Why does regular relief care end?

In a retrospective survey, patients whose regular hospital relief care came to an end were found to be similar to those in whom it continued in their medical and social features, and in the frequency of admissions, although their rota care did not last so long. The most frequent factors in ending rota care were acute illness leading to death, increased disability, and refusal by carers, the last two of which were often associated. Alternative care, refusal by patients and illness of carers affected smaller numbers. Patients whose rota care ended had a high mortality (56%) and seldom needed long-stay care, though only a minority of deaths (4/28) occurred during or shortly after a relief admission.

Ambulatory electrocardiography in the elderly: an audit.

In a retrospective analysis of 264 episodes of ambulatory electrocardiography (AECG) in 252 elderly out-patients the overall diagnostic yield was only 12 per cent. However, AECG was found to be of significant value in detecting symptomatic tachyarrhythmias, and in confirming the diagnosis of the 'sick sinus syndrome'. The AECG results influenced the management plan in at least 16 per cent, and changes in drug treatment in 10 per cent. When interpreted critically, AECG is useful tool in the investigation of elderly patients with symptoms such as syncope, faintness, dizziness and unexplained falls.

First steps in building ACME--an admission case-mix system for the elderly.

In the United Kingdom, specialists in Geriatric Medicine usually have a major role in treating acute medical problems of elderly people, in addition to running rehabilitation services and continuing care. The proportion of the different types of patients varies widely from service to service, however, making it difficult for clinicians to compare their performance with that of colleagues. Existing casemix measurement systems are usually designed to deal with a more homogeneous patient group (e.g. rehabilitation, long-stay care) and/or are too detailed for day-to-day use. We describe our attempts to devise a simple casemix system which would be of practical day-to-day use for individual specialists in Geriatric Medicine. We have classified patients according to (1) the acuteness and potential for recovery of their presenting illness and (2) their functional status (based on simple measures of mobility and cognitive impairment). These factors have been incorporated into a three-point score, CMIX, which was capable of explaining 19.5% of the variability in duration of stay in a prospective study of 400 new admissions in two centres. In contrast, age and sex explained only 1% of variability in these patients. The pattern of patient outcome also differed significantly between the three CMIX categories. We also propose a simple graphical method of classifying outcome which should prove useful for audit purposes even when our casemix system is not employed.