Search

Katarzyna Bień-Barkowska,1 Halina Doroszkiewicz,2 Barbara Bień2 1Institute of Econometrics, Warsaw School of Economics, Warsaw, 2Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland Objectives: The aim of this article was to identify the best predictors of distress suffered by family carers (FCs) of geriatric patients.Methods: A cross-sectional study of 100 FC-geriatric patient dyads was conducted. The negative impact of care (NIoC) subscale of the COPE index was dichotomized to identify lower stress (score of ≤15 on the scale) and higher stress (score of ≥16 on the scale) exerted on FCs by the process of providing care. The set of explanatory variables comprised a wide range of sociodemographic and care-related attributes, including patient-related results from comprehensive geriatric assessments and disease profiles. The best combination of explanatory variables that provided the highest predictive power for distress among FCs in the multiple logistic regression (LR) model was determined according to statistical information criteria. The statistical robustness of the observed relationships and the discriminative power of the model were verified with the cross-validation method.Results: The mean age of FCs was 57.2 (±10.6) years, whereas that of geriatric patients was 81.7 (±6.4) years. Despite the broad initial set of potential explanatory variables, only five predictors were jointly selected for the best statistical model. A higher level of distress was independently predicted by lower self-evaluation of health; worse self-appraisal of coping well as a caregiver; lower sense of general support; more hours of care per week; and the motor retardation of the cared-for person measured with the speed of the Timed Up and Go (TUG) test.Conclusion: Worse performance on the TUG test was only the patient-related predictor of distress among the variables examined as contributors to the higher NIoC. Enhancing the mobility of geriatric patients through suitably tailored kinesitherapeutic methods during their hospital stay may mitigate the burden endured by FCs. Keywords: negative impact of care, caregiver burden, comprehensive geriatric assessment, Timed Up and Go test

Poland has experienced a remarkable growth in renewable energy adoption, notably in photovoltaic (PV) solar systems. The majority of installations are prosumer PV micro-installations, exceeding predicted capacity targets outlined in the Energy Policy of Poland until 2040. Despite the significant growth in installed PV capacity, there is still a lack of comprehensive research focusing on fast assessment of energy generation capacity for solar PV micro-systems. This study aims to address this gap by providing a comprehensive analysis of energy production potential across different configurations and locations in Poland. Using geocoding techniques, solar irradiation data from PVGIS database and pvlib-python library, a methodology was developed to rapidly estimate energy generation from 1 kWp solar PV systems . Results reveal spatial disparities in energy yield from solar PV micro installations in Poland, influenced by factors such as geographical location and panel orientation and inclination. Recognizing that the presented energy indicators provide valuable initial parameters for determining solar PV system power output, this data can serve as a critical reference point for stakeholders, assisting them in estimating potential energy generation capacities in different regions of Poland.

Ash materials produced during combustion may create several technical and environmental problems. In this work, bottom and fly ashes obtained from lab-scale circulating fluidized bed oxy-fuel combustion of the mixture of sewage sludge and coal were characterized. The slagging and fouling tendency was determined; studies on the chemical composition, including heavy metals, were carried out; the environmental impact and their potential uses were also assessed. The findings showed that the lowest sintering temperature in the oxidizing atmosphere is mainly characterized by ashes from sewage sludge combustion: the higher the share of coal in the blend mixture, the higher the ash sintering temperature. A similar tendency occurs for the temperature of softening of the ash. The analysis of particle size distribution of fly ash showed that after the combustion of municipal sewage sludge alone, the volume fraction of <10 mm was 32%, while for fuel blends it was less than 10%. The shift of particle size distribution of ash from sludge combustion to fine particles results in significant activity of oxygen atoms and increased particle loading, as confirmed by the study of the amount of unburned char in ash. The fly ash after oxygen combustion was characterized by a low degree of crystallinity. The main crystalline phases were crystalline silica – SiO2, diiron trioxide – Fe2O3 and calcium sulfate – CaSO4. The main components of fly ash and bottom ash were aluminum and silicon compounds. [ABSTRACT FROM AUTHOR]

