591, CiteScore: 3)
ICSID Review : Foreign Investment Law J.     Hybrid Journal   (Followers: 10)
ILAR J.     Hybrid Journal   (Followers: 2, SJR: 1.732, CiteScore: 4)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.679, CiteScore: 1)
IMA J. of Management Mathematics     Hybrid Journal   (SJR: 0.538, CiteScore: 1)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.496, CiteScore: 1)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 1.987, CiteScore: 2)
Industrial and Corporate Change     Hybrid Journal   (Followers: 9, SJR: 1.792, CiteScore: 2)
Industrial Law J.     Hybrid Journal   (Followers: 39, SJR: 0.249, CiteScore: 1)
Inflammatory Bowel Diseases     Hybrid Journal   (Followers: 47, SJR: 2.511, CiteScore: 4)
Information and Inference     Free  
Innovation in Aging     Open Access  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 9, SJR: 1.319, CiteScore: 2)
Integrative Biology     Full-text available via subscription   (Followers: 6, SJR: 1.36, CiteScore: 3)
Integrative Organismal Biology     Open Access  
Interacting with Computers     Hybrid Journal   (Followers: 11, SJR: 0.292, CiteScore: 1)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7, SJR: 0.762, CiteScore: 1)
Intl. Affairs     Hybrid Journal   (Followers: 66, SJR: 1.505, CiteScore: 3)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 26)
Intl. Health     Hybrid Journal   (Followers: 6, SJR: 0.851, CiteScore: 2)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 2.167, CiteScore: 4)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 36, SJR: 1.348, CiteScore: 2)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 64, SJR: 0.601, CiteScore: 1)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 247, SJR: 3.969, CiteScore: 5)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 5, SJR: 0.202, CiteScore: 1)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 28, SJR: 0.223, CiteScore: 1)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 10, SJR: 0.285, CiteScore: 1)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.403, CiteScore: 1)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.808, CiteScore: 4)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 11, SJR: 1.545, CiteScore: 1)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 38, SJR: 0.389, CiteScore: 1)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 11, SJR: 0.724, CiteScore: 2)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.168, CiteScore: 1)
Intl. Political Sociology     Hybrid Journal   (Followers: 40, SJR: 1.465, CiteScore: 3)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 23, SJR: 0.401, CiteScore: 1)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 9, SJR: 0.983, CiteScore: 1)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 49, SJR: 2.581, CiteScore: 2)
Intl. Studies Review     Hybrid Journal   (Followers: 25, SJR: 1.201, CiteScore: 1)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 2, SJR: 0.15, CiteScore: 0)
ITNOW     Hybrid Journal   (Followers: 1, SJR: 0.103, CiteScore: 0)
J. of African Economies     Hybrid Journal   (Followers: 17, SJR: 0.533, CiteScore: 1)
J. of American History     Hybrid Journal   (Followers: 46, SJR: 0.297, CiteScore: 1)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 14, SJR: 1.065, CiteScore: 2)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 15, SJR: 2.419, CiteScore: 4)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 5, SJR: 0.585, CiteScore: 1)
J. of Biochemistry     Hybrid Journal   (Followers: 41, SJR: 1.226, CiteScore: 2)
J. of Breast Imaging     Full-text available via subscription  
J. of Burn Care & Research     Hybrid Journal   (Followers: 10, SJR: 0.768, CiteScore: 2)

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Similar Journals
Journal Cover
Age and Ageing
Journal Prestige (SJR): 1.989
Citation Impact (citeScore): 4
Number of Followers: 90  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-0729 - ISSN (Online) 1468-2834
Published by Oxford University Press Homepage  [406 journals]
  • Editor’s view
    • Authors: Stott D.
      Pages: 163 - 164
      PubDate: Wed, 09 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy223
      Issue No: Vol. 48, No. 2 (2019)
  • List of Reviewers 2018
    • Pages: 165 - 166
      PubDate: Tue, 19 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz004
      Issue No: Vol. 48, No. 2 (2019)
  • Older men may benefit from antimicrobial prophylaxis for recurrent urinary
           tract infections
    • Authors: Mody L; Juthani-Mehta M.
      Pages: 167 - 168
      PubDate: Mon, 04 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy195
      Issue No: Vol. 48, No. 2 (2019)
  • Clinical research methods for studies of older people
    • Authors: Thake M; Stott D, Witham M.
      Pages: 169 - 170
      PubDate: Fri, 04 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy215
      Issue No: Vol. 48, No. 2 (2019)
  • Person-centred prophylaxis for venous thromboembolism
    • Authors: Donald I.
