Introduction: Ageing is a phenomenon that has preoccupied the minds of humankind for generations but it was only in the twentieth century that medical care dedicated to the elderly was created. The field of Geriatric Medicine has grown in South Africa and globally, to be recognized as a subspecialty of Internal Medicine in its own right. Physiological changes in the elderly impact on the increased prevalence of non–communicable diseases and the raised burden of disease in this age group. The altered spectrum of diseases in this age group and atypical manifestations of these conditions make geriatric health care truly unique. In spite of the recognition that the elderly have specific medical conditions, a dedicated health care policy to improve geriatric health care is yet to be developed In South Africa. For such a policy to be created, more needs to be known about the causes of mortality and morbidity that contributes to the burden of disease in this age group. Method: A retrospective chart review was conducted on 218 admissions of persons aged 60 years and over to the medical wards of King Edward VIII Hospital. This is a regional facility in Durban, South Africa, that provides mainly secondary and tertiary levels of care. An ethical waiver was obtained from the Biomedical Research Ethics Committee of the University of KwaZulu- Natal and all data sheets were de-identified. A structured data extraction sheet was used to record demographic and clinical data, including the admission diagnoses, presence of concomitant diseases, management and complications of some of these diseases, length of hospitalization and outcome of admission. Results: The study population comprised 191 patients aged 60 years and over, with a mean age of 70.5 ± 7.4 years (range 60 – 90 years). The patients were predominantly female (61.3%) and Black African (83.8%). While the majority of patients had only 1 admission, most were admitted with multiple diagnoses. Four or more diagnoses were recorded for 58.1% of the patients, with 50 patients (26.2%) having four diagnoses and 38 patients (19.9%) having five diagnoses. A history of current smoking was recorded in 38% of males and 7.2% females. Respiratory disease was the most common admission diagnosis (42.7%), followed by cardiac (42.2%) and renal disease (40.4%). An infection was present in 116 cases (53.2%) on admission, the commonest being pneumonia in 71 (61.2%), followed by urinary tract infection in 34 (28%) and septicaemia in 11 (9.5%). Cardiovascular disease was the most common underlying chronic disease, with hypertension being present in 150 patients (68.8%) and cardiomyopathy in 60 patients (25.5%). Of the patients with hypertension, evidence of end organ damage was present in 128 patients (85.3%), with hypertensive heart disease in 97 patients (75.8%), renal disease in 61 patients (47.7%), cerebrovascular disease in 37 patients (28.91%), hypertensive retinopathy in 11 patients (8.6%) and peripheral vascular disease in 5 patients (3.91%). The most common risk factors for congestive cardiomyopathy were hypertension in 55 cases (67%) and diabetes mellitus in 24 cases (40%). In addition, infection was the most common identifiable precipitating factor for cardiac failure in 40 % of cardiac failure cases Eleven patients were on anticoagulant therapy, of which three (27.3%) presented with overwarfarinization. More importantly, eight of the 17 patients (47%) with atrial fibrillation were not on anticoagulants. Neurological disease was present in 27.5% of the admissions with cerebrovascular disease being the most common (75% of all neurological cases) A diagnosis of malignancy was recorded in 13.1% of admissions with the most common primary site being the lung. In eight patients (32 % of those with malignancy) there was evidence of metastatic disease. Men were more likely than women to be admitted with respiratory disease (22.8% vs. 2.2%, p < 0.0001) such as chronic obstructive airways disease (57% vs. 34.5%, p = 0.001). Although pneumonia was more common in men than in women, this did not reach clinical significance (40.5% vs. 28.8%, p = 0.053). In contrast, more women were admitted with arrhythmias (16.5% vs. 6.3%, p = 0.03), congestive cardiac failure (30.2% vs. 15.2%, p = 0.013) and endocrine diseases (23.7% vs. 12.7%, p = 0.048). Renal disease was more common in women than in men, but did not reach statistical significance (44.6% vs. 32.9%, p = 0.060) In the 191 patients, 64 deaths (33.7%) were recorded during hospitalization. The mortality rate was found to be significantly higher in patients with 15 cerebrovascular accidents, acute renal failure, diabetes mellitus, and infection (including pneumonias). Conclusion: This study confirms the high prevalence and disease burden of non-communicable diseases in older patients, with the majority of patients having multiple diagnoses on admission. Hypertension and other cardiovascular diseases were identified as being most common with a high prevalence of target organ damage. Furthermore, in the patients with malignancy metastatic disease was common. These findings suggest that older patients may present late due to a lack of awareness, limited access to appropriate health care, or lack of adequate treatment and screening programmes. In addition to the burden of non-communicable diseases (NCD), infection (particularly pneumonia) emerged as a common cause for admission and mortality. These findings confirm the high burden of non-communicable diseases and their complications in the older population and highlight the need screening programs to improve detection and better management of these conditions. Furthermore the association of a high mortality with infections, finding underscores the need for implementation and adherence to treatment guidelines, and to develop and adhere to vaccination guidelines. Furthermore, training of health care personnel at all levels should be intensified in an attempt to decrease the burden of disease in older persons and to improve their quality of life. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

