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Overall satisfaction levels with social care are usually high but lower levels have been reported among black and minority ethnic ( BME) service users in England. Reasons for this are poorly understood. This qualitative study therefore explored satisfaction with services among informal carer participants from five different ethnic groups. Fifty-seven carers (black Caribbean, black African, Asian Indian, Asian Pakistani and white British) were recruited from voluntary sector organisations and a local hospital in England, and took part in semi-structured interviews using cognitive interviewing and the critical incident technique. Interviews took place from summer 2013 to spring 2014. Thematic analysis of the interviews showed that participants often struggled to identify specific 'incidents', especially satisfactory ones. When describing satisfactory services, participants talked mostly about specific individuals and relationships. Unsatisfactory experiences centred on services overall. When rating services using cognitive interviewing, explicit comparisons with expectations or experiences with other services were common. Highest satisfaction ratings tended to be justified by positive personal characteristics among practitioners, trust and relationships. Lower level ratings were mostly explained by inconsistency in services, insufficient or poor care. Lowest level ratings were rare. Overall, few differences between ethnic groups were identified, although white British participants rated services higher overall giving more top ratings. White British participants also frequently took a more overall view of services, highlighting some concerns but still giving top ratings, while South Asian carers in particular focused on negative aspects of services. Together these methods provide insight into what participants mean by satisfactory and unsatisfactory services. Cognitive interviewing was more challenging for some BME participants, possibly a reflection of the meaningfulness of the concept of service satisfaction to them. Future research should include comparisons between BME and white participants' understanding of the most positive parts of satisfaction scales and should focus on dissatisfied participants. [ABSTRACT FROM AUTHOR]

This paper recounts the process of undertaking a randomised controlled trial which was designed to examine the effectiveness of an intervention for socially isolated older people aged 75 years and over. It describes the reasons for early cessation of the study and raises the implications of this outcome for policy, practice and research. The intervention under investigation was designed to alleviate loneliness and foster companionship. It involves participants being linked with a small group of others through a teleconferencing system with each group being facilitated by trained volunteers. There was a requirement to recruit and train a minimum of 30 and a maximum of 60 volunteers over 1 year to facilitate 20 friendship groups to meet the number of older people required to be recruited to the study. Problems with recruiting and retaining the volunteer workforce by the voluntary sector organisation, who were commissioned to do so, led to the study closing even though older people were recruited in sufficient numbers. The paper draws upon analysis of various data sources from the study to identify the potential reasons. The discussion raises considerations regarding the extent of infrastructure required to deliver community services to vulnerable user groups at scale, identifies some of the issues that need to be addressed if such volunteer-initiated services are to be successful and informs future research programmes in this area. [ABSTRACT FROM AUTHOR]

Purpose: To investigate associations between baseline frailty status and subsequent changes in QOL over time among community-dwelling older people. Methods: Among 363 community-dwelling older people ≥65 years, frailty was measured using Frailty Index (FI) constructed from 40 deficits at baseline. QOL was measured using Older People's Quality of Life Questionnaire (OPQOL) six times over 2.5 years. Two-level hierarchical linear models were employed to predict QOL changes over time according to baseline frailty. Results: At baseline, mean age was 73.1 (range 65-90) and 62.0 % were women. Mean FI was 0.17 (range 0.00-0.66), and mean OPQOL was 130.80 (range 93-163). The hierarchical linear model adjusted for age, gender, ethnicity, education, and enrollment site predicted that those with higher FI at baseline have lower QOL than those with lower FI (regression coefficient = -47.64, p < 0.0001) and that QOL changes linearly over time with slopes ranging from 0.80 (FI = 0.00) to -1.15 (FI = 0.66) as the FI increases. A FI of 0.27 is the cutoff point at which improvements in QOL over time change to declines in QOL. Conclusions: Frailty was associated with lower QOL among British community-dwelling older people. While less frail participants had higher QOL at baseline and QOL improved over time, QOL of frailer participants was lower at baseline and declined. [ABSTRACT FROM AUTHOR]

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 PUBLISHER]

