Age and ageing
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syncope and falls are common symptoms in older adults. Dedicated facilities for these symptoms are emerging in the UK. To date, justification for resource allocation for these day case facilities is lacking. A dedicated syncope and falls day case facility for older adults was set up in Newcastle in 1991 (at the Royal Victoria Infirmary). The facility provided rapid access for assessment of appropriate patients from the community, the accident and emergency department, or emergency admissions. Activity and performance in 1999 were compared with peer inner-city teaching hospitals and with previous performance in 1990 at the Royal Victoria Infirmary to determine whether the facility had influenced emergency activity. ⋯ the striking variance in bed days in 1999 is due to lower emergency activity and shorter length of stay at the Royal Victoria Infirmary. This is attributed to the dedicated rapid access day-case facility. This has relevant resource implications for planning of future facilities and implementation of National Service Framework standards for falls and intermediate care.
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Randomized Controlled Trial Clinical Trial
Evaluation of a nurse-led falls prevention programme versus usual care: a randomized controlled trial.
to evaluate a nurse-led management plan and care pathway for older people discharged from an Accident and Emergency Department after a fall. ⋯ although the differences were not significant, patients in the intervention group had fewer falls, less hospital attendances and spent less time in hospital. Moreover, patients in the intervention group were more functionally independent at 6 months post-Index fall.
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Randomized Controlled Trial Clinical Trial
Substitution of a nursing-led inpatient unit for acute services: randomized controlled trial of outcomes and cost of nursing-led intermediate care.
To evaluate the outcome and cost of transfer to a nursing-led inpatient unit for 'intermediate care'. The unit was designed to replace a period of care in acute hospital wards and promote recovery before discharge to the community. ⋯ The nursing-led inpatient unit led to longer hospital stays. Since length of stay is the main driver of costs, this model of care-at least as implemented here-may be more costly. However, since the unit may substitute for both secondary and primary care, longer-term follow-up is needed to determine whether patients are better prepared for discharge under this model of care, resulting in reduced primary-care costs.
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To estimate active and cognitive impairment-free life expectancy at older ages from longitudinal data collected during two consecutive rounds of health checks for patients aged > or =75 years. ⋯ The extra years lived by women over men appear to be spent with some form of activity restriction, although not all with cognitive impairment. Monitoring these trends over time will be important to ascertain whether we are exchanging longer life for poorer health.
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Historical Article
Intermediate care--a challenge to specialty of geriatric medicine or its renaissance?
The specialism of geriatric medicine has developed considerably in the last half of the twentieth century. In Great Britain it has emerged from its sombre beginnings in Victorian poor law institutions to become one of the largest specialities in medicine encompassing a wide range of disciplines and interests. More recently, there has been a parallel development in "intermediate care" a sweeping phrase that encompasses a wide diversity of practices in a plethora of venues. ⋯ Elderly people need a full multi-disciplinary assessment (comprehensive geriatric assessment) and continued involvement of skilled and trained personnel in their continuing care (geriatric evaluation and management). The recommendations of the British Geriatrics Society on intermediate care are commended and should be adhered to by all planners and providers of intermediate care. There is considerable logic in developing ways in which the two developments can be integrated to build upon the best features of both.