Dependency of the aged in the community

g’test, Students ttest, or Mann Whitney U test as appropriate. *p=00 Table: Characteristics of

019.

patients

mortality and morbidity outcomes for both groups were compared prospectively. Supply nurses had been trained for a mean of 1months compared with staff nurses who had been working in the ICU for at least 3 years. Supply nurses accounted for approximately 40% of the personnel on shifts. Severity was measured by means of a simplified acute physiological score (SAPS).2 As shown in the table, the clinical condition and time course of patients admitted during the summer months were similar to those of patients admitted during the rest of the year. The length of stay in the ICU was significantly shorter for patients admitted during the summer. However, a three-fold increase in the number of errors in drug administration was noticed among patients admitted in the summer. Hospital-acquired infections were also more common in this group of patients. Physicians were not substituted during the study period, since a sufficient number of doctors guarantee the patients’ care during the full

Figure: Percentage of subjects who were independent Statistical significance

was

examined

by X2 test.

groups of 4-5 year span, the proportion who were independent in the groups below and above 75 years and those below and above 85 years differed significantly. Comparisons between any other successive age groups showed no significant

differences. Thus, the cross-sectional data imply that the independence of the elderly in ADL may decline in a stepwise rather than linear fashion after age 65, and seem to support the prevailing age stratification of the old-ie, "young old" for the individuals aged 65-74, "old old" for those from 75-84, and "very old" for those aged 85 and over.

Kazuyuki Shimada, Toshio Ozawa, Kozo Matsubayashi Department of Cardiology, Jichi

Medical School, Tochigi 329-04, Japan; and Department of Geriatrics, Kochi Medical School

year.

had no impact on the outcome of patients admitted to our ICU. The effectiveness of a health care professional depends upon scientific knowledge, ability, and attitude. It seems that the presence of less well-trained supply nurses forces nursing staff to supervise their colleagues more closely in order to prevent possible mistakes. The very positive attitude of supply nurses seems to compensate for their lack of experience in the ICU environment.

Supply nursing

José F Solsona, Jaume Marrugat, Gaspar Masdeu, Antonia Vázquez, Gloria Nohales, Rosa Balaguer Intensive Care Unit and Department of Epidemiology, 25-29, 08003 Barcelona, Spain

Hospital

del Mar

Passeig Marítim

1 Berenson RA. Intensive Care Units (ICUs): clinical outcomes, costs, and decision making. Health technology case study 28. Washington: Office of Technology Assessment, 1984. OTA-HCS-28. 2 Le Gall J-R, Loirat P, Alperovitch A. Simplified acute physiological score for intensive care patients. Lancet 1983; ii: 741.

Dependency of the aged in the community SiR-Prevalence rates of functional dependency in older community residents are a crude way to plan the future of the various care programmes for the elderly. We assessed the activities of daily living (ADL) dependency of elderly subjects living in a Japanese village, in which individuals over 65 years account for as much as 29% of the population. Nine basic ADL were assessed about the help the elderly needed for each activity by use of the validated disability rating scaled We interviewed 1408 elderly individuals (97% of the eligible population). About 90% of residents aged 65-74 were able to do all activities alone without any help-ie, were totally independent in ADL (figure). The proportion of independent people was reduced to roughly 75 % in the age group 75-84, and in those over 85 years, about 40% were independent. Statistical analysis showed that in each comparison of two successive age

1

Pace WD. Geriatric assessment in the office 44: 29-35.

setting. Geriatrics 1989;

Procreation and HIV SIR—Recommendations to reduce the risk of human immunodeficiency virus (HIV) transmission focus on abstinence and condom use, ignoring unprotected sex for the purpose of procreation. In a follow-up to our study of HIV-negative female partners of HIV-infected men with haemophilia,l we found that 9 of 47 couples had unprotected intercourse for the purpose of conception. 4 couples did so before learning of the man’s infection; they had unprotected intercourse 12-50 times per month (median 26) for 8-30 months (median 165). The other 5 couples attempted pregnancy despite knowledge of the man’s infection. 4 of these couples, for whom data were available, had unprotected sex 2-4 times per month (median 3) for 2-12 months (median 8). to influence Knowledge of HIV status appeared childbearing decision: of 47 couples, 29 (62%) wanted more children, but only 5 attempted to conceive after learning of the male partner’s status. Thus 24 (83%) of 29 couples changed their childbearing plans after learning of one partner’s HIV infection. Furthermore, couples who were aware of the man’s HIV infection had substantially fewer acts of unprotected intercourse (median 3 vs 26 per month). Our study indicates that women who attempt to become pregnant may have a high number of exposures to potentially infectious semen. Fortunately, knowledge of HIV status appears to motivate even those who are interested in procreation to reduce their exposure to HIV. For a few, the desire to bear children may outweigh the fear of HIV transmission, but even these couples appear to reduce their exposure compared to couples unaware of their HIV status. Failure to consider procreational as well as recreational sex limits the effectiveness of current AIDS prevention efforts. Ideally, the decision to conceive a child should be made by both 1241