bluuebunny/crossref_metadata_2025 huggingface dataset:
Prophylactic Mezlocillin for Transurethral Prostatectomy
Authors: ALLAN W. R. , KUMAR A.
Published: December 2008

Summary— In a randomised clinical trial of 100 consecutive patients treated by transurethral prostatectomy, half were given prophylactic intravenous mezlocillin. Blood cultures were obtained, the urine examined and the post‐operative progress of each patient was carefully followed.

The results were analysed and a high incidence of bacteraemia and septicaemia was found. Single‐dose prophylactic mezlocillin was highly effective in preventing this complication.

The presentation of septicaemia in mild and severe form is described and the aetiology discussed. Probable risk factors are identified and prophylactic and therapeutic measures described.
Vesico‐urethral Function in Huntington's Chorea
Authors: WHEELER J. S. , SAX D. S. , KRANE R. J. , SIROKY M. B.
Published: December 2008

Summary— Six patients with Huntington's chorea (5 females, 1 male) underwent neurourological evaluation because of urological complaints, usually incontinence. Four patients had detrusor hyperreflexia with a normal sphincter and two patients had a normal study, suggesting that their incontinence might be non‐organic. A characteristic urodynamic pattern, not previously described, was observed, consisting of choreiform contractions of the abdominal perineal floor muscles during filling with selective suppression of choreiform contractions in the perineum during detrusor contraction.
Factors Influencing Post‐operative Hospital Stay after Transurethral Resection of the Prostate Gland
Authors: WOLVERSON R. L. , BLACKLOCK A. R. E. , GEDDES J. R. , O'HAGAN A.
Published: December 2008

Summary— The influence of 12 clinical and social factors on the length of post‐operative stay in hospital after transurethral resection of the prostate was investigated in 100 patients. Using a multiple binary regression analysis, the factors significantly associated with a post‐operative stay exceeding 6 days were: patient's age > 70 years (P < 0.005), the presence of existing cardiovascular disease (P < 0.005) and the weight of the prostate gland resected > 10g (P < 0.005). The first two factors are useful in providing a prediction of prolonged post‐operative stay. The results indicate that those factors associated with a prolonged post‐operative stay are beyond the control of the clinician.
Post‐hysterectomy Urethral Dysfunction: Evaluation and Management
Authors: FARGHALY S. A. , HINDMARSH J. R. , WORTH P. H. L.
Published: December 2008

Summary— A retrospective study of the functional alteration of the urethra following hysterectomy was made in 98 patients. Three groups were identified. Sixty per cent (group A) had stable stress urinary incontinence, 27.8% (group B) had high pressure detrusor instability and 12.2% (group C) had voiding dysfunction. Some of the patients in group A were treated medically and others surgically. Those in group B were treated with oxybutinin and those in group C were treated surgically. The cure rate in group A ranged from 55 to 89%; in group B it was 82% and in group C between 90 and 100%.
Further Evidence of Venous Outflow Restriction During Erection
Authors: JUENEMANN K.‐P. , LUO J.‐A. , LUE T. F. , TANAGHO E. A.
Published: December 2008

Summary— To elucidate the effect of venous outflow restriction during erection, we studied eight dogs during artificial saline perfusion of the penis with and without neurostimulation to induce erection.

With the infrarenal aorta clamped temporarily, saline infusion rates of 0.9 and 1.9 ml/min raised the mean intracorporeal pressure to 34 and 42 cm H2O, respectively, before stabilisation or return to baseline. When cavernous nerve stimulation was initiated, the mean intracorporeal pressure rose to 124 and 184 cm H2O (with infusion rates of 0.9 and 1.9 ml/min respectively) to induce full erection.

Our results show that venous outflow restriction takes place during erection and that it is necessary not only to induce full erection but also to maintain it. Evaluation of venous competence is therefore essential during the investigation of impotence.
The Treatment of Uric Acid Calculi with Extracorporeal Shock Wave Lithotripsy
Authors: ROYCE P. L. , FUCHS G. J. , LUPU A. N. , CHAUSSY C. G.
Published: December 2008

Summary— A review of the first 1000 patients treated with extracorporeal shock wave lithotripsy (ESWL) at UCLA revealed 21 patients with uric acid renal or ureteric calculi. Using the combination of ESWL and oral urinary alkalinisation, 16/21 patients (76%) were stone‐free at follow‐up 3 months later and 19 patients were stone‐free at 5 months. ESWL and urinary alkalinisation are complementary methods for the non‐invasive treatment of uric acid renal calculi.
Peritoneal Flap Ureteropexy for Idiopathic Retroperitoneal Fibrosis
Authors: FOWLER J. W.
Published: December 2008

Summary— Eight patients had 13 ureters treated by peritoneal flap ureteropexy. There were no significant post‐operative complications. Eleven ureters were functioning normally after an average follow‐up of 28 months. The operation is suggested as a method of choice where omental wrapping is not possible.
Measurement of Bladder Volume by Real‐time Ultrasound
Authors: KIELY E. A. , HARTNELL G. G. , GIBSON R. N. , WILLIAMS GORDON
Published: December 2008

Summary— The accuracy of a non‐invasive method of measuring the volume of urine in the bladder using ultrasound was assessed 32 times in 18 patients with benign prostatic hypertrophy. A method originally used with B‐mode scanners was applied to images obtained with a real‐time scanner. Although the mean error of 8% of true volume (range ‐29% to +52%, standard deviation 23%) compared favourably with that of some series, the results were less accurate than those originally reported for this method using a B‐mode scanner.