      Pages: 171 - 173
      Abstract: All medical admissions should receive risk assessment for the value of prophylaxis against venous thromboembolism. Unfortunately, for such patients the risk of thromboembolism is closely balanced with the risk of haemorrhage exaggerated by chemical prophylaxis. The recent NICE guideline continues to recommend comprehensive risk assessment, and to use prophylaxis where the risk of thromboembolism exceeds the risk of bleeding. The widely used Department of Health Risk Assessment Tool does not rank the risks of thromboembolism and bleeding, but NICE was unable to mandate another assessment tool fit for the purpose in the UK. Validated risk scores are used elsewhere, and could enable safer and better targeted prophylaxis, pending further research in the UK.
      PubDate: Mon, 07 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy190
      Issue No: Vol. 48, No. 2 (2019)
  • When is Alzheimer’s not dementia—Cochrane commentary on The National
           Institute on Ageing and Alzheimer’s Association Research Framework for
           Alzheimer’s Disease
    • Authors: McCleery J; Flicker L, Richard E, et al.
      Pages: 174 - 177
      Abstract: Early 2018 saw the release of new diagnostic guidance on Alzheimer’s disease from the National Institute on Ageing and the Alzheimer’s Association (NIA-AA). This proposed research framework represents a fundamental change in how we think about Alzheimer’s disease, moving from diagnosis based on clinical features to diagnosis based solely on biomarkers. These recommendations are contentious and have important implications for patients, clinicians, policy makers and the pharmaceutical industry. In this commentary, we offer a summary of the NIA-AA research framework. We then focus on five key areas: divorcing neuropathology from the clinical syndrome; the emphasis placed on one dementia subtype; validity of available biomarkers; the changing meaning of the term ‘Alzheimer’s disease’; and the potential for a research framework to influence clinical practice.
      PubDate: Tue, 19 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy167
      Issue No: Vol. 48, No. 2 (2019)
  • Effects of a falls prevention exercise programme on health-related quality
           of life in older home care recipients: a randomised controlled trial
    • Authors: Bjerk M; Brovold T, Skelton D, et al.
      Pages: 213 - 219
      Abstract: Backgroundfalls have serious consequences for quality of life (QOL) and contribute substantially to the global burden of disease. Home care is an important arena to address falls prevention and QOL, but this vulnerable group of older adults is underrepresented in health research. This study explores the effects of a falls prevention exercise programme on health-related quality of life (HRQOL), physical function and falls self-efficacy in older fallers receiving home care.Methodsthe study design is a parallel-group randomised controlled trial. The intervention group performed a falls prevention programme based on the Otago Exercise Programme (OEP). The control group received usual care. 155 participants were recruited from primary health care in six Norwegian municipalities. Local physiotherapists supervised the programme. The primary outcome, HRQOL, was measured by the Short-Form 36 Health Survey (SF-36). Secondary outcomes were Berg Balance Scale (BBS), 30-s sit to stand (STS), 4-m walk test, instrumental activities of daily living and Falls Efficacy Scale International.Resultsintention-to-treat analysis showed that, compared to the control group, the intervention group improved on SF-36’s physical component summary as well as BBS. However, the intervention group also demonstrated a decline in the mental health subscale of SF-36. Per-protocol analyses showed significant improvements in all physical subscales of SF-36, STS and BBS scores in the intervention group compared with the control group.Conclusiona falls prevention exercise programme based on OEP significantly improved physical HRQOL and balance in older adults receiving home care.Trial NCT02374307. First registration, 16 February 2015.
      PubDate: Mon, 07 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy192
      Issue No: Vol. 48, No. 2 (2019)
  • Relationship between HbA1c and all-cause mortality in older patients with
           insulin-treated type 2 diabetes: results of a large UK Cohort Study
    • Authors: Anyanwagu U; Mamza J, Donnelly R, et al.
      Pages: 235 - 240
      Abstract: Backgroundour aim was to study the relationship between HbA1c and cardiovascular morbidity and all-cause mortality among older insulin-treated patients with type 2 diabetes (T2D) after adjustment for multiple confounders.Methodsdata for 4589 adults with T2D (>65 years) on insulin treatment were sourced from 532 UK General Practices via the Health Improvement Network (THIN) database. Cox proportional hazard models and Kaplan–Meier estimators were fitted to derive the hazards of all-cause mortality by HbA1c categories (<6.5, 6.5–7.4, 7.5–8.4, 8.5–9.4, 9.5–10.4, 10.5–11.4%; and 11.5% and above) after 5 years of follow-up following insulin initiation.Resultswe observed a U-shaped relationship between all-cause mortality and HbA1c, with the lowest risk seen in the HbA1c range of 6.5–7.4% and marked increased in risk with HbA1c > 11%. The highest mortality risks of 31 and 40% were significantly associated with the lowest (<6.5%) and highest (11.5% and above) HbA1c categories: aHR: 1.31; (95%CI: 1.10–1.56; P = 0.002) and aHR: 1.40; (95%CI: 1.01–1.96; P = 0.039), respectively.Conclusionsboth low and high HbA1c were associated with increased all-cause mortality, among older patients with insulin-treated T2D. This cohort study supports the need for individualisation of care and suggests better outcomes with HbA1c levels around 6.5–7.4% and markedly excess risk with HbA1c > 11%
      PubDate: Mon, 07 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy178
      Issue No: Vol. 48, No. 2 (2019)
  • Lifetime physical activity and late-life cognitive function: the Rancho
           Bernardo study
    • Authors: Reas E; Laughlin G, Bergstrom J, et al.
