An awareness of the components of wellness can help clinicians determine appropriate endpoints for treatment of ill health in older people

AIM:To examine stress in carers of the elderly who attended a solo family medical practice.METHOD:Eighty-seven carers were compared with 102 non-caregiving controls. Subjects were asked to complete survey questionnaires either in the surgery or at home. The General Health Questionnaire (CHQ) was used to assess psychological morbidity, the Relative Stress Scale as a measure of subjective burden and information was collected on activities of daily living and instrumental activities of daily living.RESULTS:No significant difference was found in GHQ scores, reflecting the high level of stress in this family practice sample (mean GHQ = 4.7, standard deviation = 6.2). Psychological morbidity in carers was associated with the provision of assistance with instrumental activities of daily living such as shopping, cooking and finances.CONCLUSIONS:We suggest that because carers often encounter specific challenges which may be amenable to intervention, general practitioners should familiarise themselves with these issues, determine the caregiving status of their patients and provide information about community services to carers.

This cross-sectional study examined 99 elderly coresident stroke and dementia caregivers who had been in the caregiving role for at least 6 months, to identify risk factors for subjective burden and psychological morbidity. A worsening in the quality of relationship between the caregiver and patient, being a spouse, shorter length of caregiving, poor caregiver self-rated health, greater physical disability and behaviour/mood disturbance in the patient were found to be risk factors for burden. For psychological morbidity, risk factors also included behaviour/mood disturbance as well as female gender and low participation in life activities. These results demonstrate the multifactorial nature of caregiver stress in the elderly.

A slow-stream rehabilitation program for frail elderly patients was developed utilising nursing homes visited by a mobile rehabilitation team (MRT) based at the hospital from which these patients had been discharged following major illness. The nursing homes were able to provide physiotherapy and the MRT contributed medical, nursing, occupational therapy and social work support through weekly visits. The supported group and a control group (also discharged to nursing homes from the same hospital but unsupported) were matched for age, sex and ADL level. Outcomes for the two groups were compared and were significantly different. Of the supported group (N = 33), 64% (N = 21) were discharged home compared with only 9% (N = 2) of the 23 control subjects (chi2 = 15.6, df. = 1, P < 0.05). The potential for patient rehabilitation in a modestly supported nursing home was realised.

This paper reports results of a telephone survey undertaken on the carers of older people who contacted the Carers' Association of NSW requesting the Carer Support Kit. The survey covered a number of aspects of the caring experience, the strains this may impose and the range of disabilities of the care-recipients, in addition to the demographic characteristics of the carers and their relationships to the recipients. Comparisons are made between carers of the 'young' old and carers of the 'old' old, and important differences highlighted and discussed, Despite many government initiatives to assist carers, many require further assistance.

Forty-four patients aged 65 years and over who fell whilst in an acute hospital and 44 patients who did not fall during their hospital stay underwent structured medical examinations to identify factors associated with falling. The control subjects were matched for age (+/- 3 years), sex, patient type, and primary diagnosis. The examination was based on established assessments of posture, balance and gait, the musculoskeletal system, vision, cardiovascular status, and neurological function. Bivariate analyses revealed seven assessment measures that were significantly associated with falls: cognitive impairment, particularly impaired orientation; evidence of previous cerebrovascular accident; incoordination as measured clinically; inability to perform the 'Get-up-and-go' test, especially an inability to turn around after a 5-metre walk, and the use of psycho-active medications. Of these variables, impaired orientation, psycho-active drug use, evidence of stroke, and impaired performance in the 'Get-up-and-go' test were included in a stepwise logistic regression which correctly classified 80% of the patients into faller and non-faller groups. Falling was also related to the number of these identified risk factors. These findings suggest that a simple screening protocol, taking about 5 min to complete, can assist in the identification of patients at risk of falls whilst in hospital.

Maintenance of quality of care in Australian nursing homes has evolved, being initially concerned mainly with physical features of the buildings. Progress occurred when regulations were introduced for nursing practices, staff levels and procedures generally. In the present phase, the focus has been on outcome in terms of the quality of life of the residents. This is being achieved by laying down specific outcome standards and their implementation is controlled by an inspectorial system that has the capacity to apply sanctions.

This paper looks at two surveys of bed rest, conducted in a general hospital. The first survey, conducted early one afternoon, assessed the prevalence of bed rest within the hospital. It was found that most of the patients (67%) were in bed, and nearly half of those (42%) were in bed for reasons other than being too sick or unsafe to be up, or because bed rest was part of their treatment. A second survey, in which a sample of general hospital patients was repeatedly observed throughout the day, found that patients with no requirements for bed rest spent 63% (95% confidence limits: 51-75%) of the active part of the day in bed. It may be that because of the nature of hospital design, many patients are unnecessarily confined to bed because there is simply nowhere else to go. Inappropriate use of bed rest has implications for patient health and the utilization of scarce hospital resources.

Medical Journal of AustraliaVolume 158, Issue 4 p. 292-292 Letter to the Editor Patterns of elder abuse Frederick Ehrlich PhD, FACRM, FRCS, Frederick Ehrlich PhD, FACRM, FRCS Professor of Rehabilitation Aged and Extended Care University of New South Wales St George Hospital, Kogarah, NSW, 2217Search for more papers by this author Frederick Ehrlich PhD, FACRM, FRCS, Frederick Ehrlich PhD, FACRM, FRCS Professor of Rehabilitation Aged and Extended Care University of New South Wales St George Hospital, Kogarah, NSW, 2217Search for more papers by this author First published: 01 February 1993 https://doi.org/10.5694/j.1326-5377.1993.tb121776.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume158, Issue4February 1993Pages 292-292 RelatedInformation

