Falls in older people

Thirty per cent of people aged over 65 fall each year in the UK. This number increases to more than 60% in those in care homes, illustrating the contextual nature of falls. The social consequences (apart from any injury) are considerable, with fear of falling among the most common. Fear of falls reduces the patient's quality of life and increases dependency. This has a significant knock-on effect for social and community care. For GPs, the frequency of falls presenting depends on the nature of the practice and the environment. But if you ask patients, you will find falls. As a consequence, they form part of the single assessment process (SAP) introduced in the national service framework for older people, which is used to determine a patient's health and social care needs. To manage falls more effectively, this contribution assesses how Southwark and Lambeth Integrated care pathway for older people with falls (SLIPS Project) has been developed as a fully integrated pathway linking acute care with primary, community and social care.     

Intra-individual variation in RMR in older people

In the factorial estimation of total energy expenditure it is assumed that the intra-individual variation in RMR is small. Little is known about the intra-individual variation in RMR in older subjects. The present study investigated the intra-individual variation in RMR in older people. Measurements of RMR were made in twenty-seven older subjects, mean age 71.6 (sd 6.1) years, on two separate occasions (T1 and T2) and on a third occasion (T3) in nineteen of the subjects. Measurements of height and weight were taken in all subjects. RMR measurements were made in the laboratory using a Deltatrac (ventilated-hood indirect calorimeter; Datex, Helsinki, Finland). All subjects had fasted overnight for 12 h and refrained from strenuous exercise before measurements. The intra-individual CV in RMR (kJ/d) after T1 and T2 was 2.5 % in women and 3.6 % in men and was 2.6 % in women and 3.4 % in men after all three sets of measurements. Although mean RMR did not vary across T1, T2 and T3, there was significant "crossing tracks" across the three measurement occasions in some individuals, reflecting a high degree of within-subject variability. The methods used had a significant measurement error associated with them (high R value; significant F ratio in three-way ANOVA). In conclusion, the results from the present study indicate that intra-individual variation in RMR was low in older people. The intra-individual variation in the elderly is similar to that seen in younger age groups.     

Undernutrition and housebound older people

Aim: This paper outlines approaches to dealing with undernutrition in the older person. Method: A series of case studies is presented to expose principles of practice for management of undernutrition in the older person. Results: Screening is a necessary first step. A more in‐depth assessment of those at‐risk may reveal contributory factors that if addressed, would result in better nutritional health outcomes. Preservation of muscle mass through adequate caloric and protein intake and exercise is important. Nutritional supplementation has been shown to reduce mortality risk and improve weight. A daily multivitamin may offer some benefit. Weight loss is also seen commonly in older people with dementia. There is a need to understand why this occurs as this could guide management strategies. There is also a need to consider conservative management when dysphagia occurs in the later stages of dementia. Percutaneous endoscopic gastrostomy feeding may not necessarily have that much to offer. Conclusion: In older people, the prevalence of undernutrition increases with increasing frailty. If not treated, undernutrition is costly both to the individual and society.     

Lay consulation of older people

The study of lay consultation has drawn attention to how social interaction supports, validates and influences the perception and response to health problems. Until now, such research has not considered how the particular circumstances of older people alter the process, i.e. (1) disruption of support networks, (2) experience of chronic rather than acute illness and (3) suffering of diseases shared by a sizable proportion of their agemates. Using case study data, the authors show how everyday discussions of health problems lead to the transmission to the sufferer of new information about the health condition, the reinforcement of health actions and in some cases attempts to persuade or to intervene actively. The authors use the case study material to identify variables shaping the process of consultation and suggest the importance of this process in the adaptation of older people to declining health.     

Serum cholesterol and older people

Serum cholesterol is positively associated with coronary heart disease (CHD) at all ages. Evidence from trials in middle-aged men with CHD suggests that morbidity and mortality can be reduced after only a few years of lipid-lowering treatment. Although older patients and women have not been included in these trials, both UK and USA expert committees' recommendations on measurement and reduction of cholesterol have not excluded such people. The literature on this issue is reviewed in order to put these recommendations into context.