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Ageing Population (ageing + population)
Selected AbstractsGenetics of Type 2 diabetesDIABETIC MEDICINE, Issue 5 2005I. Barroso Abstract Type 2 diabetes (T2D) has become a health-care problem worldwide, with the rise in disease prevalence being all the more worrying as it not only affects the developed world but also developing nations with fewer resources to cope with yet another major disease burden. Furthermore, the problem is no longer restricted to the ageing population, as young adults and children are also being diagnosed with T2D. In recent years, there has been a surge in the number of genetic studies of T2D in attempts to identify some of the underlying risk factors. In this review, I highlight the main genes known to cause uncommon monogenic forms of diabetes (e.g. maturity-onset diabetes of the young,MODY,and insulin resistance syndromes), as well as describe some of the main approaches used to identify genes involved in the more common forms of T2D that result from the interaction between environmental risk factors and predisposing genotypes. Linkage and candidate gene studies have been highly successful in the identification of genes that cause the monogenic variants of diabetes and, although progress in the more common forms of T2D has been slow, a number of genes have now been reproducibly associated with T2D risk in multiple studies. These are discussed, as well as the main implications that the diabetes gene discoveries will have in diabetes treatment and prevention. [source] PENSION REFORM, POLITICAL PRESSURE AND PUBLIC CHOICE , THE CASE OF FRANCEECONOMIC AFFAIRS, Issue 4 2008Laura Thompson An ageing population and generous public sector pensions have put significant pressure on the funding of the French pension system making a reduction in the scope of state pension schemes imperative. Yet, as public-choice theory would predict, lobbying by interest groups has made reform difficult to achieve. [source] Immunosenescence: emerging challenges for an ageing populationIMMUNOLOGY, Issue 4 2007Danielle Aw Summary It is now becoming apparent that the immune system undergoes age-associated alterations, which accumulate to produce a progressive deterioration in the ability to respond to infections and to develop immunity after vaccination, both of which are associated with a higher mortality rate in the elderly. Immunosenescence, defined as the changes in the immune system associated with age, has been gathering interest in the scientific and health-care sectors alike. The rise in its recognition is both pertinent and timely given the increasing average age and the corresponding failure to increase healthy life expectancy. This review attempts to highlight the age-dependent defects in the innate and adaptive immune systems. While discussing the mechanisms that contribute to immunosenescence, with emphasis on the extrinsic factors, particular attention will be focused on thymic involution. Finally, we illuminate potential therapies that could be employed to help us live a longer, fuller and healthier life. [source] Intrinsic and extrinsic factors in skin ageing: a reviewINTERNATIONAL JOURNAL OF COSMETIC SCIENCE, Issue 2 2008M. A. Farage Synopsis As the proportion of the ageing population in industrialized countries continues to increase, the dermatological concerns of the aged grow in medical importance. Intrinsic structural changes occur as a natural consequence of ageing and are genetically determined. The rate of ageing is significantly different among different populations, as well as among different anatomical sites even within a single individual. The intrinsic rate of skin ageing in any individual can also be dramatically influenced by personal and environmental factors, particularly the amount of exposure to ultraviolet light. Photodamage, which considerably accelerates the visible ageing of skin, also greatly increases the risk of cutaneous neoplasms. As the population ages, dermatological focus must shift from ameliorating the cosmetic consequences of skin ageing to decreasing the genuine morbidity associated with problems of the ageing skin. A better understanding of both the intrinsic and extrinsic influences on the ageing of the skin, as well as distinguishing the retractable aspects of cutaneous ageing (primarily hormonal and lifestyle influences) from the irretractable (primarily intrinsic ageing), is crucial to this endeavour. Résumé Comme le pourcentage de la population vieillissante dans les pays industrialisés s'accroît, les préoccupations dermatologiques des personnes âgées augmentent en importance sur le plan médical. Les modifications structurelles intrinsèques sont une conséquence naturelle du vieillissement et sont génétiquement déterminées. La vitesse de vieillissement diffère significativement selon les différentes populations et selon les différents sites anatomiques, même pour un seul individu. La vitesse intrinsèque du vieillissement de la peau pour un individu peut être aussi très influencée par les facteurs personnels et environnementaux, en particulier le taux d'exposition à la lumière ultra-violette. La photodégradation qui accélère considérablement le vieillissement visible de la peau augmente également beaucoup le risque de formation de néoplasme cutané. Au fur et à mesure que la population vieillit, il faut davantage se préoccuper de diminuer la morbidité réelle associée au vieillissement de la peau, plutôt que de palier à ses conséquences cosmétiques. Il est donc crucial de s'efforcer à mieux comprendre les facteurs intrinsèques et extrinsèques qui agissent sur le vieillissement de la peau et aussi de faire la distinction entre les aspects réversibles du vieillissement cutané (facteurs essentiellement hormonaux et mode de vie) et les aspects irréversibles (principalement le vieillissement