Objective To compare elderly co‐resident caregivers of stroke and dementia patients on measures of burden and psychological morbidity. Design Cohort study. Setting Caregivers interviewed at home. Subjects Convenience sample, 99 co‐resident caregivers of dementia and stroke patients registered with a community rehabilitation and geriatric service and who were 60 years or over. Main Outcome Measures Caregiver burden as measured by self‐administered questionnaire and subsequent interview, using the Relatives Stress Scale (RSS) and psychological morbidity as measured on the General Health Questionnaire (GHQ). Results Forty‐six percent of caregivers had significant psychological morbidity (GHQ >4). Mean RSS score was 12.2 (SD 5.4). No significant differences were found between stroke and dementia caregivers on these measures. Caregiver burden was significantly correlated with psychological morbidity in both caregiver groups. Behavior and mood disturbance in the patient was significantly correlated with burden (dementia caregivers r = 0.66; stroke caregivers r = 0.49, P < 0.0001) and psychological morbidity (dementia caregivers r = 0.44, P < 0.01; stroke caregivers r = 0.30, P < 0.05). Caregiver's dissatisfaction with participation in life activities was correlated with burden (dementia caregivers r = 0.58; stroke caregivers r = 0.63, P < 0.0001) and psychological morbidity (dementia caregivers r = 0.67, stroke caregivers r = 0.56, P , 0.0001). Conclusion Elderly co‐resident caregivers for stroke and dementia patients experience similar degrees of burden and high levels of psychological morbidity. Psychiatric aspects of chronic disability, rather than physical aspects, were found to be more stressful to caregivers. All assessments of the disabled elderly should include measures of caregiver burden and psychological distress.

Medical Journal of AustraliaVolume 156, Issue 9 p. 590-592 Leading Article Caring for carers — a national problem† Frederick Ehrlich, Frederick Ehrlich Professorial Unit, Aged and Extended Care St George Hospital, Kogarah School of Community Medicine University of New South WalesSearch for more papers by this authorGregory Bowring, Gregory Bowring Professorial Unit, Aged and Extended Care St George Hospital, Kogarah School of Community Medicine University of New South WalesSearch for more papers by this authorBrian Draper, Brian Draper Professorial Unit, Aged and Extended Care St George Hospital, Kogarah School of Community Medicine University of New South WalesSearch for more papers by this authorChris Poulos, Chris Poulos Professorial Unit, Aged and Extended Care St George Hospital, Kogarah School of Community Medicine University of New South WalesSearch for more papers by this authorRaja Saigado, Raja Saigado Professorial Unit, Aged and Extended Care St George Hospital, Kogarah School of Community Medicine University of New South WalesSearch for more papers by this author Frederick Ehrlich, Frederick Ehrlich Professorial Unit, Aged and Extended Care St George Hospital, Kogarah School of Community Medicine University of New South WalesSearch for more papers by this authorGregory Bowring, Gregory Bowring Professorial Unit, Aged and Extended Care St George Hospital, Kogarah School of Community Medicine University of New South WalesSearch for more papers by this authorBrian Draper, Brian Draper Professorial Unit, Aged and Extended Care St George Hospital, Kogarah School of Community Medicine University of New South WalesSearch for more papers by this authorChris Poulos, Chris Poulos Professorial Unit, Aged and Extended Care St George Hospital, Kogarah School of Community Medicine University of New South WalesSearch for more papers by this authorRaja Saigado, Raja Saigado Professorial Unit, Aged and Extended Care St George Hospital, Kogarah School of Community Medicine University of New South WalesSearch for more papers by this author First published: 01 May 1992 https://doi.org/10.5694/j.1326-5377.1992.tb121449.xCitations: 13 †Based on a paper delivered at the National Social Policy Conference, Sydney, July 1991. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume156, Issue9May 1992Pages 590-592 RelatedInformation

Medical Journal of AustraliaVolume 154, Issue 4 p. 293-293 Letters to the Editor Who cares for the carer of the old and ill? Brian M Draper FRANZCP, Brian M Draper FRANZCP Psychogenatrician, Aged and Extended Care DepartmentSearch for more papers by this authorChristopher J Poulos FACRM, Christopher J Poulos FACRM Staff Specialist, Community Rehabilitation and Geriatric ServiceSearch for more papers by this authorAndrew M D Cole FACRM, Andrew M D Cole FACRM Director, Community Rehabilitation and Geriatric ServiceSearch for more papers by this authorFrederick Ehrlich PhD, FACRM, FRCS, Frederick Ehrlich PhD, FACRM, FRCS Professor of Rehabilitation, Aged and Extended CareSearch for more papers by this authorRoslyn G Poulos MB BS, MPH, Roslyn G Poulos MB BS, MPH Research Medical Officer The St George Hospital Belgrave Street, Koqarah, NSW 2217Search for more papers by this author Brian M Draper FRANZCP, Brian M Draper FRANZCP Psychogenatrician, Aged and Extended Care DepartmentSearch for more papers by this authorChristopher J Poulos FACRM, Christopher J Poulos FACRM Staff Specialist, Community Rehabilitation and Geriatric ServiceSearch for more papers by this authorAndrew M D Cole FACRM, Andrew M D Cole FACRM Director, Community Rehabilitation and Geriatric ServiceSearch for more papers by this authorFrederick Ehrlich PhD, FACRM, FRCS, Frederick Ehrlich PhD, FACRM, FRCS Professor of Rehabilitation, Aged and Extended CareSearch for more papers by this authorRoslyn G Poulos MB BS, MPH, Roslyn G Poulos MB BS, MPH Research Medical Officer The St George Hospital Belgrave Street, Koqarah, NSW 2217Search for more papers by this author First published: 01 February 1991 https://doi.org/10.5694/j.1326-5377.1991.tb121108.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume154, Issue4February 1991Pages 293-293 RelatedInformation