Purpose: The elderly are a growing part of the society and a further growth is expected in the demand for both medical and nursing services performed by primary health care institutions. The aim of this work is to answer the question: "Does the form of employment of community nurses in primary health care institutions influence the quality of interdisciplinary cooperation in caring for elderly patients?" Material and methods: The research was conducted among family doctors, who provided health care in the city of Białystok under the contract with the National Health Fund. The questionnaire was answered by 104 family doctors. Of this number 69 employed a family nurse and 35 co-operated with a non-public community nursing unit. The database of institutions and doctors employed was acquired from the National Health Fund. The research tool was an anonymous questionnaire. Conclusions: The opinions of family doctors on the quality of geriatric care provided by the nurses depend strongly on their form of employment. Family doctors' units which employ nurses have a greater scope and better quality of care services for the elderly in comparison to those, which only co-operate with nurses. [ABSTRACT FROM AUTHOR]

Background: Acne is a chronic inflammatory disease predominantly affecting young people. This study was undertaken to assess the impact of acne in young adults on their major life-changing decisions (MLCD), paying attention to the relationships between major life-changing decisions profile (MLCDP) and Quality of Life (QoL), feeling of stigmatization and acceptance of the disease., Methods: The study was performed on 213 young people diagnosed with acne. A variety of questionnaires were employed to measure the clinical and psychological aspects of acne., Results: The majority of patients (N.=148, 73.3%) reported at least one MLCD that acne affected in any way (mean number 2.9±3.2, range: 0-18). The most common MLCD influenced by acne appeared to be a decision of changing eating habits (N.=132, 65.3%), followed by changing habits associated with smoking and alcohol (N.=85, 42.1%) and deciding to be more active physically (N.=61, 30.2%). The total score of MLCDP ranged from 0 to 33 points (mean 5.41±6.23 points). MLCDP total score significantly correlated with clinical acne severity (P=0.006), QoL (P<0.001), stigmatization (P<0.001) and illness acceptance (P<0.001)., Conclusions: Acne has an important impact on life-changing decisions in young adults. MLCDP correlates with impaired QoL, level of stigmatization and degree of illness acceptance. This should be taken into consideration in the holistic approach to acne patients.

Competing Interests: The authors declare no conflict of interest.

Background: Chronic itch is a common symptom of inflammatory skin diseases. This study was undertaken to evaluate the presence and intensity of itching in two different cohorts of acne subjects. Additionally, the influence of itching on the psychosocial status of acne individuals was assessed., Methods: Consecutive acne patients seeking dermatological advice and university students diagnosed with acne during dermatological screening were considered. The clinical and psychological aspects of acne were assessed using a variety of instruments., Results: About 40% of acne subjects in both cohorts reported itching. The mean WI-NRS during the last 3 days in acne patients was 3.83 ± 2.31 points (mild itch) and was significantly more severe ( p < 0.001) than in university students diagnosed with acne (2.09 ± 1.29 points). Itch intensity did not depend on the clinical severity of acne. In consecutive acne patients, itch intensity correlated with quality-of-life impairments (assessed using DLQI and CADI) and HADS scores. There was no correlation between itch intensity and stigmatization levels., Conclusions: Itching seems to be a common phenomenon in acne sufferers. Acne itch significantly influences patients' well-being and should be considered in a holistic approach to acne patients.

Identifying factors that affect mortality requires a robust statistical approach. This study's objective is to assess an optimal set of variables that are independently associated with the mortality risk of 433 older comorbid adults that have been discharged from the geriatric ward. We used both the stepwise backward variable selection and the iterative Bayesian model averaging (BMA) approaches to the Cox proportional hazards models. Potential predictors of the mortality rate were based on a broad range of clinical data; functional and laboratory tests, including geriatric nutritional risk index (GNRI); lymphocyte count; vitamin D, and the age-weighted Charlson comorbidity index. The results of the multivariable analysis identified seven explanatory variables that are independently associated with the length of survival. The mortality rate was higher in males than in females; it increased with the comorbidity level and C-reactive proteins plasma level but was negatively affected by a person's mobility, GNRI and lymphocyte count, as well as the vitamin D plasma level.