Real‐time ultrasound can provide an approximate measurement of bladder urine volume but is not sufficiently accurate in situations where more precise measurements of changes in residual urine are required.
Urinary symptoms in the community: how bothersome are they?
Authors: JOLLEYS J.V. , DONOVAN J.L. , NANACHAHAL K. , PETERS T. J. , ABRAMS P.
Published: December 2008

Objectives To measure the level of reported urinary symptoms presumed to be associated with benign prostatic hyperplasia (BPH) among men aged 40 years and over in the community, and to assess how bothersome these symptoms are perceived to be.

Subjects and methods All ambulant men aged 40 years and over who were registered in a general practice (703) were invited to attend the health centre to complete a questionnaire containing the Maine prostatectomy scale and the International Continence Society‐BPH questionnaire, and to undergo uroflowmetry.

Results The prevalence of symptomatic BPH (as defined by a numerical score ≥11 on the Maine score, a urinary peak flow of<15 ml/s and failure to void ≥ 150 ml on three separate occasions) was 284/1000 for men aged 40 years and over. This prevalence increased from 179/1000 in men aged 40–49 to 500/1000 in men aged 70 years and over. The most commonly reported symptoms were those typically associated with BPH (terminal dribble, hesitancy, intermittency, urgency). The symptoms that caused men the greatest degree of bother were frequency, nocturia and those causing incontinence or social embarassment.

Conclusion The high prevalence of urinary symptoms assumed to be related to BPH in men in the community does not necessarily suggest that these men will require treatment. Common symptoms, typically associated with BPH, were tolerated. Further research is required to investigate the natural history of urinary symptoms, the relationships between symptoms and baldder outflow obstruction secondary to BPH, and to determine the most appropriate management for men in the community, raging from ‘watchful waiting’ (monitoring without treatment) to medical or surgical treatment.
Experience with neoadjuvant diethylstilboestrol and radical prostatectomy in patients with locally advanced prostate cancer
Authors: APRIKIAN A. G. , FAIR W. R. , REUTER V. E. , SOGANI P. , HERR H. , RUSSO P. , SHEINFELD J.
Published: December 2008

Objective To report our experience with neoadjuvant endocrine therapy and radical retropubic prostatectomy (RRP) in patients with locally advanced prostate cancer.

Fifty‐five patients with prostatic adenocarcinoma (18 clinical stage B2/3, 27 clinical stage C, and 10 clinical stage DO) were treated with diethylstilboestrol (DES) 3 mg/d (median time 12 weeks, range 5–36) followed by pelvic lymph node dissection and planned RRP. Clinical response was monitored bi‐weekly with serum prostate‐specific antigen (PSA), serum acid phosphatase and digital rectal examination.

Results The median pre‐treatment serum PSA was 20.4 ng/ml (range 1.2–620). The median post‐treatment, pre‐operative serum PSA was 0.4 ng/ml. Twenty‐seven (49%), 41 (75%) and 54 (98%) patients had serum PSA levels that were undetectable, <.0 ng/ml and <.0 ng/ml respectively. In 15 patients, transrectal ultrasound measurement of prostatic volume changes was performed, and all demonstrated prostate volume reduction (median reduction 35%, range 18–45). All 55 patients underwent pelvic lymphadenectomy, with 47 (85%) undergoing RRP. Of the eight patients not undergoing RRP, three had negative lymph nodes but prostate resection was not deemed feasible and five had nodal metastases as determined by frozen section analysis. Final pathological stage revealed the following distribution: organ confined tumours, 18 (33%): capsular perforation with negative surgical margins, seminal vesicles and lymph nodes, seven (13%); seminal vesicle and/or margin involvement with negative lymph nodes, 18 (33%): lymph node metastases, 12 (22%). Neither pre‐therapy serum PSA nor serum PSA response was predictive of final pathological stage. With a median follow‐up interval of 26 months (range 12–49), 21 patients (38%) have undetectable serum PSA without adjuvant therapy.