intrinsèque). [source] Perceptions of older people on disaster response and preparednessINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2010BSc(Hons)Nursing, Post Grad/Dip Nurse Education, Seana Duggan RN Duggan S., Deeny P., Spelman R. & Vitale C.T. (2010) Perceptions of older people on disaster response and preparedness. International Journal of Older People Nursing5, 71,76 doi: 10.1111/j.1748-3743.2009.00203.x Most disasters occur in developing countries but in the last decade due to the increasing threat of floods, air disasters and terrorist threat, disaster response and preparedness is a growing global concern. Due to an ageing population across the world, older people now constitute a significant proportion of those at risk from disasters. This paper reports on a qualitative study carried out in Sri Lanka and in the United States where a group of older people were asked about aspects of disaster response and preparedness. The group from Sri Lanka (n = 9) who had direct experience of the 2004 Indian Ocean Tsunami were asked how they perceived international aid relief and a group of white Caucasians from East Coast USA (n = 8) were asked about disaster preparedness. Findings indicate that both groups had similar issues albeit that they were looking at different phases of the disaster cycle and from different cultural perspectives. Both groups identified issues related to, protecting the rights of the older person and preventing loss of independence in responding and preparing for a disaster, mistrust of government and access to resources and all expressed strong feelings of self-responsibility. [source] Investing Public Pensions in the Stock Market: Implications for Risk Sharing, Capital Formation and Public Policy in the Developed and Developing WorldINTERNATIONAL REVIEW OF FINANCE, Issue 3 2001Deborah Lucas Concerns that existing public pension systems will be unable to pay benefits to a rapidly ageing population without sharp tax increases, and the prospect of higher average returns on stocks than on government securities, are drawing the attention of policy,makers worldwide to the option of investing public pension assets in stocks. Including stock market investments in public pension plans could improve risk sharing within and between generations, and could perhaps lead to faster market development in some countries. It could also result in excessive risk,taking, higher transactions costs and a false sense of increased financial security. This paper assesses these issues, with an emphasis on the considerations that are of special importance to developing markets. A contrast is drawn between the demographic outlook in East Asia and the major industrialized countries. Some lessons are drawn from the reform experience in Chile and elsewhere in Latin America. [source] The Russian Federation: Confronting the special challenges of ageing and social security policy in an era of demographic crisisINTERNATIONAL SOCIAL SECURITY REVIEW, Issue 3-4 2010Nicholas Eberstadt Abstract This article focuses on the Russian Federation's demographic crisis and the implications it holds for the ability of the Russian government (or the Russian people through their own efforts) to generate enough funds to provide a reasonable level of old-age economic security. Although Russia's overall population profile structure stands to be broadly similar to that of other more-developed societies, both today and in coming decades, the challenges of providing for an ageing population are far more acute for Russia than for typical Member States of the Organisation for Economic Co-operation and Development. One factor that adds significantly to the problem is that working-age Russians today suffer substantially worse health and higher mortality than residents of other countries at similar , and indeed even at much lower , levels of income. Although the arguments presented focus on pensions, the same factors that will make it difficult to supply adequate pensions also mean that other aspects of social protection will be similarly difficult to fulfil. Successful social security policy for Russia, consequently, will depend upon much more than social programmes alone: it will require the reduction of mortality rates for working-age individuals, the revitalization of higher education, and fundamental reform of the country's institutions and economic policies. [source] Living with chronic heart failure: a review of qualitative studies of older peopleJOURNAL OF ADVANCED NURSING, Issue 5 2008Doris S.F. Yu Abstract Title.,Living with chronic heart failure: a review of qualitative studies of older people Aim., This paper is a report of a systematic review of qualitative studies of how older people live with chronic heart failure. Background., Chronic heart failure is a global epidemic mainly affecting an ageing population. Understanding how older people live with this disease is important to help promote their adjustment to the distressing illness experience. Data sources., Eligible studies published in 1997,2007 were identified from several databases (Medline, CINAHL, PsycINFO and Sociological Abstracts). A manual search was conducted of bibliographies of the identified studies and relevant journals. Review methods., Two researchers independently reviewed the studies and extracted the data. Key concepts from the papers were compared for similarities and differences. The transactional model of stress was used to guide data synthesis. Findings., Fourteen qualitative studies were identified. Most described the illness experiences of older people with chronic heart failure and associated coping strategies. There was some emerging work exploring the adjustment process. The findings indicated that living with chronic heart failure was characterized by distressing symptoms, compromised physical functioning, feelings of powerlessness and