Living longer, but with more care needs: late-life dependency and the social care crisis

Solving the crisis in social care provision for older people is not just a matter of building more care homes, argues Carol Jagger. She explains the various ways in which dependency has changed compared to 20 years ago, and suggests some of the solutions the government should consider

Flow diagram of study identification.

<p>Flow diagram of study identification.</p

Summary of pooled ORs in the meta-analysis of SNP rs2910164.

†<p><i>P_h</i>, <i>P-</i>value for heterogeneity test. OR, odds ratio; CI, confidence interval.</p

Summary of polled Ors in the meta-analysis of SNP rs11614913.

†<p><i>P_h</i>, <i>P-</i>value for heterogeneity test.</p>‡<p>Random-effects model was used when the <i>p</i>-value for heterogeneity test ≤0.10, otherwise the fixed-effect model was used. OR, odds ratio; CI, confidence interval.</p

Characteristics of studies included in the meta-analysis.

†<p>Hardy-Weinberg equilibrium (HWE) was evaluated using the goodness-of-fit chi-square test. <i>P</i> values were presented. <i>P</i><0.05 was considered representative of a departure from HWE. SNP, single nucleotide polymorphism.</p

Forest plots before and after exclusion of Zhang et al’s study in the comparison between rs2910164 genotype CC and GG.

<p>A. Before exclusion of the study from Zhang et al. B. After exclusion of Zhang et al’s study. The squares and horizontal lines correspond to the study-specific OR and 95% CI. The area of the squares reflects the study specific weight. The diamond represents the pooled OR and 95% CI.</p

A Prospective Study of Alcohol Consumption and Smoking and the Risk of Major Gastrointestinal Bleeding in Men

<div><p>Background and Aims</p><p>Data regarding smoking and alcohol consumption and risk of gastrointestinal bleeding (GIB) are sparse and conflicting. We assessed the risk of major GIB associated with smoking and alcohol consumption in a large, prospective cohort.</p><p>Methods</p><p>We prospectively studied 48,000 men in the Health Professional follow-up Study (HPFS) who were aged 40–75 years at baseline in 1986. We identified men with major GIB requiring hospitalization and/or blood transfusion via biennial questionnaires and chart review.</p><p>Results</p><p>We documented 305 episodes of major GIB during 26 years of follow-up. Men who consumed >30 g/day of alcohol had a multivariable relative risk (RR) of 1.43 (95% confidence interval (CI), 0.88–2.35; <i>P</i> for trend 0.006) for major GIB when compared with nondrinkers. Alcohol consumption appeared to be primarily related to upper GIB (multivariable RR for >30 g/day vs. nondrinkers was 1.35; 95% CI, 0.66–2.77; <i>P</i> for trend 0.02). Men who consumed ≥ 5 drinks/week vs. < 1 drink/month of liquor had a multivariable RR of 1.72 (95% CI, 1.26–2.35, <i>P</i> for trend <0.001). Wine and beer were not significantly associated with major GIB. The risk of GIB associated with NSAIDs/aspirin use increased with greater alcohol consumption (multivariable RR 1.37; 95% CI, 0.85–2.19 for 1-14g/day of alcohol, RR 1.75; 95% CI, 1.07–2.88 for ≥ 15g/day compared to nondrinkers). Smoking was not significantly associated with GIB.</p><p>Conclusions</p><p>Alcohol consumption, but not smoking, was associated with an increased risk of major GIB. Associations were most notable for upper GIB associated with liquor intake. Alcohol appeared to potentiate the risk of NSAID-associated GIB.</p></div

Smoking Status and Risk of Major GI Bleeding.

<p>Smoking Status and Risk of Major GI Bleeding.</p

Study Flow Diagram.

<p>GIB, Gastrointestinal bleeding.</p

The Dose-Dependent Effect of Nesiritide on Renal Function in Patients with Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

<div><p>Background</p><p>Conflicting renal effects of nesiritide have been reported in patients with acute decompensated heart failure. To answer this controversy, we performed a meta-analysis of randomized controlled trials to evaluate the influence of nesiritide on renal function in patients with acute decompensated heart failure.</p><p>Methods</p><p>Articles were obtained from PubMed, Medline, Cochrane Library and reference review. Randomized controlled studies that investigated the effects of continuous infusion of nesiritide on renal function in adult patients with acute decompensated heart failure were included and analyzed. Fixed-effect model was used to estimate relative risk (RR) and weight mean difference (WMD). The quality assessment of each study, subgroup, sensitivity, and publication bias analyses were performed.</p><p>Results</p><p>Fifteen randomized controlled trials were eligible for inclusion. Most of included studies had relatively high quality and no publication bias was found. Overall, compared to control therapies, nesiritide might increase the risk of worsening renal function in patients with acute decompensated heart failure (RR 1.08, 95% CI 1.01–1.15, <i>P</i> = 0.023). In subgroup analysis, high-dose nesiritide strongly associated with renal dysfunction (RR 1.54, 95% CI 1.19-2.00, <i>P</i> = 0.001), but no statistical differences were observed in standard-dose (RR 1.04, 95% CI 0.98-1.12, <i>P</i> = 0.213), low-dose groups (RR 1.01, 95% CI 0.74-1.37, <i>P</i> = 0.968) and same results were identified in the subgroup analysis of placebo controlled trials. Peak mean change of serum creatinine from baseline was no significant difference (WMD -2.54, 95% CI -5.76-0.67, <i>P</i> = 0.121).</p><p>Conclusions</p><p>In our meta-analysis, nesiritide may have a dose-dependent effect on renal function in patients with acute decompensated heart failure. High-dose nesiritide is likely to increase the risk of worsening renal function, but standard-dose and low-dose nesiritide probably have no impact on renal function. These findings could be helpful to optimize the use of nesiritide in clinical practice.</p></div