Improving End-of-Life Care and Advance Care Planning for Frail Older Adults in Canad.

We present five Key Concepts that describe priorities for improving end-of-life care for frail older adults in Canada, and recommendations based on each Key Concept. Key Concept #1: Our end-of-life care system is focused on cancer, not frailty. Key Concept #2: We need better strategies to systematically identify frail older adults who would benefit from a palliative approach. Key Concept #3: The majority of palliative and end-of-life care will be, and should be, provided by clinicians who are not palliative care specialists. Key Concept #4: Organizational change and innovative funding models could deliver far better end-of-life care to frail individuals for less than we are currently spending. Key Concept #5: Improving the quality and quantity of advance care planning for frail older adults could reduce unwanted intensive care and costs at the end of life, and improve the experience for individuals and family members alike.

Allopurinol and oxypurinol are hydroxyl radical scavengers.

Allopurinol is a scavenger of the highly reactive hydroxyl radical (k2 approx. 10(9) M-1 X s-1). One product of attack of hydroxyl radical upon allopurinol is oxypurinol, which is a major metabolite of allopurinol. Oxypurinol is a better hydroxyl radical scavenger than is allopurinol (k2 approx. 4 X 10(9) M-1 X s-1) and it also reacts with the myeloperoxidase-derived oxidant hypochlorous acid. Hence the protective actions of allopurinol against reperfusion damage after hypoxia need not be entirely due to xanthine oxidase inhibition.

Leptospiral and brucellar titers in frozen bovine sera after 20 years of storage.

Generally good agreement was obtained between the rankings of sera titers when originally tested (T1), and those of the same sera 20 years later (T2). At the later time, the majority of samples (88%) were in, or within 1 dilution factor of their classification at T1. Test results for Brucella abortus and Leptospira interrogans var pomona antibodies demonstrated that original titers, in the upper-lower limits of 20 to 50, had decreased over a wide range (20% to 90%), and the later tests show that the greater the original titer, the greater the proportional decrease. Thus, titers of 20,000 at T1 had decreased by 49% to 99% and those of 200,000, by 95% to 99.8%. Variations in T2 test results were noted between some samples which had given identical results at T1. A decrease in titer over time has been demonstrated. An estimate of the expected half-lives of sera of differing initial Leptospira antibody titers is that for each unit increase in log10 of the initial titer, the half-life is reduced by about 50%. The heterogeneity of the immune response is postulated as the reason for this variation.

Theileria taurotragi in Zambia.

Theileria sp. (Bwengwa) of low virulence was isolated by feeding R. appendiculatus ticks collected from the field on a susceptible calf and subsequently transmitted between cattle by R. appendiculatus ticks- Theileria sp. (Bwengwa) was shown to be T. taurotragi on parasitological, clinical and serological grounds. T. taurotragi is the fourth Theileria sp. shown to be present in Zambia.

Continuing presence of rinderpest virus as a threat in East Africa, 1983-1985.

The re-emergence of rinderpest virus in East Africa in 1979 caused widespread outbreaks of disease and subclinical infection throughout the region until mid-1983. Subsequent massive emergency vaccination campaigns have been successful in eliminating clinical rinderpest from Tanzania and preventing its spread southwards. Unfortunately the virus is still endemic in north-eastern Uganda and has recently caused epidemic outbreaks with high mortality in cattle in that country. In Kenya, buffaloes (Syncerus caffer) in and around the Masai Mara game reserve have developed antibodies to rinderpest virus as recently as late 1984. Although there have been no outbreaks of clinical disease in Tanzania or Kenya from April 1983 to the end of 1985 this serological evidence plus the increasing incidence of clinical outbreaks in Uganda indicate that rinderpest virus still threatens East Africa. The substantial aid which has been provided to the region for rinderpest control must be maintained.

Feasibility of Using Information Derived from a Care Partner to Develop a Frailty Index Based on Comprehensive Geriatric Assessment.