Introduction: Medication‑related harm (MRH) has been recognized as a global public health issue., Objectives: This study aimed to assess the prevalence and causes of MRH in geriatric patients. Another objective of the study was to recognize how MRH and drugs prescribed after geriatric interventions affect survival., Patients and Methods: It was a cross‑sectional study of 301 geriatric patients admitted to the hospital for any cause, combined with a 2‑year survival analysis. Altogether, 71 drug items were included. Medication‑related harm was defined based on clinical reasoning. Logistic regression models were applied to identify the explanatory variables for each type of MRH. The Cox proportional hazards model was used to determine the association of MRH and postdischarge medications with patient survival., Results: Medication‑related harms were identified in 35.2% of the study patients. Those included, among others, hypotension (19.3%), hypoglycemia (13.3%), parkinsonism (4.3%), and benzodiazepine addiction (5.7%). Logistic regression, applied to estimate the impact of drugs before admission on MRH of any type, demonstrated an independent negative effect of typical neuroleptics, antidiabetic medication, benzodiazepines, and supplements, except vitamin D. After geriatric interventions, 4 drug classes showed a positive association with survival: thiazides (hazard ratio [HR], 0.45; 95% CI, 0.22-0.93), selective serotonin reuptake inhibitors (SSRIs; HR, 0.51; 95% CI, 0.34-0.75), paracetamol (HR, 0.54; 95% CI, 0.33-0.88), and angiotensin‑converting enzyme inhibitors (ACEIs; HR, 0.59; 95% CI, 0.4-0.89)., Conclusions: Geriatric-based deprescribing and drug optimization mitigate the negative impacts of MRH on patient survival and may decrease the rehospitalization rate and healthcare costs. Thiazides, ACEIs, SSRIs, and paracetamol, if indicated, were associated with better survival in geriatric patients.

The study objective is to investigate whether vitamin D is associated with the cognitive function of geriatric patients. This cross-sectional study involved 357 patients hospitalized in the geriatric ward who complained of memory problems (mean age: 82.3 years). The level of cognitive function was measured with the Mini-Mental State Examination (MMSE) and the clinical diagnosis of dementia was established according to the International Classification of Diseases (ICD-10) criteria. The serum 25-hydroxy vitamin D was measured with liquid chromatography-tandem mass spectrometry. The iterative Bayesian model averaging (BMA) procedure was applied to linear and logistic regression models in order to identify the best set of factors describing cognitive dysfunction and dementia, respectively. According to BMA, there is strong evidence that higher vitamin D levels, higher body mass index (BMI), and higher mobility function measured with the Timed Up and Go (TUG) test are independently associated with better cognitive performance and lower risk of dementia. Additionally, there is strong evidence that fewer years of education and lower vitamin B12 plasma levels independently describe worse cognitive performance. However, vitamin B12 levels higher than 800 pg/mL is negatively associated with the MMSE performance. Hypovitaminosis D in geriatric patients is an underrated marker of cognitive dysfunction and dementia.

INTRODUCTION    Multimorbidity in older adults leads to polypharmacy with all its hazardous outcomes and drug‑related problems. OBJECTIVES    We aimed to assess the difference in the number of drugs between admission to and discharge from a geriatric ward and identified the patient‑related factors associated with changes in the drug regimen. PATIENTS AND METHODS    This retrospective cross‑sectional study included 301 geriatric patients who underwent drug optimization in line with the Beers and STOPP/START criteria. The numbers of drugs per individual at hospital admission and discharge were compared using the Wilcoxon signed‑rank test. A multiple linear regression model was used to identify patient characteristics that influenced the observed difference in the number of drugs following geriatric hospitalization. RESULTS    A significant reduction of 1.29 in the number of drugs per patient, on average, was observed. The Spearman's correlation coefficient between the number of prescribed medications and the number of coexisting conditions per individual changed from 0.28 to 0.51. The patient‑related characteristics that jointly and independently explained (P <0.001) the difference in the number of drugs in the multiple regression model (R2 = 0.73) were the number of drugs on admission, number of coexisting conditions, age, fact of living alone, and the incidence of adverse drug reactions. CONCLUSIONS    Geriatric hospitalization results in deprescribing rather than prescribing medications, especially in individuals who were overtreated, older, undernourished, at risk of an adverse drug reaction, and living alone. Appropriate deprescribing may potentially lead to fewer drug‑related problems in the senior population as well as reduce health care costs.