Our results indicate that despite clinical evidence suggestive of downstaging, the majority of patients with locally advanced prostatic carcinoma managed with neoadjuvant DES and RRP continue to have pathological evidence of extraprostatic carcinoma.
The Ability to Judge the Romantic Interest of Others
Authors: Place Skyler S. , Todd Peter M. , Penke Lars , Asendorpf Jens B.
Published: December 2008

The ability to judge another individual's romantic interest level—both toward oneself and toward others—is an adaptively important skill when choosing a suitable mate to pursue. We tested this ability using videos of individuals on speed dates as stimuli. Male and female observers were equally good at predicting interest levels, but they were more accurate when predicting male interest: Predictions of female interest were just above chance. Observers predicted interest successfully using stimuli as short as 10 s, and they performed best when watching clips of the middle or end of the speed date. There was considerable variability between daters, with some being very easy to read and others apparently masking their true intentions. Variability between observers was also found. The results suggest that the ability to read nonverbal behavior quickly in mate choice is present not only for individuals in the interaction, but also for third-party observers.
Prognostic Significance of Potential Frailty Criteria
Authors: Rothman Marc D. , Leo‐Summers Linda , Gill Thomas M.
Published: December 2008

OBJECTIVES: To determine the independent prognostic effect of seven potential frailty criteria, including five from the Fried phenotype, on several adverse outcomes.

DESIGN: Prospective cohort study.

SETTING: Greater New Haven, Connecticut.

PARTICIPANTS: Seven hundred fifty‐four initially nondisabled, community‐living persons aged 70 and older.

MEASUREMENTS: An assessment of seven potential frailty criteria (slow gait speed, low physical activity, weight loss, exhaustion, weakness, cognitive impairment, and depressive symptoms) was completed at baseline and every 18 months for 72 months. Participants were followed with monthly telephone interviews for up to 96 months to determine the occurrence of chronic disability, long‐term nursing home (NH) stays, injurious falls, and death.

RESULTS: In analyses adjusted for age, sex, race, education, number of chronic conditions, and the presence of the other potential frailty criteria, three of the five Fried criteria (slow gait speed, low physical activity, and weight loss) were independently associated with chronic disability, long‐term NH stays, and death. Slow gait speed was the strongest predictor of chronic disability (hazard ratio (HR)=2.97, 95% confidence interval (CI)=2.32–3.80) and long‐term NH stay (HR=3.86, 95% CI=2.23–6.67) and was the only significant predictor of injurious falls (HR=2.19, 95% CI=1.33–3.60). Cognitive impairment was also associated with chronic disability (HR=1.82, 95% CI=1.40–2.38), long‐term NH stay (HR=2.64, 95% CI=1.75–3.99), and death (HR=1.54, 95% CI=1.13–2.10), and the magnitude of these associations was comparable with that of weight loss.

CONCLUSION: The results of this study provide strong evidence to support the use of slow gait speed, low physical activity, weight loss, and cognitive impairment as key indicators of frailty while raising concerns about the value of self‐reported exhaustion and muscle weakness.
Learning from Small Change: Clerkship and the Labors of Convenience
Authors: Whitelaw Gavin Hamilton
Published: December 2008

Convenience stores are atop the list of global retail chains blamed for homogenizing landscapes, deskilling labor, and eroding local cultural difference. Further still, their very ubiquity and “nonplace”‐ness is said to challenge conventional modes of ethnographic inquiry. In the following article, I move beyond such broad assumptions by examining how the convenience store constitutes a meaningful lifeworld and culturally embedded economic institution. Drawing on my training and experiences as a clerk, I explore in particular how impersonal familiarity is constructed and contested within the context of this retail environment.
Contact factor deficiencies and cardiopulmonary bypass surgery: detection of the defect and monitoring of heparin
Authors: Van Veen Joost Jair , Laidlaw Stuart , Swanevelder Justin , Harvey Nicholas , Watson Chris , Kitchen Steve , Makris Mike
Published: December 2008

Contact factor pathway deficiencies do not cause surgical bleeding but make heparin monitoring by the activated partial thromboplastin time (APTT) and activated clotting time (ACT) unreliable. Heparin monitoring during cardiopulmonary bypass (CPB) surgery in these patients is particularly challenging. Here we describe heparin monitoring during CPB using the chromogenic anti Xa assay in two patients with severe factor XII deficiency (FXII < 0.01 U/mL) and one patient with severe prekallikrein (PK) deficiency (PK < 0.01 U/mL). Anti Xa levels of the three patients during CPB varied between 3.8 and 4.8 U/mL in keeping with a control group (mean anti Xa 4.5 U/mL and ACT > 480 s). There were no bleeding or thrombotic complications. We also found that detection of severe PK deficiency by the APTT in the PK deficient patient was dependent on the reagent used and discuss the sensitivity of different APTT reagents for contact factor deficiencies. We conclude that the sensitivity of APTT methods for contact pathway deficiencies is highly variable and although insensitivity is not a clinical problem in terms of bleeding, it can be a cause of discrepancy between different APTT reagents and the ACT. This can lead to confusion about a possible haemorrhagic tendency and delays in surgery. If these patients need to undergo cardiac surgery requiring high dose heparin treatment, monitoring by chromogenic anti Xa assay is a good alternative.
“Demodystopias”: Prospects of Demographic Hell
Authors: Domingo Andreu
Published: December 2008

