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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   (Followers: 1, 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: 54, 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: 18, SJR: 1.376, CiteScore: 3)
American Entomologist     Full-text available via subscription   (Followers: 8)
American Historical Review     Hybrid Journal   (Followers: 179, 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: 187, SJR: 3.438, CiteScore: 6)
American J. of Epidemiology     Hybrid Journal   (Followers: 195, SJR: 2.713, CiteScore: 3)
American J. of Health-System Pharmacy     Full-text available via subscription   (Followers: 55, SJR: 0.595, CiteScore: 1)
American J. of Hypertension     Hybrid Journal   (Followers: 26, 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: 28, SJR: 1.053, CiteScore: 1)
American Literary History     Hybrid Journal   (Followers: 17, SJR: 0.391, CiteScore: 0)
Analysis     Hybrid Journal   (Followers: 23, 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: 55, SJR: 5.599, CiteScore: 9)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 11, 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: 60, 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: 53, SJR: 1.871, CiteScore: 3)
Bioinformatics     Hybrid Journal   (Followers: 347, SJR: 6.14, CiteScore: 8)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 10, 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: 2, SJR: 0.146, CiteScore: 0)
Biostatistics     Hybrid Journal   (Followers: 17, SJR: 1.553, CiteScore: 2)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 188, SJR: 2.115, CiteScore: 3)
BJA Education     Hybrid Journal   (Followers: 66)
Brain     Hybrid Journal   (Followers: 70, SJR: 5.858, CiteScore: 7)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 49, 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: 38, 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: 603, 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: 35)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 4, SJR: 1.376, CiteScore: 1)
Cambridge J. of Economics     Hybrid Journal   (Followers: 71, 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: 52, SJR: 3.892, CiteScore: 6)
CESifo Economic Studies     Hybrid Journal   (Followers: 23, 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: 23, 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: 70, SJR: 5.051, CiteScore: 5)
Communication Theory     Hybrid Journal   (Followers: 25, SJR: 2.424, CiteScore: 3)
Communication, Culture & Critique     Hybrid Journal   (Followers: 28, 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: 3)
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: 9, 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: 116, SJR: 5.161, CiteScore: 3)
Economic Policy     Hybrid Journal   (Followers: 48, 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: 18, 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: 20, 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: 205, 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: 19, 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: 15, 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: 33, SJR: 7.063, CiteScore: 13)
Fems Yeast Research     Hybrid Journal   (Followers: 14, 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: 34, 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: 3)
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: 6, 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: 15, 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: 75, SJR: 2.643, CiteScore: 5)
Human Reproduction Open     Open Access   (Followers: 1)
Human Reproduction Update     Hybrid Journal   (Followers: 21, SJR: 5.317, CiteScore: 10)
Human Rights Law Review     Hybrid Journal   (Followers: 64, 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: 11)
ILAR J.     Hybrid Journal   (Followers: 3, 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: 10, SJR: 1.792, CiteScore: 2)
Industrial Law J.     Hybrid Journal   (Followers: 41, 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: 68, SJR: 1.505, CiteScore: 3)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 27)
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: 65, SJR: 0.601, CiteScore: 1)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 260, 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: 39, 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: 24, SJR: 0.401, CiteScore: 1)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 9, SJR: 0.983, CiteScore: 1)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 50, 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   (Followers: 1)
J. of Burn Care & Research     Hybrid Journal   (Followers: 11, 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]
  • Welcome message from the new Editor-in-chief, Prof Rowan Harwood
    • Authors: Harwood R.
      Pages: 313 - 313
      PubDate: Tue, 26 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz017
      Issue No: Vol. 48, No. 3 (2019)
       
  • Co-morbidities in dementia: time to focus more on assessing and managing
           co-morbidities
    • Authors: Subramaniam H.
      Pages: 314 - 315
      PubDate: Thu, 28 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz007
      Issue No: Vol. 48, No. 3 (2019)
       
  • Growing research in geriatric medicine
    • Authors: Witham M; Roberts H, Gladman J, et al.
      Pages: 316 - 319
      Abstract: Academic geriatric medicine activity lags behind the scale of clinical activity in the specialty. A meeting of UK academic geriatricians was convened in March 2018 to consider causes and solutions to this problem. The meeting highlighted a lack of research-active clinicians, a perception that research is not central to the practice of geriatric medicine and a failure to translate discovery science to clinical studies. Solutions proposed included better support for early-career clinical researchers, schemes to encourage non-University clinicians to be research-active, wider collaboration with organ specialists to broaden the funding envelope, and the need to co-produce research programmes with end-users. Solutions to grow academic geriatric medicine are essential if we are to provide the best care for the growing older population.
      PubDate: Tue, 22 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy220
      Issue No: Vol. 48, No. 3 (2019)
       
