Use of in-patient hospital beds by people living in residential care

BACKGROUND

There is concern that people living in residential care in Australia make significant and often inappropriate use of acute in-patient hospital services. To date, no factual information has been collected in Australia and its absence may allow myths and negative stereotypes to proliferate.

OBJECTIVE

To determine how and why people living in residential care in Australia use in-patient hospital beds. To determine the outcome of hospitalisation and functional status at 3 months following discharge.

METHODS

Prospective study of 184 consecutive admissions to hospital following Emergency Department (ED) attendance involving people aged over 65 years and living in residential care in southern Adelaide, South Australia. Information was obtained from the facilities' transfer letters, and where these were inadequate or absent, telephone interviews were held with residential care staff.

RESULTS

153 people accounted for the 184 admissions. They had a mean age of 84 years and 69% were female. 61% came from hostels and 35% from nursing homes. They had a wide range of clinical problems and twice as many were admitted to medical than to surgical units. Their mean length of hospital stay was 7.9 days, 2.3 days higher than for non-same-day patients and was higher for hostel than for nursing home residents. All but two admissions were considered unavoidable though the provision of specialised care within residential care could have prevented a further 19 (10%) admissions. 96% of admissions resulted in survival to leave hospital and in 74%, people returned directly to their place of origin. At 3 months follow-up, a further 20% of the group had died while 5% were in hospital. In all, 14% of the original group were in a different long-term care facility while 56% were living at their former residence.

CONCLUSIONS

People living in residential care are often hospitalised because of acute illness. In the vast majority of cases hospitalisation is both appropriate and unavoidable. Most did not require prolonged hospitalisation and were discharged alive, usually to their original residence. However, within 3 months many had died or had functionally declined. Strategies that prevent health breakdown in the residential care setting need to be developed and trialed.

Profile of people referred to an emergency department from residential care

BACKGROUND

Elderly people in residential care are among the most infirm in society and are at high risk of developing acute medical problems. There are no Australian data on the use of acute hospital emergency services by this group.

AIM

To determine patterns of use of a major public hospital's Emergency Department (ED) by elderly people living in residential care, their presenting problems and the outcome of attendance.

METHODS

Prospective study of 300 consecutive referrals to a teaching hospital's ED involving people aged over 65 years and living in residential care in southern Adelaide, South Australia. Case records were examined and residential care staff were interviewed by telephone when information required clarification. This occurred in 25% of referrals.

RESULTS

The 300 referrals were seen over a three month period and accounted for 2.43% of the 12,371 ED attendances during this period. During this time, at least 4.9% of people in residential care in the region were referred to the ED. The referrals involved 239 residents, 196 (82%) who were referred once only, 32 (13%) twice and 11 (5%) three or more times. Residents had a mean age of 84 years and 70% were female. A broad range of acute medical problems precipitated referral and 61% of people referred were immediately hospitalised. There was no general practitioner (GP) involvement in the management of the presenting illness in 58% of all referrals and in 45% of those where symptoms had been present for over three days.

CONCLUSIONS

People living in residential care are frequently referred to an ED service, often bypassing their GP in the process. They present with a wide range of acute medical problems for which most are hospitalised. Strategies that anticipate, prevent and manage health breakdown in residential care and so minimise the need for ED referral should be trialed.

Eating disorders and the cultural forces behind the drive for thinness: are African American women really protected?

Responding to mainstream ideals of female beauty, many women and girls view thinness as a requirement for feeling acceptable to themselves and to others. The drive to be thin can lead to problematic eating patterns, such as self-starvation, binge-eating, and purging, symptoms of the eating disorders, anorexia and bulimia nervosa. Most current literature on eating disorders and the drive for thinness focuses only on White middle-class women and girls. African American females have been largely excluded from studies, due to the assumption that the Black community's acceptance of women with fuller shapes protects its women from eating problems. However, recent studies are beginning to show that race, class, and exposure to a dominant culture which denigrates Black features and physiques impact body image among Black women and may play a role in the development of eating problems.