Purpose: Identification of optimal predictors for different indicators of subjective well-being (SWB) in geriatric inpatients: (1) self-evaluated health status (SEH), (2) feeling of loneliness (FoL), and (3) severity of depression symptoms (SoDS). Investigation of the relationship between response categories of the SWB indicators and their predictors., Methods: The data were collected retrospectively from hospital records. All 555 geriatric inpatients underwent a comprehensive geriatric assessment, including the Timed Up and Go (TUG) test. The Bayesian information criterion was applied in ordinal logistic regression models to identify optimal predictors of SEH, FoL, and SoDS among different objective factors., Results: After controlling for high-stress situations in the recent past, motor slowness measured with the TUG test, and a level of education were jointly selected as the best predictors of all three SWB indicators. The speed of performing the TUG test improved SEH (OR = 2.08) and decreased both FoL (OR = 0.41) and SoDS (OR = 0.41). A higher level of education improved SEH (OR = 1.05) and alleviated both FoL (OR = 0.96) and SoDS (OR = 0.92). Additionally, a higher level of SEH was positively correlated with a lower BMI, improved instrumental activities of daily living (I-ADL), and higher hemoglobin level. FoL was reinforced by the level of comorbidity, and SoDS was increased by impaired basic ADL., Conclusion: Although SWB in geriatric inpatients can be explained by objective comorbidities and disabilities, the good motor function (i.e., a TUG test outcome of less than about 20 s) and a higher level of education were the general predictors that exert an independent beneficial impact on all three SWB indicators.

Objectives: Identification of optimal predictors of the 5.5-year survival in former geriatric inpatients.Investigation of the direction and shape of the relationship between mortality risk and its predictors., Design: Retrospective survival analysis with the application of the Cox proportional hazards model., Setting: Teaching geriatric unit., Participants: 478 inpatients (mean age 77.9; +6.8) discharged from geriatric ward during year 2008, without any exclusion criteria., Measurements: Comprehensive geriatric assessment of numerous health variables, body mass index (BMI), clinical and biochemical findings, and outcomes of the final diagnosis. Records on the dates of deaths were obtained from the Provincial Office of Population Register., Results: During the 5.5-year follow-up 209 (43.7%) patients died. In the multivariate setup, six risk factors with an independent impact on mortality were identified: age (p=0.036), cognitive functioning on the Blessed test (p=0.005), score on instrumental ADL (p<0.0001), score on Charlson comorbidity index (p<0.0001), cholesterol level (p<0.0001), BMI (p<0.0001), and hemoglobin level (p=0.02). The latter two predictors exhibited a significant inverted J-shaped association with mortality, i.e., considerably higher risk of death corresponds to the lower values of these variables in comparison to their higher levels., Conclusion: Older age, worse IADL and cognitive functioning, and higher comorbidity were recognized as endangering one's long-term survival. On the other hand, moderate obesity (BMI 36), higher cholesterol and the absence of anemia (hemoglobin 13.6 g/dL) are associated with longer survival. Therefore, irrespective of the individualized treatment and physical exercise, nutrient-dense food seems to be a key recommendation to prevent frailty or malnutrition in the oldest and comorbid population.

The article encloses definition of water role and its body requirement, review of water balance and management in older persons regarding characteristic of this age group and concomitant disorders. Based on current literature and expert's opinion the recommendations for water consumption were expressed with estimation of insufficient apply and oversupply, evaluation of hydration state, domestic water sources in diet with accent on influence of proper hydration on comfort and good health.