  • Lung health in older adults
    • Authors: Dyer C; Pugh L.
      Pages: 319 - 322
      Abstract: One in five people in the UK live with lung disease. The National Taskforce for Lung Health, supported by 29 organisations, published its report in December 2018 with 43 recommendations for the UK, most of which are highly relevant to older adults. Prevention is key, especially relating to the introduction of clean air zones and air pollution alerts. Older adults may be even more prone to the adverse effects of particulate matter. Earlier and accurate diagnosis could improve survival for lung cancer, as well as health status for patients with chronic obstructive pulmonary disease (COPD) and related conditions. Currently, less than half of patients on inhalers receive an annual check, and there are one in five patients with COPD who should be on home oxygen but are not. By contrast, one in three people on oxygen do not benefit. Social isolation is common in people with lung disease, who would benefit from a personalised care plan and better access to pulmonary rehabilitation, which is also of benefit to those who are frail. Patients with lung diseases are much less likely to have conversations about advance care planning than in other conditions, probably because of the unpredictable nature of their illness, and variability of symptoms. The taskforce recommends that all healthcare professionals should be able to offer basic end of life advice.
      PubDate: Fri, 22 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz008
      Issue No: Vol. 48, No. 3 (2019)
       
  • Podiatry interventions to prevent falls in older people: a systematic
           review and meta-analysis
    • Authors: Wylie G; Torrens C, Campbell P, et al.
      Pages: 327 - 336
      Abstract: Backgroundfoot problems are independent risk factors for falls in older people. Podiatrists diagnose and treat a wide range of problems affecting the feet, ankles and lower limbs. However, the effectiveness of podiatry interventions to prevent falls in older people is unknown. This systematic review examined podiatry interventions for falls prevention delivered in the community and in care homes.Methodssystematic review and meta-analysis. We searched multiple electronic databases with no language restrictions. Randomised or quasi-randomised-controlled trials documenting podiatry interventions in older people (aged 60+) were included. Two reviewers independently applied selection criteria and assessed methodological quality using the Cochrane Risk of Bias tool. TiDieR guidelines guided data extraction and where suitable statistical summary data were available, we combined the selected outcome data in pooled meta-analyses.Resultsfrom 35,857 titles and 5,201 screened abstracts, nine studies involving 6,502 participants (range 40–3,727) met the inclusion criteria. Interventions were single component podiatry (two studies), multifaceted podiatry (three studies), or multifactorial involving other components and referral to podiatry component (four studies). Seven studies were conducted in the community and two in care homes. Quality assessment showed overall low risk for selection bias, but unclear or high risk of detection bias in 4/9 studies. Combining falls rate data showed significant effects for multifaceted podiatry interventions compared to usual care (falls rate ratio 0.77 [95% CI 0.61, 0.99]); and multifactorial interventions including podiatry (falls rate ratio: 0.73 [95% CI 0.54, 0.98]). Single component podiatry interventions demonstrated no significant effects on falls rate.Conclusionsmultifaceted podiatry interventions and multifactorial interventions involving referral to podiatry produce significant reductions in falls rate. The effect of multi-component podiatry interventions and of podiatry within multifactorial interventions in care homes is unknown and requires further trial data.PROSPERO registration numberCRD42017068300.
      PubDate: Mon, 07 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy189
      Issue No: Vol. 48, No. 3 (2019)
       
  • Quality improvement strategies to prevent falls in older adults: a
           systematic review and network meta-analysis
    • Authors: Tricco A; Thomas S, Veroniki A, et al.
      Pages: 337 - 346
      Abstract: BackgroundFalls are a common occurrence and the most effective quality improvement (QI) strategies remain unclear.MethodsWe conducted a systematic review and network meta-analysis (NMA) to elucidate effective quality improvement (QI) strategies for falls prevention. Multiple databases were searched (inception−April 2017). We included randomised controlled trials (RCTs) of falls prevention QI strategies for participants aged ≥65 years. Two investigators screened titles and abstracts, full-text articles, conducted data abstraction and appraised risk of bias independently.ResultsA total of 126 RCTs including 84,307 participants were included after screening 10,650 titles and abstracts and 1210 full-text articles. NMA including 29 RCTs and 26,326 patients found that team changes was statistically superior in reducing the risk of injurious falls relative to usual care (odds ratio [OR] 0.57 [0.33 to 0.99]; absolute risk difference [ARD] −0.11 [95% CI, −0.18 to −0.002]). NMA for the outcome of number of fallers including 61 RCTs and 40 128 patients found that combined case management, patient reminders and staff education (OR 0.18 [0.07 to 0.47]; ARD −0.27 [95% CI, −0.33 to −0.15]) and combined case management and patient reminders (OR, 0.36 [0.13 to 0.97]; ARD −0.19 [95% CI, −0.30 to −0.01]) were both statistically superior compared to usual care.ConclusionsTeam changes may reduce risk of injurious falls and a combination of case management, patient reminders, and staff education, as well as case management and patient reminders may reduce risk of falls. Our results can be tailored to decision-maker preferences and availability of resources.Systematic review registrationPROSPERO (CRD42013004151)
      PubDate: Tue, 05 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy219
      Issue No: Vol. 48, No. 3 (2019)
       
  • Frailty and co-morbidity predict first hospitalisation after heart failure
           diagnosis in primary care: population-based observational study in England
           
