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We aimed to study the impact of conservative non-pharmacological, non-surgical management on quality of life in elderly incontinent patients. Community-dwelling patients age 60 years or older were randomized to receive immediate or delayed conservative management. A number of questions relating to quality of life were administered at admission and then at 2, 4, 8 and 12 months. By 4 months, incontinence was cured in 25% and improved in 63% of patients. The frequency and severity of incontinence was reduced (p < 0.001), and deferment time was improved (p < 0.01). There were statistically significant improvements in subjective quality of life measures at 4 and 12 months involving depression (p < 0.001), isolation (p < 0.03), embarrassment (p < 0.001), laundry (p < 0.001) and smell (p < 0.02) when comparing these variables with initial assessment. This effect did not appear to be a placebo effect as evidenced by comparison with the delayed intervention group, and was sustained over 12 months. There are significant short- and long-term benefits to the quality of life of older patients with incontinence when treated by conservative measures. Intervention studies should measure and report quality of life as an outcome variable.

We sought to ascertain whether patients with Parkinson's disease without symptoms of dysphagia have abnormalities of swallowing, and to describe the characteristics as seen on clinical examination and videofluoroscopy. Patients with stable Parkinson's disease were interviewed for symptoms of dysphagia and 16 asymptomatic patients were enrolled. Whilst on their usual medication, an examination of facial, tongue and palatopharyngeal musculature was made, and a modified barium swallow performed. All patients had at least one abnormality on videofluoroscopic examination of their swallowing. Three patients showed aspiration and 14 had evidence of vallecular residue considered a risk for aspiration. Oropharyngeal transit time was invariably prolonged as was delay in the initiation of swallow. The majority of patients also demonstrated an increased number of tongue elevations and number of swallows to clear their pharynx of the bolus. Despite having no symptoms of dysphagia, the patients demonstrated widespread abnormalities of swallowing.

There are various circumstances where the traditional face to face setting for multidisciplinary meetings is not practical or possible. This includes departments which have a responsibility covering a large geographic region. This paper describes an inexpensive, cost-effective and novel way of conducting multidisciplinary meetings using the telephone conference facility. Team members based in the community are 'linked' by telephone to other members of the hospital-based Aged and Extended Care Department. These conferences led to a significant increase in the referral rate of community-based patients for fuller multidisciplinary geriatric assessment. It also provided a forum for education, exchange of ideas and development of new policy. Other uses for telelinking are highlighted, particularly its successful applications for linking together isolated and handicapped elderly people in the community.