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Purpose: We aimed to address gaps identified in the evidence base and instruments available to measure the quality of life (QOL) of family carers of people with dementia, and develop a new brief, reliable, condition-specific instrument.Methods: We generated measurable domains and indicators of carer QOL from systematic literature reviews and qualitative interviews with 32 family carers and 9 support staff, and two focus groups with 6 carers and 5 staff. Statements with five tailored response options, presenting variation on the QOL continuum, were piloted (n = 25), pre-tested (n = 122) and field-tested (n = 300) in individual interviews with family carers from North London and Sussex. The best 30 questions formed the C-DEMQOL questionnaire, which was evaluated for usability, face and construct validity, reliability and convergent/discriminant validity using a range of validation measures.Results: C-DEMQOL was received positively by the carers. Factor analysis confirmed that C-DEMQOL sum scores are reliable in measuring overall QOL (ω = 0.97) and its five subdomains: 'meeting personal needs' (ω = 0.95); 'carer wellbeing' (ω = 0.91); 'carer-patient relationship' (ω = 0.82); 'confidence in the future' (ω = 0.90) and 'feeling supported' (ω = 0.85). The overall QOL and domain scores show the expected pattern of convergent and discriminant relationships with established measures of carer mental health, activities and dementia severity and symptoms.Conclusions: The robust psychometric properties support the use of C-DEMQOL in evaluation of overall and domain-specific carer QOL; replications in independent samples and studies of responsiveness would be of value. [ABSTRACT FROM AUTHOR]

Psychiatric morbidity, using the General Health Questionnaire, which detects mainly anxiety and depression, was examined in three samples of elderly people at baseline and at follow-up 2&frac;12-3 years later. One sample comprised all people aged 85 plus who could be traced from Family Health Services Authority records living in an East End district of London (City and Hackney) and the other two samples were representative random samples of people aged 65-85, one sample from the same inner city area and the other from a semi-rural area for comparison with the younger sample (Braintree, Essex). The analyses reported here relate to changes in psychiatric morbidity at follow-up 2&frac;-3 years later. Previous analyses showed that poor health and functional ability were the strongest predictors of baseline psychiatric morbidity. The results from the follow-up data show that the most significant predictor of changes in psychiatric morbidity at follow-up was baseline psychiatric status, followed by health status. Poor health and functional ability explained 15% of the variance between the groups among the 85 plus sample and 17% and 16% in the two younger 65 plus samples. The strength of the study is its longitudinal design and verification of the results in three samples of elderly people. including one very elderly group. It contributes to the small body of literature on outcome of psychiatric morbidity. The lack of consistent associations with recovery from psychiatric morbidity (eg depression) in the literature enhances the importance of studies which aim to identify factors associated with different outcomes. [ABSTRACT FROM AUTHOR]

This article reports findings from a longitudinal survey of very elderly people living at home in London. The research aimed to identify social, psychological and physical characteristics associated with positive ageing and successful survival in the community in later life and its converse-negative ageing-as well as the associated policy implications. Association with psychiatric morbidity, measured using the General Health Questionnaire, among sample members without cognitive impairment between the baseline interviews in 1987 and at follow-up, two and a half years later in 1990, are reported. Twenty-five per cent of survivors scored over the threshold of the GHQ in 1987 and 30% scored over the threshold in 1990. Half of those with a score over the threshold in 1990 also scored over the threshold in 1987. Hierarchical regression (using residualized change analysis) was used to estimate the effects of the independent variables on changes in psychiatric morbidity. The most significant predictor of psychiatric morbidity (GHQ score) in 1990 was baseline GHQ score, followed by health and functional status scores. Health and functional status were also the strongest predictors of baseline (1987) GHQ scores. The uniqueness of the study lies in the collection of follow-up data on a sample of very elderly people, given that most surveys are cross-sectional and contain too few people aged 85 + to merit separate analysis. It contributes to the small body of literature on outcome of depression. The lack of consistent associations with recovery form psychiatric morbidity in the literature enhances the importance of studies aiming to identify factors associated with different outcomes. [ABSTRACT FROM AUTHOR]

Examines the prevalence of locomotor disabilities on elderly people in London, England. Cost effectiveness of providing aids for daily living of aged by the screening intervention programme; Association between the incidence of chronic disease and disability; Types of disability.

Examines the views of general practitioners on quality specifications for hospital care contracts in London, England. Availability of patients' notes in outpatient clinics; Assessment on the patients management plans for general practitioners; Importance of an effective communication between primary and secondary sources of care.