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Biomedical subjects

E Grundy

Publications and source records attributed to E Grundy.

At least 19 recordsLinked to original sources
PubMed2004

Living arrangements and place of death of older people with cancer in England and Wales: a record linkage study.

The main objectives of the study were to (1) see whether the household circumstances of people aged 50 years and over with cancer, and trends in these, differ from those of the rest of the population and (2) whether living arrangements and presence and health status of a primary coresident are associated with place of death among older people dying of cancer and those dying from other causes. The design included prospective record linkage study of people aged 50 years and over included in a 1% sample of the population of England and Wales (the Office for National Statistics Longitudinal Study). The main outcome measures comprised family and household type, and death at home. The household circumstances of older people with cancer were very similar to those of the rest of the population of the same age and both showed a large increase in living alone, and decrease in living with relatives, between 1981 and 1991. The primary coresident of cancer sufferers who did not live alone was in most cases a spouse, with much smaller proportions living with a child, sibling or other person. In all, 30% of spouse, and 23% of other, primary coresidents had a limiting long-term illness. Compared with people who lived alone in 1991, odds of a home death among those dying of cancer between 1991 and 1995 were highest for those who lived with a spouse who had no limiting long-term illness (odds ratio (OR) 2.52, 95% confidence interval (CI) 2.15-2.97) and raised for those living with a spouse with a long-term illness (OR 2.14, CI 1.79-2.56) and those living with someone else who was free of long-term illness (OR 2.13, CI 1.69-2.68). Higher socioeconomic status, both individual and area, was positively associated with increased chance of a home death, while older age reduced the chance of dying at home. The changing living arrangements of older people have important implications for planning and provision of care and treatment for cancer sufferers.

Aged↗
PubMed2001

The socioeconomic status of older adults: how should we measure it in studies of health inequalities?

STUDY OBJECTIVE: To identify which of seven indicators of socioeconomic status used singly or combined with one other would be most useful in studies of health inequalities in the older population. DESIGN: Secondary analysis of socioeconomic and health data in a two wave survey. SETTING: Great Britain. Participants were interviewed at home by a trained interviewer. PARTICIPANTS: Nationally representative sample of 3543 adults aged 55-69 interviewed in 1988/9, 2243 of whom were interviewed again in 1994. METHODS: Desirable features of socioeconomic measurement systems for identifying health inequalities in older populations were identified with reference to the literature. Logistic regression was used to examine variations in self reported health by seven indicators of socioeconomic status. The pair of indicators with the greatest explanatory power was identified. MAIN RESULTS: All indicators were significantly associated with differences in self reported health. The best pair of variables, according to criteria used, was educational qualification or social class paired with a deprivation indicator. DISCUSSION: For a range of reasons the measurement of socioeconomic status is particularly challenging in older age groups. Extending our knowledge of which indicators work well in analyses and are relatively easy to collect should help both further study of health inequalities in the older population and appropriate planning.

Aged↗
PubMed2000

Adult life experiences and health in early old age in Great Britain.

In Britain and other developed countries older people comprise a large majority of all those reporting long term illness or disability. However, most studies of socio-demographic variations in health have focussed on those in younger age groups. Moreover approaches to the study of health variations are often fragmented. In this study we have adopted a life course approach to analyse differentials in health in early old age. The data comes from the Retirement and Retirement Plans Survey and follow-up, a two-wave study of persons aged 55-69 in 1988/9. As well as information on current circumstances, the data set includes occupational, marital, and fertility history information. At baseline a nationally representative sample of the population of Great Britain were interviewed at home by trained interviewers (n = 3543). The sample was followed up and in 1994, 2247 survivors were re-interviewed, a response rate of 70% (of survivors). The data were weighted to adjust for non-response bias. Two outcome measures were used: self rated health and presence or absence of disability assessed from a scale derived from detailed questions on thirteen domains of disability. The severity score used was that developed for the 1985/6 ONS Surveys of Disability. The findings indicate that health and disability status at baseline and at follow up were associated with socioeconomic and geographic variables, such as proportion of adult life spent unemployed and residence outside the Southeast of England; demographic factors, such as early age at marriage and high parity; and experience of adverse events, such as the death of a child and being dismissed from work. The results show that socio-economic, demographic, and geographical and life events' factors are all associated with health status in early old age and that integrated, rather than bifurcated, approaches to the study of health differentials are needed.

