Search

Author(s): Thomas A. Jackson 1,2,*, John R. F. Gladman 3, Rowan H. Harwood 4, Alasdair M. J. MacLullich 5, Elizabeth L. Sampson 6, Bart Sheehan 7, Daniel H. J. Davis [...]

Introduction There were major changes in population structures and disease patterns in the last century in economically more developed countries (the so-called demographic and epidemiological transitions). Other countries are currently [...], Objective To estimate the number of people worldwide requiring daily assistance from another person in carrying out health, domestic or personal tasks. Methods Data from the Global Burden of Disease Study were used to calculate the prevalence of severe levels of disability, and consequently, to estimate dependency. Population projections were used to forecast changes over the next 50 years. Findings The greatest burden of dependency currently falls in sub-Saharan Africa, where the "dependency ratio" (ratio of dependent people to the population of working age) is about 10%, compared with 7-8% elsewhere. Large increases in prevalence are predicted in sub-Saharan Africa, the Middle East, Asia and Latin America of up to 5-fold or 6-fold in some cases. These increases will occur in the context of generally increasing populations, and dependency ratios will increase modest y to about 10%. The dependency ratio will increase more in China (14%) and India (12%] than in other areas with large prevalence increases. Established market economies, especially Europe and Japan, will experience modest increases in the prevalence of dependency (30%), and in the dependency ratio (up to 10%). Former Socialist economies of Europe will nave static or declining numbers of dependent people, but will have large increases in the dependency ratio (up to 13%). Conclusion Many countries will be greatly affected by the increasing number of dependent people and will need to identify the human and financial resources to support them. Much improved collection of data on disability and on the needs of caregivers is required. The prevention of disability and provision of support for caregivers needs greater priority. Keywords Dependency (Psychology); Population dynamics; Aging; Chronic disease; Disabled persons; Health services needs and demand; Activities of daily living; Cost of illness; Forecasting (source: MeSH, NLM). Mots cles Dependance (Psychologie), Dynamique population; Vieillissement; Maladie chronique; Handicape; Besoins et demande services sante; Activite quotidienne; Cout maladie; Prevision (source: MeSH, INSERM). Palabras clave Dependencia (Psicologia); Dinamica de poblacion; Envejecimiento; Enfermedad cronica; Evaluacion de la incapacidad; Necesidades y demanda de servicios de salud; Actividades cotidianas; Costo de la enfermedad; Prediccion (fuente: DeCS, BIREME).

The Continuous Assessment, Review and Evaluation (CARE) program of auditing standards of long-term hospital care does not appear to improve the quality of care for patients in Britain's National Health Service hospitals. Two non-audited wards that cared for elderly people had an 11% mortality rate, compared to a 35% mortality rate in the audited wards studied. Mortality rates alone, however, should not be used to judge an audit system. No significant difference in rate of recovery or patient satisfaction were found between audited and non-audited hospitals. The staff at the audited hospitals believed that the CARE audits did improve the quality of care their patients received, however.

ROWAN H. HARWOOD Introduction Screening for early detection of cancer carries an implied promise of benefit, but involves risks, and may be costly. This is why the criteria for justifying [...]

Abstract Objective: to measure the prevalence of impairments, disabilities and handicaps in a geographically-defined elderly population. Design: cross-sectional analysis of an interview survey. Setting: a single North London electoral ward [...]