Unlabelled: Although laryngeal malignancies of mesenchymal origin (laryngeal sarcomas, LS) are extremely rare (1% of all laryngeal malignancies), the histological manifestations are very diverse. LS sign as a solid tumor covered with an intact mucosa., The Aim of the Study: was to evaluate retrospective data referring: epidemiology, clinical manifestations, treatment and early follow-up; based on medical record made in ORL, HNS Surgery Dpt of Holy Cross Cancer Centre in Kielce during 9-years period 2001-2009., Material and Methods: The retrospective analysis of the group of 12 patients with LS was made. Studied characteristics were: age, sex, primary focus, histological outcome, treatment options and early follow-up., Results: Age of the group of 12 studied patients (10 M, 2 F) ranged from 48 to 84 (mean 69.8). LS accounted 1.2% (12/935) for all of laryngeal malignancies. The focus of origin were: glottis (6), epiglottis (5); subglottis (1). The most common histological types of LS at studied group were: neurosarcoma (2), fibrosarcoma (2), plasmocytoma (2), chondrosarcoma (1), malignant fibrous histiocytoma (1), sarcoma low grade (1), lymphoma malignum (1), liposarcoma (1) and haemangioendothelioma epithelioides vel plasmocytoma (1). Methods of treatment were: surgery (6); radiotherapy (1); chemotherapy (1); chemo- and radiotherapy (3); symptomatic treatment (1). The clinical results of treatment are: 9 patients are still alive (5 pts more than 5 years, 3 pts less than 5 years, 1 pts less than 2.5 years with residual disease); 3 patient died: 2 pts in 1st year from diagnosis, 1 pts after 3 years of treatment died of non-oncological causes., Conclusions: 1. LS are extremely rare and diversed histologically. 2. Immunochemical analyses are very important procedures used in diagnostics of these malignancies. 3. An individual approach is needed in diagnostic and therapeutic procedures of LS.

This study examines rural-urban differences in informal caregivers' perceptions of caregiving. The study's theoretical framework is based on the two-factor model of caregiving, which views caregiving as having both positive and negative impact. Data were collected in personal interviews with 126 rural and 127 urban caregivers in the Bialystok region. The COPE-Index was used to assess caregivers. Rural caregivers reported a greater negative impact of caregiving than their urban counterparts, controlling for caregiver socio-demographic characteristics and care-recipient disability level. There was no difference in caregivers' perceptions of positive aspects of caregiving. These findings are consistent with previous research, which suggests that rural caregivers experience greater caregiver burden. Better understanding of rural-urban differences in caregiving outcomes can be useful in designing supportive services for informal caregivers in Poland.

Purpose: Worsening of health as well as raising disability in course of aging lead to the increase in the needs for medical and nursing services. The on-going reforms of the primary health care system has brought the organizational transformation in community nursing care into the forms of non-public community nursing units. The aim of the study was to describe the characteristics of community nursing care provided to older people with regard to the differences between a traditional model of the public (SPZOZ) and new model of non-public units (NZOZ)., Material and Methods: The study was carried out in all 113-community nurses employed in Bialystok, regardless of the form of employment. The questionnaire was answered by 101 nurses, from which one was excluded due to double employment in public (SPZOZ) and non-public (NZOZ) settings. From among of the remaining 100, 76 were employed in SPZOZ and 24 in NZOZ. As the research tool was used the questionnaire., Results: The data obtained show the predominance of the therapeutic (95%) and diagnostic (78%) services which were more frequently provided by nurses employed in public sector (SPZOZ). Assessment of social situation as well as a caring process, education was rarely provided in both groups of nurses., Conclusions: Mostly instrumental and therapeutic activities predominated in the community nursing. Generally, any significant differences between two settings of nursing care there were not found. The traditional model of community nursing care enables the realization the full professional competence of nurse in the primary health care system.

Purpose: Falls (instability)--as well as immobility, incontinence, intellectual impairment, depression and visual and auditory impairment are considered to be serious problems in the field of geriatrics. They have multiple causes, tend to reoccur, have no simple cure and make the older person dependent on others for care. This paper presents the results of the study on the prevalence of falls and their determinants in communities of older people (aged 75 and over)., Material and Methods: The study design: cross-sectional questionnaire study and survey. The studied population lived in two chosen areas (urban and rural). The questionnaire, as well as instruments to verify the respondent's skills and functional ability, were used. Doctors and nurses employed in the studied areas were interviewers., Results: 457 randomly selected older people (228 from the rural area and 229 from the urban one) took part in the study. Falls in the course of the last year were reported by 45.1% of the group; more frequently by people living in the rural area (58.3% versus 31.9% in the urban one), by women (66.7% versus 44.8% in the men's group) and by people with different disabilities (cognitive impairment, locomotive disabilities, ADL-dependence, visual and auditory impairment), with poor self-reported health status and living arrangements. The score according to Tinetti's test--conducted in the rural areadetermined the frequency of the falls reported., Conclusions: The study has confirmed that falling is an increasing hazard for older people, especially for women, for people living in rural areas and for those with different mental and physical disabilities.