hopelessness, and social and role dysfunction. There were gender differences in the way the disease was conceived. Adjustment required patients to make sense of the illness experience, accept the prognosis, and get on with living with the condition. Conclusion., Empowering older people to manage chronic heart failure, instilling hope and bolstering support system are means of promoting successful adjustment to the disease. Further research needs to explore the cultural differences in the adjustment process. [source] Reporting a research project on the potential of aged care nurse practitioners in the Australian Capital TerritoryJOURNAL OF CLINICAL NURSING, Issue 2 2009Paul Arbon Aim., This paper reports a project investigating the potential role of the nurse practitioner in aged care across residential, community and acute care venues in the Australian Capital Territory. Background., Australia, like many other countries, faces unprecedented challenges in the provision of health care. Escalating health care costs, an ageing population, increasing prevalence of comorbidities and chronic illnesses, inefficient health care delivery, changing models of health care and shifting professional role boundaries are factors that have contributed to the development of advanced practice roles for nursing. Design., This was a mixed methods study using multiple data sources. Methods., Student aged care nurse practitioners were examined across the continuum of care in the acute, community and residential aged care settings. The potential role of the nurse practitioner in these areas was evaluated qualitatively and quantitatively to identify a model of care to enhance the delivery of efficient and effective health care. Results., The project findings have demonstrated that there is potential for significant improvement in client outcomes arising from a transboundary aged care nurse practitioner model. The improved outcomes are associated with a decrease in acute hospital admissions for residential care clients, timely intervention for a range of common conditions and strengthened multidisciplinary approaches to care provision for older people. Conclusions., Overall the project findings strongly support the potential of a transboundary aged care nurse practitioner role. This role would focus on skilled assessment, timely assessment and intervention, brokering around access to care and clinical leadership and education for nurses. Relevance to clinical practice., This paper offers further evidence of support for the role of nurse practitioners in complementing existing health services and improving delivery of care. [source] Treatment recommendations in patients diagnosed with high-risk cutaneous squamous cell carcinomaJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 5 2005MJ Veness Summary Non-melanoma cutaneous cancers occur at an epidemic rate in Australia. With an ageing population, more Australians will develop these cancers and at an increasing rate. In the majority of cases local treatment is highly curative. However, a subset of the population will be diagnosed with a high-risk cutaneous squamous cell carcinoma. These can be defined as patients at risk of having subclinical metastases to regional lymph nodes based on unfavourable primary lesion features (including inadequately excised and recurrent lesions), patients with metastatic squamous cell carcinoma to regional lymph nodes, and squamous cell carcinoma in immunosuppressed patients. The mortality and morbidity associated with high-risk cutaneous squamous cell carcinoma is usually as a consequence of uncontrolled metastatic nodal disease and, to a lesser extent, distant metastases. Radiotherapy has an essential role in treating these patients and in many cases the addition of adjuvant radiotherapy may be life saving. It is therefore important that all clinicians treating skin cancers have an understanding and awareness of the optimal approach to these patients. The aim of this article is to present treatment recommendations based on an overview of the current published literature. [source] Attrition in nursing among Black and White nursesJOURNAL OF NURSING MANAGEMENT, Issue 3 2007STEVEN A. SMITH PhD Fundamental to dealing with the problems associated with attracting and retaining nurses during a tight labour market are issues centreing upon attrition from the field. In the United States, attrition has become such a significant issue that efforts to attract individuals to the field and recruit them to positions in the health care industry are not adequate to offset the flow of individuals from the field, much less bring in the additional nurses who are needed for an ageing population with increasing health care needs. As an example of the seriousness of the problem, it is probably safe to say that of the students who graduate from nursing schools each year and who enter the field of nursing, a significant number will no longer be practicing after 5 years in the profession. In a high attrition environment, even if many individuals were entering nursing, these losses will potentially offset any gains that are made. From the perspective of this study, it is important to know what is leading nurses to leave their careers. Do all nurses face the same challenges in the course of their careers, or is the pattern of turnover somewhat different for different groups of nurses or those in different stages of their careers? In this study, we consider what career differences may exist between the two major groups of nurses in the USA today , Black and White nurses , and ask whether there are differences between the two groups in terms of ,whether' and ,why' they may be leaving the field. Our primary purpose was to determine if differences in attrition exist between Black and White nurses, and if so, where in the career process are those differences most