Older people are wrongly excluded from drug trials

The national service framework for childrenIs about making maternal and child health a priority, not a luxury

IntroductionIn the context of a population that is growing older, and a number of high-profile scandals about care standards in hospital and community settings, having a skilled and knowledgeable workforce...

Oral health care for elderly people is important to improve quality of life, extend healthspan and is related with well being and good death. However, food debris and dental plaque remain in the oral cavity of much elderly people required long-term care and cause systemic disease such as aspiration pneumonitis. Dentist and dental hygienist can keep clean the oral cavity of requiring long-term care and prevent the decline of oral function by professional oral function care, professional oral hygiene care and general oral care with multi-disciplinary.

The UK has an ageing population--there are currently more people aged over 60 years than aged 16 years and under. The National Service Framework (NSF) for Older People provides standards for health and social services to ensure that older people receive high quality care (Department of Health (DoH), 2001a). An addendum to the NSF describes how the use of medicines for and by older people can be improved (DoH, 2001b). The aim of the document is to ensure that older people achieve the greatest benefit from their medications in order to sustain and increase their quality of life. The document also attempts to ensure that the older person does not suffer needlessly from illness that may be brought about by excessive, inappropriate or inadequate consumption of medicines. This article discusses how medications for older people can be taken in a safe and effective manner in relation to the addendum to the NSF (DoH, 2001b). Nurses must ensure that a multidisciplinary approach is adopted when setting standards and developing protocols for the safe and effective administration of medicines.

Our population is ageing. The need to pay for decent care for older people becomes more pressing, and last month's Wanless report recommended how to provide long term care fairly.1 But what is decent care? The national standards for the health, treatment, and social care of older people in England—set in 2001 in the national service framework (NSF) for older people—provide a good grounding. Last week the UK national director for older people, Professor Ian Philp, presented the next steps for the framework in the report A New Ambition for Old Age, which examined how the framework is being implemented and announced new aims and targets.2 The national service framework for older people set out eight standards to improve the experiences of older people and their carers who are using health, social care, and other services (box 1). A standard on medicines management followed later. Last week's report added a further 10 programmes for implementing the framework, under three important and timely themes: dignity in care, joined up care, and healthy ageing. Box 1: National service framework for older people Standards are focused on Rooting out age discrimination Promoting person centred care (including a single assessment process for care records) Intermediate care General hospital care Stroke services Falls services Mental health in older people Promoting health and active life in old age What has improved since the framework was launched five years ago? A third of older people needing intensive daily help in England now receive this in their own homes rather than in residential care; delayed discharge from acute hospitals has been reduced by more than two thirds; and specialist services for people with stroke and for those prone to falls continue to improve.2 In 2000-1, 12 900 people aged 60 and over who had attended NHS stop smoking services had successfully quit smoking a month later; this total rose to 42 900 in 2003-4. And uptake of influenza immunisation among those aged 65 and over rose from 65% in 2000-1 to 71% in 2003-4.2 Such health gains now need to be built on, however, with campaigns among older people to promote greater physical fitness, reduced obesity, and better management of sensory impairment and incontinence. These campaigns could be run by voluntary organisations such as Age Concern and Help the Aged and be supported by teams in primary and secondary care. Furthermore, many targets set in the overall NHS plan are still directed mainly at younger people and largely ignore the milestones set in the national service framework for older people. Other national service frameworks were supported with new monies, and despite older people being the prime users of primary care, secondary care, and social services and having benefited from a reduction of four hour waits on trolleys, investments have not been made in more specific services such as general hospital care for older people or an effective continence service.3

Self-reported data and/or medical records are often used to assess the prevalence of illness and impairment in epidemiological studies. However, these two data sources do not always provide the same information. The aim was to compare data from interviews and medical records regarding illness, symptoms and impairment in the elderly, and to analyze the agreement between a consensus from both data sources and data from interviews and medical records, respectively. We interviewed 130 persons (age range 67-99) regarding socio-demographic background data and physical and mental health. Medical records were reviewed. Illness burden was rated according to the Cumulative Illness Rating Scale for Geriatrics, and was rated in three ways based on: (1) interview data; (2) medical records; (3) information from both interviews and medical records considered to be consensus. Agreement was measured by the Kappa coefficient and the Svensson Paired Rank Measurement. A permutation test tested whether the ratings from interviews and medical records had the same agreement when compared with consensus. Statistically significant differences in agreement were found between interview versus consensus and medical records versus consensus for the vascular system (medical records best), eyes/ears/nose/throat/larynx and musculoskeletal/integument (interview best). Medical records gave better in formation concerning specific diseases and diagnoses, whereas interview data provided a better measure of illness, functional impairment and health in a broader sense. Both medical records and interviews yield good information of elderly people's health status, but they focus on different aspects of health.

The National Health Service (NHS) spent £10 billion (40%) of its total budget on people aged 65 and over in 1998/1999. The profile of the health and social care of older people has been raised recently by the publication of the National Service Framework (NSF) for Older People (Department of Health, 2001). The NSF contains standards that older people can expect when they receive health and social care (Box 1). The document also discusses in detail medication management issues in older people. Its two aims in this area are to ensure that older people gain the maximum benefit from their medication in order to maintain or improve quality and duration of life, and do not suffer unnecessarily from illness caused by excessive, inappropriate or inadequate consumption of medicines.