      Pages: 241 - 246
      Abstract: Backgroundphysical activity in older age has been associated with better cognitive function, but the role of earlier life physical activity is less well understood.Objectivedetermine associations between physical activity throughout the lifespan and cognitive function in older age.Designcross-sectional study.Settingthe Rancho Bernardo Study of Healthy Aging in southern California.SubjectsA total of 1,826 community-dwelling men and women (60–99 years) who attended a research visit in 1988–92.Methodsparticipants underwent cognitive testing at older age, and reported physical activity as a teenager, at age 30 years, 50 years and currently. For each time-point, participants were classified as regularly active (3+ times/week) or inactive.Resultsregular physical activity was associated with better cognitive function, with physical activity at older ages showing the strongest associations. Physical activity in older age was associated with better global cognitive function, executive function and episodic memory, regardless of intensity. Intense physical activity in teenage years was associated with better late-life global cognitive function in women. Teenage physical activity interacted with older age physical activity on executive function; those active at both periods performed better than those active at only one period. Similar patterns of associations were observed after excluding individuals with poor health.Conclusionsregular physical activity in older age, regardless of intensity, is associated with better cognitive function. Physical activity in teenage years may enhance cognitive reserve to protect against age-related decline in executive function. Further research is needed to assess the effect of physical activity across the lifespan on healthy brain ageing.
      PubDate: Mon, 07 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy188
      Issue No: Vol. 48, No. 2 (2019)
  • Adiposity in middle and old age and risk of death from dementia: 40-year
           follow-up of 19,000 men in the Whitehall study
    • Authors: Allen A; Clarke R, Shipley M, et al.
      Pages: 247 - 253
      Abstract: Aims and objectivesto examine the hypothesis that obesity is protective for dementia, we compared the associations of death from dementia with body weight and body mass index (BMI) in both middle and old age.Designheight and weight were measured in a prospective study of 19,019 middle-aged men in the Whitehall study in 1967–70 and in 6,158 surviving participants at resurvey in 1997. Cox regression was used to examine the associations of death from dementia over a 40-year period with weight or BMI measured by health professionals in middle and old age adjusting for age, smoking habits, employment grade and marital status.Settingcentral government employees in London, UK.Main outcomes measuredeath due to dementia in 320 participants.Resultsbody weight measured in middle age was weakly inversely associated with death from dementia (hazard ratio 0.98 [95%CI: 0.97–0.99] per kg), but neither height nor BMI were related to risk of dementia. In contrast, body weight in old age was more strongly inversely related to deaths from dementia (0.96; [0.95–0.98] per kg) as was BMI (0.92 [0.86–0.97] per kg/m2). Weight loss over the 30 years between baseline and resurvey was associated with a higher risk of death from dementia, with an adjusted HR per kg/30 years of 1.04 [95%CI: 1.02–1.08] and the association with loss of BMI was even stronger (adjusted HR of 1.10 [1.03–1.19]) per kg/m2 decrease.Conclusionsthe stronger inverse associations of deaths from dementia with BMI in old age, compared with middle age, together with strong positive associations of loss of BMI or body weight between middle and old age casts doubt on previous suggestions that obesity protects against death from dementia.
      PubDate: Wed, 09 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy182
      Issue No: Vol. 48, No. 2 (2019)
  • Subjective memory complaints and incident dementia in a high risk older
           adult hypertensive population
    • Authors: Peters R; Beckett N, Antikainen R, et al.
      Pages: 253 - 259
      Abstract: Backgroundthere is a growing body of evidence demonstrating an association between subjective memory complaints (SMC) and an increased risk of incident cognitive decline or dementia. To date this has not been examined in hypertensive older adults, a prevalent and growing population group at high risk of cognitive decline.Methodsusing data from participants in the Hypertension in the Very Elderly Trial cohort the association between baseline SMC and incident cognitive decline and dementia was examined using Cox proportional hazard regression. Cognitive function was assessed using the Mini-Mental State Exam and diagnoses of dementia were made using standard diagnostic criteria. SMC was assessed by the question ‘do you feel that you have more problems with memory than most'’ Analyses were rerun to examine the associations by level of baseline cognitive function, to evaluate the role of SMC by dementia type and by sex.Resultsbaseline SMC were associated with an increased risk of developing any dementia (hazard ratio (HR)1.63 (95% confidence intervals (CI): 1.18:2.25)), Alzheimer’s disease (HR1.59 (95% CI: 1.08:2.34)) and vascular dementia (HR2.05 (95% CI: 1.19:3.54)). Similar patterns were seen across all levels of baseline MMSE but were strongest in those with scores of 25–27. There were no clear differences by sex.Discussiona positive report of SMC assessed by a single question in an older adult with hypertension raises the possibility of increased risk of incident dementia. As such its use may be a useful addition to the repertoire of the general practitioner and geriatrician when assessing older adults.
