No / to measure general practitioners' knowledge of, confidence with and attitudes to the diagnosis and management of dementia in primary care. Setting: 20 general practices of varying size and prior research experience in Central Scotland, and 16 similarly varied practices in north London. Participants: 127 general practitioners who had volunteered to join a randomised controlled trial of educational interventions about dementia diagnosis and management. Methods: self-completion questionnaires covering knowledge, confidence and attitudes were retrieved from practitioners prior to the educational interventions. Results: general practitioners' knowledge of dementia diagnosis and management is good, but poor awareness of its epidemiology leads to an over-estimate of caseload. Knowledge of local diagnostic and support services is less good, and one third of general practitioners expressed limited confidence in their diagnostic skills, whilst two-thirds lacked confidence in management of behaviour and other problems in dementia. The main difficulties identified by general practitioners were talking with patients about the diagnosis, responding to behaviour problems and coordinating support services. General practitioners perceived lack of time and lack of social services support as the major obstacles to good quality care more often than they identified their own unfamiliarity with current management or with local resources. Attitudes to the disclosure of the diagnosis, and to the potential for improving the quality of life of patients and carers varied, but a third of general practitioners believed that dementia care is within a specialist's domain, not that of general practice. More experienced and male general practitioners were more pessimistic about dementia care, as were general practitioners with lower knowledge about dementia. Those reporting greater difficulty with dementia diagnosis and management and those with lower knowledge scores were also less likely to express attitudes endorsing open communication with patient and carer. Conclusion: educational support for general practitioners should concentrate on epidemiological knowledge, disclosure of the diagnosis and management of behaviour problems in dementia. The availability and profile of support services, particularly social care, need to be enhanced, if earlier diagnosis is to be pursued as a policy objective in primary care.

The present study determined the effects of flexing and extending the head on the postural stability and mean anterior-posterior (A-P) center of mass (CM) position during upright stance in the elderly. To ensure visual input to stability was not a confounding variable, visual information was kept as constant as possible for all head positions. Twelve healthy elderly subjects (72.3±4.7 years) were asked to stand stationary on a single force-platform. Postural stability (assessed using the rms A-P excursion of the center of pressure (CP)) was determined for standing with the head erect, and with the head flexed and extended. The vestibular contribution to postural stability becomes increasingly important under challenging conditions, so to highlight the effects of vestibular system input, measurements of postural stability under conditions where visual and somatosensory inputs were disrupted were included. Changes in the mean A-P CM position when tilting the head were assessed by determining changes in the mean A-P location of the CP from standing with the head erect. Compared to standing with the head erect and looking straight ahead, postural stability was reduced when the head was flexed or extended (P<0.01). Changes in mean A-P CM position were only significant when standing with the head flexed (P<0.05). This suggests that increases in postural instability with the head tilted from the erect position may be in part due to mechanical perturbation rather than solely vestibular disruption.

PURPOSE. To determine the influence of cataractous and refractive blur on postural stability and limb-load asymmetry (LLA) and to establish how postural stability changes with the spatial frequency and contrast of the visual stimulus. METHODS. Thirteen elderly subjects (mean age, 70.76 ± 4.14 [SD] years) with no history of falls and normal vision were recruited. Postural stability was determined as the root mean square [RMS] of the center of pressure (COP) signal in the anterior¿posterior (A-P) and medial¿lateral directions and LLA was determined as the ratio of the average body weight placed on the more-loaded limb to the less-loaded limb, recorded during a 30-second period. Data were collected under normal standing conditions and with somatosensory system input disrupted. Measurements were repeated with four visual targets with high (8 cyc/deg) or low (2 cyc/deg) spatial frequency and high (Weber contrast, ¿95%) or low (Weber contrast, ¿25%) contrast. Postural stability was measured under conditions of binocular refractive blur of 0, 1, 2, 4, and 8 D and with cataract simulation. The data were analyzed in a population-averaged linear model. RESULTS. The cataract simulation caused significant increases in postural instability equivalent to that caused by 8-D blur conditions, and its effect was greater when the input from the somatosensory system was disrupted. High spatial frequency targets increased postural instability. Refractive blur, cataract simulation, or eye closure had no effect on LLA. CONCLUSIONS. Findings indicate that cataractous and refractive blur increase postural instability, and show why the elderly, many of whom have poor vision along with musculoskeletal and central nervous system degeneration, are at greater risk of falling. Findings also highlight that changes in contrast sensitivity rather than resolution changes are responsible for increasing postural instability. Providing low spatial frequency information in certain environments may be useful in maintaining postural stability. Correcting visual impairment caused by uncorrected refractive error and cataracts could be a useful intervention strategy to help prevent falls and fall-related injuries in the elderly.

