A new perspective on how humans assess their surroundings; derivation of head orientation and its role in 'framing' the environment

Understanding the way humans inform themselves about their environment is pivotal in helping explain our susceptibility to stimuli and how this modulates behaviour and movement patterns. We present a new device, the Human Interfaced Personal Observation Platform (HIPOP), which is a head-mounted (typically on a hat) unit that logs magnetometry and accelerometry data at high rates and, following appropriate calibration, can be used to determine the heading and pitch of the wearer’s head. We used this device on participants visiting a botanical garden and noted that although head pitch ranged between −80° and 60°, 25% confidence limits were restricted to an arc of about 25° with a tendency for the head to be pitched down (mean head pitch ranged between −43° and 0°). Mean rates of change of head pitch varied between −0.00187°/0.1 s and 0.00187°/0.1 s, markedly slower than rates of change of head heading which varied between −0.3141°/0.1 s and 0.01263°/0.1 s although frequency distributions of both parameters showed them to be symmetrical and monomodal. Overall, there was considerable variation in both head pitch and head heading, which highlighted the role that head orientation might play in exposing people to certain features of the environment. Thus, when used in tandem with accurate position-determining systems, the HIPOP can be used to determine how the head is orientated relative to gravity and geographic North and in relation to geographic position, presenting data on how the environment is being ‘framed’ by people in relation to environmental content.

Constituent country inequalities in myocardial infarction incidence and case fatality in men and women in the United Kingdom, 1996-2005

BACKGROUND

Understanding myocardial infarction (MI) incidence and case fatality trends across the four UK constituent countries is of importance following devolution of the government of health-care services.

METHODS

Retrospective cohort study using a primary care database (5.19 million patients) examining trends in incidence of first MI and 30-day case fatality.

RESULTS

From 1996 to 2005, the incidence of MI decreased in all countries, but reductions were greater in England (men, -3.1%; women, -2.8%) and Wales (men, -3.3%; women, -4.6%) than in Scotland (men, -1.9%; women, -0.6%) and Northern Ireland (men no change, women, -0.8%) (average annual percentage change). Greater reductions in England and Wales than Scotland and Northern Ireland meant a widening of north-south difference in MI incidence over the study period. Downward trends in 30-day case fatality were found in each country but less regional variation was evident (England men, -12.0%, women, -11.0%; Wales men, -18.4%, women, -12.6%; Scotland men, -9.5%, women, -9.0%; Northern Ireland men, -8.6%, women, -13.0%).

CONCLUSION

From 1996 to 2005, downward trends in the incidence of first MI and 30-day case fatality were evident in each constituent country. Greater improvements in case fatality, compared with incidence, were found within each country.

Living arrangements and place of death of older people with cancer in England and Wales: a record linkage study

The main objectives of the study were to (1) see whether the household circumstances of people aged 50 years and over with cancer, and trends in these, differ from those of the rest of the population and (2) whether living arrangements and presence and health status of a primary coresident are associated with place of death among older people dying of cancer and those dying from other causes. The design included prospective record linkage study of people aged 50 years and over included in a 1% sample of the population of England and Wales (the Office for National Statistics Longitudinal Study). The main outcome measures comprised family and household type, and death at home. The household circumstances of older people with cancer were very similar to those of the rest of the population of the same age and both showed a large increase in living alone, and decrease in living with relatives, between 1981 and 1991. The primary coresident of cancer sufferers who did not live alone was in most cases a spouse, with much smaller proportions living with a child, sibling or other person. In all, 30% of spouse, and 23% of other, primary coresidents had a limiting long-term illness. Compared with people who lived alone in 1991, odds of a home death among those dying of cancer between 1991 and 1995 were highest for those who lived with a spouse who had no limiting long-term illness (odds ratio (OR) 2.52, 95% confidence interval (CI) 2.15–2.97) and raised for those living with a spouse with a long-term illness (OR 2.14, CI 1.79–2.56) and those living with someone else who was free of long-term illness (OR 2.13, CI 1.69–2.68). Higher socioeconomic status, both individual and area, was positively associated with increased chance of a home death, while older age reduced the chance of dying at home. The changing living arrangements of older people have important implications for planning and provision of care and treatment for cancer sufferers.

The living arrangements of elderly people

"In order to assess possible future trends in the living arrangements of elderly people and their implications, we need to understand the causes of...relatively recent changes. Analysts have variously stressed demographic trends, economic factors and behavioural or cultural shifts as major influences on changing household patterns. These arguments are reviewed [in this article]." Aspects considered include the availability of spouse and children, coresidence between elderly parents and children, cultural factors, income, and health and health care. The primary geographical focus is on the United Kingdom, with some additional information for the United States and selected other developed countries.

