Professor Kichu Nair

Objectives: To describe the development and performance of an instrument for health assessment of older Australian veterans and war widows, including: (a) the underlying dimensions of the assessment instrument, (6) problems identified and (c) associations with health related quality of life. Method: Participants were randomly selected veterans and war widows aged 70 years and over, livingindependently in 10 regions of NSW and QLD. The intervention consisted of a series of preventive care home visit health assessments by health professionals using a specially developed I 13-item screening checklist, together with targeted health education materials, telephone follow-up and computer generated reports to the veteran's local medical officer. Main outcome measures were underlying facets of the checklist, and associations with self reported quality of life. Results: 904 home visit assessments were conducted using the checklist. Problems identified included having no recent hearing check, poor rate of vaccination against pneumonia and tetanus vaccination, and problems with feet. Exploratory factor analysis of the checklist reported four main factors, explaining 31 YO of the variance. Three out of four checklist scales were significantly associated with both physical and mental component scores of the SF- 36 quality of life measure. Conclusions: The preventive care checklist proved easy to administer, acceptable to participants, and contained valid items for use with an older veteran population.

Recognition of cognitive impairment in the elderly is an important part of medical care. This will lead to the proper diagnosis and optimum treatment. Families seldom realise that the patient has dementia. Even with a high index of suspicion, the diagnosis can often be missed. The correct tool for making the diagnosis is also controversial.

We describe a simple quality assurance (QA) exercise that compared the practices of two physicians providing geriatric consultations at a University teaching hospital. Two hundred consecutive referrals were randomly allocated to either physician. Although the patients referred had similar characteristics, their problems were managed differently. This led to an evaluation of work practices and identification of problems to which solutions were found. As the study was incorporated into routine clinical work, its cost in terms of resources and manpower was minimal. Such simple practical QA exercises should be used more extensively to enhance the practice of medicine.

Swallowing difficulties are very common in patients who have suffered cerebrovascular accidents. An inexpensive and simple device called the Palatal Training Appliance was tried successfully in four patients. This appliance could be beneficial for more patients and is under-utilized at present. 1990 Australian Dental Association