Social determinants of older adults' awareness of community support services in Hamilton, Ontario.

Community support services (CSSs) have been developed in Canada and other Western nations to enable persons coping with health or social issues to continue to live in the community. This study addresses the extent to which awareness of CSSs is structured by the social determinants of health. In a telephone interview conducted in February-March 2006, 1152 community-dwelling older adults (response rate 12.4%) from Hamilton, Ontario, Canada were made to read a series of four vignettes and were asked whether they were able to identify a CSS they may turn to in that situation. Across the four vignettes, 40% of participants did name a CSS as a possible source of assistance. Logistic regression was used to determine factors related to awareness of CSSs. Respondents most likely to have awareness of CSS include the middle-aged and higher-income groups. Being knowledgeable about where to look for information about CSSs, having social support and being a member of a club or voluntary organisations are also significant predictors of awareness of CSSs. Study results suggest that efforts be made to improve the level of awareness and access to CSSs among older adults by targeting their social networks as well as their health and social care providers.

Where would you turn for help? Older adults' awareness of community support services.

Previous findings on older adults' awareness of community support services (CSSs) have been inconsistent and marred by acquiescence or over-claiming bias. To address this issue, this study used a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In telephone interviews, 1,152 adults aged 50 years and over were read a series of vignettes and asked if they were able to identify a community organization or agency that they may turn to in that situation. They were also asked about their most important sources of information about CSSs. The findings show that, using a vignette methodology, awareness of CSSs is much lower than previously thought. The most important sources of information about CSSs included information and referral sources, the telephone book, doctors' offices, and word of mouth.

Influence of social deprivation on intensive care outcome.

OBJECTIVE: To assess the influence of social deprivation on outcome from admission to the intensive care unit. DESIGN: Retrospective cohort study. SETTING: Tertiary referral centre mixed adult intensive care unit (ICU). PATIENTS: Seven hundred seventy-four consecutive admissions to the ICU over a 2-year period. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Age, admission illness severity measured by APACHE II score, predicted hospital mortality, actual hospital mortality and length of ICU stay were obtained for all patients. Social deprivation was assessed by Carstairs Score for postcode sector of residence categorised from 1 (most affluent ) to 7 (most deprived). Carstairs Scores were obtained for 716 patients. When patients in categories 6 and 7 were compared with the others there were no significant differences in age, admission illness severity, predicted or actual hospital mortality and length of ICU stay. On multivariate analysis there was no evidence of an increased mortality risk for patients in categories 6 and 7 (p = 0.256, odds ratio 1.2, 95% confidence interval 0.9-1.7). CONCLUSIONS: Social deprivation does not influence outcome in patients admitted to the ICU.

The Riyadh Intensive Care Program mortality prediction algorithm assessed in 617 intensive care patients in Glasgow.

The hospital mortality prediction algorithm from the Riyadh Intensive Care Program was assessed in 617 general intensive care unit patients and the results were compared with APACHE II admission scoring. Of the 119 patients predicted to die by the Riyadh Intensive Care Program, 24 (20.2%) recovered sufficiently to be discharged home. The overall false-positive rate was 5.2%, the false predictions mostly occurring in the trended component, the admission component having similar performance to admission APACHE II. For equivalent specificity the Riyadh Intensive Care Program was more sensitive than admission APACHE II risk of death figures, but the very high false-positive rate in those predicted to die precludes the algorithm's use in patient management decisions. In our view, the Riyadh Intensive Care Program does not justify the considerable extra work involved in data collection and processing over current admission scoring systems.

Moral principles in withdrawing advanced life support.

Decisions regarding withdrawal of life support are more frequently required as our technological capabilities increase. Doctors have to recognize that in certain cases maximal use of these capabilities may be incompatible with the patient's best interests. An ethical framework may help guide doctors through these dilemmas.