      PubDate: Mon, 07 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy193
      Issue No: Vol. 48, No. 2 (2019)
  • Regaining pre-fracture basic mobility status after hip fracture and
           association with post-discharge mortality and readmission—a nationwide
           register study in Denmark
    • Authors: Kristensen M; Öztürk B, Röck N, et al.
      Pages: 278 - 284
      Abstract: Backgroundearly mobilization after hip fracture (HF) is an important predictor of outcome, but knowledge of the consequences of not achieving the pre-fracture basic mobility status in acute hospital recovery is sparse.Objectivewe examined whether the regain of pre-fracture basic mobility status evaluated with the cumulated ambulation score (CAS) at hospital discharge was associated with 30-day post-discharge mortality and readmission.Designthis is a population-based cohort study.Measuresusing the nationwide Danish Multidisciplinary HF Database from January 2015 through December 2015, 5,147 patients 65 years or older undergoing surgery for a first-time HF were included. The pre-fracture and discharge CAS score (0–6 points with six points indicating an independent basic mobility status) were recorded. CAS was dichotomized as regained or not and entered into adjusted Cox regression overall analysis and stratified by sex, age, body mass index, Charlson comorbidity index, type of fracture, residential status and length of acute hospital stay. Outcome measures were 30-day post-discharge mortality and readmission.Resultsoverall mortality and readmission were 8.3% (n = 425) and 17.1% (n = 882), respectively. Mortality was 3.5% (n = 71) among patients who regained their pre-fracture CAS score compared with 11.4% (n = 354) among those who did not. Adjusted hazard ratios for 30-day mortality and readmission were 2.76 (95% confidence interval [CI] = 2.01–3.78) and 1.26 (95% CI = 1.07, 1.48), respectively, for patients who did not regain their pre-fracture CAS compared with those who did.Conclusionswe found that the loss of pre-fracture basic mobility level upon acute hospital discharge was associated with increased 30-day post-discharge mortality and readmission after a first time HF.
      PubDate: Mon, 07 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy185
      Issue No: Vol. 48, No. 2 (2019)
  • The use of an electronic health record system reduces errors in the
           National Hip Fracture Database
    • Authors: Lawrence J; Cundall-Curry D, Stewart M, et al.
      Pages: 285 - 290
      Abstract: Aimto compare the validity of data submitted from a UK level 1 trauma centre to the National Hip Fracture Database (NHFD) before and after the introduction of an electronic health record system (EHRS).Patients and methodsa total of 3224 records were reviewed from July 2009 to July 2017. 2,133 were submitted between July 2009 and October 2014 and 1,091 between October 2014 and July 2017, representing data submitted before and after the introduction of the EHRS, respectively. Data submitted to the NHFD were scrutinised against locally held data.Resultsuse of an EHRS was associated with significant reductions in NHFD errors. The operation coding error rate fell significantly from 23.2% (494/2133) to 7.6% (83/1091); P < 0.001. Prior to EHRS introduction, of the 109 deaths recorded in the NHFD, 64 (59%) were incorrect. In the EHRS dataset, all the 112 recorded deaths were correct (P < 0.001). There was no significant difference in the error rate for fracture coding. In the EHRS dataset, after controlling for sample month, entries utilising an operation note template with mandatory fields relevant to NHFD data were more likely to be error free than those not using the template (OR 2.69; 95% CI 1.92–3.78).Conclusionthis study highlights a potential benefit of EHR systems, which offer automated data collection for auditing purposes. However, errors in data submitted to the NHFD remain, particularly in cases where an NHFD-specific operation note template is not used. Clinician engagement with new technologies is vital to avoid human error and ensure database integrity.
      PubDate: Tue, 19 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy177
      Issue No: Vol. 48, No. 2 (2019)
  • Experiences with and outcomes of Advance Care Planning in bereaved
           relatives of frail older patients: a mixed methods study
    • Authors: Overbeek A; Korfage I, Hammes B, et al.
