Alcohol consumption in a community sample of older people.

OBJECTIVE: To examine the prevalence and pattern of alcohol use among community-living elderly Australians. METHODS: A survey was conducted of randomly selected non-institutionalised people aged 75 years and older living in the inner western suburbs of Sydney. Personal interviews by trained interviewers covered background demographic information and self-reported alcohol use. RESULTS: 72% of men and 54% of women drank alcohol. The median usual daily volume of ethanol consumed by drinkers was 10 grams for men and 1.3 grams for women. However 11% of male drinkers and 6% of female drinkers consumed at defined hazardous or harmful levels. CONCLUSIONS AND IMPLICATIONS: Although a sizeable majority of these older people were either non-drinkers or very light drinkers, a small but important proportion drank in the hazardous to harmful range. Despite increasing evidence of the health benefits of alcohol consumption it remains important to be alert for potentially harmful alcohol use among older people.

Cerebral babesiosis in a new-born calf.

A case of intra-uterine transmission of Babesia bovis is reported. The calf was born normally but showed signs of intravascular haemolysis and nervous involvement 24 h after birth. It died shortly afterwards from cerebral babesiosis. The dam was not clinically affected.

A haemorrhagic syndrome in recently weaned pigs ascribed to hypovitaminosis K.

An outbreak of a haemorrhagic syndrome involved recently weaned, mixed-breed pigs in a large piggery. The pigs were fed a pelleted complete ration containing antibacterial drugs. Affected pigs failed to grow, became pale and developed large, subcutaneous haematomas. Some pigs became lame and one had epistaxis. The monthly mortality rate in the weaner house, which was previously less than 2%, exceeded 6% during the outbreak. Coagulation time, activated partial thromboplastin time and prothrombin time were prolonged in blood from some of the pigs. The outbreak resolved promptly after supplementation of the diet with vitamin K3.

Clinical diagnoses and disability of cognitively impaired older persons as predictors of stress in their carers.

BACKGROUND: Aspects of the caring relationship are often promoted as more important than the clinical features of the care recipient in predicting caregiver wellbeing. However, studies of consequences of caring for cognitively impaired people seldom include detailed measures of the diagnostic profile and disability of the care recipient. METHODS: Ninety community-living elderly persons with cognitive impairment were clinically assessed for severity on a range of illnesses. Their disability was examined via informant reports. Informants (88% of whom were primary carers) provided information on the behaviour and personality of the subject and reports of their own (informant) wellbeing. Using multiple regression, features of the subjects' clinical profile (severity of diseases, disability, behavioural problems and personality change) were examined as predictors of informant wellbeing. After controlling for subject clinical profile, we explored the additional associations between informant stress measures and other descriptors of the subject, caregiver and their relationship. RESULTS: The subjects' clinical characteristics, in particular disability and disturbed behaviour, were strong predictors of caregiver wellbeing, accounting for most of the explained variance. After control for the subjects' clinical profile, few of the sociodemographic, caregiver or relationship variables examined had any influence on caregiver outcome measures. The exceptions were caregiver time demands, older subject age and self-identification as primary carer. Coresidence was not associated with caregiver distress. CONCLUSION: Clinical characteristics of the care recipient are determinants of caregiver wellbeing, while socio-demographic, caregiver and relationship characteristics are less influential.

Performance of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening test for dementia.

A 26-item informant questionnaire (IQCODE) and the Mini-Mental State Examination (MMSE) were compared as screening tests for dementia in a sample of 69 patients. Dementia diagnoses were made by both a clinician and a research interview using a computer algorithm to meet DSM-III-R and ICD-10 (Draft) criteria. The IQCODE was found to perform at least as well as the MMSE against all diagnoses and significantly better when judged against the algorithmic ICD-10 diagnoses. Also, the IQCODE was found to be uncontaminated by pre-morbid ability as estimated from the National Adult Reading Test and to have very high test-retest reliability after a delay of a day or more.

The Psychogeriatric Assessment Scales: a multi-dimensional alternative to categorical diagnoses of dementia and depression in the elderly.

