Search

Background: The purpose of this study was to compare apolipoprotein E ε4 (Apo E ε4) and apolipoprotein E ε2 (Apo E ε2) as predictors of cognitive and functional trajectories over 30 months., Methods: This prospective cohort study included 287 community-dwelling memory clinic patients with dementia, mild cognitive impairment, or no cognitive impairment. The Addenbrooke Cognitive Examination, Mini-Mental State Examination, Montreal Cognitive Assessment, Delirium Index, and Nottingham Instrumental Activities of Daily Living tests were administered to each subject., Results: One hundred and nine subjects (40%) carried Apo E ε4 and 48 (16.7%) carried Apo E ε2. One hundred and nine ε4-positive subjects differed significantly from 178 ε4-negative subjects in 19/52 comparisons (36.5%), whereas 46 Apo E ε2-positive subjects had 0/52 significant differences from 239 ε2-negative subjects (P < 0.0001). The variables most affected by ε4 were the Delirium Index and Mini-Mental State Examination. Instrumental Activities of Daily Living score and residence were unrelated to Apo E ε4 or ε2., Conclusion: Apo E ε4 positivity predicted four cognitive scores measured every 6 months over 30 months. Apo E ε2 scores predicted none of 52 comparisons.

Objective: To determine the balance between acute and chronic medical problems in the PBL cases at 2 Australian medical schools., Methods: Analysis of 162 PBL cases., Results: Cases concentrate on acute problems in young people and neglect chronic disease in the old., Conclusion: This imbalance may contribute to negative attitudes towards elderly patients and people with chronic disease.

Background: To provide optimal care for our ageing population, some form of advance care planning (ACP) is essential. Overseas data suggest that the process of ACP and the use of advance care directives (ACD) is suboptimal in residential care institutions. By comparison there are few Australian data., Aim: To study the process of ACP and the prevalence of ACD in residential care., Methods: Cross-sectional study using a questionnaire in the Hunter area, NSW, Australia., Results: Very low levels of formal advance directives were found (available for only 0.2%). Only 1.1% of residents had 'no-CPR' orders documented in the medical record, while 5.6% had a formal guardian and 2.8% had an enduring guardian. Informal processes of advance planning were much more prevalent. Sixty-five per cent had a 'person responsible' recorded to make decisions for them while in 13% of cases, there was 'staff consensus' as to the optimal care for the patient. However, in 10.6% there was no clear process for medical decision making identified., Conclusions: Advanced directives are infrequently used in residential care. Further qualitative and quantitative studies are warranted to explore current processes of decision making.

To examine the patterns of use of patient restraints in Australian hospitals and the level of adherence to accepted guidelines, we undertook a point-prevalence study in four teaching hospitals in three different States. This involved ward inspections and review of case notes. Overall, 51 (12.5%) of the 408 people audited were being restrained with a variety of physical and chemical agents. The rate of restraint use varied from 8.5% to 18.5% between hospitals. Although the overall prevalence of restraint use increased with age, the hospital with the oldest patients used restraints least. At all hospitals, there was scant documentation in the case notes concerning the use of restraints. The prevalence of restraint use varies widely in different hospitals. As this is not explained by the patient profile, it probably reflects different philosophies of care. Documentation of the use of restraints needs to be improved in all the centres studied.

Background: A descriptive study of self-reported healthy elderly in Newcastle was undertaken for an adequate understanding of the normal characteristics of the elderly., Aims: We sought to determine the frequency of abnormal clinical, laboratory and echocardiographic findings in a self-reported healthy elderly population., Methods: Volunteers aged greater than 75 years were recruited from active members of the region's bowling clubs. Forty-five subjects with no self-reported vascular or cardiac disease underwent clinical, laboratory and echocardiography assessment., Results: Minor cardiovascular abnormalities were frequently detected. Echocardiography correspondingly found a high frequency of haemodynamically insignificant degenerative valvular lesions. Doppler left ventricular filling pattern of abnormal relaxation was a universal finding., Conclusion: There is a high prevalence of age-related echo-Doppler abnormalities in the self-reported healthy elderly with important implications for the interpretation of echo-Doppler studies.