pronounced. Based on our analysis of data from the National Science Foundation, we do find significant differences in patterns of attrition for the two groups and we suggest what we believe may be their implications for policy. [source] Out-of-area placements in Scotland and people with learning disabilities: a preliminary population studyJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2008M. BROWN bsc (hons) msc pgce phd rgn rnld People with learning disabilities have a different pattern of disease from the general population and high health needs that are frequently unidentified and unmet. Many require responses from general and specialist health services. A picture is emerging of some people with learning disabilities, often with complex care needs, moving from their home area on what is being termed, out-of-area placements, to receive specialist care. However, within the learning disability population, limited research has been undertaken and the impact on health services is unknown. Data were collected from health and social care providers to identify people with learning disabilities moving in and out of services across Scotland. Further data about the consequences and impact of out-of-area placements were gathered in one geographical area using focus group methodology. The results suggest that people with learning disabilities are moving in, out and across Scotland, often as a result of breakdown of local care arrangements or because of lack of specialist resources. Planning, service development and effective communication need to be in place to address the needs of this increasing and ageing population. [source] Cartilage tissue engineering using resorbable scaffoldsJOURNAL OF TISSUE ENGINEERING AND REGENERATIVE MEDICINE, Issue 6 2007Nicole Rotter Abstract Cartilage tissue engineering holds considerable promise for orthopaedic and reconstructive head and neck surgery. With an increasingly ageing population, the number of patients affected by arthritis and recurrent joint pain is constantly growing, along with the associated socio-economic costs. In head and neck surgery reconstructive procedures gain increasing importance in multimodal tumour therapies. These procedures require the harvesting of large amounts of donor tissue, which causes significant donor site morbidity. Therefore, in vitro -engineered cartilage may provide for a cost-effective and clinically valuable medical need. This article presents an overview of the clinical background as well as considerations for engineered cartilage in the head and neck, and provides examples of cartilage tissue engineering based on various scaffolds. Copyright © 2007 John Wiley & Sons, Ltd. [source] Engineering tissues, organs and cellsJOURNAL OF TISSUE ENGINEERING AND REGENERATIVE MEDICINE, Issue 2 2007Anthony Atala Abstract Patients suffering from diseased and injured organs may be treated with transplanted organs; however, there is a severe shortage of donor organs that is worsening yearly, given the ageing population. In the field of regenerative medicine and tissue engineering, scientists apply the principles of cell transplantation, materials science and bioengineering to construct biological substitutes that will restore and maintain normal function in diseased and injured tissues. Therapeutic cloning, where the nucleus from a donor cell is transferred into an enucleated oocyte in order to extract pluripotent embryonic stem cells, offers a potentially limitless source of cells for tissue engineering applications. The stem cell field is also advancing rapidly, opening new options for therapy, including the use of amniotic and placental fetal stem cells. This review covers recent advances that have occurred in regenerative medicine and describes applications of these technologies using chemical compounds that may offer novel therapies for patients with end-stage organ failure. Copyright © 2007 John Wiley & Sons, Ltd. [source] Review article: medical management of the liver transplant recipient , a primer for non-transplant doctorsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2007A. SETHI Summary Background Survival 10 years after orthotopic liver transplantation now approaches 65%. Consequently, community doctors must manage the metabolic and neoplastic complications of orthotopic liver transplantation in an ageing population. Aims To review common sources of morbidity and mortality in long-term orthotopic liver transplantation recipients, and to make evidence-based recommendations regarding their management. Methods Pertinent studies and reviews were identified by literature search through PubMed. Where evidence-based recommendations could not be gleaned from the literature, expert opinion was obtained from syllabi of national meetings. Results The two most common causes of morbidity and mortality in orthotopic liver transplantation recipients are atherosclerotic vascular disease and de novo malignancy. The pathogenesis of many complications begins before orthotopic liver transplantation, and many are potentially modifiable. Most complications, however, can be directly ascribed to immunosuppressive agents. Despite improvements in our understanding of the pathogenesis and epidemiology of the metabolic and neoplastic complications of orthotopic liver transplantation, remarkably few randomized-controlled studies exist to define their optimal management. Conclusions Orthotopic liver transplantation recipients experience and succumb to the same afflictions of old age as non-transplant patients, but with greater frequency and at an earlier age. Most recommendations regarding surveillance for, and treatment of, medical complications of orthotopic liver transplantation remain based upon expert opinion rather than evidence-based medicine. [source] The impact of immigration on the increasing incidence of hepatocellular carcinoma in the United StatesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2004K. Kulkarni Summary Aims :,To assess if the rising incidence of hepatocellular carcinoma in the United States can be accounted for by immigration and an ageing population, or is a true increase among the USA-born residents. Methods :,Design, A retrospective chart review. Setting, Urban, multiethnic hospital and specialty clinics in a large indigent health system in Houston, Texas. Subjects, Approximately 23 000 admissions and 143 000 out-patient clinic visits each year from 1992 through 2001 were assessed. A total of 494 patient records were selected and reviewed because of suspicion of hepatocellular carcinoma. Analysis, Hepatocellular carcinoma was confirmed by histopathology, , -fetoprotein level >400 ng/mL, and suggestive imaging studies. The age-adjusted incidence was determined and causative factors were identified. Results :,About 111 cases of confirmed hepatocellular carcinoma were found. The age-adjusted incidence rose from 3.44 per 100 000 hospital admissions during 1992,1996 (95% confidence interval: 2.86,4.02) to 5.19 during 1997,2001 (95% confidence interval: 4.41,5.97). The proportion of patients of non-USA place of birth decreased between 1992,1996 and 1997,2001 (46,24%, respectively, P = 0.03). Fifty-two per cent and 68% were hepatitis C virus-positive respectively; 37% and 34% were hepatitis B surface antigen-positive respectively; 46% and 59% had a history of alcohol abuse; and 22% and 11% had no identifiable risk factors. Conclusions :,The incidence of hepatocellular carcinoma within the greater Houston area has increased during the past decade, rising by 51% from 1992,1996 to 1997,2001. This increase is not from immigration or population ageing but represents a true rise among the native born population. Hepatitis C and alcoholic cirrhosis are associated with a majority of cases, particularly in the latter half of the decade. [source] Enteric neurodegeneration in ageingNEUROGASTROENTEROLOGY & MOTILITY, Issue 4 2008M. Camilleri Abstract, The objective of this article is to review the clinical presentation and neurobiology of degeneration of the enteric nervous system with emphasis on human data where available. Constipation, incontinence and evacuation disorders are frequently encountered in the ageing population. Healthy lower gastrointestinal function is essential for successful ageing as it is critical to maintaining independence and autonomy to pursue further activity. One clinical expression of enteric neurodegeneration is constipation. However, the aetiology may be multifactorial as disturbances of epithelial, muscle or neural function may all result from neurodegeneration. There is evidence of loss of excitatory (e.g. cholinergic) enteric neurons and interstitial cells of Cajal, whereas inhibitory (including nitrergic) neurons appear unaffected. Understanding neurodegeneration in the enteric nervous system is key to developing treatments to reverse it. Neurotrophins have been shown to accelerate colonic transit and relieve constipation in the medium term; they are also implicated in maintenance programmes in adult enteric neurons through a role in antioxidant defence. However, their effects in ageing colon require further study. There is evidence that 5-HT2 and 5-HT4 mechanisms are involved in development, maintenance and survival of enteric neurons. Further research is needed to understand and potentially reverse enteric neurodegeneration. [source] Description of a return-to-work occupational therapy programme for stroke rehabilitation in SingaporeOCCUPATIONAL THERAPY INTERNATIONAL, Issue 2 2008Mei Leng Chan Abstract Stroke is the fourth leading cause of death and the major cause of disability in Singapore. The number of stroke survivors is expected to rise with the increase in the ageing population. This paper describes how occupational therapists are involved in stroke and work rehabilitation in Singapore. A retrospective study of stroke clients referred to a vocational assessment unit in 2004 showed that 55% of the clients were able to return to work. The majority of the clients changed their job positions from blue-collar workers to clerical workers. On the other hand, the main reasons for poor outcome were: unfit to work in general, needed further rehabilitation, further medical care was indicated, failed to meet appointments and withdrawal from the job trial. Three case vignettes are discussed to illustrate the multifactorial aspects influencing positive work outcomes. Further research is needed in exploring the factors that affect stroke rehabilitation and return-to-work outcomes. Copyright © 2008 John Wiley & Sons, Ltd. [source] Ageing in "Poor Household" or Ageing into Poverty?ASIAN SOCIAL WORK AND POLICY REVIEW, Issue 1 2010Tackling the Policy Dilemma of Redistribution The policy issue of how to target poor households rather than provide universal coverage takes the primary place in the question of redistribution where resources are limited. The Government of India's social protection programs, particularly the old age pension for the informal sector of the economy, has taken a targeting approach. In this article we show that there is a case for universal coverage since ageing households experience greater exclusion from market-based protection as well as from informal (household-based) protection. We make the argument for universal coverage on two grounds: first, a targeted approach has resulted in leakage, indicating that non-poor elderly individuals in the unorganized sector also require some sort of support. Though they are valid, we do not resort to traditional arguments against targeting, such as that it creates institutional lock-in mechanisms and stigmatizes the recipients. Second, the loss of income on age-related matters (e.g. hospitalization) or the ability of elderly individuals