The Psychogeriatric Assessment Scales (PAS) provide an assessment of the clinical changes seen in dementia and depression. Principal components analysis and latent trait analysis were used to develop a set of scales to summarize these clinical changes. There are three scales derived from an interview with the subject (Cognitive Impairment, Depression, Stroke) and three from an interview with an informant (Cognitive Decline, Behaviour Change, Stroke). Results are reported on the reliability and validity of these scales using data from clinical samples in Sydney and Geneva and a population sample from Canberra. The scales were found to have excellent validity when judged against clinical diagnoses of dementia and depression and could distinguish Alzheimer's from vascular dementia. Cut-off points were developed to indicate correspondence between scale scores and clinical diagnoses. Percentile rank norms were developed from the Canberra population sample. The PAS is easy to administer and score and can be used by lay interviewers after training. It is intended for application both in research and in services for the elderly.

Neurodegenerative and other chronic disorders among people aged 75 years and over in the community.

OBJECTIVES: To assess age-related disease patterns in the older population in the community, especially the prevalence of neurodegenerative disorders and their association with systemic and vascular diseases. DESIGN: Cross-sectional, community-based study. SETTING: Area served by the Central Sydney Area Health Service, August 1991 to March 1994. SUBJECTS: 647 people aged 75 years or over, living in the community; 537 (83%) underwent medical assessment. OUTCOME MEASURES: Clinician diagnoses of chronic disease, including neurodegenerative disorders (cognitive and visual impairment, gait ataxia and slowing, dementia and Parkinson's disease); arteriopathy score; age-related trends; and correlations among diagnoses and arteriopathy score. RESULTS: Subjects had mean age of 81.0 years (range, 75-97). The most common diagnosis was arthritis (women, 73%; men, 68%), while the most common neurodegenerative diagnoses were gait ataxia (women, 57%; men, 42%), visual impairment (women, 40%; men, 45%) and cognitive impairment (women, 39%; men, 36%). Neurodegenerative diagnoses increased significantly in prevalence with increasing age, while most systemic diseases tended to decrease, although not significantly. Dementia was diagnosed in 92 subjects (17%), with Alzheimer's disease being the most common cause, but many having multiple causes. Significant correlations were found between neurodegenerative diagnoses and between the arteriopathy score and stroke, but not neurodegenerative diagnoses. CONCLUSIONS: The increase in comorbidities in the older population arises from an age-related increase in neurodegenerative disorders. These form a cluster suggesting a common aetiologic process which is not arteriopathic.

Impact of chronic systemic and neurological disorders on disability, depression and life satisfaction.

OBJECTIVE: To assess the effects of a range of chronic systemic and neurological disorders on three life quality indicators: disability, depressive symptoms and life satisfaction. METHODS: As part of the Sydney Older Persons Study, a community survey was carried out with 434 non-demented people aged 75 or over living in Sydney, Australia. Subjects were given a medical examination covering the following disorders: heart disease, chronic lung disease, bone and joint disease, stroke, visual loss, peripheral vascular disease, obesity, other systemic diseases, gait ataxia, gait slowing (including Parkinsonism) and cognitive impairement short of dementia. They were also assessed on a clinician-rated disability scale and given self-report depression and life satisfaction scales. RESULTS: Gait slowing affected all three indicators of life quality. Heart disease and chronic lung disease affected disability and depressive symptoms, but not life satisfaction. These associations were present when the effects of age, sex, education and all other disorders were controlled in multiple regression analyses. However, when disability was also controlled, none of the physical disorders predicted life satisfaction and only heart disease continued to predict depressive symptoms. CONCLUSION: Of the physical disorders considered in the study, gait slowing, heart disease and chronic lung disease had the greatest impact on life quality. These disorders affect depressive symptoms and life satisfaction largely because they increase disability.

The Canberra Interview for the Elderly: assessment of its validity in the diagnosis of dementia and depression.

The Canberra Interview for the Elderly (CIE) has been developed as a field instrument for identifying cases of dementia and depression, according to the diagnostic criteria in both draft ICD-10 and DSM-III-R. It has been designed to be administered by lay interviewers and responses are assembled algorithmically to derive diagnoses. The validity of the CIE was assessed using a sample of 75 elderly patients attending a hospital clinic. The CIE diagnoses were compared with clinical judgements made at the time of recruitment into the study and later by 3 clinicians using the information collected by the lay interviewers. Agreement between the CIE and the clinicians' diagnoses was as great as agreement between the clinicians themselves, meeting or exceeding agreement observed for comparable instruments designed for lay administration.