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... In addition, non-stochastic effects are more common in organs/ systems (e.g., brain, cartilage, heart, kidney, lung parenchyma and spinal cord) where terminally differentiated cells have a low turnover and exhibit limited regenerative capacity (Ballard and Edelberg, 2007;Carlson, 1998;Goldspink et al., 2003;Rando, 2006). Non-stochastic processes produce a broad spectrum of agerelated declines in the function of physiological processes (e.g., basal metabolic rate, blood volume, cardiac index, glomerular filtration rate, maximal breathing capacity and nerve conduction velocity) that were enumerated by the early biogerontologists (Falzone and Shock, 1956;Shock, 1957) and geriatricians (Anderson and Cowan, 1955;Rowe et al., 1976) and continue to be identified (Aalami et al., 2003;Nakamura and Miyao, 2003;Olivetti et al., 1991;Sehl and Yates, 2001;Weale, 1993). ...
This chapter presents an interdisciplinary collaboration that has made scientific contributions to the emerging field of biodemography. It identities personal and professional challenges that emerge from collaborations in general and interdisciplinary research in particular. It then describes how researchers attempted to resolve these problems over the course of a collaboration that is long-term and ongoing.
... The data relate to 362 men and 394 women seen at the Rutherglen Consultative Health Centre for Older People (Anderson and Cowan, 1955). All were considered to be in good health after a detailed clinical examination, which included ophthalmoscopic examination and where necessary electrocardiographic assessment. ...
... In addition, non-stochastic effects are more common in organs/systems (e.g., brain, cartilage, heart, kidney, lung parenchyma and spinal cord) where terminally differentiated cells have a low turnover and exhibit limited regenerative capacity (Ballard and Edelberg, 2007;Carlson, 1998;Goldspink et al., 2003;Rando, 2006). Non-stochastic processes produce a broad spectrum of age-related declines in the function of physiological processes (e.g., basal metabolic rate, blood volume, cardiac index, glomerular filtration rate, maximal breathing capacity and nerve conduction velocity) that were enumerated by the early biogerontologists (Falzone and Shock, 1956;Shock, 1957) and geriatricians (Anderson and Cowan, 1955;Rowe et al., 1976) and continue to be identified (Aalami et al., 2003;Nakamura and Miyao, 2003;Olivetti et al., 1991;Sehl and Yates, 2001;Weale, 1993). ...
The distinctions between senescence and disease are blurred in the literature of evolutionary biology, biodemography, biogerontology and medicine. Theories of senescence that have emerged over the past several decades are based on the concepts that organisms are a byproduct of imperfect structural designs built with imperfect materials and maintained by imperfect processes. Senescence is a complex mixture of processes rather than a monolithic process. Senescence and disease have overlapping biological consequences. Senescence gives rise to disease, but disease does not give rise to senescence. Current data indicate that treatment of disease can delay the age of death but there are no convincing data that these interventions alter senescence. An understanding of these basic tenets suggests that there are biological limits to duration of life and the life expectancy of populations and reveal biological domains where the development of interventions and/or treatments may modulate senescence.
... These people did not represent a random sample of the population as the Centre was an experiment designed to provide clinical facilities for the early detection of disease in the elderly, and intake was dependent on general practitioner referral. Deaths which subsequently occurred were noted in the Register of Deaths maintained by the Health Department and from information derived from general practitioners (Anderson and Cowan, 1955). By the early part of 1974 17 men and nine women could not be traced, while of the remaining 222 men and 175 women, four and five respectively were still alive. ...
The purpose of this study was to discover any relationships which might exist between measurable variables recorded when a healthy group of men and women, aged 70 years and over, were examined and their subsequent survival time. It was found that height, body weight, systolic and diastolic blood pressures, haemoglobin, hand grip power, cardiothoracic ratio, and pulse rate are of no predictive value in the estimation of survival time. Survival is not influenced by marital status or occupational class. For both sexes the degree of kyphosis and age are useful predictive criteria in respect of survival time. However, much research work requires to be done to explain why many people die at the time they do.
... There have been many reports on screening programmes for the elderly in general practice (Williamson et al., 1964; Thomas, 1968; Burns, 1969; Lowther et al, 1970; Irwin, 1971; Currie et al., 1974): these uniformly confirm that ill health in old age is made up of many and varied problems, a significant number of which can be alleviated, if not solved. The ability of the health visitor to screen the elderly patient has been stressed by many authors (Anderson and Cowan, 1955; Williamson et al, 1964; Irwin, 1971; Currie et al, 1974), but health visitors have other work apart from caring for the elderly, and a continuous screening programme in a group practice of three doctors would require the full-time involvement of one health visitor, additional to the normal service commitment (Ness and Reekie, 1970; Currie et al., 1974) The form contains several sections: the first page contains demographic data about the patient and details of the acceptance of the interview by the patient. The next section includes questions of such medical complaints as mobility, vision, and hearing, which are socially important. ...
