Duncan Robertson

The prevalence of cognitive impairment in an elderly Canadian population

ABSTRACT— We investigated cognitive impairment in a study of the health of the elderly population of Saskatchewan. Surveys of elderly persons living at home (n=1267) and living in long‐term care facilities (n‐990) were conducted in 1981. Cognitive impairment was assessed by a short 10‐item mental status questionnaire previously validated against a clinical diagnosis of dementia in an elderly Canadian population. The prevalence of clinically significant cognitive impairment was found to increase with age and with dependence level in long‐term care facilities. We estimate that 7.8% of the elderly population have cognitive impairment consistent with a clinical diagnosis of dementia. Our estimates are compared with those derived from other studies. These findings affirm the importance of dementia as a cause of dependence in the elderly and the need for long‐term care facilities to deal with dementia and its consequences. Also, since at least as many persons with cognitive impairment live at home as in long‐term care facilities, health care planners must direct attention to the elderly with dementia at home.

A Short Mental Status Questionnaire

A mental status questionnaire (MSQ) developed tor use in surveys of the non-institutionalized elderly has been validated against clinical assessment. The MSQ identities moderate and severe cognitive impairment in the elderly. However, using the suggested scoring subjects with mild impairment cannot be separated from normals. The test is short, acceptable and reproducible and rate for false-positives and false-negatives fall well within acceptable limits for use in estimating the prevalence of dementia in the non-institutionalized elderly population.

Skeletal Deformities in the Elderly and Their Effect on Postural Sway

In a group of 151 elderly men and women (age range, 65–85+), postural sway was studied in relation to various physical attributes and skeletal deformities that might be contributory factors. Weight, loss of height (span‐height), scoliosis, grip strength, and the knee angle, measured laterally with the subject erect, all proved to be correlated with postural sway. Kyphosis was related to loss of muscle power and other general indications of frailty. Scoliosis appeared to be related to joint disease in the pelvis and lower limbs.

Outcome of Hospital Admission of the Very Elderly

Hospital utilization by persons aged 85 or older before the development of a specialized geriatric service in a Canadian city is described. Admissions to surgical units slightly outnumbered those to medical units and were more likely to be elective admissions or interhospital transfers. Three fourths of the medical admissions were classified as “emergent,” and half of the admissions came through the emergency department. Although a number of patients, particularly older women, came from extended care facilities, most patients had been living in the community before admission. The mean length of stay was 18.8 days and the in‐hospital mortality rate was 13 per cent. The majority of patients were discharged to the community, and this placement appeared stable, in that less than 10 per cent of those discharged to the community entered an extended care facility within the one‐year follow‐up period.

An alternative model of pre-hospital care for 999 patients who require non-emergency medical assistance

Purpose With the increasing demand on ambulance services, paramedics are tasked to arrange as much out of hospital care as possible, to develop integrated systems of care and work with hundreds of different providers – all in the 15 minutes allocated for assessment. A UK ambulance trust is navigating and leading much of this work as one of the first trusts to implement a general practitioner referral policy as an alternate to direct conveyance. The paper aims to discuss this issue. Design/methodology/approach Here the authors discuss the referral scheme, examine the limited evidence available and discuss what is needed to influence prospective success of implementing this scheme in other trusts. Findings Limited evidence for these schemes are described, however there is a clear gap in critical appraisal and methodologically rigorous evidence needed to implement these schemes in other ambulance schemes. Originality/value In order to facilitate collaboration of healthcare services and to minimize the burden of increasing numbers of patients, communication and discussion of alternate routes of care is crucial. This viewpoint piece is one of the first to emphasize the potential benefits of such schemes.

04 Paramedic perspectives towards gp referral schemes in north west england: a qualitative-observational study

Background An innovative policy developed and implemented by a UK Ambulance Service allows paramedics to refer patients to the GP Acute Visiting Service scheme. Initial evidence suggests that using this alternate route of care can decrease hospital admission rates, increase bed availability, decrease wait time in A and Es and provide substantial savings for the NHS. However, there are many unrecognised barriers to referral that have not been captured by the quantitative analysis. The goal of this qualitative-observational study was to gain insight into the GP referral scheme from a paramedic’s perspective. Methods We observed eight paramedics throughout full shifts of 8–12 hours. Data was collected using participant demographics, researcher observations and informal semi-structured interviews. All notes were transcribed, coded and analysed using a Grounded Theory approach to identify emerging themes. Results Paramedics expressed a wide range of frustrations with the scheme, identifying the waiting time, the process and a lack of confidence, experience and training as the three major barriers to referrals. They described how they approached patients with the GP referral scheme in mind, identified common characteristics of referrals, described how the triage tool shaped their decision making and shared how they involved the patient in the decision making. They shared too their frustrations with some GP decision making, which they admitted then influenced their future decision making. Finally, they described what motivated them to refer and discussed the lack of awareness and understanding of the scheme’s impact and aims. Conclusions This study provided valuable insight into the paramedic’s perspective of the GP referral scheme. Maximising understanding of the scheme, investigating the GP’s perspective in decision making and ensuring knowledge and accountability of paramedics, GPs and the public were identified as solutions to strengthen and increase referral rates and scheme success.