to gain credit is not particularly class-specific, although the targeting policy implies it is. The article is based on the secondary data source of the National Sample Survey, primary data sources, particularly those conducted by the authors in Kerala and Maharashtra and specifically designed for the ageing population, and ethnographic observations from fieldwork. [source] Ageing Society Issues in Korea,ASIAN SOCIAL WORK AND POLICY REVIEW, Issue 1 2009Sung-Jae Choi Korean society is facing unprecedentedly higher population ageing, particularly in the first half of the 21st century. The implications of population ageing have a much wider effect than the welfare of the elderly. From a broader and long-term perspective, understanding population ageing may require a new paradigm. Korea has attempted to model its policies for ageing society on those of advanced welfare states, but as these no longer seem viable, Korean policy-makers are searching for more effective and efficient measures to deal with its rapid ageing population. Reflecting a broader and long-term perspective, the Korean government recently produced a comprehensive national policy plan to deal with the consequences of rapid population ageing. This article outlines the phenomenon of population ageing in Korea and the recent development of national policies for population ageing, describing the Korean comprehensive national policy plan for responding to it and examining major issues and problems related to developing and implementing the plan. This article finally suggests a new, age-integrated social system approach to an ageing society. [source] Learning from Japanese Experience in Aged Care PolicyASIAN SOCIAL WORK AND POLICY REVIEW, Issue 1 2007Guat Tin Ng Like Singapore, Japan is projected to age rapidly. Japan is the first country in the world where more than 20% of the total population is over 65. Even as Japan adapts from western Europe and America where population ageing is more advanced up till now, it has been pioneering its own aged care policy, given the differences in sociocultural and political contexts. Of particular interest is its introduction of long-term care insurance and its effectiveness in meeting the needs of the long-term care of the aged and their family caregivers. In this article I seek to compare and contrast Singapore and Japan in terms of their demographic changes leading to rapid ageing, and their respective policy and program responses to a rapidly ageing population, drawing lessons from the Japanese experience. [source] Driving and dementia: a prospective audit of clients referred to an aged care assessment teamAUSTRALASIAN JOURNAL ON AGEING, Issue 4 2003Robert Bunt Objective: Many people with dementia or cognitive Impairment continue to drive. Given Australia's ageing population, this raises safety concerns for the driver in the community. This paper presents data collected by the NS W Central Coast Aged Care Assessment Team (ACAT), outlining the extent of the problem on the Central Coast and offers some suggestions about dealing with this issue. Method: A prospective audit of clients referred to Central Coast ACAT over a seven month period. Data describing the clients' cognitive state and also their driving habits were collected during routine ACAT assessments. Results: 1203 people were referred to ACAT during the study period. 100 (8%) of these were driving and 34% of those driving had some form of cognitive impairment. In some cases the impairment was quite severe. Most of these drivers were male. In a majority of the cases, concerns were expressed by someone familiar with the person, regarding their capacity to drive safely. Conclusion: The results support findings from other studies, which suggest there is a small but significant number of elderly people with cognitive impairment who are still driving. We propose that a safety first policy should be adopted and where there is doubt about the persons ability to drive safely, an Occupationul Therapy driving test in conjunction with a detailed cognitive assessment needs to be performed. [source] Animal models in urological disease and sexual dysfunctionBRITISH JOURNAL OF PHARMACOLOGY, Issue S2 2006Gordon McMurray There are several conditions associated with dysfunction of the lower urinary tract or which result in a reduction in the ability to engage in satisfactory sexual function and result in significant bother to sufferers, partners and/or carers. This review describes some of the animal models that may be used to discover safe and effective medicines with which to treat them. While alpha adrenoceptor antagonists and 5-alpha-reductase inhibitors deliver improvement in symptom relief in benign prostatic hyperplasia sufferers, the availability of efficacious and well-tolerated medicines to treat incontinence is less well served. Stress urinary incontinence (SUI) has no approved medical therapy in the United States and overactive bladder (OAB) therapy is limited to treatment with muscarinic antagonists (anti-muscarinics). SUI and OAB are characterised by high prevalence, a growing ageing population and a strong desire from sufferers and physicians for more effective treatment options. High patient numbers with low presentation rates characterizes sexual dysfunction in men and women. The introduction of ViagraÔ in 1998 for treating male erectile dysfunction and the success of the phosphodiesterase type 5 inhibitor class (PDE5 inhibitor) have indicated the willingness of sufferers to seek treatment when an effective alternative to injections and devices is available. The main value of preclinical models in discovering new medicines is to predict clinical outcomes. This translation can be established relatively easily in areas of medicine where there are a large number of drugs with different underlying pharmacological mechanisms in clinical