      Pages: 299 - 306
      Abstract: BackgroundAdvance Care Planning (ACP) may prepare relatives of frail older patients for future decision-making.Objectiveto investigate (1) how bereaved relatives of frail older patients experience ACP conversations and (2) whether ACP has an effect on relatives’ preparation for decision-making and on their levels of anxiety and depression.Designcluster randomised controlled trial.Settingresidential care homes in the Netherlands and community setting.Subjectsbereaved relatives of care home residents and community-dwelling frail older patients.Methodswe randomised 16 residential care homes to either the intervention group, where patient-participants were offered facilitated ACP, or the control group (n = 201), where they received ‘care as usual’. If patient-participants died, we approached relatives for an interview. We asked relatives who had attended ACP conversations for their experience with ACP (open-ended questions). Furthermore, we compared relatives’ preparation levels for decision-making and levels of anxiety and depression (HADS) between groups. This trial was registered (NTR4454).Resultswe conducted interviews with 39/51 (76%) bereaved relatives (intervention group: n = 20, control group: n = 19). Relatives appreciated the ACP conversations. A few considered ACP redundant since they were already aware of the patients’ preferences. Nine of 10 relatives in the intervention group felt adequately prepared for decision-making as compared to 5 of 11 relatives in the control group (P = 0.03). Relatives’ levels of anxiety and depression did not differ significantly between groups.Conclusionsin our study, bereaved relatives of frail older patients appreciated ACP. ACP positively affected preparedness for decision-making. It did not significantly affect levels of anxiety or depression.
      PubDate: Mon, 07 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy184
      Issue No: Vol. 48, No. 2 (2019)
  • Expression of concernEffect of immobilization on vitamin D status and bone
           mass in chronically hospitalized disabled stroke patients
    • Authors: Sato Y; Kuno H, Asoh T, et al.
      Pages: 312 - 312
      PubDate: Tue, 05 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy221
      Issue No: Vol. 48, No. 2 (2019)
  • Age and Ageing to introduce a new category of paper: healthcare
           improvement science
    • Authors: Parker S; Downes T, Godfrey M, et al.
      Pages: 178 - 184
      Abstract: Age and Ageing is now inviting papers on healthcare improvement for older people. In this article we outline the nature and scope of healthcare improvement and reference improvement models and the tools and methods of improvement science. We emphasise the issues of sustainability, including scale and spread; evaluation – including associated ethical consideration and the involvement of patients and the public in healthcare improvement and associated research. Throughout we refer to resources the authors have found useful in their own work, and provide a bibliography of sources and web-links which will provide essential guidance and support for potential contributors to this new category of submission to Age and Ageing.
      PubDate: Mon, 05 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy175
      Issue No: Vol. 48, No. 2 (2018)
  • Interventions to improve adherence to exercise therapy for falls
           prevention in community-dwelling older adults: systematic review and
    • Authors: Hughes K; Salmon N, Galvin R, et al.
      Pages: 185 - 195
      Abstract: Backgroundexercise therapy is highly recommended for falls prevention in older adults; however, poor exercise adherence may limit treatment effectiveness.Objectiveto assess the effectiveness of interventions to improve exercise adherence for community-dwelling adults (aged over 65 years), at risk of falling.Methodseight databases were searched to identify randomised/quasi-randomised trials. The Capability, Opportunity, Motivation model of behaviour (COM-B) was used to categorise the identified adherence interventions. Studies with similar interventions that provided adherence outcome data per group were analysed to establish pooled intervention effect. Protocol registration with Propsero: (CRD42016033677).Resultsof the 20 trials included (n = 4419), five provided data per group for adherence outcome. Meta-analysis of four studies (n = 482), containing interventions exploring the way exercise is delivered, demonstrated significantly better adherence in the intervention group (n = 166 experimental, n = 161 control Fixed effects model (FEM), SMD = 0.48 95% CI [0.26–0.70] P < 0.0001 I2 = 0%, very low GRADE evidence). Within this limited evidence base, interventions using telecommunication and the integration of exercise into activities of daily living appear most promising when delivering exercise at home. Meta-analysis to explore the effect that these interventions to improve adherence had on balance (n = 166 experimental, n = 161 control Random-effects model (REM), SMD = 0.82, 95% CI [−1.20–2.84] P = 0.43 I2 = 52%) and gait (n = 59 experimental, n = 56 control REM, SMD = 0.29, 95% CI [−1.62–2.20] P = 0.77 I2 = 48%), found no statistically significant effect.Conclusionsadherence to exercise can be positively influenced; however, insufficient data exists to support any single intervention that also achieves effective outcomes for balance and gait.
      PubDate: Wed, 24 Oct 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy164
      Issue No: Vol. 48, No. 2 (2018)
  • Management of atrial fibrillation for older people with frailty: a
           systematic review and meta-analysis
    • Authors: Wilkinson C; Todd O, Clegg A, et al.