Dystopian fiction, stories envisioning dire human futures, originated with the novels of H. G. Wells and others a century ago. “Demodystopias” are a subgenre of dystopias where the imagined futures derive from demographic change, taken perhaps to an extreme: the population explosion, aging and depopulation, mass migration, global epidemics, and the eugenic possibilities of new reproductive technologies. This essay traces the genealogy of demodystopias over the twentieth and early twenty‐first centuries. Their themes reflect the demographic issues of the day: fear of overpopulation in the “population bomb” era; later, threatened societal senescence or swamping by immigrants under ultra‐low fertility; new reproductive regimes under genetic engineering; and the geopolitics of demographic change. As with other dystopias, demodystopias seek to identify present‐day negative tendencies that might lead to a future theatrum diabolorum—and to pin responsibility for such an outcome on ourselves. Authors discussed include Margaret Atwood, Anthony Burgess, Günter Grass, Michel Houellebecq, José Saramago, Lionel Shriver, and Kurt Vonnegut.
SOME ISSUES IN THE USE, PERCEPTION, AND CONSTRAINTS OF CHOICE OF ACCOMMODATION OPTIONS FOR THE ELDERLY
Authors: Radford Anthony J.
Published: December 2008

Choice with respect to relocation for the elderly is rarely simple. Individuals need to be able to make informed choices about relocation whenever they are mentally capable of doing so. When this is not possible it is equally important that the relatives and professionals who decide for them are in a position to make informed decisions. Choice is concerned with ‘notions’ as well as with ‘knowledge’. Successful relocation requires successful adaptation, and the older a person is the longer the process of adaptation and the less the likelihood of it being successful.

This paper explores three areas:

The accommodation situation in South Australia today.

The thoughts of the elderly regarding their future accommodation.

Possible directions for future policy.
APPRAISAL OF LONGEVITY AND CONSIDERATION OF A NEW PARAMETER
Authors: Harwood Elsie , Enticknap L. E.
Published: December 2008

The advanced ages and good health of many of the surviving members of the longitudinal study known as “Operation Retirement” prompted the researchers to initiate a study of longevity. One hundred and eleven subjects were interviewed intensively (average age 80) and life‐data and information of psychological concern were collated concerning panel members and their siblings and ancestors. Age at death and causes of death were generally reliably reported from family records, variously reaching back through two or three generations. Methodological problems caused the investigators to seek a new parameter, which they have called the Longevity Quotient (LQ), in some ways analogous to the Age‐Resistance Quotient established in relation to the UQOR retirement recreation guidance tests. For this purpose, a tabulation of life‐expectancy at birth had to be compiled, beyond the earliest birth dates available in the official Australian records. This will be discussed, in the explanation of the formula:

Longevity Quotient (LQ) = Age of death/Life Expectancy at birth × 100

Since the LQ cannot properly be estimated until death, the method has had to be applied tentatively in respect of panel members, but firmly in a comparison of IQs and LQs of deceased members of the panel.
AGEING POPULATIONS AND SOCIAL CARE: POLICY ISSUES
Authors: Graycar Adam , Harrison Jo
Published: December 2008

Official policy statements and parliamentary recommendations are re‐emphasizing the importance of community care for elderly people. This paper * examines questions of responsibility in the light both of demographic changes and the associated increases in dependency amongst the elderly in Australia. Definitional questions are raised in relation to the concept of community. The distinction between care in and by the community is probed in relation to evidence concerning the role of women in the provision of care. The responsibilities for provision which exist at the statutory, commercial, voluntary and informal levels are outlined. Actual allocation of fiscal resources to home support services is detailed and policy considerations which arise from this analysis are proposed.
THE ROLE OF MICROANALYTIC SIMULATION MODELS IN THE ANALYSIS OF AUSTRALIAN RETIREMENT INCOME POLICY
Authors: Borowski Allan
Published: December 2008

It is the contention of this paper that the development of Australian microanalytic simulation models will offer an especially useful tool For analyzing the effects of retirement income policy on the economic situation of the aged. In contrast to the contemporary practice of casting the impacts of policy in aggregate terms, microanalytic simulation generates data that permit addressing the more central questions of the size and distribution of retirement income. This paper describes microanalytic simulation and illustrates its application to the retirement income policy domain.
PETS, LONELINESS AND HEALTH IN SOLITARY OLDER PEOPLE
Authors: Delin Catherine , Delin Catherine
Published: December 2008

There has been increasing interest in the possibility that owning pet animals can contribute positively to the health of older people. The present study was undertaken to determine whether pet‐ownership does benefit the health and well‐being of older people living alone. The 28‐item General Health Questionnaire was administered to 130 solitary respondents aged from 55–93 years (mean age 74.28 years). Additional information relating to age, sex, type of pet, feelings of loneliness, frequency of visits by friends and family, and history of pet‐ownership was also obtained. 47 (36.2%) of the respondents were pel‐owners and 82 (63.1%) did not own pets (1 missing value). There were no significant differences between pet‐owners and non‐pet‐owners in subscale scoring on the GHQ or on total GHQ score. Significant positive correlations were found between strength of experienced loneliness and scoring on the GHQ. Implications for the care of older people are discussed.
RETIREMENT VILLAGES: SEGREGATED COMMUNITIES?
Authors: McDonald John
Published: December 2008

