Person-centred prophylaxis for venous thromboembolism.

All medical admissions should receive risk assessment for the value of prophylaxis against venous thromboembolism. Unfortunately, for such patients the risk of thromboembolism is closely balanced with the risk of haemorrhage exaggerated by chemical prophylaxis. The recent NICE guideline continues to recommend comprehensive risk assessment, and to use prophylaxis where the risk of thromboembolism exceeds the risk of bleeding. The widely used Department of Health Risk Assessment Tool does not rank the risks of thromboembolism and bleeding, but NICE was unable to mandate another assessment tool fit for the purpose in the UK. Validated risk scores are used elsewhere, and could enable safer and better targeted prophylaxis, pending further research in the UK.

Trends in disability prevalence over 10 years in older people living in Gloucestershire.

INTRODUCTION: life expectancy in the UK appears to be growing faster than healthy life expectancy, which may imply that there are increasing years of disability. There are few sequential studies examining changes in disability amongst older people within a defined locality. METHODS: the population aged 75 and over of 10 general practices in Gloucestershire was surveyed using a validated postal questionnaire for disability called the Elderly At Risk Rating Scale. Surveys were carried out in 1998 and 2008. Age-adjusted disability prevalences were measured. Care home residents were under-represented in the 1998 survey, and missing data was supplied from a countywide census of care home residents in 2000. RESULTS: response rates of 81 and 74% were achieved. Reductions in disability prevalence were found for mobility, vision and self-care, but there was no significant change in a measure of self-rated health. Higher rates of independence were found in both genders and across the age range in 2008. The improvements suggested that the latter sample was equivalent to subjects being 3.8 years 'younger' than 10 years before and entering dependency on care 2.1 years later. DISCUSSION: the prevalence of disability affecting activities of daily living appears to have reduced over 10 years in older people in Gloucestershire. If generalisable, these results provide some optimism for current trends in ageing in England.

Housing and health care for older people.

There is an enormous impact of home conditions both on the health of an older person living with a long-term illness, and their ability to remain independent in the face of disability. Geriatricians are often called upon to give advice to older people with a new illness about where to live. It is important therefore that they should understand the relationship between housing and health, and how to signpost patients and their families to advice on housing options. Vulnerable older people are more likely to be living in non-decent homes, generally private rented or owner-occupied. A new UK government initiative, Lifetime Homes, Lifetime neighbourhoods, offers the prospect for improvements in Home Improvement Agencies, Lifetime Homes Standards, and Disabled Facilities Grants.

Care home medicine in the UK--in from the cold.

The quality of care within care homes comes under frequent media scrutiny, and is underpinned by the medical support to the staff. In the UK, medical care to care homes is provided by general practitioners. A GP is likely to have patients in many homes, and each home relates to many GPs. The growing complexity of patients in care requires proactive models of care delivered by those with an understanding of care home medicine. A range of innovative models of medical care are emerging across the UK which have the potential to improve the standard of care in homes, and reduce inappropriate use of secondary care admissions. These models are described, and the need for them to be subjected to evaluation.