Karen Waters

Quality of life in elderly patients with COPD: measurement and predictive factors

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity in old age. It leads to reduced quality of life (QoL), but the factors that contribute to this are less understood. There is no consensus on measurement of QoL in elderly COPD patients. We assessed (a) factors predicting QoL in elderly COPD out-patients and (b) specificity (SP), sensitivity (SEN), positive and negative predictive values (PPV and NPV) and repeatability of two disease-specific QoL instruments, the Chronic Respiratory Disease Questionnaire (CRQ) and the Breathing Problems Questionnaire (BPQ) in elderly people. All subjects also completed an ADL measure [Nottingham Extended ADL (NEADL)] and a measure of psychological well-being [Brief Assessment of Depression Cards (BASDEC)] as well as a 6-min walk test. Subjects comprised 96 (56 men) elderly out-patients with irreversible COPD aged 70-93 years (mean 78) who were clinically stable for > or = 6 weeks. Controls were 55 (23 men) aged 71-90 years (mean 78) with normal lung function. All were cognitively intact. Mean FEV1/FVC in COPD subjects was 45.5 (SE = 1.4)% and for controls was 71.4 (SE = 1.3)%. Repeatability was good for both BPQ and CRQ with no significant difference. There were no significant differences in specificity and positive predictive values between the two questionnaires but BPQ performed better than CRQ with regard to sensitivity (P = 0.02) and NPV (P < 0.001). A multiple regression analysis was used to identify variables that best predicted BPQ and CRQ in COPD subjects. For BPQ predictive values were NEADL (P < 0.0001); BASDEC (P < 0.0001); age (P < 0.0001); 6-min walk distance (P = 0.001); body mass index (P < 0.05); resting oxygen saturation (P < 0.05); and household composition (living alone or with relatives, P = 0.05). In contrast only the following predicted CRQ: NEADL, BASDEC and resting oxygen saturation. Sixteen per cent of the variance in BPQ was accounted for by NEADL score, 9% by BASDEC, 4% by age and 3% by 6-min walk distance (total r2 = 0.70). It was concluded that: (1) BPQ provides more valid assessment than CRQ of QoL in elderly COPD subjects; (2) severity of disease in terms of its impact on QoL is not predicted by lung function tests; (3) the most important determinants of QoL are ADL score and emotional status.

Physiotherapists Working with Stroke Patients A national survey

Summary This study sought to develop an insight into the existing profile of physiotherapists working with stroke patients in the United Kingdom. Its focus was on demography, approach to treatment, conflict with other professionals and assumptions or beliefs surrounding intervention. A total of 1,667 questionnaires were distributed to 262 hospitals and health centres in the UK. Of these, 1,078 were returned (representing a 64.67% return rate). A total of 973 were analysed (representing an effective return rate for the purposes of analysis of 58.36%). The research focused on senior I and senior II physiotherapists, although junior physiotherapists with at least one years experience were included. The analysis revealed that stroke patients were treated across many locations, the most frequent locations being the community, medical wards, elderly wards and stroke units. Information regarding age, sex, designation and geographical location of respondents is included as are details of approach followed. Examination of the results showed a great deal of variation in the beliefs held by physiotherapists about treatment of stroke patients, despite the strong similarities in stated approach. The analysis also revealed the extent to which physiotherapists are in conflict with other professionals (namely doctors and nurses) about delaying walking with patients and their early discharge.

Coping strategies employed by informal carers of terminally ill cancer patients

A qualitative study using data obtained from 55 interactions with 21 families caring for a member who had terminal cancer revealed three different strategies which carers use to deal with their situation. These strategies are: denial, normalizing and togetherness. Carers are not fixed in one particular behaviour pattern but can move within and between strategies. Denial is the most destructive of the strategies because, although in the short term it enables carers to cope with the situation, eventually failure to face reality results in increased stress and can be a cause of estrangement in families. Normalizing the situation by attempting to live life in as ordinary a way as possible is a valuable means of coping because it makes the prospect of dying and death seem less threatening. However, the most positive coping strategy is seen when couples work through the situation together. Most people did not achieve such complete togetherness but the case of a man and woman who did is cited and the reasons why they were able to form a partnership to deal with her dying are discussed. The value of professional help and support and the need for individual assessment of each family are considered.

A study to assess the effect of nursing interventions at the weekend for people with stroke

Objective: To examine whether additional therapy provided by nurses at the weekend improved the physical outcome for people with stroke on a stroke rehabilitation unit. Design: A single blind randomized controlled trial. Setting: A 16-bed stroke rehabilitation unit in the north of England. Subjects: Forty-one people with stroke were randomized by means of minimization to intervention and control groups. Interventions: The intervention group received additional exercise at the weekend provided by the nursing staff and the control group received their usual care. Both groups received usual care during weekdays. Main outcome measures: The Motor Assessment Scale (MAS), the Barthel Index (BI) and length of stay in hospital. Results: No significant differences were found between the groups in terms of MAS and BI at discharge but there was a borderline significant difference between the groups on unconditional testing in terms of length of stay in hospital and on the stroke unit (p = 0.05 and p = 0.07 respectively). However, these findings were in favour of the control group. On conditional testing (adjusting for BI on admission and age) these differences disappeared (p = 0.14 and p = 0.15) for length of stay in hospital and on the stroke unit respectively. Conclusions: The present study indicates that an increase in one-to-one input by nurses for people with stroke did not lead to a measurable difference in outcome in this small study.

Pass the parcel: care of the elderly in the community

I have always had some conceptual difficulty with the division of health and social care, finding it difficult to make the distinction between personal care and nursing care. However, recent experience within the family has shed some light on this subject. I now know that I do not have to struggle to make sense of a division of health and social care for older people, since the definition depends not on the service but on who is providing it.