This article* reviews the literature on the relationships among retirement village residents. Based upon the available American data, such villages can be said to be segregated communities. Comparable Australian data is sadly lacking. The American findings and theoretical frameworks are critically analysed before extrapolating to the Australian situation. It is hypothesized that the integration of villages into wider society (strongly advocated by Australian committees of inquiry) may occur at the expense of ‘community’ among the residents.
THE DO CARE TELELINK PROGRAMME — ENCOURAGING THE ACTIVE PARTICIPATION OF THE ELDERLY, HOUSE‐BOUND PERSON
Authors: Cole Penny
Published: December 2008

This article outlines the philosophy and structures of the Do Care Telelink Programme with particular emphasis on the ways elderly house‐bound people are given power over decision‐making, relationships. information and resources through their active participation in every facet of the Programme. It is proposed that such active participation is both 3 goal and a process which not only lays the foundation for social action but is an essential ingredient in developing a sense of community through which these frail older people also gain a greater sense of their own identity.
AGEIST ATTITUDES PROMOTE URINARY INCONTINENCE IN OLDER PEOPLE AND CAN LEAD TO THE DEMORALISATION OF NURSING STAFF
Authors: Wellings Cynthea
Published: December 2008

The purpose of this paper is to analyse some myths surrounding ageing. The particular focus is on myths associated with urinary incontinence in older people. It is suggested that nursing attitudes of acceptance and apathy promote urinary incontinence. The result of these attitudes is that the nursing profession demeans itself and creates an unfavourable environment in which to work.
NURSING HOME WAITING LISTS — INDICATORS OF NEED?
Authors: Gray L. , Lazarus R.
Published: December 2008

The waiting lists maintained by the nursing homes in the catchment area of the Bundoora Extended Care Centre were reviewed to establish their accuracy as indicators of demand for nursing home admission within the region. The status of listed applicants was established by reviewing lists of current nursing home residents and by telephone contact of listed contact persons.

A maximum of 46% and possibly fewer than 37% of the listed applicants were available for immediate admission. Inflation of apparent demand for admission was attributable to several factors: duplication of names, prior death or admission to another nursing home, change of intention, inability to contact the applicant and the practice of listing for possible future need.
UNIVERSITIES OF THE THIRD AGE: AN EXERCISE IN PARTNERSHIP
Authors: Picton C.J.
Published: December 2008

Older people represent a significant and growing element in the Australian population. In recent years they have demonstrated an apparently insatiable thirst for knowledge about an ever‐widening range of topics and issues. Research has now shown conclusively that older people generally retain the capacity to acquire, absorb and use new information and knowledge until much later in life than was hitherto thought possible. While this finding deals a gratifying blow to the negative stereotype of old age, much needs to be done to make opportunities available to older people to pursue a suitable range of intellectually stimulating activities.

One exciting model well‐established in Europe is now well established in Australia. Universities of the Third Age (U3As) are based on the notion that older people have the skills to teach and learn together. They are essentially self help organisations with members determining the form and content of programmes that reflect the rich diversity of interests and talents of the participants.

Approximately 8,000 people are now active participants in campuses throughout mainland Australia. The First National Conference of Universities of the Third Age was held in Melbourne on 22–23 August 1988 with the assistance of a grant of 60,000 from the Australian Bicentennial Authority.
GERIATRIC REHABILITATION AND PHYSICAL EDUCATION: A NEW DIRECTION
Authors: Hamdorf P. A. , Penhall R. K.
Published: December 2008

Physical educators are playing an important role in the rehabilitation of aged clients within a day hospital in South Australia. Many varied and previously unavailable rehabilitation activities have characterised their approach to specific problems and the general restoration of physical fitness amongst referred clients. The physical educator's place within a multidisciplinary team setting is now fundamental in the provision of physical rehabilitation services.
BOOKSHELF
Authors: Chekaluk Eugene
Published: December 2008

Book reviewed in this article:

Minichiello, Victor, Rosalie Aroni, Eric Time well & Loris Alexander: In‐depth Interviewing: Researching People

Polgar, Stephea and Shane Thomas: Introduction to Research in the Health Sciences
SENIOR AUSTRALIANS WHO JOIN GROUPS: EFFECTS ON QUALITY OF LIFE
Authors: James C. , Swindell R.
Published: December 2008

The importance of physical, intellectual and social stimulation in promoting quality of life amongst older people has long been recognised. The role of voluntary groups in contributing to quality of life has not been identified. This project set out to identify the effects on perceived quality of life for 78 people belonging to a range of different types of groups: those with a focus on intellectual stimulation, social interaction only, and voluntary ‘helping’ activities. Subsequently an artificially constructed group comprising frail elderly people with major illnesses was established to test whether quality of life factors associated with groups could be integrated into the lives of socially isolated individuals.
MEDICATION USE BY ELDERLY PERSONS IN SYDNEY
Authors: Snowdon J.
Published: December 2008