... Scott (1962) considers that routine visiting of the elderly by their general practitioner would enable medical and other needs to be identified and relieved at an earlier stage. When such need has been identified it may be possible for the general practitioner to refer his patient to a consultative health centre (Anderson and Cowan 1955; Maddison 1960) for further advice and treatment of medical and of social problems. The difficulty of such a scheme is that it is doubtful whether frequent routine visiting of the elderly by the busy general practitioner would be acceptable either to the doctor or to the patient. ...
... These periodic examinations will show what self-reporting of minor illnesses has failed to achieve (Williamson et at., 1964 Richardson, 1964). In the long run this early detection avoids hospital admission, as has been shown at Rutherglen (Anderson and Cowan, 1955), and must inevitably reduce the demands made by the aged on the community as a whole. ...
... METHODS The data are derived from the records of 111 men and 160 women, aged 60 to 69 years, and 123 men and 129 women, aged 70 to 79 years, who attended the Rutherglen Consultative Health Centre for older people (Anderson and Cowan, 1955). All were considered to be in good health after a complete clinical examination which included ophthalmoscopic and rectal examinations. ...
As in most European countries, medical care in Great Britain began with the church and the gradual development of infirmaries within its monasteries. Both St Thomas’ and St Bartholomew’s hospitals in London came into being in this way and both of these were closed in 1540 during the suppression of the monasteries by Henry VIII. However, the subsequent accumulation of the sick and lame in London streets created the obvious need for alternative accommodation and St Bartholomew’s was re-opened in 1547 to be run by the Lord Mayor of London. Ten years later, St Thomas’ was re-opened in a collective charter of the Royal Hospitals which included Christ’s Hospital (for orphaned children), Bethlehem (for the lunatic poor) and Bridewell (for idle rogues).
It is perhaps only human to be influenced by the worse case examples, and negative stereotypes of older people will be hard to reverse, but to see all older people as being frail, dependent and diseased is a serious and unjustifiable distortion of the true picture. Sociodemographic trends justify society’s concern about the impact of the growing number of older people, but for many the prospect of an ageing population is not simply about numbers, since their fears are greatly influenced by the prevailing images of old age. It is likely that when asked to think of an old person, most of us, whether lay or professional, are likely to picture a frail, bent person, slow to move and think and short of memory. More specific medical stereotypes such as incontinence, dementia and deafness are also likely to spring to mind. As with many commonly held beliefs, there is some basis for this one. The prevalence of disease and dependency problems is higher in the over-65-year-old age group, and the frequency of reported health problems increases with advancing years (Abrams, 1978; Office of Population Censuses and Surveys, 1982; Ford and Taylor, 1985).
Ein 72jähriger litt zu gleicher Zeit an folgenden Affektionen: Hypertonie, Herzfehler (Kardiosklerose) mit tachykardem Vorhofflimmern und kardiovaskulärer Dekompensation, Angina pectoris, infektiöse Bronchitis, chronische Zystitis bei Prostatahypertrophie II. Grades, mäßiger Diabetes mellitus mit Pruritis, Morbus Parkinson mit Neigung zu seelischen Depressionen und Schlaflosigkeit. Diese Leiden können nicht gleichzeitig mit etwa 10 Medikamenten pro Tag behandelt werden. Die das gesamte Krankheitsbild beherrschende Herzinsuffizienz besserte sich in wenigen Tagen nach oralen Gaben von Digitoxin, wobei auch die Schlaflosigkeit zurückging (1. Medikament). Von einer intensiven diuretischen Therapie, z. B. mit Furosemidpräparaten, haben wir wegen der Gefahr der Überlaufblase bei fortgeschrittener Prostatahypertrophie Abstand genommen. Die diätetisch nicht ganz einstellbare Zuckerkrankheit sprach auf kleine Dosen von Glibenclamid unter Beachtung des Hyperglykämien gut an (2. Medikament). Die gleichzeitig bestehende chronische Zystitis haben wir — entsprechend dem bakteriologischen Harnbefund — mit langfristigen Gaben eines Sulfonamidpräparats (Trimethoprim+Sulfamethoxazol) beherrscht (3. Medikament). Die Zystitistherapie mit Gentamycin ist wegen der Gefahr der Hörschädigung bei meist bestehender Altersschwerhörigkeit kontraindiziert. Da das Hautjucken, das sich auf die eingeleitete Diabetesbehandlung hin nur wenig besserte, wandten wir mit gewissem Erfolg antipruriginöse Salben (4. Medikament) an. Auf eine orale Behandlung mit Kortisonpräparaten sollte man in Anbetracht der damit verbundenen Osteoporosegefährdung bei Betagten verzichten: auch vermieden wir, den gleichzeitig bestehenden Morbus Parkinson mit den üblichen anticholinergischen Pharmaka wegen der Gefahr der Blasenatonie bei fortgeschrittener Prostatahypertrophie anzugehen. Erst Wochen später konnte die Parkinsonsymptomatik mit kleinen Dosen Bromocriptin (5. Medikament) beherrscht werden (Franke 1984).