Purpose: This study investigates the effect of changes in moderate or vigorous physical activity (MVPA) on trajectories in health-related quality of life (HR-QoL) over 7 years in British elderly women. Methods: A total of 1,926 women from the British Women’s Heart and Health Study with information on MVPA and HR-QoL [measured using Euro quality of life 5 dimension (EQ-5D)] at baseline and at 7 years of follow-up were included in the analysis. Baseline and 7-year follow-up MVPA values were categorised into 3 groups, generating 9 categories of change in MVPA. Logistic regression was used to obtain odds ratios (ORs) of maintaining or improving HR-QoL according to different patterns of change in MVPA level. Results: Women who remained inactive over the 7 years of follow-up had the largest reduction in their EQ-5D scores. Compared to these women, women that increased their MPVA level from “inactive” to “low” or to “moderate-high” were more likely to maintain or improve their HR-QoL over 7 years (ORs 1.65 or 2.70, respectively, p value for trend <0.001). After adjustment for baseline EQ-5D score and a wide range of potential confounders, results remained largely unchanged, though precision of the estimates generally decreased. Conclusions: Our findings suggest that relatively regular MVPA, even taken up later in life, can help older women prevent a decline in HR-QoL and even improve their enjoyment of life. [ABSTRACT FROM AUTHOR]

This study investigated associations between chronic inflammation and coagulation and incident locomotor disability using prospective data from the British Women's Heart and Health Study. Locomotor disability was assessed using self-reported questionnaires in 1999/2000, and 3 and 7 years later. Scores for inflammation and coagulation were obtained from summation of quartile categories of all available biomarkers from blood samples taken at baseline. 534 women developed locomotor disability after 3 years, 260 women after 7 years, while 871 women remained free of locomotor disability over the whole study period. After adjustment for demographic characteristics, lifestyle factors and health conditions, we found associations between inflammation and incident locomotor disability after three (OR per unit increase in score = 1.08, 95 % confidence interval (CI): 1.03, 1.13) and 7 years (OR = 1.10, 95 % CI: 1.03, 1.18) and between coagulation and incident locomotor disability after 3 (OR = 1.06, 95 % CI: 0.98, 1.14) and 7 years (OR = 1.09, 95 % CI: 1.00, 1.18). This corresponds to ORs between 1.8 and 2.4 comparing women with highest to lowest inflammation or coagulation scores. These results support the role of inflammation and coagulation in the development of locomotor disability in elderly women irrespective of their lifestyle factors and underlying age-related chronic diseases. [ABSTRACT FROM AUTHOR]

Longitudinal studies of loneliness among older people are comparatively rare. At 8 years after the initial survey in 1999–2000, we followed up on the 999 people aged 65+ years who were living in the community in the United Kingdom. We found that 583 participants were still alive, and 287 (58%) participated in the follow-up survey. The overall prevalence of loneliness at both time points was very similar, with 9% reporting severe loneliness; 30% reporting that they were sometimes lonely, and 61% reporting that they were never lonely. We developed a 12-category typology to describe changes in loneliness across the follow-up period and report that 60% of participants had a stable loneliness rating, with 40–50% rating themselves as never lonely, and 20–25% rating themselves as persistently lonely; 25% demonstrated decreased loneliness, and approximately 15% demonstrated worse loneliness. Changes in loneliness were linked with changes in marital status, living arrangements, social networks, and physical health. Importantly improvements in physical health and improved social relationships were linked to reduced levels of loneliness. This result suggests that strategies to combat loneliness are not confined to the arena of social interventions such as befriending services, which aim to build and support social embeddedness, but may also result from the treatment of chronic and long-term health conditions. [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]

Following a critical overview of the active ageing concept, a thematic decomposition of 42 transcribed interviews with British people aged 72 years and over indicates that active ageing is understood in relation to physical, cognitive, psychological and social factors, but that these co-exist in complex combinations. The notion of activity in active ageing is grasped in relation to an active/passive distinction which emphasizes the enhancement or diminishment of concrete powers of activity. A ‘challenge and response’ framework is suggested for future research on active ageing. [ABSTRACT FROM PUBLISHER]

Background Most measures of quality of life (QoL) are based on 'expert' opinions. This study describes a new measure of QoL in older age, the Older People's QoL Questionnaire (OPQOL), which is unique in being derived from the views of lay people, cross-checked against theoretical models for assessment of comprehensiveness. Its performance was assessed cross-sectionally and longitudinally. It was compared with two existing QoL measures in the cross-sectional studies in order to identify the optimal measure for use with older populations. Methods Data were taken from three surveys of older people living at home in Britain in 2007-2008: one population survey of people aged 65+, one focused enumeration survey of ethnically diverse older people aged 65+, one follow-up of a population survey of people aged 65+ at baseline in 1999/2000. Measures were QoL (using OPQOL, Control, Autonomy, Satisfaction, Pleasure - 19 items (CASP-19), World Health Organization Quality of Life questionnaire - version for older people (WHOQOL-OLD)), health, social and socioeconomic circumstances. The CASP-19 and WHOQOL-OLD were not administered to the longitudinal sample in order to reduce respondent burden. Results Psychometric tests were applied to each QoL measure. The OPQOL, CASP-19 and WHOQOL-OLD performed well with the cross-sectional samples; however, only the OPQOL met criteria for internal consistency in the Ethnibus samples. Conclusion The OPQOL is of potential value in the outcome assessment of health and social interventions, which can have a multidimensional impact on people's lives. Further research is needed to examine whether differences by ethnicity reflect real differences in QoL, methodological issues, variations in expectations or cultural differences in reporting. [ABSTRACT FROM AUTHOR]