The socioeconomic status of older adults: how should we measure it in studies of health inequalities?

STUDY OBJECTIVE

To identify which of seven indicators of socioeconomic status used singly or combined with one other would be most useful in studies of health inequalities in the older population.

DESIGN

Secondary analysis of socioeconomic and health data in a two wave survey.

SETTING

Great Britain. Participants were interviewed at home by a trained interviewer.

PARTICIPANTS

Nationally representative sample of 3543 adults aged 55-69 interviewed in 1988/9, 2243 of whom were interviewed again in 1994.

METHODS

Desirable features of socioeconomic measurement systems for identifying health inequalities in older populations were identified with reference to the literature. Logistic regression was used to examine variations in self reported health by seven indicators of socioeconomic status. The pair of indicators with the greatest explanatory power was identified.

MAIN RESULTS

All indicators were significantly associated with differences in self reported health. The best pair of variables, according to criteria used, was educational qualification or social class paired with a deprivation indicator.

DISCUSSION

For a range of reasons the measurement of socioeconomic status is particularly challenging in older age groups. Extending our knowledge of which indicators work well in analyses and are relatively easy to collect should help both further study of health inequalities in the older population and appropriate planning.

Adult life experiences and health in early old age in Great Britain

In Britain and other developed countries older people comprise a large majority of all those reporting long term illness or disability. However, most studies of socio-demographic variations in health have focussed on those in younger age groups. Moreover approaches to the study of health variations are often fragmented. In this study we have adopted a life course approach to analyse differentials in health in early old age. The data comes from the Retirement and Retirement Plans Survey and follow-up, a two-wave study of persons aged 55-69 in 1988/9. As well as information on current circumstances, the data set includes occupational, marital, and fertility history information. At baseline a nationally representative sample of the population of Great Britain were interviewed at home by trained interviewers (n = 3543). The sample was followed up and in 1994, 2247 survivors were re-interviewed, a response rate of 70% (of survivors). The data were weighted to adjust for non-response bias. Two outcome measures were used: self rated health and presence or absence of disability assessed from a scale derived from detailed questions on thirteen domains of disability. The severity score used was that developed for the 1985/6 ONS Surveys of Disability. The findings indicate that health and disability status at baseline and at follow up were associated with socioeconomic and geographic variables, such as proportion of adult life spent unemployed and residence outside the Southeast of England; demographic factors, such as early age at marriage and high parity; and experience of adverse events, such as the death of a child and being dismissed from work. The results show that socio-economic, demographic, and geographical and life events' factors are all associated with health status in early old age and that integrated, rather than bifurcated, approaches to the study of health differentials are needed.

Proximity of adult children to their parents in Great Britain

Much of the authors' knowledge of kin interaction and exchange in Britain is partial, in that it is based on studies of co-resident groups and excludes consideration of kin "beyond the household". It is known that there have been large declines in intergenerational co-residence, raising fears that family bonds have weakened. It is also commonly assumed that family members are less likely to live in close proximity than in the past. In this paper the authors examine one important aspect of kin relationships--proximity of adult children to their parents--using nationally representative data from 1986, 1995, and 1999. The analyses presented focus on: differences between 1986, 1995, and 1999 in proximity of adults to their parents; sociodemographic characteristics associated with variations in proximity, and temporal differences in the pattern of these variations. The paper concludes with an assessment of some of the policy implications of the findings.

Socio-demographic differences in the onset and progression of disability in early old age: a longitudinal study

OBJECTIVES

to analyse socio-demographic differences in the onset and progression of disability.

DESIGN

analysis of a cohort of people aged 55-69 in 1988-9 and in 1994.

SUBJECTS

a representative sample of 3543 adults.

METHODS

we measured severity of disability at baseline and follow-up. We analysed variations in incidence and progression of disability by using logistic regression.

RESULTS

Baseline severity of disability was similar for men and women but varied by age group, social class, educational qualifications and housing tenure. At follow-up, 36% had worse disability, 12% better and 53% the same as at baseline. Increased severity of disability and new incidence of disability were associated with lower socioeconomic status, baseline self-rated health status, age and gender. High initial levels of disability were associated with improvement at follow-up.

CONCLUSION

disability can be dynamic, although deterioration is more usual than improvement. The reasons for the associations found between disability and socio-economic status are unclear.

