Self-rated health in the unwell elderly presenting to the emergency department.

OBJECTIVE: Self-rated health (SRH) has been shown to be a reliable predictor of functional decline and mortality. These studies, however, have largely focused on well community-dwelling elderly. We assessed whether the predictive value of SRH would still be valid for the acutely unwell older person presenting to the ED. METHODS: The present study was a secondary analysis of data obtained from the Discharge of Elderly from Emergency Department (DEED II) study. The sample consisted of 741 older people sent home from an ED. On enrollment, patients were asked the SRH question, 'In general, would you say your health is excellent, very good, good, fair or poor?' Phone interviews were conducted at 3, 6, 12 and 18 months. Functional status was assessed using the Barthel index of activities of daily living (ADL), modified instrumental activities of daily living (IADL) and the Short Portable Mental Status Questionnaire (MSQ). RESULTS: An SRH of fair/poor produced a hazard ratio of 3.1 (95% confidence interval 1.3-7.2, P = 0.010) for predicting mortality after controlling for confounders. The rate of decline in ADL and IADL (but not MSQ) over time was also more pronounced for those with an SRH of fair/poor (P < 0.001 for both ADL and IADL). An SRH of fair/poor had a relative risk of 3.4 for predicting decline in ADL at 18 months (95% confidence interval 1.7-7.1, P = 0.001). The effects of SRH on IADL and MSQ were not statistically significant. CONCLUSIONS: The ability of SRH to predict functional decline and mortality persists for the acutely unwell elderly presenting to the ED. SRH is a simple and valuable tool to assess the elderly in the ED and to identify high-risk patients who would benefit from comprehensive geriatric assessment aimed at delaying such outcomes.

Comparison of the performance of 6- or 30-night extended wear schedules with silicone hydrogel lenses over 3 years.

AIM: To compare the clinical performance of silicone hydrogel lenses worn for 6- or 30-nights, with monthly replacement, for 3 years. METHODS: In this 3-year prospective clinical trial, 161 subjects were enrolled and 154 commenced extended wear. Clinical performance was assessed by comparing discontinuations and lens surface characteristics (front surface deposits, lens wettability, number of mucin balls), lens fitting performance (primary gaze movement, lens tightness), and physiologic parameters (limbal and bulbar redness, corneal and conjunctival staining, microcysts) and subjective parameters (ratings of comfort and vision) between groups. RESULTS: Eighty-eight subjects remained in the study after 36 months. There were no differences in the probability of subjects surviving in either group, and the major cause of lens-related discontinuation in both groups was contact lens-induced papillary conjunctivitis. There were no clinically important differences in performance between wear schedules. CONCLUSION: The long-term clinical performance of silicone hydrogels worn for 6- or 30-nights continuously was similar. Clinical markers of hypoxia were low in both groups, and the 6-night wear schedule was not superior to the 30-night wear schedule with regard to preventing lens spoilage, improving corneal physiology, or subjective symptoms of comfort and vision.

A survey of pediatric visual assessment by optometrists in New South Wales.

BACKGROUND: The importance of early vision care in the prevention and treatment of amblyopia is clear from an abundance of literature on visual development. Optometrists possess the necessary skills to detect and manage amblyogenic factors and thus have an important role to play in paediatric visual assessment and management. The present study investigates the role that optometrists in New South Wales are taking in paediatric vision care and the methods and strategies used in this role. METHODS: Questionnaires were sent to 400 optometrists practising in New South Wales; 179 completed questionnaires were returned. RESULTS AND DISCUSSION: Our findings reveal a number of associations between practice characteristics (such as location) and the management of paediatric patients. In general, practitioners in rural locations, in full-time practice or self-employed were more likely to treat patients and less likely to refer them elsewhere than those in city locations, in part-time practice or employed by others. In addition, our findings suggest the possibility of a changing pattern of collaboration between optometrists and ophthalmologists in the management of paediatric patients.