Personal factors, communication and vision predict social participation in older adults

Social isolation is a predictor of morbidity and mortality in older people. Speech pathologists often consider that communication disabilities associated with normal ageing (sensory loss, language and discourse changes) contribute to social isolation. The aims of this study were to describe the functioning of older people using the International Classification of Functioning, Disability and Health (WHO, 2001) as a conceptual framework for language and sensory functioning, communicative activity, and social participation, and to explore the relationship between communication (both at an impairment level and an activity level), social participation and personal factors (demographics and emotional health). In a prospective study, 47 women and 28 men aged 62 to 98 years (mean=74 yrs) completed objective and subjective assessments of functioning and participation, and provided personal information. Assessments were individually conducted in a face- to-face interview situation with the primary researcher, who was a speech pathologist. Assessments revealed the sample had predominantly mild hearing and vision impairments, unimpaired naming ability, frequent involvement in a wide range of communication activities, and variable social network size and social activities participation. Social participation was shown to be associated with vision, communication activities, age, education and emotional health. Naming and hearing impairments were not reliable predictors of social participation. It was concluded that professionals interested in maintaining and improving social participation of older people could well consider these predictors in community-directed interventions. Speech pathologists should therefore promote older people's involvement in everyday communicative activities while also limiting the impact of communication-related impairments, so that social participation is maintained in our ageing population.

Eating disorders and oral health: A review of the literature

This article is a review of the recent literature pertaining to the oral sequelae of eating disorders (EDs). Dentists are recognized as being some of the first health care professionals to whom a previously undiagnosed eating disorder patient (EDP) may present. However, despite the prevalence (up to 4 per cent) of such conditions in teenage girls and young adult females, there is relatively little published in the recent literature regarding the oral sequelae of EDs. This compares unfavourably with the attention given recently in the dental literature to conditions such as diabetes mellitus, which have a similar prevalence in the adult population. The incidence of EDs is increasing and it would be expected that dentists who treat patients in the affected age groups would encounter more individuals exhibiting EDs. Most of the reports in the literature concentrate on the obvious clinical features of dental destruction (perimolysis), parotid swelling and biochemical abnormalities particularly related to salivary and pancreatic amylase. However, there is no consistency in explanation of the oral phenomena and epiphenomena seen in EDs. Many EDPs are nutritionally challenged; there is a relative lack of information pertaining to non-dental, oral lesions associated with nutritional deficiencies.

Anxiety and social worries in children with Asperger syndrome

Objective: The current study examined anxiety and social worries in a group of children with Asperger syndrome (AS). Method: Sixty-five children with AS were compared with a clinically anxious sample and a normative sample using parent and child reports. Results: Comparisons between clinically anxious children and children with AS showed similar scores on overall anxiety and on six anxiety subscales using child reports. Parent reports revealed higher ratings of overall anxiety and described children with AS experiencing more obsessive-compulsive symptoms and physical injury fears than clinically anxious children. Conclusions: Children with AS without a diagnosis of anxiety, present with more anxiety symptoms than a normal population and with a different profile than a clinically anxious population. Study limitations are identified and considerations for future research presented.

Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America

Background There are substantial social inequalities in adult male mortality in many countries. Smoking is often more prevalent among men of lower social class, education, or income. The contribution of smoking to these social inequalities in mortality remains uncertain. Methods The contribution of smoking to adult mortality in a population can be estimated indirectly from disease-specific death rates in that population (using absolute lung cancer rates to indicate proportions due to smoking of mortality from certain other diseases). We applied these methods to 1996 death rates at ages 35-69 years in men in three different social strata in four countries, based on a total of 0.6 million deaths. The highest and lowest social strata were based on social class (professional vs unskilled manual) in England and Wales, neighbourhood income (top vs bottom quintile) in urban Canada, and completed years of education (more than vs less than 12 years) in the USA and Poland. Results In each country, there was about a two-fold difference between the highest and the lowest social strata in overall risks of dying among men aged 35-69 years (England and Wales 21% vs 43%, USA 20% vs 37%, Canada 21% vs 34%, Poland 26% vs 50%: four-country mean 22% vs 41%, four-country mean absolute difference 19%). More than half of this difference in mortality between the top and bottom social strata involved differences in risks of being killed at age 35-69 years by smoking (England and Wales 4% vs 19%, USA 4% vs 15%, Canada 6% vs 13%, Poland 5% vs 22%: four-country mean 5% vs 17%, four-country mean absolute difference 12%). Smoking-attributed mortality accounted for nearly half of total male mortality in the lowest social stratum of each country. Conclusion In these populations, most, but not all, of the substantial social inequalities in adult male mortality during the 1990s were due to the effects of smoking. Widespread cessation of smoking could eventually halve the absolute differences between these social strata in the risk of premature death.

Genetic and environmental influences on dentofacial structures and oral health: studies of Australian twins and their families

Our studies of the teeth and faces of Australian twins commenced at the School of Dentistry, The University of Adelaide in the early 1980s. There are now over 900 pairs of twins enrolled in our continuing investigations, together with 1200 relatives. There are 3 main cohorts of participants. The first cohort comprises around 300 pairs of teenage twins for whom various records have been collected, including dental casts, facial photographs, finger and palm prints and information on laterality, including handedness. The second cohort comprises around 300 pairs of twins who have been examined at 3 stages of dental development from approximately 4 years of age to about 14 years: at primary, mixed, and permanent dentition (excluding 3rd molars) stages. The most recent study of tooth emergence and oral health, for which we are currently recruiting twins, will provide a third cohort of around 500 twin pairs aged from around birth to 3 to 4 years of age. Our broad aim in these studies has been to improve our understanding of how genetic and environmental factors contribute to variation in dental and facial features, and to oral health. We have also used our data to investigate aspects of the determination of laterality, particularly the fascinating phenomenon of mirror imaging. We plan to maximize the use of the longitudinal data and DNA we have collected, and continue to collect, by performing genome-wide scans for putative genetic linkage peaks for a range of dental features, and then to test for association between a series of likely candidate genes and our phenotypes.

Models of psychological service provision under Australia's better outcomes in mental health care program

The Access to Allied Psychological Services component of Australia's Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found: 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way; Allied health professionals were providing services from GPs' rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%. Many of these models were being used in combination. No model was predictive of differential levels of access, suggesting that the approach of adapting models to the local context is proving successful.

Social communication in older age: Lessons from people with aphasia

Lessons on social communication in older age are drawn from the stories and qualitative case reports of three older people who have aphasia following stroke. Descriptive accounts of participant responses to qualitative interviews and stimulated recall of natural conversations, together with information from a social network diary, provide evidence of aspects of social communication relevant to the older person with aphasia. The perspectives of individuals and common themes relating to social communication with family and friends, the experience of aphasia, and living with aphasia in older age are presented. The prominence of conversations and the role of storytelling and of humor within the daily social communication of older people are illuminated. Key words: aphasia, older people, social communication