Medical screening of 100 old people at the time of their acceptance for admission to residential (part 3) care revealed a great deal of previously unreported yet treatable illness. As a result of screening, alternative care was thought more appropriate in 32 cases—hospital admission in 16, sheltered housing in 4, and remaining at home in 12. It is therefore suggested that the time of translocation of an old person from independent to institutional living is a time when medical screening is particularly appropriate.
In the December issue Iliffe1 assured us that our article ‘anticipatory care of older patients represented the triumph of hope over experience’.2 We find this a bewildering claim in view of the extensive research evidence to the contrary. No less than six controlled trials between 1979 and 1993 showed that a programme of care, tailored to the special needs of those in advanced old age, reduced the time spent in institutional care (hospitals and nursing homes). They …
The projected doubling of the >75-year-old population in the next 20 years presents a major challenge.1 While standards of care in general practice have risen steadily over the past 30 years, for vulnerable older people the picture is different. The term ‘vulnerable’ covers multimorbidity, functional incapacity, and socioeconomic and psychological problems severe enough to put the patients at significantly increased risk of hospital and institutional admission. Routine GP surgery sessions alone are inadequate to assess complex comorbidity, polypharmacy, and adherence, in addition to reviewing disabilities and carer pressure. At the age of 75 years, patients will have, on average, three medical disorders. At least one-quarter will have a significant level of functional disability, rising exponentially with increasing age, and they will often have socioeconomic and psychological problems which loom larger in advanced old age. It is vital that all these problems are addressed if the patient’s needs are to be adequately met.
We challenge primary care to develop cost-effective ways to integrate population scanning of the older population, most logically for those over the age of 75 years, leading to risk stratification and a coordinated primary care and community response. Community programmes, working with primary care, are also needed to reduce behavioural risks such as smoking cessation as well as encourage exercise and give dietary advice. In our own practices we valued cooperative work with trained volunteers.2 De Maeseneer, argued that ‘practices integrate individual and population-based care, blending the clinical skills of practitioners with epidemiology, preventive medicine and health promotion’.3
The first requirement may be to change the mindset, from student level into practice, of some GPs in their management of vulnerable older people; recognising that they require a different programme of care geared to …
We contest D’Souza and Guptha’s claim that “no convincing evidence exists that increases in the provision of community services reduce the length of stay for frail older people.”1
There are two commonly used markers of the effectiveness of such programmes in older patients—the number of institutional referrals and time spent in institutional care. The ultimate objective of care in this field is to keep these vulnerable old people active and independent for as long as possible. Thus, the effectiveness of these measures is best reflected by reductions in the number of bed days of institutional care rather than the number of institutional referrals.
The authors …
A randomized controlled trial of geriatric screening and surveillance was undertaken on a practice population of 295 patients aged 70 years or more over a two-year period. In the screened group (145 patients) many social problems were found and a total of 380 medical conditions were reported during the study period, 144 (38 per cent) of which were previously undetected. Conditions found most frequently involved the circulatory, musculoskeletal and nervous systems; 67 per cent of the conditions found were manageable, half being improved and the remainder resolved completely.The screening programme was found to increase the use of social and health services but it did also decrease the expected duration of stay in hospital.Independent assessment of patients in the study and control groups at the end of the two-year period showed that the screening programme had made no significant impact on the prevalence of socio-economic, functional, and medical disorders affecting health.We formed the firm impression that the study patients were made more comfortable (by control of pain) and less disabled, although there was no unequivocal objective evidence of this. They were, however, kept independent for longer.The findings are discussed and a model of geriatric care is suggested combining conventional management on demand with comprehensive screening to identify the high-risk patients on whom care might need to be focussed.