Objective To use semi-structured interviews to ascertain patterns in patients’ expectations of health care and the extent to which these expectations were met or not. Background In health policy it is important to evaluate health services from varying perspectives including consumers’. One concept of emerging importance in this regard is that of patient expectations. Whether expectations are met or not have been found to be related to general patient satisfaction with treatment and treatment compliance. However, there is conceptual and methodological uncertainty and little informing empirical work regarding what is an ‘expectation’ and how it should be measured. Design A qualitative study using semi-structured interviews to elicit 20 GP patients’ expectations prior to their consultation. A post consultation interview gauged the extent to which these expectations had been met. Setting and participant Twenty patients of a GP practice in Norfolk (UK). Results Results suggest several different expectations, concerned with the doctor-patient interaction, the specific processes of the consultation, outcomes, and issues to do with time and space. Conclusions This research has used an innovative exploratory approach to address the expectations of GP patients and has implications for how doctors ought to manage their consultations. These results will be used to inform the development of a quantitative expectations questionnaire so as to develop a validated measure of expectations. Such an instrument has great potential to aid in health care research and practice. [ABSTRACT FROM AUTHOR]

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]

Purpose. To present the psychometric properties of a new measure of quality of life in older age, the Older People's Quality of Life (OPQOL) Questionnaire, compared with the CAPSE-19 and theWHOQOL-OLD. Design and Methods. The vehicle was three national population surveys of older people living at home in Britain, including a survey of ethnically diverse older people. Results. The OPQOL had acceptable levels of reliability and validity in British population samples of older people, but more modest in the ethnically diverse population sample. The CASP-19 and WHOQOL-OLD had acceptable levels of reliability and validity in the British population sample, but not in the ethnically diverse sample. Implications. The OPQOL has potential for use as a multidimensional population surveillance instrument for use with older populations, or as an outcome measure of multisector policy. Its strengths are that its development was embedded firmly in the perspectives of older people, integrated with theory. [ABSTRACT FROM AUTHOR]

Background There is a growing literature suggesting that access to cardiology services is affected by age. However, there is a dearth of studies that have considered age and sex in conjunction. Aim This study aims to examine the impact of age, and its interaction with sex, on reported healthcare seeking, based on responses to symptom vignettes, in an attempt to standardise symptomatology across all responders. Design of study A cross-sectional survey design was utilised. Setting Primary care. Method A random sample of 911 individuals, stratified by sex, was selected from one practice in the UK. Participants were invited to state how they would react in response to the chest pain symptoms presented. Patterns of response were examined, by age and sex, using Χ² and logistic regression models. Results This study identified differences by age and sex in a general practice population in the propensity to seek health care. In particular, men aged 60-69 years and women aged 70 years and over were more likely to report healthcare seeking than younger responders. For example, women aged 70 years and over had over three times greater odds of reporting contact with the GP compared to the reference category. Evidence for an interaction effect between age and sex was observed. Conclusion The results suggest that the inequity that has been demonstrated in access to cardiology services by age is not likely to be due to the patient's illness behaviour as, overall, older people are more likely than younger people to be willing to consult their doctors. [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 the relation between perceived neighbourhood environment, social contact and support, and self efficacy, on the health of older people. Design: British cross sectional population survey of people aged 65 and over. Participants: 999 people aged 65 plus living at home in Britain. Results: Regression modelling showed that high self efficacy had a strong independent association with better self rated health status and physical functioning. Indicators of perceived neighbourhood environment that showed strong associations with both good health and functioning were: perceptions of good quality facilities in the area (social/leisure, facilities for people aged 65+, rubbish collection, health services, transport, closeness to shops, somewhere nice to walk), and high levels of neighbourliness (knows/trusts people). Perceptions of problems in the area (noise, crime, air quality, rubbish/litter, traffic, graffiti) were also predictive of poorer health. Measures of social contact and support did not show any independent associations with health or functioning. Conclusions: The unique value of this paper is in the simultaneous analysis of associations between perceived neighbourhood, social contact and support, self efficacy, and health. The consistent strength of older people's perceptions of the quality of facilities in their neighbourhoods shows that responsive reinforcement of local infrastructures might have wider health benefits. Also of interest was the strength of self efficacy as a predictor of self rated health and physical functioning. The results have implications for both neighbourhood level interventions and self management programmes in chronic illness. [ABSTRACT FROM AUTHOR]

