Norman J. Vetter

Can health visitors prevent fractures in elderly people

OBJECTIVES--To assess whether intervention by a health visitor could reduce the number of fractures, over a four year period, in those aged 70 and over. DESIGN--Randomised, controlled trial; randomisation by household. SETTING--General practice in a market town. SUBJECTS--Of 863 patients aged 70 and over on the practice records, 674 were traced and successfully interviewed; 350 were assigned to the intervention group, 324 as controls. INTERVENTION--The people in the intervention group were allocated to the care of a health visitor. The approach was four pronged: assessment and correction of nutritional deficiencies, including reducing smoking and alcohol intake; assessment and referral of medical conditions such as heart block or inappropriate medication; assessment and correction of environmental hazards in the home such as poor lighting; assessment and improvement of fitness--for example, exercise classes for the moderately fit. The intervention continued for four years. MAIN OUTCOME MEASURE--Fracture rate over four years. RESULTS--The incidence of fractures was 5% (16/350) in the intervention group and 4% (14/324) in the control group (difference not significant). CONCLUSIONS--A health visitor visiting a group of people aged 70 and over and using simple preventive measures had no effect on the incidence of fractures.

Effect of health visitors working with elderly patients in general practice: a randomised controlled trial.

Health visitors were employed specifically to care for two years for a random sample of patients in general practice who were aged over 70. Independent assessments made at the beginning and end of the study showed that the health visitor in an urban practice had some impact on her caseload of patients; she provided more services for them, their mortality was reduced, and their quality of life improved, though the last measure just failed to be statistically significant. The health visitor working in a rural practice had no such effect.

Inappropriately delayed discharge from hospital: What do we know?

A patients discharge from hospital can be classed as inappropriately delayed, thus causing bed blocking. However, is the inappropriateness in the hospital rather than in the patient?

Hearing Aid Possession in the Population: Lessons from a Small Country: Posesión de auxiliares auditivos en la población: Lecciones de un pequeño pais

The results of several studies on hearing aid use in the Welsh population were considered to investigate some general principles on determinants of such use within the general populations of developed countries. Overall hearing aid possession and use were not found to have changed significantly over the past 18 years, remaining at 4 per cent having obtained hearing aids and 3 per cent using them. The possession figures were consistent across all methodologies used. Higher hearing aid use in the post-industrial valleys (in which the traditional industries of coal mining and steel production had disappeared) was explained entirely by a higher level of reported hearing difficulties there. In all populations, less than 20 per cent of those reporting difficulties possessed hearing aids. Whether a hearing aid had been obtained free of charge from the National Health Service or purchased privately did not influence whether it was still used. It was concluded that an effort to improve the acceptability of hearing aids and reduce their stigma is required.

health visitor intervention to reduce days of unplanned hospital re-admission in patients recently discharged from geriatric wards : the results of a randomised controlled study

A randomised controlled trial was conducted to assess whether a single intervention by a health visitor reduced the unplanned re-admission of elderly people discharged from geriatric wards. Two hundred and four consecutive discharges from geriatric wards were randomly allocated to receive either a single visit from the health visitor at 72 h in addition to normal follow-up services or to a control group receiving the normal follow-up services. The primary outcome measure was the unplanned re-admissions over the following 6 months. There were 40 cases and 43 control patients with unplanned re-admissions in the first 6 months. The total lengths of the unplanned re-admissions were 1237 days for cases and 1427 for controls, an average of 12.1 days for cases and 14.0 for controls (95% confidence interval -4.9 to 8.7 days, not significant). A visit by a health visitor to elderly patients after discharge from geriatric wards is unlikely to be of sufficient benefit to the patients for the service to be funded from a saving in unplanned re-admissions.

Investigating lifestyle factors affecting hearing aid candidature in the elderly.

Within this presentation, the authors consider briefly the published data on the effects of hearing impairment on lifestyle in the elderly, and suggest that the World Health Organizations International Classification of Functioning. Disability and Health (ICF) would provide a framework for standardizing the study of effects of impairments. This is followed by two studies, In the first study, we asked a consecutive sample of elderly patients (hearing aid candidates and users) to list the activities, transactions and interactions in which they participated, and classified these using the ICF. We then took the main categories, and, in a second study, explored how often individuals participated in them, how much difficulty they had because of their hearing loss, and how much they enjoyed them. This highlighted the considerable difficulties that most such individuals experience in common activities and communication situations, and which seem to be little influenced by whether or not they use hearing aids.

Rearranging the deckchairs on the Titanic: failure of an augmented home help scheme after discharge to reduce the length of stay in hospital

An augmented home help service was set up in the Rhondda Valley in South Wales in order to facilitate discharge from hospital of elderly subjects who were kept in hospital because of mainly social problems. Patients were allocated to the new service or the pre-existing services according to their date of birth. The extra social support did not result in a faster discharge from hospital, nor in any improvement in well-being of the intervention group, largely because the small extra amount of service input was inadequate to ameliorate the extreme physical, mental and social problems experienced by the study group.

Supporting elderly dependent people at home.

OBJECTIVE--To clarify the relation between the dependency of elderly people and the assistance they receive from others by using a detailed but simple measure of dependency. DESIGN--Secondary analysis of data from a survey of people aged 70 and over. SETTING--Two general practices in south Wales. SUBJECTS--1280 people aged 70 and over. MAIN OUTCOME MEASURES--Dependency on others to perform essential functions; detailed data on who assists with those functions. RESULTS--Increasing dependency was associated with increased use of more than one member of the family or friends and an increase in the provision of statutory services. CONCLUSION--The complexity of the relation between dependency and those who care for dependent people has previously been underestimated. The presence of providers of statutory services at the household of elderly dependent people suggests that these services can be developed further to help those caring for elderly people at home.

The Cardiff Health Survey. The relationship between smoking habits and beliefs in the elderly.

A survey of over 4,000 people in Cardiff about their health beliefs and practices showed that elderly people had a lower prevalence of cigarette smoking. However the elderly were more resistant to the idea of giving up smoking and were less likely than younger people to believe that their smoking was harmful. In contrast elderly people had very similar views to younger people on the harmful effects of smoking on younger people. If elderly people are to be persuaded to stop smoking, the beneficial effect upon younger people rather than the elderly themselves should be stressed.

Poverty, disability and use of services by the elderly: Analysis of the 1980 general household survey

Poverty is one of the most distinctive features of old age in Britain. At least half the population aged over 65 live in, or on the margins of, poverty. Old age is also characterized by a decrease in functional capacity and an increase in use of statutory social and health services. However the inter-links between poverty, disability and use of services have not been well researched. In this paper we examine these inter-relationships using data derived from the 1980 General Household Survey.