Smoking habits and attitudes of age concern volunteers

As the population is ageing, health promotion is becoming increasingly important to prevent disease and disability. Cigarette smoking is strongly associated with excess mortality and smoking cessation even after the age of 65 years, improves health and lowers mortality. The voluntary sector is an under-utilised resource for health promotion to older people. Age Concern Cymru is the leading voluntary organisation in Wales involved in promoting 'healthy ageing'. The aim of this study was to determine the smoking habits and attitudes of older Age Concern volunteers. A questionnaire enquiring about smoking habits and attitudes was circulated to all volunteers aged 65 years and over attending age concern meetings in Wales between July and September 1999. Of 375 respondents (93% response rate) 16% were current-smokers, 58% ex-smokers and 26% life-long non-smokers. A significantly greater proportion of women were non-smokers. Significantly more ex-smokers (90%) and non-smokers (93%) compared with current-smokers (72%) believed that smoking causes heart disease (P<0.002). More ex-smokers (91%) and non-smokers (94%) than current-smokers (80%) believed smoking causes lung cancer (P<0.05). In conclusion, the majority of volunteers are currently non-smokers. Over 90% of ex-smokers and non-smokers believed in the deleterious effects of smoking on health. These volunteers could be utilised for smoking-cessation campaigns.     

Short course palliative radiotherapy of 20 Gy in 5 fractions for advanced and incurable head and neck cancer: AIIMS study.

BACKGROUND AND PURPOSE: A proportion of advanced stage head and neck cancer patients are incurable and have a limited life expectancy of 100 days or less. The study aimed to offer a short course of palliative radiotherapy (PRT) and evaluate the symptom relief, disease response and duration of survival. PATIENTS AND METHODS: Between 1995 and 2001, 505 patients of stage IV squamous cell carcinoma received uniform dose of 20 Gy in 5 fractions over 1 week along with symptom relief drugs. Incurable status and decision for palliation was made conjointly. Distressing symptoms were assessed before PRT. Patients showing more than 50% objective regression (PR) at tumor and nodal sites received further RT (FRT) up to 70 Gy. RESULTS: The overall PR rate was 37% (189 patients), but 153 (30%) completed FRT, and rest 352 were followed up after PRT only. None of the patients died due to radiation toxicity, and the radiation morbidities were confined to dry desquamation and patchy mucositis, which healed over 1 month. Symptom relief for pain, dysphagia, hoarseness, cough and otalgia was obtained in 47%-59% of the patients following PRT. The overall survival ranged from 34 days to 2065 days and median survival to PRT and FRT were 200 days and 400 days, respectively. Only 10% were disease-free after FRT. CONCLUSIONS: Unfavourable advanced stage head and neck cancer can be identified for a suitable short course of palliative radiotherapy which will achieve growth restraint and symptom relief in sizeable proportions for an approximate period of 7 months.     

Neuroleptic malignant syndrome—an unrecognized problem in elderly patients with psychiatric illness?

Until recently, neuroleptic malignant syndrome (NMS) was considered to be most unusual in elderly patients. During a two-year period, we encountered five patients with the syndrome among some 13000 admissions to our acute geriatric assessment beds. As there have been few other reports of the syndrome in elderly patints, we believe that many cases go unrecognized. All of our patients had existing neurological and/or psychiatric illness which tended to mask the clinical features and in some cases this may have contributed to a delay in making a diagnosis. A delayed diagnosis in NMS can have serious consequences, as early recognition with appropriate intervention offers the best prospect of reducing the high mortality rate.     

Acute central chest pain in the elderly. A review of 296 consecutive hospital admissions during 1976 with particular reference to the possible role of beta-adrenergic blocking agents in inducing substernal pain.

Two hundred and ninety-six patients were admitted to geriatric medical beds in Cardiff in 1976 with acute central chest pain. One hundred and eighty-six (63 per cent) had a confirmed acute myocardial infarction. Of the 37 per cent without evidence of cardiac infarction, 32 per cent were on beta-blocking drugs. The possible role of adrenergic blocking agents in producing acute central chest pain is discussed.     

The effects of discontinuing long-term diuretic therapy in the elderly.

The effects of discontinuing long-term diuretic therapy were investigated by means of a double-blind randomized controlled trial. A total of 141 elderly patients in the long-stay wards of six hospitals were found to be taking maintenance diuretics, and for 33 of these the drugs were judged to be mandatory. Of the remaining patients, 52 continued to receive diuretics while 54 were given matching placebo tablets. Eight in the latter group required diuretic therapy to be resumed during the following 12 weeks. The main change observed in patients who completed the trial was a slight increase of ankle oedema in the placebo group. Plasma potassium levels below 3.5 mEq/1 were found in some patients taking diuretics but not when the drugs had been withdrawn for 12 weeks. Blood pressure rose slightly in the placebo group and plasma urea rose slightly in the diuretic group. It was concluded that old people receiving long-term diuretic therapy without obvious current indication should have the drugs withdrawn under careful supervision so that those needing them could be identified.     

INFECTION WITH DIFFERENT SPECIES OF LEPTOSPIRES IN HUSBAND AND WIFE

Leptospirosis occurring in a husband and wife is described. Both were responsible for cleaning up the excreta of a recently acquired puppy. The wife developed leptospirosis canicola, and three months later the husband developed leptospirosis icterohaemorrhagica. Difficulty was experienced in ascertaining the infecting species of leptospire in the husband owing to the agglutination tests giving an equal rise and fall in titres for both L. icterohaemorrhagiae and L. canicola. The diagnosis was only confirmed after cross-absorption tests had been done.