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Objective: to develop and validate a prediction model for incident locomotor disability after 7 years in older adults.Setting: prospective British cohort studies: British Women's Heart and Health Study (BWHHS) for development and the English Longitudinal Study of Ageing (ELSA) for validation.Subjects: community-dwelling older adults.Methods: multivariable logistic regression models after selection of predictors with backward elimination. Model performance was assessed using metrics of discrimination and calibration. Models were internally and externally validated.Results: locomotor disability was reported in BWHHS by 861 of 1,786 (48%) women after 7 years. Age, a history of arthritis and low physical activity levels were the most important predictors of locomotor disability. Models using routine measures as predictors had satisfactory calibration and discrimination (c-index 0.73). Addition of 31 blood markers did not increase the predictive performance. External validation in ELSA showed reduced discrimination (c-index 0.65) and an underestimation of disability risks. A web-based calculator for locomotor disability is available (http://www.sealedenvelope.com/trials/bwhhsmodel/).Conclusions: we developed and externally validated a prediction model for incident locomotor disability in older adults based on routine measures available to general practitioners, patients and public health workers, and showed an adequate discrimination. Addition of blood markers from major biological pathways did not improve the performance of the model. Further replication in additional data sets may lead to further enhancement of the current model. [ABSTRACT FROM AUTHOR]

Background: Social capital is considered to be an important determinant of life expectancy and cardiovascular health. Evidence on the association between social capital and all-cause mortality, cardiovascular disease (CVD) and cancer was systematically reviewed.Methods: Prospective studies examining the association of social capital with these outcomes were systematically sought in Medline, Embase and PsycInfo, all from inception to 8 October 2012. We categorized the findings from studies according to seven dimensions of social capital, including social participation, social network, civic participation,social support, trust, norm of reciprocity and sense of community, and pooled the estimates across studies to obtain summary relative risks of the health outcomes for each social capital dimension. We excluded studies focusing on children, refugees or immigrants and studies conducted in the former Soviet Union.Results: Fourteen prospective studies were identified. The pooled estimates showed no association between most social capital dimensions and all-cause mortality, CVD or cancer. Limited evidence was found for association of increased mortality with social participation and civic participation when comparing the most extreme risk comparisons.Conclusions: Evidence to support an association between social capital and health outcomes is limited. Lack of consensus on measurements for social capital hinders the comparability of studies and weakens the evidence base. [ABSTRACT FROM AUTHOR]

Aim. To document population perceptions of well-being and predictors of self-assessed well-being.Methods. National face-to-face interview survey of adults aged ≥16 years, conducted by the Office for National Statistics for their Omnibus Survey in Britain (response 58%; 1049 of 1823 eligible).Results. People aged 65+ years were more likely than younger people to define well-being as being able to continue to do the things they had always done. Most men and women, in all age groups, rated their well-being and mental well-being positively. Self-rated health, mental health symptoms, long-standing illness and social support were the main drivers of overall well-being in all age groups. Mental health symptoms, long-standing illness and social support were the main drivers of mental well-being. For example, in reduced multivariable models, those who reported no long-standing illness had almost twice the odds of others, of good, rather than not good, overall well-being, and over three times the odds of good, rather than not good, mental well-being. The odds of good versus not good overall well-being were also multiplied by 1.002 for each additional available person for comfort and support and similarly by 1.073 in relation to mental well-being.Conclusions. Understanding the drivers of well-being among adults, including older adults, is of high policy importance. Attention should be focused on improvements in population health and functioning and on encouraging younger and older people to develop and maintain social support networks and engagement in social activities. [ABSTRACT FROM PUBLISHER]

Aim To examine fears about dying in an ethnically diverse population sample, and a more homogeneous population sample, aged 65 and over. Methods Personal interviews with people aged 65+ living at home responding to two Office for National Statistics Omnibus Surveys in Britain, and two Ethnibus Surveys of ethnically diverse populations in Britain. Results Ethnically diverse respondents were more likely than British population respondents to express fears about dying on all measures used. Respondents in both samples with better, compared with worse, quality of life had significantly reduced odds of having extreme fears of dying (ethnically diverse sample, OR 0.924 (95% CI 0.898 to 0.951); British population sample, OR 0.981 (95% CI 0.966 to 0.996); both p<0.001). In the latter sample only, older age was protective (OR 0.957; 95% CI 0.930 to 0.985; p<0.001), whereas in the Ethnibus sample, having a longstanding illness (OR 2.024; 95% CI 1.158 to 3.535; p<0.05) and having more relatives to help them (OR 1.134; 95% CI 1.010 to 1.274; p<0.05) increased fears about dying. Conclusions Enabling older people to express fears about dying is likely to be important when planning supportive end-of-life care. Practitioners should not assume that fears about dying are the same in different social groups, or that extensive family support is protective against such anxiety. Older people from ethnic minorities had more anxieties about dying than others, and were more likely to express fears the more extensive their family support. These findings have implications for commissioners and practitioners of primary and secondary care. [ABSTRACT FROM AUTHOR]