Problems facing the modern health care worker are examined. These include population changes, the changing pattern of disease, the psychosocial aspects of aging, and altered pathophysiologic mechanisms. The major future requirements in health care for the elderly are outlined. Greater emphasis should be placed upon education in the disciplines of Gerontology and Geriatric Medicine. Society needs to be made more aware of the realities of aging. Health care professionals need to develop their communication skills and to practice more effective teamwork. Greater coordination of the components of health care delivery systems will be needed in order to provide comprehensive and continuing health services. Research into the true and changing needs of the elderly recipients of health care should be emphasized. Prevention and early detection of disease is an important focus in Geriatric Medicine for the future.
Health screening for old people who live at home has been the subject of debate for 30 years or so. It has come to the fore again in the UK with the new emphasis on annual assessments by general practitioners (GPs) of those aged 75 or more. Screening in the elderly has implications for manpower. How can it best be done? We describe here a randomised, controlled study of case finding and surveillance in patients aged 65 and over in a general practice in South Wales. Problem identification was by a postal questionnaire, focusing on function, that was sent at random to 369 eligible patients with subsequent verification and intervention by a specially appointed nurse. The 356 controls had no questionnaires and no contact with that nurse. The study lasted 3 years, and end-points included mortality, self-ratings of quality of life, and health status, and use of all services (GP contacts, hospital admission, home help, and so on). Mortality was significantly lower in the intervention group (18%) than in the controls (24%) (difference 6.0% [95% CI 0.1-11.9%], p less than 0.05). Total number of hospital admissions did not differ between intervention and control groups, but duration of hospital stay of patients aged 65 to 74 years was significantly shorter in the intervention group (difference 4.6 days [95% CI 1.6-7.6], p less than 0.01). An increase in visits to a GP was largely offset by a lower number of home visits by a GP. Quality-of-life measures revealed no between-group differences, but self-rated health status was superior in the intervention group. We conclude that the use of a postal screening questionnaire with selective follow-up and intervention can favourably influence outcome and use of health care resources by elderly people living at home.
There is little information on how best to provide health promotion and disease prevention services to elderly persons. This paper reports participants' perceptions of the effectiveness of a health promotion program consisting of health education classes and case management services. A single-group, posttest only design was used for the county-wide program, which operated independent of participants' primary care physicians. Each person received a thorough screening evaluation, was invited to health education classes, and was assigned a case manager for a 2-year health promotion period. Community residents 64-71 years of age were recruited; 475 entered the study, and 378 (79.6 percent) completed the followup evaluation interview. Only one-third of the participants attended at least one class, but a majority of those attending each class rated it very or extremely effective in increasing knowledge. To determine the effectiveness of the case managers, each participant identified the three health problems that were of greatest concern to him or her and indicated which of these priority problems were discussed with the case manager. Discussion with the case manager was significantly associated with continuing to see a personal physician for the problem, following the physician's recommendations, the problem's being under control, and the problem's improving over the 2-year followup. The classes and case management services benefited the participants who used them. How to best deliver these services to the target group needs further study.
There is a considerable volume of literature on the needs of elderly people, derived from both the medical and social sciences. This article reviews material relevant to preventive care and the best ways of arranging it, with particular reference to the developments as a result of the new general practitioner contract. It is argued that although the new contract disregards much of the medical research, there are still some benefits to be gained by applying research findings within the new framework, as well as by reviewing its operation in the light of research and experience currently available.
A random 10% sample of patients aged 65 years and over in a large rural practice were screened by a member of the primary health care team. Five 'at risk' categories were chosen: lives alone, unable to prepare own food, no telephone, death of partner in last two years and discharged from hospital in last two months. The aim was to identify those at risk and those who had unmet needs for services and to see if the at risk criteria were valid indicators of unmet need. The cost of the screening itself and the cost of the services and aids were calculated. Thirty nine per cent of those aged 65 years old and over had one or more of the risk factors. The cost of screening all people in our practice aged 65 years and over who were living independently was estimated at 16,600 pounds and this screening revealed the estimated cost of additional needs to be 45,151 pounds per annum. The cost of screening the elderly could be reduced by first restricting it to those aged 75 years and over, the group with greatest need, and secondly by using opportunistic screening, since 87% of all those aged 85 years and over and 71% of the 75-84 year olds are seen annually by the primary health care team for other reasons. This could reduce the cost of screening all those aged 75 years and over in our practice from 7560 pounds to 1925 pounds. Contact is not synonymous with screening and a conscious effort to ask the salient questions is required in order to discover the unmet needs.