Looking beyond the household: intergenerational perspectives on living kin and contacts with kin in Great Britain

In this article we present the first results from a special module on kin and contact with kin included in the Omnibus Survey earlier in 1999. Our results show that nearly everybody in contemporary Britain has a living parent or a living child, and many have both. Membership of three generational families is now common and quite large minorities of very old people aged 80 and over are members of families including four living generations. Half or more of those with a father, mother or (eldest) child alive see them at least once a week and exchanges of help between mothers and their own mothers are common. Half of those who have the relatives considered, live within half an hour's journey time of them, and half of the sample live within half an hour of the place where they spent most of their childhood. The results show that in contemporary Britain the vast majority has close relatives in different generations with whom they are in regular contact.

Migration and household change in the population aged 65 and over, 1971-1991

"This analysis uses the ONS [Office for National Statistics] Longitudinal Study, a record linkage study including individual-level data from three national Censuses (1971, 1981 and 1991) and linked vital registration data, to examine migration patterns among older people [in Great Britain]. The aims of this study are to examine regional differences in household composition, to look at changes in the relationship between household change and migration over time, and finally, to analyse the interrelationships between changes in household composition, health and migration in the 1981-91 period.... Despite...dramatic changes in the living arrangements of older people, results show that mobility among the elderly remained relatively stable between the 1971-81 and 1981-91 decades."

Trends in, and transitions to, institutional residence among older people in England and Wales, 1971-91

OBJECTIVES

To compare transitions from private households to institutions between 1971-81 and 1981-91 among elderly people and see whether (1) differentials in the risk of institutionalisation changed and (2) whether the risk was higher in the second period.

DESIGN

Cross sequential analysis of data from the Office of National Statistics longitudinal study, a record linkage study which included individual level data from three national censuses, (1971, 1981, and 1991) and linked vital registration data.

SUBJECTS

Altogether 26,400 people aged 65 and over in 1971-81 and 32,500 persons aged 65 and over in 1981-91. These samples represent 1% of the population of England and Wales.

RESULTS

In both periods models including age, housing tenure, and marital status or household/family type terms fitted the data reasonably well. The effect of age was stronger in the second decade, while that of marital status was reduced. The risk of transition to an institution was nearly 33-52% higher in the second decade after controlling for these factors.

CONCLUSIONS

During the 1980s the availability of state financed institutional care increased substantially; a growth which the 1990 NHS and Community Care Act was designed to reverse. Increased access to institutional care undoubtedly is one factor underlying the higher transition rate to institutions observed in 1981-91 than for the previous decade. During 1981-91, transitions to live with relatives also declined substantially. It is not clear whether this simply represents the continuation of a previous trend or whether the increased availability of institutional care led to some substitution for family care. Either interpretation has worrying implications for policy makers keen to promote care in the community.

Activities of daily living: changes in functional ability in three samples of elderly and very elderly people

OBJECTIVES

to investigate changes in functional ability and physical health, psychiatric morbidity, life satisfaction, service use and social support.

DESIGN

a structured interview survey of three samples of elderly people living at home at two points in time. The three samples comprised one census of people aged 85 and over [City (of London) and Hackney], and two random samples of people aged 65-84 (City and Hackney and Braintree). The follow-up interviews took place 2.5-3 years after the baseline interviews.

SETTING

City and Hackney (East London) and Braintree (Essex). Respondents were interviewed at home by one of 12 trained interviewers.

SUBJECTS

630 people aged 85+ at baseline (70% response rate) and 78% of survivors re-interviewed at follow-up; 464 people aged 65-84 in Hackney at baseline (67% response rate), and 83% of survivors re-interviewed; 276 people aged 65-84 in Braintree at baseline (82% response rate), and 78% of survivors re-interviewed.

MAIN OUTCOME MEASURES

scores on scales of functional ability, psychiatric morbidity, life satisfaction and social support, and items measuring number and type of health symptoms and services used.

CONCLUSIONS

decreasing levels of physical functioning were associated with poor mental health, trouble with feet and problems with muscles and joints. There were no associations with level of physical functioning and use of rehabilitative or general medical services, use of social worker or carer relief. Few respondents used preventive or rehabilitation services.

Elderly housebound: changes over time

This article, which completes the research discussed in recent articles in Nursing Standard (1, 2), describes the changes in the ability of very elderly frail people to go outdoors. The sample members were first interviewed in 1987 when they were aged 85 or over, and followed up in 1990. Cross-sectional analyses showed that the groups who could not get outside alone or at all in either 1987 or 1990 were more likely to be taking prescribed medication, had poorer functional ability, reported problems with eyesight and aches/pains/stiffness in muscles/joints, had poorer emotional well-being, spent most of their days 'just sitting', and wanted more help with activities of daily living. There were, however, no differences in their social network characteristics, or their use of services.