Immuno-electron microscopy reveals that the excitotoxin quinolinate is associated with the plasma membrane in human peripheral blood monocytes/macrophages

Quinolinate (QUIN), a tryptophan-derived excitotoxin, was localized ultrastructurally in human peripheral blood monocytes/macrophages (MO) by immuno-electron microscopy. A combined carbodiimide/glutaraldehyde/paraformaldehyde-based fixation procedure was developed for optimal retention of QUIN in the cell as well as minimal loss of ultrastructure; a silver-enhanced colloidal gold detection system was used for electron-microscopic analysis. Gold particles representing QUIN immunoreactivity were associated with the inner side of the plasma membrane in normal MO. The number of gold particles increased significantly when QUIN levels were elevated by treatment with its precursor kynurenine, but location of the gold particles remained essentially the same under this condition. Treatment with interferon-gamma increased the number of Golgi bodies, vacuoles and pseudopodia, reflecting the activated state of the cell. Significantly increased numbers of gold particles representing QUIN were detectable in approximately the same location as in the case of kynurenine treatment. Combined treatment with kynurenine and interferon-gamma maximally increased the number of gold particles at the periphery of the cell. The pseudopodia were intensely stained with gold particles, while they were not detectable in the inner part of the cytoplasm or in any other organelle even under this activated condition. The significance of the specific location of QUIN revealed in the present study and its relation to the release and subsequent actions of QUIN are discussed.

Collective bargaining in private industry, 1994

In sum, for the last 3 years, bargainers have negotiated wage and compensation increases that have been lower, on average, than those agreed to the last time the same parties met, despite an improving national economy. While negotiators may have been taking their cue from economic conditions specific to their company or industry, rather than from overall economic conditions, the modest changes in compensation under 1994 settlements were similar to the moderate changes in compensation prevailing the economy.

HIV agencies: can they evaluate their own services?

This paper describes the development and implementation of self-evaluation methods and guidelines in non-statutory HIV agencies that have been funded by Lothian Health. Two researchers developed this work under the aegis of the Lothian Health Centre for HIV/AIDS and Drug Studies (CHADS). It was implemented in eight agencies providing a diverse range of services. The methodology used included seminars, interviews, and self-evaluation report booklets, which the agencies completed. This process was not designed to be a full evaluation on its own, but rather used in conjunction with independent health board evaluation and monitoring systems. It proved to be an effective system and is currently being used with drug services who have already received an independent evaluation.

Source monitoring during name recognition in older adults: psychometric and electrophysiological correlates

The hypothesis that source monitoring in older adults is specifically related to frontal lobe function was tested. In a fame-judgment task, older adults' ability to monitor the source of name familiarity was independent of their short-term recognition ability. Source errors were not related to performance on the Wisconsin Card Sorting Test, a psychometric index of frontal function, or to the initial orienting response of the contingent negative variation (CNV), a frontally based electrophysiological measure, even though these "frontal" measures were reliably related to each other. Source error was predicted by the latter portion of the CNV, the expectancy response, and by the Benton Facial Recognition Test, a visuoperceptual task not typically linked to frontal function. These data suggest that the accuracy of source attribution in older adults depends on various attentional control processes, not all of which may be frontally based.

Urethral recess dilatation in a Charolais-cross bull calf

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Perimenstrual complaints in women complaining of PMS, menorrhagia, and dysmenorrhea: toward a dismantling of the premenstrual syndrome

Four groups of women were compared in terms of their perimenstrual symptoms, reported menstrual blood loss and period pain, and neuroticism scores: three patient groups were referred to a Gynaecology Outpatient Clinic because of menorrhagia (N = 101), PMS (N = 104), dysmenorrhea (N = 56), and a control group (N = 105). The three patient groups showed considerable overlap in a number of symptoms. This has led us to postulate three factors contributing to perimenstrual complaints: a) a 'timing factor' linked to the ovarian cycle; b) a 'menstruation factor,' associated with the buildup of the endometrium and its shedding; and c) a 'vulnerability factor,' one aspect of which, 'neuroticism,' was measured in this study. Depressive symptoms, which were the most important in leading women to seek help for their PMS, were related to all three factors. Depressive mood changes seemed to be linked to the 'timing factor' but were noticeably worse and more prolonged in women with high neuroticism, heavy bleeding, or severe pain. One premenstrual symptom, food craving, was of considerable interest. This was weakly related to neuroticism, not apparently affected by the 'menstruation factor' and differed in severity between those in the PMS group and the other three groups. It is potentially relevant that both carbohydrate craving and depression are linked to serotonergic changes in the brain, which may prove to be particularly marked in the late luteal phase.