Since the beginning of the 1990s, nutrition education and health promotion have increasingly focused on the influence of diet on the quality of life in old age. The Government′s Health of the Nation policy in 1991 and the COMA report on The Nutrition of Elderly People in 1992 both emphasized the need for older age groups to adopt the dietary changes recommended for the population as a whole. In order to promote healthier eating habits and consequently improve health status, it is first vital to understand what makes elderly people follow particular dietary patterns and, equally, which factors constrain their choice. Reviews the current state of research on the social, economic, psychological, physiological, educational and personal factors which mediate food choice in later life. Indications are that it is the structural influences on choice which have the greatest impact – education, income, class and access to good health care. As a result, action at national level in the form of health and social policy designed to take into account the needs of older generations is highlighted.
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Background: Patients living with chronic pain are typically resource intensive, their care requirements are long term and referral to secondary care is not always expeditious. To provide more appropriate, accessible and cost-effective care, Tower Hamlets Primary Care Trust reviewed the needs of the patients, their current care and the numbers requiring treatment for non-malignant chronic pain, initially starting with musculoskeletal pain. Method: We estimated the number of people with chronic pain being treated outside general practice by the NHS in Tower Hamlets. A working group established set criteria to define a chronic pain patient. We surveyed appropriate clinicians to determine the approximate number of patients who fitted our inclusion criteria, the approximate number of follow-up appointments they required and their care pathways. Secondly, we estimated the cost of care for chronic pain patients using NHS national tariff and reference cost data. We also took a convenience sample of chronic pain patients and recorded their history of care. Findings: The routes and pathways of care are complex and multiple. We estimate between 4.0% and 5.5% of new patients in rheumatology, orthopaedics, occupational therapy and musculoskeletal physiotherapy and up to 90% in the pain clinic are people living with chronic pain. The cost of this care ranged from £296 for a course of physiotherapy to £1911 for a patient seen in physiotherapy, orthopaedic and the pain clinics. Conclusion: There is no facility in current management information services that identifies people being treated for non-specific chronic pain; therefore, estimating both the numbers and costs for treating these people is difficult. National tariff and notional cost data provide estimates only, of an 'average patient'; the real cost of these patients is unknown.
Discusses the current situation whereby the majority of elderly people in the UK regularly take at least one prescribed drug and a significant proportion are given long‐term multiple drug therapy. Those in institutions are particularly prone to over‐prescribing. Shows that the rate of prescription is highly significant because large numbers of elderly people have adverse reactions to their medication. In the case of nutritional reactions, the side‐effects of drugs can cause loss of interest in food or precipitate micronutrient deficiencies. Notes that in an elderly person these drug‐diet reactions have considerable knock‐on effects on nutritional status, physical and mental health and immunity to infection. Stresses, therefore, that programmes of drug review and reductions are vital among all elderly people but should be integrated especially into the routines of homes and hospitals
The most significant demographic change in the UK this century has been the relatively rapid ageing of the population. More specifically, the growth of the very old (those over 80) has widespread implications for health and community care in the UK. Despite the Government′s recently revised community care policy, the changes in family structure brought about through divorce, geographical mobility and lower birth rate, as well as the degenerative nature of many mental and physical diseases, has meant that there are more elderly people being cared for in institutions, particularly private care homes. Consequently, private homes are responsible for the nutritional wellbeing of thousands of elderly people. Reviews the findings of a study of private homes in West Yorkshire in 1992‐3 on the problems of catering for elderly people in care and points to some areas where successes in the field of healthy eating and improving health and independence have occurred.
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