Despite of higher operative risk in the elderly, coronary artery bypass grafting (CABG) is more often performed in this age group to achieve the remission of the disease and to improve the quality of life. The aim of the study was to assess some subjective and objective health indices in the elderly two years after CABG (I group) in comparison to analogous group of older patients just waiting for CABG (II group). 109 patients aged 65 years and older, consecutively discharged from the Cardiac Surgery Department 2 years ago, were analyzed as well as 60 patients currently waiting for such surgery. Both groups of patients did not differ with demographic features. The health related quality of life was measured with the EASYCare questionnaire and similar one of own construction supplemented with some items of the WHOQol-BREF scale. Two years after CABG, 100 patients were available for the study (six persons died and three persons refused). Response rate was 92%. Significant reduction of symptoms of the coronary artery disease were shown. The chest pain was declared in 18% in I group vs 70% in II group; palpitation in 23% in I group vs 38% in II group and effort angina in 38% in I group vs 65% in II group. The positive evaluation of the health status was declared significantly more often in the patients of I group in comparison to patients in II group. CABG caused positive change concerning health-related quality of life in the elderly two years after surgery.

Data was collected in five countries from informal carers of older people (n = 577) via a common protocol. Carers completed: (1) a 17-item version of the Carers of Older People in Europe (COPE) Index, an assessment of carers' perceptions of their role : (2) a questionnaire on demographic and caregiving circumstances : and (3) three instruments included for the criterion validation of the COPE Index (the General Health Questionnaire, the Hospital Anxiety and Depression Scale, and the World Health Organization Quality of Life-BREF). Principal Component Analysis of the COPE Index was followed by internal consistency analysis of emergent components. Scales derived by summing items loading on the components were analyzed for their association with the criterion measures. Two components, negative impact and positive value, emerged consistently across countries. A third component, quality of support was less consistent across countries. Scales derived from the negative impact and positive value components were internally consistent and significantly associated with the criterion validity measures. These two scales and four items drawn from the quality of support component were retained in the final COPE Index. While further testing is required, the COPE Index has current utility in increasing understanding of the role perceptions of carers of older people.

The development of civilization and progress in medicine made the prolongation of the life span and increased share of the advanced old age people in the population. The consequence of this process is growth in frequency of diseases related to age including dementia. However diagnosis of cognitive impairment is still difficult and it makes some problems in an everyday medical practice. The aim of this report is to define main and significant determinants of dementia basing on the MMSE scale. This could make it easier to suspect the cognitive disorders to make indepth diagnosis and to start earlier therapy. The sample consisted of 124 community dwelling persons 75-year old and over. 64 of them were mildly, moderately or severely demented according to Katzman scale administered previously and 60 were intellectually intact. The both groups of persons were tested with MMSE. Geriatric Depression Scale, ADL scale (EASY-Care questionnaire) and short internal and neurological examination. The multiple regression model were used, where dependent variable was the MMSE score and independent variables social-demographic data, ADL and GSD scales and data from interview and medical examination. 72 variables were included to the model and 39 of them were significantly connected with cognitive impairment. The valid factors explained dementia in 78.7% (adjusted R2 = 0.787). The strongest connection was found with (1) an ignorance of own date of birth, (2) low education level, (3) behaviour disorders and (4) an advanced old age. These determinants, including difficulties with handling own money, have explained dementia in 57%. The presence such symptoms could make easier to suspect the cognitive disorders, to make in-depth diagnosis, and to start earlier therapy.

