Haemodialysis in the Octogenarian: More Than a Decade of Experience from a Single UK Centre

Background. To assess factors affecting survival in an octogenarian cohort commencing haemodialysis (HD) and describe outcomes associated with prolonged survival. Materials and Methods. We retrospectively analysed 11 years of data (1 January 2000–31 December 2010) from patients aged ≥ 80 years starting HD at a teaching hospital in the United Kingdom. Data was collected on patient demographics, aetiology of renal failure, indication and duration of HD, access type at first dialysis, Charlson comorbidity index score, and cause of death. Results. Data from 139 eligible patients was included for analysis (85 male, 54 female (1.54 : 1)). The mean age was 83.6±2.8 years and 90% of this cohort were Caucasian. Thirty percent (42/139) of the cohort died within 90 days of starting dialysis. For those who survived >90 days the mean (median) duration of HD was 871.8 (805) days. Long-term survival was more common in females and those who first dialysed through an AVF. Conclusions. There is a significant early mortality risk in octogenarians commencing HD. For individuals who survive beyond the initial 90 days, the majority have a good long-term survival and our results are better than previously published UK data. Long-term survival was more common in female patients and those starting HD using an AVF.

How Do Nursing Students Perceive the Needs of Older Clients? Addressing a Knowledge Gap

Background. Many nurse educators understand that students need to embrace the challenges and rewards of working with older clients. Yet, they might wonder how they can help students to develop and what is the specialized knowledge necessary to care for older clients. Question. How do students perceive the nursing needs of older adults? Method. A qualitative descriptive study was undertaken. Data collection occurred through semistructured interviews (9 students) and one focus group (8 students) using a photoelicitation technique. The researchers used a descriptive approach to analyze the data. Findings. Six themes emerged from the data: ask the older client!; physiology rules; personal, not professional; who can validate?; hierarchy of needs; and help us learn. Conclusion. Participants relied upon previous patterns of learning, primarily experiential, and on the views of health care colleagues in clinical practice to make decisions about the health needs of older clients. Participants clearly recognized the need to and significance of understanding the health care requirements of older clients. Findings have implications for how the care of older clients is introduced into nursing education programs.

Cerebral Small Vessel Disease Clinical, Neuropsychological, and Radiological Phenotypes, Histopathological Correlates, and Described Genotypes: A Review

Introduction. Vascular cognitive impairment is a common yet preventable cause for dementia. It needs high degree of suspicion and appropriate designing of investigatory tools to confirm diagnosis, identify comorbidities, and ascertain the areas of impairment. Commonly DSM-IV criterion is applied for diagnosis and detailed clinical and neuropsychological examination for identifying the specific phenotype is used. Early diagnosis using the mandatory criteria will help in early initiation of disease modifying treatment strategies which can result in partial reversal of vascular changes and arrest of progression. Patients with young onset disease might require genetic characterization for designing more aggressive treatment. Discussion and Conclusion. Dementias as such carry poor course and prognosis resulting in severe Disability Adjusted Life Years (DALYs) for patients and caregivers. Therefore, it is mandatory to identify treatable and preventable causes so that man power loss can be reduced.

Gender Differences in the Association between Childhood Socioeconomic Status and Cognitive Function in Later Life

Objectives. This study was aimed to explore the gender differences in the association between childhood socioeconomic status (SES) and cognitive function in later life. Methods. Using a nationally representative sample from the Health and Retirement Study, 5,544 females and 3,863 males were analyzed separately. Growth curve models were used to examine memory status and change in memory from 1998 to 2010. Results. The results showed that SES disadvantage in childhood was associated with lower memory at baseline controlling for adult SES and other covariates. In addition, cumulated disadvantage in SES was associated with poor memory in both genders. Statistically, the impact of cumulative SES on memory function at baseline was significantly different by gender. Discussion. These findings suggest that childhood SES has long-term effects on cognitive function among both men and women, and cumulative SES from childhood to adulthood may be more important for men than women with respect to their memory performance.

Pupillographic Sleepiness Test and Polysomnography in Nondemented Patients with Ischemic White Matter Lesions

Background. Patients with ischemic white matter lesions (WML) frequently report nonrestorative sleep or daytime sleepiness. However, subjective estimations of sleep and sleepiness can differ considerably from objective measures. The pupillographic sleepiness test (PST) could identify patients with sleep disorders requiring polysomnography (PSG) and further treatment. Methods. We performed a PST and a PSG of 35 nondemented patients with WML, who reported nonrestorative sleep or daytime sleepiness, and assessed the diagnostic value of the pupillary unrest index (PUI). Sleep parameters were compared to normative data. Results. The mean PUI of WML patients was normal (5.89 mm/min) and comparable to PUIs of patients with other neurological disorders. All 9 of the 35 WML patients (25.7%) who had a PUI above normal also had clinically relevant sleep disorders (5: sleep apnea, 7: periodic leg movements, and 4: insomnia). Six patients with a normal PUI had mild to moderate primary insomnia. Conclusion. PST and PSG parameters were physiological in most patients with WML. Age-related changes and affective and neuropsychological disorders might account for their sleep-related complaints. An elevated PUI in patients with WML seems to indicate comorbid sleep disorders that require further diagnostic evaluation and treatment (sleep apnea, insomnia with periodic leg movements, but not primary insomnia).

