Social exclusion of older persons: a scoping review and conceptual framework

As a concept, social exclusion has considerable potential to explain and respond to disadvantage in later life. However, in the context of ageing populations, the construct remains ambiguous. A disjointed evidence-base, spread across disparate disciplines, compounds the challenge of developing a coherent understanding of exclusion in older age. This article addresses this research deficit by presenting the findings of a two-stage scoping review encompassing seven separate reviews of the international literature pertaining to old-age social exclusion. Stage one involved a review of conceptual frameworks on old-age exclusion, identifying conceptual understandings and key domains of later-life exclusion. Stage two involved scoping reviews on each domain (six in all). Stage one identified six conceptual frameworks on old-age exclusion and six common domains across these frameworks: neighbourhood and community; services, amenities and mobility; social relations; material and financial resources; socio-cultural aspects; and civic participation. International literature concentrated on the first four domains, but indicated a general lack of research knowledge and of theoretical development. Drawing on all seven scoping reviews and a knowledge synthesis, the article presents a new definition and conceptual framework relating to old-age exclusion

Nutrition screening of older people in a community general practice, using the MNA-SF

Background: Objective The study aimed to determine the prevalence of malnutrition risk in a population of older people (aged 75 years and over) attending a community general practice and identify characteristics of those classified as malnourished or at risk of malnutrition.Design Cross-sectional study of nutritional risk screen conducted over a six month period.Participants and setting Patients attending a general practice clinic in Victoria, Australia, who attended for the &ldquo;75 plus&rdquo; health assessment check.Measurements The Mini Nutritional Assessment Short Form (MNA&reg;-SF) was included as part of the health assessment. Information was collected on living situation, co-morbidities, independence with meal preparation and eating, number of medications. Height and weight was measured and MNA&reg;-SF score recorded.Results Two hundred and twenty five patients attending a general practice for a health assessment with a mean age of 81.3(4.3)(SD) years, 52% female and 34% living alone. Only one patient was categorised by the MNA&reg;-SF as malnourished, with an additional 16% classified as at risk of malnutrition. The mean Body Mass Index (BMI) of the at-risk group was significantly lower than the well-nourished group (23.6 &plusmn; 0.8 (SEM) vs 27.4 &plusmn; 0.3; p=0.0001). However, 34% of the at-risk group had a BMI of 25 or more with only 13% in the underweight category.Conclusion In this population of older adults attending their general practitioner for an annual health assessment, one in six were identified as being at nutritional risk which is an additional risk factor for a severe health issue. Importantly, one third of the at-risk group had a BMI in the overweight or obese category, highlighting that older people can be at nutritional risk although they may be overweight or obese.<br /

Quality of life in residential care

While some of the changes in life that accompany increasing age may promote higher quality of life, the increased prevalence of disease and other negative life events presumably operate in the opposite direction. Among the most salient negative life events in later life is the development of physical or mental disability sufficiently severe 10 justify moving from an independent life in the community to a residential care facility. This chapter first reviews the current state of knowledge concerning quality of life with increasing age. Most studies note changes. but the distinction of age effects from cohort effects is not often made. Illness in later life has a major impact upon quality of life, especially if disability is one outcome. As illness and disability often lead to a move into a residential care facility, the quality of life in residential care becomes of broader interest. Such interest is enhanced by the strong contrast in views expressed by people when contemplating life in residential care and when actually experiencing it. Various models of this apparent "disability paradox" are described, followed by an analysis of the conceptual difficulties underlying research into quality of life because of the varied definitions in current use