Adult↗
PubMed2000

Socio-demographic differences in the onset and progression of disability in early old age: a longitudinal study.

OBJECTIVES: to analyse socio-demographic differences in the onset and progression of disability. DESIGN: analysis of a cohort of people aged 55-69 in 1988-9 and in 1994. SUBJECTS: a representative sample of 3543 adults. METHODS: we measured severity of disability at baseline and follow-up. We analysed variations in incidence and progression of disability by using logistic regression. RESULTS: Baseline severity of disability was similar for men and women but varied by age group, social class, educational qualifications and housing tenure. At follow-up, 36% had worse disability, 12% better and 53% the same as at baseline. Increased severity of disability and new incidence of disability were associated with lower socioeconomic status, baseline self-rated health status, age and gender. High initial levels of disability were associated with improvement at follow-up. CONCLUSION: disability can be dynamic, although deterioration is more usual than improvement. The reasons for the associations found between disability and socio-economic status are unclear.

Aged↗
PubMed1999

Looking beyond the household: intergenerational perspectives on living kin and contacts with kin in Great Britain.

In this article we present the first results from a special module on kin and contact with kin included in the Omnibus Survey earlier in 1999. Our results show that nearly everybody in contemporary Britain has a living parent or a living child, and many have both. Membership of three generational families is now common and quite large minorities of very old people aged 80 and over are members of families including four living generations. Half or more of those with a father, mother or (eldest) child alive see them at least once a week and exchanges of help between mothers and their own mothers are common. Half of those who have the relatives considered, live within half an hour's journey time of them, and half of the sample live within half an hour of the place where they spent most of their childhood. The results show that in contemporary Britain the vast majority has close relatives in different generations with whom they are in regular contact.

Adult↗
PubMed1998

Migration and household change in the population aged 65 and over, 1971-1991.

"This analysis uses the ONS [Office for National Statistics] Longitudinal Study, a record linkage study including individual-level data from three national Censuses (1971, 1981 and 1991) and linked vital registration data, to examine migration patterns among older people [in Great Britain]. The aims of this study are to examine regional differences in household composition, to look at changes in the relationship between household change and migration over time, and finally, to analyse the interrelationships between changes in household composition, health and migration in the 1981-91 period.... Despite...dramatic changes in the living arrangements of older people, results show that mobility among the elderly remained relatively stable between the 1971-81 and 1981-91 decades."

Adult↗
PubMed1997

Activities of daily living: changes in functional ability in three samples of elderly and very elderly people.

OBJECTIVES: to investigate changes in functional ability and physical health, psychiatric morbidity, life satisfaction, service use and social support. DESIGN: a structured interview survey of three samples of elderly people living at home at two points in time. The three samples comprised one census of people aged 85 and over [City (of London) and Hackney], and two random samples of people aged 65-84 (City and Hackney and Braintree). The follow-up interviews took place 2.5-3 years after the baseline interviews. SETTING: City and Hackney (East London) and Braintree (Essex). Respondents were interviewed at home by one of 12 trained interviewers. SUBJECTS: 630 people aged 85+ at baseline (70% response rate) and 78% of survivors re-interviewed at follow-up; 464 people aged 65-84 in Hackney at baseline (67% response rate), and 83% of survivors re-interviewed; 276 people aged 65-84 in Braintree at baseline (82% response rate), and 78% of survivors re-interviewed. MAIN OUTCOME MEASURES: scores on scales of functional ability, psychiatric morbidity, life satisfaction and social support, and items measuring number and type of health symptoms and services used. CONCLUSIONS: decreasing levels of physical functioning were associated with poor mental health, trouble with feet and problems with muscles and joints. There were no associations with level of physical functioning and use of rehabilitative or general medical services, use of social worker or carer relief. Few respondents used preventive or rehabilitation services.

Activities of Daily Living↗
PubMed1997

Trends in, and transitions to, institutional residence among older people in England and Wales, 1971-91.