Stereotypes of Aging: Their Effects on the Health of Older Adults

The purpose of this review is to present findings on the effects of stereotypes of aging on health outcomes related to older adults, such as physical and mental functioning (specifically) and overall well-being and perceived quality of life (more broadly). This review shows that both positive and negative stereotypes of aging can have enabling and constraining effects on the actions, performance, decisions, attitudes, and, consequently, holistic health of an older adult. This review further highlights a variety of limitations in stereotype research in aging contexts, including a lack of qualitative studies focusing on older adult perspectives and the fluctuating definition of what constitutes “good health” during older age.

Psychiatric Assessment and Screening for the Elderly in Primary Care: Design, Implementation, and Preliminary Results

Introduction. We describe the design and implementation of a psychiatric collaborative care model in a university-based geriatric primary care practice. Initial results of screening for anxiety and depression are reported. Methods and Materials. Screens for anxiety and depression were administered to practice patients. A mental health team, consisting of a psychiatrist, mental health nurse practitioner, and social worker, identified patients who on review of screening and chart data warranted evaluation or treatment. Referrals for mental health interventions were directed to members of the mental health team, primary care physicians at the practice, or community providers. Results. Subjects (N=1505) comprised 38.2% of the 3940 unique patients seen at the practice during the 4-year study period. 37.1% (N=555) screened positive for depression, 26.9% (N=405) for anxiety, and 322 (21.4%) screened positive for both. Any positive score was associated with age (P<0.033), female gender (P<0.006), and a nonsignificant trend toward living alone (P<0.095). 8.87% had suicidal thoughts. Conclusions. Screening captured the most affectively symptomatic patients, including those with suicidal ideation, for intervention. The partnering of mental health professionals and primary care physicians offers a workable model for addressing the scarcity of expertise in geriatric psychiatry.

Treating Urge Incontinence in Older Women: A Cost-Effective Investment in Quality-Adjusted Life-Years (QALY)

Objectives. To conduct cost-effectiveness analyses of urge incontinence treatments for older women. Methods. Decision-analytic models assessed three treatment pathways: (1) limited behavioral therapy (LBT); (2) full behavioral therapy (FBT) with biofeedback; and (3) drug (DRUG), with allowances for crossover options following initial treatments. Model inputs were gathered from published data. Cost data were based on third party payer reimbursement. Outcomes were measured as the number of incontinence episodes avoided and quality-adjusted life years gained (QALYs). Results. At baseline values costs per QALY gained ranged from US$3696 to $10609. LBT was the least costly with the lowest benefit. Switching from LBT to FBT, with the greatest gain, was $415 per additional QALY. DRUG was the most expensive option. Sensitivity analyses showed that only small changes in key inputs were required for DRUG to generate greater gains than FBT. Medication costs had to fall substantially for DRUG to be cost competitive. Conclusion. All treatment strategies provide QALYs gains at a bargain price, compared to the standard of US$50,000 per QALY gained. No single treatment strategy dominated under all conditions. Clinicians should offer multiple treatment options to older women with urge incontinence.

Community-Based Supports and Services for Older Adults: A Primer for Clinicians

Although 20% of adults 60 years and older receive community-based supports and services (CBSS), clinicians may have little more than a vague awareness of what is available and which services may benefit their patients. As health care shifts toward more creative and holistic models of care, there are opportunities for CBSS staff and primary care clinicians to collaborate toward the goal of maintaining patients’ health and enabling them to remain safely in the community. This primer reviews the half-century history of these organizations in the United States, describes the most commonly used services, and explains how to access them.

Effect of Mild and Severe Unilateral Knee Joint Pain on Gait in Elderly Females

Gait change in the elderly may be a strategy to maintain postural stability while walking. However, gait laterality is accompanied by back pain or an increased risk of a fall. This study aimed to examine group-related differences and gait laterality in elderly females with mild or severe unilateral knee pain. Seventy-five elderly females (66–87 years old) were included, which comprised the following groups: 47 with mild unilateral knee pain and 28 with severe unilateral knee pain. They completed a 12 m walk test with maximum effort. Stance time, swing time, and step length were selected as evaluation parameters. A two-way ANOVA (group × leg) was used for analysis. No significant differences were found in interaction or in either main factor of the group and leg. In conclusion, elderly females do not show group-related differences or gait laterality regardless of the degree (mild or severe) of unilateral knee pain.