The prevalence of loneliness amongst older people in Great comparisons with the findings of studies undertaken during In addition, the risk factors for loneliness are examined using of vulnerability and protective factors derived from a model of depression. Loneliness was measured using a self-rating scale, and measures of socio-demographic status and health/social resources were included. Interviews were undertaken with 999 people aged 65 or more years living in their own homes, and the sample was broadly representative of the population in 2001. Among them the prevalence of `severe loneliness' was seven per cent, indicating little change over five decades. Six independent vulnerability factors for loneliness were identified: marital status, increases in loneliness over the previous decade, increases in time alone over the previous decade; elevated mental morbidity; poor current health; and poorer health in old age than expected. Advanced age and possession of post-basic education were independently protective of loneliness. From this evidence we propose that there are three loneliness pathways in later life: continuation of a long-established attribute, late-onset loneliness, and decreasing loneliness. Confirmation of the different trajectories suggests that policies and interventions should reflect the variability of loneliness in later life, for undifferentiated responses may be neither appropriate nor effective. This study examines Britain, and makes the last five decades. a conceptual model [ABSTRACT FROM AUTHOR]

This paper is based on the results of a national survey of the quality of life of 999 randomly sampled people aged 65 and over, living at home in Britain. The survey was semi-structured, and a sample of survey respondents was followed up and interviewed in-depth in order to explore their perceptions of quality of life in full. Comparisons are made here between the results of (i) a hierarchical multiple regression model based on theoretically derived indicators of survey respondents' ratings of their overall quality of life, with (ii) the same respondents' own definitions of quality of life, categorized from their responses to open ended survey questions, and (iii) the views of a sub-sample of these survey respondents who were subsequently interviewed in greater depth. Respondents were asked the open ended questions on quality of life at the outset of the survey interview in order to prevent any respondent bias from the structured measures used. The core components, and the central planks, of quality of life, which were consistently emphasized by the three approaches, were psychological characteristics and outlook, health and functional status, personal and neighborhood social capital. The lay models also emphasized the importance of financial circumstances and independence, which need to be incorporated into a definition of broader quality of life. [ABSTRACT FROM AUTHOR]

This study aimed to explore older peoples' definitions of, and priorities for, a good quality of life for themselves and their peers. Nine hundred and ninety-nine people aged 65 and over, living at home in Britain, were interviewed for the study. Good social relationships were the most commonly mentioned constituent that gave respondents' lives quality (mentioned by 81 percent). Other important factors were social roles and activities, health, psychological outlook and well-being, home and neighborhood, finances, and independence. Poor health was most often mentioned as taking quality away from life (by 50 percent). Social relationships and health were judged to be the most important areas. Having health and enough money were the two most frequently mentioned things that would improve the quality of their own lives and those of their peers (though in different order of magnitude). The need for dynamic, multidimensional, and integrated models of quality of life in older age is suggested by these results. [ABSTRACT FROM AUTHOR]

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.

The aim of the analyses presented here was to explore subjective and objective components and predictors of self-rated quality of life (QoL). The vehicle for the study was a questionnaire module on perceptions of quality of life, which was commissioned by the authors for inclusion in the Office of National Statistics (ONS) Omnibus Survey in Great Britain. For the survey, 2033 randomly sampled adults aged 16 and over were interviewed in their own homes (77% response rate). Multiple regression analyses showed that relatively little of the variance in overall QoL ratings was explained by the objective, socio-demographic indicators (5%), and the addition of the health status indicator (reported longstanding illness) contributed nothing. The subjective ratings of life in self-nominated areas of importance explained the most, with those who did not prioritise the area at all as the referent (relationships, finances, own health, others' health, work and social life). These variables contributed over twice as much as the objective and health status variables, indicating the relative importance of self-nominated ‘important areas of life’ over theoretically important, objective variables and reported illness. However, the final model still only explained a modest amount of the variance in quality of life ratings (16%), confirming the amorphous nature of quality of life. [ABSTRACT FROM AUTHOR]

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]

This article presents the analyses of mortality rates of elderly people in a randomized controlled trial of nursing home and long-stay ward care in hospital. No statistically significant differences between settings were found in relation to mortality rates. Ages, accident rate and existence of cognitive impairment were associated with mortality with bivariate analyses, although they were found to explain very little of the variation between survival and mortality when logistic regression analysis was employed. In both settings, those who had some cognitive impairment had just over twice the relative risk of dying than others, although this difference was not statistically significant. [ABSTRACT FROM AUTHOR]

Focuses on the prevalence and treatment of injuries among dancers in Great Britain. Body mass index of women dancers; Sites of chronic injuries; Necessity for rest as treatment of the injury.