User involvement in health care has received a high profile within the NHS Plan (Department of Health, 2000a), giving patients a greater say in their treatment and in the way that the NHS works. Older people, i.e. those over 65 years of age, as a group, are the highest users of hospital and community services (DH, 2001a). The national service framework (NSF) for older people (DH, 2001a) highlights the need to listen to older people, help them make informed choices and involve them in achieving a healthy lifestyle. While the NSF for older people rightly attempts to ensure fair and equitable access to health care services for older people, it is assumed that they want to be involved, and want to exercise their rights as users. This assumption needs to be tested. This study, presented as a series of four articles, sets out to explore if there is a consumerist ethic among older people in relation to health care. The first paper outlines some of the literature reviewed together with the methodology.

In 1998 the Journal of Epidemiology and Community Health argued that the new millennium requires a journal of the times bringing together the strands of public health—the science and art,...

The National Service Framework for Older People (DoH, 2001) is a ten‐year plan which aims radically to improve health services for older people. Central to the plan is the belief that older people should be involved as ‘genuine partners’ in the implementation process. In this article we describe how regional and local implementation teams in the North West of England are working in partnership to develop a coherent and sustainable strategy for engaging with older people.

Beyond Neglect: Long-term Care Research in Low and Middle Income Countries

The Health and social care needs of older people cover a large number of different systems, resulting in inadequate priorities for their needs. There is no single acknowledged ‘big issue’ for older people's health and social care. We need concerted effort to achieve clarity and consensus on key issues such as quality, rights, entitlements, and levels of funding. A national initiative, led by Government, is required, built on the involvement of older people and a genuine respect for them.

There is no doubt that charitable organizations are critical contributors in the provision of essential services of public interest. In the recent past, the number of people contributing to charity has been reducing due to lack of financial accountability and performance concerns. The environment these organizations operate, therefore calls for leaders who will come up with radical new ideas that will enable them re-invent their organizations to perform. The study sought to find out how strategic leadership impact performance of Charitable Ambulance Services in Nairobi City County. Study objective was to examine the outcome of strategic direction, operational efficacy, human capital development, and strategic control on the performance of charitable Ambulance service organizations in Nairobi City County. The researcher used resource-based view, upper echelon and contingency theories to anchor the study on the outcome of strategic leadership practices on organizational performance. Descriptive design research was used by the researcher. Target population comprised of 144 Managers and staff, a sample of 130 responded giving a response rate of 90.28%. Data analysis was conducted using SPSS software using descriptive statistics to infer to the data and connection between independent and depend variable were found using multiple regression. Pilot study was done to pretest the questionnaire. The study results show that strategic direction correlate with performance up to 22.3% which is a weak positive correlation with organizational performance. A unit change in strategic direction yields 0.171 positive changes on performance of charitable ambulance services in Nairobi County. Operational efficacy correlates with performance up to 63.4% which is a strong positive correlation. A unit change in operational efficacy yields 0.735 positive changes on performance. Human capital development correlates with performance up to 49.7% which is an average positive correlation. A unit change in human capital development yields 0.422 positive changes on performance. Strategic control correlates with performance up to 47.6% which is an average positive correlation. A unit change in strategic control yields 0.270 positive changes on performance. The Overall, analysis showed that strategic leadership practices correlate with organizational performance of charitable ambulance services up to 69.3% which is a strong positive correlation. A unit change yields 0.108 negative change in strategic direction, 0.599 positive change in operational efficacy, 0.120 positive change in human resources development and 0.135 positive change in strategic control. This change is statistically significant, meaning that strategic direction, operational efficacy, human resource development and strategic control influence on organizational performance significantly. The study recommends replication of the study using the same variable with other sectors. The study informs the strategic leadership practice in academia, students in strategic management will use the variables used in this study to study the different sectors contributing to academia. The outcome of the study is valuable to charitable ambulance service organizations as it will inform the strategic leadership practices and their influence on organizational performance.

This study explores the underlying factors that sustain the practice of herbal medicine in a non-English speaking background (Korean) community in Australia. Qualitative study was undertaken of 8 herbal doctors' practice of herbal medicine, their understanding of Korean immigrants' life and work involvement, and the use of herbal medicine, using semi-structured interview schedules. The demand for herbal medicine is linked to Korean immigrants' involvement in manual work or long working hours irrespective of their qualifications. Hanbang tonic medicine is a way to maintain their health--that is, a capacity to work. Although hanbang doctors claim that hanbang medicine differs from biomedicine, they share more similarities than differences under the current economic environment. The increasing interest in complementary therapies has ramifications on people's health and health care industry. Government and professional regulations on complementary therapies could be developed in close consultation with relevant stakeholders. Health care practice in the migrant community is an area to be approached with caution.

ObjectiveAccording to the seventh demographic census, China's elderly population reached 260 million, accounting for 18.7% of the total population, indicating that China is on the verge of transitioning from a relatively mild aging to a moderately aging society, and an aging society inevitably brings concerns about the elderly people's health. The purpose of this study was to better understand the effect of economic development on the physical fitness of the elderly people aged 60–69 in China during the first two decades of the twenty-first century, as well as to establish a correlation between China's gross domestic product (GDP) and changes in the elderly people's passing rate of national physical fitness standards.MethodsA linear regression analysis was performed on the data of GDP and the passing rate of national physical fitness standards of Chinese elderly people aged 60–69 in 2000, 2005, 2010, 2014, and 2020.ResultsThe passing rate of national physical fitness standards for elderly people aged 60–69 increased linearly (R2 = 80.56%, p < 0.05), indicating that the physical fitness of the elderly tends to increase steadily with GDP expansion.ConclusionsBetween 2000 and 2020, the annual improvement in the physical fitness of the elderly people in China is inextricably linked to rapid economic development. Increased financial investments in public sports services and a corresponding national fitness plan all contribute to an overall improvement in the physical fitness of the elderly people. This outcome is the effect of fiscal and policy coordination, which may represent a distinctive Chinese model and contribution to the global effort to manage and improve population physical fitness.