usage. However, apart from, for example, the use of PDE5 inhibitors to treat male erectile dysfunction and the use of anti-muscarinics to treat OAB, this clinical information is limited. Therefore, current confidence in existing preclinical models is based on our understanding of the biochemical, physiological, pathophysiological and psychological mechanisms underlying the conditions in humans and how they are reflected in preclinical models. Confidence in both the models used and the pharmacological data generated is reinforced if different models of related aspects of the same disorder generate confirmatory data. However, these models will only be fully validated in retrospect once the pharmacological agents they have helped identify are tested in humans. British Journal of Pharmacology (2006) 147, S62,S79. doi:10.1038/sj.bjp.0706630 [source] Norwegian neurology: present status and future trendsACTA NEUROLOGICA SCANDINAVICA, Issue 2009A. Storstein Diseases of the nervous system constitute a major cause of morbidity and mortality. The chronic nature of many neurological diseases demands long-term follow-up and good communicative skills. Financial conditions and compensation is closely linked to modern health care and may limit the availability of new therapeutic options. An ageing population and modern lifestyle represent challenges for neurology in the future. The participation in public debate and strategic planning of health services are crucial to improve neurological services on a national and global level. Our focus should be the promotion of special needs of patients with neurological disease. [source] Giant cell arteritis: an updated reviewACTA OPHTHALMOLOGICA, Issue 1 2009Aki Kawasaki Abstract. Giant cell arteritis (GCA) is the most common primary vasculitis of adults. The incidence of this disease is practically nil in the population under the age of 50 years, then rises dramatically with each passing decade. The median age of onset of the disease is about 75 years. As the ageing population expands, it is increasingly important for ophthalmologists to be familiar with GCA and its various manifestations, ophthalmic and non-ophthalmic. A heightened awareness of this condition can avoid delays in diagnosis and treatment. It is well known that prompt initiation of steroids remains the most effective means for preventing potentially devastating ischaemic complications. This review summarizes the current concepts regarding the immunopathogenetic pathways that lead to arteritis and the major phenotypic subtypes of GCA with emphasis on large vessel vasculitis, novel modalities for disease detection and investigative trials using alternative, non-steroid therapies. [source] Management of metastatic carcinoma of the uveal tract: an evidence-based analysisCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 6 2007Gowri L Kanthan MBBS Abstract Uveal metastasis from carcinoma is the most common cause of ocular malignancy in adults and represents an increasing problem in the context of an ageing population and enhanced survival of stage IV cancer patients. The reported prevalence of clinically evident uveal metastases in carcinoma patients ranges from 2% to 9%, with breast and lung cancer together accounting for between 71% and 92% of cases. Most patients (66,97%) have a known history of cancer and, although the majority have metastatic lesions elsewhere, up to 33% may present with an isolated ocular metastasis. These lesions may progress rapidly and are potentially sight-threatening. Early diagnosis and appropriate timely treatment are therefore of paramount importance to maintain patients' quality of life. The diagnosis is usually clinical and detailed descriptions of symptomatology and physical characteristics are provided. In 21,50% of patients, involvement is bilateral. External beam radiotherapy (EBRT), chemotherapy, hormone and biological therapies, brachytherapy, transpupillary thermotherapy, laser photocoagulation/photodynamic therapy and enucleation are therapeutic modalities described in the literature for the management of uveal metastases. The strongest evidence favours timely EBRT for the management of sight-threatening uveal metastases. The published evidence supporting EBRT for sight-threatening uveal metastases was given a grade B (strong support for recommendation). Newer alternative therapies are emerging and may have a role in selected patients; however, there are unfortunately few large studies examining such treatments for carcinoma metastatic to the eye. The role of these modalities will be further clarified with the results of larger comparative trials. [source] HEREDITARY AND ENVIRONMENTAL INFLUENCES ON ARTERIAL FUNCTIONCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 7 2007CS Hayward SUMMARY 1With the ageing population and increasing heart failure, arterial function has been shown to contribute to cardiovascular risk because of its adverse effects on ventriculovascular coupling. Population studies have confirmed independent prognostic information of arterial stiffening on cardiovascular survival. 2The term ,arterial function' encompasses a range of phenotypes, including measures of arterial structure/remodelling, measures of arterial wall mechanics, surrogate measures of stiffness and of wave reflection. There exists significant interaction between these measures and none is truly independent of the others. Added to this complexity is the recognition that, although arterial function has a strong genetic component, quantification requires a range of techniques from twin to family and population studies. 