Unlabelled: The aim of the paper was the indepth comparison of the health services use by the elderly living in rural and urban area of Poland. The representative survey of the 65-year old and older people was carried out in the year 2000, as a comparative study to the Piotrowski's survey from 1967. The sample (total N = 1821; consisted of 743 people living in rural and 1078 in urban area), was corresponding to the demographic structure of the general older population in Poland., Results: As far as concerning socio-demographic features there were found slightly higher percentage of 'old old' people in rural community, their much worse living conditions and material situation in comparison to counterparts in urban community. The elderly living in the countryside have shown the worse subjective and objective health and functional indices. The positive selfrated health was found only in 12% of respondents living in rural and in 22% living in urban area. 71% people living in villages declared three or more complaints simultaneously while in the cities much less (57%). Moreover, the impairment of vision, hearing, chewing were found significantly more frequently among rural inhabitants, as well as almost twice higher percentages of dependence on P-ADL. The use of health services by the elderly during the last 12 months, in term of doctor's outpatient consultations, dentist visits rehabilitation, except of nurse visits, was significantly lower in countryside than in the cities. Use of an emergency (17%) and hospital stays (22%) was the same in the both sites., Conclusions: (1) Health status and functional ability of the older people living in rural area are dramatically worse than in cities. (2) Health care system for elderly people in Poland does not fulfill the geriatric standards in term of the commonness, availability and complexity. (3) The chance to improve health care on the elderly is an enhancement of knowledge and competence of practitioners in gerontology. The development of the geriatric base in the Medical Universities is a crucial for that.

Unlabelled: Hypertension is a serious medical, social and economical problem. It is accepted that high blood pressure is one of the major risk factors of all kinds of cardiovascular diseases. The aim of the study was to estimate the prevalence of hypertension and evaluate the difficulties with antihypertensive treatment in the rural and urban community dwelling elderly in advanced old age. The survey was carried out, as a screening, in systematically sampled 463 people 75 years old and over, coming from area served by primary health units (230 in urban area--Białystok and 233 in rural area--Sokółka). Estimation of blood pressure (single measure) and medical anamnesis concerning earlier diagnoses and pharmacological treatment was made in proband's home by general practitioner or community nurse. The diagnosis of hypertension was established according to the WHO-ISN criteria., Results: In general 49.1% of the elderly in urban and 70.4% in rural area had elevated systolic or/and diastolic blood pressure independently on antihypertensive medication; significantly more frequent in female than in male. 32% of the elderly in urban and 22% in rural area had normal blood pressure without antihypertensive treatment ("healthy"), whereas respectively 19% and 7% had normal blood pressure with antihypertensive treatment. 21% of persons in Białystok city and 38% in Sokółka had elevated high arterial pressure and hadn't any antihypertensive treatment. The results of the study confirm the high prevalence of hypertension in elderly population, higher in rural than urban area. Therapy of hypertension in studied group was ineffective in most of the hypertensive patients, mainly in neglected rural area. The differences between urban and rural samples can be partly explained by socio-demografic characteristic of the two studied population.

Indications for CABG (coronary artery bypass grafting) procedures are on the rise with ageing population. Because in the world literature there is not consensus on the elderly patients operative risk estimation we have conducted a retrospective analysis of 300 consecutive patients treated at Cardiac Surgery Department of Bialystok University Centre. The postoperative mortality and morbidity rates were assessed in an each case. 103 patients over 65 and 197 younger patients were included to the study. An operative risk was assessed according to EuroSCORE protocol and was higher in the elderly group. Strangely enough, this was not accompanied by higher mortality and morbidity rates, which were rather similar in the two groups. A female gender and an inclination to gastrointestinal bleeding were the independent risk factors in the elderly group. Probably diabetes mellitus is to be held for the higher mortality rate amongst them. In conclusion, the results of the presented investigation suggest that a biological and not a chronological age is essential in the qualification for CABG procedures.

