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Our ageing population creates challenges for palliative care, including accuracy of prognostication. This study highlights this by profiling the outcomes of an Australian, community-based palliative service over 6 months with collection of epidemiological, comorbidity and physical function data. Most patients had cancer, comorbidities and died during the study. Low scores on the Australian-modified Karnofsky Performance Scale and the presence of congestive cardiac failure were predictive of shorter survival. [ABSTRACT FROM AUTHOR]

Objectives: To determine fall risk factors in nursing home and intermediate-care residents who can and cannot stand unaided., Design: Prospective cohort study., Setting: Residential elderly care facilities in Sydney, Australia., Participants: One thousand people aged 65 to 103 (mean age +/- standard deviation: 85.0 +/- 7.4)., Measurements: Accidental falls., Results: Fall rates were highest in those with fair standing balance, intermediate in those with the best standing balance, and lowest in those with the worst standing balance. This nonlinear pattern was even more striking when subjects were categorized according to their standing balance and ability to rise from a chair. Using this dual classification, fall rates were highest in those who could rise from a chair but could not stand unaided (81%) and lowest in those who could neither rise from a chair nor stand unaided (48%). In residents who could stand unaided, risk factors included increased age, male sex, higher care classifications, incontinence, psychoactive medication use, previous falls, and slow reaction times. In contrast, quite different risk factors were evident in residents who could not stand unaided, with a number of known fall risk factors (previous stroke, reduced ability to rise from a chair, slow reaction times) being associated with fewer falls. In this group, risk factors were intermediate versus nursing home care, poor health status, psychoactive medication use, Parkinson's disease, previous falls, and being able to get out of a chair., Conclusion: The findings indicate that there are different risk factors for falls for people living in residential aged care facilities who can and cannot stand unaided. These findings provide important information for developing fall-prevention strategies and suggest that those who can stand unaided but have multiple falls risk factors constitute the highest priority group for such interventions.

Objective: Most studies of falls among older people have focused on those with some degree of balance or mobility impairment. This study aimed to establish whether falls and associated injuries were a major problem among healthy, older women, whether there were some common features in the falls, and whether these falls could be accurately predicted., Method: Ninety-six healthy, active community-dwelling women in Melbourne, Australia, aged at least 70 years (mean 74.1 +/- 4.0) were initially measured on a comprehensive series of laboratory and clinical balance tests, gait, strength and psychometric measures. Subjects were monitored for falls events, circumstances and consequences by use of falls diaries and monthly phone calls. Baseline measures of clinical balance measures and gait were comparable to other studies reporting scores on these measures in samples of healthy older people., Results: During the 12-month follow-up period, 49% of subjects fell, with 23% falling more than once; 9% suffered fractures as a result of their fall and 10% suffered strains or other moderate injuries. Many of the falls occurred during non-threatening activities such as walking, often under altered sensory or environmental conditions. Multivariate logistic regression identified gait symmetry and gait double support duration as the variables most strongly associated with prediction of multiple fallers., Conclusions: The results highlight that falls are a major problem among healthy active older women, and that targeted falls prevention programs are required for this group.

Objectives: To determine the prevalence and determinants of disability among elderly people living in the community., Design: A cross-sectional postal questionnaire survey., Setting: Northern Sydney Area Health Service., Participants: 1527 residents (622 men and 905 women) aged 65 years and over., Main Outcome Measures: Self-reported chronic illnesses, injuries or conditions; difficulties with activities of daily living assessed by the Health Assessment Questionnaire (HAQ); and home modification and use of functional aids., Results: "Arthritis or rheumatism" was the leading long term condition, reported by 59.5%, 55.8% and 59.7% of women and 40.5%, 47.0% and 43.6% of men in the three age groups (65-74, 75-84 and 85 years and over), respectively. The back, neck and knees were the most common sites of pain and stiffness. Of the respondents, 23.4% of women and 24.3% of men reported regularly taking nonsteroidal anti-inflammatory drugs. Impaired performance of activities of daily living increased with age, with 53.9%, 70.7% and 89.6% of women and 37.6%, 63.6% and 73.2% of men in the respective age groups reporting at least some difficulty (HAQ score > 0). Multivariate analysis found self-reported poor general health, loss of a limb, arthritis or rheumatism, other long term conditions restricting physical activity, impaired vision, female sex, and age to be significant predictors of disability as measured by HAQ scores. Only 13.9% of women and 9.4% of men had made changes to their home. Functional aids were used by 27.7%, 37.3% and 65.9% of women and 15.6%, 33.4% and 59.1% of men in the respective age groups., Conclusion: Arthritis and rheumatism were the most prevalent chronic conditions among elderly people in the community, and were significantly associated with difficulty with performing activities of daily living, after controlling for effects of age, sex and other chronic conditions.

Objective: To evaluate the use of a postal survey to detect subjects in the community with osteoarthritis (OA) and the ability of metrologists to detect clinical OA., Methods: Questionnaires were posted to a random sample of residents of the Northern Sydney Health Area, aged 45-64 years old, asking for details of musculoskeletal complaints and diagnoses. A questionnaire definition of OA was made if 'osteoarthritis' was reported or 'degenerative arthritis', 'joints wearing' out together with pain in joints during the previous 6 months. Hands, hips, and knees of 106 subjects were examined by one of two trained metrologists according to ACR clinical criteria for OA. A second subsample was examined by two metrologists and two rheumatologists independently to test for inter-observer variation. Data were analyzed for percentage agreement and concordance using the kappa statistic., Results: After two mailouts, 59% responded (526 males and 796 females). Definite OA (excluding spine alone) was reported by 52 males (10%), 155 females (19.5%) and possible OA by 62 males (11.8%), 164 females (20.6%). Following examination, 81% of self-reported 'definite' OA was confirmed, while 57% of 'possibles' and one self-reported 'negative' were determined to have clinical OA. Reporting of specific joint OA was less reliable than the highly reliable self-reporting of general OA. Good agreement was demonstrated between rheumatologists and metrologists in the clinical diagnosis., Conclusion: Postal questionnaires have the potential to detect OA in the community. The clinical diagnosis can be confirmed by a trained metrologist. Further evaluation of this instrument is warranted in other populations.