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BMJ No 7115 Volume 315 This week in brief Saturday 25 October 1997
Rehabilitation for stroke is as successful at home as in
hospital Rehabilitation for stroke is as successful at home as in hospitalMost patients with stroke are admitted to hospital, where most resources are concentrated. Shifting care to the community has been suggested as appropriate. On p 1039 Rudd et al report a randomised controlled trial of early discharge from hospital with community rehabilitation from a team of specialist therapists for patients with stroke. On measures of impairment, disability, handicap, and patient and carer satisfaction this early discharge seemed to be as good as conventional care. Length of stay was reduced by a mean of 6 days in the community therapy group. Inpatient beds are thus released, and an opportunity may exist to shift resources from hospital to community care for this common and expensive condition. In elderly people a simple tool predicts falls, and an exercise programme reduces risk of fallsTwo studies this week concern falls - the most common cause of injury among elderly people. On p 1049 Oliver et al report a tool to assess elderly patients' risk of falling. In a case-control study they identified five factors that were significantly associated with falls and used these factors to construct a risk assessment tool, which they validated in two elderly care units. It showed high sensitivity and specificity in predicting falls. The authors conclude that this simple tool could be used in hospitals to target prevention programmes at patients at high risk of falling. On p 1065 Campbell et al report the results of a randomised controlled trial aimed at reducing falls in older people. Women aged 80 years and older were given a personalised home exercise plan. The programme was safe and effective, resulting in a significant reduction in falls and injuries. The authors conclude that a home based programme prescribed from a general practice can be highly effective. Prevention of insulin resistance may reduce risk of Alzheimer's diseaseApolipoprotein E4 phenotype is a risk factor for late onset Alzheimer's disease, but other risk factors for the disease are not well documented. Kuusisto et al (p 1045) investigated the association between cardiovascular risk factors and Alzheimer's disease in a large population based study including 980 subjects aged 68-79 years. Features of the insulin resistance syndrome (abnormal glucose tolerance and high fasting insulin concentration) were associated with an increased risk of Alzheimer's disease independently of apolipoprotein E4 phenotype. Two thirds of the subjects with the disease had impaired glucose tolerance or diabetes, and non-diabetic subjects with high insulin concentrations and no apolipoprotein E4 phenotype had as high a risk of Alzheimer's disease as those with apolipoprotein E4 phenotype. The authors suggest that as the insulin resistance syndrome is partly preventable by lifestyle changes, the risk of Alzheimer's disease might be reducible by the same measures. Burden of illness from colds exceeds that of flu in elderly peopleWhereas the toll of epidemic flu is generally visible as increased consultation rates, admission to hospital, and excess deaths, the impact of other respiratory viruses is less clear. On p 1060 Nicholson et al report findings of a two year population based study of the nature and impact of acute upper respiratory tract infections among 533 elderly subjects. Infections caused by rhinoviruses, coronaviruses, flu, respiratory syncytial virus, and those of unknown aetiology occurred at a rate of 1.2 episodes a year. Lower respiratory illness complicated 65% of upper respiratory episodes, and more than half of subjects with lower airways symptoms consulted the family practitioner. Although flu and respiratory syncytial virus caused substantial individual illness, rhinoviruses caused the greatest burden overall. Mild cognitive impairment is linked to raised mortality riskSevere cognitive impairment is associated with increased mortality, but the impact of mild impairment on survival is unclear. Gussekloo et al (p 1053) studied the impact of borderline scores in the Dutch mini-mental state examination on survival among 891 subjects aged 85 and over. They found that the annual mortality risk was twice as high for subjects with mild cognitive impairment (borderline scores) as for subjects with normal cognitive function. The authors suggest that the mini-mental state examination could be used as a simple screening tool for mild impairment, and the scores may act an important predictor of survival in very elderly people. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline
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