    • Authors: Bottle A; Kim D, Hayhoe B, et al.
      Pages: 347 - 354
      Abstract: Backgroundfrailty has only recently been recognised as important in patients with heart failure (HF), but little has been done to predict the first hospitalisation after diagnosis in unselected primary care populations.Objectivesto predict the first unplanned HF or all-cause admission after diagnosis, comparing the effects of co-morbidity and frailty, the latter measured by the recently validated electronic frailty index (eFI).Designobservational study.Settingprimary care in England.Subjectsall adult patients diagnosed with HF in primary care between 2010 and 2013.Methodswe used electronic health records of patients registered with primary care practices sending records to the Clinical Practice Research Datalink (CPRD) in England with linkage to national hospital admissions and death data. Competing-risk time-to-event analyses identified predictors of first unplanned hospitalisation for HF or for any condition after diagnosis.Resultsof 6,360 patients, 9% had an emergency hospitalisation for their HF, and 39% had one for any cause within a year of diagnosis; 578 (9.1%) died within a year without having any emergency admission. The main predictors of HF admission were older age, elevated serum creatinine and not being on a beta-blocker. The main predictors of all-cause admission were age, co-morbidity, frailty, prior admission, not being on a beta-blocker, low haematocrit and living alone. Frailty effects were largest in patients aged under 85.Conclusionsthis study suggests that frailty has predictive power beyond its co-morbidity components. HF patients in the community should be assessed for frailty, which should be reflected in future HF guidelines.
      PubDate: Wed, 09 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy194
      Issue No: Vol. 48, No. 3 (2019)
       
  • Physical frailty in older men: prospective associations with diet quality
           and patterns
    • Authors: Parsons T; Papachristou E, Atkins J, et al.
      Pages: 355 - 360
      Abstract: Backgroundincreasing numbers of older adults are living with frailty and its adverse consequences. We investigated relationships between diet quality or patterns and incident physical frailty in older British men and whether any associations were influenced by inflammation.Methodsprospective study of 945 men from the British Regional Heart Study aged 70–92 years with no prevalent frailty. Incident frailty was assessed by questionnaire after 3 years of follow-up. Frailty was defined as having at least three of: low grip strength, low physical activity, slow walking speed, unintentional weight loss and feeling of low energy, all based on self-report. The Healthy Diet Indicator (HDI) based on WHO dietary guidelines and the Elderly Dietary Index (EDI) based on a Mediterranean-style dietary intake were computed from questionnaire data and three dietary patterns were identified using principal components analysis: prudent, high fat/low fibre and high sugar.Resultsmen in the highest EDI category and those who followed a prudent diet were less likely to become frail [top vs bottom category odds ratio (OR) (95% CI) 0.49 (0.30, 0.82) and 0.53 (0.30, 0.92) respectively] after adjustment for potential confounders including BMI and prevalent cardiovascular disease. No significant association was seen for the HDI. By contrast those who had a high fat low fibre diet pattern were more likely to become frail [OR (95% CI) 2.54 (1.46, 4.40)]. These associations were not mediated by C-reactive protein (marker of inflammation).Conclusionsthe findings suggest adherence to a Mediterranean–style diet is associated with reduced risk of developing frailty in older people.
      PubDate: Tue, 22 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy216
      Issue No: Vol. 48, No. 3 (2019)
       
  • Obesity and Longer Term Risks of Dementia in 65–74 Year Olds
    • Authors: Bowman K; Thambisetty M, Kuchel G, et al.
      Pages: 367 - 373
      Abstract: Backgroundoverweight or obesity at ages <65 years associates with increased dementia incidence, but at ≥65 years estimates are paradoxical. Weight loss before dementia diagnosis, plus smoking and diseases causing weight loss may confound associations.Objectiveto estimate weight loss before dementia diagnosis, plus short and longer-term body mass index associations with incident dementia in 65–74 year olds within primary care populations in England.Methodswe studied dementia diagnosis free subjects: 257,523 non-smokers without baseline cancer, heart failure or multi-morbidity (group A) plus 161,927 with these confounders (group B), followed ≤14.9 years. Competing hazard models accounted for mortality.Resultsin group A, 9,774 were diagnosed with dementia and in those with repeat weight measures, 54% lost ≥2.5 kg during 10 years pre-diagnosis. During <10 years obesity (≥30.0 kg/m2) or overweight (25.0 to <30.0) were inversely associated with incident dementia (versus 22.5 to <25.0). However, from 10 to 14.9 years, obesity was associated with increased dementia incidence (hazard ratio [HR] 1.17; 95% CI: 1.03–1.32). Overweight protective associations disappeared in longer-term analyses (HR, 1.01; 95% CI: 0.90–1.13). In group B, (n = 6,070 with incident dementia), obesity was associated with lower dementia risks in the short and longer-term.Conclusionsin 65–74 year olds (free of smoking, cancer, heart failure or multi-morbidity at baseline) obesity associates with higher longer-term incidence of dementia. Paradoxical associations were present short-term and in those with likely confounders. Reports of protective effects of obesity or overweight on dementia risk in older groups may reflect biases, especially weight loss before dementia diagnosis.
      PubDate: Wed, 06 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz002
      Issue No: Vol. 48, No. 3 (2019)
       