3The contribution of heritability is often derived from statistical models with input from genomic scanning and candidate gene studies. Studies to date confirm a significant heritable component for the majority of phenotypes examined. However, it has also been recognized that the factors involved in blood pressure maintenance are likely to be separate to those in arterial structural degeneration with ageing. Candidate genes for arterial function go beyond those of the sympathetic and renin,angiotensin systems and include genes involved in signalling pathways and extracellular matrix modulation. 4The present review examines the evidence for heritability of the major arterial function phenotypes with environmental and ageing modulation. A brief overview of the impact of atherosclerotic risk factors on arterial function is included. [source] Covariance-based subdivision of the human striatum using T1-weighted MRIEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 6 2008Michael X Cohen Abstract The striatum plays a key role in many cognitive and emotional processes, and displays an intricate pattern of connectivity with cortical and subcortical structures. Invasive tracing work in rats and non-human primates demonstrates that the striatum can be segregated into subregions based on similar clustering of input and output fibers. In contrast, the human striatum is typically segregated according to local anatomical landmarks without considering natural boundaries formed by functional/anatomical networks. Here, we used non-invasive magnetic resonance (MR) imaging in young, healthy adults to define subregions of the human striatum based on volume correlations with other subcortical and cortical structures. We present three methods to delineate anatomical volumetric correlations based on gray matter content estimated from T1-weighted MR images. We observed both consistencies with and divergences from invasive tracing work in animals, suggesting that magnetic resonance imaging (MRI)-based covariance likely does not correspond to direct anatomical connections, although it might index other forms of connectivity or tissue type similarity. These novel approaches may be useful in understanding connectivity of other regions, and changes in connectivity in patient or ageing populations. [source] What is the perceived nature of parental care and support for young people with cystic fibrosis as they enter adult health services?HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2010Nicola Iles RN MSc Abstract The majority of those diagnosed with cystic fibrosis (CF) now live to adulthood. In response to increased survival age, transition services have been developed to ensure smooth transfer from paediatric to adult specialist healthcare, although the majority of treatment and care continues to be delivered in the home. However, little is known about how young adults and staff conceptualise the nature of the parental role after young people have left paediatric care. The aim of this study is to explore the nature of parental support that is perceived to be available at this time. As part of a larger study of transitional care, semi-structured interviews were conducted with 50 young people with CF aged 13,24 years (32 with experience of transition and/or adult CF services) and 23 specialist healthcare professionals (14 working in adult care) across two CF centres in Southeast England. Interviews took place in young people's homes or within CF services, using a topic guide and were recorded, transcribed and analysed thematically. Four domains of perceived parental support were identified by the young people interviewed, with varying degrees of continuity into adult care: (1) Providing non-clinical practical and emotional support; (2) Acting as ,troubleshooters' in times of health-related crisis; (3) Working in partnership with offspring in ongoing disease management in the home and clinic; (4) Acting as ,protectors' of their children. Young people and service staff expressed tensions in managing parental involvement in post-paediatric consultations and the degree to which parents should be aware of their offspring's deteriorating health and social concerns. Parental anxiety and over-involvement was perceived by many young people and staff as unsupportive. We suggest that although health and social care providers are mindful of the tensions that arise for those leaving paediatric services, the place of parental support in adult care is currently contentious for these ,new' ageing populations. [source] Population ageing and older workers: employers' perceptions, attitudes and policiesPOPULATION, SPACE AND PLACE (PREVIOUSLY:-INT JOURNAL OF POPULATION GEOGRAPHY), Issue 5 2006Wendy Loretto Abstract Increasing employment of older workers (those aged 50 and over) has been proposed as a strategy to cushion the impact of declining and ageing populations. Focusing on Scotland, this article considers the various measures that have been put forward to counteract population decline, and reviews public policy approaches aimed at increasing economic activity rates among older workers. It is argued that the attitudes and behaviours of employers are a crucial, but neglected, issue within the debates on employability of older workers. After reviewing existing research relating to employers' approaches towards older workers, we present findings from focus groups of employers conducted in four areas of Scotland in 2003. Our findings show that, whilst employers claimed to operate equal opportunities policies, they also showed partiality in favour of and against older workers. There was little evidence of strategic deployment of older workers, either currently, or in relation to forward planning. Instead a range of sectoral, structural and spatial factors influenced the heterogeneous approaches of employers towards older workers. We discuss the future employability of older workers in light of recent migration trends, and conclude by examining the wider relevance of our research for population ageing and decline. Copyright © 2006 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||||||||