The present study investigated discrepancy between reports of depressive symptoms of 36 psychogeriatric patients and their family informants. It also examined factors potentially affecting this discrepancy such as selected characteristics of the patients and their informants, the type of measure assessing depression, and the type of depressive symptoms being assessed. The 15-item Geriatric Depression Scale (GDS-15) and the Clinically Useful Depression Outcome Scale (CUDOS) were completed by the patient, and the informant version of both the GDS-15 and CUDOS were completed by their informant. A sizable discrepancy was found between patient and informant reports of depressive symptomatology; informants reported significantly more symptoms than patients themselves. The discrepancy in reports was greater on the GDS-15 than on the CUDOS. Multiple regression analyses revealed that both patient‟s gender and type of setting (inpatient vs. day hospital) significantly influenced the discrepancy. The highest kappa agreement was obtained on items related to feelings of worthlessness and life satisfaction on the GDS-15, and suicidal ideation and intent on the CUDOS. The study‟s strengths and limitations, implications for clinical practice and research, and directions for future research are discussed.

Thesis (M.P.H.) -- University of Adelaide, Dept. of Public Health, 1999. / Bibliography: leaves 117-136.

Thesis (Ph. D.)--University of Virginia, 1995. / Includes bibliographical references (leaves 141-166). Also available online through Digital Dissertations.

Thesis--Columbia University. / Bibliography: leaves 131-136.

Thesis (D.N. Sc.)--Catholic University of America. / Typescript. eContent provider-neutral record in process. Description based on print version record. Bibliography: leaves 125-133.

Thesis--Columbia University. / Bibliography: leaves 131-136.

Thesis (D.N. Sc.)--Catholic University of America. / Typescript. Bibliography: leaves 125-133.

The role of group activity participation in depression among a group of residents (N=65), age 80 and older, in a nursing home was examined using the framework of Roy's Adaptation Theory and Nolen-Hoeksema's Response Style Theory of Depression. Roy views depression as a maladaptation. Nolen-Hoeksema views group activity participation as a therapeutic distraction to break depressed moods and thus allow for positive adaptation. This study utilized data from medical records, group activity attendance, and self-report questionnaires. Demographic distributions were computed and correlational statistics were performed between subjects' participation and their degree of depression, pain experience, functional status, presence of social support, and perception of benefits. Results show a negative correlation between frequency of participation and Geriatric Depression Scale score (GDS). The wide range of measured frequencies among low GDS-scored subjects suggests that less depressed individuals exercise more freedom of choice to participate than those who are more depressed. Significant finding show a positive correlation of group activity participation with functional status in terms of ambulation. Data shows that the experience of pain was not a significant deterrent to participation. The presence of social support from the staff and family did not increase participation. However there is a lesser GDS score among subjects who had recent family/friends visit suggesting a positive role of family in decreasing depression. These results are significant not only for optimizing group therapeutic effects but also for understanding basic human and environmental correlates of depression. Study limitations are pointed out and recommendations are presented.

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