Functional ability of very elderly people

This article, which expands on the research discussed four weeks ago in Nursing Standard, describes the circumstances of very elderly people with different levels of functional ability, and how their ability's changed over a 2.5 year period. In particular, it focuses on the needs of those with poor functional ability, who were found to be more likely to have health problems, poorer emotional well-being, almost no friends in their social networks, and greater needs for help (or more help) from services such as chiropody. Few received services specific to rehabilitation and social support, although this group were more likely to receive a greater amount of help, in terms of instrumental aid, with tasks of daily living.

Elderly people's use of services: a survey

This article describes some of the findings of a longitudinal survey of three samples of older people living at home in East London and Mid Essex. It describes the service use and need for community services of the three samples at their baseline interviews, and then looks at how their patterns of use and need changed by the time of their follow-up interviews. It shows that older people are generally using services appropriately, but that there are still unmet needs. Service use was found to increase with age as health and functional ability declined. Further findings will be published shortly.

Changes in life satisfaction over a two and a half year period among very elderly people living in London

Research evidence concerning the contributions of social networks and support to the subjective wellbeing (i.e. life satisfaction) of older persons is not consistent. This paper reports the results of an investigation of the effects life satisfaction at baseline, social network type and health status, on life satisfaction at follow-up at two and a half years later among people ages 85+ living in the East end of London. The percentage of the total variation in overall life satisfaction which was explained by the model was 47%. Baseline life satisfaction score explained most of this (43%), and the remaining variation was explained largely by functional status and age. Previous analyses of baseline life satisfaction reported that health and functional status had accounted for most of the variation between groups, far more than social network and support variables.

Community care for the elderly 1976-84

The aging of the elderly population is of crucial importance as people who are over 80 make far greater use of health and social services than any other age group. Government guidelines on the provision of services, which are generally related to the whole population aged 65 and over, fail to take account of this change in the age structure of the elderly population and are no longer appropriate. Recent trends in the provision of domiciliary services, day care, specialist housing for the elderly, and residential care have been related to changes in the number of potential consumers. Ironically, despite the government's stated commitment to "community care," the chief growth area has been private institutional care. The number of day care places and sheltered housing units has also increased in real terms, but the provision of domiciliary services, such as home help and health visitor visits to the elderly, has either fallen behind or barely matched the increase in the number of very old people. If community care is to be made a reality and if the present inadequate levels of service are to be maintained, let alone improved, then additional resources, greater cooperation among agencies, and a more imaginative approach to the development and delivery of services are urgently needed.

60 years of suicide in England and Wales. A cohort study

In a cohort analysis of suicides recorded in England and Wales from 1921 to 1980, there was no discernible trend across the younger cohorts, but there was a fall in the suicide rates of successive older cohorts over this period. The impact of period events (eg, World War II and the detoxification of domestic gas) is demonstrated in these cohorts. In addition to the period effects, there was evidence of a more prolonged cohort effect on suicide rates of the middle-aged and elderly associated with these events. Little relationship was found between early and later suicide rates within cohorts, casting doubt on the usefulness of predicting the future rates of cohorts from their early behavior.

Migration and fertility behaviour in England and Wales: a record linkage study

Relationships between migration and fertility are examined, using data from the OPCS Longitudinal Study of England and Wales, including linked information from the 1971 and 1981 Censuses and birth registration data for the period 1971–80. The results showed that the proportion moving between the 1971 Census and the first subsequent birth was higher among tenants than owner occupiers, particularly for women in shared accommodation in 1971. The association between tenure and moving was more consistent than the relationship between moving and the husband's social class. Differences in the proportions moving between the censuses were positively associated with fertility in the same period particularly for women in potentially crowded accommodation in 1971. Moving in 1970–71 was not associated with differences in parity progression ratios 1971–81. There were, however, differences in the timing of births, suggesting that long distance migration was associated with a postponement of the first or second child, probably because both longer distance migration and fertility behaviour are associated with other characteristics such as education.

A controlled trial of antidepressant medication in elderly in-patients

A multi-centre controlled trial of amitriptyline, dothiepin and mianserin in the treatment of depressive illness was undertaken in psychiatric inpatients over the age of 65. Despite the co-operation of many of the leading practitioners in this field in Great Britain, it proved impossible to recruit sufficient patients for firm conclusions to be drawn. Forty-five patients were entered into the trial, 13 withdrew because of lack of improvement, 4 because of intercurrent physical illness, 3 because of adverse effects of trial medication and 2 because of lack of compliance. Only 11 of the 23 patients completing had a final score on the Hamilton Depression Rating Scale of 10 or less. No treatment showed a significant superiority over the others, nor was there any difference in tolerance.