As the giants of geriatrics are considered: immobility, instability, incontinence, intellectual impairment, depression, visual and auditory impairment. They have multiple causation, chronic course, no simple cure and make the elderly person dependent on others for care. The paper presents the results of the study on the prevalence of the giants of geriatrics in community dwelling elderly people 75 yers old +. The study design: cross-sectional questionnaire study, survey. Population studied lived in two chosen areas (the urban and the rural one) with the high percentages of the demographic senility. The interviewers were doctors and nurses serving the studied areas. 463 randomly selected elderly people (233 from the rural and 230 from the urban area) took part in the study. The serious locomotive disability (III/IV group according to J. Piotrowski) was observed in 17.1% of the probands (20.4% in the urban and 13.7% in the rural area; the worse locomotive ability was observed in women and in the older age groups.). Falls were reported by 45.1% of the group (more frequently by women and in the rural area--58.3% vs. 31.9% in the city). Visual impairment reported 21.1% of probands in the urban area and above 50% in rural one and auditory impairment respectively 30.8% and 53.9% of them (in both cases positive correlation with the age was noticed). Incontinence of urine was found in 31.7% of cases in the city and in 46% of them in the rural area (more frequently in women) and incontinence of faeces in 6% (without urban/rural differences). The pathologic result of the Geriatric Depression Scale was observed in 49.2% of the elderly (more frequently in women) and of the Cognitive Impairment Test by Katzman in 20.5% (more frequently in women and in the older age groups). Only 18.4% of the studied group of the elderly maintained the community nurse visited their home during the last 12 months (27.8% in the city and 9% in the rural area) and more frequently--34.3%--general practitioner (respectively 48.7% and 20.2%). The marginal percentage of the elderly (and only in the city) received any kind of physical rehabilitation or contacted the social worker. In the presence of high rate of disability in the elderly population the most important need is the development of community care for the elderly with the great emphasis on the role of community/home nurses and rehabilitation institutions for the elderly on the primary care level.

Unlabelled: The paper is one of the publications presenting the Polish part of the study on the EASY-Care questionnaire. The study was carried out as the multi-centre project "Supporting Clinical Outcomes in Primary Care of the Elderly". The EASY-Care Questionnaire is an instrument to assess the health care needs and social situation of older people for use in primary care., Objectives: To identify the main providers of help to the frail community-dwelling elderly people aged 75 years and over., Design: Cross-sectional questionnaire study, survey., Setting: Community-dwelling elderly people living in the administrative borders one of the community health care centres in Białystok-city., Participants: 117 randomly selected people aged 75 years and over; the interviewers were doctors and nurses, serving the studied area., Measurements: Elderly Assessment System EASY-Care, version 1997,98., Results: 81 persons of the studied group (69.2%) were ADL-dependent. Most of the elderly people in need of care were women, more often with the suspicion of depression and with cognitive impairment. Most of the caregivers (80%) of the frail community-dwelling elderly people 75 and over were family members living together (42%), living apart (21%) or it was wife/husband (17%). Almost 10% of the ADL-dependent elderly had no carer at all. The category of carers fulfilling all of the needs of the care recipient were more often the spouse. The role of the public care providers was marginal., Conclusions: The family is still the basic source of support and the central element in the care system for the elderly in Poland. The family is insufficiently supported by formal and informal carers.

The multiplicity and complexity of diagnostic and therapeutical problems affecting elderly patients requires a special approach which has come to be known as the comprehensive geriatric assessment. This approach demands the interdisciplinary cooperation of several practitioners in the field of geriatric care, led by the family doctor. An essential prerequisite for their cooperation to be successful is that there should be some commonly acknowledged starting point in the form of a standardised assessment of the functional state of elderly patients, irrespective of the the number and type of chronic conditions from which they may be suffering. The aim of this paper is to put forward a short and straightforward instrument for assessment of the functional state of elderly people in the form of the EASY-Care questionnaire for the use of family doctors. EASY-Care is a system "picture" of the needs of elderly people. It focuses more on the quality of life of the elderly person rather than on his/her illnesses and takes into consideration the role played by family carers. EASY's main aim is to provide family doctors and other primary care practitioners with information to help them to improve the services that they provide for the elderly. Moreover, the data gained from the use of EASY may help to serve epidemiological purposes, by providing measures of the social and medical needs of the elderly together with information about the degree to which these are being met. Consequently, it also provides a rationale for the provision of funding, directing research and developing a policy for the care of the elderly. The EASY-Care questionnaire has been developed in order to promote a common approach in Europe for the assessment of the elderly.

A case is presented of a 30-year old man with long-term history of painful muscle cramps, episodes of tetany, general malaise and persistent hypokaliemia. On the ground of clinical appearance and biochemical data the Bartter's syndrome in Gitelman's variant was diagnosed. In differential diagnosis we considered renal tubular acidosis, other tubular defects (Liddle's syndrome), primary and secondary hyperaldosteronism. Other possible causes of hypokaliemia were excluded such as surreptitious diuretic and lexative abuse, persistent vomiting and diarrhea. Good therapeutic effect were achieve using spironolacton, indomethacin, propranolol and potassium supplementation.