  • Should we provide outreach rehabilitation to very old people living in
           Nursing Care Facilities after a hip fracture' A randomised controlled
           trial
    • Authors: Crotty M; Killington M, Liu E, et al.
      Pages: 373 - 380
      Abstract: Objectiveto determine whether a 4-week postoperative rehabilitation program delivered in Nursing Care Facilities (NCFs) would improve quality of life and mobility compared with receiving usual care.Designparallel randomised controlled trial with integrated health economic study.SettingNCFs, in Adelaide South Australia.Subjectspeople aged 70 years and older who were recovering from hip fracture surgery and were walking prior to hip fracture.Measurementsprimary outcomes: mobility (Nursing Home Life-Space Diameter (NHLSD)) and quality of life (DEMQOL) at 4 weeks and 12 months.Resultsparticipants were randomised to treatment (n = 121) or control (n = 119) groups. At 4 weeks, the treatment group had better mobility (NHLSD mean difference −1.9; 95% CI: −3.3, −0.57; P = 0.0055) and were more likely to be alive (log rank test P = 0.048) but there were no differences in quality of life. At 12 months, the treatment group had better quality of life (DEMQOL sum score mean difference = −7.4; 95% CI: −12.5 to −2.3; P = 0.0051), but there were no other differences between treatment and control groups. Quality adjusted life years (QALYs) gained over 12 months were 0.0063 higher per participant (95% CI: −0.0547 to 0.0686). The resulting incremental cost effectiveness ratios (ICERs) were $5,545 Australian dollars per unit increase in the NHLSD (95% CI: $244 to $15,159) and $328,685 per QALY gained (95% CI: $82,654 to $75,007,056).Conclusionsthe benefits did not persist once the rehabilitation program ended but quality of life at 12 months in survivors was slightly higher. The case for funding outreach home rehabilitation in NCFs is weak from a traditional health economic perspective.Trial registrationACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry. Trial protocol available at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx'id = 361980
      PubDate: Fri, 22 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz005
      Issue No: Vol. 48, No. 3 (2019)
       
  • Association of blood pressure with clinical outcomes in older adults with
           chronic kidney disease
    • Authors: Masoli J; Delgado J, Bowman K, et al.
      Pages: 380 - 387
      Abstract: Backgroundin chronic kidney disease (CKD), hypertension is associated with poor outcomes at ages <70 years. At older ages, this association is unclear. We tested 10-year mortality and cardiovascular outcomes by clinical systolic blood pressure (SBP) in older CKD Stages 3 and 4 patients without diabetes or proteinuria.Methodsretrospective cohort in population representative primary care electronic medical records linked to hospital data from the UK. CKD staged by CKD-EPI equation (≥2 creatinine measurements ≥90 days apart). SBPs were 3-year medians before baseline, with mean follow-up 5.7 years. Cox competing models accounted for mortality.Resultsabout 158,713 subjects with CKD3 and 6,611 with CKD4 met inclusion criteria. Mortality increased with increasing CKD stage in all subjects aged >60. In the 70 plus group with SBPs 140–169 mmHg, there was no increase in mortality, versus SBP 130–139. Similarly, SBPs 140–169 mmHg were not associated with increased incident heart failure, stroke or myocardial infarctions. SBPs <120 mmHg were associated with increased mortality and cardiovascular risk. At ages 60–69, there was increased mortality at SBP <120 and SBP >150 mmHg.Results were little altered after excluding those with declining SBPs during 5 years before baseline, or for longer-term outcomes (5–10 years after baseline).Conclusionsin older primary care patients, CKD3 or 4 was the dominant outcome predictor. SBP 140–169 mmHg having little additional predictive value, <120 mmHg was associated with increased mortality. Prospective studies of representative older adults with CKD are required to establish optimum BP targets.
      PubDate: Sat, 02 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz006
      Issue No: Vol. 48, No. 3 (2019)
       
  • Frailty predicts mortality in all emergency surgical admissions regardless
           of age. An observational study
    • Authors: Hewitt J; Carter B, McCarthy K, et al.
      Pages: 388 - 394
      Abstract: Backgroundfrail patients in any age group are more likely to die than those that are not frail. We aimed to evaluate the impact of frailty on clinical mortality, readmission rate and length of stay for emergency surgical patients of all ages.Methodsa multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure was included. The study was carried out during 2015 and 2016.Frailty was defined using the 7-point Clinical Frailty Scale. The primary outcome was mortality at Day 90. Secondary outcomes included: mortality at Day 30, length of stay and readmission within a Day 30 period.Resultsthe cohort included 2,279 patients (median age 54 years [IQR 36–72]; 56% female). Frailty was documented in patients of all ages: 1% in the under 40’s to 45% of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80% increase in mortality at Day 90 (OR 1.80, 95% CI: 1.61–2.01) supporting a linear dose–response relationship. In addition, the most frail patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days.Conclusionsworsening frailty at any age is associated with significantly poorer patient outcomes, including mortality in unselected acute surgical admissions. Assessment of frailty should be integrated into emergency surgical practice to allow prognostication and implementation of strategies to improve outcomes.
      PubDate: Tue, 19 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy217
      Issue No: Vol. 48, No. 3 (2019)
       
