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Study objectives: Design and setting: Main results: Conclusion: Key words: urinary incontinence; dementia; institutionalization; community-institutional relationsUrinary incontinence is a prevalent condition among the elderly, and is associated withage, dementia, and ambulatory function. Although incontinence is highly prevalent among institutionalizedpersons, the majority of persons with incontinence live in the community.Overall, 16.9% of the women and 8.0% of the men reported incontinence, the numbersfor daily incontinence were 7.0% and 5.2% respectively. The prevalence increased by age, severity ofdementia, and decreasing ambulatory function. It is calculated that 69% of elderly men and 73% ofelderly women with any incontinence live in the community. 31% of the male and 32% of the femalepatients have some kind or severity of dementia, and 21% of the men and 27% of the women havedecreased ambulatory function. One half of the persons with incontinence live in the community, withno cognitive or ambulatory impairment.Population based multi-centre survey with stratified random sampling all overCanada. Randomly selected persons aged 65 and over were interviewed. Those having cognitive impairment(n=1614), a randomly selected sample of those without (n=731) and an institutional sample(n=1255) underwent clinical assessment.Data from The Canadian Study of Health and Aging are analysed for prevalence ofurinary incontinence, and its association with dementia, ambulatory function, and institutionalization.ABSTRACT

A sample of 761 subjects 70 years and over was drawn from general-practice records of a rural township. Each subject was assessed and followed for 1 year to determine the incidence of and factors related to falls. The fall rate (number of falls per 100 person-years) increased from 47 for those aged 70-74 years to 121 for those 80 years and over. There was no sex difference in fall rate but men were more likely than women to fall outside and at greater levels of activity. Twenty per cent of falls were associated with trips and slips but we found no evidence that inspection of homes and installation of safety features would have decreased the fall rate. Ten per cent of falls resulted in significant injury. Men who fell had an increased subsequent risk of death compared with those who did not fall (relative risk 3.2, 95% CI 1.7-6.0). Subsequent mortality was increased among women who fell but not to significant levels (relative risk 1.6, 95% CI 0.9-2.7).

In a community based, prospective study to determine risk factors for falls, 465 women and 296 men 70 years and over were followed for 1 year and 507 falls were documented. A greater proportion of women (32.7%) than men (23.0%) experienced at least one fall in which there was no or minimal external contribution. Using unconditional logistic regression models we investigated the effect of physical and sociological variables on the sex difference in fall rate. Controlling for the variables age, use of psychotropic drugs, inability to rise from a chair without using arms, going outdoors less than daily and living alone decreased the relative risk of women falling compared to men from 2.02 (95% CI, 1.40-2.92) to 1.55 (95% CI 1.04-2.31). Some of the increased risk of falling associated with being a women was able to be explained and is potentially correctable. But even after controlling for the physical and social variables which we had assessed, women compared to men still had a significantly increased relative risk of falling.

Corrected arm muscle area (CAMA), triceps skin-fold thickness (TSF) and body mass index (BMI) were measured in a community sample of 758 people who were then followed for 40-46 months. Percentile values were calculated for each sex in 5-year age groups. The relative risk of death of those in the upper and lower percentiles was compared with those between the 10th and 90th percentiles, controlling for age and sex. Subjects below the 5th percentile for CAMA, TSF and BMI and between the 5th and 10th percentile for CAMA had a significantly increased risk of death. There was no increased risk of death in those subjects above the 90th percentile in any measurement. In the logistic regression model, both low CAMA and low TSF were associated with a significantly increased risk of subsequent mortality. Poor nutritional state shown by low muscle bulk and fat stores was an important predictor of mortality, but obesity had no adverse effect on survival.

To examine common clinical problems in geriatric rehabilitation and to make recommendations for current practice based on evidence from the literature.A CINAHL database and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search was completed by using the Cochrane database.One author reviewed the references for relevance and another for quality. A total of 336 articles were considered relevant. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports on a small number of patients.The following areas were the major geriatric rehabilitation subtopics identified in the search: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. This article focuses on the latter 5 subtopics. The literature was reviewed by using a level-of-evidence framework. Level 1 evidence was a randomized controlled trial (RCT) or meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts, descriptive studies, or reports of expert committees.Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic according to the level of evidence in the specific area. In cases in which several articles were written on a topic with similar conclusions, we selected the articles with the strongest level of evidence, thereby reducing the total number of references.Frail older patients with hip fracture should receive geriatric rehabilitation. They should also be screened for nutrition, cognition, and depression. Older persons should receive nutritional supplementation when malnourished. If severe dysphagia occurs in stroke patients, gastrostomy tube feeding is superior to nasogastric tube feeding.