The lack of evidence to support formal annual screening of all older people does not weaken arguments for a preventive and anticipatory component to primary care. A number of short screening schedules for use by nurses or volunteers or for self-completion by patients have been developed. Patients 'failing' the screening stage are then fully assessed. This paper describes the design and pilot study of a brief anticipatory care system which can be integrated into routine general practice as the first stage of the twostage process. It was found that only about 28 of the 102 patients screened required follow up and in general the doctors found the system easy to administer during normal surgery sessions.
A medico-social survey of 259 elderly patients aged 70-72 was carried out by three doctors, a health visitor and a nurse in an urban general practice. Seven hundred and ninety diseases or disabilities were identified-an average of 3.2 per patient-of which 20.5% were unknown to the doctors. Using a simple check list for symptom inquiry, the health visitor or nurse missed very little of the physical or psychological disease. In some respects their symptom inquiry was more revealing than that of the doctors but they had difficulty in eliciting evidence of malnutrition, masked depression, and incipient dementia. Initial health screening of the elderly for unreported disease in general practice can easily be done by a health visitor with training in geriatric problems and the recognition of psychiatric illness.Initial health screening can also be done by a nurse with community-nursing experience but she will require additional training in the techniques of social assessment. The doctor must examine those patients found to be suffering from alerting symptoms. A general practice of three or four doctors requires one health visitor for routine work and one additional health visitor or nurse for screening of the elderly. Unreported disease in the elderly indicates failure to make contact and failure to ask the right questions. Unknown disease may be due to inadequate records.
: A program for the practice of preventive medicine in the 70+ age group is outlined. This type of work is extremely satisfactory, as in all countries it is essential not only to treat illness but to keep the population as healthy as possible. Old age can be a time of great pleasure and enjoyment and should not be associated in the public mind with either poverty or ill health. In essence, it is postulated that the positive planning of activities with a purpose clearly understood by the elderly will improve their physical, mental and social health. Such activities will provide a place and life purpose for older citizens in the community and will ensure their continued integration as a useful and essential part of society.
A group of 255 patients accepted for a geriatric unit in Glasgow was compared with a random sample of old people in the community matched with the patients for age, sex and economic status; and with a group of old people admitted to a general medical unit. The social factors which increased the probability of becoming a geriatric patient were: advanced old age; being a widower, bachelor or spinster; having no children; and living alone. The medical factors were the presence of two or more of the following symptoms: stroke, falls, gait loss, incontinence, and mental abnormality. These symptoms were associated with insufficient community care, heavy burden on relatives, high mortality and low discharge rate from hospital. Geriatric patients are drawn predominantly, although not exclusively, from a ‘hard core’ of socially disadvantaged old people with multiple diseases; they present with symptoms which deprive them of the ability for self-care and frequently they are in the terminal stage of their lives.
A study of the reasons for admission of 280 patients from their own homes to a geriatric unit in the East End of Glasgow showed that in two-thirds of cases patients were admitted primarily because they failed to receive adequate basic care at home (usually because of lack of relatives) or because their relatives suffered undue strain in caring for them. Neglect by relatives played a negligible part in the need for admission.
Medical examination was offered to a group of "high risk" old people who were not necessarily patients or known to their family doctors, but with the agreement of these family doctors. Two clinics set up for this purpose have been running for several years, and the results of examination and follow-up of 300 consecutive patients are reported.Major conditions were found in two-thirds of patients producing functional impairment in most of these.Recommendations as to therapy and management were carried out in 161 of 194 patients but not in the remainder.Clear evidence of improvement was found in half of the patients who carried out recommendations, and this improvement was attributable to earlier diagnosis than would have been achieved without these clinics in 42% of cases.Including all patients examined, the proportion helped by early diagnosis at 18 to 30 months' follow-up was 23%.It is concluded that the offer of a routine examination to high risk groups is of benefit to old people and a form of medical practice which should be widely adopted.
The new contract for general practitioners, introduced in 1990, required them to offer an annual assessment, or 'health check', to patients aged 75 years or more.
A study was undertaken to collect details of practice organization of these assessments, general practitioners' and practice nurses' experience of assessments, and their views of the value of such assessments.
A nationwide postal survey of 1000 general practitioners and interview surveys with general practitioners and practices nurses from 150 practices were carried out in 1992.
