The effect of inpatient respite care on elderly patients and their carers.

Fifty-eight carers and their dependents who received inpatient respite care were studied before and during the admission period. Although there was no observable improvement in the carers' emotional well-being the majority of the patients showed an improvement in functioning, particularly those who were being looked after by highly stressed carers. Many carers expressed a wish for more respite than they were currently offered, and some would have preferred a more flexible type of service.

Abuse of elderly people by their carers.

OBJECTIVE: To assess the prevalence of abuse of elderly people by their carers and the characteristics of abusers and the abused. DESIGN: Information on abuse and risk factors was collected over six months from carers and patients. Risk factors were identified in the abused group and compared with those in a non-abused control group. SETTING: Carers were interviewed at home; patients were examined in the wards of Putney and Barnes geriatric hospitals, London. SUBJECTS: All patients referred from any source for respite care to the geriatric services over a six month period and their carers. MAIN OUTCOME MEASURES: Amount of physical and verbal abuse or neglect. Quantification of risk factors and correlation with the presence or absence of abuse. RESULTS: 45% Of carers openly admitted to some form of abuse. Few patients admitted abuse. The most significant risk factor for physical abuse was alcohol consumption by the carer (p less than 0.001). Other significant risk factors were a poor pre-morbid relationship and previous abuse over many years. Abuse was often reciprocated and was associated with social dysfunction in many patients. Service delivery, respite care, and level of mental and physical disability were not significantly associated with abuse. CONCLUSION: The high level of abuse found in elderly patients in respite care was particularly associated with alcohol abuse and long term relationships of poor quality, which are difficult to change. Even with increased provision of services, care in the community may not be the best solution for these people.

Diagnosing dementia: do we get it right?

To find out whether the diagnosis of dementia agreed with findings at necropsy a detailed assessment of 27 elderly patients (mean age 82 (range 70-94] presenting with dementia was conducted at a combined department of geriatric medicine and psychiatry for the elderly. On the basis of the results the cause of the dementia was diagnosed clinically. Neuropathological examinations were performed after death. The clinical diagnosis made during life was not supported by the findings at necropsy in 11 cases. Alzheimer's disease was overdiagnosed in life (13 cases, of which only six were confirmed at necropsy). Although the clinical investigation was limited by availability of resources, neither cranial computed tomography nor the Hachinski score helped to distinguish between multi-infarct dementia and Alzheimer's disease in this age group. This study confirms the value of neuropathological studies in the precise diagnosis of dementia.

Is Nd-Yag laser treatment for upper gastrointestinal bleeds of benefit in a district general hospital?

104 consecutive patients with upper gastrointestinal bleeding admitted to a district general hospital over a period of 20 months were considered for laser photocoagulation. 58 patients were found to have peptic ulcers, of which 42 had stigmata of recent haemorrhage accessible to laser photocoagulation. 17 were treated with a Nd-YAG laser and 25 were managed conservatively. There was no significant difference in the number of patients who re-bled and required surgery, mortality rate, length of stay in hospital or the amount of blood transfusion required in either group. We suggest that the routine use of a laser for bleeding peptic ulcers in a district general hospital is not justified.