The purpose of this study was to compare the use of medication by elderly persons in four different settings in Sydney. Information was obtained from 143 people living in their own homes, and medication charts were studied in relation to 79 hostel residents, 134 nursing home residents and 43 patients in long‐stay psychogeriatric wards. Prescription of psychotropic medication for residents of hostels and nursing homes in 1985–1988 was at a high level when compared with overseas studies carried out during the same period. Antidepressants were prescribed more often in Sydney than in overseas institutions for older people, though a high percentage of depressed subjects were found not to be taking antidepressants. Other details of medication use are discussed.
HEALTH ADVOCACY AND AGEING: A SEARCH FOR UNDERSTANDING
Authors: Seedsman T.A.
Published: December 2008

This paper represents an exploratory study into the conceptual basis of advocacy and its potential value for health and caring professionals working to enhance the well‐being of the aged. The view is offered that advocacy and its related processes are not as clearly understood as perhaps claimed by those who have humanitarian interests and concerns for the aged. An advocacy model is proposed that shows the possibilities for developing community and individual empowerment through health promotion strategies. Empowerment is seen as an important outcome of the advocacy process that benefits the aged and those working to facilitate improvements in quality of life for the aged. Some well known impediments to aged advocacy are discussed, including perspectives on advocacy for physically active lifestyles. The paper concludes with the identification of the major challenges facing communities and individuals with a genuine interest in health advocacy initiatives for the aged.
‘BARELY MANAGING’: THE NEEDS OF PEOPLE WITH DEMENTIA AND THEIR CARERS
Authors: Waite H. , Knapman C.
Published: December 2008

Studies of caring for people with dementia have concentrated on the physical and psychological well‐being of the carer using a primarily individualistic model. By drawing on a study of the needs of people with dementia and their carers in the Australian Capital Territory, the importance of a complementary, socially based perspective is demonstrated. The data, from a survey and interviews, indicate that quality of life for the person with dementia and the carer is shaped by a complex of social factors. Some of these, particularly age and gender, are discussed in relation to findings in such areas as diagnosis, employment and the experience of caring. Several commonly held beliefs about ‘ideal’ carers and caregiving situations are challenged by the findings.
‘I THINK HE MIGHT HAVE HIT ME ONCE’: AGGRESSION TOWARDS CAREGIVERS IN DEMENTIA CARE
Authors: Cahill S. , Shapiro M.
Published: December 2008

Little is known about aggression in caregiving relationships in the Australian context, although the topic has received considerable attention in recent overseas literature. This paper reports on a sample of 39 female primary caregivers recruited from the Brisbane metropolitan area and interviewed about a range of aggressive acts directed against them by dementing dependents, while they were providing care in the community. Results show that aggression against caregivers was reported in 89 per cent of cases. Serious violence was experienced by 26 per cent of the sample. In order to provide a coordinated policy an intersectoral approach may be useful.
Measuring Disability in the Australian Government Aged Care System
Authors: Rickwood D.
Published: December 2008

The ICIDH was developed to assess the consequences of disease and classify them as impairments, disabilities and handicaps. By developing a standard classification system it provides a common conceptual framework and terminology for specialists in diverse health care areas. Disability measures collated nationally across the Australian Government aged care system are plagued by some of the problems that the ICIDH was designed to address. This paper considers the aged care data collections in the context of the ICIDH system and shows that measurement of disability in national aged care data could benefit from such a classification system.
Collective Reminiscence or Senior Activism? The Role of Veterans' Groups in Victoria
Authors: McCormack J.
Published: December 2008

The formation of interest or pressure groups representing older people is increasing in Australia. Following the American model, the new groups have a primary focus on financial matters and state explicitly that they will act politically on behalf of their members. Ex‐service organisations for veterans on the other hand, have existed for many years and formed in a different context. As a contribution to the commemorative year this paper, through a State survey, documents a small part of their history, and reviews the role and function of veterans' support groups in reference to these new aged group developments. The paper also looks at expression of intergenerational support for the veterans' groups by surveying a group of younger people's attitudes and understanding of them. The results indicate that the veterans' support groups, despite variation in some characteristics, have implicitly acted in the same manner as the political aged interest groups. Also, contrary to the groups' beliefs, there is intergenerational support for them, although a revised marketing strategy is recommended to enhance that support.
How Should Toilets be Labelled for People With Dementia?
Authors: Wilkinson T.J. , Henschke P.J. , Handscombe K.
Published: December 2008

A mailed survey of 28 residential facilities for ambulant people with dementia questioning the types of labelling of residents' toilets yielded 24 replies: 42% (10) had no labelling, “Toilet” was used in 50% and “Male” or “Female” was used in 8%. The survey was followed by asking elderly people in an acute medical hospital ward and in an aged care residential complex their preferences for toilet word and symbol labelling There were 21 elderly people with normal cognition, 11 people with mild dementia and 16 people with moderate dementia. The international symbol was preferred by people with normal cognition or mild dementia but a symbol more representative of a toilet was preferred by people with moderate dementia (p < 0.05). “Ladies” or “Gents” was the word most preferred by people with normal cognition. “Toilet” was the word preferred by people with moderate dementia (p < 0.05). We recommend the use of the word “Toilet” accompanied by a picture of a toilet for labelling toilet doors for people with dementia.
Dementia and Driving: a Survey of Clinical Practice in Aged Care Assessment Teams
Authors: Fox G.K. , Withaar F. , Bashford G.M.
Published: December 2008