BACKGROUND: Frailty is a state of increasing vulnerability that places an individual at high risk for adverse health outcomes. The best approach for frailty measurement in clinical practice has not been resolved. Frailty can be measured by deficit accumulation and be derived from a comprehensive geriatric assessment (CGA). In busy clinical practice, it may not be feasible to gather this information entirely from patients, particularly from those with cognitive decline. OBJECTIVE: We describe the feasibility of a frailty index based upon a care partner derived CGA (CP-CGA). In addition, we sought to establish the acceptability of the questionnaire and explore whether care partners felt that the provided information contribute to patient assessment. DESIGN AND SETTING: A cross-sectional data analysis of 99 community dwelling older adults attending geriatric ambulatory care clinics at a single tertiary care center. MEASUREMENTS: Care partners completed the CP-CGA and a Clinical Frailty Scale (CFS; Range 1 -Very fit- to 9 -Terminally ill). We evaluated the time to complete and item completeness. RESULTS: The mean age of patients was 81.3±5.7 years. Most were women (n=54), widowed, lived in their own home, with a median CFS of 5 (Mildly Frail). The care partner respondent was usually an offspring. Item completeness was 95% with a mean time to complete of 15.5±8.6 minutes. CONCLUSION: The CP-CGA seems feasible for gathering information that would be integral towards determining frailty by deficit accumulation. Future inquiries will evaluate its feasibility in other settings and validity as a form of frailty assessment.

Frailty and its quantitative clinical evaluation.

Frailty is a progressive physiological decline in multiple organ systems marked by loss of function, loss of physiological reserve and increased vulnerability to disease and death. Frail older adults are vulnerable to poor health outcomes including an increased risk of disability, social isolation and institutionalisation. With the advances in understanding of the physiological underpinnings and clinical measurement of frailty over the past decade, opportunities both to streamline and quantify the clinical measurement and care planning associated with frailty have emerged. Such tools allow clinicians to recognise and quantify frailty in order to understand a patient's vulnerability to poor health outcomes in a way that chronological age does not provide. Clinical research into outcomes associated with frailty in specific settings is ongoing and will be instrumental to the provision of appropriate care of older adults in the future.

Serological study of the incidence and prevalence of antibodies to bovine leukemia virus in aged sera.

Ninety-seven sera collected from 21 animals that had been repeatedly sampled more than 17 years before and stored at -18 degrees C were tested for bovine leukemia virus antibodies using the agar gel immunodiffusion test. The prevalences for the different ages matched current prevalences in the same herd. The consistency of these results over a prolonged period suggests the validity of long-term retrospective seroepidemiological studies of this disease. Because the original titers could not be determined and some indications of a possible loss of activity, the results must be interpreted with a measure of caution.

Prevalence of trypanosomiasis in cattle in south-west Zambia.

A trypanosomiasis survey was conducted in South-West Zambia. From a total of 3,346 cattle sampled 342 cattle showed a positive trypanosomiasis parasitaemia. During the survey trypanosome species and PCV values were also recorded. With simple statistical analysis populations with higher and lower prevalence rates were differentiated. The results indicated that the Kwando River Basin Tsetse Fly Belt and the Kafue River Basin Tsetse Fly Belt infested a larger area than originally assumed and that a link-up between both belts occurred or will occur in the near future.

Epidemiology of bovine babesiosis and anaplasmosis in Zambia.

The serological prevalence of bovine babesiosis and anaplasmosis in the traditional farming sector of six provinces of Zambia was determined using the indirect fluorescent antibody test (IFAT) for babesiosis and the card agglutination test (CAT) for anaplasmosis. Antibodies to Babesia bigemina occurred throughout the country whereas the prevalence of B. bovis followed the distribution of its tick vector Boophilus microplus which is limited to the north-eastern part of the country. Low numbers of B. bovis serologically positive cattle were demonstrated in central and southern Province. Anaplasma spp. occurred throughout Zambia but the overall percentages of positive sera were low ranging between 14.7% and 38.6% using the CAT. Two hundred sera were retested for anaplasmosis using an enzyme-linked immunosorbent assay (ELISA). Sero-prevalence rates were 1.5 to 2.3-fold greater with the ELISA than with the card agglutination test.