Presents the views of a nationally representative sample of adults in Great Britain on priorities for health services. Interview survey based on a random sample of people aged 16 and over; Response rate to the survey; Treatments for children with life threatening illness; Special care and relief for people who are dying.

Describes the impact of surgery for stress incontinence on the severity of symptoms and the incidence of postoperative complications. Surgical procedures used in United Kingdom for treating stress incontinence in women; Percentage of women who reported an improvement in the severity of incontinence.

The authors comment on a study which assessed the geographical and sociodemographic factors associated with variations in access to total hip and knee replacement surgery in England. They present the findings of the study on inequity in access to surgery by sex, age, area of residence and ethnicity. They discuss the relevance of the key findings of the study, as well as their limitations in changing current policy. They also call on the National Health Service (NHS) to meet the health needs of the public.

The author reflects on ageism in medicine in Great Britain. He remarks that age has been used as a measure for allotting healthcare resources as it is believed that older people have a shorter duration of benefit from treatment hence limited resources should be assigned to younger people. The author notes that special treatment for younger people may have sense in 1948 when 40% of people died before they arrive the age of 65, compared with the present 7%.

This article discusses a 2006 white paper from Great Britain's Department of Health which recommended a major transfer of National Health Service functions to the community. This transfer would move as many as 15 million outpatient attendances to community settings. The paper also named a variety of clinical activities and procedures that could be performed outside the acute hospital setting.

Focuses on the inadequacies of population registers in Great Britain. Use of registers of medical screening; Performance of preliminary checks on the accuracy of lists; Overrepresentation of women in cervical cancer.

Background: The current international interest in well-being indicators among governmental agencies means that many quality of life scales are potential components of such national indicator sets. Measuring well-being in minority groups is complex and challenging. Scales are available that have been validated in specific parts of the population, such as older people. However, validation among combinations of minority groups, such as older adults of ethnic minority backgrounds, is lacking., Findings: We pooled data from two surveys of older adults in Great Britain: one conducted among White British people, and one among four ethnic minority groups. Quality of life was measured by the Older People's Quality of Life (OPQOL); Control, Autonomy, Self-realisation, Pleasure (CASP-19); and World Health Organization Quality of Life scale for older people (WHOQOL-OLD). We found differences, some significant, between groups in terms of self-reported importance of various aspects of quality of life. A regression model of each total quality of life scale revealed greater unexplained variability in the White British group than the others. Principal components analysis within each ethnic group's data showed considerable differences in the correlation structures., Conclusions: There are differences between ethnic groups that are consistent across the three scales and are not explained by a battery of predictor variables. If scales such as these are used to compare quality of life between ethnic groups, or equivalently between geographical regions, the different results in each group are liable to bias any comparison which could lead to inequitable policy decisions.

Background: Elderly patients with cardiovascular disease are relatively undertreated and undertested., Objectives: To investigate whether, and how, individual doctors are influenced by a patient's age in their investigation and treatment of angina., Design: Process-based judgment analysis using electronic patients, semistructured interviews., Setting: Primary Care, Care of the Elderly and Cardiology in England., Participants: Eighty five doctors: 29 cardiologists, 28 care of the elderly specialists and 28 general practitioners (GPs)., Main Outcome Measures: Testing and treatment decisions on hypothetical patients., Results: Forty six per cent of GPs and care of the elderly doctors, and 48% of cardiologists treated patients aged 65+ differently to those under 65, independent of comorbidity. This effect was evident on several decisions: elderly patients were less likely to be prescribed a statin given a cholesterol test, referred to a cardiologist, given an exercise tolerance test, angiography and revascularisation; more likely to have their current prescriptions changed and to be given a follow-up appointment. There was no effect of specialty, gender or years of training on influence of patient age. Those doctors who were influenced by age were on average five years older than those who were not. Interviews revealed that some doctors saw old age as a contraindication to treat., Conclusions: Age, independent of comorbidity, presentation and patients' wishes, directly influenced decision-making about angina investigation and treatment by half of the doctors in the primary and secondary care samples. Doctors explicitly reasoned about the direct influence of age and age-associated influences.

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.