Alistair Tulloch

Outcomes of referrals to gynaecology outpatient clinics for menstrual problems: an audit of general practice records

Objective— To determine referral rates and intermediate and long‐term outcomes for patients consulting for menstrual disorders and referred by their general practitioner to gynaecology outpatient clinics.

Prevalence of visual impairment in people aged 75 years and older in Britain: results from the MRC trial of assessment and management of older people in the community

Aims: To measure the prevalence of visual impairment in a large representative sample of people aged 75 years and over participating in the MRC trial of assessment and management of older people in the community. Methods: 53 practices in the MRC general practice research framework. Data were obtained from 14 600 participants aged 75 years and older. Prevalence of visual impairment overall (binocular visual acuity <6/18) which was categorised separately into low vision (binocular visual acuity <6/18–3/60) or blindness (binocular visual acuity of <3/60). The prevalence of binocular acuity <6/12 was presented for comparison with other studies. Visual acuity was measured using Glasgow acuity charts; glasses, if worn, were not removed. Results: Visual acuity was available for 14 600 people out of 21 241 invited (69%). Among people with visual acuity data, 12.4% overall (1803) were visually impaired (95% confidence intervals 10.8% to 13.9%); 1501 (10.3%) were categorised as having low vision (8.7% to 11.8%), and 302 (2.1%) were blind (1.8% to 2.4%). At ages 75–79, 6.2% of the cohort were visually impaired (5.1% to 7.3%) with 36.9% at age 90+ (32.5% to 41.3%). At ages 75–79, 0.6% (0.4% to 0.8%) of the study population were blind, with 6.9% (4.8% to 9.0%) at age 90+. In multivariate regression, controlling for age, women had significant excess risk of visual impairment (odds ratio 1.43, 95% confidence interval 1.29 to 1.58). Overall, 19.9% of study participants had a binocular acuity of less than 6/12 (17.8% to 22.0%). Conclusion: The results from this large study show that visual impairment is common in the older population and that this risk increases rapidly with advancing age, especially for women. A relatively conservative measure of visual impairment was used. If visual impairment had been defined as visual acuity of <6/12 (American definition of visual impairment), the age specific prevalence estimates would have increased by 60%.

Reduced hearing, ownership, and use of hearing aids in elderly people in the UK--the MRC Trial of the Assessment and Management of Older People in the Community: a cross-sectional survey.

BACKGROUND Reduced hearing in elderly people is important because it is disabling and potentially treatable. We aimed to assess the prevalence of reduced hearing in elderly people and levels of ownership of hearing aids and use. METHODS We have done a cross-sectional survey of people aged at least 75 years in 106 family practices in the UK. We obtained self-reported data on hearing difficulties for 32,656 people and gave 14,877 a whispered voice test (response rate 78%). FINDINGS 2537 (8%) of 32,656 participants reported a lot of difficulty hearing and 13,630 (42%) a little or a lot of difficulty. 3795 (26%) of 14877 participants who completed the whispered voice test (95% CI 23-29) failed the test, the proportion rising sharply with age. Following wax removal, 343 passed a retest, leaving 3452 (23%, 20-26) who failed the test, even after wax removal if present. 998 (46%) of 2180 people wearing a hearing aid at the time of testing failed the whispered voice test. More than half the people who failed the test did not own a hearing aid. 2200 (60%) of 3846 people who owned a hearing aid said they used it regularly. Level of use was strongly related to perceived benefit. INTERPRETATION Reduced hearing is common and provision of hearing aids inadequate in elderly people. Many people who own a hearing aid do not use it regularly, and even when wearing their aid many still have socially disabling levels of hearing loss. A major source of morbidity in elderly people could be alleviated by improvements in detection and management of reduced hearing.

The MRC trial of assessment and management of older people in the community: objectives, design and interventions [ISRCTN23494848]

BackgroundThe benefit of regular multidimensional assessment of older people remains controversial. The majority of trials have been too small to produce adequate evidence to inform policy. Despite the lack of a firm evidence base, UK primary care practitioners (general practitioners) are required to offer an annual health check to patients aged 75 years and over.DesignCluster-randomised factorial trial in primary care comparing a package of assessments (i) universal versus targeted assessment and (ii) management by the primary care team (PC) or a multidisciplinary geriatric assessment team (GM). The unit of randomization is the general practice.MethodsOlder people aged 75 and over eligible for the over 75s health check and excluding those in nursing homes or terminally ill were invited to participate. All participants receive a brief assessment covering all areas of the over 75s check. In the universal arm all participants also receive a detailed health and social assessment by a study nurse while in the targeted arm only participants with a pre-determined number and range of problems at the brief assessment go on to have the detailed assessment. The study nurse follows a standard protocol based on results and responses in the detailed assessment to make referrals to (i) the randomised management team (PC or GM) (ii) other medical services, health care workers or agencies (iii) emergency referrals to the GP. The main outcomes are mortality, hospital and institutional admissions and quality of life. 106 practices and 33,000 older people have been recruited to the trial.

Respiratory symptoms in older people and their association with mortality

Background: A study was undertaken to assess the prevalence of reported respiratory symptoms in a population aged over 75 years and their association with mortality. Methods: A total of 14 458 people aged 75 years and over participating in a trial of health screening of older people in general practice answered questions on three respiratory symptoms: cough, sputum production, and wheeze. The association of symptoms with mortality was examined for all cause and respiratory causes of death taking account of potential confounders. Results: Coughing up phlegm in winter mornings had a prevalence of 27.0% (95% confidence interval (CI) 26.8 to 27.2). Those with this symptom had an adjusted hazard ratio for all cause mortality of 1.35 (95% CI 1.21 to 1.50), p<0.001 and for respiratory specific mortality of 2.01 (95% CI 1.66 to 2.41), p<0.001. Phlegm at any time of the day in winter had a prevalence of 16.5% (95% CI 16.3 to 16.7) with hazard ratios for all cause and respiratory specific mortality of 1.28 (95% CI 1.15 to 1.42) and 2.28 (95% CI 1.92 to 2.70), p<0.001. Wheeze or whistling from the chest had a prevalence of 14.3% (95% CI 14.1 to 14.5) with hazard ratios of 1.45 (95% CI 1.31 to 1.61) and 2.86 (95% CI 2.45 to 3.35), p<0.001. Conclusions: The prevalence of respiratory symptoms is widespread among elderly people and their presence is a strong predictor of mortality.