bmj.com -- Press Releases

Press Releases Saturday 24 April 1999
No 7191 Volume 318

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(1) BETTER INTEGRATION OF LONG-TERM AND ACUTE
CARE OF ELDERLY NEEDED

(2) INTENSIVE CARE BEFORE A MAJOR OP MAY
IMPROVE SURVIVAL

(1) BETTER INTEGRATION OF LONG-TERM AND ACUTE
CARE OF ELDERLY NEEDED

(Profile of disability in elderly people: estimates from a
longitudinal population study)
http://www.bmj.com/cgi/content/full/318/7191/1108

Better integration between acute and long term care for elderly
patients is needed, say researchers in this week's BMJ. Their
claim is based on an analysis of the Medical Research Council's
cognitive function and ageing study. They found that disabled
elderly people both use acute hospitals extensively and a large
proportion of them live outside institutions, depending on formal
and informal care givers.

In their analysis of 10,377 people in Cambridgeshire, Newcastle,
Nottingham and Oxford, Dr David Melzer and colleagues found
that eleven per cent of men and 19 per cent of women aged 65
years and over were disabled, totalling 1.3 million people in the
UK. Overall they discovered that more than 80 per cent of
elderly disabled people needed help on at least a daily basis and
that 63 per cent used acute hospital services over a two year
period.

The authors write that throughout the developed world the
funding of care for disabled elderly people has become a highly
publicised political issue. They say that according to previously
published figures, UK total expenditure on long term care is
estimated to account for 3.6 per cent of gross domestic product
and that this figure could rise to 10.8 per cent by the year 2030.

Melzer et al conclude that there is considerable overlap between
acute hospital and long term care and that there is a strong case
for improved co-operation between the two. They say that there
should be incentives for the provision of services aimed at
preventing the need for hospital admission as well as
improvement in arrangements for early discharge and
rehabilitation in the community.

Contact:

Dr David Melzer, Clinical Senior Research Associate,
Department of Community Medicine, University of Cambridge,
Institute of Public Health, Cambridge
Email:dm214{at}medschl.cam.ac.uk

(2) INTENSIVE CARE BEFORE A MAJOR OP MAY
IMPROVE SURVIVAL

(Reducing the risk of major elective surgery: randomised
controlled trial of pre-operative optimisation of oxygen delivery)
http://www.bmj.com/cgi/content/full/318/7191/1099

Intensive care treatment of patients about to undergo major
elective surgery can help to improve survival rates, say
researchers in this week's BMJ. Major surgery in high risk
people produces large numbers of critically ill patients, but
appropriate pre-operative care may help to reduce mortality,
morbidity and even reduce total stay in hospital, say Dr Jonathan
Wilson and colleagues from York District Hospital.

They studied 138 patients undergoing major elective surgery,
who were at risk of developing postoperative complications. In
the UK, most patients are taken from a general ward directly to
the operating theatre before such surgery and so the authors
compared the outcome of patients who were treated in this
normal way and of those who were given pre-operative
treatment.

They found that those patients who had received treatment
before their operation had a mortality rate of three per cent as
opposed to 17 per cent in those patients who did not. Wilson et
al conclude that even though a formal cost benefit analysis was
not performed, the cost of pre-operative investment in high
dependency care facilities could be offset by the reduction in
complications and length of hospital stay.

Contact:

Dr Jonathan Wilson, Consultant, Department of Anaesthetics,
York District Hospital, York
Email:jonathan{at}critbase.demon.co.uk

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