Attitudes to Ageing and to Geriatric Medicine

The ageing of populations across the developed and developing world is a consequence of success (better nutrition and sanitation, improved medical care, greater choice about whether and when to have children) but older people are not always viewed or portrayed in a positive light, either in the hospital setting or in wider society. Similarly, geriatric medicine is a low prestige specialty, facing problems with recruitment. Even the British Geriatrics Society debates changing its name since "geriatrics" has "acquired negative connotations". Here, we briefly review the attitudes to geriatric medicine among medical professionals, including physicians, medical students and nurses. Societal attitudes to ageing are explored from different eras and across cultural perspectives. We consider how older people's own attitudes to their health may impact both their recovery from illness and life expectancy. We conclude that it is essential to consider the broader cultural milieu of medical schools, as this may have a greater influence than the formal curriculum on physicians' personality and conduct. Positive forces such as governmental edicts to abolish ageist practices may be undermined by what medical students hear and see on the wards. With the ageing of the inpatient population, it is critical that all physicians and nursing staff respect the ageing process and provide dignified and appropriate care to vulnerable older people

Frailty: A global measure of the multisystem impact of COPD

Chronic obstructive pulmonary disease (COPD) is a multisystem disease that resembles the accumulation of multiple impairments seen in aging. A comprehensive geriatric assessment (CGA) captures multisystem deficits, from which a frailty index (FI) can be derived. We hypothesized that patients with COPD would be frailer than a comparator group free from respiratory disease. In this cross-sectional analysis, the CGA questionnaire was completed and used to derive an FI in 520 patients diagnosed with COPD and 150 comparators. All subjects were assessed for lung function, body composition, 6-minute walking distance (6MWD), and handgrip strength. Patients completed validated questionnaires on health-related quality of life and respiratory symptoms. Patients and comparators were similar in age, gender, and body mass index, but patients had a greater mean ± SD FI 0.16 ± 0.08 than comparators 0.05 ± 0.03. In patients, a stepwise linear regression 6MWD (β = −0.43), number of comorbidities (β = −0.38), handgrip (β = −0.11), and number of exacerbations (β = 0.11) were predictors of frailty (all p < 0.01). This large study suggests patients with COPD are frailer than comparators. The FI derived from the CGA captures the deterioration of multiple systems in COPD and provides an overview of impairments, which may identify individuals at increased risk of morbidity and mortality in COPD

Are health assets associated with improved outcomes for hospitalised older adults? A systematic review

Objective Health assets are protective factors that support health and wellbeing, rather than risk factors that are associated with disease. This concept was developed in the community setting. In hospitalised older adults, the dominant approach has been to identify risk factors, with little examination of health assets. The purpose of this systematic review was to determine whether, in hospitalised older people, individual health assets decrease the risk of post hospital mortality, functional decline, new need for residential care, readmission or longer length of stay. Methods MEDLINE, EMBASE, CINAHL and PsycINFO were searched to identify studies examining outcomes for hospitalised older adults. Included studies examined at least one potential individual health asset, which was a psychosocial characteristic or health characteristic. Study quality was assessed, and findings are narratively described. Results Nine prospective cohort and two retrospective cohort studies were identified. subjective, functional and biological health assets were identified. Health assets were associated with decreased risk of post-hospital mortality, functional decline, new need for residential care and readmission. Conclusion The complex interplay between health status and psychological and social factors is incompletely understood. Health assets are associated with improved outcomes for hospitalised older adults. The small number of studies suitable for inclusion indicates the need for further research in this area

The COVID-19 Pandemic and Its Implications for Rural Economies

This paper presents a rapid assessment of current and likely future impacts of the COVID-19 outbreak on rural economies given their socio-economic characteristics. Drawing principally on current evidence for the UK, as well as lessons from the 2001 Foot and Mouth Disease outbreak and the 2007/8 financial crises, it outlines the likely key demand and supply effects, paying attention to the situation for agriculture as well as discussing the implications for rural communities. A distinction is made between the effects on businesses offering goods and services for out-of-home as opposed to in-home consumption. Gendered dimensions are also noted as likely business and household strategies for coping and adaptation. The paper concludes with a brief mapping of a research agenda for studying the longer-term effects of COVID-19 on rural economies

Derivation of a frailty index from the interRAI acute care instrument

Background: A better understanding of the health status of older inpatients could underpin the delivery of more individualised, appropriate health care

Apples and pears? A comparison of two sources of national lung cancer audit data in England

In 2014, the method of data collection from NHS trusts in England for the National Lung Cancer Audit (NLCA) was changed from a bespoke dataset called LUCADA (Lung Cancer Data). Under the new contract, data are submitted via the Cancer Outcome and Service Dataset (COSD) system and linked additional cancer registry datasets. In 2014, trusts were given opportunity to submit LUCADA data as well as registry data. 132 NHS trusts submitted LUCADA data, and all 151 trusts submitted COSD data. This transitional year therefore provided the opportunity to compare both datasets for data completeness and reliability. We linked the two datasets at the patient level to assess the completeness of key patient and treatment variables. We also assessed the interdata agreement of these variables using Cohen’s kappa statistic, κ. We identified 26 001 patients in both datasets. Overall, the recording of sex, age, performance status and stage had more than 90% agreement between datasets, but there were more patients with missing performance status in the registry dataset. Although levels of agreement for surgery, chemotherapy and external-beam radiotherapy were high between datasets, the new COSD system identified more instances of active treatment. There seems to be a high agreement of data between the datasets, and the findings suggest that the registry dataset coupled with COSD provides a richer dataset than LUCADA. However, it lagged behind LUCADA in performance status recording, which needs to improve over time

Authors of pictures, draughtsmen of words

Human thought is unique. We have the ability to create and share meaning through the use of various kinds of symbol systems. This study explored the shared dynamics of visual and verbal symbolic thought processes and their consequences for the acquisition of literacy. In particular, the study focused on the writing, reading, and drawing processes of the children in a process-based first-grade classroom. Research methods included participant/observations, open-ended interviews, audio-taped classroom discussions and interviews, and samples of the writing and drawing of the children in the entire class, with a special focus on five of the students. A detailed analysis of the data revealed that young children strive to transfer the many dimensions of their mental images to the page, especially the dimensions of time, space, movement, and color. As they transfer these images, they rely on both words and pictures in a complementary manner, depending on the task at hand and the cognitive bias of the child. This research calls for an extension of the definition of literacy to include multi-literacies, and further investigations of the fine-tuning of these literacies that occurs beyond elementary school into adulthood