  • Comparing the predictive ability of the Revised Minimum Dataset Mortality
           Risk Index (MMRI-R) with nurses’ predictions of mortality among frail
           older people: a cohort study
    • Authors: Cole A; Arthur A, Seymour J.
      Pages: 394 - 400
      Abstract: Objectivesto establish the accuracy of community nurses’ predictions of mortality among older people with multiple long-term conditions, to compare these with a mortality rating index and to assess the incremental value of nurses’ predictions to the prognostic tool.Designa prospective cohort study using questionnaires to gather clinical information about patients case managed by community nurses. Nurses estimated likelihood of mortality for each patient on a 5-point rating scale. The dataset was randomly split into derivation and validation cohorts. Cox proportional hazard models were used to estimate risk equations for the Revised Minimum Dataset Mortality Risk Index (MMRI-R) and nurses’ predictions of mortality individually and combined. Measures of discrimination and calibration were calculated and compared within the validation cohort.Settingtwo NHS Trusts in England providing case-management services by nurses for frail older people with multiple long-term conditions.Participants867 patients on the caseload of 35 case-management nurses. 433 and 434 patients were assigned to the derivation and validation cohorts, respectively. Patients were followed up for 12 months.Results249 patients died (28.72%). In the validation cohort, MMRI-R demonstrated good discrimination (Harrell’s c-index 0.71) and nurses’ predictions similar discrimination (Harrell’s c-index 0.70). There was no evidence of superiority in performance of either method individually (P = 0.83) but the MMRI-R and nurses’ predictions together were superior to nurses’ predictions alone (P = 0.01).Conclusionspatient mortality is associated with higher MMRI-R scores and nurses’ predictions of 12-month mortality. The MMRI-R enhanced nurses’ predictions and may improve nurses’ confidence in initiating anticipatory care interventions.
      PubDate: Tue, 26 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz011
      Issue No: Vol. 48, No. 3 (2019)
       
  • Priorities for research in multiple conditions in later life
           (multi-morbidity): findings from a James Lind Alliance Priority Setting
           Partnership
    • Authors: Parker S; Corner L, Laing K, et al.
      Pages: 401 - 406
      Abstract: Introductionmultiple conditions in later life (multi-morbidity) is a major challenge for health and care systems worldwide, is of particular relevance for older people, but has not (until recently) received high priority as a topic for research. We have identified the top 10 research priorities from the perspective of older people, their carers, and health and social care professionals using the methods of a James Lind Alliance Priority Setting Partnership.Methodsin total, 354 participants (162 older people and carers, 192 health professionals) completed a survey and 15 older people and carers were interviewed to produce 96 ‘unanswered questions’. These were further refined by survey and interviews to a shortlist of 21 topics, and a mix of people aged 80+ living with three or more conditions, carers and health and social care providers to prioritised the top 10.Resultsthe key priorities were about the prevention of social isolation, the promotion of independence and physical and emotional well-being. In addition to these broad topics, the process also identified detailed priorities including the role of exercise therapy, the importance of falls (particularly fear of falling), the recognition and management of frailty and Comprehensive Geriatric Assessment.Conclusionthese topics provide a unique perspective on research priorities on multiple conditions in later life and complement existing UK and International recommendations about the optimisation of health and social care systems to deliver essential holistic models of care and the prevention and treatment of multiple co-existing conditions.
      PubDate: Wed, 20 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz014
      Issue No: Vol. 48, No. 3 (2019)
       
  • Measuring health-related quality of life of care home residents:
           comparison of self-report with staff proxy responses
    • Authors: Usman A; Lewis S, Hinsliff-Smith K, et al.
      Pages: 407 - 413
      Abstract: Introductioncare home residents are often unable to complete health-related quality of life questionnaires for themselves because of prevalent cognitive impairment. This study compared care home resident and staff proxy responses for two measures, the EQ-5D-5L and HowRU.Methodsa prospective cohort study recruited residents ≥60 years across 24 care homes who were not receiving short stay, respite or terminal care. Resident and staff proxy EQ-5D-5L and HowRu responses were collected monthly for 3 months. Weighted kappa statistics and intra-class correlation coefficients (ICCs) adjusted for clustering at the care home level were used to measure agreement between resident and proxies for each time point. The effect of staff and resident baseline variables on agreement was considered using a multilevel mixed effect regression model.Results117, 109 and 104 matched pairs completed the questionnaires at 1, 2 and 3 months, respectively. When clustering was controlled for, agreement between resident and staff proxy EQ-5D-5L responses was fair for mobility (ICC: 0.29) and slight for all other domains (ICC ≤ 0.20). EQ-5D Index and Quality-Adjusted Life Year scores (proxy scores higher than residents) showed better agreement than EQ-5D-VAS (residents scores higher than proxy). HowRU showed only slight agreement (ICC ≤ 0.20) between residents and proxies. Staff and resident characteristics did not influence level of agreement for either index.Discussionthe levels of agreement for EQ-5D-5L and HowRU raise questions about their validity in this population.
      PubDate: Mon, 07 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy191
      Issue No: Vol. 48, No. 3 (2019)
       
  • Impact of sarcopenia on 1-year mortality in older patients with cancer
    • Authors: Otten L; Stobäus N, Franz K, et al.
      Pages: 413 - 418
      Abstract: Objectivessarcopenia is common especially in hospitalised older populations. The aim of this study was to assess the prevalence of sarcopenia, defined as low skeletal mass and muscle strength, and its impact on 1-year mortality in older patients with cancer.Methodsskeletal muscle mass was estimated using bioelectric impedance analysis and related to height2 (SMI; Janssen et al. 2002). Grip strength was measured with the JAMAR dynamometer and the cut-offs suggested by the European Working Group on Sarcopenia in Older People (EWGSOP) were applied. One-year mortality was assessed by telephone follow-up and the local cancer death registry.Resultsof the 439 consecutively recruited cancer patients (60–95 years; 43.5% women), 119 (27.1%) had sarcopenia. Of the patients with sarcopenia, 62 (52.5%) died within 1 year after study entry compared to 108 (35.1%) patients who did not have sarcopenia (P = 0.001). In a stepwise, forward Cox proportional hazards analysis, sarcopenia (HR = 1.53; 95% CI: 1.034–2.250; P < 0.05), advanced disease (HR = 1.87; 95% CI: 1.228–2.847; P < 0.05), number of drugs/day (HR = 1.11; 95% CI: 1.057–1.170; P < 0.001), tumour diagnosis (overall P < 0.05) and Karnofsky index (HR = 0.98, 95% CI: 0.963–0.995; P < 0.05) associated with 1-year mortality risk. The factors sex, age, co-morbidities and involuntary 6-month weight loss ≥5% were insignificant.Conclusionssarcopenia was present in 27.1% of older patients with cancer and was independently associated with 1-year mortality. The fact that sarcopenia was nearly as predictive for 1-year mortality as an advanced disease stage underlines the importance of preservation of muscle mass and function as a potential target of intervention in older patients with cancer.
      PubDate: Fri, 04 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy212
      Issue No: Vol. 48, No. 3 (2019)
       