Poor standards of care are unacceptable, but solutions are far from being straightforward. This is a complex issue that is influenced by individual attitudes, perceptions and cultural norms

Elderly consumers are often overlooked in the retail marketplace; however, evidence suggests that the elderly population has a considerable amount of discretionary time and purchase power. Unlike past generations, this consumer group is relatively healthy, active, and demands a wide array of products and services. The purpose of this research was to determine the relationship between store attributes and approach-avoidance behavior of elderly apparel consumers. In addition, this research examined the relationships between age, the importance of store attributes, and shopping orientations of elderly apparel consumers. Data were collected using a convenience sample of persons 65 and older from the southeastern part of the United States. The final sample consisted of 208 subjects. Four hypotheses were formulated. Data were analyzed using frequencies, chi-square, factor analysis, regression, and MANOVA. Results revealed that elderly consumers in this study preferred to shop department stores and mass merchandisers for clothing. These consumers reported that they would spend more time and money in retail stores that offered credit, discounts for those 65 and over, and liberal return policies. Further, the consumers reported they would not return to and would avoid looking around in retail stores without rest areas, with difficult to find items, inferior products, and poor business practices. Regression analyses showed significant relationships between shopping orientations and three of the five attribute factors. MANOVA revealed significant differences between two age groups and the importance placed on quality products, store reputation, and well-known labels/brands. Chi-square analyses showed no significant relationship between age and shopping orientations. / Master of Science

Two experiments were conducted to examine the effects of type of milk (whole; nonfat; nonfat, 70% lactose-reduced) and type of egg (fresh, whole egg; egg substitute) on the quality of baked custards. The egg substitute was a combination of dried egg whit e solids, dried low-fat, low-cholesterol egg yolk solids, and xanthan gum. Custard formulations served as prototypes for use in studies conducted in the Department of Food Science and Technology, Virginia Tech. In those studies, the effects of processing parameters on the quality of the custards were examined. The goal of all the studies was to develop shelf-stable lactose-reduced custard mixes that have potential for use in the foodservice industry. In Experiment I, chemical, physical, and sensory characteristics of a dessert type baked custard, made with sucrose, were examined. In Experiment II, the same characteristics were examined for a cheese flavored, entree type custard made without sucrose. Results indicate that use of nonfat and nonfat, 70% lactose-reduced milk in place of whole milk decreased significantly total fat and cholesterol concentrations in both types of custard mixes. Lactose-reduced milk also decreased lactose and increased galactose concentrations. The egg substitute decreased total fat and cholesterol concentrations and increased protein concentration. In general, lactose reduction had little effect on the physical and sensory characteristics of both types of custards, but the egg substitute affected these characteristics. Custards made with the egg substitute had less intense yellow color and greater gel strength than those made with fresh, whole egg. These custards also were less bright and more uneven in color and had weaker egg flavor and aftertaste. Based on results of this study, development of a lactose-reduced custard is feasible. However, additional studies are needed to examine potential for use of the formulations in the foodservice industry. Because the mixes could be used as bases for other types of products, such as custard pies, filled pastries, and quiches, studies that focus on development of those products could help define the niche for the mixes in the foodservice industry. Because of the trend in today1s market for reduced-fat, reduced-cholesterol foods, additional studies could be done to examine the effects of various types of egg substitutes on the quality of the custards. / Master of Science

