Attitudes to aging: a comparison of obituaries in Canada and the UK

Background: Populations worldwide are aging and the overall prevalence of dementia at death is now 30%. Since the contemporary social impact of a disease is indicated by the frequency of its newspaper coverage and since obituary notices illuminate conceptions of death, we hypothesized that obituary notices placed by families would reflect societal attitudes to aging and dementia.Methods: We undertook critical discourse analysis of obituaries in representative national and local newspapers in Canada and the U.K.Results: In the 799 obituaries studied, chronological age, suggested donations in memory of the deceased, and donations to dementia charities were each included in significantly more obituaries in Canadian newspapers than in U.K. ones. Military service was explicit for significantly more men aged >= 80 years in Canada compared to the U.K. (41% versus 4%; p = 70 years were more likely to recommend donations to children's charities (n = 12) or the Royal National Lifeboat Institution (8) than dementia charities (7).Conclusions: Donations to dementia charities were significantly more common in obituaries in Canada than in the U.K. In both countries, donations to medical charities did not reflect disease prevalence or impact to the individual. Societal attitudes in the U.K. may be impacted by the fragmentation of aging research and antipathy to geriatric medicine in the national medical press

Specialist physician approaches to discussing cardiopulmonary resuscitation for frail older adults: a qualitative study

Background: Despite the impact and importance of end-of-life discussions, little is known about how physicians discuss cardiopulmonary resuscitation (CPR) with patients and their families. The necessary components for successful communication about CPR are poorly understood and an established framework to structure these conversations is lacking. Here, we were motivated to understand how physicians approach resuscitation planning with families when older patients have limited life expectancy and a high burden of illness. Method: Qualitative analysis was conducted of semi-structured interviews of 28 physicians of varying medical sub-specialties in a tertiary care hospital. Results: Most physicians explored the surrogates' goals and values, but few provided explicit information about the patients' overall health status or expected long-term health outcome related to CPR and underlying illnesses. Conclusion: There is considerable heterogeneity in physicians' approaches to CPR discussions. The principle of autonomy is dominant with less emphasis on providing adequate information for effective decision-making

Comparison of clinical assessment and actigraphy in the characterization of delirium

Background A school mental-health programme has been developed as a component of the community mental-health programme in Rawalpindi, Pakistan. It has the objective of improving the understanding of disorders of mental health in the rural community. We aimed to assess the impact of a school mental-health programme on the awareness of schoolchildren, their parents, friends who were not attending school, and neighbours. Methods We chose two secondary schools for boys and two for girls that were similar in terms of size, staff-pupil ratio, and drop-out rates. 100 children aged 12–16 years (25 girls and 25 boys in each of the study and control groups), 100 parents (one for each child), 100 friends who did not attend school (one for each child), and 100 neighbours (one for each child) were given a 19-item questionnaire before and after the study group had had a 4-month programme of mental-health education. The maximum score for the questionnaire was 16 points. Findings Before the school mental-health programme the awareness of mental-health issues was poor (mean score 5·7–7·6) in the four groups of participants. In the study group there was a significant improvement in the mean scores after the school programme in the schoolchildren (mean improvement 7·6 [95% CI 6·7–8·5], p\u3c0·01), their parents (5·3 [4·5–6·1], p\u3c0·01), friends (5·1 [4·1–6·1], p\u3c0·01), and neighbours (3·4 [2·6–4·2], p\u3c0·01). In the control group the difference in awareness was significant only in schoolchildren (1·5 [0·5–2·3], p=0·01) and their friends (0·8 [0·3–1·3], p\u3c0·01). Interpretation The school programme succeeded in improving awareness of mental health in schoolchildren and the community. The schoolchildren were receptive to the programme, and shared their new understanding with family, friends, and neighbours. Mental-health planners who wish to improve community awareness of mental health, particularly in areas with low literacy rates, should consider setting up school mental-health programmes