      Pages: 196 - 203
      Abstract: Backgrounddespite a large and growing population of older people with frailty and atrial fibrillation (AF), there is a lack of guidance on optimal AF management in this high-risk group.Objectiveto synthesise the existing evidence base on the association between frailty, AF and clinical outcomes.Methodsa systematic review of studies examining the association between validated measures of frailty, AF and clinical outcomes, and meta-analysis of the association between frailty and oral anticoagulation (OAC) prescription.Resultstwenty studies (30,883 patients) were included, all observational. Fifteen were in hospital, four in the community, one in nursing care. Risk of bias was low-to-moderate. AF prevalence was 3%–38%. In people with AF, frailty was associated with increased stroke incidence, all-cause mortality, symptom severity and length of hospital stay.Meta-analysis of six studies showed frailty was associated with decreased OAC prescription at hospital admission (pooled adjusted OR 0.45 [95%CI 0.22–0.93], three studies), but not at discharge (pooled adjusted OR 0.40 [95%CI 0.13–1.23], three studies). A community-based study showed increased OAC prescription associated with frailty (OR 2.33 [95%CI 1.03–5.23]).Conclusionfrailty is common, and associated with adverse clinical outcomes in patients with AF. There is evidence of an association between frailty status and OAC prescription, with different direction of effect in community compared with hospital cohorts. Despite the majority of care for older people being provided in the community, there is a lack of evidence on the association between frailty, AF, anticoagulation and clinical outcomes to guide optimal care in this setting.
      PubDate: Thu, 15 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy180
      Issue No: Vol. 48, No. 2 (2018)
  • The prevalence of non-communicable disease in older people in prison: a
           systematic review and meta-analysis
    • Authors: Munday D; Leaman J, O’Moore É, et al.
      Pages: 204 - 212
      Abstract: Backgroundpeople in prison often experience poor health. Those aged 50 and over are the fastest growing age-group in prison and present particular challenges to criminal justice systems around the world. Non-communicable diseases (NCDs) account for two-thirds of deaths globally and no estimate of the prevalence of NCDs in this vulnerable population exists.Methodswe searched PubMed, Medline, CINAHL, EMBASE and Global Health databases to identify original research papers that met our pre-defined inclusion criteria. No date or language restrictions were applied. Two authors undertook full-text screening as well as quality assessment and data extraction for all included studies. A random effects model was used to calculate pooled prevalence of any disease that was reported in two or more articles.Resultsthe initial search identified 2,712 articles. 119 underwent full-text screening with 26 meeting the inclusion criteria. This provided prevalence data on 28 NCDs in 93,862 individuals from prisons in 11 countries. Pooled prevalence for the most significant NCDs was a follows; cancer 8% (95% CI 6–10%), cardiovascular disease 38% (95% CI 33–42%), hypertension 39% (95% CI 32–47%), diabetes 14% (95% CI 12–16%), COPD prevalence estimates ranged from 4% to 18%. Heterogeneity across studies was high.Conclusionsthose in prison over 50 years of age experience a high burden of NCDs which is often higher than younger prison and age-matched community peers. This health inequality is influenced by lifestyle, environmental and societal factors. Prison services should be adapted to serve the needs of this growing population.
      PubDate: Thu, 27 Dec 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy186
      Issue No: Vol. 48, No. 2 (2018)
  • Effects of exercise and nutrition supplementation in community-dwelling
           older Chinese people with sarcopenia: a randomized controlled trial
    • Authors: Zhu L; Chan R, Kwok T, et al.
      Pages: 220 - 228
      Abstract: BackgroundLimited trials examining the effect of exercise and nutrition supplementation in older people with sarcopenia are available.Objectivesto assess the impact of resistance exercise program targeting muscle strength and power with and without nutrition supplementation on gait speed, body composition, physical function and quality of life.Methodsthis trial randomized 113 community-dwelling older Chinese adults aged ≥65 and with sarcopenia defined using the Asian Criteria into one of the three groups: exercise program alone, combined-exercise program and nutrition supplement or waitlist control. The exercise program consisted of 90-min group training twice weekly and one-home session weekly for 12 weeks. Participants in the combined group were additionally asked to consume nutrition supplement twice daily for 12 weeks. Both groups were encouraged to keep home exercise after intervention period for another 12 weeks to detect sustained effect. The primary outcome was gait speed.Resultsat 12 and 24 weeks, gait speed did not differ significantly between groups. Significant improvement in leg extension, and five-chair stand test occurred in both intervention groups that persisted to 24 weeks. Physical Activity Scale for the Elderly improved in both intervention groups that persisted until 24 weeks only in the combined group. Lower limb muscle and appendicular skeletal muscle mass increased significantly in the combined group but the increase was not sustained to 24 weeks.Conclusionthe exercise program with and without nutrition supplementation had no significant effect on the primary outcome of gait speed but improved the secondary outcomes of strength and the five-chair stand test in community-dwelling Chinese sarcopenic older identifierNCT02374268.
