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to examine the relationship between seven predictor variables (recorded on Day 3 of hospital admission) and discharge destination in non-elective medical patients aged 65+ years.prospective cohort.eight centres in six European countries.age, gender, living alone, physical function (three categories based on Barthel Index), cognition (Katzman's orientation-memory-concentration test), main body system affected (based on International Classification of Diseases), number of geriatric giants (GGs) involved in the referral (a GG being a problem with falling, mobility, continence or cognition).discharge destination (by Day 90) in three categories: 'HOMESAME' (return to previous residence), 'INSTIN90' (discharge to alternative residence or still in hospital at 90 days), 'DEADINHO' (death in hospital),in 1,626 patients, discharge destination was HOMESAME in 84.7%, DEADINHO in 8.9% and INSTIN90 in 6.4%. Mean duration of stay was 17.7 days, median 12. Univariate analyses showed a statistically significant relationship between all seven predictor variables and discharge destination. Physical function was the best single predictor with a seven-fold difference in adverse outcome rates between the best and worst categories. On multiple logistic regression, significant predictor variables were as follows. (i) For DEADINHO: physical function, cognition, gender; (ii) for INSTIN90: physical function, living alone, GGs, age, gender. Multiple linear regression identified physical function, GGs and living alone as predictors of loge length of stay.case-mix systems to compare risk-adjusted hospital outcome in older medical patients need to incorporate information about physical function, cognition and presenting problems in addition to diagnosis.

Patients with proximal femoral fracture occupy 20% of all orthopaedic beds at any one time [1]. In postmenopausal women, proximal femoral fracture accounts for more bed days annually than breast cancer, acute myocardial infarction, diabetes mellitus or chronic obstructive pulmonary disease. Most people with a proximal femoral fracture are old: 90% are older than 65 and 75% are older than 75. Most are women: one in six women who reach the age of 80 years will suffer a hip fracture [2, 3]The incidence is rising, partly because of the ageing population, but the agerelated fracture rate is also increasing [4], which may be related to smoking and a more sedentary lifestyle. Although treated on orthopaedic wards, patients with proximal femoral fracture frequently have complex problems. Eighty percent have hypertension, diabetes mellitus, Parkinson's disease or dementia [5].

Introduction A reliable measure capable of detecting progression towards smoking cessation would be valuable for evaluating and optimizing the effectiveness of low- to moderate-intensity cessation interventions, such as brief advice in the primary care setting. This article presents the development and evaluation of a brief self-report measure of Incremental Behavior Change toward Smoking cessation (IBC-S). Methods Sequential samples of 411 and 399 adult smokers completed items representing a spectrum of behavioral and cognitive changes antecedent to smoking cessation. The dimensionality, fit, range of difficulty, and reliability of items were evaluated using factor analysis and Rasch modeling. Results The final 15-item IBC-S measure met fit criteria and demonstrated acceptable reliability. Participants with a significant change in IBC-S score were over four times more likely to report cessation at 6-week follow-up (OR 4.37, 95% CI 1.83-10.42). Conclusion The IBC-S is brief, reliable and associated with self-report of smoking reduction and cessation. Implications This article presents the psychometric evaluation of a measure to assess a spectrum of behaviors and cognitions antecedent to smoking cessation. The findings indicate that the items show good measurement properties and good potential as a sensitive measure to evaluate interventions. This measure provides an alternative outcome for interventions that are designed to move individuals towards cessation attempts.