Assessing balance and mobility to track illness and recovery in older inpatients

BACKGROUND: Archetypal symptoms and signs are commonly absent in frail older people who are acutely unwell. This challenges both recognition of illness and monitoring of disease progression in people at high risk of prolonged hospital stays, institutionalization and death. OBJECTIVE: To determine whether bedside assessment of balance and mobility could track acute changes in the health status of older people admitted to hospital. DESIGN: Prospective cohort study. PARTICIPANTS: Four hundred nine patients, with a mean age of 81.8 years, admitted to general medical and rehabilitation wards at a tertiary care teaching hospital in Halifax, Nova Scotia. No patient refused assessment, and the only exclusion criterion was age. INTERVENTIONS: The Hierarchical Assessment of Balance and Mobility (HABAM) was completed daily during the first 2 weeks of admission. For each patient, frailty status was measured on admission by a Frailty Index based on a Comprehensive Geriatric Assessment (FI-CGA). MAIN MEASURES: Death and discharge destination. KEY RESULTS: Poor performance in balance, transfers and mobility was associated with adverse outcomes. Forty-eight percent of patients with the lowest scores in all three domains died, compared with none with the highest scores. The relative risk of death for people who deteriorated during the first 48 h of admission was 17.1 (95% confidence interval: 4.9-60.3). Changes in HABAM scores were related to the discharge destination: patients discharged home showed the greatest rate of improvement, whereas those discharged to institutions stabilised at a lower level of performance. Fitter patients tended to have better performance on admission and faster recovery. CONCLUSIONS: Daily bedside observation of mobility and balance allows assessment of acute changes in the health of older people. Frailty slows recovery of mobility and balance, and reduces recovery potential. By identifying patients most vulnerable to adverse outcomes, the HABAM and FI-CGA may facilitate risk stratification in older people admitted to hospital

Neurological injury in intermediate-risk transcatheter aortic valve implantation

Background--The application of transcatheter aortic valve implantation (TAVI) to intermediate-risk patients is a controversial issue. Of concern, neurological injury in this group remains poorly defined. Among high-risk and inoperable patients, subclinical injury is reported on average in 75% undergoing the procedure. Although this attendant risk may be acceptable in higher-risk patients, it may not be so in those of lower risk. Methods and Results--Forty patients undergoing TAVI with the Edwards SAPIEN-XT™ prosthesis were prospectively studied. Patients were of intermediate surgical risk, with a mean±standard deviation Society of Thoracic Surgeons score of 5.1±2.5% and a EuroSCORE II of 4.8±2.4%; participant age was 82±7 years. Clinically apparent injury was assessed by serial National Institutes of Health Stroke Scale assessments, Montreal Cognitive Assessments (MoCA), and with the Confusion Assessment Method. These identified 1 (2.5%) minor stroke, 1 (2.5%) episode of postoperative delirium, and 2 patients (5%) with significant postoperative cognitive dysfunction. Subclinical neurological injury was assessed using brain magnetic resonance imaging, including diffusionweighted imaging (DWI) sequences preprocedure and at 3±1 days postprocedure. This identified 68 new DWI lesions present in 60% of participants, with a median±interquartile range of 1±3 lesions/patient and volumes of infarction of 24±19 lL/lesion and 89±218 μL/patient. DWI lesions were associated with a statistically significant reduction in early cognition (mean ΔMoCA -3.5±1.7) without effect on cognition, quality of life, or functional capacity at 6 months. Conclusions--Objectively measured subclinical neurological injuries remain a concern in intermediate-risk patients undergoing TAVI and are likely to manifest with early neurocognitive changes

Genome-wide association study identifies susceptibility loci for B-cell childhood acute lymphoblastic leukemia

Genome-wide association studies (GWAS) have advanced our understanding of susceptibility to B-cell precursor acute lymphoblastic leukemia (BCP-ALL); however, much of the heritable risk remains unidentified. Here, we perform a GWAS and conduct a meta-analysis with two existing GWAS, totaling 2442 cases and 14,609 controls. We identify risk loci for BCP-ALL at 8q24.21 (rs28665337, P = 3.86 × 10−9, odds ratio (OR) = 1.34) and for ETV6-RUNX1 fusion-positive BCP-ALL at 2q22.3 (rs17481869, P = 3.20 × 10−8, OR = 2.14). Our findings provide further insights into genetic susceptibility to ALL and its biology