Current clinical practice in Aged Care Assessment Teams (ACATs) in NSW and ACT regarding assessment of fitness to drive in clients with a diagnosis of dementia was examined. Of 42 ACATs with a geriatrician on staff, 38 (90.5%) responded to a telephone survey. Results showed that assessment of driver fitness is largely a medically based procedure, with functional on‐road assessment of driver competence occurring in 42.1% of ACATs. Use of the Mini Mental Status Examination in determining the severity of dementia and impact on driving was common (94.7%), although such predictive ability has not been demonstrated. Few ACATs (36.8%) systematically review drivers despite likely disease progression. 73.7% of ACATs reported experience of clients continuing to drive against advice. Approaches to assessment in city and rural ACATs are compared.
Staff Perceptions of Communication Difficulty among Nursing Home Residents
Authors: Burnip L.G. , Erber N.P.
Published: December 2008

Hearing and vision impairment are prevalent among older people in long‐term care, contributing to their communication difficulties. Data on 44,012 nursing home residents were obtained with the Resident Classification Instrument, a rating scale designed to determine each resident's need for nursing and personal care, and hence entitlement to Federal funding. Comparison with related studies suggests that nursing home staff in Australia underestimate the contribution hearing loss makes to the communication difficulties of the residents in their care. An alternative approach to the assessment of the communication needs of residents is recommended to permit a more accurate assessment of needs.
Polish Carers, Their Dependents and Respite Care Services
Authors: Evert H. , Kukulska E.
Published: December 2008

A study of Polish carers, their dependents and respite care services was conducted by the Australian Polish Community Services with funding from the Commonwealth Respite for Carers program. Thirty care‐givers and their dependents were interviewed in the western suburbs of Melbourne. It was found that some of the carers were elderly and suffered from a range of health problems themselves. Their dependents suffered from stroke‐related illnesses, heart attacks and dementia. Most carers who cared for dependents with dementia reported suffering from tiredness, sleeplessness and depression. Most carers were using some sort of support services but were unfamiliar with the concept of respite care. It is hoped that the results of this study will alert mainstream service providers to the needs of Polish care‐givers and their dependents.
Caring for Frail Aged/Dementia Sufferers: an Evaluation of a Nursing Staff Team Approach
Authors: Godfrey S.
Published: December 2008

The following report is a personal evaluation of a change in a nursing style of care delivery for the frail aged/dementia sufferer. It outlines the history of the facility and the transition to a different style of care. It then discusses benefits and deficits of this style of care.
Staff Knowledge Regarding Hearing Loss and Communication among Nursing Home Residents
Authors: Burnip L. G. , Erber N.P.
Published: December 2008

Hearing loss is prevalent in nursing homes, and communication by residents is reported to be restricted both in quality and quantity. Programs to manage hearing loss in nursing homes are uncommon, and residents are infrequently referred for assessment of communication difficulties. To understand this situation, it is necessary to consider how staff perceive residents' communication needs and difficulties. A questionnaire was completed by 140 staff in five nursing homes. They answered questions relating to the prevalence and effects of hearing loss, residents' opportunities for communication, and the communication environment. Findings suggest that staff underestimate the prevalence of hearing loss, that they recognise some of the communicative obstacles encountered by residents, but that they are overly optimistic about residents' opportunities for communication and also the ability of staff to improve that communication.
Funding for Long‐term Care: the Private Insurance Option
Authors: Davey J.A.
Published: December 2008

Increasing emphasis on self reliance as an objective of social policy calls for a re‐assessment of how long‐term care for dependent elderly people will be funded. A variety of options are available for sharing the costs between the state and users. Private long‐term care insurance has the potential to play a part in the future, but constraints from both the supply and demand sides must be taken into account, as must the wider social implications of policy choices.
Men, Friends and Widowhood: Toward Successful Ageing
Authors: Riggs A.
Published: December 2008

The study upon which this paper is based, investigated the process by which older widowers adapt to being alone after the death of a spouse. In‐depth interviews were conducted with eight men aged between 73 and 86 years. One prevalent assumption in the literature is that when a wife dies men's social networks disintegrate because of their lack of social skills. Contrary to this assumption, the men in this study not only maintained friendships but also instigated new ones. The success of retaining and maintaining old friendships and making new friends, was intrinsic to the men's adaptation to widowhood and thus to successful ageing.
The Attitudes of Medical Students Towards Careers in Geriatric Medicine
Authors: Couteur D.G. Le , Bansal A.S. , Price D.A.
Published: December 2008

When designing a geriatric medical curriculum, it is important to understand the attitudes that medical students have towards the elderly and careers in geriatric medicine. Therefore, attitudes of senior medical students at the University of Queensland towards a career with the elderly were assessed using a questionnaire. Very few students were considering pursuing a career in geriatric medicine and most students excluded the elderly from the age groups that they would prefer to treat This appeared to be secondary to a perception that geriatric medicine is a ‘low tech’ specialty concerned with psychosocial and placement issues and rarely with cure.
The Demography of Ageing and Families in Australia
Authors: Rowland D.T.
Published: December 2008