Objective: to identify perceptions of, and associations with, active ageing among ethnically diverse and homogeneous samples of older people in Britain. [ABSTRACT FROM PUBLISHER]

Objective: to identify predictors of mortality among a national sample of elderly widowed people 28 years post-baseline interview. Design and setting: face to face home interview survey across England. Measures: physical, psychological, social, and socio-economic status and circumstances. Results: excess risk of mortality, which had been noted up to six months post bereavement among males aged 75+, had disappeared. In contrast to findings up to 13 years post-bereavement, neither psycho-social factors, social circumstances nor social class independently predicted differentials in mortality when analysed up to 28 years post-bereavement. The most significant, independent predictors, up to the 28-year term, were, as would be expected, male sex, older age, poorer physical functioning, and expressed 'relief at the death of the spouse'. When the sample was split by duration of widow(er)hood male sex and older age retained significance. Conclusion: the increasing frailty of the sample overall, and reduced statistical power in split-sample analyses, may explain the loss of significance of physical functioning and 'expressed relief at the death' in the split-sample results. The psycho-social risk factors for mortality after bereavement reduce over time, although further examination of expressed relief would be worthwhile. [ABSTRACT FROM AUTHOR]

Objective: to identify socio-psychological predictors of mortality during a 20-year follow-up period among people aged 65 to <85 and 85+ at baseline interview. Study design and setting: elderly people living at home in East London and mid-Essex, who responded to surveys of successful survival in older age in the late 1980s; their mortality was traced through the National Health Central Registry. Results: adjusted analyses show that, as expected, the hazard rate for mortality over a 20-year follow-up was reduced for younger respondents and increased for less functionally able respondents. The hazard ratio for males was almost one and a half times that of females. The hazard rate was also reduced with each categorical increase in life satisfaction and was consistently reduced for those who undertook crafts, social visiting and activities regularly. There was some variation by age and sex. Conclusion: the results show that social participation is associated with lower risks of death, particularly among people aged 65 to <85, and that life satisfaction is also protective, particularly among females and people aged 85+, even when health status and socio-demographic circumstances are controlled. The study thus provides support for the hypothesised influence of social participation and subjective well-being on survival in older age. [ABSTRACT FROM AUTHOR]

Objective: to investigate the apparently incongruous coupling of poor physical functioning with high QoL. Study design and setting: face-to-face interview survey of random sample of 999 people aged 65+ across Britain. Results: twenty-one per cent of respondents reported fairly to very severe levels of functional difficulty, and 62% of these rated their QoL as 'good'. Better self-rated health, lower burden of chronic disease, not having fallen, higher social engagement and higher levels of perceived control over life, distinguished between people who had difficulties with physical functioning and who perceived their QoL to be 'good', rather than 'not good'. The open-ended survey responses broadly supported the quantitative findings. Conclusion: people with difficulties with physical functioning, who perceived their QoL to be 'not good', as opposed to 'good', were adversely affected by a higher burden of disease and having fewer socio-psychological resources to help them to cope effectively. [ABSTRACT FROM AUTHOR]

Background: there is increasing interest in how to age 'successfully' and in reaching consensus over its definition. Objective: to assess different models of successful ageing, using a British longitudinal survey of ageing in 2000-1. Setting: community, settings in Britain. Methods: five models of successful ageing were tested on a British cross-sectional population survey of 999 people aged 65+. The models were biomedical, broader biomedical, social, psychological and lay based. Results: the lay model emerged as the strongest. Respondents who were classified as successfully aged with this model, compared with those not successfully aged, had over five times the odds of rating their quality of life (QoL) as good rather than not good [odds ratio (OR) = 5.493, 95% confidence interval (95% CI) - 2.655-11.364]. Conclusion: the lay-based, more multidimensional, model of successful ageing predicted perceived QoL more powerfully than unidimensional models and should be used to evaluate the outcomes of health promotion in older populations. [ABSTRACT FROM AUTHOR]

Objectives: To investigate referral rates for cardiac interventions by clinical specialty, to document doctors' reasons for referrals and to explore doctors' perceptions of the factors that influenced their clinical decisions. Study Design: Doctors completed a clinical decision-making exercise involving, in total, 6093 electronic patients with cardiac disease, and subsequently took part in the semi-structured interviews about influences on their decisions. Interviews were audio-recorded, transcribed and coded using a thematic approach, with the coding categories derived from the data. Study Setting: Eighty-eight doctors (GPs, care-of-the-elderly specialists, cardiologists) participated in the full study, in seven areas in southern, central and northern England. Complete interview data were analysed for 76 of these. Principal Findings: Not all patients who were eligible for specific investigations or treatment received these. The extent of variations in clinical decisions differed by type of intervention. Apart from the general reasons for referrals, doctors raised nine main influences on their actual decision making. The most commonly reported influence ('barrier') was poor access to equipment for intervention, which increased thresholds for investigation and treatment. Conclusions: The current emphasis on achieving targets in the British NHS has led to a focus on easily measurable, but crude, process targets such as waiting lists. This study points to the need to include a broader quality assurance element to investigate the cluster of system failures which lead to variations in clinical decisions and thereby to inequitable treatment. [ABSTRACT FROM AUTHOR]

Background One of the main primary data collection instruments in social, health and epidemiological research is the survey questionnaire. Modes of data collection by questionnaire differ in several ways, including the method of contacting respondents, the medium of delivering the questionnaire to respondents, and the administration of the questions. These are likely to have different effects on the quality of the data collected. [ABSTRACT FROM PUBLISHER]

Presents a study that measured whether older people living in Great Britain would be willing to give up their place on the cardiac surgery waiting list for a younger person. Increase in willingness to cede priority with older age; Methodology; Results and discussion.