OBJECTIVES: To compare transitions from private households to institutions between 1971-81 and 1981-91 among elderly people and see whether (1) differentials in the risk of institutionalisation changed and (2) whether the risk was higher in the second period. DESIGN: Cross sequential analysis of data from the Office of National Statistics longitudinal study, a record linkage study which included individual level data from three national censuses, (1971, 1981, and 1991) and linked vital registration data. SUBJECTS: Altogether 26,400 people aged 65 and over in 1971-81 and 32,500 persons aged 65 and over in 1981-91. These samples represent 1% of the population of England and Wales. RESULTS: In both periods models including age, housing tenure, and marital status or household/family type terms fitted the data reasonably well. The effect of age was stronger in the second decade, while that of marital status was reduced. The risk of transition to an institution was nearly 33-52% higher in the second decade after controlling for these factors. CONCLUSIONS: During the 1980s the availability of state financed institutional care increased substantially; a growth which the 1990 NHS and Community Care Act was designed to reverse. Increased access to institutional care undoubtedly is one factor underlying the higher transition rate to institutions observed in 1981-91 than for the previous decade. During 1981-91, transitions to live with relatives also declined substantially. It is not clear whether this simply represents the continuation of a previous trend or whether the increased availability of institutional care led to some substitution for family care. Either interpretation has worrying implications for policy makers keen to promote care in the community.

Age Factors↗
PubMed1993

Changes in life satisfaction over a two and a half year period among very elderly people living in London.

Research evidence concerning the contributions of social networks and support to the subjective wellbeing (i.e. life satisfaction) of older persons is not consistent. This paper reports the results of an investigation of the effects life satisfaction at baseline, social network type and health status, on life satisfaction at follow-up at two and a half years later among people ages 85+ living in the East end of London. The percentage of the total variation in overall life satisfaction which was explained by the model was 47%. Baseline life satisfaction score explained most of this (43%), and the remaining variation was explained largely by functional status and age. Previous analyses of baseline life satisfaction reported that health and functional status had accounted for most of the variation between groups, far more than social network and support variables.

Activities of Daily Living↗
PubMed1992

The living arrangements of elderly people.

"In order to assess possible future trends in the living arrangements of elderly people and their implications, we need to understand the causes of...relatively recent changes. Analysts have variously stressed demographic trends, economic factors and behavioural or cultural shifts as major influences on changing household patterns. These arguments are reviewed [in this article]." Aspects considered include the availability of spouse and children, coresidence between elderly parents and children, cultural factors, income, and health and health care. The primary geographical focus is on the United Kingdom, with some additional information for the United States and selected other developed countries.

Adolescent↗
PubMed1987

Community care for the elderly 1976-84.

The aging of the elderly population is of crucial importance as people who are over 80 make far greater use of health and social services than any other age group. Government guidelines on the provision of services, which are generally related to the whole population aged 65 and over, fail to take account of this change in the age structure of the elderly population and are no longer appropriate. Recent trends in the provision of domiciliary services, day care, specialist housing for the elderly, and residential care have been related to changes in the number of potential consumers. Ironically, despite the government's stated commitment to "community care," the chief growth area has been private institutional care. The number of day care places and sheltered housing units has also increased in real terms, but the provision of domiciliary services, such as home help and health visitor visits to the elderly, has either fallen behind or barely matched the increase in the number of very old people. If community care is to be made a reality and if the present inadequate levels of service are to be maintained, let alone improved, then additional resources, greater cooperation among agencies, and a more imaginative approach to the development and delivery of services are urgently needed.

Aged↗
PubMed1986

60 years of suicide in England and Wales. A cohort study.

In a cohort analysis of suicides recorded in England and Wales from 1921 to 1980, there was no discernible trend across the younger cohorts, but there was a fall in the suicide rates of successive older cohorts over this period. The impact of period events (eg, World War II and the detoxification of domestic gas) is demonstrated in these cohorts. In addition to the period effects, there was evidence of a more prolonged cohort effect on suicide rates of the middle-aged and elderly associated with these events. Little relationship was found between early and later suicide rates within cohorts, casting doubt on the usefulness of predicting the future rates of cohorts from their early behavior.

Adolescent↗
PubMed1986

A controlled trial of antidepressant medication in elderly in-patients.

A multi-centre controlled trial of amitriptyline, dothiepin and mianserin in the treatment of depressive illness was undertaken in psychiatric inpatients over the age of 65. Despite the co-operation of many of the leading practitioners in this field in Great Britain, it proved impossible to recruit sufficient patients for firm conclusions to be drawn. Forty-five patients were entered into the trial, 13 withdrew because of lack of improvement, 4 because of intercurrent physical illness, 3 because of adverse effects of trial medication and 2 because of lack of compliance. Only 11 of the 23 patients completing had a final score on the Hamilton Depression Rating Scale of 10 or less. No treatment showed a significant superiority over the others, nor was there any difference in tolerance.

Aged↗