The postal survey yielded a response rate of 69% and the interview survey a practice response rate of 76%. Organization of assessments varied enormously between, and often within, practices with a variety of methods of invitation and assessment instruments being used. Of general practitioners 13% did not use a letter of any sort to invite patients to attend, and many doctors excluded certain patients from assessment, particularly those who were seen regularly or had been seen recently. However, 70% of general practitioners estimated that they had assessed over 60% of their elderly patients in the first year (1990-91). A substantial proportion of assessments were estimated to have been conducted on an opportunistic basis and few practices were doing all the assessments of those aged 75 years and over in the patients' homes. In the majority of practices, the general practitioners and practice nurses were the only personnel carrying out assessments. Only 9% of the doctors and 34% of the nurses interviewed had been specially trained to carry out the assessment; 54% of nurses said they would like more training in this area. Both doctors and nurses reported that the assessments did detect previously unknown problems, although over half of doctors reported that they rarely picked up new mental health problems. Increased referrals to social services as a direct result of the assessments were reported by 63% of doctors. The majority of doctors and nurses reported that routine assessments were useful in providing advice and reassurance to elderly people. Two thirds of doctors said they would continue to offer at least selected groups of their elderly patients routine assessments, even if not contractually obliged to do so.
The findings suggest that the experiences of the first two years of this activity had convinced some general practitioners that routine assessment of elderly patients is worthwhile. However the increased demand for other services must obviously be met by an increase in resources if the effectiveness of these assessments is not to be undermined.
The recent reforms of the NHS have clearly emphasised the potential role of prevention in reducing mortality and morbidity. The specific focus of this paper is the preventive aspects of the new GP contract, and in particular the contractual obligation on GPs to offer an annual assessment to all patients within their practice aged 75 years and over. In reviewing the literature for evidence pertaining to the assessment of elderly people, it is argued that there are a number of unresolved issues which raise certain question marks over the Government's decision to include such assessments in the GP contract. The most fundamental of these issues is whether the costs of such screening are justified by the associated benefits. Other issues relate to the organisation of the assessments. In an attempt to cast some light on these unresolved issues, the results from a recent national survey of GPs in Scotland are presented. The results do not allow a categorical statement to be made on whether or not the assessments are worthwhile per se. However, they do help to clarify the current state of screening elderly people in general practice. In the light of this, directions for future research into the screening of elderly people are suggested.
To compare three different methods of administering a brief screening questionnaire to elderly people: post, interview by lay interviewer, and interview by nurse.
Randomised comparison of methods within a cluster randomised trial.
106 general practices in the United Kingdom. Participants: 32 990 people aged 75 years or over registered with participating practices.
Response rates, proportion of missing values, prevalence of self reported morbidity, and sensitivity and specificity of self reported measures by method of administration of questionnaire for four domains.
The response rate was higher for the postal questionnaire than for the two interview methods combined (83.5% v 74.9%; difference 8.5%, 95% confidence interval 4.4% to 12.7%, P<0.001). The proportion of missing or invalid responses was low overall (mean 2.1%) but was greater for the postal method than for the interview methods combined (4.1% v 0.9%; difference 3.2%, 2.7% to 3.6%, P<0.001). With a few exceptions, levels of self reported morbidity were lower in the interview groups, particularly for interviews by nurses. The sensitivity of the self reported measures was lower in the nurse interview group for three out of four domains, but 95% confidence intervals for the estimates overlapped. Specificity of the self reported measures varied little by method of administration.
Postal questionnaires were associated with higher response rates but also higher proportions of missing values than were interview methods. Lower estimates of self reported morbidity were obtained with the nurse interview method and to a lesser extent with the lay interview method than with postal questionnaires.
In Great Britain, since the end of the Second World War, the problems of old age have tended to supersede those of poverty and unemployment as the object of social studies. The following article assesses some of the most important findings of 33 surveys conducted between 1945 and 1958 investigating the social needs and circumstances of old people.The fact emerges that family ties are stronger than is perhaps realized and that most of the aged live a reasonably secure life within their families. It is pointed out, however, that a small minority exists whose distress is evident and who do not seem to be contacted by social welfare agencies. These are the housebound and bed-ridden; the "isolates" and "semi-isolates"-old people who are without relatives or whose care puts too great a strain on the relatives they have; and those for whom retirement and the consequent loss of occupation is a source of unhappiness. In a discussion of how the needs of this group can be met, it is suggested that the pattern of home and welfare services should be based less on administrative tradition and more on the way of life of the people.