Objective: to investigate the clinical management of heart disease and determine whether there was age‐ and sex‐related bias in the use of investigations and interventions. [ABSTRACT FROM PUBLISHER]

Background Population norms for the attributes included in measurement scales are required to provide a standard with which scores from other study populations can be compared. This study aimed to obtain population norms for the Short Form 36 (SF-36) Health Survey Questionnaire, derived from a random sample of the population in Britain who were interviewed at home, and to make comparisons with other commonly used norms. [ABSTRACT FROM PUBLISHER]

Investigates changes in functional ability and associations with these changes in relation to physical health, psychiatric morbidity, life satisfaction, service use and social circumstance among elderlies. Relationship of physical functioning and use of rehabilitative and medical services; Importance of maintaining levels of functioning in old age.

The article focuses on the health beliefs and illness causation among Turkish and white British living in London, England. A research was conducted involving an evaluation of written health promotion material aimed at reducing smoking in these communities. The study shows that self-assessments of health vary widely among different ethnic groups. Things that currently had a negative effect on their health included smoking and stress or worries. The most common individual lifestyle cause of illness that was mentioned by the Turks was poor diet.

Social scientists frequently refer to the ‘greying’ of the population in the west, the extension of the average lifespan to around the age of 76, and the projected increases in the numbers of people aged 85 and over, with the ensuing problems of chronic illness and disability that often accompany very old age. Increasing interest is being expressed in positive aspects of ageing: given the increases in life expectancy during this century, is it resulting in a life worth living? Concern is heightened by the estimate that, although most people aged 65+ live in their own homes and are relatively healthy and independent, years of disability can begin as early as 60 years. Conversely, some researchers and policy makers feel that enough time has been spent on the negative aspects of ageing and that the balance should be addressed by analysing successful, or positive ageing (sometimes defined in terms of an overlapping but separate dimension ‘health-related quality of life’), with the aim of promoting well-being for future generations. [ABSTRACT FROM PUBLISHER]

Many studies suggest that there is a relationship between social support and physical and psychological health status, risk of institutionalization and mortality of the elderly. Although longitudinal analyses confirm these suggestions, all studies experience problems with network methodology, and none use comparable operational or working definitions. It is known that there is an effect between these variables, but the nature of the relationship is still unknown. This paper reviews existing research on social networks, social support and associations with health status, mortality and risk of institutionalization. [ABSTRACT FROM PUBLISHER]

The success of screening programmes for breast and cervical cancer partly depends on women's acceptance and take-up of the service. Uptake of preventive health care programmes appears to be related to people's underlying motivations and attitudes, not only towards the disease in question, but towards health and illness generally. The perceived costs to the individual of embarking on particular courses of action also have to be taken into consideration. These attitudes and motivations vary between social groups. Unless the reasons for non-participation in preventive health care and screening programmes is understood, programmes will be misdirected and inappropriately designed. However, the failure of any one theory to account for most of the variance in health behaviour between social groups emphasizes the importance of health education and provision of information about health and prevention on a personal basis. General practitioners and practice based nurses are in a good position to be able to elicit the fears, prejudices and priorities of patients in this area, and thus provide more effective health education and information about preventive and screening services. [ABSTRACT FROM PUBLISHER]

This paper describes two surveys carried out at the accident and emergency department of Queen Elizabeth Hospital, a specialist children's hospital situated in the east end of London. Both studies explored factors influencing attendance at the accident and emergency department. One was based on an analysis of recorded information (hospital notes) for a random sample of attenders, spread over a 12-month period. The second was based on personal interviews with a sample of children's parents. Both studies found problems with access to general practitioner care to be the main factors influencing attendance. [ABSTRACT FROM PUBLISHER]

A survey of the health and social circumstances of 662 people aged 85 and over, living at home in inner London, was conducted in 1987. A primary aim was to analyze the structure of social support networks of the sample in relation to respondents' emotional well-being and met and unmet needs for practical help. The conceptual and methodological framework that was applied to the study was derived from the theory of social networks. In confirmation of the common assumption that people aged 85+ are different from younger elderly people, as they are the “survivors” high levels of social support and informal help were given to most respondents. Although associations were found between social network variables and the provision of informal help, multifactorial analysis showed that health status explained more of the variation in emotional well-being. [ABSTRACT FROM PUBLISHER]