To increase recognition of geriatric rehabilitation and to provide recommendations for practice and future research.A CINAHL and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search used the Cochrane database.One author reviewed the reference for relevance and another for quality. A total of 336 articles were selected. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports.The following major geriatric rehabilitation subtopics were identified: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. Part I describes the first 5 subtopics on concepts and processes in geriatric rehabilitation. Part II focuses on the latter 5 subtopics of common clinical problems in frail older persons. A level-of-evidence framework was used to review the literature. Level 1 evidence was a randomized controlled trial (RCT) or a meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts or descriptive studies.Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic. In cases in which several articles were written on the same topic and drew similar conclusions, the authors chose those articles with the strongest level of evidence, reducing the total number of references.Frail elderly patients should be screened for rehabilitation potential. Standardized tools are recommended to aid diagnosis, assessment, and outcome measurement. The team approach to geriatric rehabilitation should be interdisciplinary and use a comprehensive geriatric assessment. Medication reviews and self-medication programs may be beneficial. Future research should address cost effectiveness, consensus on outcome measures, which components of geriatric rehabilitation are most effective, screening, and what outcomes are sustainable.

A novel, clinical curriculum was developed to teach third-year medical students the principles of prescribing for elderly people. The experience involved a didactic session with a community pharmacist and a home visit to assess a senior citizen volunteer who was over age 75 years and was prescribed more than five medications. The medical students completed pre- and postexperience questionnaires to assess knowledge and opinions. Statistical analysis used paired t tests to compare pre- and postknowledge. The percentage agreeing or disagreeing were calculated for Likert opinion responses by using mean summary scores. Pre- and postexperience results were compared using paired t tests. Students showed improved knowledge scores on recognizing drug-drug (P=0.029) and drug-disease interactions (P=0.012). Knowledge on true/false prescribing questions was improved (P=0.005). Students felt that their current curriculum gave insufficient time to prescribing issues, and wanted more education about the use of medications and appropriate prescribing. The majority of students felt that they learned new things (81%), the experience was enjoyable (65%), important topics were covered (71.4%) and they would be more likely to confer with a community pharmacist because of the experience (75%). The novel curriculum described appears to be effective and warrants further evaluation.

The usual alcohol intake in a community-based sample of subjects aged 70 years and over was investigated. A sample of 825 subjects was drawn from the records of five general practices in a rural township and 774 subjects (93.8%) agreed to participate. A stratified sub-sample of subjects from the abstainers, infrequent, weekly, and daily drinkers was subsequently investigated in more detail. Men took alcohol more frequently than women and in greater quantities although frequency and amount decreased with age. The usual place for drinking was the home. The highest use of psychotropic drugs occurred in the abstainers, but this was significant for men only. When compared with drinking patterns in middle age, 60.1% of men and 30.3% of women said that they took less alcohol, while 7.4% of men and 11.1% of women said that they took more. The main reasons for decrease in alcohol intake were change in health and fewer social opportunities. The main reasons for increase in alcohol intake were more money and more time. Drinking was most commonly associated with social activities and few took alcohol to help cope with personal situations.

During one year 151 patients with 154 strokes were studied prospectively to determine the occurrence and outcome of urinary incontinence after a stroke. Seventeen per cent had pre-existing urinary incontinence. At 1, 4 and 12 weeks, 60%, 42% and 29% of the survivors, respectively, were not continent. Cystometry was performed in those with moderate or severe urinary incontinence persisting 4 weeks after the stroke. Detrusor instability was present in 85% of those who had been continent prior to their stroke. Factors associated with urinary incontinence at 4 weeks were moderate or severe motor deficit, impaired mobility and mental impairment (P less than 0.001). Two-thirds of patients with mild urinary incontinence at 4 weeks regained continence by 12 weeks.

We investigated factors associated with falls in a community-based prospective study of 761 subjects 70 years and older. The group experienced 507 falls during the year of monitoring. On entry to the study a number of variables had been assessed in each subject. Variables associated with an increased risk of falling differed in men and women. In men, decreased levels of physical activity, stroke, arthritis of the knees, impairment of gait, and increased body sway were associated with an increased risk of falls. In women, the total number of drugs, psychotropic drugs and drugs liable to cause postural hypotension, standing systolic blood pressure of less than 110 mmHg, and evidence of muscle weakness were also associated with an increased risk of falling. Most falls in elderly people are associated with multiple risk factors, many of which are potentially remediable. The possible implications of this in diagnosis and prevention are discussed. Language: en