  • Effect of person-centred care on antipsychotic drug use in nursing homes
           (EPCentCare): a cluster-randomised controlled trial
    • Authors: Richter C; Berg A, Langner H, et al.
      Pages: 419 - 425
      Abstract: Backgroundantipsychotic drugs are regularly prescribed as first-line treatment for neuropsychiatric symptoms in persons with dementia although guidelines clearly prioritise non-pharmacological interventions.Objectivewe investigated a person-centred care approach, which has been successfully evaluated in nursing homes in the UK, and adapted it to German conditions.Designa 2-armed 12-month cluster-randomised controlled trial.Settingnursing homes in East, North and West Germany.Methodsall prescribing physicians from both study arms received medication reviews for individual patients and were offered access to 2 h of continuing medical education. Nursing homes in the intervention group received educational interventions on person-centred care and a continuous supervision programme. Primary outcome: proportion of residents receiving at least one antipsychotic prescription after 12 months of follow-up. Secondary outcomes: quality of life, agitated behaviour, falls and fall-related medical attention, a health economics evaluation and a process evaluation.Resultsthe study was conducted in 37 nursing homes with n = 1,153 residents (intervention group: n = 493; control group: n = 660). The proportion of residents with at least one antipsychotic medication changed after 12 months from 44.6% to 44.8% in the intervention group and from 39.8 to 33.3% in the control group. After 12 months, the difference in the prevalence was 11.4% between the intervention and control groups (95% confidence interval: 0.9–21.9; P = 0.033); odds ratio: 1.621 (95% confidence interval: 1.038–2.532).Conclusionsthe implementation of a proven person-centred care approach adapted to national conditions did not reduce antipsychotic prescriptions in German nursing homes.Trial registrationClinicalTrials.gov NCT02295462.
      PubDate: Tue, 26 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz016
      Issue No: Vol. 48, No. 3 (2019)
       
  • Evaluation of the directional relationship between handgrip strength and
           cognitive function: the Korean Longitudinal Study of Ageing
    • Authors: Kim G; Sun J, Han M, et al.
      Pages: 426 - 432
      Abstract: Backgroundrecent studies suggest that handgrip strength is linked with cognitive impairment at older ages. However, it remains unclear as to whether muscular strength influences subsequent cognitive performance, or whether lower levels of cognitive function increase the likelihood of muscle strength decline.Objectiveto investigate the directional relationship between handgrip strength and cognitive impairment using longitudinal data among older adults.Methodsrepeated measures of handgrip strength and cognitive function were collected in a sample of 5,995 participants of the Korean Longitudinal Study of Aging (KLoSA) over a period of 8 years. Time-lagged general estimating equations, while accounting for correlation among repeated measures, was used to assess the temporal effect of handgrip strength on cognitive impairment and vice versa with adjustment for other confounding factors.Resultsafter adjustment, greater handgrip strength was related to subsequent reduction in the risk of cognitive impairment, such that participants in the highest quartile presented approximately 50% decrease in their risk of cognitive impairment [adjusted odds ratio (OR) = 0.499 (95% CI 0.422 to 0.589] compared to the lowest quartile after controlling for potential confounding factors. Conversely, cognitive impairment was a significant predictor of reduced muscular strength [β regression coefficient −0.804, 95% CI, −1.168 to −0.439, for participants with dementia compared with those with normal cognitive function].Conclusionsin conclusion, a significant bi-directional relationship was found between muscular strength and cognitive function, suggesting that these may have shared common pathways that are worthy of being further elucidated in future studies.
      PubDate: Fri, 22 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz013
      Issue No: Vol. 48, No. 3 (2019)
       