This paper discusses Australian research on the demography of ageing and the family and identifies frontiers for further inquiry. Beginning with the topics of demographic ageing and demographic theory, the paper then outlines studies concerned with population projections, living arrangements and the ethnic minority aged Later sections provide an overview of the changing characteristics of cohorts reaching later life and of avenues for further advancement of the field The paper nominates four priorities for future demographic research namely: (i) projections of the characteristics of the aged (ii) the ageing of ethnic minorities, (iii) the links between the life cycle experiences of different generations within families and (iv) the impact of socio‐economic status on life chances.
Issues in Geriatric Medicine
Authors: Flicker L. , Gray L.
Published: December 2008

In Australia there has been rapid growth in the number of geriatricians and the provision of aged care services. This has been accompanied by increasing sophisrication in the assessment and management of the common syndromes of old age: impaired cognition, incontinence, impaired mobility, impaired homeostasis and iatrogenic disease. Innovative systems of service delivery have been developed in diverse fields including dementia services and orthogeriatrics. Adequate planning and funding strategies are required to ensure that older people continue to have appropriate access to high quality services and that there is provision for education and research in ageing.
New Zealand Based Research in Gerontology
Authors: Campbell A.J.
Published: December 2008

From early years New Zealand has had a well developed system of social and medical support for elderly people. More recently, a broadly based network of research workers has developed and them has been an increased representation of those involved in gerontological research in academic institutions. The small size of New Zealand has meant that the number of research workers is small but this is compensated for by increased collaboration and strong links with the community and community groups and to those developing health policy. These strengths, coupled with a commitment to funding gerontological studies should ensure continued high quality research.
The Access Unit: Facilitating Entry to an Aged Care Program
Authors: Callaghan J.D. , Katz B.
Published: December 2008

Abstract. The Access Unit was established in 1995 to provide a single point of entry to programs provided by North West Hospital in Victoria. All telephone enquiries are now answered by health care professionals who are able to provide an immediate clinical response. Each referral is triaged to an appropriate service, whether provided by North West Hospital or elsewhere. The establishment of the Access Unit has not only improved clinical management, it has identified a number of deficiencies in the hospital's protocols which have now been addressed. Following the successful implementation of this model in the subacute sector, the Western Healthcare Network is investigating the feasibility of expanding it to the acute hospital sector.
Psychotropic Medication Use in a Sample of Frail, Elderly Inpatients in Sydney, Australia
Authors: McInnes Elizabeth , Mira Michael , Atkin Nicola , Kennedy Peter , Cullen John
Published: December 2008

Objective: To examine rates of use and predictors of psychotropic drug use among a group of frail, aged inpatients admitted under the care of a geriatrician. To examine correlates of psychotropic drug use at discharge with inpatient characteristics.

Method: The number of psychotropic medications taken were obtained from a medical records audit of 311 frail inpatients under the care of a geriatrician. Medication taken at the point of admission and at discharge, and rates of commencement and cessation of different psychotropic agents were measured.

Results: Patients discharged to a nursing home were more likely to be admitted and discharged on anti‐psychotics and anxiolytics/hypnotics. Subjects from an English‐speaking background were more likely to be prescribed anti‐depressants on discharge and there was a trend for females to be discharged on anxiolytic/hypnotic medication. Subjects discharged on anti‐psychotics were also more likely to have lower MMSE scores and higher average DRG cost weights. However, lower numbers of patients admitted from nursing homes and hostels were discharged on psychotropic medication. For those discharged home, the reverse was true.

Conclusion: The finding that fewer nursing home and hostel patients were discharged on such medication that admitted on it, suggests that careful review of psychotropics for frail aged inpatients admitted under the care of a geriatrician is practised.
The Lidcombe Hospital Memory (Cognitive Disorders) Clinic: Review of Clinical Experience
Authors: Chan Daniel , Eleazar Joel , Williams Sid , Arpadi Virginia , Ford Roger , Gibian Tom , Kirkby Christopher , McMaster Wendy
Published: December 2008

Objective: A retrospective review of clinical experience of the Memory (Cognitive Disorders) Clinic at Lidcombe Hospital.

Method: 100 available records of patients seen consecutively in the clinic were reviewed. The following information was extracted: demographics, clinical diagnosis, investigations and results. Follow‐up contact was made by phone where possible and the patients' status established in terms of mortality, domicile, dependency, use of basic community services and any significant deterioration in function.

Results: 11% of patients were found not to be suffering from dementia and most of these were suffering from potentially reversible conditions, particularly depression and delirium which could be detected clinically rather than on the basis of investigations.

Discussion: The clinic was felt to be useful in providing education and support to the families and others caring for those suffering from dementia, in providing a sound basis for case management of dementia sufferers, and in providing a focus for the development and dissemination of skills and knowledge among health professionals.