Age and ageing
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We sought the views of purchasers and provider managers in the South and West Region on the relative priorities of 15 possible performance measures of a geriatric medical service. Using a postal questionnaire, subjects were asked to rank the measures in order of priority. ⋯ The lowest priority was given to measurement of levels of activity and reducing mortality rates. Priorities were similar to those found with patients and geriatricians in a previous study, and supports the development and use of performance measures of disability and the quality of life of patients.
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The study aimed to find whether subcutaneous morphine administration by syringe driver for terminally ill patients in a Dutch nursing home led to higher morphine doses and earlier death than routine morphine administration. The data comprised the files of all patients dying over a 2 year period in a 355-bed nursing home in Delft in the Netherlands. ⋯ The data indicate that subcutaneous morphine administration by syringe driver decreases dose frequency problems and improves the control of pain and other symptoms in the last week before death. There was no evidence that administration of morphine in this way shortens survival.
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We wished to obtain information about the principal and subsidiary diagnoses, sex, age, marital status, religion and background characteristics of Dutch nursing home patients to whom euthanasia/assisted suicide (EAS) was administered. We performed an exploratory, descriptive, retrospective study involving all Dutch nursing home physicians (NHPs) who in September 1990 were members of the Dutch Association of Nursing Home Physicians (NVVA; n = 713). An anonymous printed questionnaire in two parts was used. ⋯ The principal diagnosis for patients who were given EAS was a malignancy, whereas relatively few physically ill nursing home patients die as a result of a malignancy. The patients to whom EAS was administered were younger and more often male. EAS patients had been in the nursing home for a shorter time than the other somatic (physically disabled) patients who died during the study period.
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We undertook a two-round Delphi study of the views of consultant geriatricians in three Health Regions on the relative appropriateness of 12 possible performance measures for geriatric services. We compared geriatricians' responses with those of 44 cognitively-intact day hospital patients. Of 138 geriatricians, 89 responded to the first round postal survey, 84 to the second round. ⋯ The study shows that it is possible to obtain a consensus amongst geriatricians about the priorities for measuring the performance of geriatric medical services. Similarities to and differences from patients' views illustrate the need to engage more than one group in the debate about appropriate measures of performance. Findings in both groups give support to recent attempts to develop and use assessment methods for the measurement of disability and quality of life in clinical practice.