  • Understanding the factors associated with patients with dementia achieving
           their preferred place of death: a retrospective cohort study
    • Authors: Wiggins N; Droney J, Mohammed K, et al.
      Pages: 433 - 439
      Abstract: Backgrounddying in one’s preferred place is a quality marker for end-of-life care. Little is known about preferred place of death, or the factors associated with achieving this, for people with dementia.Aimsto understand preferences for place of death among people with dementia; to identify factors associated with achieving these preferences.Populationadults with a diagnosis of dementia who died between December 2015 and March 2017 and who were registered on Coordinate My Care, an Electronic Palliative Care Coordination System.Designretrospective cohort study.Analysismultivariable logistic regression investigated factors associated with achieving preferred place of death.Resultswe identified 1,047 people who died with dementia; information on preferred and actual place of death was available for 803. Preferred place of death was most commonly care home (58.8%, n = 472) or home (39.0%, n = 313). Overall 83.7% (n = 672) died in their preferred place. Dying in the preferred place was more likely for those most functionally impaired (OR 1.82 95% CI 1.06–3.13), and with a ceiling of treatment of ‘symptomatic relief only’ (OR 2.65, 95% CI 1.37–5.14). It was less likely for people with a primary diagnosis of cancer (OR 0.52, 95% CI 0.28–0.97), those who were ‘for’ cardio-pulmonary resuscitation (OR 0.32, 95% CI 0.16–0.62) and those whose record was created longer before death (51–250 days (ref <50 days) OR 0.60, 95% CI 0.38–0.94).Conclusionsmost people with dementia want to die in a care home or at home. Achieving this is more likely where goals of treatment are symptomatic relief only, indicating the importance of advance care planning.
      PubDate: Tue, 26 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz015
      Issue No: Vol. 48, No. 3 (2019)
       
  • Everyday life after a hip fracture: what community-living older adults
           perceive as most beneficial for their recovery
    • Authors: Pol M; Peek S, van Nes F, et al.
      Pages: 440 - 447
      Abstract: Objectiveto gain insight into what older adults after hip fracture perceive as most beneficial to their recovery to everyday life.Designqualitative research approach.Settingsix skilled nursing facilities.Participants19 older community dwelling older adults (aged 65–94), who had recently received geriatric rehabilitation after hip fracture.Methodssemi-structured interviews were conducted with 19 older adults after hip fracture. Coding techniques based on constructivist grounded theory were applied.Resultsfour categories were derived from the data: ‘restrictions for everyday life’, ‘recovery process’, ‘resources for recovery’ and ‘performing everyday activities’. Physical and psychological restrictions are consequences of hip fracture that older adults have struggled to address during recovery. Three different resources were found to be beneficial for recovery; ‘supporting and coaching’, ‘myself’ and ‘technological support’. These resources influenced the recovery process. Having successful experiences during recovery led to doing everyday activities in the same manner as before; unsuccessful experiences led to ceasing certain activities altogether.Conclusionparticipants highlight their own role (‘myself’) as essential for recovery. Additionally, coaching provides emotional support, which boosts self-confidence in performing everyday activities. Furthermore, technology can encourage older adults to become more active and being engaged in the recovery process. The findings suggest that more attention should be paid to follow-up interventions after discharge from inpatient rehabilitation to support older adults in finding new routines in their everyday activities.A conceptual model is presented and provides an understanding of the participants’ experiences and perspectives concerning their process of recovery after hip fracture to everyday life.
      PubDate: Tue, 26 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz012
      Issue No: Vol. 48, No. 3 (2019)
       
  • Changes in physical and mental health are associated with cardiovascular
           disease incidence in postmenopausal women
    • Authors: Saquib N; Brunner R, Desai M, et al.
      Pages: 448 - 453
      Abstract: Backgroundphysical and mental health are important risk factors for cardiovascular disease (CVD) incidence and death among postmenopausal women. The objective of this study was to assess whether changes in physical and mental health were associated with CVD incidence and death.Methodsin the Women’s Health Initiative Observational Study, 48,906 women (50–79 years) had complete data at baseline on physical and mental health (assessed with Short Form-36) and key covariates. Changes in self-reported physical and mental health were calculated between baseline and year 3. Incident CVD and death between year 3 and end of the study were verified with medical records.Resultsover a median 8.2-year follow-up, 2,319 women developed CVD, and 1,571 women died, including 361 CVD deaths. Women with continued poor health and those with worsened health had significantly increased risk of CVD incidence, CVD-specific death and all-cause death relative to women with continued good health. Both major and minor declines in physical health were associated with an increased risk of these outcomes relative to women with no change in physical health. Only major declines in mental health were associated with poor prognosis.Conclusionschanges in physical and mental health over 3 years were independently associated with subsequent CVD events.
      PubDate: Mon, 11 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy213
      Issue No: Vol. 48, No. 3 (2019)
       
  • Service organisation for people with dementia after an injurious fall:
           challenges and opportunities
    • Authors: Wheatley A; Bamford C, Shaw C, et al.
      Pages: 454 - 458
      Abstract: Introductionpeople with dementia are more likely to fall and less likely to recover well after a fall than cognitively intact older people. Little is known about how best to deliver services to this patient group. This paper explored current service provision to help inform the development of a new intervention.Methodsqualitative approaches were used to explore the views and experiences of people with dementia, family carers and professionals providing services to people with dementia following an injurious fall. These data were analysed using a thematic, iterative analysis.Findingswhile a wide range of services potentially relevant to people with dementia was identified, there were no dedicated services for people with dementia with fall-related injuries in our three geographical areas. Factors influencing service uptake included a lack of knowledge of local provision amongst professionals and underdeveloped information sharing systems. Some aspects of current service organisation were incompatible with the needs of people with dementia. These include an emphasis on time-limited interventions; lack of longer-term follow-up; and service delivery in environments that could be challenging for people with dementia.Conclusionscare pathways for people with dementia who fall are fragmented and unclear. This is likely to preclude people with dementia from receiving all appropriate support and contribute to poor recovery following a fall. The findings highlight the need for new approaches to service organisation and delivery which address the specific needs of people with dementia who fall.
      PubDate: Thu, 28 Mar 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz010
      Issue No: Vol. 48, No. 3 (2019)
       