Divorce, widowhood, remarriage and geographic mobility among women

Data from the 1971 Census records included in the OPCS Longitudinal Study were used to examine the relationship between geographic mobility and marriage termination and remarriage. Remarried women had high rates of mobility and there seemed to be a clear ‘excess’ of moves made around the time of remarriage, shortly after the end of the first marriage. There was a suggestion too of a peak in movements following widowhood but no indication of excess movement at the time of de jure divorce. The data were not adequate to allow examination of moves made at the the time of separation. Additional data from linked 1971–81 Census information showed that changes of marital status were strongly associated with changes of tenure. Other characteristics of divorced, widowed and remarried women were also examined to see how they might affect their patterns of geographic movement.

Institutionalization and the elderly: international comparisons

This paper is an exploratory attempt to examine international differences in the proportion of old people living in non-private households. The aim of the study was to provoke further discussion of the role which institutions play in the care of the elderly in various settings and to examine the effect of certain demographic and economic parameters on the proportion of elderly people in non-private households. Data were drawn from national censuses and indirect standardization was used to allow comparison of the probability of institutionalization in the countries considered. Considerable variation in standardized institutionalization ratios was found but this variation was not significantly associated with any of the demographic or economic variables considered.

A comparative study of bed usage by younger and older patients with depression

Recent follow-up studies of depression in old age have highlighted the high relapse rate in older patients compared with younger patients. The consequences for the provision of acute psychiatric beds for elderly patients has been investigated by comparing the usage of beds by younger and older patients with depression over a 4-year period. Overall, elderly depressed patients consumed one and a half times as many bed days as younger depressed patients and a quarter of all acute bed days available in the hospital were used by elderly depressed patients.

Demography and old age

Demography is of great importance for those involved in caring for the elderly or in planning services. In this paper, current and future variations in the proportions of elderly people around the world are reviewed. The determinants of age structure are considered, and aging and aged populations are defined and discussed. The consequences of population aging extend into every sphere of life; particular attention is paid to the health service and economic implications. Attitudes to population aging and some of the special characteristics of the elderly in the West today are also considered. The paper concludes with a discussion of probable future trends in both the developed and the less developed parts of the world.

Falling rate of provision of residential care for the elderly

The rapid increase in the number of very aged people has not been accompanied by appropriate expansion of local authority residential facilities. The rate of provision in 1976 was already acknowledged to be inadequate, but data are now presented to show that since then there has been an effective fall in the rate of provision of some 9000 places equivalent to, say, 180 old people's homes of 50 places each. The prospects for the future are even gloomier: public spending cuts and local authority priorities suggest a continuing fall in the rate of provision that can be expected to have a profound effect on the National Health Service, on the burden on families, and on the condition in which old people are obliged to remain "in the community" (where support services have likewise failed to keep pace with demographic change).

Raised enzyme markers of chronic inflammation in asymptomatic farmers' lung

Subclinical inflammatory activity may be one of the factors which influences the variable natural history of farmers' lung. Serum lysozyme (LYS) and angiotensin converting enzyme (ACE) have been measured in 52 farmers with a previous history of farmers' lung and in 51 healthy control farmers. The group with farmers' lung assessed during the winter, although having had no recent acute symptoms, had significantly higher levels of LYS and ACE compared to both healthy control farmers seen in winter and farmers' lung subjects seen in summer. There was a mild but significant negative correlation between LYS and farm size in the farmers' lung subjects assessed in winter. The results suggest that active inflammation may be present in subjects with farmers' lung in the absence of acute symptoms during the season when dust exposure occurs as the result of feeding cattle.

Value of measuring serum angiotensin I converting enzyme and serum lysozyme in the management of sarcoidosis

Serum angiotensin I converting enzyme (ACE) and lysozyme have been measured in 23 controls, 115 patients with sarcoidosis, and 64 with other chest diseases. Both enzymes were significantly raised in sarcoidosis. ACE was raised above the normal range in 21 of 72 (29%) patients with definite sarcoidosis and in 17 of 38 (45%) of those who were untreated and seen within one year of presentation. The rise discriminated usefully between those with stable and progressive disease (5% and 62% respectively). Lysozyme was raised in 50 of 72 (69%) patients with sarcoidosis but also in 11 of 54 (20%) patients with other chest diseases. Discrimination between stable and progressive disease was useful only if very high levels were considered. Five patients had serial measurements after treatment with oral steroids and showed a progressive fall in levals of both enzymes, but patients with other diseases also showed a significant fall within the normal range when so treated. Measurement of these enzymes may help in the management of some cases of sarcoidosis, but results require critical interpretation.