      PubDate: Wed, 14 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy179
      Issue No: Vol. 48, No. 2 (2018)
  • Antibiotic prophylaxis and clinical outcomes among older adults with
           recurrent urinary tract infection: cohort study
    • Authors: Ahmed H; Farewell D, Jones H, et al.
      Pages: 228 - 234
      Abstract: Backgroundclinical guidelines recommend antibiotic prophylaxis for preventing recurrent urinary tract infections (UTIs), but there is little evidence for their effectiveness in older adults.Methodsthis was a retrospective cohort study of health records from 19,696 adults aged ≥65 with recurrent UTIs. We used prescription records to ascertain ≥3 months’ prophylaxis with trimethoprim, cefalexin or nitrofurantoin. We used random effects Cox recurrent event models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for risks of clinical recurrence (primary outcome), acute antibiotic prescribing and hospitalisation.Resultsof 4,043 men and 15,653 women aged ≥65 with recurrent UTIs, 508 men (12.6%) and 2,229 women (14.2%) were prescribed antibiotic prophylaxis. In men, prophylaxis was associated with a reduced risk of clinical recurrence (HR, 0.49; 95% CI, 0.45–0.54), acute antibiotic prescribing (HR, 0.54; 95% CI, 0.51–0.57) and UTI-related hospitalisation (HR, 0.78; 95% CI, 0.64–0.94). In women, prophylaxis was also associated with a reduced risk of clinical recurrence (HR, 0.57; 95% CI, 0.55–0.59) and acute antibiotic prescribing (HR, 0.61; 95% CI, 0.59–0.62), but estimates of the risk of UTI-related hospitalisation were inconsistent between our main analysis (HR, 1.16; 95% CI, 1.05–1.28) and sensitivity analysis (HR, 0.82; 95% CI, 0.72–0.94).Conclusionsantibiotic prophylaxis was associated with lower rates of UTI recurrence and acute antibiotic prescribing in older adults. To fully understand the benefits and harms of prophylaxis, further research should determine the frequency of antibiotic-related adverse events and the impact on antimicrobial resistance and quality of life.
      PubDate: Tue, 28 Aug 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy146
      Issue No: Vol. 48, No. 2 (2018)
  • The development of a Core Outcome Set for medicines management
           interventions for people with dementia in primary care
    • Authors: McGrattan M; Barry H, Ryan C, et al.
      Pages: 260 - 266
      Abstract: Backgroundpeople with dementia (PWD), and their carers, face challenges with medicines management activities. As interventions to support medicines management for PWD are developed, consideration must be given to the outcomes chosen to measure their effectiveness. A Core Outcome Set (COS) is a minimum set of outcomes to be measured in all trials in a particular clinical area, which seeks to reduce heterogeneity of outcome reporting across trials.Objectiveto develop a COS for trials assessing the effectiveness of medicines management interventions for PWD in primary care.Methodsa comprehensive list of outcomes was compiled through a systematic review and semi-structured interviews with PWD (n = 18), their carers (n = 15), community pharmacists (n = 15) and general practitioners (n = 15). These outcomes were rated by a Delphi panel (n = 52) on a nine-point Likert scale from 1 (limited importance) to 9 (critical) during three sequential rounds of questionnaire distribution. The Delphi panel comprised participants with expertise in dementia and medicines management, including academics and healthcare professionals. An outcome was eligible for inclusion in the COS if ≥70% of participants rated it critical and <15% of participants rated it of limited importance.Resultstwenty-nine outcomes identified from the systematic review and stakeholder interviews were presented to the Delphi panel. Consensus was reached on 21 outcomes, of which the 7 most highly rated were recommended for inclusion in the COS.Conclusionthis study used robust methodology to develop a COS for medicines management interventions for PWD. Future work should identify the most appropriate tools to measure these outcomes.
      PubDate: Mon, 05 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy172
      Issue No: Vol. 48, No. 2 (2018)
  • Is retirement associated with physical health benefits' A longitudinal
           investigation with older New Zealanders
    • Authors: Szabó Á; Allen J, Stephens C, et al.
      Pages: 267 - 272
      Abstract: Objectivesthe impact of retirement on physical health is an important focus of ageing research; however, research findings vary greatly. To investigate under what conditions retirement might benefit health, we examined physical functioning 8 years pre- and post-retirement.Methodsusing longitudinal data from the New Zealand Health, Work and Retirement Study, multiple linear trajectories of physical functioning were estimated. Growth mixture analysis indicated three distinct trajectory profiles.ResultsProfile 1 displayed good but declining physical functioning from 8 years pre-retirement until retirement, which continued to decline more slowly post-retirement. Profile 2 was characterised by poor and declining physical functioning pre-retirement that improved post-retirement. Profile 3 displayed good and stable physical functioning pre-retirement and a slow decline post-retirement. Significant differences were identified across profiles in smoking behaviour, pre-existing chronic conditions, marital status and educational level. Profile 2 also showed increased economic living standards post-retirement.Discussionfindings indicate that retirement can be beneficial for those with poor health and limited resources. For the wealthy and healthy, retirement does not necessarily advantage health. Universal superannuation initiatives may partly address inequalities experienced by older persons in poor health and socio-economic circumstances prior to retirement.