No

A qualitative study of 15 families caring for an elderly parent in a noninstitutional setting was conducted for the purpose of discovering how families perceive and carry out their responsibilities to their older relatives. Forty-three persons representing up to three generations per family were interviewed. They articulated the meaning of their responsibility to care for the parent, how they learned to be responsible to family members, and what experiences inside and outside the family shaped their sense of responsibility. They expressed their views about how family caregiving labor should be divided between male and female members. Questions about the factors that affected use of services provided by persons other than family were asked of all families. Results suggested that caregiving in this context requires balancing the needs of the parent with those of the whole family. Caregivers learn their responsibilities through incorporating family member expectations, through role modeling of family and friends, and through a continuous process of role-making. A sense of filial responsibility is shaped by feelings and interpersonal ties within the multigenerational family. Although respondents were divided in their thinking about which gender was best suited to assist the aged parent, most families practiced a very traditional gendered division of labor when helping their parents. Of the factors affecting use of formal care services, need of the older person for additional assistance was the most important. The family’s sense of responsibility was not altered by use of formal care services. Data from this study advance development of family caregiving theory by specifying relationships among perceptions of responsibility to the older person, individual and family ethos, and family caregiving patterns, and by delineating the components of family ethos. Findings affirm previous theoretical work on factors that affect family use of formal services. Results demonstrate that formal care services are valued by elderly persons and their families, and suggest the need for long-term care policies that offer home care services to all disabled adults. Findings indicate that obtaining data from multiple family members is desirable when seeking information about family relationships that contribute to family caregiving patterns. / Ph. D.

Yes / Multiple factors and conditions can lead to impaired wound healing. Chronic non-healing wounds are a common problem among the elderly. To identify microRNAs negatively impacting the wound repair, global miRNA profiling of wounds collected from young and old mice was performed. A subset of miRNAs that exhibited an age-dependent expression pattern during wound closure was identified, including miR-31 and miR-200c. The expression of miR-200 family members was markedly downregulated upon wounding in both young and aged mice, with an exception of acute upregulation of miR-200c at the early phase of wound healing in aged skin. In unwounded aged skin (versus unwounded younger skin), the level of miR-200c was also found elevated in both human and mice. Overexpression of miR-200c in human ex vivo wounds delayed re-epithelialisation and inhibited cell proliferation in the wound epithelium. Modulation of miR-200c expression in both human and mouse keratinocytes in vitro revealed inhibitory effects of miR-200c on migration, but not proliferation. Accelerated wound closure in vitro induced by anti-miR-200c was associated with upregulation of genes controlling cell migration. Thus, our study identified miR-200c as a critical determinant that inhibits cell migration during skin repair after injury and may contribute to ageassociated alterations in wound repair. / Supported by a grant from Medical Research Council UK (MR/K011324/1)

This paper examines the response of Swedish local governments to a targeted intergovernmental stimulus grant aimed at increasing staffing levels in elderly care. The focus is on two key outcomes: municipal elderly care personnel costs relative to total municipal costs and the number of full-time employees in elderly care per elderly user. An OLS regression based on panel data between 2011 and 2018 initially estimates the grant’s spending effects. An instrumental variable (IV) model is then employed to address potential endogeneity, utilizing an update in the grant allocation formula. Both the OLS and IV estimates suggest that the stimulus grant has no discernible effect on the ratio of elderly care personnel costs to total municipal spending. Furthermore, the IV results show insignificant short-run effects on full-time employment in elderly care. However, significant increases are observed three years after the allocation formula update. The overall effects confirm standard economic grant theory predicting how non-matching targeted grants only contribute to an income effect.