  • Where are we now in perioperative medicine' Results from a repeated UK
           survey of geriatric medicine delivered services for older people
    • Authors: Joughin A; Partridge J, O’Halloran T, et al.
      Pages: 458 - 462
      Abstract: Introductionnational reports highlight deficiencies in the care of older patients undergoing surgery. A 2013 survey showed less than a third of NHS trusts had geriatrician-led perioperative medicine services for older surgical patients. Barriers to establishing services included funding, workforce and limited interspecialty collaboration. Since then, national initiatives have supported the expansion of geriatrician-led services for older surgical patients.This repeat survey describes geriatrician-led perioperative medicine services in comparison with 2013, exploring remaining barriers to developing perioperative medicine services for older patients.Methodsan electronic survey was sent to clinical leads for geriatric medicine at 152 acute NHS healthcare trusts in the UK. Reminders were sent on four occasions over an 8-week period. The survey examined the nature of the services provided, extent of collaborative working and barriers to service development. Responses were analysed descriptively.Resultseighty-one (53.3%) respondents provide geriatric medicine services for older surgical patients, compared to 38 (29.2%) in 2013. Services exist across surgical specialties, especially in orthopaedics and general surgery. Fourteen geriatrician-led preoperative clinics now exist. Perceived barriers to service development remain workforce issues and funding. Interspecialty collaboration has increased, evidenced by joint audit meetings (33% from 20.8%) and collaborative guideline development (31% from 17%).Conclusionsince 2013, an increase in whole-pathway geriatric medicine involvement is observed across surgical specialties. However, considerable variation persists across the UK with scope for wider adoption of services facilitated through a national network.
      PubDate: Wed, 09 Jan 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afy218
      Issue No: Vol. 48, No. 3 (2019)
       
  • Unilateral hearing loss in a 94-year-old patient
    • Authors: Cole R; Thompson S, Gargalas S.
      Pages: 463 - 464
      Abstract: A case report of a 94-year-old, previously well male patient who presented with fever thought to be caused by community acquired pneumonia, new unilateral hearing loss and reduced consciousness. Despite antibiotic treatment he continued to deteriorate. Brain imaging with computer tomography and magnetic resonance imaging revealed a left otomastoiditis with osteomyelitis of the skull base, associated with an adjacent subdural empyema. He was also found to have a venous sinus thrombosis, most likely secondary to otitis media. He was managed with intravenous antibiotics, anticoagulation, grommet insertion and a hearing aid and he made a good recovery. This case reminds us to consider otitis media in older patients who present with hearing loss and fever. Otitis media can lead to serious complications including subdural empyema and osteomyelitis of the skull base.
      PubDate: Wed, 06 Feb 2019 00:00:00 GMT
      DOI: 10.1093/ageing/afz003
      Issue No: Vol. 48, No. 3 (2019)
       
  • Highlighting the goals for Parkinson’s care: commentary on NICE
           Guidelines for Parkinson’s in Adults (NG71)
    • Authors: Brock P; Fisher J, Hand A, et al.
      Pages: 323 - 326
      Abstract: Parkinson’s disease is a chronic multi-system disease that can cause motor and non-motor symptoms, cognitive changes and variably effective medications. Optimal management of the condition requires a multi-disciplinary team of healthcare professionals to work closely with the patient and their carers. The National Institute for Health and Care Excellence published updated guidelines on managing Parkinson’s disease in adults in 2017. Here we discuss the implications of this guidance to current healthcare professionals involved in the care of people with Parkinson’s disease.The guidance highlights the importance of clear communication with people with Parkinson’s disease. We discuss examples of this, including providing a point of contact with specialist services for people with Parkinson’s disease and ensuring information about the risks of impulse control disorders are given to people on dopaminergic therapy. The breadth of services required by people with Parkinson’s disease is also described, including the need for access to physiotherapy, occupational therapy and speech and language therapy as well as treatment monitoring services for Clozapine. In addition, we emphasise the continued importance of ensuring people with Parkinson’s disease receive their medications on time when in hospital or a care home.
      PubDate: Thu, 27 Sep 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy158
      Issue No: Vol. 48, No. 3 (2018)
       
  • The impact of co-morbidity on the quality of life of people with dementia:
           findings from the IDEAL study
    • Authors: Nelis S; Wu Y, Matthews F, et al.
      Pages: 361 - 367
      Abstract: BackgroundThe aim was to investigate the co-morbidity profile of people with dementia and examine the associations between severity of co-morbidity, health-related quality of life (HRQoL) and quality of life (QoL).MethodsThe improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort consisted of 1,547 people diagnosed with dementia who provided information on the number and type of co-morbid conditions. Participants also provided ratings of their health-related and dementia-specific QoL.ResultsThe majority of the sample were living with more than one chronic condition. Hypertension was commonly reported and frequently combined with connective tissue disease, diabetes and depression. The number of co-morbid conditions was associated with low QoL scores, and those with severe co-morbidity (≥5 conditions) showed the greatest impact on their well-being.ConclusionsCo-morbidity is an important risk factor for poor QoL and health status in people with dementia. Greater recognition of the nature and impact of co-morbidity is needed to inform support and interventions for people with dementia and a multidisciplinary approach to care provision is recommended.
      PubDate: Wed, 07 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy155
      Issue No: Vol. 48, No. 3 (2018)
       
 
 
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