      PubDate: Wed, 31 Oct 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy176
      Issue No: Vol. 48, No. 2 (2018)
  • The electronic frailty index as an indicator of community healthcare
           service utilisation in the older population
    • Authors: Boyd P; Nevard M, Ford J, et al.
      Pages: 273 - 277
      Abstract: Backgroundolder people with frailty are particularly high users of healthcare services, however a lack of standardised recording of frailty in different healthcare electronic datasets has limited investigations into healthcare service usage and demand of the older frail population.Objectivesto investigate the community service demand of frail patients using the electronic frailty index (eFI) as a measure of frailty.Study design and settinga retrospective cohort study using anonymised linked healthcare patient data from primary care, community services and acute hospitals in Norfolk.Participantspatients aged 65 and over who had an eFI assessment score established in their primary care electronic patient record in Norwich based General Practices.Resultswe include data from 22,859 patients with an eFI score. Frailty severity increased with age and was associated with increased acute hospital admission within a 6-month window. Patients with a frail eFI score were also more likely to have a community service referral within a 6-month window of frailty assessment, with a RR of 1.84 (1.76–1.93) for mild frailty, 1.96 (1.83–2.09) for moderate frailty and 2.95 (2.76–3.14) for severe frailty scores. We also found that frail patients had more community referrals per patient then those classified as fit and required more care plans per community referral.ConclusionseFI score was an indicator of community service use, with increasing severity of frailty being associated with higher community healthcare requirements. The eFI may help planning of community services for the frail population.
      PubDate: Thu, 27 Dec 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy181
      Issue No: Vol. 48, No. 2 (2018)
  • European postgraduate curriculum in geriatric medicine developed using an
           international modified Delphi technique
    • Authors: Roller-Wirnsberger R; Masud T, Vassallo M, et al.
      Pages: 291 - 299
      Abstract: Backgroundthe European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations.Methodsunder the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators.Resultsthe final recommendations include four different domains: ‘General Considerations’ on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), ‘Knowledge in patient care’ (36 sub-items), ‘Additional Skills and Attitude required for a Geriatrician’ (9 sub-items) and a domain on ‘Assessment of postgraduate education: which items are important for the transnational comparison process’ (1 item).Conclusionthe current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.
      PubDate: Tue, 13 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy173
      Issue No: Vol. 48, No. 2 (2018)
  • Hereditary haemorrhagic telangiectasia with multiple complications
           presenting in an older patient
    • Authors: Abdulla Kyzy R; Durojaiye V, Walsh J.
      Pages: 307 - 309
      Abstract: Hereditary haemorrhagic telangiectasia (HHT) is a rare autosomal dominant multi-organ vascular disorder associated with bleeding and a reduced life expectancy. We present a 91-year-old woman with complications of previously undiagnosed HHT. This case demonstrates three potential complications: pulmonary arteriovenous malformation (AVM) resulting in a right to left shunt, cerebral infarctions and pericardial effusion. Despite these potentially life-threatening complications and the reduced life-expectancy associated with HHT the patient has survived to an advanced age. Due to the patient’s late diagnosis and frailty, the treatment options of AVM embolization and pericardiocentesis were deemed inappropriate. The patient was treated with tranexamic acid to reduce bleeding severity and discharged home with a care package and home oxygen.
      PubDate: Fri, 05 Oct 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy160
      Issue No: Vol. 48, No. 2 (2018)
  • Oesophageal ulcer due to a herbal remedy
    • Authors: Naous J; Saab B, Abou Hamdan T.
      Pages: 309 - 311
      Abstract: Herbal-induced oesophageal lesions are rare. We report the case of an 85-year-old male who presented with cough and odynophagia. An upper endoscopy showed white deposit under the proximal oesophageal sphincter. Biopsy of the lesion revealed an oesophageal ulcer with adherent plant material and ruled-out candidiasis. At this point, the patient divulged self-preparation of an herbal remedy consisting of Aloe Vera pulp, whisky, honey, ginger and turmeric. Aloe Vera, ginger and turmeric are commonly used to sooth some gastroenterological symptoms in Complementary and Alternative Medicine. Incorrect extraction of Aloe Vera pulp and adding honey to it transformed the recipe into a sticky paste that may have injured the oesophageal mucosa. Follow-up showed that the cough and odynophagia subsided after discontinuing this herbal remedy.
      PubDate: Mon, 29 Oct 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy174
      Issue No: Vol. 48, No. 2 (2018)
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